Predictors Of Behavioral And Psychological Symptoms Of Dementia With Different Severity At Home

Objective:With the increase of disease severity,behavioral and psychological symptoms of dementia also changed.This study aimed to explore the influence of patient,caregiver and environment factors on behavioral and psychological symptoms of dementia patients with different severity at home,so as to provide reference for intervention research on dementia patients.Methods:193 pairs of home dementia patient-caregiver who were admitted to memory clinic of neurological department of the First Affiliated Hospital of Jilin University(a top three hospital)in Changchun city from November 2018 to May 2019 were selected as the study subjects.The purpose of this study to investigate the effects of patient factors(gender,age,educational status,dementia severity,psychotropic drug use),caregiver factors(positive aspect,expressed emotion,coping style)and environmental factor(home environment)on behavioral and psychological symptoms of dementia patients at home.Frequency/percentage,mean/standard deviation were used to describe general demographic data and influence factors;then compared the differences in score and frequency of behavioral and psychological symptoms of dementia with different severity by using respectively analysis of variance and chi-square test,and post-test was conducted;in addition,variance analysis and independent sample t-test were used to analyze the influence of general demographic information of patients on behavioral and psychological symptoms of dementia patients at home;furthermore,Pearson correlation was applied respectively to explore the relationship between caregiver,environment factors and behavioral and psychological symptoms of dementia patients at home;finally,multiple stepwise linear regression was utilized to analyze the influencing factors of behavioral and psychological symptoms of dementia patients at home.Results:1 The proportion of patients with mild dementia,60-70 years,high education,and no psychotropic drug use was higher in the study population.Caregivers' positive aspect,positive coping style were high level,negative coping style and expressed emotion were low level,and home environment was medium to high level.2 Among the 12 behavioral and psychological symptoms of dementia,apathy,aberrant motor behavioral,and anxiety were the symptoms with a higher scores,and euphoria and disinhibition were the symptoms with the lower scores;the higher frequencies were apathy,depression and anxiety,the least common was euphoria;Score and frequency of most symptoms showed significant differences between moderate and severe dementia,such as euphoria score and frequency of aberrant motor behavioral.3 Patients' age,education,dementia severity,and psychotropic drug use affected behavioral and psychological symptoms of dementia patients at home.4 Caregivers' positive aspect was negatively related to depression and agitation scores;expressed emotion was positively associated to total NPI,agitation,euphoria,irritability,aberrant motor behavior,delusion,depression,apathy scores;positive coping style was negatively linked to delusion score;home environment was negatively linked to total NPI,night-time behavior disorder,hallucination scores.5 Older age increased risk of aberrant motor behavior and hallucination;higher education level worsened appetite;psychotropic drug aggravated total NPI,night-time behavior disorder,hallucination scores;increasing dementia severity intensified total NPI,euphoria,aberrant motor behavior,night-time behavior disorder,delusion,and apathy scores,but reduced hallucination;more caregivers' positive aspect exacerbated depression,lessened irritability;more expressed emotion increased total NPI,agitation,euphoria,irritability,aberrant motor behavior,delusion scores,reduced apathy;the better home environment lessened night-time behavior disorder,hallucination,appetite,and exacerbated agitation.Conclusions:1 Among the 12 behavioral and psychological symptoms of dementia,apathy was the most serious and highest frequency.The mildest symptom was disinhibition,and the least frequency symptom was euphoria.2 In the progress of moderate dementia to severe dementia,there was a significant trend of aggravation in behavioral and psychological symptoms of dementia patients at home.Therefore,the pre-moderate dementia is a critical period to implement intervention.3 The patient(older age,higher educational status,increased dementia severity,used psychotropic drug),caregiver(lower positive aspect,higher expressed emotion)and environmental(poor home environment)factors aggravated behavioral and psychological symptoms of dementia patients.Among them,patients' psychotropic drug use and caregivers' positive aspect,expressed emotion and home environment are modifiable factors.Compared with previous the patient-caregiver dyadic intervention,the development of patient-caregiver-environment intervention may more effectively improve behavioral and psychological symptoms of dementia.