Temporal Patterns of BPSD During a Multimodal Non-Pharmacological Intervention in Nursing Home and Daycare Centre Settings.

BACKGROUND

Behavioural and psychological symptoms of dementia (BPSD) fluctuate over time, yet multimodal non-pharmacological interventions (MNPIs) are usually evaluated by pre-post comparison alone. We examined BPSD trajectories during an MNPI delivered within routine care in two dementia-specialised settings.

METHODS

In this one-group pretest-posttest study, 23 nursing home residents and 14 daycare centre users with physician-confirmed dementia (Global Deterioration Scale [GDS] Stage 4 or higher) received an 8-week MNPI comprising seven care domains. Neuropsychiatric Inventory Questionnaire (NPI-Q) total severity scores (0-36) were rated at baseline and Weeks 1, 3, 4, 6, 7 and 8. Linear mixed-effects models, fitted separately by setting, adjusted for baseline NPI-Q score and GDS stage.

RESULTS

Baseline BPSD severity differed markedly between settings (nursing home 14.35 ± 7.63; daycare centre 2.86 ± 1.88). In the nursing home, time had a significant effect (p = 0.021). Adjusted mean scores fell from 11.83 at Week 1 to 7.65 at Week 3, then returned to 10.51 by Week 8 and only the Week 1-3 contrast survived Bonferroni correction. In the daycare centre, adjusted scores remained low throughout (1.67-3.53) and no temporal change was detected (p = 0.580). Instead, baseline NPI-Q score (p = 0.002) and GDS stage (p = 0.008) predicted BPSD severity.

CONCLUSIONS

BPSD trajectories differed by care setting. Change in the nursing home was real but transient, and would have been missed or misread by a single post-intervention assessment. In the daycare centre, where baseline BPSD severity was low, no change was detectable and severity was explained by individual baseline characteristics rather than by time. Participant selection, outcome measures and assessment timing should therefore be matched to the setting and the BPSD severity of the population served. Absent a control group and medication data, causal inference is precluded.