title: Differences of Behavioral and Psychological Symptoms of Dementia in Disease Severity in Four Major Dementias.
abstract: OBJECTIVE
  Behavioral and psychological symptoms of dementia (BPSDs) negatively impact the prognosis of dementia patients and increase caregiver distress. The aims of this study were to clarify the differences of trajectories of 12 kinds of BPSDs by disease severity in four major dementias and to develop charts showing the frequency, severity, and associated caregiver distress (ACD) of BPSDs using the data of a Japan multicenter study (J-BIRD).
  
  
  METHODS
  We gathered Neuropsychiatric Inventory (NPI) data of patients with Alzheimer's disease (AD; n = 1091), dementia with Lewy bodies (DLB; n = 249), vascular dementia (VaD; n = 156), and frontotemporal lobar degeneration (FTLD; n = 102) collected during a 5-year period up to July 31, 2013 in seven centers for dementia in Japan. The NPI composite scores (frequency × severity) of 12 kinds of items were analyzed using a principal component analysis (PCA) in each dementia. The factor scores of the PCA were compared in each dementia by disease severity, which was determined with Clinical Dementia Rating (CDR).
  
  
  RESULTS
  Significant increases with higher CDR scores were observed in 1) two of the three factor scores which were loaded for all items except euphoria in AD, 2) two of the four factor scores for apathy, aberrant motor behavior (AMB), sleep disturbances, agitation, irritability, disinhibition, and euphoria in DLB, and 3) one of the four factor scores for apathy, depression, anxiety, and sleep disturbances in VaD. However, no increases were observed in any of the five factor scores in FTLD.
  
  
  CONCLUSIONS
  As dementia progresses, several BPSDs become more severe, including 1) apathy and sleep disturbances in AD, DLB, and VaD, 2) all of the BPSDs except euphoria in AD, 3) AMB, agitation, irritability, disinhibition, and euphoria in DLB, and 4) depression and anxiety in VaD. Trajectories of BPSDs in FTLD were unclear.
authors.affiliation: Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kazui
authors.affiliation: Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yoshiyama
authors.affiliation: Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kanemoto
authors.affiliation: Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Hashimoto
authors.affiliation: Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.|Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Ikeda
authors.affiliation: Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan.
authors.forename: Hibiki
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hatada
authors.affiliation: Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan.
authors.forename: Masateru
authors.initials: M
authors.lastname: Matsushita
authors.affiliation: Department of Behavioral Neurology and Cognitive Neurosciences, Tohoku University School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Nishio
authors.affiliation: Department of Behavioral Neurology and Cognitive Neurosciences, Tohoku University School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Etsuro
authors.initials: E
authors.lastname: Mori
authors.affiliation: Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.|Comprehensive community care for elderly, nursing and Health science, Graduate School of Medicine, Ehime University, Toon, Ehime, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tanimukai
authors.affiliation: Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.|Zaidan-Niihama Hospital, Niihama, Ehime, Japan.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Komori
authors.affiliation: Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Shimizu
authors.affiliation: Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Mori
authors.affiliation: Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.|Departments of Neurology and Cognitive disorders, Hyogo Prefectural Rehabilitation Center at Nishi-harima, Tatsuno, Hyogo, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Kashibayashi
authors.affiliation: Departments of Neurology and Cognitive disorders, Hyogo Prefectural Rehabilitation Center at Nishi-harima, Tatsuno, Hyogo, Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Yokoyama
authors.affiliation: Department of Dementia Research, Akita Prefectural Center for Rehabilitation and Psychiatric Medicine, Daisen, Akita, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Shimomura
authors.affiliation: Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.|The Sleep Medical Center of Osaka University Hospital, Suita, Osaka, Japan.|Department of Psychiatry, Osaka University Health Care Center, Toyonaka, Osaka, Japan.
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Kabeshita
authors.affiliation: Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.|The Sleep Medical Center of Osaka University Hospital, Suita, Osaka, Japan.|Department of Psychiatry, Osaka University Health Care Center, Toyonaka, Osaka, Japan.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Adachi
authors.affiliation: Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000523:psychology; D003704:Dementia / Q000523:psychology*; D015140:Dementia, Vascular / Q000523:psychology; D005260:Female; D057180:Frontotemporal Dementia / Q000523:psychology; D006801:Humans; D020961:Lewy Body Disease / Q000523:psychology; D008297:Male; D009483:Neuropsychological Tests; D012720:Severity of Illness Index