title: Behavioral and psychological symptoms and the progression of dementia of the Alzheimer type in nursing home residents.
abstract: BACKGROUND
  Behavioral and psychological symptoms are common in the course of dementia of the Alzheimer's type (DAT). Some behavioral and psychological symptoms may be predictors of the progression of dementia and cognitive impairment in DAT. However, studies on this topic face serious methodological problems. The aim of our study was to investigate how aggressive and impulsive behaviors correlate with the progression of dementia and related cognitive impairments in DAT patients.
  
  
  METHODS
  Using the Cohen-Mansfield Agitation Inventory (CMAI) and the ADAS-cog we examined 39 nursing home residents diagnosed with mild to moderate DAT. Of these participants, 26 were re-evaluated with the ADAS-cog two years after baseline.
  
  
  RESULTS
  Aggressive and impulsive behaviors correlated with the degree of cognitive impairment. However, we also found that particular ADAS-cog items correlated differently with the CMAI score. Moreover, various CMAI categories were differently related to cognitive disorders. Impairments in cognitive functioning best explain the fluctuations of verbal aggression and physical agitation (non-aggressive). At baseline, the more demented subjects had a higher general score on the CMAI scale and showed greater rates of physical aggression, verbal aggression and non-aggressive physical agitation.
  
  
  CONCLUSIONS
  Particular items of the CMAI scale significantly differentiated our subjects in terms of progression of cognitive impairment. Aggressive behaviors in patients with DAT are linked to both the severity of dementia and the rate of its progression. At the same time, significant differences were noted with respect to particular behaviors.
authors.affiliation: Department of Developmental, Psychotic, and Geriatric Psychiatry, Medical University of Gdansk, Gdańsk, Poland.
authors.forename: Leszek
authors.initials: L
authors.lastname: Bidzan
authors.forename: Maria
authors.initials: M
authors.lastname: Pachalska
authors.forename: Bozena
authors.initials: B
authors.lastname: Grochmal-Bach
authors.forename: Mariola
authors.initials: M
authors.lastname: Bidzan
authors.forename: Grazyna
authors.initials: G
authors.lastname: Jastrzebowska
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000503:physiopathology* / Q000523:psychology*; D001519:Behavior; D018450:Disease Progression; D005500:Follow-Up Studies; D006707:Homes for the Aged; D006801:Humans; D009735:Nursing Homes