Behaviour changes in dementia. 2: Are there behavioural syndromes?

OBJECTIVE

To establish whether robust behavioural 'syndromes' can be identified from among the widely heterogeneous behavioural changes which occur in dementia.

DESIGN

Longitudinal, prospective study with follow-up at 4 and 8 months.

SETTING

Community settings in Oxfordshire, UK.

PARTICIPANTS

97 elderly people with a diagnosis of Alzheimer's disease or vascular dementia (in many cases confirmed by postmortem examination) and who were living at home with a carer.

MEASURES

Each subject's behaviour was assessed in detail at each interview using the Present Behavioural Examination to assess subject's behaviour over the preceding 4 weeks. Seventeen key behaviour items which were both common and clinically important were selected for further analysis.

RESULTS

Three syndromes were identified: (a) overactivity (walking more, walking aimlessly, trailing the carer or checking where the carer was); (b) aggressive behaviour (physical aggression, aggressive resistance, verbal aggression); (c) psychosis (anxiety, persecutory ideas and hallucinations). The same syndromes were found using data collected at three different time points and by using a variety of statistical techniques, confirming their robustness.

CONCLUSIONS

Overactivity, aggressive behaviour and psychosis form three distinct behavioural syndromes in dementia.