Journal of Gerontological Nursing

Feature Article Supplemental Data

Exploring the Relationship Between Premorbid Personality and Dementia-Related Behaviors

Susan Zielin, BA (Hons); Marita McCabe, PhD, FAPS

Abstract

The purpose of the current study was to investigate whether premorbid personality traits (i.e., neuroticism, extroversion, openness, agreeableness, and conscientiousness) can predict behavioral and psychological symptoms of dementia (BPSD). In particular, agitation-related behaviors were examined. The current study used convenience sampling from 14 residential care facilities in Melbourne, Australia. Demographic and health data, cognitive ability, BPSD, and premorbid personality characteristics were collected from 62 female and 27 male older adults. Close informants of participants were asked to provide premorbid personality data (i.e., before the development of dementia) using the NEO-Five-Factor Inventory. Residential care staff used the Cohen-Mansfield Agitation Inventory to rate agitation-related behaviors over a 2-week period. Correlational analyses revealed associations between premorbid agreeableness and verbally nonaggressive behaviors, and between premorbid conscientiousness and verbally nonaggressive behaviors. Although the findings provide some support that premorbid personality shapes problematic behaviors exhibited in dementia, they are inconsistent with previous research and the hypotheses were generally not supported. [Journal of Gerontological Nursing, 42(1), 40–48.]

Abstract

The purpose of the current study was to investigate whether premorbid personality traits (i.e., neuroticism, extroversion, openness, agreeableness, and conscientiousness) can predict behavioral and psychological symptoms of dementia (BPSD). In particular, agitation-related behaviors were examined. The current study used convenience sampling from 14 residential care facilities in Melbourne, Australia. Demographic and health data, cognitive ability, BPSD, and premorbid personality characteristics were collected from 62 female and 27 male older adults. Close informants of participants were asked to provide premorbid personality data (i.e., before the development of dementia) using the NEO-Five-Factor Inventory. Residential care staff used the Cohen-Mansfield Agitation Inventory to rate agitation-related behaviors over a 2-week period. Correlational analyses revealed associations between premorbid agreeableness and verbally nonaggressive behaviors, and between premorbid conscientiousness and verbally nonaggressive behaviors. Although the findings provide some support that premorbid personality shapes problematic behaviors exhibited in dementia, they are inconsistent with previous research and the hypotheses were generally not supported. [Journal of Gerontological Nursing, 42(1), 40–48.]

Behavioral and psychological symptoms of dementia (BPSD), such as wandering, screaming, aggression, sleep disturbances, and sexual disinhibition, are a major cause of caregiver burden and the most important factor when considering the need for institutionalization of older adults with dementia (Cohen-Mansfield, 2000; Tampi et al., 2011). Prevalence numbers of BPSD are high and vary among studies. Tampi et al. (2011) reported BPSD are present in one third of patients with dementia residing in the community and increases to approximately 80% in those residing in care facilities. These challenging behaviors are emotionally taxing on caregivers and loved ones. BPSD can also cause caregivers embarrassment, stress, and anxiety (Cohen-Mansfield, 2009). BPSD are not constant and generally fluctuate over time (Savva et al., 2009). Although extensively studied, the cause of BPSD is not entirely known. Researchers are unsure whether BPSD are symptoms of specific biological changes that occur within dementia or if they occur separately from the neurodegenerative process (Savva et al., 2009). The current study focused on agitation-related behaviors as identified by Cohen-Mansfield (2000). Agitation is illustrated by inappropriate verbal, vocal, or motor activity that cannot otherwise be explained (Cohen-Mansfield & Billig, 1986). Cohen-Mansfield (2000) divided agitation-related behaviors into four categories: (a) physically aggressive behaviors, (b) physically nonaggressive behaviors, (c) verbally aggressive behaviors, and (d) verbally nonaggressive behaviors. The Figure summarizes the behaviors associated with each category.

Behavioral and psychological symptoms of dementia behavior categories as defined by and adapted from Cohen-Mansfield (2000).

Figure.

Behavioral and psychological symptoms of dementia behavior categories as defined by and adapted from Cohen-Mansfield (2000).

Over the past decade, premorbid personality traits have become increasingly more important in assessing the vulnerability of BPSD in patients with dementia (Meins, Frey, & Theisemann, 1998; Osborne, Simpson, & Stokes, 2010). Premorbid personality, in this context, refers to one's personality prior to the onset of illness or disease. Research into personality has established that personality traits are consistent and remain stable over time during normal aging (Chatterjee, Strauss, Smyth, & Whitehouse, 1992). However, conflicting research suggests personality changes throughout adulthood (Lucas & Donnellan, 2011; Soto, John, Gosling, & Potter, 2011). A prominent view is that personality changes are due to changes in the psychological process (Roberts, Donnellan, & Hill, 2013) and that changes in personality may indicate an early sign of dementia (Cipriani, Borin, Del Debbio, & Di Fiorino, 2015). Given that previous research suggests one's personality may influence dementia-related behaviors (Osborne et al., 2010), premorbid personality may be an important predictor of such behaviors. The trait approach to the study of personality is the most frequently adopted to assess premorbid personality and BPSD. As such, for the purpose of the current study, the Five-Factor Model (FFM; Costa & McCrae, 1992) of personality was used. The FFM of personality uses the Big Five personality factors (i.e., extroversion, neuroticism, agreeableness, conscientiousness, and openness to experience [Paunonen, 2003]) to explain personality-based variations in behavior. Table 1 illustrates the characteristics of each personality domain. As compared to their premorbid personality, patients with dementia have been found to have an increase in neuroticism and a decrease in extraversion, openness, agreeableness, and conscientiousness (Kolanowski, Strand, & Whall, 1997). Although BPSD behaviors are well-documented, research analyzing the association between premorbid personality and BPSD is inconclusive. Osborne et al.'s (2010) systematic review of the available literature illustrates that multiple studies have examined the link between premorbid personality and dementia-related behaviors. Although 72% of the reviewed studies found significant relationships between premorbid personality and challenging behaviors, many had several limitations, including small sample sizes and failing to control for confounding variables (Osborne et al., 2010). Knowledge of personality traits and behavior may provide early identification of individuals at risk of experiencing BPSD and may assist in designing effective interventions to address these challenging behaviors.

Characteristics of Each Personality Domain of the Five-Factor Model

Table 1:

Characteristics of Each Personality Domain of the Five-Factor Model

Although some studies suggest premorbid personality is related to BPSD (Archer et al., 2006; Kolanowski et al., 1997; Kolanowski & Litaker, 2006; Low, Brodaty, & Draper, 2002; Song & Algase, 2008; Thomas, 1997), others suggest no significant relationship exists (Clark, Bosworth, Welsh-Bohmer, Dawson, & Siegler, 2000; Kolanowski & Garr, 1999; Lebert, Pasquie, & Petit, 1995; Swearer, Hoople, Kane, & Drachman, 1996). Although the majority of these studies used validated measures to assess personality traits and dementia-related behaviors, they used different behavior observation inventories, personality inventories, and definitions for type of behavior. As such, the reliability of these studies could be compromised and may be the cause of inconsistency in results.

The current study aimed to overcome inconsistency among past research by using reliable personality and behavior measures to assist developing consistency in assessing the relationship between premorbid personality and agitation-related behaviors (as measured by the NEO-Five-Factor Inventory [NEO-FFI; Costa & McCrae, 1992] and Cohen-Mansfield Agitation Inventory [CMAI; Cohen-Mansfield, 1991]). By using reliable measures, internal validity remains strong (Osborne et al., 2010). Premorbid personality was informant-based (i.e., completed by guardians/next of kin), whereas the behavior inventory was completed by residential care staff. Guardians/next of kin may have been hindered by patients' current behavior and may rate them more negatively on a behavior scale (Osborne et al., 2010); thus, having staff complete the behavior inventory may eliminate such bias. Further, the current study analyzed how agitation-related behaviors are related to all five personality trait factors while attempting to control for confounding variables.

The current authors hypothesized:

  • Neuroticism will be positively associated with physically aggressive, physically nonaggressive, verbally aggressive, and verbally nonaggressive behaviors;
  • Extraversion will be negatively associated with physically aggressive, physically nonaggressive, verbally aggressive, and verbally nonaggressive behaviors;
  • Agreeableness will be negatively associated with physically aggressive and verbally aggressive behaviors, and positively associated with physically nonaggressive behaviors; and
  • There will be no association between openness and conscientiousness and agitation-related behaviors.

Method

Design

The current study used a cross-sectional design. The independent variable was premorbid personality and the dependent variable was agitation-related behaviors.

Participants

Individuals With Dementia. A total of 89 participants diagnosed with dementia (as per criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders [American Psychiatric Association, 2013]), ranging in age from 74 to 100 (mean = 88.08 years; SD = 5.88 years), were recruited from 14 residential care facilities in Melbourne, Australia. The sample comprised 27 males (mean age = 85.7 years; SD = 6.63 years) and 62 females (mean age = 89.11 years; SD = 5.25 years).

Participants' sociodemographic and health data were collected from a review of patient files. Data collected included age, gender, past or current psychological disorders, type of dementia, current medications, and level of cognitive impairment. Level of cognitive impairment was measured using the Mini-Mental State Examination (Folstein, Folstein, & McHugh, 1975) and Psychogeriatric Assessment Scale (Jorm et al., 1995).

Informants. A total of 88 informants were recruited to provide premorbid personality data for individuals with dementia. One informant provided personality data for two individuals with dementia.

Cohen-Mansfield Agitation Inventory Raters. Residential care staff (n = 42) were also recruited to complete the CMAI questionnaire for individuals with dementia.

Measures

The CMAI questionnaire was completed by staff at the residential facility to identify agitation-related behaviors and comprised 29 agitated behaviors, each rated on a 7-point scale of frequency ranging from 1 = never to 7 = several times per hour. Interrater agreement averaged 0.92 (Cohen-Mansfield, 1991), providing evidence that the CMAI is a reliable measure. Residential care staff completed a training program to better manage BPSD. Training involved learning how to administer the CMAI questionnaire. CMAI data were collected retrospectively at one time point. Staff were asked to think of the past 2-week period and rate the frequency with which participants manifested physically aggressive, physically nonaggressive, verbally aggressive, and verbally nonaggressive behaviors. Scores were calculated by finding the mean frequency for each of the four subscales. The higher the score, the more frequent the problematic behavior occurred.

Premorbid personality was measured using the NEO-FFI. The NEO-FFI is a 60-item, Likert-type self-report form. This version was adapted for informants. A willing informant, preferably a spouse or child, was recruited to provide premorbid personality data for an individual with dementia. Informants providing retrospective personality reports were required to be able to speak English and identified as the participant's next of kin for consent purposes. Informants were excluded if they believed they would not be able to complete the report accurately. The NEO-FFI provides a comprehensive assessment of adult personality in five domains: neuroticism, extraversion, openness, agreeableness, and conscientiousness. There are 12 items on each domain and each is scored on a scale from 0 = strongly disagree to 4 = strongly agree (Archer et al., 2006). Informants' relationships to primary participants included son (n = 26), daughter (n = 41), wife (n = 10), husband (n = 2), grandson (n = 1), granddaughter (n = 1), nephew (n = 2), niece (n = 2), son-in-law (n = 2), daughter-in-law (n = 1), and sister (n = 1). Informants were asked to think of participants as they were prior to the onset of dementia. The NEO-FFI is a validated personality measure for self- and informant-based report (Costa & McCrae, 1992; Strauss & Pasupathi, 1994). Scores range from 25 to 75 for each domain. Higher scores indicate higher ranks in the domain.

Procedure

Ethics approval was obtained from the University Human Research Ethics Committee. The residential manager (or similar position) at each facility contacted responsible parties of potential participants and received permission to release contact information to the Deakin University research team. A total of 118 potential participants were approached, with 89 providing consent. The researcher (S.Z.) read the Plain Language Statement and consent form to participants over the phone and verbal consent was obtained. Upon verbal consent being provided, the researcher asked informants to think about the individual with dementia prior to the onset of dementia when answering each question. Informants were then asked to provide a response of whether they strongly disagreed, disagreed, were neutral, agreed, or strongly agreed with each statement. Statements were read by the researcher and answers were noted on the NEO-FFI answer sheet. A file review was then performed to obtain demographic data, medical history, and level of cognitive functioning. If the resident met all eligibility requirements, residential care facility staff were then asked to complete the CMAI questionnaire, rating participants' problematic behavior over a 2-week period.

Data Analysis

Scores on each personality domain were converted to gender-appropriate T scores as per the NEO-FFI manual (Costa & McCrae, 1992). Data were analyzed using SPSS Statistics version 20. Pearson correlations were computed to assess the hypothesized relationship between premorbid personality (as measured by the NEO-FFI) and problematic behaviors (as measured by the CMAI). Multiple regression analyses were computed to further assess the relationships. The four agitation-related behavior groups (i.e., verbally aggressive, verbally nonaggressive, physically aggressive, and physically nonaggressive) were the dependent variables and the six independent variables included years with dementia, neuroticism, extraversion, openness, agreeableness, and conscientiousness.

Results

Descriptive statistics for the study variables are listed in Table 2. Initially, the relationship between premorbid personality (as measured by the NEO-FFI) and agitation-related behaviors (as measured by the CMAI) was investigated using Pearson's product–moment correlation coefficients.

Participant Characteristics (N = 89)

Table 2:

Participant Characteristics (N = 89)

There was a weak negative correlation between agreeableness and verbally nonaggressive behaviors (r = −0.28, p < 0.01), suggesting participants who scored low on agreeableness exhibited more verbally nonaggressive behavior. There were also weak negative correlations between conscientiousness and verbally aggressive behaviors (r = −0.23, p < 0.05) and verbally nonaggressive behaviors (r = −0.21, p < 0.05), suggesting participants who scored low on conscientiousness exhibited more verbally aggressive and verbally nonaggressive behaviors (Table A, available in the online version of this article). These results were not consistent with the predicted hypotheses.

Correlation Matrix

Table A:

Correlation Matrix

Two demographic variables also produced significant correlations. Years with dementia produced a weak negative correlation with neuroticism (r = −0.27, p < 0.05), physically nonaggressive behavior (r = 0.22, p < 0.05), and physically aggressive behavior (r = 0.28, p < 0.01). There was also a weak negative correlation with past/current psychological disorder and physically nonaggressive behavior (r = −0.24, p < 0.05) (Table A).

Four separate multiple regression analyses were conducted with scores on the four CMAI subscales as the dependent variable. Years with dementia and the five NEO-FFI domains were the independent variables. None of the independent variables were significant predictors of physically nonaggressive behavior (F = 1.37, R2 = 0.09, p > 0.05), physically aggressive behavior (F = 1.8, R2 = 0.12, p > 0.05), and verbally nonaggressive behavior (F = 2.20, R2 = 0.14, p > 0.05). For verbally aggressive behavior (F = 2.38, R2 = 0.15, p < 0.05), there was a significant association with conscientiousness (β = −0.25, p < 0.05), indicating individuals who scored low on conscientiousness were more likely to exhibit more verbally aggressive behavior. Further, there was a significant association with years with dementia (β = −0.27, p < 0.05), indicating the older an individual is, the more likely he/she is to exhibit verbally aggressive behaviors. Results for the regression analysis are detailed in Table 3.

Variables Predicting Verbally Aggressive Behavior

Table 3:

Variables Predicting Verbally Aggressive Behavior

Discussion

The current study aimed to investigate the potential role of premorbid personality and problematic behaviors associated with the progression of dementia. None of the hypotheses were supported.

Problematic Physical Behaviors

From the results of previous research, it was expected that (a) neuroticism would be positively associated with physically aggressive and physically nonaggressive behaviors; (b) extraversion would be negatively associated with physically aggressive and physically nonaggressive behaviors; and (c) agreeableness would be negatively associated with physically aggressive behaviors and positively associated with physically nonaggressive behaviors. The current study found that none of the premorbid personality characteristics were related to physically aggressive and nonaggressive behaviors. These results are surprising, as there is a body of evidence suggesting significant associations between these factors (Archer et al., 2006; Holst, Hallberg, & Gustafson, 1997; Kolanowski et al., 1997; Low et al., 2002; Song & Algase, 2008; Thomas, 1997). Results from the current study may be attributed to the low levels of reported physically aggressive behaviors. Given the age of participants (mean = 88 years) in the current study, it would be expected that they have comorbid physical disabilities that may inhibit them from physically expressing problematic behaviors (Desai & Grossberg, 2001). Studies that have found support for the association between personality and physically aggressive behaviors have had participants with a mean age ranging from 77 to 83 (Archer et al., 2006; Holst et al., 1997; Kolanowski et al., 1997; Low et al., 2002; Song & Algase, 2008; Thomas, 1997), which may support the suggestion of a higher rate of comorbid physical disabilities among the current study's cohort.

Problematic Verbal Behaviors

Based on previous research, it was expected that (a) neuroticism would be positively associated with verbally aggressive and nonaggressive behaviors; (b) extraversion would be negatively associated with verbally aggressive and nonaggressive behaviors; (c) agreeableness would be negatively associated with verbally aggressive behaviors; and (d) there would be no association between openness and conscientiousness and agitation-related behaviors. The current study found that there were no associations between neuroticism, extraversion and agreeableness, and verbally aggressive and verbally nonaggressive behaviors.

However, there was an association between low premorbid conscientiousness and high levels of verbally aggressive behavior. The verbally aggressive behavior subscale measures cursing, making strange noises, verbal sexual advances, and screaming. The conscientiousness personality domain measures one's ability to be organized, reliable, careful, and perform tasks well. Based on personality domains, the results indicate that individuals displaying disinhibiting aggressive verbal behavior are those who were not dependable or organized prior to the onset of dementia. As research into the needs-driven, dementia-compromised behavior model suggests, exhibiting such behaviors may be a way of communicating individuals' needs (Cohen-Mansfield, Dakheel-Ali, Marx, Thein, & Regier, 2015; Kovach, Noonan, Schlidt, & Wells, 2005). As individuals may be unable to express these needs physically due to comorbid physical disabilities, they are more likely to express unmet needs verbally. Prior to the onset of dementia, these individuals lacked order in their lives and were less planned in the way they did things. As such, they may not have a strategy to meet their needs and may not know how to address such needs. These individuals become frustrated and display disinhibiting problematic verbal behaviors as a form of communication (Cohen-Mansfield, 2000).

In addition, correlational analyses produced significant associations between low premorbid agreeableness and verbally nonaggressive behaviors, and between low premorbid conscientiousness and verbally aggressive and verbally nonaggressive behaviors. The verbally nonaggressive subscale measures the frequency of complaining, negativism, repetitious words and sentences, and unwanted requests for attention. The agreeableness personality domain measures one's level of altruism. The results indicate individuals who were more argumentative and less likely to cooperate prior to the onset of dementia were more likely to be negative, complain, and display attention-seeking behavior. Individuals who were less likely to be organized and dependable and more likely to be argumentative prior to the onset of dementia were more likely to yell and scream and make strange noises. These individuals are more stubborn and uncooperative and like to do things their own way. As dementia progresses, these individuals no longer have complete control over their own lives and are frustrated and exhibit problematic verbal behaviors as a way of communicating frustration. When placed in a regression analysis, these results were not produced.

Results indicated individuals with low premorbid personality traits of conscientiousness and agreeableness primarily exhibited verbal agitation-related behaviors. In terms of the agreeableness personality trait, individuals who were more argumentative prior to the onset of dementia were likely to be more verbally aggressive, which is problematic in terms of BPSD. In terms of the conscientious personality trait, individuals who were frustrated due to not being able to communicate their needs expressed unmet needs in inappropriate, difficult ways. Further, older adults with chronic physical illnesses were more likely to exhibit problematic verbal behaviors than problematic physical behaviors (Desai & Grossberg, 2001).

Surprisingly, there were no associations between neuroticism and extraversion and agitation-related behaviors. Neuroticism refers to one's level of emotional stability. Low scores indicated an individual being more relaxed and even-tempered, whereas high scores indicated he/she is more susceptible to experiencing negative emotions, such as guilt and anger. Extraversion refers to one's level of sociability and assertiveness. Low scores indicated an individual is more reserved and may prefer to be alone, whereas high scores indicated he/she is more talkative and seeks social situations. As such, one would think that patients with dementia with high premorbid scores on neuroticism and extraversion would display some form of problematic behavior to fulfill or communicate unmet needs, such as social isolation and under-stimulation, as suggested by other research (Holst et al., 1997; Kolanowski et al., 1997; Song & Algase, 2008; Thomas, 1997).

Carers need to be aware of individual personality characteristics and cannot manage each patient in the same ways. Some patients may find it easier to communicate their needs whereas others may become frustrated and angry and express themselves in inappropriate ways.

Implications

Although limited, there is some indication that associations between premorbid personality characteristics and problematic behaviors exist in dementia. Caregivers need to be aware of why problematic behaviors occur when interpreting these behaviors, and may also need to consider other factors as to why individuals with dementia behave the way they do (e.g., environmental triggers, complexities of tasks, pain management). Difficulty in caring for an individual displaying problematic behavior is often why informal caregivers place their loved ones in residential care facilities. Knowledge of how personality plays a role in the exhibition of problematic behaviors may help health care professionals design and implement activities that take into consideration a patient's personality, which in turn may reduce problematic behaviors, increase work satisfaction, and decrease staff burnout. As such, throughout the intake process, residential care staff should consider exploring premorbid personality factors with patients' families to develop a more person-centered approach to care and management.

An alternate explanation for these results is that there may not be a strong association between premorbid personality and problematic behaviors that would be consistent with other research (Clark et al., 2000; Kolanowski & Garr, 1999; Lebert et al., 1995; Swearer et al., 1996).

Limitations

A limitation of the current study is the relatively small sample. Given the small selective sample, results are not generalizable to a wider population. Another limitation is that premorbid personality data were retrospective and provided by a proxy. As such, data may be erroneous and not an accurate representation of participants. This inaccuracy may be due to informants' possible altered memories of their family members, an inability to remember detailed information, or that they may not have known the true personality of their family members. Although proxies were participants' next of kin, they may not necessarily have been those most familiar with participants. Next of kin were used as participants because they were able to provide consent for individuals with dementia. A further limitation is that there were no significant predictors for three of four regression models. This may have been due to the relatively small sample as well as there being a limited range and variability of problematic behaviors across all four categories, as illustrated by the means of each CMAI subscale. A limited range and variability within the CMAI subscales may be due to a number of factors. First, reporting of problematic behaviors should be examined. Many nurses were rating multiple residents and it may be difficult to keep track of behaviors. In addition, staff were busy at residential facilities and may have rushed through questions. In a broader context, definitions of CMAI behaviors may not be consistent across each staff member. Interpretation of problematic behaviors is relatively subjective. Although one staff member may determine a particular behavior to be problematic, it may not be a problem for another staff member. Further, interrater reliability measures were not completed for the current study, which may have impacted data as behavior scores were low across all subscales. Clearer definitions of CMAI behaviors may be needed.

Future Research

Problematic behaviors in dementia cause high caregiver stress and burnout for care staff at residential facilities. Examining the possible relationship between premorbid personality and problematic behaviors in dementia may assist caregivers in managing such behaviors and decreasing burnout. Further research is needed to clarify the association between premorbid personality and problematic behaviors. It is recommended that future research examine whether personality profiles are related to different types of BPSD. The sample size in the current study did not allow establishing how the different dimensions of personality might cluster to form different personality profiles. Future research should encompass not only agitation-related behaviors but also passive behaviors, such as apathy, to develop a clearer understanding of BPSD as a whole.

Conclusion

The current study provides some support that premorbid personality may affect problematic behaviors associated with dementia. However, low levels of problematic behavior, lack of variance in variables, and reliance on others for reports of premorbid personality and problematic behaviors may have affected results. Clarification of the association between premorbid personality and BPSD requires further research to establish whether conducting personality assessments as part of the nursing process can equip nurses to develop more effective treatment programs and provide better person-centered care to individuals with dementia. This clarification may create a better quality of life for individuals with dementia and reduce burnout for care staff.

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
  • Archer, N., Brown, R., Boothby, H., Foy, C., Nicolas, H. & Lovestone, S. (2006). The NEO-FFI is a reliable measure of premorbid personality in patients with probable Alzheimer's disease. International Journal of Geriatric Psychiatry, 21, 477–484. doi:10.1002/gps.1499 [CrossRef]
  • Chatterjee, A., Strauss, M.E., Smyth, K.A. & Whitehouse, P.J. (1992). Personality changes in Alzheimer's disease. Archives of Neurology, 49, 486–491. doi:10.1001/archneur.1992.00530290070014 [CrossRef]
  • Cipriani, G., Borin, G., Del Debbio, A. & Di Fiorino, M. (2015). Personality and dementia. Journal of Nervous and Mental Disorders, 203, 210–214. doi:10.1097/NMD.0000000000000264 [CrossRef]
  • Clark, L.M., Bosworth, H.B., Welsh-Bohmer, K.A., Dawson, D.V. & Siegler, I.C. (2000). Relation between informant-rated personality and clinician-rated depression in patients with memory disorders. Neuropsychiatry, Neuropsychology and Behavioral Neurology, 1, 39–47.
  • Cohen-Mansfield, J. (1991). Instruction manual for the Cohen-Mansfield Agitation Inventory (CMAI). Retrieved from http://www.dementia-assessment.com.au/symptoms/CMAI_Manual.pdf
  • Cohen-Mansfield, J. (2000). Theoretical frameworks of behavioral problems in dementia. Alzheimer's Care Quarterly, 1, 8–12.
  • Cohen-Mansfield, J. (2009). Agitated behavior in persons with dementia: The relationship between type of behavior, its frequency, and its disruptiveness. Journal of Psychiatric Research, 43, 64–69. doi:10.1016/j.jpsychires.2008.02.003 [CrossRef]
  • Cohen-Mansfield, J. & Billig, N. (1986). Agitated behaviors in the elderly: A conceptual review. Journal of the American Geriatrics Society, 44, 77–84.
  • Cohen-Mansfield, J., Dakheel-Ali, M., Marx, M.S., Thein, K. & Regier, N.G. (2015). Which unmet needs contribute to behavior problems in persons with advanced dementia?Psychiatry Research, 228, 59–64. doi:10.1016/j.psychres.2015.03.043 [CrossRef]
  • Costa, P.T. & McCrae, R.R. (1992). Revised NEO personality inventory (NEO-PI-R) and NEO Five-Factor inventory (NEO-FFI): Professional manual. Odessa, FL: Psychological Assessment Resources.
  • Desai, A.K. & Grossberg, G.T. (2001). Recognition and management of behavioral disturbances in dementia. Primary Care Companion to the Journal of Clinical Psychiatry, 3, 93–109. doi:10.4088/PCC.v03n0301 [CrossRef]
  • Folstein, M.F., Folstein, S.E. & McHugh, P.R. (1975). “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198. doi:10.1016/0022-3956(75)90026-6 [CrossRef]
  • Holst, G., Hallberg, I.R. & Gustafson, L. (1997). The relationship of vocally disruptive behavior and personality in severely demented institutionalized patients. Archives of Psychiatric Nursing, 11, 147–154. doi:10.1016/S0883-9417(97)80038-6 [CrossRef]
  • Jorm, A.F., Mackinnon, A.J., Henderson, A.S., Scott, R., Christensen, H., Korten, A.E. & Mulligan, R. (1995). The Psychogeriatric Assessment Scales: A multidimensional alternative to categorical diagnosis of dementia and depression in the elderly. Psychological Medicine, 25, 447–460. doi:10.1017/S0033291700033377 [CrossRef]
  • Kolanowski, A.M. & Garr, M. (1999). The relation of premorbid factors to aggressive physical behavior in dementia. Journal of Neuroscience Nursing, 31, 278–284. doi:10.1097/01376517-199910000-00004 [CrossRef]
  • Kolanowski, A.M. & Litaker, M. (2006). Social interaction, premorbid personality, and agitation in nursing home residents with dementia. Archives of Psychiatric Nursing, 20, 12–20. doi:10.1016/j.apnu.2005.08.006 [CrossRef]
  • Kolanowski, A.M., Strand, G. & Whall, A. (1997). A pilot study of the relation of premorbid characteristics to behavior in dementia. Journal of Gerontological Nursing, 23(2), 21–30. doi:10.3928/0098-9134-19970201-08 [CrossRef]
  • Kovach, C.R., Noonan, P.E., Schlidt, A.M. & Wells, T. (2005). A model of consequences of need-driven, dementia-compromised behavior. Journal of Nursing Scholarship, 37, 134–140. doi:10.1111/j.1547-5069.2005.00025_1.x [CrossRef]
  • Lebert, F., Pasquie, F. & Petit, H. (1995). Personality traits and frontal lobe dementia. International Journal of Geriatric Psychiatry, 10, 1047–1049. doi:10.1002/gps.930101209 [CrossRef]
  • Low, L.F., Brodaty, H. & Draper, B. (2002). A study of premorbid personality and behavioral and psychological symptoms of dementia in nursing home residents. International Journal of Geriatric Psychiatry, 17, 779–783. doi:10.1002/gps.697 [CrossRef]
  • Lucas, R.E. & Donnellan, M.B. (2011). Personality development across the life span: Longitudinal analyses with a national sample from Germany. Journal of Personality and Social Psychology, 101, 847–861. doi:10.1037/a0024298 [CrossRef]
  • Meins, W., Frey, A. & Thiesemann, R. (1998). Premorbid personality traits in Alzheimer's disease: Do they predispose to noncognitive behavior symptoms?International Psychogeriatrics, 10, 369–378. doi:10.1017/S1041610298005468 [CrossRef]
  • Osborne, H., Simpson, J. & Stokes, G. (2010). The relationship between premorbid personality and challenging behavior in people with dementia: A systematic review. Aging and Mental Health, 14, 503–515. doi:10.1080/13607861003713208 [CrossRef]
  • Paunonen, S.V. (2003). Big five factors of personality and replicated predictions of behavior. Journal of Personality and Social Psychology, 84, 411–424. doi:10.1037/0022-3514.84.2.411 [CrossRef]
  • Roberts, B.W., Donnellan, M.B. & Hill, P.L. (2013). Personality trait development in adulthood. In Tennen, H., Suls, J. & Weiner, I.B. (Eds.), Handbook of psychology, personality and social psychology: Volume 5 (2nd ed.) (pp. 183–196). Hoboken, NJ: John Wiley & Sons.
  • Savva, G.M., Zaccai, J., Matthews, F.E., Davidson, J.E., McKeith, I. & Brayne, C. (2009). Prevalence, correlates and course of behavioral and psychological symptoms of dementia in the population. British Journal of Psychiatry, 194, 212–219. doi:10.1192/bjp.bp.108.049619 [CrossRef]
  • Song, J. & Algase, D. (2008). Premorbid characteristics and wandering behavior in persons with dementia. Archives of Psychiatric Nursing, 22, 318–327. doi:10.1016/j.apnu.2007.10.008 [CrossRef]
  • Soto, C.J., John, O.P., Gosling, S.D. & Potter, J. (2011). Age differences in personality traits from 10 to 65: Big Five domains and facets in a large cross-sectional sample. Journal of Personality and Social Psychology, 100, 330–348. doi:10.1037/a0021717 [CrossRef]
  • Strauss, M.E. & Pasupathi, M. (1994). Primary caregivers' descriptions of Alzheimer's patients' personality traits: Temporal stability and sensitivity to change. Alzheimer's Disease and Associated Disorders, 8, 166–176. doi:10.1097/00002093-199408030-00003 [CrossRef]
  • Swearer, J.M., Hoople, N.E., Kane, K.J. & Drachman, D.A. (1996). Predicting aberrant behavior in Alzheimer's disease. Neuropsychiatry, Neuropsychology and Behavioral Neurology, 9, 162–170.
  • Tampi, R.R., Williamson, D., Muralee, S., Mittal, V., McEnerney, N., Thomas, J. & Cash, M. (2011). Behavioral and psychological symptoms of dementia: Part I–epidemiology, neurobiology, heritability, and evaluation. Clinical Geriatrics, 19, 1–6.
  • Thomas, D.W. (1997). Understanding the wandering patient: A continuity of personality perspective. Journal of Gerontological Nursing, 23(1), 16–24. doi:10.3928/0098-9134-19970101-09 [CrossRef]

Characteristics of Each Personality Domain of the Five-Factor Model

Domain Characteristics
Extraversion One's level of sociability and assertiveness
Low score = more reserved, independent, may prefer to be alone
High score = talkative, seek social situations, assertive, like excitement
Neuroticism One's level of emotional stability
Low score = relaxed, calm, even tempered, rarely upset or anxious in stressful situations
High score = more susceptible to experiencing negative emotions, such as guilt, anger, embarrassment, disgust, and fear
Agreeableness One's level of altruism
Low score = more egocentric, competitive, skeptical of others
High score = more sympathetic, eager to help others
Conscientiousness One's ability to be careful, thorough, and perform tasks well
Low score = lack order in life, less goal-oriented
High score = strong-willed, determined, punctual, reliable
Openness to experience One's active imagination, aesthetic sensitivity, intellectual curiosity, and independence of judgment
Low score = more conservative and conventional, has narrower interests
High score = more curious about the world, more creative, more willing to question authority

Participant Characteristics (N = 89)

Variable n Mean (SD) Range
Age (years) 88.08 (5.88) 74 to 100
Sex
  Female 62
  Male 27
Years with dementia 6.55 (3.49)
Comorbid psychological disorder
  Yes 71
  No 18
Psychotropic medication
  Yes 68
  No 21
Cohen-Mansfield Agitation Inventory
  Physically aggressive behavior 1.6 (0.83) 1 to 4.3
  Physically nonaggressive behavior 2.12 (0.92) 1 to 4.8
  Verbally aggressive behavior 2.08 (1.16) 1 to 5.5
  Verbally nonaggressive behavior 2.76 (1.63) 1 to 6.5
NEO-Five-Factor Inventory
  Neuroticism 52.4 (9.58) 32 to 75
  Extraversion 48.76 (11.86) 25 to 75
  Openness 41.03 (8.97) 25 to 62
  Agreeableness 46.87 (12.69) 25 to 75
  Conscientiousness 50.94 (11.28) 25 to 72

Variables Predicting Verbally Aggressive Behavior

Variable B SE β
Years with dementia 0.09 0.04 −0.27*
Neuroticism 0.01 0.02 0.1
Extraversion 0.01 0.01 0.13
Openness 0.03 0.01 0.2
Agreeableness 0.02 0.01 0.17
Conscientiousness 0.03 0.01 −0.25*

Correlation Matrix

Years With Dementia Past/Current Psychological Disorder Neuroticism Extraversion Openness Agreeableness Conscientiousness Verbally Non-Aggressive Behavior Verbally Aggressive Behavior Physically Non-Aggressive Behavior Physically Aggressive Behavior
Years With Dementia 1
Past/Current Psychological Disorder −.181 1
Neuroticism −.266* −.133 1
Extraversion .054 −.049 −.449** 1
Openness −.099 .023 −.196 .238* 1
Agreeableness .089 .025 −.263* .322** .306** 1
Conscientiousness .206 −.030 −.381** .338** .188 .364** 1
Verbally Non-Aggressive Behavior .105 .067 .012 −.092 −.188 −.282** −.233* 1
Verbally Aggressive Behavior .163 −.100 .071 .005 .083 −.162 −.215* .593** 1
Physically Non-Aggressive Behavior .215* −.244* .060 −.104 −.093 −.168 −.089 .340** .242* 1
Physically Aggressive Behavior .276** .024 −.149 .072 .092 −.011 −.023 .218* .586** .253* 1

Keypoints

Zielin, S. & McCabe, M. (2016). Exploring the Relationship Between Premorbid Personality and Dementia-Related Behaviors. Journal of Gerontological Nursing, 42(1), 40–48.

  1. It is important to consider premorbid personality in the understanding of the behavior of older adults with dementia.

  2. Personality plays a role in psychological and behavioral problems associated with dementia.

  3. Verbal aggression was predicted by personality factors, but not other aspects of behavior.

Authors

Ms. Zielin is PhD Candidate, Deakin University; and Dr. McCabe is Director, Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Marita McCabe, PhD, FAPS, Director, Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, Victoria 3000, Australia; e-mail: Marita.McCabe@acu.edu.au.

Received: May 03, 2015
Accepted: September 18, 2015
Posted Online: October 15, 2015

10.3928/00989134-20151008-77

Sign up to receive

Journal E-contents