INTRODUCTION: Behavioral and psychological symptoms in dementia (BPSD) are highly prevalent in patients with Alzheimer's dementia (AD). We examined sex differences in the frequency and severity of BPSD in patients with AD living in long-term care homes or admitted to inpatient psychiatric units.
METHODS: Data were obtained from the Standardizing Care for Neuropsychiatric Symptoms and Quality of Life in Dementia (StaN) study (ClinicalTrials.gov/NCT03672201). BPSD were assessed using the Neuropsychiatric Inventory-Clinician rating scale (NPI-C), and symptom clusters were clustered as follows: (1) psychosis (hallucinations and delusions), (2) emotional distress cluster A (depression and anxiety), (3) emotional distress cluster B (depression, anxiety, and apathy), and (4) agitation (agitation, aggression, irritability, aberrant motor behavior, and aberrant vocalizations). Sex differences in frequency and severity of individual BPSD and clusters were compared using chi-square and Mann-Whitney U tests and generalized linear models while controlling for age and place of residence.
RESULTS: Females had higher frequency (males = 21.7% vs. females = 42.9%, χ2 = 8.83, N = 174, p = 0.003) and greater severity of delusions (mean [SD] males = 51.87 [44.15], mean [SD] females = 67.93 [70.53], U = 2,924, N = 174, p = 0.002). Males had higher frequency (males = 51.8% vs. females = 27.5%, χ2 = 10.80, N = 174, p = 0.001) and greater severity of sleep disorders (mean [SD] males = 2.94 [4.21], mean [SD] females = 1.76 [3.92], U = 2,885.50, N = 174, p = 0.002). After controlling for age and residence, sex differences remained significant for delusions (Wald χ2 = 3.97, N = 176, p = 0.046), but not for sleep disorders. There were no sex differences in the frequency or severity of any BPSD clusters.
CONCLUSIONS: We observed sex differences in the frequency and severity of specific BPSD. Future studies should aim to understand potential mechanisms underlying these differences and to study their relevance in screening, and for individualized sex-specific management of BPSD.