Longitudinal patterns of behavioral and psychological symptoms of dementia in community‐dwelling older people

Abstract

AbstractBackgroundBehavioral and psychological symptoms of dementia (BPSD) exhibit fluctuate by symptoms. This can cause difficulty for caregivers in addressing symptoms and a greater care burden. Few studies have analyzed the longitudinal course of multiple BPSD together. We aimed to identify the trajectory groups of 12 BPSD symptoms and assess the predictors of trajectory group membership.MethodData were drawn from the National Alzheimer’s Coordinating Center Uniform Data Set comprising participants who were followed up approximately annually in the United States. We examined home‐dwelling participants who were followed‐up for at least 1 year from 2015 to 2020. Individuals with cognitive decline (Clinical Dementia Rating of more than 0.5 and diagnosis of mild cognitive impairment or dementia) were included (n = 1,585). Twelve symptoms of BPSD were measured using the Neuropsychiatric Inventory. We used group‐based multi‐trajectory models to identify latent trajectory groups. Multinomial logistic regression analysis was conducted to assess participants’ characteristics at baseline associated with trajectory groups.ResultAmong participants, mean age was 75.7 years, median annual number of visits was 3 (interquartile range: 2‐5 visits), 44% were female, 74% lived with their spouse/partner, and 38% were able to live independently. Four trajectory groups were identified. One group showed relatively higher levels of all symptoms across years. In two groups, moderate levels of agitation, irritability, and depression, and moderate levels of apathy, appetite disturbances, and hallucinations were observed. The fourth group exhibited lower levels of all symptoms. Multinomial logistic regression models revealed that, compared with the lower‐level group, older age was associated with lower odds of other group membership. The level of dependence and cognitive decline were associated with higher odds of other group membership, although their interaction indicated lower odds. Male was a predictor of higher‐level group. Living with someone was a predictor for a group with moderate levels of apathy, appetite disturbances, and hallucinations.ConclusionWe identified at least four trajectories in 12 BPSD symptoms over 5 years, and their common and specific predictors among community‐dwelling people with dementia. Inferring individual group membership using these predictors may be helpful for determining appropriate measures for addressing expected BPSD.