The treatment of behavioral disturbances and psychosis associated with dementia

Comparative efficacy of various art therapies for patients with dementia: A network meta-analysis of randomized controlled trials

BACKGROUND

Dementia have brought great challenges to patients, families and society. Numerous art therapies for patients with dementia have been developed in recent years. However, it is still unclear which art therapy represents the optimal strategy for promoting physical and mental health.

OBJECTIVES

To compare the efficacy of various art therapies in improving cognitive function, activity of daily living, depression, anxiety, agitation behavior and quality of life, and rank the art therapies for practice consideration.

METHODS

A comprehensive literature search was performed in eight electronic databases from their inception to April 2022. Two authors independently completed study selection, data extraction, and assessed methodological quality according to the revised version of the Cochrane tool (RoB 2). Comparative evaluation of different art therapies' effect was performed by conducting network meta-analysis. The study protocol was registered at PROSPERO.

RESULTS

A total of 39 randomized controlled trials involving 2801 participants were included. Calligraphy therapy (MD = 4.39) and reminiscence therapy (MD = 2.53) significantly improved cognitive function compared with the usual care, and reminiscence therapy (MD = 1.75) significantly enhanced cognitive function compared with music therapy. Horticultural therapy significantly decreased agitation behavior compared with the usual care (MD = -31.34), music therapy (MD = -26.66), reading therapy (MD = -28.44) and reminiscence therapy (MD = -27.32). In addition, calligraphy therapy (MD = 9.00) improved quality of life compared with the usual care.

CONCLUSION

Calligraphy therapy might be the most effective art therapy for improving cognitive function and quality of life. Horticultural therapy might be the best art therapy for decreasing agitation behavior. Health-care professionals could consider applying these art therapies to improve cognitive function, agitation behavior and quality of life in patients with dementia.

Relation among Caregivers' Burden, Abuse and Behavioural Disorder in People with Dementia

Dementia produces a loss of independence to carry out the activities of daily life. The great demand for care that these people need usually falls on the family through informal care. This study aims to analyse the burden showed by the informal caregiver of a person with dementia. In addition, we analyse whether this burden present in informal caregivers could be related to abusive behaviour. We also study the relationship between the stage of the disease, the appearance of behavioural disorders and the level of burden in the caregiver using the Scales of Zarit, CASE and FAST. The data showed that 45.50 per cent of caregivers have light burden or burden. After the research, it was identified that the presence of behavioural disorders in patients with dementia showed a correlation with the increase in both the main caregiver burden and abuse. An increase in the level of burden is followed by an increase in the level of abuse (r = 0.844; p = 0.000). Furthermore, we analysed several conditions that could have a correlation with this burden and abuse. It was found that burden in the caregiver could be linked with the presence of behavioural disorders, like aggression (r = 0.577; p = 0.008) and irritability (r = 0.600; p = 0.005) at the moderate stage of the disease. On the other hand, there is a positive correlation between the probability that people with dementia suffer abuse in the moderate stage of the disease and the presence of aggression (r = 0.732; p = 0.000), lack of inhibition (r = 0.571; p = 0.009) and irritability (r = 0.827; p = 0.000). Taking this data into account, burden and abuse seem to be linked to the presence of behavioural disorders in patients with dementia in the moderate stage.

Psychosis

PURPOSE OF REVIEW

Psychosis is a psychiatric condition that has significant overlap with neurologic disease. This article is intended to educate the neurologist on the psychiatric manifestations of psychosis and its evaluation, diagnosis, and treatment. How to differentiate a primary psychiatric cause of psychosis from psychosis secondary to a medical or neurologic condition is also reviewed.

RECENT FINDINGS

Current research in psychotic disorders has focused increasingly on negative symptoms and cognitive impairment in psychotic illness, as it is now recognized that these cause the greatest impact on functional deficits for patients. A number of new medications have also been introduced to target negative symptoms and cognitive deficits in psychotic illness. These have new implications in terms of treatment overlap with medications being prescribed by providers in psychiatry, neurology, and general practice.

SUMMARY

This article discusses the current methods for evaluating, diagnosing, and treating psychosis. Psychosis as a primary mental health disorder is a diagnosis of exclusion, as psychosis can be a direct symptom of underlying medical or neurologic disease. Delirium and dementia are the two most important disorders to rule out. This article will help readers be more prepared to assess and treat the patient with psychosis.

Validation of the Italian Version of the Caregiver Abuse Screen among Family Caregivers of Older People with Alzheimer's Disease

Introduction. Elder abuse is often a hidden phenomenon and, in many cases, screening practices are difficult to implement among older people with dementia. The Caregiver Abuse Screen (CASE) is a useful tool which is administered to family caregivers for detecting their potential abusive behavior. Objectives. To validate the Italian version of the CASE tool in the context of family caregiving of older people with Alzheimer's disease (AD) and to identify risk factors for elder abuse in Italy. Methods. The CASE test was administered to 438 caregivers, recruited in the Up-Tech study. Validity and reliability were evaluated using Spearman's correlation coefficients, principal-component analysis, and Cronbach's alphas. The association between the CASE and other variables potentially associated with elder abuse was also analyzed. Results. The factor analysis suggested the presence of a single factor, with a strong internal consistency (Cronbach's alpha = 0.86). CASE score was strongly correlated with well-known risk factors of abuse. At multivariate level, main factors associated with CASE total score were caregiver burden and AD-related behavioral disturbances. Conclusions. The Italian version of the CASE is a reliable and consistent screening tool for tackling the risk of being or becoming perpetrators of abuse by family caregivers of people with AD.