Specific agitation behaviours in dementia differentially contribute to aspects of caregiver burden

Effects of simulated presence therapy on agitated behavior, cognition, and use of protective constraint among patients with senile dementia

The research was conducted to investigate the improvement of agitated behaviors, cognitive functions, and negative emotions among patients with senile dementia and the burden of caregivers after simulated presence therapy (SPT) intervention. 85 Patients with senile dementia were included as the research subjects and divided into control group (40 cases performed with routine nursing) and observation group (45 cases undergoing routine nursing combined with SPT) via a random number table method. Cohen-Mansfield agitation inventory (CAMI) and protective constraint were used to assess the improvement of agitated behaviors among patients. Besides, apathy evaluation scale-informant (AES-I), functional independence measure (FIM), self-rating depression scale (SDS), self-rating anxiety scale (SAS), clock drawing test, and caregiver burden inventory (CBI) were adopted to evaluate the differences in apathy, daily living and sociability, depression, anxiety, cognitive functions, and caregiver burden between the two groups. It was demonstrated that CAMI score, the duration of protective constraint use, AES-I score, SDS score, SAS score, and CBI score among patients in observation group all apparently decreased compared with those in control group after the intervention. In contrast, FIM and clock drawing test scores both notably increased (p < 0.05). The above findings suggested that SPT could obviously reduce the incidence of agitated behaviors, improve the level of apathy, daily living and sociability, depression, anxiety, and cognitive functions, and relieve caregiver burden among patients with senile dementia during SPT intervention for patients with senile dementia.

Longitudinal effects of ambivalent and guilt feelings on dementia family caregivers' depressive symptoms

BACKGROUND

The world prevalence of people with dementia is increasing. Most of the care received by people with dementia is provided by family caregivers, and this prolonged activity has a significant impact on caregivers' levels of depression. Stressors and frequency of leisure are known predictors of caregivers' depressive levels. The longitudinal impact of caregivers' ambivalent and guilt feelings is unknown.

METHODS

Participants were 177 family caregivers of relatives with dementia who were assessed three times during a 2-year period. In addition to demographic variables, psychological symptoms of the dementias, and frequency of leisure activities, caregivers' ambivalent feelings, guilt, and depressive symptoms were measured. The longitudinal association of changes in these variables with changes in caregivers' depressive symptoms over time was assessed using mixed linear models.

RESULTS

Changes over time in the assessed variables predicted 48.05% of variance of changes over time in depressive symptoms. Even when variables strongly associated with increased depressive symptoms were controlled (lower caregivers' age and educational level, higher reaction to BPSD, and lower leisure activities), increases in ambivalence and guilt contributed to an increase of 9.22% of the variance of changes depressive symptoms over a 2-year period. The effects of ambivalent feelings on depression are indirect, mediated by guilt feelings. Cessation of caregiving do not seem to alter these findings.

CONCLUSIONS

Caregivers' ambivalent and guilt feelings are significant predictors of caregivers' mental health. Caregivers may significantly benefit from early detection of ambivalent and guilt feelings and preventive strategies targeting triggers associated with ambivalent and guilt symptoms.

Effectiveness of dyadic sensory art therapies for People with dementia and their caregivers:A systematic review and meta-analysis

BACKGROUND

The need for dyadic intervention is enhanced with increasing numbers of older adults with dementia. Studies have shown that sensory art therapies are essential for dementia patients and their caregivers. The effects of dyadic sensory art therapies for people with dementia and their caregivers require further exploration.

OBJECTIVES

This review aimed to assess the efficacy of dyadic sensory art therapies on neuropsychiatric symptoms and mental function for dementia patients, caregiver burden and psychological state for caregivers, dyad relationship quality for dyads, and evaluate the potential effects of dyadic sensory art therapies on quality of life for both dementia patients and caregivers.

METHODS

An electronic literature search of the PubMed, EMBASE, CINAHL, Web of Science, Cochrane Library, PsycINFO and three Chinese databases (CNKI, Wanfang and CBM) was conducted up to November 2022. Two reviewers (SZ and QG) worked independently to identify relevant studies. Risk of bias was assessed by the Cochrane's and Joanna Briggs Institute's tool. Meta-analyses were conducted using RevMan software 5.4.

RESULTS

This systematic review included 15 studies (7 RCTs and 8 quasi-experimental studies). The meta-analysis showed that dyadic sensory art therapies significantly ameliorated neuropsychiatric symptoms (SMD = -0.90, 95% CI -1.61 to -0.20, P = .01), caregiver burden (SMD = -0.75; 95% CI -1.03 to -0.47; P < .001). No significant improvements were found in caregiver depression and quality of life for both patients and caregivers.

CONCLUSIONS

Dyadic sensory art therapies are generally effective at ameliorating neuropsychiatric symptoms, and caregiver burden. Future studies are encouraged to design large-scale randomized controlled trials with high-quality study to examine and confirm the effectiveness of dyadic sensory art therapies for these dyads composed of dementia patients and their caregivers.

TRIAL REGISTRATION

PROSPERO CRD 42023393577; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023393577.

A Confirmatory and an Exploratory Factor Analysis of the Cohen-Mansfield Agitation Inventory (CMAI) in a European Case Series of Patients with Dementia: Results from the RECage Study

BACKGROUND

One of the most widely used instruments for assessing agitation in dementia patients is the Cohen-Mansfield Agitation Inventory (CMAI), nevertheless no global score has been proposed. The aim of this study is: (a) to conduct a confirmatory (CFA) and exploratory factor analysis (EFA) of CMAI on people with dementia and Psychological and Behavioral Symptoms (BPSD), and (b) to propose an alternative structure, based on clinical criteria including all CMAI items.

METHODS

Confirmatory and exploratory factor analyses were carried out on the CMAI 29 items administered at baseline to 505 patients with dementia (PwD) and BPSD enrolled in the international observational RECage study.

RESULTS

The three-factor structure has not been confirmed by the CFA, whilst the EFA was carried out respectively on 25 items disregarding 4 items with a prevalence ≤5% and then on 20 items disregarding 9 items with a prevalence ≤10%. The four-factor structure explaining 56% of the variance comprised Physically Aggressive behavior, Verbally Aggressive behavior, Physically non-aggressive behavior, and Physically and verbally aggressive behavior.

CONCLUSIONS

A new grouping of all items according to a clinical criterion is proposed, allowing for a more sensible evaluation of the symptoms leading to better differentiation.