Missing Data Analysis in Drug-Naive Alzheimer's Disease with Behavioral and Psychological Symptoms

PURPOSE: To clarify the effects of missing values due to behavioral and psychological symptoms in dementia (BPSD) in Alzheimer's disease (AD) patients on the neuropsychological tests, this study describes the pattern of missing values due to BPSD, and its influence on tests. MATERIALS AND METHODS: Drug-naive probable AD patients (n=127) with BPSD and without BPSD (n=32) were assessed with Seoul Neuropsychological Screening Battery including measures of memory, intelligence, and executive functioning. Moreover, patients were rated on Korean Neuropsychiatry Inventory (K-NPI). RESULTS: The more severe the K-NPI score, the less neuropsychological tests were assessable, leading to many missing values. Patients with BPSD were more severely demented than those without BPSD. K-NPI scores were significantly correlated with the number of missing values. The effect of BPSD was largest for tests measuring frontal functions. The replacement of the missing values due to BPSD by the lowest observed score also showed the largest effect on tests of frontal function. CONCLUSION: The global cognitive and behavior scales are related with missing values. Among K-NPI sub-domains, delusion, depressing, apathy, and aberrant motor behavior are significantly correlated for missing values. Data imputation of missing values due to BPSD provides a more differentiated picture of cognitive deficits in AD with BPSD.

Characteristics of Behavioral and Psychological Symptoms by Dementia Stage: Evaluated by the Korean Version of Neuropsychiatric Inventory / 신경정신의학

OBJECTIVES: This study aimed to compare the behavioral psychological symptoms of dementia by stages and to suggest the proper management treatment plan. METHODS: We examined behaviral psychological symptoms in 17 dementia patients with mild stage (CDR=0.5, 1), 18 dementia patients with moderate stage (CDR=2) and 24 dementia patients with severe stage (CDR=3, 4). We compared the prevalence and the composite scores (frequency X severity) of each behavioral domain in K-NPI among three groups. The MMSE-K, GDS, Barthel ADL were also administrated to evaluate the general cognitive function, severity of the patients and activity of daily living. RESULTS: The most common behavioral disturbances were apathy/indifference, depression/dysphoria, and aberrant motor behavior. The mean composite score of aberrant motor behavior increased by stages of dementia severity with statistical significance. The total score of the K-NPI increased with severer stages of dementia the result didn't show statistical significance. The K-NPI score showed the positive correlation with CDR, GDS and the negative correlation with MMSE-K, B-ADL. But, there was no statistically significant correlation. CONCLUSION: Behavioral and Psychological Symptoms of Dementia (BPSD) change by the stages of dementia. The practical guideline for BPSD management according to dementia stage is needed. Re-evaluation and new therapeutic inter-vention must be considered by the stages of dementia.

Characteristics of Behavioral and Psychological Symptoms by Dementia Stage: Evaluated by the Korean Version of Neuropsychiatric Inventory / 신경정신의학

OBJECTIVES: This study aimed to compare the behavioral psychological symptoms of dementia by stages and to suggest the proper management treatment plan. METHODS: We examined behaviral psychological symptoms in 17 dementia patients with mild stage (CDR=0.5, 1), 18 dementia patients with moderate stage (CDR=2) and 24 dementia patients with severe stage (CDR=3, 4). We compared the prevalence and the composite scores (frequency X severity) of each behavioral domain in K-NPI among three groups. The MMSE-K, GDS, Barthel ADL were also administrated to evaluate the general cognitive function, severity of the patients and activity of daily living. RESULTS: The most common behavioral disturbances were apathy/indifference, depression/dysphoria, and aberrant motor behavior. The mean composite score of aberrant motor behavior increased by stages of dementia severity with statistical significance. The total score of the K-NPI increased with severer stages of dementia the result didn't show statistical significance. The K-NPI score showed the positive correlation with CDR, GDS and the negative correlation with MMSE-K, B-ADL. But, there was no statistically significant correlation. CONCLUSION: Behavioral and Psychological Symptoms of Dementia (BPSD) change by the stages of dementia. The practical guideline for BPSD management according to dementia stage is needed. Re-evaluation and new therapeutic inter-vention must be considered by the stages of dementia.