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Malena K, Rao S, Mosler C. Review of Current Clinical Options for the Management of Behavioral and Psychological Symptoms of Dementia. Sr Care Pharm 2024; 39:300-310. [PMID: 39080869 DOI: 10.4140/tcp.n.2024.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Dementia is a disease most prevalent in the older adult population. The cognitive symptoms of dementia include impairments in problem-solving, memory, and language. Some patients experience noncognitive symptoms in addition to the cognitive symptoms of dementia. These noncognitive symptoms are called behavioral and psychological symptoms of dementia or BPSD. The primary objective of our study was to examine the therapeutic options, guidelines, and clinical considerations for the management of BPSD. The existing literature about BPSD was reviewed with searches in PubMed, MEDLINE, and online search platforms. Dysregulation of neurotransmission involving acetylcholine, dopamine, and serotonin has been shown to cause behavioral and psychological symptoms of Alzheimer's disease. BPSD can include hallucinations, agitation, delusions, anxiety, apathy, abnormal body movements, irritability, depression, disinhibition, and sleep or appetite changes. Pharmacologic therapies used in the treatment of BPSD include antidepressants, antipsychotics, anxiolytics, and anticonvulsants. Treatment can be tailored to the specific noncognitive symptoms that are experienced. The use of these agents may be limited based on recommendations from the Beers Criteria®, STOPP criteria, treatment guidelines, and FDA warnings.
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Lunghi C, Domenicali M, Vertullo S, Raschi E, De Ponti F, Onder G, Poluzzi E. Adopting STOPP/START Criteria Version 3 in Clinical Practice: A Q&A Guide for Healthcare Professionals. Drug Saf 2024:10.1007/s40264-024-01453-1. [PMID: 38990488 DOI: 10.1007/s40264-024-01453-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 07/12/2024]
Abstract
The growing complexity of geriatric pharmacotherapy necessitates effective tools for mitigating the risks associated with polypharmacy. The Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP)/Screening Tool to Alert doctors to Right Treatment (START) criteria have been instrumental in optimizing medication management among older adults. Despite their large adoption for improving the reduction of potentially inappropriate medications (PIM) and patient outcomes, the implementation of STOPP/START criteria faces notable challenges. The extensive number of criteria in the latest version and time constraints in primary care pose practical difficulties, particularly in settings with a high number of older patients. This paper critically evaluates the challenges and evolving implications of applying the third version of the STOPP/START criteria across various clinical settings, focusing on the European healthcare context. Utilizing a "Questions & Answers" format, it examines the criteria's implementation and discusses relevant suitability and potential adaptations to address the diverse needs of different clinical environments. By emphasizing these aspects, this paper aims to contribute to the ongoing discourse on enhancing medication safety and efficacy in the geriatric population, and to promote more person-centred care in an aging society.
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Affiliation(s)
- Carlotta Lunghi
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy.
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Centre, Quebec, Quebec, Canada.
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Stefano Vertullo
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
- Department of Medical Biotechnology and Translational Medicine, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, Milan, Italy
| | - Emanuel Raschi
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Fabrizio De Ponti
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Graziano Onder
- Department of Gerontology, Neuroscience and Orthopedics, Sacred Heart Catholic University, Rome, Italy
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
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Mercier C, Rollason V, Eshmawey M, Mendes A, Frisoni GB. The treatment of behavioural and psychological symptoms in dementia: pragmatic recommendations. Psychogeriatrics 2024; 24:968-982. [PMID: 38638077 DOI: 10.1111/psyg.13116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/20/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024]
Abstract
Behavioural and psychological symptoms of dementia (BPSD) are a clinical challenge for the lack of a sound taxonomy, frequent presentation with comorbid BPSD, lack of specific pharmacologic interventions, poor base of methodologically sound evidence with randomized clinical trials, contamination from the treatment of behavioural disturbances of young and adult psychiatric conditions, and small efficacy window of psychotropic drugs. We present here a treatment workflow based on a concept-driven literature review based on the notions that (i) the aetiology of BPSD can be mainly neurobiological (so-called 'primary' symptoms) or mainly environmental and functional ('secondary' symptoms) and that this drives treatment; (ii) the clinical efficacy of psychotropic drugs is driven by their specific profile of receptor affinity; (iii) drug treatment should follow the rules of 'start low-go slow, prescribe and revise'. This article argues in support of the distinction between primary and secondary BPSD, as well as their characteristics, which until now have been just sketchily described in the literature. It also offers comprehensive and pragmatic clinician-oriented recommendations for the treatment of BPSD.
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Affiliation(s)
- Camille Mercier
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Memory Center, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Victoria Rollason
- Department of Acute Medicine, Clinical Pharmacology and Toxicology Service, University Hospitals of Geneva, Geneva, Switzerland
| | - Mohamed Eshmawey
- Department of Psychiatry, Geriatric Psychiatry Service, University Hospitals of Geneva, Geneva, Switzerland
| | - Aline Mendes
- Geriatrics and Rehabilitation Department, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Giovanni B Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Memory Center, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Geneva, Switzerland
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Yin Z, Li Y, Bao Q, Zhang X, Xia M, Zhong W, Wu K, Yao J, Chen Z, Sun M, Zhao L, Liang F. Comparative efficacy of multiple non-pharmacological interventions for behavioural and psychological symptoms of dementia: A network meta-analysis of randomised controlled trials. Int J Ment Health Nurs 2024; 33:487-504. [PMID: 38012101 DOI: 10.1111/inm.13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/14/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
Non-pharmacological interventions can improve the behavioural and psychological symptoms of dementia (BPSD). However, the optimal non-pharmacological treatments remain controversial. This study aimed to compare the efficacy of multiple non-pharmacological methods and identify the optimal therapy for BPSD. Potential randomised controlled trials (RCTs) were searched and selected from 15 databases and sources from the inception of the databases until 1 October 2022. Two independent authors implemented study screening, data extraction, and methodological quality assessment. Primary outcome was reduction of Neuropsychiatric Inventory (NPI). The secondary outcome were changes of Cornell Scale for Depression in Dementia (CSDD), the Cohen-Mansfield Agitation Inventory (CMAI), the Quality of Life in Alzheimer's Disease (QoL-AD), the Abilities of Daily Living scale, and the Apathy Evaluation Scale. Meta-analyses were performed using STATA v15.0 and ADDIS v1.16.8. The GRADE approaches were utilised to evaluate evidence quality. The present study included 43 RCTs with 4978 participants. The global methodological quality of the RCTs was moderate. Regarding NPI reduction, with moderate-certainty evidence, exercise plus treatment as usual (TAU) outperformed TAU (mean difference [MD]: -7.13; 95% confidence interval [CI]: -13.22, -0.76) and ranked as the optimal treatment. For reduction in CSDD, with low- to moderate-certainty evidence, massage plus TAU (MD: -15.26; 95% CI: -20.13, -10.52) and music plus TAU (MD: -2.40; 95% CI: -4.62, -0.12) were associated with greater reduction compared with TAU. For reduction in CMAI, with moderate-certainty evidence, aromatherapy plus massage (MD: -15.84; 95% CI: -29.76, -2.42) and massage plus music (MD: -13.12; 95% CI: -25.43, -0.76) were significantly more effective than TAU. For improvement in QoL-AD, with critically low- to low-certainty evidence, there were no statistical differences between any of non-pharmacological treatments and TAU. Due to the limited number of included studies, network meta-analysis was not performed for other outcomes. In conclusion, non-pharmacological treatments are effective for overall symptoms, depression, and agitation. Exercise plus treatment as usual may be an optimal non-pharmacological intervention for improving the overall BPSD. This may help to guide patients, doctors, and policymakers.
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Affiliation(s)
- Zihan Yin
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Yaqin Li
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qiongnan Bao
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Xinyue Zhang
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Manze Xia
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Wanqi Zhong
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Kexin Wu
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Jin Yao
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Zhenghong Chen
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Mingsheng Sun
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Ling Zhao
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Fanrong Liang
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
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Schulte PFJ. Can clozapine be used for treatment-refractory behavioral and psychological symptoms in dementia patients? Schizophr Res 2024; 268:285-288. [PMID: 37479589 DOI: 10.1016/j.schres.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/08/2023] [Accepted: 07/09/2023] [Indexed: 07/23/2023]
Affiliation(s)
- Peter F J Schulte
- Mental Health Services Noord-Holland-Noord, Alkmaar, the Netherlands.
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Fernandes S, von Gunten A, Verloo H. Using AI-Based Technologies to Help Nurses Detect Behavioral Disorders: Narrative Literature Review. JMIR Nurs 2024; 7:e54496. [PMID: 38805252 PMCID: PMC11167323 DOI: 10.2196/54496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The behavioral and psychological symptoms of dementia (BPSD) are common among people with dementia and have multiple negative consequences. Artificial intelligence-based technologies (AITs) have the potential to help nurses in the early prodromal detection of BPSD. Despite significant recent interest in the topic and the increasing number of available appropriate devices, little information is available on using AITs to help nurses striving to detect BPSD early. OBJECTIVE The aim of this study is to identify the number and characteristics of existing publications on introducing AITs to support nursing interventions to detect and manage BPSD early. METHODS A literature review of publications in the PubMed database referring to AITs and dementia was conducted in September 2023. A detailed analysis sought to identify the characteristics of these publications. The results were reported using a narrative approach. RESULTS A total of 25 publications from 14 countries were identified, with most describing prospective observational studies. We identified three categories of publications on using AITs and they are (1) predicting behaviors and the stages and progression of dementia, (2) screening and assessing clinical symptoms, and (3) managing dementia and BPSD. Most of the publications referred to managing dementia and BPSD. CONCLUSIONS Despite growing interest, most AITs currently in use are designed to support psychosocial approaches to treating and caring for existing clinical signs of BPSD. AITs thus remain undertested and underused for the early and real-time detection of BPSD. They could, nevertheless, provide nurses with accurate, reliable systems for assessing, monitoring, planning, and supporting safe therapeutic interventions.
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Affiliation(s)
- Sofia Fernandes
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Sion, Switzerland
- Les Maisons de la Providence Nursing Home, Le Châble, Switzerland
- Faculty of Biology and Medicine, Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Henk Verloo
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Mok PLH, Carr MJ, Guthrie B, Morales DR, Sheikh A, Elliott RA, Camacho EM, van Staa T, Avery AJ, Ashcroft DM. Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study. BMJ 2024; 385:e076268. [PMID: 38631737 PMCID: PMC11022137 DOI: 10.1136/bmj-2023-076268] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To investigate risks of multiple adverse outcomes associated with use of antipsychotics in people with dementia. DESIGN Population based matched cohort study. SETTING Linked primary care, hospital and mortality data from Clinical Practice Research Datalink (CPRD), England. POPULATION Adults (≥50 years) with a diagnosis of dementia between 1 January 1998 and 31 May 2018 (n=173 910, 63.0% women). Each new antipsychotic user (n=35 339, 62.5% women) was matched with up to 15 non-users using incidence density sampling. MAIN OUTCOME MEASURES The main outcomes were stroke, venous thromboembolism, myocardial infarction, heart failure, ventricular arrhythmia, fracture, pneumonia, and acute kidney injury, stratified by periods of antipsychotic use, with absolute risks calculated using cumulative incidence in antipsychotic users versus matched comparators. An unrelated (negative control) outcome of appendicitis and cholecystitis combined was also investigated to detect potential unmeasured confounding. RESULTS Compared with non-use, any antipsychotic use was associated with increased risks of all outcomes, except ventricular arrhythmia. Current use (90 days after a prescription) was associated with elevated risks of pneumonia (hazard ratio 2.19, 95% confidence interval (CI) 2.10 to 2.28), acute kidney injury (1.72, 1.61 to 1.84), venous thromboembolism (1.62, 1.46 to 1.80), stroke (1.61, 1.52 to 1.71), fracture (1.43, 1.35 to 1.52), myocardial infarction (1.28, 1.15 to 1.42), and heart failure (1.27, 1.18 to 1.37). No increased risks were observed for the negative control outcome (appendicitis and cholecystitis). In the 90 days after drug initiation, the cumulative incidence of pneumonia among antipsychotic users was 4.48% (4.26% to 4.71%) versus 1.49% (1.45% to 1.53%) in the matched cohort of non-users (difference 2.99%, 95% CI 2.77% to 3.22%). CONCLUSIONS Antipsychotic use compared with non-use in adults with dementia was associated with increased risks of stroke, venous thromboembolism, myocardial infarction, heart failure, fracture, pneumonia, and acute kidney injury, but not ventricular arrhythmia. The range of adverse outcomes was wider than previously highlighted in regulatory alerts, with the highest risks soon after initiation of treatment.
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Affiliation(s)
- Pearl L H Mok
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, M13 9PT, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Matthew J Carr
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, M13 9PT, UK
- Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Daniel R Morales
- Population Health and Genomics, University of Dundee, Dundee, UK
| | - Aziz Sheikh
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rachel A Elliott
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
- Manchester Centre for Health Economics, Division of Population Health, Manchester, UK
| | - Elizabeth M Camacho
- Manchester Centre for Health Economics, Division of Population Health, Manchester, UK
| | - Tjeerd van Staa
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Anthony J Avery
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
- Centre for Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, M13 9PT, UK
- Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
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Chang C, Sun J, Zhao X, Chen S, Song D, Wang L, Yang Y, Huang R, Zhang H, Du J. Clinical practice guidelines for the nutrition of colorectal cancer patients: a systematic review. Support Care Cancer 2024; 32:187. [PMID: 38396102 DOI: 10.1007/s00520-024-08394-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/17/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE The aim of this study is to rigorously assess the methodological quality of published clinical practice guidelines (CPGs) related to nutrition among colorectal cancer patients, to compile consensus recommendations, and to evaluate the quality of the included CPGs. METHODS The systematic search covered eight electronic databases, two relevant professional association websites, and six guideline websites from their inception up to January 22, 2023. The methodological quality of the eligible guidelines was evaluated using the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument, and then, consensus recommendations were synthesized. The scores for each domain were expressed as the mean ± standard deviation (SD). Using the mean score as the benchmark for comparison, they were subsequently ranked from highest to lowest. The included guidelines were then categorized as having "high," "moderate," or "low" quality based on their scores. RESULTS The literature search yielded ten guidelines. The findings indicated that the "Clarity of presentation" domain had the highest mean score (65.2 ± 7.7). This demonstrates how the guidelines effectively articulate recommendations. Additionally, the "Scope and purpose" domain achieved a mean score of 60.7 ± 10.9, followed by "Rigor of development" (51.7 ± 15.7), "Editorial independence" (51.1 ± 21), "Stakeholder involvement" (48 ± 16.8), and "Applicability" domains (47.5 ± 17.3). Two CPGs received an overall rating of "high quality" and were recommended; four CPGs received an overall rating of "moderate" and were recommended with modifications; and four CPGs received an overall rating of "low quality" and were not recommended. Furthermore, this study compiled twenty consensus recommendations related to nine distinct clinical issues. CONCLUSION This study identified disparities in the methodological quality of the included CPGs, particularly in the "Applicability" domain, thus emphasizing the need for advancement in clinical feasibility and implementation. Notably, there is few guidelines specifically targeting colorectal cancer nutrition. These synthesized findings provided an intuitive, convenient, and comprehensive reference for evaluating nutrition among colorectal cancer patients. When applying these results, users should make careful decisions based on their specific situations.
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Affiliation(s)
- Cheng Chang
- The First Hospital of Jilin University, No. 1 Xinmin Street, ChangchunJilin, 130021, China
| | - Jiao Sun
- School of Nursing, Jilin University, No.965 Xinjiang Street, ChangchunJilin, 130021, China
| | - Xiaosu Zhao
- The First Hospital of Jilin University, No. 1 Xinmin Street, ChangchunJilin, 130021, China.
| | - Si Chen
- The First Hospital of Jilin University, No. 1 Xinmin Street, ChangchunJilin, 130021, China
| | - Dongpo Song
- School of Nursing, Jilin University, No.965 Xinjiang Street, ChangchunJilin, 130021, China
| | - Lijie Wang
- The First Hospital of Jilin University, No. 1 Xinmin Street, ChangchunJilin, 130021, China
| | - Yang Yang
- The First Hospital of Jilin University, No. 1 Xinmin Street, ChangchunJilin, 130021, China
| | - Ruling Huang
- The First Hospital of Jilin University, No. 1 Xinmin Street, ChangchunJilin, 130021, China
| | - Haijia Zhang
- The First Hospital of Jilin University, No. 1 Xinmin Street, ChangchunJilin, 130021, China
| | - Jing Du
- The First Hospital of Jilin University, No. 1 Xinmin Street, ChangchunJilin, 130021, China
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Li KY, Lin BT, Hsu ST, Chien CF, Chang YP, Yang YH. Quetiapine Oral Solution in Alzheimer's Disease: Efficacy and Dosage Insights from a Real-World Retrospective Study. J Alzheimers Dis 2024; 97:805-811. [PMID: 38143365 DOI: 10.3233/jad-231007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are distressing for patients with dementia, often accelerating functional decline and nursing home placement. Medications such as quetiapine are used to alleviate NPS, but their side effects require cautious use. Liquid formulations such as quetiapine oral suspension suit specific populations; however, real-world data on their use in patients with dementia are limited. OBJECTIVE The purpose of this retrospective, naturalistic study was to provide preliminary data on the effects of treatment with quetiapine oral suspension on behavioral and psychiatric disturbances in Alzheimer's disease (AD) outpatients in Taiwan. METHODS Between January 2022 and June 2023, data were collected from outpatients with a diagnosis of probable AD who received treatment with Qting® (quetiapine oral solution 25 mg/ml). Primary outcome measures were changes in Neuropsychiatric Inventory (NPI) total score and its sub-items from baseline to the endpoint. RESULTS We recruited 66 AD patients with a mean age of 72.1±7.6 years, most of whom were female (69.7%). Twenty-three patients had data on neuropsychological test and NPI scores before and after quetiapine treatment. There was no significant change in global cognitive function from baseline to the endpoint. A significant reduction in NPI total score after quetiapine treatment was noted, while the effect on NPI sub-items was limited. The average maintenance dose was 1.5±0.6 ml. CONCLUSIONS We demonstrated our clinical experience of the use of quetiapine oral solution in AD patients with NPS. Our results showed that quetiapine oral solution treatment significantly improved these symptoms at a relatively low dose.
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Affiliation(s)
- Kuan-Ying Li
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Bin-Tse Lin
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Ting Hsu
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Fang Chien
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yang-Pei Chang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Loftus KL, Wand APF, Breen JL, Hunt GE, Peisah C. Factors Associated with Psychotropic Medication Use in People Living with Dementia in the Community: A Systematic Review and Meta-Analysis. Drugs Aging 2023; 40:1053-1084. [PMID: 37943474 PMCID: PMC10682283 DOI: 10.1007/s40266-023-01070-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND There has been considerable focus on the use of psychotropic agents in people living with dementia in long-term care. However, psychotropic use often commences well before transitioning to long-term care. OBJECTIVES To synthesize the available literature to identify factors associated with psychotropic medication use in people living with dementia in the community. METHODS This PROSPERO-registered review reports findings from a comprehensive search of Embase, PsycINFO, and PubMed (including MEDLINE) databases according to predefined inclusion and exclusion criteria (2010-2022). Inclusion criteria were original prospective or retrospective design research papers enrolling people diagnosed with dementia utilizing a psychotropic medication and living at home. Quality and risk of bias was assessed Newcastle-Ottawa Quality Assessment Scale. The last search was conducted in November 2022. Thematic analysis was used to synthesize the emergent factors identified, and a meta-analysis was undertaken on suitable data. RESULTS The search identified 619 articles. After review and exclusions, 39 articles were included for synthesis, including 1,338,737 people. The majority of papers (67%) were rated as low risk of bias and corresponding good quality. Thematic analysis suggested associations between psychotropic prescribing and patient and environmental factors, with little data concerning carer and prescriber factors. Such factors included age (< 75 years, > 90 years), sex, more advanced functional decline, and living alone. Meta-analysis identified significant associations between psychotropic use and respite (temporary full-time care or hospitalization) and comorbid psychiatric illness. CONCLUSIONS While it is clear from this review that there remains a significant lack of clarity as to the reasons why these medications are being utilized in this population, this review provides greater insight and understanding into the context of psychotropic use. The study has highlighted an opportunity for further targeted research to be conducted and provides a much-needed context for this to occur. PROSPERO REGISTRATION NUMBER CRD42021286322.
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Affiliation(s)
- Kerryn L Loftus
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
- JARA UNIT, Concord Centre for Mental Health, Concord Hospital, 1 Hospital Road, Concord, NSW, 2137, Australia.
| | - Anne P F Wand
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Juanita L Breen
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Capacity Australia, Australian Centre for Capacity, Ethics and the Prevention of Exploitation of People with Disabilities, Sydney, NSW, Australia
| | - Glenn E Hunt
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Carmelle Peisah
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Capacity Australia, Australian Centre for Capacity, Ethics and the Prevention of Exploitation of People with Disabilities, Sydney, NSW, Australia
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11
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Jiang J, Liu Y, Wang A, Zhuo Z, Shi H, Zhang X, Li W, Sun M, Jiang S, Wang Y, Zou X, Zhang Y, Jia Z, Xu J. Development and validation of a nutrition-related genetic-clinical-radiological nomogram associated with behavioral and psychological symptoms in Alzheimer's disease. Chin Med J (Engl) 2023:00029330-990000000-00878. [PMID: 38031345 PMCID: PMC11407811 DOI: 10.1097/cm9.0000000000002914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Few evidence is available in the early prediction models of behavioral and psychological symptoms of dementia (BPSD) in Alzheimer's disease (AD). This study aimed to develop and validate a novel genetic-clinical-radiological nomogram for evaluating BPSD in patients with AD and explore its underlying nutritional mechanism. METHODS This retrospective study included 165 patients with AD from the Chinese Imaging, Biomarkers, and Lifestyle (CIBL) cohort between June 1, 2021, and March 31, 2022. Data on demoimagedatas, neuropsychological assessments, single-nucleotide polymorphisms of AD risk genes, and regional brain volumes were collected. A multivariate logistic regression model identified BPSD-associated factors, for subsequently constructing a diagnostic nomogram. This nomogram was internally validated through 1000-bootstrap resampling and externally validated using a time-series split based on the CIBL cohort data between June 1, 2022, and February 1, 2023. Area under receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were used to assess the discrimination, calibration, and clinical applicability of the nomogram. RESULTS Factors independently associated with BPSD were: CETP rs1800775 (odds ratio [OR] = 4.137, 95% confidence interval [CI]: 1.276-13.415, P = 0.018), decreased Mini Nutritional Assessment score (OR = 0.187, 95% CI: 0.086-0.405, P <0.001), increased caregiver burden inventory score (OR = 8.993, 95% CI: 3.830-21.119, P <0.001), and decreased brain stem volume (OR = 0.006, 95% CI: 0.001-0.191, P = 0.004). These variables were incorporated into the nomogram. The area under the ROC curve was 0.925 (95% CI: 0.884-0.967, P <0.001) in the internal validation and 0.791 (95% CI: 0.686-0.895, P <0.001) in the external validation. The calibration plots showed favorable consistency between the prediction of nomogram and actual observations, and the DCA showed that the model was clinically useful in both validations. CONCLUSION A novel nomogram was established and validated based on lipid metabolism-related genes, nutritional status, and brain stem volumes, which may allow patients with AD to benefit from early triage and more intensive monitoring of BPSD. REGISTRATION Chictr.org.cn, ChiCTR2100049131.
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Affiliation(s)
- Jiwei Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Yaou Liu
- National Clinical Research Center for Neurological Diseases, Beijing 100070, China
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Zhizheng Zhuo
- National Clinical Research Center for Neurological Diseases, Beijing 100070, China
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Hanping Shi
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing 100081, China
| | - Xiaoli Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Wenyi Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Mengfan Sun
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Shirui Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Yanli Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Xinying Zou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Yuan Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Ziyan Jia
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Jun Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- National Clinical Research Center for Neurological Diseases, Beijing 100070, China
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12
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Onoda T, Tanaka H, Ishii T. Bibliometric analysis of Kampo medicine hotspots and trends for the decade: 2013-2022. Medicine (Baltimore) 2023; 102:e35897. [PMID: 37932994 PMCID: PMC10627683 DOI: 10.1097/md.0000000000035897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/11/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Kampo medicine is a traditional medicine that originated in ancient China and has since developed as a uniquely Japanese medicine. Although Kampo medicine is one of Japan's most important therapeutic modalities and numerous papers have been published recently, information on current hotspots and trends in Kampo research is lacking. This bibliometric analysis of Kampo medicine surveyed the latest research hotspots and trends. METHODS Articles on Kampo medicine were retrieved from the Web of Science Core Collection. We used medical subject headings related to Kampo medicine and searched for publications from 2013 to 2022. The retrieved articles were analyzed for countries, authors, journals, references, and keywords related to Kampo medicine using CiteSpace, VOSviewer, and SCImago Graphica. RESULTS A total of 1170 articles were included. The number of Kampo medicine-related publications and citations has recently increased, mainly from Japan. Author Keiko Ogawa-Ochiai published the most papers (40 papers), while Yoshio Kase had the highest frequency at 663 citations. Among the co-cited authors, Toru Kono was the most cited and had the highest total link strength. The journal with the most submissions was Evidence-based Complementary and Alternative Medicine. A comprehensive keyword and literature analysis revealed the following research hotspots: "Yokukansan and behavioral and psychological symptoms of dementia," "Ninjinyoeito and geriatric care," "Daikenchuto and postoperative gastrointestinal cancer," and "Rikkunshito and functional dyspepsia." We also identified a new research frontier by identifying an association between hochuekkito and COVID-19. CONCLUSIONS Our findings reveal trends in Kampo medicine research, with specific hotspots and the authors and publications with the largest research impact. Collecting a large volume of literature data, analyzing the impact of studies, and identifying research hotspots, as in this study, will provide researchers with future directions for Kampo research.
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Affiliation(s)
- Toshihisa Onoda
- Department of Practical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Hiroyuki Tanaka
- Department of Practical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Toshihiro Ishii
- Department of Practical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
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Cognat E, Sabia S, Fayel A, Lilamand M, Handels R, Fascendini S, Bergh S, Frisoni GB, Fabbo A, Tsolaki M, Frölich L, Peters O, Merlo P, Ciccone A, Mecocci P, Dumurgier J, Defanti CA, Hugon J, Paquet C. BPSD Patterns in Patients With Severe Neuropsychiatric Disturbances: Insight From the RECAGE Study. Am J Geriatr Psychiatry 2023; 31:633-639. [PMID: 37183097 DOI: 10.1016/j.jagp.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Behavioral and psychological symptoms of dementia (BPSD) profiles vary depending on etiology in patients with mild-to-moderate BPSD. It is not known if similar differences exist in patients with severe BPSD. METHODS We analyzed data collected at baseline in 398 patients with severe BPSD (NPI ≥ 32) and defined diagnosis of dementia (Alzheimer's disease [AD] 297; frontotemporal dementia [FTD] 39; Lewy body disease/Parkinsonian dementia [LBD/PD] 31; and vascular dementia [VD] 31) included in the European multicenter cohort RECAGE. RESULTS Mean total NPI was 52.11 (18.55). LBD/PD patients demonstrated more hallucinations, more anxiety and more delusions than patients with other dementia. FTD patients had less delusions and more disinhibition than patients with other neurodegenerative disorders. These profiles overlapped partially with those reported in the literature in patients with less severe symptoms. CONCLUSION Patients with severe BPSD display different and specific profiles of neuropsychiatric symptoms depending on dementia etiology.
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Affiliation(s)
- Emmanuel Cognat
- Université Paris Cité (EC, ML, CP, SS, JD, JH), UMR-S 1144, INSERM, Paris, France; Cognitive Neurology Center (EC, AF, ML, JD, JH, CP), AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France.
| | - Séverine Sabia
- Université Paris Cité (EC, ML, CP, SS, JD, JH), UMR-S 1144, INSERM, Paris, France; Université Paris Cité (SS, JD), Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Alexandra Fayel
- Université Paris Cité (SS, JD), Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Matthieu Lilamand
- Université Paris Cité (EC, ML, CP, SS, JD, JH), UMR-S 1144, INSERM, Paris, France; Cognitive Neurology Center (EC, AF, ML, JD, JH, CP), AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France; Department of Geriatry (ML), AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Ron Handels
- Alzheimer Centre Limburg (RH), School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Sara Fascendini
- Fondazione Europea di Ricerca Biomedica (FERB Onlus) (SF), Gazzaniga, Italy
| | - Sverre Bergh
- The Research Centre for Age-related Functional Decline and Disease (SB), Innlandet Hospital Trust, Ottestad, Norway; The Norwegian National Centre for Aging and Health (SB), Vestfold Hospital Trust, Tønsberg, Norway
| | - Giovanni B Frisoni
- Memory Clinic (GBF), Geneva University Hospitals, Geneva, Switzerland; Laboratory of Neuroimaging of Aging (LANVIE) (GBF), University of Geneva, Geneva, Switzerland
| | - Andrea Fabbo
- Geriatric Service-Cognitive Disorders and Dementia (AF), Department of Primary Care, Health Authority and Services of Modena, Modena, Italy
| | - Magdalina Tsolaki
- Greek Association of Alzheimer's Disease and Related Disorders (GAADRD) (MT), Thessaloniki, Hellas, Macedonia Greece; First Department of Neurology, School of Medicine (MT), Aristotle University of Thessaloniki (AUTh), Hellas, Macedonia Greece
| | - Lutz Frölich
- Department of Geriatric Psychiatry (LF), Central Institute of Mental Health; Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Oliver Peters
- Department of Psychiatry (OP), Charité Universitätsmedizin Berlin, Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE) (OP), Berlin, Germany
| | - Paola Merlo
- Neurological Unit (PM), U.V.A. Centre, Humanitas Gavazzeni, Bergamo, Italy
| | - Alfonso Ciccone
- Department of Neurology with neurosurgical activity and stroke unit (AC), ASST di Mantova, Mantova, Italy
| | - Patrizia Mecocci
- Section of Gerontology and Geriatrics (PM), Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Clinical Geriatrics (PM), NVS Department, Karolinska Institutet, Stockholm, Sweden
| | - Julien Dumurgier
- Université Paris Cité (EC, ML, CP, SS, JD, JH), UMR-S 1144, INSERM, Paris, France; Cognitive Neurology Center (EC, AF, ML, JD, JH, CP), AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France; Université Paris Cité (SS, JD), Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Carlo A Defanti
- Fondazione Europea di Ricerca Biomedica (FERB Onlus) (SF), Gazzaniga, Italy
| | - Jacques Hugon
- Université Paris Cité (EC, ML, CP, SS, JD, JH), UMR-S 1144, INSERM, Paris, France; Cognitive Neurology Center (EC, AF, ML, JD, JH, CP), AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Claire Paquet
- Université Paris Cité (EC, ML, CP, SS, JD, JH), UMR-S 1144, INSERM, Paris, France; Cognitive Neurology Center (EC, AF, ML, JD, JH, CP), AP-HP.Nord, Site Lariboisière Fernand-Widal, Paris, France
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Pozzi FE, Calì L, Ferrarese C, Appollonio I, Tremolizzo L. Assessing behavioral and psychological symptoms of dementia: a comprehensive review of current options and future perspectives. FRONTIERS IN DEMENTIA 2023; 2:1226060. [PMID: 39082001 PMCID: PMC11285590 DOI: 10.3389/frdem.2023.1226060] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 06/29/2023] [Indexed: 08/02/2024]
Abstract
The behavioral and psychological symptoms of dementia (BPSD) are a heterogeneous set of challenging disturbances of behavior, mood, perception, and thought that occur in almost all patients with dementia. A huge number of instruments have been developed to assess BPSD in different populations and settings. Although some of these tools are more widely used than others, no single instrument can be considered completely satisfactory, and each of these tools has its advantages and disadvantages. In this narrative review, we have provided a comprehensive overview of the characteristics of a large number of such instruments, addressing their applicability, strengths, and limitations. These depend on the setting, the expertise required, and the people involved, and all these factors need to be taken into account when choosing the most suitable scale or tool. We have also briefly discussed the use of objective biomarkers of BPSD. Finally, we have attempted to provide indications for future research in the field and suggest the ideal characteristics of a possible new tool, which should be short, easy to understand and use, and treatment oriented, providing clinicians with data such as frequency, severity, and triggers of behaviors and enabling them to find appropriate strategies to effectively tackle BPSD.
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Affiliation(s)
- Federico Emanuele Pozzi
- Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
| | - Luisa Calì
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Carlo Ferrarese
- Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ildebrando Appollonio
- Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Lucio Tremolizzo
- Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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15
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Complementary and integrative medicines for behavioral and psychological symptoms of dementia: Overview of systematic reviews. Explore (NY) 2023; 19:176-194. [PMID: 35973932 DOI: 10.1016/j.explore.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSDs) are major contributing factors to disease burden in dementia patients. Complementary and integrative medicine (CIM) has received attention in the management of dementia in patients with BPSDs. This overview aimed to comprehensively and critically review previous systematic reviews (SRs) of CIM modalities for BPSD management. METHODS Thirteen databases were searched in November 2021 to identify SRs on CIM for BPSDs. The methodological quality of the included studies was assessed using A MeaSurement Tool to Assess systematic Reviews 2. RESULTS Among 38 SRs, aromatherapy was the most commonly studied intervention, followed by herbal medicine (HM), acupuncture/acupressure, mindfulness-based interventions, relaxation, and Taichi. Half of the studies on aromatherapy reported significantly improved BPSDs, especially agitation, while the remainder reported mixed results/insufficient evidence. Most studies (85.71%) on HM supported its significant benefits in BPSDs. Yokukansan, an individual HM, was most frequently studied for BPSDs, with a significant beneficial effect on delusions, hallucinations, and agitation/aggression. Moreover, some meta-analyses supported the benefits of HM as an adjunct to psychotropic drugs in BPSD management. Other CIM interventions had insufficient clinical evidence. The methodological quality of the included studies was poor, and most were rated low or critically low (92.11%). CONCLUSION Aromatherapy, the most frequently investigated CIM for BPSD, had mixed results or insufficient evidence. HM, as an adjunct to psychotropic drugs including antipsychotics, exhibited additional benefits regarding the efficacy and safety for BPSDs. This overview emphasizes the requirement for greater quantity and quality of research in this field. REGISTRATION NUMBER Open Science Framework registry (g5f3m) (https://osf.io/g5f3m), PROSPERO (CRD42020211009) (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020211009).
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James IA, Reichelt K, Shirley L, Moniz-Cook E. Management of Agitation in Behaviours That Challenge in Dementia Care: Multidisciplinary Perspectives on Non-Pharmacological Strategies. Clin Interv Aging 2023; 18:219-230. [PMID: 36843632 PMCID: PMC9946002 DOI: 10.2147/cia.s399697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/19/2023] [Indexed: 02/19/2023] Open
Abstract
Objective NICE guidelines recommend non-pharmacological interventions as the first-line approach for the management of behaviours that challenge. Recent work, however, highlights dissatisfaction with the lack of detailed guidance in the national guidelines regarding non-drug interventions. This study examines the views of practitioners regarding non-pharmacological treatments. It further explores perspectives on non-pharmacological strategies used in the management of agitation occurring within episodes of behaviours that challenge. Methods Forty-two experienced practitioners attended a workshop where behaviours that challenge were described as occurring in three phases of agitation, using a framework adapted from the Positive Behaviour Support framework (pre-agitation, triggering and escalating, high level). The participants were asked to populate a template derived from the adapted framework. The completed templates recorded the clinical strategies the participants found useful to (i) prevent the occurrence of agitation, (ii) de-escalate distress and (iii) deal with perceived high levels of agitation. Results The Positive Behaviour Support conceptual framework was perceived by participants as helpful in organising their clinical work. A number of interventions were suggested as preventative strategies: music therapy, doll therapy, physical activity and generic person-centred communication skills to enhance wellbeing. In contrast, de-escalation strategies identified by the participants focused on reducing emotional distress. The approaches for dealing with continued high levels of agitation involved a number of "control and restraint" techniques as well as medication. Conclusion The template allowed specialist multidisciplinary professionals to identify skills for the management of distress and agitated behaviour linked to the respective phase of arousal. The template has scope to guide practitioners to identify the detail needed for the management of behaviours that challenge. The findings have the potential to influence the contents of forthcoming guidelines on alternatives to psychotropics in dementia care.
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Affiliation(s)
- Ian Andrew James
- Innovations Group, Cumbria Northumberland Tyne & Wear NHS Trust, Newcastle upon Tyne, UK,Correspondence: Ian Andrew James, Innovations Team, Campus for Ageing and Vitality, Westgate Road, Newcastle-Upon-Tyne, NE4 6BE, UK, Tel +44 7375635573, Email
| | - Katharina Reichelt
- Older People’s Services, Cumbria Northumberland Tyne & Wear NHS Trust, Newcastle upon Tyne, UK
| | - Louisa Shirley
- Clinical and Health Psychology, University of Manchester, Manchester, UK
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Trenaman SC, von Maltzahn M, Sketris I, Tamim H, Wang Y, Stewart SA. Patterns of Antipsychotic Dispensation to Long-Term Care Residents. J Am Med Dir Assoc 2023; 24:185-191.e6. [PMID: 36309099 DOI: 10.1016/j.jamda.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/29/2022] [Accepted: 09/24/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe dispensing patterns of antipsychotic medications to long-term care (LTC) residents and assess factors associated with continuation of an antipsychotic after a fall-related hospitalization. DESIGN A retrospective cohort study. SETTING AND PARTICIPANTS Nova Scotia Seniors Pharmacare Program (NSSPP) beneficiaries age 66 years and older who resided in LTC and received at least 1 dispensation of an antipsychotic within the study period of April 1, 2009, to March 31, 2017. METHODS Linkage of administrative claims data from the NSSPP and the Canadian Institute of Health Information Discharge Abstract Database identified LTC residents with an antipsychotic dispensation and from the subgroup of those dispensed antipsychotic medications who experienced a fall-related hospitalization. Antipsychotic dispensing patterns were reported with counts and means. Predictors of continuation of an antipsychotic after a fall-related hospitalization (sex, length of stay, days supplied, age, year of admission, rural/urban) were reported and analyzed with multiple logistic regression. RESULTS There were 19,164 unique NSSPP beneficiaries who were dispensed at least 1 prescription for an antipsychotic medication. Of those who received at least 1 antipsychotic dispensation 90% (n = 17,201) resided in LTC. A mean of 40% (n = 2637) of LTC residents received at least 1 antipsychotic dispensation in each year. Risperidone and quetiapine were dispensed most frequently. Of the 544 beneficiaries residing in LTC who survived a fall-related hospitalization, 439 (80.7%) continued an antipsychotic after hospital discharge. Female sex [OR 1.7, 95% CI (1.013‒2.943)], age 66‒69 [OR 4.587, 95% CI (1.4‒20.8)], 75-79 [OR 2.8, 95% CI (1.3‒6.3)], and 80‒84 years [OR 3.1, 95% CI (1.6‒6.4)] (compared with age 90+ years) were associated with increased risk of antipsychotic continuation. CONCLUSIONS AND IMPLICATIONS With 90% of antipsychotic dispensations in Nova Scotia being to LTC residents and 40% of LTC residents being dispensed antipsychotics in any year there is a need to address this level of antipsychotic dispensation to older adults.
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Affiliation(s)
| | - Maia von Maltzahn
- Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia.
| | - Ingrid Sketris
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia
| | - Hala Tamim
- School of Kinesiology and Health Science, York University, Toronto, Ontario
| | - Yan Wang
- Health Data Nova Scotia, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia
| | - Samuel A Stewart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia
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