[Behavioral and psychological symptoms in elderly people with cognitive impairment. Differences between assessment at home and at an adult day-care facility].
OBJECTIVE
In order for activities preventing cognitive decline in the elderly and burdens of the caregiver to be effective and efficient, it is important to assess cognitive impairment and the behavioral and psychological symptoms of dementia (BPSD) in community-dwelling elderly people with cognitive impairment. The purpose of this study was to investigate differences in BPSD between assessment at home and assessment at an adult day-care facility, and to assess the relationship, between BPSD and caregiver burden in disabled elderly people with and without mild cognitive impairment (MCI) or dementia.


METHODS
We studied 594 participants with activity limitations out of a target population of 917 community-dwelling elderly persons utilizing adult day-care service. Dementia and MCI were determined using a clinical history of dementia, the Clinical Dementia Rating scale, and/or the Mini-Mental State Examination (MMSE); 116 were diagnosed with dementia, 103 as having MCI, and 243 as cognitively normal controls (CN). BPSD were assessed at home and at the adult day-care facility with the Neuropsychiatric Inventory (NPI) and the Dementia Behavior Disturbance Scale (DBD). Activities of daily living (ADL) were evaluated using the Barthel index, and caregiver burden was assessed using the short version of the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI_8).


RESULTS
People diagnosed with dementia were found to be significantly more impaired on the DBD, MMSE, BI, and J-ZBI_8, than CN or those with MCI. Those with MCI also showed significantly more impairments relative to CN. The scores on the NPI and DBD assessed at home were higher than that assessed at the adult day-care facility in each group. The differences of NPI and DBD scores between home assessment and assessment at the adult day-care facility were greater for people with dementia than for people with MCI or CN. Multiple regression analysis revealed that the best explanatory variables for J-ZBI_8 are home assessments of NPI and DBD, the MMSE for people with dementia, home assessment of DBD and MCI, and home assessment of NPI and BI for CN. Both NPI and DBD were not associated with the J-ZBI_8 when assessed at the adult day-care facility regardless of level of cognitive impairment.


CONCLUSIONS
The scores of the BPSD and caregiver burden worsened with increasing severity of cognitive impairment, and the BPSD was more apparent when assessed at home compared to at the adult day-care facility. These findings suggest that the assessment of BPSD at home is important in determining MCI or dementia and to estimate caregiver burden in community-dwelling elderly people with basic ADL limitations.
Department of Physical Therapy, School of Health Sciences, Kyorin University.
Hiroyuki
H
Hashidate
Kazuhiro
K
Harada
Yasuyoshi
Y
Asakawa
Tetsuya
T
Yamagami
Kenji
K
Nihei
Satomi
S
Kaneya
Chiharu
C
Yoshii
D000369:Aged, 80 and over; D017028:Caregivers; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000523:psychology; D003631:Day Care, Medical; D003704:Dementia / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales