JMIR Publications

ABSTRACT

Background:

Although disclosing the predictors of different behavioral and psychological symptoms of dementia (BPSD) is the first step in developing person-centered interventions, the current understanding is limited as it considers BPSD as a homogenous construct, not accounting for its heterogeneity.

Objective:

The objective of our study was to explore factors associated with subsyndromes of BPSD and build models for predicting these subsyndromes.

Methods:

A two wave prospective observational study design was employed. Study participants were older adults with dementia living at home (N = 145; mean age = 81.2; 59.3% women, at baseline). BPSD was measured with a BPSD diary kept by caregivers and was categorized into seven subsyndromes. Independent variables consisted of background characteristics, proximal factors including sleep and physical activity level measured using actigraphy, and caregiver-reported contributing factors, including physical and interpersonal unmet needs states and environmental triggers. We fit the generalized linear mixed models using the Wave 1 data and then validated them using the Wave 2 data.

Results:

The amount of nighttime sleep hours was a predictor for next day sleep and nighttime behaviors (OR = 0.87; P= .005), and amounts of energy expenditure for euphoria/elation (OR = 0.02; P= .02). All but euphoria/elation were significantly associated with hunger and/or thirst, and urination and/or bowel movements, with all the BPSD subsyndromes showing an association with environmental change. Age, marital status, premorbid personality, and taking sedatives were found as predictors for specific BPSD subsyndromes. The area under the receiver operating characteristic curve (AUC) scores for the data were greater than 0.9 and 0.8 in Waves 1 and 2, respectively, for all of the BPSD subsyndromes.

Conclusions:

BPSD are clinically heterogeneous and their occurrence can be predicted by different contributing factors. Evidence-based prediction models for various BPSD would provide a critical window for timely intervention and care planning. Findings from this study will help to devise more symptom targeted and individualized interventions for preventing and managing BPSD.