Classification of the Behavioral and Psychological Symptoms of Dementia and Associated Factors in Inpatients in Psychiatric Hospitals – with Special Reference to Rehabilitation

Abstract

Objective: In Japan, the number of patients hospitalized in psychiatric hospitals for the treatment of behavioral and psychological symptoms of dementia (BPSD) continues to increase. In order to provide more effective treatment and management of BPSD for inpatients, it is necessary to clarify the target BPSD and contributing factors. Therefore, the aims of the present study were to classify BPSD and determine the associated factors. The results are discussed with a focus on cognitive and physical functions. Methods: A retrospective cross sectional study was performed to analyze data from 176 patients with dementia admitted to the acute psychogeriatric ward at Ishikawa Prefectural Takamatsu Hospital for the treatment of BPSD between April 2013 and September 2015. Patients underwent comprehensive geriatric assessment batteries including the neuropsychiatric inventory, Mini-Mental State Examination (MMSE), and Nishimura-style senile activities of daily living score. Factor analysis (maximum likelihood method and promax rotation) was carried out on 12 items from the neuropsychiatric inventory. The factors associated with factor scores which were extracted by factor analysis were analyzed using multiple linear regressions. Results: Factor analysis identified three behavioral sub-syndromes: hyperactivity, affective symptoms, and psychosis. Multiple regression analysis showed that “hyperactivity” was associated with lower MMSE scores and younger age. “Affective symptoms” were associated with female gender and lower eating scores. “Psychosis” was associated with the type of dementia. Conclusion: Our study classified BPSD in inpatients into three sub-syndromes and showed that cognitive and physical functions are associated with BPSD.