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Assessing antipsychotic effectiveness in dementia with the factor structure of the Psychogeriatric Dependency Rating
Bryan E Adams1, Sandra L Tunis, William S Edell
1Mental Health Outcomes, Lewisville, Texas, USA.
Objective:
Behavioral and psychological symptoms of dementia (BPSD) impact patient functioning, caregiver burden, and transition to structured living environments. The purpose of this study was to use the derived factor structure of the Psychogeriatric Dependency Rating Scale (PGDRS) to retrospectively assess short-term antipsychotic effectiveness. SETTING AND MEASUREMENT: A principal components factor analysis was conducted with PGDRS admission ratings for a large national sample of hospitalized dementia patients (N = 2747). Changes in calculated factor scores (admission to discharge) were used to compare effectiveness for a subset of patients treated with one of three antipsychotic agents: haloperidol, olanzapine, or risperidone.
Results:
A four-factor solution accounted for almost 60% of rating variance. Factors were interpreted as disruptive overactivity, thought/communication disorder, interpersonal aggressiveness, and destructiveness. Medication effects (adjusting for group differences) were found for only the Interpersonal Aggressiveness factor. Improvement in this factor score was significantly greater in the olanzapine group.
Conclusions:
Findings suggest that these four PGDRS factors can provide a useful framework for symptom assessment and for targeted treatment.