Evaluation of behavioral disturbance with dementia behavior disturbance (DBD) scale in the outpatients of the Medical Center for Dementia

Haruyasu Yamaguchi^1,2), Tomoko Nakajima²⁾, Haruka Uchida²⁾, Mie Matsumoto²⁾, Masakuni Amari²⁾, Masaki Ikeda³⁾, Tomoharu Yamaguchi⁴⁾, Masamitsu Takatama²⁾

¹⁾Tokyo Center for Dementia Research and Practices
²⁾Geriatrics Research Institute and Hospital
³⁾Gunma University Graduate School of Medicine
⁴⁾Department of Rehabilitation, Gunma University of Health and Welfare

Purpose:To supply appropriate and high quality medical support for demented subjects and their care givers, we analyzed the usefulness of the Dementia Behavior Disturbance (DBD) scale.
Methods:DBD scale was assessed in 69 subjects with mild cognitive impairment (MCI) and 344 subjects with dementia, who attended the Medical Center for Dementia as outpatients.  Correlation with age and cognitive function (Hasegawa dementia scale-revised;HDS-R) and difference between dementia types were analyzed.  Correlation between DBD and Neuropsychiatric Inventory (NPI) was also analyzed in 144 subjects.
Results:DBD in MCI and dementia groups were 13.1±9.5 and 21.2±13.6, respectively, showing significant high score in dementia group (ANOVA, p<0.001).  In subgroup analysis, mild dementia group (HDS-R≥17) was 16.3±11.7, mild dementia group (10≤HDS-R≤16) was 21.5±12.9 and severe dementia group (HDS-R≤9) was 30.0±14.1, showing significant increase according to disease progression (ANOVA, p<0.001).
In dementia group, DBD inversely and weakly correlated with HDS-R (r=−0.354, p<0.001, Spearman), and also correlated very weakly with age (p=0.196, p<0.001, Spearman).  Correlation between DBD and NPI was moderate (r=0.544, p<0.001, Spearman).
In subjects having one diagnosis of dementia disease (pure case), dementia with Lewy bodies group showed significant higher score than Alzheimer disease dementia group.
Positive rate of each item of DBD was compared between MCI and dementia groups.  Item “Asks the same question over and over again” showed the highest prevalence of 91 and 80% in dementia and MCI groups, respectively.  Next, item “Loses, misplaces, or hide things” showed high prevalence of 82 and 68%, respectively.  The third item “Shows lack of interest in daily activities” was 51 and 30%, respectively.  The fourth item “Sleeps excessively during the day” was 50% and 29%, respectively.  The item “Expose himself/herself indecently”, “Makes inappropriate sexual advances”, “Throw foods” and “Destroys property or clothing, brakes things” showed low prevalence of less than 2% in both MCI and dementia groups.
Conclusion:Behavioral disturbance increase according to progression of dementia.  However, it appears even in MCI stage.  DBD scale is beneficial, because caregiver describes.  Medical Center for Dementia should supply appropriate education of care methods for high−prevalence symptoms of forgetfulness and apathy, which were revealed with DBD scale, to caregivers.

Address correspondence to Dr. Haruyasu Yamaguchi, Tokyo Center for Dementia Research and Practices (1-12-1 Takaido-Nishi, Suginami-ku, Tokyo 168-0071, Japan)