BPSD in Europe: an EADC Study Behavioral and Psychological Symptoms of Dementia (BPSD) in Europe: A Report of the EADC BPSD Thematic Group
Jane Byrne, MD
Old Age Psychiatry
School of Psychiatry and Behavioral Sciences
University of Manchester
Manchester, United Kingdom

Dr. Byrne reported findings of a survey of behavioral and psychological symptoms of dementia (BPSD) in clinical practice in Europe. Apathy was the most common symptom. The survey questionnaire examined BPSD in the context of caring, and included symptoms that are not addressed in other BPSD measures.

The symptoms of BPSD are a common cause of distress to patients and their caregivers. However, what constitutes BPSD differs according to various classification systems and guidelines. The standard measure of BPSD is the Neuropsychiatric Inventory (NPI). However, this measure does not address the qualitative aspects of BPSD, such as the time of occurrence or the consequences of the unwanted behavior. Thus, there is a danger that clinicians will see only the behavior, ignoring the dynamic aspects of that behavior in the patient.

To address these concerns, the European Alzheimer’s Disease Consortium (EADC) conducted a survey of BPSD in clinical practice. The survey population included patients and caregivers from 12 centers in Europe.

Of 698 patients entered, 368 (52.7%) had Alzheimer’s disease. Of that group, 232 (63%) had BPSD. By comparison, Lyketsos et al. published a U.S. investigation in 2002 called the Cardiovascular Health Study. For all dementia patients in this study, 62% had clinically significant neuropsychiatric symptoms as defined by the NPI.

According to the results of the EADC survey, the most common BPSD symptoms in the 232 Alzheimer’s disease patients with BPSD included apathy (21%), anxiety (16%), and dysphoria (15%). Sleep was relatively uncommon (3%). In contrast, Lyketsos and colleagues found sleep symptoms to be more common (13%). However, the magnitude of the apathy measure was similar (18%). Dr. Byrne said investigators expected some difference in prevalence, since the populations were not identical. Thus, the relative frequency of any BPSD symptom appears to depend very much on the population under study.

The survey results included some behaviors and symptoms that are not included in the NPI. Changes in personality were quite frequent, as were misidentification, shouting and hoarding.

The EADC survey also looked at duration of symptoms. They found that 50% of the subjects did not present to clinicians until 2 to 5 years after symptom onset. Dr. Byrne said this is worrying, since investigators consider early diagnosis to be important. For the subset of patients with Alzheimer’s disease, a somewhat smaller percentage of patients (45%) presented 2 to 5 years after symptom onset.

The EADC researchers asked not only about frequency and duration of BPSD, but also about the qualitative aspects of BPSD.

About 34% of responders said that BPSD symptoms were a problem in the daytime, while 20% said the symptoms were not time-specific. About one-third said the behaviors are a problem in the home, while 47% said the behaviors were not specific to any place. The behaviors were a problem to 30% patients and 44% of caregivers.

Investigators asked what starts the behavior, but in most cases (70.9%) responders could not identify a trigger. However, a few cited tiredness (6.3%) and being left alone (3.8%).
The consequences of BPSD included impairment in activities of daily living (16.5%) and depression, anxiety or tiredness (13.9%).

Dr. Byrne said the effect on the mood of the patient is a notable finding. Previously, there was data showing that BPSD affect the mood of the caregiver. Now, the EADC provides preliminary data that these behaviors can also affect the mood of the patient.

For the future, EADC researchers hope to elucidate cross-cultural differences in BPSD in North, South and Mediterranean Europe. They are also interested in conducting intervention studies, particularly with regard to apathy.

 

Reporter: Andrew Bowser