title: A 1-year follow-up study of behavioral and psychological symptoms in dementia among people in care environments.
abstract: BACKGROUND
  Behavioral and psychological symptoms in dementia (BPSD) are common and distressing for patients and caregivers, but little is known about the natural history of these symptoms, particularly among patients in care facilities. This information is essential for informed clinical management. We report a 1-year follow-up study of the prevalence, incidence, and outcome of the 3 main BPSD (agitation, depression, and psychosis) in care facilities.
  
  
  METHODS
  136 elderly residents with dementia (29% living in social care facilities and 71% in nursing home care) were assessed longitudinally on 2 occasions a year apart using a range of standardized psychiatric schedules, including the Neuropsychiatric Inventory.
  
  
  RESULTS
  The overall prevalence of BPSD was stable over the year (76% at baseline and 82% at follow-up). Subjects with subclinical symptoms at baseline were more likely to develop clinically significant BPSD during follow-up than those who were symptom free (83% vs. 52%; Mann-Whitney U test, z = 2.36, p = .01). Agitation was the most common individual syndrome (55%). Although overall BPSD were persistent, > or = 45% of dementia patients with any of the major syndromes experienced resolution, indicating the development of different BPSD in many residents. There was no evidence that residents taking neuroleptics were more likely to experience resolution of BPSD than neuroleptic-free residents.
  
  
  CONCLUSIONS
  BPSD are highly frequent and persistent among residents of care facilities with dementia. This emphasizes the need for ongoing treatment trials. The pattern of resolution with the development of new symptoms indicates that short focused periods of treatment may be a more effective management approach. In addition, the potential value in treating patients with subclinical BPSD to prevent the development of full-blown syndromes needs to be investigated.
authors.affiliation: Institute for the Health of the Elderly, University of Newcastle, United Kingdom.
authors.forename: C G
authors.initials: CG
authors.lastname: Ballard
authors.forename: M
authors.initials: M
authors.lastname: Margallo-Lana
authors.forename: J
authors.initials: J
authors.lastname: Fossey
authors.forename: K
authors.initials: K
authors.lastname: Reichelt
authors.forename: P
authors.initials: P
authors.lastname: Myint
authors.forename: D
authors.initials: D
authors.lastname: Potkins
authors.forename: J
authors.initials: J
authors.lastname: O'Brien
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003702:Delusions / Q000175:diagnosis* / Q000453:epidemiology; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005500:Follow-Up Studies; D006212:Hallucinations / Q000175:diagnosis* / Q000453:epidemiology; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D009735:Nursing Homes / Q000706:statistics & numerical data*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011595:Psychomotor Agitation / Q000175:diagnosis* / Q000453:epidemiology; D012720:Severity of Illness Index