TY - JOUR
T1 - Neuropsychiatric symptom profiles of community-dwelling persons living with dementia
T2 - Factor structures revisited
AU - Regier, Natalie G.
AU - Hodgson, Nancy A.
AU - Gitlin, Laura N.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Objectives: Most persons living with dementia (PLWD) will develop neuropsychiatric symptoms (NPS) at some point. NPS are often clustered into subsyndromes with other related symptoms, but the evidence supporting commonly used clusters is insufficient. We reexamine behavioral clusters in community-dwelling PLWD and identify associated risk factors and potential contributors. Methods: This study used baseline data from a longitudinal behavioral intervention study of 250 community-dwelling older adults with dementia and their caregivers. Using exploratory factor analysis (principal component analysis [PCA]), the factor structure of NPS frequency scores of the Neuropsychiatric Inventory (NPI-C) was evaluated. Multiple linear regressions assessed the association of the derived behavioral clusters with caregiver burden, caregiver depression, and quality of life of the PLWD. Results: PCA yielded eight behavioral clusters (factors): 1 = Aggression/Rejection of Care, 2 = Apathy/Withdrawal, 3 = Restlessness/Agitation, 4 = Anxiety, 5 = Impulsivity/Disinhibition, 6 = Psychosis, 7 = Circadian Disturbance, and 8 = Depression. In multiple linear regressions, caregiver burden was significantly influenced by the anxiety cluster, caregiver depression was significantly influenced by the apathy/withdrawal cluster, and quality of life of the PLWD was significantly associated with the anxiety and circadian disturbance clusters. Conclusions: Our eight derived behavioral clusters suggest that commonly accepted clusters of NPS may not reflect the clinical reality for community-dwelling PLWD. Behavioral clusters appear to differentially impact and put caregivers and PLWD at risk such that personalized intervention strategies are warranted. J Am Geriatr Soc 68:-, 2020.
AB - Objectives: Most persons living with dementia (PLWD) will develop neuropsychiatric symptoms (NPS) at some point. NPS are often clustered into subsyndromes with other related symptoms, but the evidence supporting commonly used clusters is insufficient. We reexamine behavioral clusters in community-dwelling PLWD and identify associated risk factors and potential contributors. Methods: This study used baseline data from a longitudinal behavioral intervention study of 250 community-dwelling older adults with dementia and their caregivers. Using exploratory factor analysis (principal component analysis [PCA]), the factor structure of NPS frequency scores of the Neuropsychiatric Inventory (NPI-C) was evaluated. Multiple linear regressions assessed the association of the derived behavioral clusters with caregiver burden, caregiver depression, and quality of life of the PLWD. Results: PCA yielded eight behavioral clusters (factors): 1 = Aggression/Rejection of Care, 2 = Apathy/Withdrawal, 3 = Restlessness/Agitation, 4 = Anxiety, 5 = Impulsivity/Disinhibition, 6 = Psychosis, 7 = Circadian Disturbance, and 8 = Depression. In multiple linear regressions, caregiver burden was significantly influenced by the anxiety cluster, caregiver depression was significantly influenced by the apathy/withdrawal cluster, and quality of life of the PLWD was significantly associated with the anxiety and circadian disturbance clusters. Conclusions: Our eight derived behavioral clusters suggest that commonly accepted clusters of NPS may not reflect the clinical reality for community-dwelling PLWD. Behavioral clusters appear to differentially impact and put caregivers and PLWD at risk such that personalized intervention strategies are warranted. J Am Geriatr Soc 68:-, 2020.
KW - behaviors
KW - caregiver
KW - cluster
KW - dementia
KW - neuropsychiatric symptoms
UR - http://www.scopus.com/inward/record.url?scp=85085553121&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85085553121&partnerID=8YFLogxK
U2 - 10.1002/gps.5323
DO - 10.1002/gps.5323
M3 - Article
C2 - 32363605
AN - SCOPUS:85085553121
VL - 35
SP - 1009
EP - 1020
JO - International Journal of Geriatric Psychiatry
JF - International Journal of Geriatric Psychiatry
SN - 0885-6230
IS - 9
ER -