Objective: One of the greatest impacts on Alzheimer’s caregivers is the presence of problematic behavior (inappropriate verbal or motor activity) which is easily attributed to the dementing illness. This study was conducted to investigate whether the reported mood symptoms which are frequently ignored are related to their cognitive function and to the problematical behavior observed by the caregivers.
Design: Participants are from DEPAD cohort study, an ongoing longitudinal clinical study of patients suffering from dementia using the Minimum Data Set of Resident Assessment Instrument (RAI), largely used in United States and which was validated in France.
Materials and Methods: The mood condition was assessed with a 8-item scale including symptoms experienced by the patient in the past 30 days. The problematic behaviour was assessed with a scale including 5 types of behavior (wandering, aggressive verbal behavior, aggressive physical behavior, socially inappropriate behavior, resistance against care) observed by the family caregivers. A total problematic behavior index (PBI) is calculated by summing scores on the 5 items for each patient. Statistical analyses were conducted in three steps: first, a factor analysis (with varimax rotation) was performed on the 8 item mood scale responses; second, bivariate correlations were calculated among study variables; and third, a stepwise multiple regression analysis was conducted to determine the predictive relationship of the problematic behavior and the four dimensions of mood status adjusting on demographic variables and cognition.
Results: Analyses are based on 399 demented people (280 women and 119 men) living at home, who completed the baseline evaluation using the RAI instrument. The factor analysis identified four components of mood condition: dimension of sadness (including feelings of sadness, hopelessness, tears and facial expression of sadness), anxiety dimension (including excessively anxiety complaints, fear of being neglected), the dimension of irritable symptoms (including easily annoyed and provoked to anger) and the dimension of hypochondriac symptoms (including excessively somatic complains). The bivariate correlations shows that PBI is significantly related to education, MMS, the irritable symptoms dimension and hypochondriac symptoms dimension. Results of multivariate analysis show that the PBI score is not only related to cognitive deterioration but also significantly linked to two of the four dimensions of mood status (irritable and hypochondriac) even after controlling for demographic variables and the cognitive performance (MMS).
Conclusion: Although overall the behavior disturbance in Alzheimer’s disease may be related primarily to dementia severity, the major finding of the study is that the reported mood symptoms can be valuable information in understanding and predicting behavior changes. Further research is needed to clarify the relationship between patient mood state and the problematic behavior and whether the treatment of the mood problems may affect the prognosis of their illness.
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