Is there a need to study behavioral and psychological signs and symptoms of dementia across cultures?

Is there a need to study behavioral and psychological signs and symptoms of dementia across cultures? Behavioral and psychological symptoms of dementia (BPSD) include disorders of behavior, mood, thought content and perception (Foli and Shah, 2000). They cause distress to patients, relatives and carers, result in institutional care and long-term hospitalization, and lead to physical restraint and overmedication. Traditionally, BPSD have been poorly studied for several reasons (Fairburn and Hope, 1988): 1) the importance attached to cognition in the diagnosis of dementia; 2) the assumption that BPSD are secondary to cognitive and personality changes in dementia; 3) the difficulty with accurately defining BPSD; and, 4) the paucity of standardized instruments to measure BPSD. This latter reason is further amplified in developing countries and for ethnic minority groups in developed countries, because instruments measuring BPSD have only recently emerged in languages other than English. Population-based cross-cultural epidemiological studies of dementia have largely concentrated on cognitive impairment and neglected BPSD. Most singlecountry studies of BPSD are from developed countries (Foli and Shah, 2000). However, studies are emerging from developing countries including Hong Kong (Lam et al., 1997; 2001; Choy et al., 2001; Leung et al., 2001), Taiwan (Hwang et al., 1997; Fuh et al., 1999; 2001), Japan (Schreiner et al., 2000; Schreiner, 2001), India (Kar and Sharma, 2001; Shaji et al., 2003), Turkey (Eker and Ertan, 2000), Poland (Kloszewska, 1998), Nigeria (Baiyewu et al., 2003) and Korea (Suh, 2004; Shah et al., 2004; Suh and Kim, 2004). There are only a few cross-cultural studies of BPSD: between Italy and U.S.A, (Binetti et al., 1998); between Nigeria, Jamaica and African Americans (Hendrie et al., 1996; 2000); between Korea and the UK (Shah et al., 2004); between Hong Kong, Taiwan and America (Chow et al., 2002); and, a large preliminary crossnational study between Argentina, Cuba, Brazil, Chile, Dominican Republic, Guatemala, Mexico, Panama, Peru, Uruguay, Venezuela, India, China, Hong Kong and Nigeria (The 10/66 Dementia Research Group, 2005). There are a few U.S. studies (Fabrega et al., 1988; Akpaffiong et al., 1999; Cohen and Carlin, 1993; Cohen and Magai, 1999; Cohen et al., 1998a; 1998b; Mintzer et al., 1996; Harwood et al., 2000; 2001; Chen et al., 2000; Bassiony et al., 2002), one Argentine study (Mangone, 1996), and one U.K. study (Haider and Shah, 2004) of BPSD in specific ethnic minority groups within a given country. U.S. studies