Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea.
College of Nursing, Yonsei University, Seoul, Republic of Korea.
J Med Internet Res. 2021 Oct 29;23(10):e29001. doi: 10.2196/29001.
Although disclosing the predictors of different behavioral and psychological symptoms of dementia (BPSD) is the first step in developing person-centered interventions, current understanding is limited, as it considers BPSD as a homogenous construct. This fails to account for their heterogeneity and hinders development of interventions that address the underlying causes of the target BPSD subsyndromes. Moreover, understanding the influence of proximal factors-circadian rhythm-related factors (ie, sleep and activity levels) and physical and psychosocial unmet needs states-on BPSD subsyndromes is limited, due to the challenges of obtaining objective and/or continuous time-varying measures.
The aim of this study was to explore factors associated with BPSD subsyndromes among community-dwelling older adults with dementia, considering sets of background and proximal factors (ie, actigraphy-measured sleep and physical activity levels and diary-based caregiver-perceived symptom triggers), guided by the need-driven dementia-compromised behavior model.
A prospective observational study design was employed. Study participants included 145 older adults with dementia living at home. The mean age at baseline was 81.2 (SD 6.01) years and the sample consisted of 86 (59.3%) women. BPSD were measured with a BPSD diary kept by caregivers and were categorized into seven subsyndromes. Independent variables consisted of background characteristics and proximal factors (ie, sleep and physical activity levels measured using actigraphy and caregiver-reported contributing factors assessed using a BPSD diary). Generalized linear mixed models (GLMMs) were used to examine the factors that predicted the occurrence of BPSD subsyndromes. We compared the models based on the Akaike information criterion, the Bayesian information criterion, and likelihood ratio testing.
Compared to the GLMMs with only background factors, the addition of actigraphy and diary-based data improved model fit for every BPSD subsyndrome. The number of hours of nighttime sleep was a predictor of the next day's sleep and nighttime behaviors (odds ratio [OR] 0.9, 95% CI 0.8-1.0; P=.005), and the amount of energy expenditure was a predictor for euphoria or elation (OR 0.02, 95% CI 0.0-0.5; P=.02). All subsyndromes, except for euphoria or elation, were significantly associated with hunger or thirst and urination or bowel movements, and all BPSD subsyndromes showed an association with environmental change. Age, marital status, premorbid personality, and taking sedatives were predictors of specific BPSD subsyndromes.
BPSD are clinically heterogeneous, and their occurrence can be predicted by different contributing factors. Our results for various BPSD suggest a critical window for timely intervention and care planning. Findings from this study will help devise symptom-targeted and individualized interventions to prevent and manage BPSD and facilitate personalized dementia care.
尽管揭示不同行为和心理症状痴呆（BPSD）的预测因素是开发以患者为中心的干预措施的第一步，但目前的理解是有限的，因为它将 BPSD 视为同质结构。这不能解释它们的异质性，并阻碍了针对目标 BPSD 亚综合征的潜在原因的干预措施的发展。此外，由于难以获得客观和/或连续的时变测量，因此对与昼夜节律相关的因素（即睡眠和活动水平）以及身体和心理社会未满足需求状态对 BPSD 亚综合征的影响的理解有限。
本研究旨在探讨社区居住的痴呆老年人中与 BPSD 亚综合征相关的因素，考虑了一系列背景和近端因素（即通过活动记录仪测量的睡眠和体力活动水平以及基于日记的照顾者感知的症状触发因素），并以需求驱动的痴呆受损行为模型为指导。
采用前瞻性观察研究设计。研究参与者包括 145 名居住在家中的痴呆老年人。基线时的平均年龄为 81.2（SD 6.01）岁，样本由 86 名（59.3%）女性组成。通过照顾者的 BPSD 日记来测量 BPSD，并将其分为七个亚综合征。自变量包括背景特征和近端因素（即通过活动记录仪测量的睡眠和体力活动水平以及通过 BPSD 日记报告的照顾者报告的促成因素）。使用广义线性混合模型（GLMM）来检查预测 BPSD 亚综合征发生的因素。我们根据赤池信息量准则、贝叶斯信息量准则和似然比检验比较了模型。
与仅具有背景因素的 GLMM 相比，添加活动记录仪和日记数据可提高每个 BPSD 亚综合征的模型拟合度。夜间睡眠时间与次日的睡眠和夜间行为有关（优势比[OR]0.9，95%CI 0.8-1.0；P=.005），而能量消耗与欣快或兴奋有关（OR 0.02，95%CI 0.0-0.5；P=.02）。除欣快或兴奋外，所有亚综合征均与饥饿或口渴以及排尿或排便有关，所有 BPSD 亚综合征均与环境变化有关。年龄、婚姻状况、发病前人格和服用镇静剂是特定 BPSD 亚综合征的预测因素。
BPSD 在临床上具有异质性，其发生可以由不同的促成因素预测。我们对各种 BPSD 的研究结果表明，及时干预和护理计划的关键窗口。本研究的结果将有助于制定针对症状和个性化的干预措施，以预防和管理 BPSD，并促进个性化的痴呆护理。
