| BackgroundIn China,the number of people over the age of 65 reached 150 million in 2017.As a corollary of this,the number of people with dementia has also increased dramatically.China has the largest population of people with dementia in the world:9.5 million in 2015,and this number is projected to increase to 27 million by 2050.The rapidly growing population of dementia patients presents a huge need for long-term care.Behavioural and psychological symptoms of dementia(BPSDs),also termed neuropsychiatric symptoms(NPS),as symptoms of disturbed perceptions,thought content,mood,or behaviour that frequently occur in patients with dementia.BPSD contribute to increases in the patients' clinical deterioration,and are thought to be highly correlated with decrement of quality of life for dementia patients and high levels of caregiver burden,which poses huge challenge to long-term care and clinical intervention.However,the long-term care system in China is still in the primary stage of construction,caregiver have not yet prepared for the understanding and management of BPSD in institutionalized dementia patients.Because of the lack of effective drugs,to identify the types of BPSD and the influencing factors,and to develop the non pharmacological intervention strategies for the treatment of BPSD has become the focus of current research.Therefor,it is especially urgent to use reliable assessment tools to investigate the type of BPSD in institutionalized dementia patients,and to develop effective strategies for managing BPSD to improve the quality of life.ObjectivesDevelop and test the reliability and validity of the NPI-NH and form the suitable NPI-NH scale for the China dementia patients in long term care institutions.Then use the scale to investigate the BPSD types and characteristics in institutionalized dementia patients,to provide a basis for developing the non-pharmacological intervention.Finally,to explore a precise estimate of the BPSD prevalence in mainland China by meta analysis so as to provide evidence for identifying effective non-pharmacological intervention strategies for BPSD.Methods1.After the authorization of the original scale,forward and backward translations as well as cultural adaptation of the inventory were conducted.Then the internal consistency,test-retest reliability and structure validity of the Chinese version of NPI-NH were tested.2.By convenient sampling,160 dementia patients are investigated with the Chinese version of NPI-NH for the analysis of the epidemiological characteristics of BPSD in institutionalized dementia patients.3.A Meta-analysis was conducted to understand the characteristics of BPSD prevalence in Mainland China.Results1.There are 12 items in the Chinese version of NPI-NH.Factor analysis yielded 5 factors,the cumulative variance contribution rate was 69.8%.Cronbach's a for the frequency,severity and disturbance sub-scales were 0.70,0.73 and 0.80,respectively,suggesting an acceptable level of internal consistency for the Chinese version of the NPI-NH.The test-retest reliability of total scale was(ICC 0.93,95%CI:0.87-0.97),frequency was(ICC 0.92,95%CI 0.90-0.93),severity was(ICC 0.89,95%CI 0.87-0.91),and disturbance was(ICC 0.91,95%CI 0.89-0.92),suggesting that the Chinese version of the NPI-NH have an excellent test-retest reliability.2.In this sample,behavioural problems were present in 91.88%of people with dementia,with apathy(57%)being the most common BPSD and anxiety(15%)being the least commnon neuropsychiatric behaviours.The agitation/attack was the most troubling symptom for the caregiver,followed by delusion.The most common symptom of mild dementia is agitation/attack,and the most common symptom of moderate and severe dementia are apathy.Agitation/attack,disinhibition and irritability,aberrant motor behavior were present in the different stages of dementia patients.The prevalence characteristics of BPSD were similar in male and female patients,but the prevalence of agitation,sleep disorders and appetite disorders were significantly higher in male than female patients.3.The meta-analysis included 37 studies and 5356 dementia patients.The overall results show that the most common symptom was aberrant motor behavior,and followed by:sleep disorders 37.11%(95%CI:29.75-45.11),apathy 38.20%(95%CI:25.99-52.12),depression 36.31%(95%CI:30.46-42.60),agitation 36.34%(95%CI:29.49-43.78),delusions 33.05%(95%CI:26.21-41.69),irritability 31.15%(95%CI:23.64-39.80),anxiety 25.23%(95%CI:21.14-29.82),hallucinations 19.86%(95%CI:16.07-24.28),eating disorders 12.75%(95%CI:7.02-22.03),disinhibition 8.59%(95%CI:4.21-16.75),euphoria 7.43%(95%CI:4.07-13.19).The prevalence of agitation,apathy,irritability,and aberrant motor behavior in Alzheimer's patients was higher than in vascular dementia patients,and the prevalence of anxiety and depression was higher in vascular dementia than Alzheimer's patients.The prevalence of delusions,agitation,aberrant motor behavior,and sleep disorders was higher in hospital patients than community patients.According to the subgroup analysis,the dementia subtype,dementia severity,sample source may affect the heterogeneity of the pooled prevalence of BPSD.Conclusions1.The Chinese version of NPI-NH has a good reliability and validity,which can be used as a valid tool for the investigation of the BPSD prevalence in institutionalized dementia patients.2.The prevalence of BPSD in long-term care institutions in China is relatively high,but the burden of care caused by different types of BPSD is not the same;and the BPSDs are often changed in the period of different severity of dementia.Dementia patients with different severity and gender often exhibit specific BPSD types and prevalence characteristics.The staff of the institution should carry out targeted nursing interventions based on the BPSD,allocate the care resources rationally and improve the quality of life of the patients with dementia.3.In this systematic review,the summary estimate of the BPSD prevalence mirrored the characteristics of BPSD in mainland China to a certain extent.According to the subgroup analysis,the dementia subtype,dementia severity,sample source and assessment tool may affect the heterogeneity of the pooled prevalence of BPSD. |
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