Contribution of psychosis and depression to behavioral disturbances in geropsychiatric inpatients with dementia

Background Specific behavioral disturbances in dementia may be associated w ith underlying disorders such as the presence of psychosis and depression. The objective of this study was to examine the association of depression an d psychosis with behavioral disturbances in geropsychiatric inpatients with dementia. Methods. All admissions between October 1993 and May 1995 were reviewed to identify those patients admitted to the Houston Veterans Affairs Geropsychi atry Unit with a diagnosis of dementia; 208 patients were included in the s tudy. Hierarchical regression models were constructed to explore the contri bution of depressive and psychotic symptoms, and depression and psychosis d iagnoses to Cohen-Mansfield Agitation Inventory (CMAI) scores. Results. Both depression and psychotic symptoms were significantly and posi tively correlated with behavioral disturbances. Psychotic symptoms were ass ociated with aggressive behavioral symptoms, and depressive symptoms were a ssociated with constant requests for help, complaining, and negativism. Dem entia severity accounted for significant variance in CMAI scores and was po sitively associated with behavioral disturbance; thought disorder symptoms accounted for more behavioral disturbance variance than did depressive symp toms. Conclusions. Both depressive and psychotic symptoms were associated with ov erall behavioral disturbances in patients with dementia. Psychotic symptoms and depressive symptoms were associated with different types of behavioral disturbances. Our findings support the contention that underlying depressi on or psychosis may partially account for different behavioral disturbances and that not all behavioral disturbances should be globally labeled "agita tion." Future studies should address symptom-specific treatment of behavior ally disturbed patients.