title: Comparison of behavioral and psychological symptoms of Alzheimer's disease among institution residents and memory clinic outpatients.
abstract: BACKGROUND
  Behavioral and psychological symptoms of dementia (BPSD) cause caregiver distress and earlier institutionalization. We compared the prevalence and characteristics of BPSD between institution residents and memory clinic outpatients with Alzheimer's disease (AD) to test the hypothesis that there is more BPSD among institution residents than among their outpatient counterparts. We assessed BPSD by interviewing the patients' principal caregivers, either family or professionals, using the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). Data from 138 patients with probable AD from the memory clinic and 173 residents with possible AD living in the long-term care facilities were collected. The diagnoses followed the NINCDS-ADRDA criteria.
  
  
  RESULTS
  BPSD profiles of the two groups were similar but not identical. The prevalence of at least one BPSD was high in both groups (community 81.9%, institution 74.9%). Activity disturbance was the most frequently reported BPSD in both groups (community 52.2%, institution 38.7%). Delusions, hallucinations, anxiety and aggressiveness were seen more frequently in memory clinic outpatients. The outpatients also had higher scores of BEHAVE-AD subscales in delusion/paranoid ideation, affective disturbance, and global rating of severity. With the increase of disease severity there were significantly more activity disturbance, psychosis, and aggressiveness in patients with AD.
  
  
  CONCLUSIONS
  Caregiver factor and institution effect were two possible reasons for the higher prevalence and the greater severity of BPSD in community patients. BPSD caused more distress to family caregivers than the professional caregivers. High levels of psychotropic prescriptions for patients living in the long-term care facilities may also play a role.
authors.affiliation: Department of Neurology, National Taiwan University Hospital, National Taiwan University, Taiwan.
authors.forename: Ting-Wen
authors.initials: TW
authors.lastname: Cheng
authors.forename: Ta-Fu
authors.initials: TF
authors.lastname: Chen
authors.forename: Ping-Keung
authors.initials: PK
authors.lastname: Yip
authors.forename: Mau-Sun
authors.initials: MS
authors.lastname: Hua
authors.forename: Chi-Cheng
authors.initials: CC
authors.lastname: Yang
authors.forename: Ming-Jang
authors.initials: MJ
authors.lastname: Chiu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression / Q000523:psychology; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D000553:Ambulatory Care; D017028:Caregivers / Q000523:psychology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007326:Institutionalization; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D008609:Mental Status Schedule / Q000706:statistics & numerical data; D011594:Psychometrics; D013624:Taiwan