University of Texas Health Science Center at Houston, Cizik School of Nursing, Houston, Texas, USA.
Department of Educational Sciences, Amasya University, Education Faculty, Amasya, Turkey.
Alzheimers Dement. 2024 Oct;20(10):6699-6708. doi: 10.1002/alz.14075. Epub 2024 Aug 15.
Behavioral and psychological symptoms in dementia (BPSD) are dynamic phenomena with a high amount of intraindividual variability. We applied a multilevel framework to identify subsyndromes (between-person factors) that represent clinically relevant profiles of BPSD and identify symptom clusters (within-person factors) that represent contextually driven daily symptom experiences.
This study used an intensive longitudinal design in which 68 co-residing family caregivers to persons living with dementia were recruited to proxy report on their care recipient's daily symptom experiences of 23 different BPSD for eight consecutive days (n = 443 diaries). A multilevel exploratory/confirmatory factor analysis was used to account for nested data and separate within-person variances from between-level factor estimates.
Exploratory factor analysis identified a 4-between 3-within factor structure based on fit statistics and clinical interpretability.
This study offers major methodological and conceptual advancements for management of BPSD within Alzheimer's disease and related dementias by introducing two related but distinct concepts of subsyndromes and symptom clusters.
Because behavioral and psychological symptoms of dementia (BPSD) are dynamic temporal phenomenon, this introduces measurement error into aggregate group-level estimates when trying to create subsyndromes. We propose a multilevel analysis to provide a more valid and reliable estimation by separating out variance due to within-person daily fluctuations. Using a multilevel exploratory factor analysis with intensive longitudinal data, we identified distinct and meaningful groups of BPSD. The four factors at the between-person level represented subsyndromes that are based on how BPSD co-occurred among persons with Alzheimer's disease (AD). These subsyndromes are clinically relevant because they share features of established clinical phenomena and may have similar neurobiological etiologies. We also found three within-person factors representing distinct symptom clusters. They are based on how BPSD clustered together on a given day for an individual with AD and related dementias. These clusters may have shared environmental triggers.
痴呆症患者的行为和心理症状（BPSD）是具有高度个体内变异性的动态现象。我们应用多层次框架来确定亚综合征（个体间因素），这些亚综合征代表了 BPSD 的临床相关特征，并确定症状群（个体内因素），这些症状群代表了与情境相关的日常症状体验。
本研究采用密集纵向设计，招募了 68 名与痴呆症患者同住的家庭护理人员，代表他们的护理对象在连续 8 天内报告 23 种不同 BPSD 的日常症状体验（n=443 份日记）。使用多层次探索性/验证性因素分析来解释嵌套数据，并将个体内方差与个体间因素估计分开。
探索性因素分析基于拟合统计和临床可解释性确定了 4 个个体间因素和 3 个个体内因素的结构。
本研究通过引入亚综合征和症状群两个相关但不同的概念，为阿尔茨海默病和相关痴呆症患者的 BPSD 管理提供了重大的方法学和概念上的进展。
由于痴呆症的行为和心理症状（BPSD）是动态的时间现象，因此当试图创建亚综合征时，这会在汇总的群体水平估计中引入测量误差。我们提出了一种多层次分析方法，通过分离个体内日常波动引起的方差，提供更有效和可靠的估计。使用密集纵向数据的多层次探索性因素分析，我们确定了具有不同意义的 BPSD 群体。个体间水平的四个因素代表了基于阿尔茨海默病患者中 BPSD 共同发生的亚综合征。这些亚综合征具有临床相关性，因为它们具有已建立的临床现象的特征，并且可能具有类似的神经生物学病因。我们还发现了三个代表不同症状群的个体内因素。它们基于特定日子里单个阿尔茨海默病和相关痴呆症患者的 BPSD 聚类情况。这些聚类可能具有共同的环境触发因素。
