TY - JOUR
T1 - Co-Occurrence and Predictors of Three Commonly Occurring Behavioral Symptoms in Dementia
T2 - Agitation, Aggression, and Rejection of Care
AU - Choi, Scott Seung W
AU - Budhathoki, Chakra B.
AU - Gitlin, Laura N
PY - 2016/4/12
Y1 - 2016/4/12
N2 - 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.
AB - 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.
KW - Aggression
KW - Agitation
KW - Behavioral symptom
KW - Dementia
KW - Rejection
UR - http://www.scopus.com/inward/record.url?scp=85007453834&partnerID=8YFLogxK
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U2 - 10.1016/j.jagp.2016.10.013
DO - 10.1016/j.jagp.2016.10.013
M3 - Article
C2 - 27914870
AN - SCOPUS:85007453834
SN - 1064-7481
JO - American Journal of Geriatric Psychiatry
JF - American Journal of Geriatric Psychiatry
ER -