Sex Differences in Behavioral and Psychological Symptoms in Institutionalized Patients with Advanced Alzheimer’s Disease

Abstract

AbstractBackgroundBehavioral and psychological symptoms in dementia (BPSD) are highly prevalent in patients with Alzheimer’s dementia (AD). We examined sex differences in the frequency and severity of BPSD in patients with advanced AD residing in long term care or admitted to inpatient psychiatric units. Also, sex differences in the frequency and severity of BPSD symptom clusters were explored.MethodWe analyzed data from the Standardizing Care for Neuropsychiatric Symptoms and Quality of Life in Dementia (StaN) study (ClinicalTrials.gov/NCT03672201). BPSD was assessed with the Neuropsychiatric Inventory Clinician rating scale. Chi‐squared tests and Mann‐Whitney U tests were used to determine sex differences in frequency and severity of BPSD, respectively. Bonferroni correction was used for multiple comparisons. Generalized linear models were performed to examine effect of sex on severity of BPSD while controlling for age and residence. BPSD symptom clusters were defined as: (1) psychosis (hallucinations and delusions), (2) emotional distress (depression and anxiety), and (3) agitation (agitation, aggression, irritability, aberrant motor behavior, and aberrant vocalizations).Result194 participants (99 female, 95 male) were included. Females had higher frequency of delusions (X2(N = 176) = 8.47, p = .004) and males had higher frequency of sleep disturbances (X2(N = 176) = 9.89, p = .002). Further, females had greater severity of delusions (N = 176, U = 2976, p = .001), and sleep disturbances (N = 176, U = 2950, p = .002). In generalized linear models, sex was associated with severity of delusions (Wald X2 = 3.97, N = 176, p = .046), but not with sleep disturbances. Examination of clusters revealed that females had higher frequency of psychosis (X2(N = 176) = 4.25, p = .039).ConclusionWe observed sex differences in the frequency and severity of specific BPSD. Future studies should aim to understand potential mechanisms underlying these differences, and to study their relevance for screening, and individualized management of BPSD.