Download Psychological and Behavioral Symptoms in a Sample of Elderly

EL-MINIA MED., BUL., VOL. 22, NO. 2, JUNE 2011
El-Sherbini
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PSYCHOLOGICAL AND BEHAVIORAL SYMPTOMS IN A SAMPLE OF
ELDERLY INDIVIDUALS WITH DEMENTIA
By
Amr Makram EL-Sherbini
Department of Neurology and Psychiatry,
EL-Minia Faculty of Medicine
ABSTRACT:
Introduction: Behavioral and psychological symptoms are common in individuals
with dementia and affect the patients negatively and cause distress to the caregivers.
Aim of Work: The aim of the current study is to assess the prevalence of behavioral
and psychological symptoms in a sample of individuals with dementia and to
determine the effect of such symptoms on the patients and the caregivers.
Methods: Twenty eight individuals diagnosed with dementia were assessed using the
Neuropsychiatric Inventory (NPI), Mini Mental State Examination (MMSE), the
Activity of Daily Living tool (ADL) and the Instrumental activity of daily living
(IADL).
Results: Of the 28 individuals 24 (85.7%) had neuropsychological symptoms as
assessed with the NPI. The most common symptoms were those of depression
occurring in 32.1% of the sample followed by apathy or indifference which was
diagnosed in eight individuals (28.6%) and irritability found in 21.4% of the patients.
Caregiver distress was correlated with the NPI scores and functional disability was
correlated with MMSE scores.
In conclusion: Psychological and behavioral symptoms are very prevalent in
individuals with dementia and these symptoms cause significant family distress and
negatively affect the functional ability of the patients. It is recommended that such
symptoms should be diagnosed and managed effectively to decrease their negative
effect on the patients and the caregivers.
KEY WORDS:
Dementia
Activities of Daily living
Psychological symptoms
persons and this number is expected to
increase to 63 million in 2030, 41
million in less developed regions2.
INTRODUCTION:
Dementia is a generic term that
describes a chronic or progressive
dysfunction of cortical and subcortical
functions. This dysfunction is characterized by impairment of memory and
of at least one other cognitive function
(aphasia, apraxia, agnosia, executive
dysfunction)1. Today, dementia is
considered one of the major social
burdens in developing countries and it
was estimated that the worldwide
number of persons with dementia in
the year 2000 was about 25 million
Since the first description of
Alzheimer’s disease it has been recognized that the disease is multidimensional in nature and is characterized clinically by cognitive decline,
psychiatric and behavioral disturbances, and an impaired ability to
perform activities of daily living3.
Dementia is associated with a diverse
array of behavioral changes, and the
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nature of the psychiatric and behavioral disturbances varies among
patients with dementia4. It is not clear
whether behavioral and psychological
symptoms of dementia (BPSD) are
epiphenomena of the neurodegenerative process or are the symptoms
of specific, biologically distinct subtypes of dementing disorders 5.
ability to perform daily activity as well
as the effect of such symptoms on the
caregivers of these patients.
SUBJECTS AND METHODS:
This cross sectional study
involved patients with dementia assessed for the presence of neuropsychiatric symptoms. A patient was
considered eligible for inclusion in the
study only if he or she had a
responsible caregiver who knows the
patient well and can reliably give
account on the patient behavior.
Exclusion criteria:1- Patients with previous psychiatric disorder prior to the onset of
dementia.
2- Patients with chronic pulmonary disease, renal failure, advanced
hepatic disease and brain tumors or
other brain pathology that may result in
reversible dementia.
Behavioral and psychiatric
symptoms associated with dementia
include apathy, psychosis, and
aggression6. Delusions are observed in
high proportion of dementia patients,
and their onset is predictive of a rapid
cognitive deterioration7,8. Symptoms of
depression and anxiety are also
common in patients with dementia and
may be among the first signs of
dementia9. Agitation and depression
exacerbate functional and cognitive
deficits.10 Other psychiatric and behavioral disturbances are also common in
dementia, including agitation, and
labile affect 5.
Patients were recruited from the
outpatient clinic of the hospital of
Bahrain. The sample was collected
over a period of ten months starting
from June 2010 till March 2011. All
patients presented with symptoms
suggestive of dementia had a routine
brain CT scan and were subjected to:
The majority of dementia
patients are cared for at home by
family members, including both
spouses and adult children11-12. The
psychiatric and behavioral disturbances
of an individual with dementia greatly
impact on both the patient and the
caregiver13-14, such disturbances can
compromise the patient’s social
functioning and safety. The frequency
and severity of psychiatric and
behavioral disturbances exhibited by a
dementia patient may influence caregiver burden as well as distress 15-16.
Socio-demographic
questionnaire
sheet which was intended to obtain
personal history mainly; name, age,
sex, address, marital status and medical
history.
Clinical Psychiatric Assessment
concentrating on the clinical diagnosis
of dementia using DSM-1V criteria1.
AIM OF WORK:
The aims of the current study
are to determine the prevalence of
behavioral and psychiatric symptoms
in a sample of outpatient elderly with
dementia. In addition, we tried to
detect the effect of behavioral and
psychiatric symptoms on the patient’s
Mini-Mental State Examination
(MMSE) This tool was used to
determine the degree of cognitive
impairment17.
Activities of Daily Living (ADL)18
Which is a tool used to detect the
patient ability to perform basic life
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tasks as bathing, dressing,.. Each item
is scored on a 3-point scale, reflecting
independence, the need for assistance,
or dependence with higher scores
reflecting greater functioning independence.
The NPI contain an integral part for
measurement of family distress which
is rated separately, the total caregiver
distress score is generated by adding
the item-related distress scores20.
STATISTICAL ANALYSIS:
Data were analyzed by using
SPSS version 10.0 software. Means
with standard deviations or percentages
were used to describe the sample.
Group differences were assessed using
the unpaired student t- test, for
categorical variables the chi-square test
was used. We also determined the
Pearson linear correlation between
certain variables. A P value below 0.05
was considered to indicate statistical
significance.
The aim of the study was explained to
the patient and to the caregiver and
they gave a written consent to
participate in the study.
Instrumental Activity of Daily
Living (IADL) A tool used to assess
individual ability to handle more
complex tasks as shopping, handling
finance... Each item is scored on a 3point scale, reflecting independence,
the need for assistance, or dependence
with higher scores reflecting greater
functioning independence 19.
The Neuropsychiatric Inventory
(NPI) psychological and behavioral
symptoms were assessed using the
Neuropsychiatric Inventory (NPI), a
widely used instrument in dementia
research. It is an informant-based
interview that is well validated with
excellent interrater reliability. The NPI
was administered to caregivers or to
persons very familiar with the
participants. The NPI covers 10 domains:
delusions,
hallucinations,
agitation/aggression,
dysphoria/
depression, anxiety, euphoria/elation,
apathy/indifference,
disinhibition,
irritability/lability, and aberrant motor
behaviors. Each domain has a
screening question, with a positive
answer being followed up by a detailed
set of questions about the domain.
Symptom severity was assessed by
then asking the informant to rate both
the frequency and severity of symptoms which produces a composite
domain-specific frequency x severity
score. Since no participants endorsed
the euphoria/elation domain, it was
excluded from the analyses. Total NPI
score was calculated by summing the
composite domain specific severity
ratings for the remaining nine domains.
Higher scores indicate greater overall
neuropsychiatric symptom severity.
RESULTS:
The results of the current study
show that out of 32 individuals eligible
for inclusion in the study 28
individuals completed the study. Two
refused to participate in the study and
two had no consistent reliable
caregiver.
Description of the participants:
The sample was formed of 15
females (53.6%) and 13 males (46.4%)
the mean age of individuals included in
the study was 71.3± 6.9. The MMSE
mean score was 19.4±2.3 while the
ADL mean score was 7.2±2.9 and the
IADL score was 6.7±3.5. There were
no statistically significant differences
between males and females in any of
the above mentioned parameters.
(Table 1)
Activities of daily living:
The functional level of
individuals included in the study was
measured using the ADL and the
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IADL. Description of these activities
are given in table 2 and table 3 in
which it could be seen that 85.7% of
individuals with dementia were unable
to bath without help and that 71.4%
needed help for dressing and that 75%
needed assistance in toileting and
transferring (Table2). As regards
instrumental activity of daily living it
was found that more than two thirds of
individuals with dementia (85.6%) are
unable of shopping alone and that
92.9% cannot use transportation alone,
75% cannot be responsible for their
own medications and that about one
third (32.1%) can handle financial
issues independently (table 3).
patients while delusions occurred in
17.9% of the sample followed by
aberrant motor behavior and anxiety
each occurring in 14.3% of the
individuals; finally hallucination was
found in 3 patients (10.7%) and
disinhibition in 2 patients (7.1%) . The
highest score on the NPI scale was for
depression (mean=1.2±2.6) followed
by delusions (mean=0.9±1.9), apathy
and indifference (Mean=0.79±1.3),
irritability (Mean=0.6±1.8), agitation
and aggression (Mean=0.62±1.6) and
anxiety (Mean=0.58±1.6). The total
mean INP score was 6.1±4.2 and the
total mean distress score was 1.8±1.1.
Psychological and behavioral symptoms:
The prevalence of different
psychiatric and behavioral symptoms is
given in table 4 in which it could be
seen that the total number of
individuals
with
any
neuropsychological symptoms was 24
representing 85.7% of the total sample.
The most common symptoms were
those of depression observed in 9
individuals (32.1%) followed by
apathy or indifference which was
diagnosed in 8 individuals (28.6%),
irritability was found in 21.4% of the
Correlation between different variables:
Correlation studies shows that
scores on the NPI were correlated
negatively with scores on the IADL
indicating that higher NPI score is
associated with worse instrumental
activities,
there
were
positive
correlations between scores on the NPI
and both family distress (R=0.35
P=0.01) and MMSE scores (R=0.3
P=0.05). On the other hand, scores of
the MMSE were correlated positively
with the ADL score (R=0.9 P=0.000)
and age of the patient (R=0.6
P=0.000).
Table I: Description of individuals of the study
Variable
Sex
Age
MMSE
ADL
IADL
Males= 13 (46.4%)
Mean=71.3
Mean=19.4
Mean=7.2
Mean= 6.7
Females= 15(53.6%)
SD=6.9
SD=2.3
SD=2.9
SD=3.5
19
Difference between
both sex
Chi sq=1.1 P=0.2
T=0.08
P=0.93
T=0.1
P=0.89
T=0.2
P=0.81
T=0.02
P=0.98
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Table II: Activities of Daily Living
Bathing
Dressing
Toileting
Transferring
Continence
Feeding
Without help
4(14.3%)
8(28.6%)
7(25%)
7(25%)
8(28.6%)
15(53.5%)
With some help
17 (60.7%)
15(53.5%)
17(60.7%)
16(57.1%)
17(60.7%)
10(35.7)
Unable completely
7 (25%)
5 (17.9%)
4 (14.2%)
5 (17.9%)
3 (10.7%)
3 (10.7%)
Table III: Instrumental Activities of Daily Living
Without help
8(28.6%)
Use telephone
4(14.3%)
Shopping
8(28.6%)
Food preparation
5(17.9%)
Do house work
4(14.3%)
Laundry
2(7.1%)
Transportation
7(25%)
Responsible for medications
9 (32.1%)
Handle finance
With some help Unable completely
11 (39.3%)
9 (32.1%)
9(32.1%)
15(53.5%)
7(25%)
13 (46.4%)
9(32.1%)
14 (50%)
8(28.6%)
16 (57.1%)
8 (28.6%)
18 (64.3%)
7(25%)
14 (50%)
11 (39.3%)
8 (28.6%)
Table IV: Neuropsychiatric Inventory
Delusions
Hallucinations
Agitation/aggression
Depression
Anxiety
Apathy/indifference
Irritability
Disinhibition
Aberrant motor behavior
Total individuals with any
symptom
Total INP score
Total Distress score
Number (%)
5(17.9%)
3(10.7%)
5(17.9%)
9(32.1%)
4(14.3%)
8(28.6%)
6(21.4%)
2(7.1%)
4(14.3%)
N=24 (85.7%)
Score
0.9± 1.9
0.39± 1.1
0.62± 1.6
1.2± 2.6
0.58±1.6
0.79±1.3
0.6±1.8
0.16± 0.6
0.53± 1.4
Mean= 6.1± 4.2
Mean= 1.8 ± 1.1
Table V: Correlation studies between different variables
NPI Scores
MMSE
Family
distress
ADL
R=-0.27
P=0.07
R= 0.9
P=0.000*
R=0.26
P=-0.08
IADL
R=-0.6
P=0.000*
R=0.3
P=0.05*
R=0.2
P=0.1
Family distress
R=0.35
P=0.01*
R= -0.28
P=0.07
-
20
Age
R= 0.03
P=0.8
R=0.6
P=0.000*
R=0.2
P=0.1
MMSE
R=0.3
P=0.05*
R= -0.28
P=0.07
EL-MINIA MED., BUL., VOL. 22, NO. 2, JUNE 2011
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depression as a risk factor for cognitive
deterioration28,29.
The
current
prevalence in our study of depression
is comparable to those reported in
previous studies5,21.
DISCUSSION:
In this study we tried to assess
the prevalence of psychiatric and
behavioral symptoms in a sample of
patients with dementia as well as their
effect on family distress and activities
of daily living. The NPI was the main
tool used to assess the presence of
psychiatric and behavioral symptoms
while the MMSE was used to
determine the degree of cognitive
impairment.
Apathy was the second most
common symptom in the current study
occurring in 28.6% of the population,
the reported prevalence of apathy in
different studies ranged from 17.6% to
56.7%30,31 and some studies found
apathy as the most common
psychopathology in individuals with
dementia6 but this was not the case in
our study although using the same tool,
this might be due to difference in
sampling.
Psychotic
symptoms
occurred in considerable proportion of
individuals in the current study with
delusions occurring in 17.9% of the
sample and hallucination in 10.7%,
these rates are in line with those
reported in other studies7,8. As
mentioned before the scores of NPI are
the result of multiplication of the
severity of the symptom by its
frequency, in this regard depression
showed the highest score (mean=1.4)
followed by delusions (mean=0.9);
although delusions were not the second
most common symptom its mean score
come next to depression indicating that
delusions when present is either severe
or persistent resulting in their high
mean score.
In the current study females
were slightly more represented than
males and most of the individuals were
in the moderate dementia severity as
indicated by a mean score on the
MMSE of 19.4 this findings reflect the
clinical setting of the study compared
to community studies in which females
constitute the majority of cases with
better scores on the MMSE5-21.
Activities of daily living and
instrumental activities of daily living
were significantly impaired in our
sample as indicated by scores on both
scales. Comparable results were
reported in studies using the same tools
in patients assessed in a clinical
setting22,21 where as individuals
assessed in community studies show
better scores on the same scales 23,24.
Individuals functioned better in the
basic activity of daily living than in the
more
complicated
instrumental
activities this finding was reported in
previous studies24,25.
As
regards
correlations
between different variables, scores of
the MMSE was correlated positively
with
age,
increased
cognitive
dysfunction with advancing of age is
one of the most consistent finding in
different studies32,33. In addition,
MMSE scores were correlated
significantly with ADL and less
significantly with IADL where as
scores on the NPI was correlated
negatively only with IADL. This might
indicate that more complicated skills
As regards psychiatric and
behavioral symptoms the most
common symptoms found in our
sample was that of depression
occurring in 32.1% of the sample. High
association between depression and
dementia is reported in several
studies26, 21 and some studies views
depression as a predictor of dementia
in the elderly9 while others see
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are more impaired with the occurrence
of neuropsychiatric symptoms this
might reflect increased disease severity
or that there are an underlying common
mechanism for both conditions. This
debate as whether behavioral and
psychological symptoms of dementia
are
epiphenomena
of
the
neurodegenerative process or are the
symptoms of specific, biologically
distinct subtypes of dementing
disorders is still not settled5.
negatively affect the functional ability
of the patients and causes significant
family distress. It is recommended that
such symptoms should be promptly
probed for and managed to decrease
their negative effect on the patients and
the care givers.
REFERENCES:
1American
Psychiatric
Association. (1994) Diagnostic and
statistical manual of mental disorders,
4. Ed. (DSM-IV). Washington DC:14
3-147.
2- Wimo A, Winblad B, AgueroTorres H, et al. (2003) The magnitude
of dementia occurrence in the world.
Alzheimer Dis Assoc Disord;17:63-67.
3- Morris J. (2005) Dementia
Update. Alzheimer Dis Assoc Disord;
19: 100-117.
4- Ritchie K, Lovestone S. (2002)
The dementias. Lancet;360:1759-1766.
5-Savaa GM, Mthews F, Julie E,
Brayne C (2009) Prevalence, correlates
and course of behavioral and
psychological symptoms of dementia
in the population. Br. J. of Psychiatry
194:212-219.
6-Landes AM, Sperry SD, Strauss
ME, (2005) Prevalence of Apathy,
Dysphoria, and Depression in Relation
to Dementia Severity in Alzheimer’s
Disease. J Neuropsychiatry Clin Neurosci 17:342-349
7-Scarmeas N, Brandt J, Albert M,
Dubios B (2005) Delusions and
Hallucinations Are Associated With
Worse Outcome in Alzheimer Disease.
Arch Neurol, 62(10): 1601 - 1608.
8-Ropacki SA, and Jeste DJ (2005)
Epidemiology of and Risk Factors for
Psychosis of Alzheimer’s Disease: A
Review of 55 Studies Published From
1990 to 2003 Am J Psychiatry 162:
2022-2030.
9- Van Reekum R, Simard M,
Clarke D, Binns MA, Conn D (1999)
Late-life depression as a possible
predictor of dementia: cross-sectional
As regards family distress, the
results of the current study shows that
family distress was correlated with the
scores on NPI, increased family
distress with increased psychological
and behavioral symptoms had been
reported in several studies15,16. In the
current study family distress was not
correlated with the degree of cognitive
dysfunction or functional disability,
this is contrary to results reported in
most studies conducted in western
communities23.24 and this difference
might be due to the availability of help
and care from personal nurses
available to many patients included in
the current study, while psychological
and behavioral symptoms affect
directly family members and are not
mitigated by external help leading to
increased family distress.
This study has its own
limitations most importantly is the
small sample size, the clinical
orientation of the study which might
not reflect the true extent of the
problem in the society, and the absence
of differentiation of subtypes of
dementia which would have required
more investigations to determine.
In conclusion psychological
and behavioral symptoms are very
prevalent in individuals with dementia
affecting 86% of the patients included
in the study. These symptoms
22
EL-MINIA MED., BUL., VOL. 22, NO. 2, JUNE 2011
El-Sherbini
__________________________________________________________________________________
and short-term follow-up results. Am J
Geriatr Psychiatry. (2):151-9.
10-Nygaard HA (1991) Who cares
for the caregiver? Factors exerting
influence on nursing home admissions
of demented elderly. Scand J Caring
Sci; 5:157-162
11- Aneshensel CS, Pearlin LI,
Schuler RH (1993) Stress, role
captivity, and the cessation of caregiving. J Health Soc Behav; 34: 54–70
12- Stommel M, Collins CE, Given
BA (1994) The costs of family contributions to care of persons with
dementia. Gerontologist; 34:199–205
13- Borson S, Raskind MA (1997)
Clinical features and pharmacologic
treatment of behavioral symptoms of
Alzheimer’s
disease.
Neurology;
48(Suppl 6):Sl7-S24.
14- Hamel M, Gold DP, Andres D
(1990) Predictors and consequences of
aggressive behavior by communitybased dementia patients. Gerontologist;
30:206-211.
15- Schoenmakers B, Buntinx F
and De Lepeleire J (2009) Can
pharma-cological treatment of behavioural disturbances in elderly patients
with dementia lower the burden of
their family caregiver? Family
Practice; 26: 279–286.
16- Steele C, Rovner B, Chase GA,
Folstein M (1990) Psychiatric problems and nursing home placement of
patients with Alzheimer’s disease. Am
J Psychiatry; 147:1049-1051.
17- Folstien MF, Folestein S,
McHugh PR, (1975) MINI-mental
state: a practical method for grading
the cognitive state of patients for the
clinician. J Psychiatr Res.; 12:189.
18- Katz S, Ford AB, Moskowitz
RW, Jackson BS, Jaffe MW (1963)
Studies of illness in the aged. the
Index of ADL: A Standardized
measure of biological and psychosocial
function JAMA.;185(12):914-919.
19- Lawton MP and Brody EM.
(1969) Assessment of older people:
self-maintaining and instrumental
activities of daily living. Gerontologist; 9(3):179-86.
20- Cummings JL, Mega M, Gray
K (1994) The Neuropsychiatric Inventory: Comprehensive assessment of
psychopathology in dementia. Neurology; 44:2308–2314.
21- M Ikeda, R Fukuhara, K
Shigenobu, K Hokoishi, N Maki, A
Nebu, K Komori, H Tanabe (2004)
Dementia associated mental and behavioural disturbances in elderly people
in the community: findings from the
first Nakayama study. J Neurol
Neurosurg Psychiatry; 75:146–148
22- Davis JD and Tremont G
(2007) Impact of Frontal Systems
Behavioral Functioning in Dementia
on Caregiver Burden. J Neuropsychiatry Clin Neurosci 19:43-49
23-Desai AK, Grossberg GT, Sheth
DN (2004) Activities of Daily Living
in Patients with Dementia: Clinical
Relevance, Methods of Assessment
and Effects of Treatment.CNS Drugs
18; 853-875
24- Sikkes SA, de Klerk SM,
Pijnenburg YA, Scheltens P (2009) A
systematic review of Instrumental
Activities of Daily Living scales in
dementia: room for improvement J
Neurol Neurosurg Psychiatry 80;7-12.
25- Liu K P, Chan C C, Chu M
M, Chu L, Hui F S, Yuen H K, Fisher
A G (2007) Activities of daily living
performance in dementia. Acta Neurologica Scandinavica; 116: 91-95.
26- Ballard CG, Bannister C, Solis
M (1996) The prevalence, associations
and symptoms of depression amongst
dementia sufferers. J Affect Disord;
36:135–144
27- Jason M. Stroud JM, Victoria
S, Cletus L (2008) Predictors of
depression among older adults with
dementia. Dementia; 7: 127-138
28- Forsell Y, Winblad B (1998)
Major depression in a population of
demented and nondemented older
23
‫‪EL-MINIA MED., BUL., VOL. 22, NO. 2, JUNE 2011‬‬
‫‪El-Sherbini‬‬
‫__________________________________________________________________________________‬
‫‪people: prevalence and correlates. JAm‬‬
‫‪Geriatr Soc; 46:27-30.‬‬
‫‪29- Payne JL, Lyketsos CG, Steele‬‬
‫‪C (1998) Relationship of cognitive and‬‬
‫‪functional impairment to depressive‬‬
‫‪features in Alzheimer’s disease and‬‬
‫‪other dementias. J Neuropsychiatry‬‬
‫‪Clin Neurosci. 10:440-447.‬‬
‫‪30- Rao V, Rosenberg P, Miles Q,‬‬
‫‪Patadia D, (2010) neuropsychiatric‬‬
‫‪Symptoms in Dementia Patients With‬‬
‫‪and Without a History of Traumatic‬‬
‫‪Brain Injury J Neuropsychiatry Clin‬‬
‫‪Neurosci 22:166-172‬‬
‫‪31- Cummings JL, Nadel A,‬‬
‫)‪Masterman D, Cyrus PA (2001‬‬
‫‪Efficacy of Metrifonate in Improving‬‬
‫‪the Psychiatric and Behavioral Distur‬‬‫‪bances of Patients with Alzheimer’s‬‬
‫‪disease . J Geriatr Psy-chiatry Neurol‬‬
‫‪14: 101‬‬
‫‪32- Dong MJ, Peng B, Lin XT, et‬‬
‫‪al. (2007) The prevalence of dementia‬‬
‫‪in the People's Republic of China: a‬‬
‫‪systematic analysis of 1980–2004‬‬
‫‪studies. Age & Ageing; 36:619–24.‬‬
‫‪33- Nitrini R, Caramelli P, Herrera‬‬
‫‪E, Jr, et al. (2004) Incidence of deme‬‬‫‪ntia in a community-dwelling Brazilian‬‬
‫‪population. Alzheimer Dis Assoc‬‬
‫‪Disord.; 18:241–46.‬‬
‫األعراض النفسية والسلوكية في عينة من المسنين المصابين‬
‫بمرض عته الشيخوخة‬
‫عمرو مكرم الشربيني‬
‫قسم األمراض العصبية و النفسية كلية الطب جامعة المنيا‬
‫الملخص العربي‬
‫تنتشر األعراض النفسية والسلوكية بين مرضى عته الشيخوخة وتأثر بالسلب على‬
‫المرضى كما تؤدى الى زيادة الضغط على من يقومون برعاية المريض‪ .‬الهدف من هذا البحث‬
‫هو التعرف على مدى أنتشار األعراض النفسية و السلوكية في مرضى عته الشيخوخة‬
‫والوقوف على أثر هذه األعراض على المرضى واألهل‪ .‬فى هذا البحث تم تقييم ثماني وعشرين‬
‫مريض مصابين بمرض عته الشيخوخه و قد تم تحديد وجود األعراض النفسية والسلوكية عن‬
‫طريق أستخدام جداول األعراض النقسية والسلوكية باألضافة الى أستخدام أختبار الحالة العقلية‬
‫المصغر‪ ,‬أختبار النشاطات اليومية وأختبار النشاطات اليومية األلية‪ .‬أظهرت نتائج هذه الدراسة‬
‫أن ‪ %85.7‬من العينة يعانون من أعراض نفسية وسلوكية‪ .‬كما أظهرت النتائج أن األكتئاب‬
‫كان العرض األكثر شيوعا بين المرضى حيث تم تشخيصه في ‪ %32.1‬من العينة متبوعا بعدم‬
‫األهتمام ‪ %28.6‬ثم القلق ‪ .%21.4‬وأظهرت النتائج أن معاناة األهل كانت مرتبطة يشدة‬
‫األعراض النفسية والسلوكية في حين أرتبط التدهور الوظيفي بأختبار الحالة العقلية المصغر‪ .‬و‬
‫قد خلص البحث الى أن األعراض النفسية والسلوكية واسعة األنتشار في مرضى عته الشيخوخة‬
‫و يجب تشخيص هذه األعراض ومعالجتها بشكل فعال للتقليل من أثرها السلبي‪.‬‬
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