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Correlates of agitation and depression in nursing home residents with dementia

Published online by Cambridge University Press:  17 May 2012

Tomislav Majić ,
Jan P. Pluta ,
Thomas Mell ,
Yvonne Treusch ,
Hans Gutzmann  and
Michael A. Rapp
Tomislav Majić
Affiliation:
Clinic for Psychiatry and Psychotherapy, Charité University Medicine, Campus Mitte, Hospital St. Hedwig, Berlin, Germany
Jan P. Pluta
Affiliation:
Medical School, Charité University Medicine, Berlin, Germany
Thomas Mell
Affiliation:
Clinic for Psychiatry and Psychotherapy, Charité University Medicine, Campus Mitte, Hospital St. Hedwig, Berlin, Germany
Yvonne Treusch
Affiliation:
Clinic for Psychiatry and Psychotherapy, Charité University Medicine, Campus Mitte, Hospital St. Hedwig, Berlin, Germany
Hans Gutzmann
Affiliation:
Clinic for Psychiatry and Psychotherapy, Hospital Hedwigshöhe, Berlin, Germany
Michael A. Rapp*
Affiliation:
Clinic for Psychiatry and Psychotherapy, Charité University Medicine, Campus Mitte, Hospital St. Hedwig, Berlin, Germany Department of Psychiatry, Charité Campus Mitte, Berlin, Germany
*
Correspondence should be addressed to: Michael A. Rapp, MD, PhD, Geriatric Psychiatry Center, Psychiatric University Hospital St. Hedwig, Department of Psychiatry, Charité Campus Mitte, Charitéplatz 1, Berlin, Germany. Phone: ++ 49-30-2311-2035; Fax: ++ 49-30-2311-2945. Email: michael.rapp@charite.de.
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Abstract

Background: The purpose of this study was to investigate the relationship between dementia severity, age, gender, and prescription of psychotropics, and syndromes of agitation and depression in a sample of nursing home residents with dementia.

Methods: The Cohen-Mansfield Agitation Inventory (CMAI) was administered to residents with dementia (N = 304) of 18 nursing homes. Agitation symptoms were clustered using factorial analysis. Depression was estimated using the Dementia Mood Assessment Scale (DMAS). Dementia severity was assessed categorically using predefined cut-off scores derived from the Mini-Mental State Examination (MMSE). The relationship between agitation and its sub-syndromes, depression, and dementia severity was calculated using χ2-statistics. Linear regression analyses were used to calculate the effect of dementia severity and psychotropic prescriptions on agitation and depression, controlling for age and gender.

Results: Increasing stages of dementia severity were associated with higher risk for physically aggressive (p < 0.001) and non-aggressive (p < 0.01) behaviors, verbally agitated behavior (p < 0.05), and depression (p < 0.001). Depressive symptoms were associated with physically aggressive (p < 0.001) and verbally agitated (p < 0.05) behaviors, beyond the effects of dementia severity. Prescription of antipsychotics was correlated with depression and all agitation sub-syndromes except hiding and hoarding.

Conclusions: Dementia severity is a predictor for agitation and depression. Beyond that, depression increased with dementia severity, and the severity of depression was associated with both physically and verbally aggressive behaviors, indicating that, in advanced stages of dementia, depression in some patients might underlie aggressive behavior.

Keywords

Alzheimer's diseasebehavioral and psychological symptomsBPSDagitationdepressionnursing home
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 11 , November 2012 , pp. 1779 - 1789
Copyright
Copyright © International Psychogeriatric Association 2012

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