Premorbid Personality and BPSD 5th March 2003 APS: Ageing Special Interest Group Meeting

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Premorbid Personality and BPSD 5th March
2003APS Ageing (Special Interest Group)
Meeting

• Presented by
• Wendy L. BrownM Psych Clin, BA (Hons Psych), RN.
  EM

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Overview

• Behavioural psychological problems in dementia
  (BPSD)
• Multiple causes of BPSD
• Premorbid personality BPSD
• Assessment of premorbid personality
• Validity of observer formats of measures
• Methodology
• Results
• Discussion

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BPSD

• Behavioural Symptoms
• Wandering
• Agitation (Catastrophic reactions, complaining)
• Disinhibition
• Intrusiveness
• Negativism
• Psychological Symptoms
• Delusions
• Hallucinations
• Misidentifications
• Depressed mood (apathy)
• Anxiety

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Prevalence of BPSD Recent local study by Slack
Byrne (In Press)

• Delusions - 25.5
• Hallucinations - 17
• Agitation - 46.8
• Depression - 25.5
• Anxiety - 57.4
• Euphoria - 8.5

• Apathy - 274.5
• Disinhibition - 6.4
• Lability - 29.8
• Motor behaviour - 23.4
• Sleep disturbance - 31.9
• Appetite/eating - 31.9

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Multiple Causes of BPSD

• Genetic factors (e.g., personality/ temperament
• Biological factors (e.g., cognitive physiological
  psychological)
• Learning experience (previous/current)
• Things that affect carers
• Environmental factors
• Other factors

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Research on BPSD

• Presence of BPSD adversely affects Q of L
  (Little, Molchan, Cantillon Sunderland, 1995
  Marin, Green Schmeider et al, 1997)
• Major source of stress physical emotional ill
  health in carers (Gilhooly, Sweeting, Whittick
  McKee, 1994)
• Increase caregiver burden (Burns, 2000 Hallberg
  Norberg, 1995)
• Cause low morale, burnout stress (Burgio
  Bourgeois, 1992 Hallberg Norberg, 1995)
• Can increase cost of care provided (OBrien,
  Shomphe Caro, 2000)
• Complex social psych factors implicated in
  development of BPSD (Meins, 2000)

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Model of Personality

• Eysencks Hierarchical Model (1981)
• Types (extraversion, neuroticism,
  psychoticism)(These are structural differences
  in temperament or non-cognitive domains of
  personality)
• Traits (anxious, sociable, aggressive)
• Habitual and specific responses
• Grays modification of that model
• Rotation of Eysencks two major axes
  (extraversion neuroticism) by 45 degrees -gttwo
  new axes
• anxiety (BAS) impulsivity (BIS)

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Research Premorbid Personality BPSD

• Chaterjee et al (1992) found relationships
  (N38) (Probable AD)
• high level of premorbid neuroticism current
  depression
• Premorbid hostility and current delusions
• Premorbid personality might not predispose
  patients to subsequent aberrant behaviour
  (e.g., aggression) (Swearer et al, 1996)
• Premorbid personality traits associated with
  increased risk of BPSD (Meins et al, 1998)
  (Probable AD)
• Low level of PM frustration tolerance (facet of
  N) assoc with signs symptoms of depression
• High level of PM M associated with troublesome
  behaviour

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Research (Cont.)

• Overall (in AD patients) (Meins, 2000)
• High levels of PM Neuroticism may be at increased
  risk of BPSD (Behavioural Disturb Depression)
• BPSD appears to be related to severity of
  dementing disorder
• Severe dementia
• Premorbid aggression predicted current aggression
  (Ryden et al,1988 Burns et al, 1990, Hamel et al
  1990)
• Mild-Moderate dementia
• Results mixed due to diverse measures of
  premorbid personality BPSD
• Slack Byrne (In Press) - factors related to NPI
  score Dementia duration, Age of onset N (NEO
  PI-R)

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Research Issues Hypothesis

• Measurement of premorbid personality
• Reliability and validity of observer formats of
  two personality measures
• NEO FFI - strong support for observer form (Foltz
  et al, 1997)
• BIS-BAS - untested in observer form
• Hypothesis - high levels of agreement between
  self and informant reports for NEO FFI BIS-BAS
  across series of statistical analyses

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Methods Study 1

• Participants
• 54 healthy ageing participants (and their
  research partners) from existing pool currently
  involved in other UQ studies
• 8 members of a local service club (and their
  research partners)
• Measures
• Demographics
• NEO FFI - 60 item informant rated scale
• NEO FFI - Observer form
• BIS-BAS - 24 item informant rated scale
• BIS-BAS - Observer form

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Procedure

• Information,
• Informed consent,
• Completion of questionnaires (2 Forms - one for
  self, one for partner)
• Demographics (Re Self Self report)
• NEO FFI BIS BAS (Re Self Self report)
• NEO FFI BIS BAS (Re Partner Informant version)

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Analyses

• Demographics
• For NEO FFI BIS-BAS
• Internal consistency of self observer rating
• Factor structure of each
• Agreement of self observer ratings
• Pearson Correlations
• Lins concordance correlation coefficient
• Profile correlations (across 5 personality scales
  BIS BAS scales
• Coefficient of Profile Agreement (McRaes)

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Results Discussion

• Presented in terms of the level of agreement
  found between self observer forms of these
  instruments