A 1-year follow-up study of behavioral and psychological symptoms in dementia among people in care environments

Background: Behavioral and psychological symptoms in dementia (BPSD) are co mmon and distressing for patients and caregivers. but little is known about the natural history of these symptoms. particularly among patients in care facilities. This information is essential for informed clinical management . We report a 1-year followup study of the prevalence. incidence, and outco me of the 3 main BPSD (agitation, depression, and psychosis) in care facili ties. Method: 136 elderly residents with dementia (29% living in social care faci lities and 71% in nursing home care) were assessed longitudinally on 2 occa sions a year apart using a range of standardized psychiatric schedules, inc luding the Neuropsychiatric Inventory. Results: The overall prevalence of BPSD was stable over the year (76% at ba seline and 82% at follow-up). Subjects with subclinical symptoms at baselin e were more likely to develop clinically significant BPSD during follow-up than those who were symptom free (83% vs. 52%: Mann-Whitney U test, z = 2.3 6, p = .01), Agitation was the most common individual syndrome (55%). Altho ugh overall BPSD were persistent, greater than or equal to 45% of dementia patients with any of the major syndromes experienced resolution, indicating the development of different BPSD in many residents. There was no evidence that residents taking neuroleptics were more likely to experience resoluti on of BPSD than neuroleptic-free residents. Conclusion: BPSD are highly frequent and persistent among residents of care facilities with dementia. This emphasizes the need for ongoing treatment t rials. The pattern of resolution with the development of new symptoms indic ates that short focused periods of treatment may be a more effective manage ment approach. In addition. the potential value in treating patients with s ubclinical BPSD to prevent the development of full-blown syndromes needs to be investigated.