Frailty and behavioral and psychological symptoms of dementia: a single center study

Abstract Background Dementia is a devastating neurodegenerative disease widely spread, representing a huge health, social and economic burden. During the dementia time-course, Behavioral and Psychological Symptoms of Dementia (BPSD) may arise, greatly impacting on the management and outcomes of the disease. Considering that dementia mainly affects the older population, the possible link to frailty should be considered. Methods Aim of this single centre, longitudinal study was to evaluate the correlation between frailty and BPSD in a population of older patients with dementia. BPSD were classified in three clusters: “mood/apathy” (depression, apathy, sleep disturbances, appetite disturbances), “psychosis” (delusions, hallucinations and anxiety) and “hyperactivity” (agitation, elation, motor aberrant behavior, irritability, disinhibition). Using the Clinical Frailty Scale (CFS), patients were categorized as “severely frail”, “mild/moderately frail” and “robust” (CFS ≥ 7, 4–6 and ≤ 3, respectively). Results Two-hundreds and nine patients (mean age 83.24 ± 4.98 years) with a clinical diagnosis of dementia were enrolled. Among the “severely frail” the percentage of BPSD was higher compared to the other two groups in the three clusters. A positive correlation between frailty and “hyperactivity” cluster, at baseline and follow up visits (p < 0.001, p = 0.022, p = 0.028 respectively) was found. This result was confirmed with the network analysis, showing that frailty, expressed by CFS, relates to agitation and motor aberrant activity. Conclusions Frailty may help identifying patients at the highest risk for developing BPDS thus, targeting intervention in the earliest phases of the disease. In-depth studies in larger cohorts of patients are needed to confirm and extend these results.