title: Co-Occurrence and Predictors of Three Commonly Occurring Behavioral Symptoms in Dementia: Agitation, Aggression, and Rejection of Care.
abstract: OBJECTIVE
  To investigate co-occurrences of agitation, aggression, and rejection of care in community-dwelling families living with dementia.
  
  
  METHODS
  Cross-sectional, secondary analysis from a randomized controlled trial testing a nonpharmacological intervention to reduce behavioral symptoms. We examined frequency of occurrence of presenting behaviors at baseline and their combination. Omnibus tests compared those exhibiting combinations of behaviors on contributory factors. Multinomial logistic regression analyses examined relationships of contributory factors to combinations of behaviors.
  
  
  RESULTS
  Of 272 persons with dementia (PwDs), 41 (15%) had agitation alone (Agi), 3 (1%) had aggression alone, 5 (2%) had rejection of care alone. For behavioral combinations, 65 (24%) had agitation and aggression (Agi+Aggr), 35 (13%) had agitation and rejection (Agi+Rej), 1 (0%) had aggression and rejection, and 106 (39%) had all three behaviors (All). Four behavioral subgroups (Agi, Agi+Aggr, Agi+Rej, and All) were examined. Kruskal-Wallis tests showed that there were significant group differences in PwD cognition, functional dependence, and caregiver frustration. PwDs in Agi+Rej and All were more cognitively impaired than those in Agi and Agi+Aggr. Also, caregivers in All were more frustrated than those in Agi. In logistic regression analyses, compared with Agi, greater cognitive impairment was a significant predictor of Agi+Rej and All, but not Agi+Aggr. In contrast, greater caregiver frustration was a significant predictor of Agi+Aggr and All, but not Agi+Rej.
  
  
  CONCLUSIONS
  We found that agitation, aggression, and rejection are common but distinct behaviors. Combinations of these behaviors have different relationships with contributory factors, suggesting the need for targeting treatment approaches to clusters.
authors.affiliation: Johns Hopkins University School of Nursing, Baltimore, MD. Electronic address: schoi51@jhu.edu.
authors.forename: Scott Seung W
authors.initials: SSW
authors.lastname: Choi
authors.affiliation: Johns Hopkins University School of Nursing, Baltimore, MD.
authors.forename: Chakra
authors.initials: C
authors.lastname: Budhathoki
authors.affiliation: Johns Hopkins University School of Nursing, Baltimore, MD.
authors.forename: Laura N
authors.initials: LN
authors.lastname: Gitlin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression / Q000523:psychology*; D017028:Caregivers / Q000523:psychology; D003072:Cognition Disorders / Q000150:complications / Q000523:psychology*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000150:complications* / Q000523:psychology*; D005260:Female; D005639:Frustration; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011595:Psychomotor Agitation / Q000150:complications* / Q000453:epidemiology*; D016032:Randomized Controlled Trials as Topic; D012059:Rejection, Psychology; D014481:United States / Q000453:epidemiology
keywords: Dementia; aggression; agitation; behavioral symptom; rejection