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Aging Ment Health. 2004 Mar;8(2):126-32.

Escalation/de-escalation patterns of behavioral symptoms of persons with dementia.

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  • 1University of California, Los Angeles, California 90095-6919, USA.


Behavioral and psychological symptoms of dementia (BPSD) may be framed within the Needs Driven Dementia-Compromised Behavior (NBD) Model. Current literature suggests that BPSD may escalate. Several researchers have described a sequence of behavioral escalation that has a clear starting point and ending point. This 'ideal' or concatenated sequence is used to explain behavior that begins with relatively calm behavior and progresses through a prescribed sequence of behaviors that end in violence. This article presents two studies, a descriptive study and an intervention study that examine the escalation and de-escalation patterns of BPSD. Results of the descriptive study indicate a dominant pattern of agitation, aggression, and agitation while results of the intervention study, using sequential analysis indicate persistence of behavior from one 20-minute period to another. The persistence of vocalization at intensity level 2 changed from pre-intervention (mean conditional probability 29%) to post-intervention (mean conditional probability 13%). Taken together these studies shed light on the pattern of escalation and de-escalation of BPSD and suggest an intervention to alter behavior persistence. This article discusses methodological challenges of measuring the escalation and de-escalation of BPSD and offers suggestions for analysis and design such as time series and sequential analysis.

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