Behavioural and Psychological Symptoms of Dementia (BPSD)

Background: The symptoms of dementia can be aggregated into two major groups; decline in cognitive function and behavioral and psychological symptoms. Although BPSD have been the focus of an increasing amount of research in the developed world (Brodaty and Finkel, 2003), only one detailed population based study of their prevalence and associations has been undertaken in the USA (Lyketsos et al., 2000) and little is known about their manifestation in individuals with dementia in developing countries. One might anticipate that cultural and environmental factors could have a strong influence upon both the expression of BPSD and their perception by caregivers as problematic.

Methods: Individuals diagnosed as having dementia according to DSM IV criteria (mild and moderate cases as defined by the Clinical Dementia Rating scale), together with their main caregiver were recruited from 21 centers in 17 developing countries. People with dementia were directly assessed with the Community Screening Interview for Dementia and the Geriatric Mental State schedule; GMS data were processed by the AGECAT computer program to yield diagnostic information on 8 psychiatric syndromes. Caregivers answered direct questions about behavioral symptoms of dementia (BSD) and completed the Zarit Burden Inventory.

Results: At least one BSD was reported in 70.9% of the 555 participants. At least one case level AGECAT psychiatric syndrome was exhibited by 49.5% of people with dementia. Depression syndromes (43.8%) were most common followed by anxiety neurosis (14.2%) and schizophrenifrom/paranoid psychosis (10.9%). Caregivers were more likely to report BSD in people with dementia who were married, younger and better educated. More advanced dementia, poorer functioning and the presence of depression or anxiety were each associated with BSD. BSD, and psychiatric syndromes (anxiety neurosis and schizophreniform/paranoid psychosis) predicted caregiver strain after controlling for cognitive impairment. BPSD are poorly understood, leading to shame and blame.

Conclusions: BPSD are common among people with dementia in developing countries, though we found marked regional variations. Representative population studies are needed to clarify prevalence and impact, but our research suggests considerable unmet need, with much scope for intervention. Raising awareness of the problem should be the first step.

10/66 Publication

1. The 10/66 Dementia Research Group. Behavioural and psychological symptoms of dementia in developing countries. International Psychogeriatrics. 16(4): 1-19, 2004 here (in PDF format)

Other key publications

1. Brodaty, H. & Finkel, S. I. (2003). Behavioral and Psychological Signs and Symptoms of Dementia Educational Pack, Skokie, Illinois: International Psychogeriatric Association.
2. Finkel, S. I., Costa e Silva, J., Cohen, G. et al. (1996) Behavioral and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment. International Psychogeriatrics, 8 (suppl.), 497-500.
3. Lyketsos, C., Steinberg, M., Tschanz, J., Norton, M., Steffens, D., Breitner, J. (2000) Mental and behavioral disturbances in dmentia: findings from the Cache County Study on memory in aging. American Journal of Psychiatry, 157, 708-714.