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Awareness and behavioral problems in dementia patients: a prospective study

Published online by Cambridge University Press:  03 January 2006

Pauline Aalten ,
Evelien van Valen ,
Marjolein E. de Vugt ,
Richel Lousberg ,
Jelle Jolles  and
Frans R. J. Verhey
Pauline Aalten
Affiliation:
Department of Psychiatry and Neuropsychology, Brain and Behavior Institute, University of Maastricht, Maastricht, the Netherlands
Evelien van Valen
Affiliation:
Department of Psychiatry and Neuropsychology, Brain and Behavior Institute, University of Maastricht, Maastricht, the Netherlands
Marjolein E. de Vugt
Affiliation:
Department of Psychiatry and Neuropsychology, Brain and Behavior Institute, University of Maastricht, Maastricht, the Netherlands
Richel Lousberg
Affiliation:
Department of Psychiatry and Neuropsychology, Brain and Behavior Institute, University of Maastricht, Maastricht, the Netherlands
Jelle Jolles
Affiliation:
Department of Psychiatry and Neuropsychology, Brain and Behavior Institute, University of Maastricht, Maastricht, the Netherlands
Frans R. J. Verhey
Affiliation:
Department of Psychiatry and Neuropsychology, Brain and Behavior Institute, University of Maastricht, Maastricht, the Netherlands
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Abstract

Background: The results of studies of the association between awareness and clinical correlates in patients with dementia are inconclusive. The aims of this study were to investigate whether awareness changed during the course of dementia and to determine whether awareness was associated with certain behavioral symptoms. Specifically, it was hypothesized that relatively intact awareness was related to affective disorders.

Methods: One hundred and ninety-nine patients with dementia were included in a prospective 18-month follow-up study. Behavioral problems were assessed with the Neuropsychiatric Inventory and the Cornell Scale for Depression in Dementia. Awareness was assessed by means of the Guidelines for the Rating of Awareness Deficits.

Results: Cross-sectional analyses showed awareness to be positively associated with age, gender, education and socioeconomic status, and negatively associated with psychosis, apathy, and overall behavioral disorders at baseline. After 1 year, a higher level of awareness was related to depression and anxiety. The level of awareness at baseline also predicted depression and anxiety after 1 year. Awareness decreased during the study.

Conclusions: A higher level of awareness is associated with subsyndromal depression and anxiety, whereas lack of awareness is associated with psychosis and apathy. The level of awareness decreases as dementia progresses. Clinicians should be more alert to changes in awareness in patients with dementia because psychosocial support might help to prevent the development of affective symptoms.

Keywords

neuropsychiatric symptomsAlzheimer's diseaseawarenessNeuropsychiatric Inventorydepressionanxietyapathy
Type
2005 IPA RESEARCH AWARDS FIRST-PRIZE WINNER
Information
International Psychogeriatrics , Volume 18 , Issue 1 , March 2006 , pp. 3 - 17
Copyright
© International Psychogeriatric Association 2006

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