Alzheimer's Disease Behavioral and Psychological Symptoms of Dementia: Analysis of Symptoms and Interventions in a Multi-Ethnic Cohort

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2022

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University of Hawaii at Manoa

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INTRODUCTION Alzheimer’s Disease (AD) is a complex and difficult diagnosis for caregivers, clinicians, and patients. Behavioral and psychological symptoms of dementia (BPSD) are a set of symptoms that can range in severity from change in sleep patterns to violent outbursts. There are also different intervention options for BPSD including complementary, environmental, psychosocial, and pharmacologic interventions. Our multi-ethnic cohort provides a look into an understudied population on demographics, BPSD manifestations, interventions used, and efficacy of those treatments. METHODS We conducted a retrospective chart review to quantify and analyze our research questions. Data and variables collected were monitored and approved by physicians practicing at Hawaii Pacific Neuroscience Clinics. Using R for analysis we evaluated the associations between interventions and BPSD and demographic variables using chi-square tests or Fisher’s exact test. Multiple logistic regression models were used to assess the associations between interventions with BPSD, adjusting for the demographic variables. For descriptive statistics we used frequencies and percentages while modeling data using the ggplot2 package and table1 functions. Patients were grouped into four race/ethnicity categories, Asian (n=160), Caucasian (n=122), Pacific Islander (n=53), and Mixed Ethnic (n=33) based on a self reported demographics questionnaire. RESULTS Bivariate analyses between ethnicity and BPSD symptoms were not statistically significant. Differences between our two groups of early onset AD and late onset AD showed statistical significance for rates of sleep problems, anxiety, stress, and apathy (p-values=0.003, 0.002, 0.006, and <0.001, respectively) with early onset seeing higher rates in all four symptoms. We see overall that psychosocial interventions are used most frequently (87.2%, n=321) amongst all patients and complementary interventions (20.7%, n=76) are used the least. The odds of having a change in appetite among Asians is 2.57 times higher than Caucasians (95% CI=1.31-5.26). Regarding the demographic variable, years since diagnosis were positively associated with apathy (OR=1.14, 95% CI=1.01-1.30), jitteriness (OR=1.34, 95% CI=1.02-1.73), and sleep problems (OR=1.16, 95% CI=1.03-1.30). The odds of having depression for women are 2.09 times higher than men (95% CI=1.13-4.06). Regarding the demographic variable, number of hospitalization was negatively associated with use of nonpharmacologic interventions (OR=0.79, 95% CI=0.64-0.99) and years since diagnosis were positively associated with use of pharmacologic interventions (OR=1.25, 95% CI=1.08-1.47). CONCLUSION Our four race/ethnicity groups did not show any statistical significance in difference between prevalence rates of BPSD or use of interventions. We did however see differences in BPSD prevalence between our two groups of early onset AD and late onset AD which is to be expected of the diagnosis. We also saw some significant associations between demographic variables and BPSD manifestations. This data as a whole adds to current knowledge and work to develop better more effective intervention and treatment options including information on an understudied population in AD research. It also adds key information on BPSD prevalence and manifestations using a multi-ethnic cohort applicable to Hawaii and other Pacific Island communities.

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Alzheimer's disease--Psychological aspects, Alzheimer's disease--Treatment, Ethnicity

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