Prevalence of behavioural and psychological symptoms of dementia in cognitively impaired elderly residents of long‐term care facilities in East Asia: a cross‐sectional study

Abstract

Objective: The aim of this study was to compare the prevalence of behavioural and psychological symptoms of dementia (BPSD) in cognitively impaired elderly residents of long-term care facilities in East Asia and to explore the factors associated with these patterns. Methods: This was a cross-sectional survey of BPSD in cognitively impaired elderly residents of long-term care facilities in Japan, South Korea, China, Taiwan, and Thailand. The Mini-Mental State Examination, Clinical Dementia Rating (CDR), and Neuropsychiatric Inventory, Nursing Home version (NPI-NH), were used to assess cognitive status, dementia severity, and BPSD, respectively. NPI-NH subscale severity scores were multiplied by frequency scores to obtain the subscale scores and aggregated into two groups based on score (clinically insignificant = 1-3; clinically significant ≥4). Results: Data from 662 people were analyzed. Median age, median Mini-Mental State Examination scores, and median CDR scores differed significantly among the seven study sites. The prevalence of BPSD varied from 64% in Taiwan to 100% in dementia care units in Japan, and the median total NPI-NH scores ranged from 2 in Taiwan to 14 in dementia care units in Japan. After stratification of the sample by dementia severity and clinical significance of NPI-NH scores, differences in the prevalence of clinically significant BPSD were mostly observed among facilities dedicated to dementia patients in the CDR 1 group. In the CDR 3 group, the prevalence of some clinically significant BPSD, such as apathy, was high even among study sites with low median total NPI-NH scores. Conclusions: Our findings may suggest referral and selection biases in the study sites. Future prospective studies are needed to address the impact of environmental and care factors on the occurrence of BPSD in Asian countries.

Is Barthel Index Suitable for Assessing Activities of Daily Living in Patients With Dementia?

“…This cross-sectional study was part of the Prevalence of SymptOms of DementIa in East-Asian Cross-cultural (ePiSODIC) study comparing the type and prevalence of neuropsychiatric symptoms in patients with dementia residing in long-term care facilities (LTCFs) in East Asia. A detailed description of The ePiSODIC has been presented elsewhere (16).…”

“…Exclusion criteria were as follows: 1) past or present comorbidity of any other psychotic disorder; 2) complication with another end-stage disease; 3) the patient or their legal guardian refused to participate in this study. The diagnostic criteria for dementia were based on the International Classification of Diseases, 10th Revision, Diagnostic and Statistical Manual of Mental Disorders, 4th edition, or international diagnosis guidelines (16). Demographics and clinical data were obtained from medical records.…”

“…All the raters were trained in each region. The method regarding who performed the assessment using the above-mentioned instruments has been described previously (16).…”

Development of a Thai tool for assessing behavioral and psychological symptoms of dementia: A confirmatory factor analysis

“…As dementia progress, psychosis frequently coexists with agitation (Matsui et al., 2006). Delusion and hallucination usually co‐occur (Aalten et al., 2008; Cheng et al., 2012; Garre‐Olmo et al., 2010; Kang et al., 2010; Makimoto et al., 2019), and frequently combine with agitation/aggression and irritability (Feghali, Fares, & Abou Abbas, 2019; Frisoni et al., 1999; Johnson et al., 2011; Vaingankar et al., 2017). Our findings revealed that delusion and aggression/agitation are in the same factor, which is similar to the results of previous studies (Aarsland, Cummings, Yenner, & Miller, 1996; Lachs, Becker, Siegal, Miller, & Tinetti, 1992; Poletti et al., 2013).…”

“…Moreover, recent studies have reported similar BPSD characteristics for Asian PwD, confirming that the types of symptoms included in the BPSD could be the same in all Asian countries. This therefore suggests that the BPSD‐T might be useful in other Asian countries (Haibo et al., 2013; Makimoto et al., 2019).…”