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Parrotta I, Cacciatore S, D'Andrea F, D'Anna M, Giancaterino G, Lazzaro G, Arcara G, Manzo N. Prevalence, treatment, and neural correlates of apathy in different forms of dementia: a narrative review. Neurol Sci 2024; 45:1343-1376. [PMID: 38015288 PMCID: PMC10942903 DOI: 10.1007/s10072-023-07197-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES The aim of this review is to provide an overview on prevalence and clinical tools for the diagnosis of apathy, as well as on neurophysiological and neuroimaging findings obtained from studies in patients with apathy in different forms of dementia, including Alzheimer's disease (AD), vascular (VaD) and mixed dementia, frontotemporal dementia (FTD), and Parkinson's disease dementia (PDD). METHODS Randomized controlled trials, non-randomized controlled trials, controlled before-after studies, and interrupted time series from four databases (WebOfScience, Scopus, Pubmed, and PsycINFO) addressing apathy in adults or older people aged over 65 years of age affected by dementia were included. RESULTS The prevalence of apathy was 26-82% for AD, 28.6-91.7 for VaD, 29-97.5% in PDD, and 54.8-88.0 in FTD. The assessment of apathy was not consistent in the reviewed studies. Methylphenidate was the most successful pharmacological treatment for apathy. Neurobiological studies highlighted the relationship between both structural and functional brain areas and the presence or severity of apathy. CONCLUSION Apathy is a very common disorder in all types of dementia, although it is often underdiagnosed and undertreated. Further studies are needed to investigate its diagnosis and management. A consensus on the different evaluation scales should be achieved.
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Affiliation(s)
- Ilaria Parrotta
- Movement Control and Neuroplasticity Research Group, Tervuursevest 101, 3001, Louvain, Belgium
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Italy
- Young Epidemiologists of the Italian Society of Gerontology and Geriatrics (SIGG) (YES) Working Group, Italian Society of Gerontology and Geriatrics, Via Giulio Cesare Vanini 5, 50129, Florence, Italy
| | - Stefano Cacciatore
- Young Epidemiologists of the Italian Society of Gerontology and Geriatrics (SIGG) (YES) Working Group, Italian Society of Gerontology and Geriatrics, Via Giulio Cesare Vanini 5, 50129, Florence, Italy.
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, 00168, Rome, Italy.
| | - Flavio D'Andrea
- Department of Human Neuroscience, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Marianna D'Anna
- Department of Human Neuroscience, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Giulia Giancaterino
- Department of Human Neuroscience, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Giovanni Lazzaro
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Italy
| | - Giorgio Arcara
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Italy
| | - Nicoletta Manzo
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Italy
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Noguchi T, Nakagawa T, Sugimoto T, Komatsu A, Kuroda Y, Uchida K, Ono R, Arai H, Sakurai T, Saito T. Behavioral and psychological symptoms of dementia and mortality risk among people with cognitive impairment: an 8-year longitudinal study from the NCGG-STORIES. J Epidemiol 2024:JE20230343. [PMID: 38522914 DOI: 10.2188/jea.je20230343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) are common among people with dementia from the early stages and can appear even in mild cognitive impairment (MCI). However, the prognostic impact of BPSD is unclear. This study examined the association between BPSD and mortality among people with cognitive impairment. METHODS This longitudinal study involved 1,065 males and 1,681 females (mean age: males = 77.1 years; females = 78.6 years) with MCI or dementia diagnosis, from the National Center for Geriatrics and Gerontology-Life Stories of People with Dementia (NCGG-STORIES), a single-center memory clinic-based cohort study in Japan that registered first-time outpatients from 2010-2018. Information about death was collected through a mail survey returned by participants or their close relatives, with an up to 8-year follow-up. BPSD was assessed using the Dementia Behavior Disturbance Scale (DBD) at baseline. RESULTS During the follow-up period, 229 (28.1%) male and 254 (15.1%) female deaths occurred. Cox proportional hazards regression analysis showed that higher DBD scores were significantly associated with increased mortality risk among males, but not females (compared with the lowest quartile score group, hazard ratios [95% confidence intervals] for the highest quartile score group = 1.59 [1.11-2.29] for males and 1.06 [0.66-1.70] for females). Among the DBD items, lack of interest in daily living, excessive daytime sleep, and refusal to receive care had a higher mortality risk. CONCLUSIONS The findings suggest a potential association between BPSD and poor prognosis among males with cognitive impairment.
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Affiliation(s)
- Taiji Noguchi
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London
- Japan Society for the Promotion of Science
| | - Takeshi Nakagawa
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology
| | - Taiki Sugimoto
- Department of Medicine, University of Washington
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology
- Center for Comprehensive Care and Research on Memory Disorders, Hospital, National Center for Geriatrics and Gerontology
| | - Ayane Komatsu
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology
| | - Yujiro Kuroda
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology
| | - Kazuaki Uchida
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology
| | - Rei Ono
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition
- Department of Public Health, Graduate School of Health Sciences, Kobe University
| | | | - Takashi Sakurai
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology
- Research Institute, National Center for Geriatrics and Gerontology
- Department of Cognition and Behavior Science, Nagoya University Graduate School of Medicine
| | - Tami Saito
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology
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Hwang Y, Kim J. Influence of caregivers' psychological well-being on the anxiety and depression of care recipients with dementia. Geriatr Nurs 2024; 55:44-51. [PMID: 37972435 DOI: 10.1016/j.gerinurse.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023]
Abstract
This study was conducted to examine how caregivers' psychological well-being influences the anxiety or depression of care recipients with dementia. A secondary data analysis was conducted using 666 dyads of older adults with dementia and their caregivers. The odds that care recipients with dementia would experience anxiety increased when caregivers had a negative relationship with care recipients (OR = 1.22, p = 0.042), lower perception of the positive aspects of caregiving (OR = 0.86, p = 0.047), or anxiety (OR = 2.41, p = 0.036). The odds that care recipients with dementia would experience depression increased when caregivers had a greater perception of the negative aspects of caregiving (OR = 1.15, p = 0.023) or anxiety (OR = 2.21, p = 0.045). Since care recipients with dementia and their caregivers spend considerable time together daily, caregivers' psychological well-being can impact care recipients' anxiety and depression.
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Affiliation(s)
- Yeji Hwang
- Seoul National University, College of Nursing and Research Institute of Nursing Science, Seoul, Korea.
| | - Jayeong Kim
- Seoul National University, College of Nursing and Research Institute of Nursing Science, Seoul, Korea
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García-Martín V, de Hoyos-Alonso MC, Delgado-Puebla R, Ariza-Cardiel G, Del Cura-González I. Burden in caregivers of primary care patients with dementia: influence of neuropsychiatric symptoms according to disease stage (NeDEM project). BMC Geriatr 2023; 23:525. [PMID: 37644410 PMCID: PMC10463529 DOI: 10.1186/s12877-023-04234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Caregiver burden is related to personal factors and patient characteristics and is greater when neuropsychiatric symptoms (NPSs) are present. OBJECTIVE Estimate the prevalence of burden among caregivers of dementia patients and its association with NPSs and identify NPSs causing greater caregiver distress according to dementia stage. METHODS A cross-sectional observational study in caregivers of noninstitutionalized dementia patients was conducted. Caregiver variables were sociodemographic, time of care, NPS-associated distress based on the Neuropsychiatric Inventory Caregiver Distress Scale (NPI-D) and burden based on the Zarit Burden Interview (ZBI). Patient variables were time since disease onset, Global Deterioration Scale (GDS) disease stage, functional assessment and NPS presence and intensity according to the Neuropsychiatric Inventory (NPI). The mean ZBI score, prevalence of burden and NPI-D score with 95% CIs at each dementia stage were estimated. Factors associated with burden were identified by multivariate analysis. RESULTS Of the 125 caregivers included, 77.6% were women, with a mean age of 60.7 (± 14.3) years; 78.4% (95%CI: 71.0; 86.0) experienced burden. The mean ZBI score was 12.3 (95%CI: 11.6; 12.9) and increased according to NPS number (p = 0.042). The NPSs causing the most burden were disinhibition (93.5%), irritability (87.3%) and agitation (86.1%). Agitation, apathy, and sleep disorders were the NPSs generating the greatest overall caregiver distress; depression (max NPI-D 1.9), hyperactivity (max NPI-D 2.1), and psychosis symptoms (max NPI-D 1.6) generated the greatest distress at stage GDS 3, stages GDS 4-5, and stages GDS 6-7, respectively. The NPI score (OR = 1.0, 95%CI 1.0; 1.1), intensity of irritability (OR = 1.2, 95%CI 1.0; 1.6), disinhibition (OR = 2.6, 95%CI 1.1; 5.8) and hyperactivity subsyndrome (OR = 1.1, 95%CI 1.0; 1.2) were associated with caregiver burden. Other associated factors were female gender (OR = 6.0, 95%CI 1.6; 22.8), ≥ 8 h daily care (OR = 5.6, 95%CI 1.4; 22.8), working outside the home (OR = 7.6, 95%CI 1.8; 31.8), living with the patient (OR = 4.5, 95%CI 1.1; 19.6), kinship (OR = 5.4, 95%CI 1.0; 28.2) and lower patient education (OR = 8.3, 95%CI 2.3; 30.3). CONCLUSIONS The burden on caregivers of dementia patients is high and associated with NPS presence and intensity. Disinhibition and irritability caused the highest burden. Depression, hyperactivity and psychosis produce more distress in mild, mild-moderate and severe dementia, respectively.
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Affiliation(s)
- Victoria García-Martín
- Epidemiology and Public Health, Universidad Rey Juan Carlos (Rey Juan Carlos University), Madrid, Spain.
| | - M Canto de Hoyos-Alonso
- Pedro Laín Entralgo Health Care Center, Primary Care Management, Madrid Health Service, Alcorcón, Madrid, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
| | - Rosalía Delgado-Puebla
- Primary Care Management, Horta Health Care Center, Catalonia Health Service, Barcelona, Catalonia, Spain
| | - Gloria Ariza-Cardiel
- Family and Community Medicine Teaching Unit Oeste, Primary Care Management, Madrid Health Service, Móstoles, Madrid, Spain
| | - Isabel Del Cura-González
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
- Research Unit, Primary Care Management, Madrid Health Service, Madrid, Spain
- Department of Medical Specialties and Public Health, Universidad Rey Juan Carlos (Rey Juan Carlos University), Alcorcón, Madrid, Spain
- Ageing Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Instituto Investigación Sanitaria Gregorio Marañón IiSGM, Madrid, Spain
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Chen YR, Huang WY, Lee TY, Chu H, Chiang KJ, Jen HJ, Liu D, Chen R, Kang XL, Lai YJ, Chou KR. Efficacy of Blue LED Phototherapy on Sleep Quality and Behavioral and Psychological Symptoms of Dementia: A Double-Blind Randomized Controlled Trial. Gerontology 2023; 69:1175-1188. [PMID: 37527625 DOI: 10.1159/000531968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION People with dementia often experience behavioral and psychological symptoms of dementia (BPSD), which are a major cause of caregiver burden and institutionalization. Therefore, we conducted a double-blind, parallel-group randomized controlled trial to examine the efficacy of blue-enriched light therapy for BPSD in institutionalized older adults with dementia. METHODS Participants were enrolled and randomly allocated into blue-enriched light therapy (N = 30) or the conventional light group (N = 30) for 60 min in 10 weeks with five sessions per week. The primary outcome was sleep quality measured by actigraphy and Pittsburgh Sleep Quality Index (PSQI). The secondary outcome was overall BPSD severity (Cohen-Mansfield Agitation Inventory [CMAI] and Neuropsychiatric Inventory [NPI-NH]). The outcome indicators were assessed at baseline, mid-test, immediate posttest, 1-month, 3-month, and 6-month follow-up. The effects of the blue-enriched light therapy were examined by the generalized estimating equation model. RESULTS Blue-enriched light therapy revealed significant differences in the objective sleep parameters (sleep efficiency: β = 5.81, Waldχ2 = 32.60, CI: 3.82; 7.80; sleep latency: β = -19.82, Waldχ2 = 38.38, CI:-26.09; -13.55), subjective sleep quality (PSQI: β = -2.07, Waldχ2 = 45.94, CI: -2.66; -1.47), and overall BPSD severity (CMAI: β = -0.90, Waldχ2 = 14.38, CI: -1.37; -0.44) (NPI-NH: β = -1.67, Waldχ2 = 30.61, CI: -2.26; -1.08) compared to conventional phototherapy immediate posttest, 1-month, 3-month, and 6-month follow-up. Furthermore, the effects for sleep efficiency and sleep latency lasted for up to 6 months. In the subscale analysis, the differences of the behavioral symptoms changed significantly between the groups in physical/nonaggressive (CI: -1.01; -0.26) and verbal/nonaggressive (CI: -0.97; -0.29). CONCLUSIONS Blue-enriched light therapy is a feasible low-cost intervention that could be integrated as a comprehensive therapy program for BPSD among older adults with dementia.
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Affiliation(s)
- Ying-Ren Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Wen-Yu Huang
- Department of Nursing, Taipei Veterans General Hospital, Yuanshan Branch, I-lan, Taipei, Taiwan
| | - Tso-Ying Lee
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Nursing Research Center, Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kai-Jo Chiang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Xiao Linda Kang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Nursing, University of Pennsylvania, PA, Philadelphia, USA
| | - Yueh-Jung Lai
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
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Hayashi Y, Hyodo F, Tana, Nakagawa K, Ishihara T, Matsuo M, Shimohata T, Nishihira J, Kobori M, Nakagawa T. Continuous intake of quercetin-rich onion powder may improve emotion but not regional cerebral blood flow in subjects with cognitive impairment. Heliyon 2023; 9:e18401. [PMID: 37533986 PMCID: PMC10391933 DOI: 10.1016/j.heliyon.2023.e18401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023] Open
Abstract
Depression in later life is associated with dementia. Changes in motivated behavior are an important mechanism contributing to dysfunctional cognitive control in depression. Although continuous intake of quercetin-rich onion suppresses cognitive decline in aged people by improving their emotional condition, the effect of quercetin-rich onion on emotional condition in people living with cognitive impairment remains unclear. In this randomized, double-blind, placebo-controlled study of subjects with cognitive impairment, we found that subjects wrote more adjectives and adverbs per sentence on the Mini-Mental State Examination after intake of quercetin-rich onion powder than before intake, although regional cerebral blood flow on n-isopropyl-4-[123]iodoamphetamine hydrochloride single-photon emission computed tomography was not changed. In the EPM, mice that had received a quercetin-supplemented chow diet made a significantly increased number of exploratory head dips from the open arms of the maze. Moreover, the 3-methoxycarbonyl-2,2,5,5-tetramethyl-pyrrolidine-1-oxyl decay rate, reflecting redox activity, was increased in mice fed a quercetin-added diet. These results indicate that quercetin-rich onion may affect motivated behavior in subjects with cognitive impairment, for whom quercetin intake may preserve redox homeostasis in the brain.
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Affiliation(s)
- Yuichi Hayashi
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Fuminori Hyodo
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu, Japan
- Institute for Advanced Study Gifu University, Gifu, Japan
| | - Tana
- Department of Neurobiology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kiyomi Nakagawa
- Department of Neurobiology, Gifu University Graduate School of Medicine, Gifu, Japan
- Department of Nursing, University of Tokyo Health Science, Tokyo, Japan
| | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takayoshi Shimohata
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Jun Nishihira
- Department of Medical Management and Informatics, Hokkaido Information University, Hokkaido, Japan
| | - Masuko Kobori
- Institute of Food Research, National Agriculture and Food Research Organization, Ibaraki, Japan
| | - Toshiyuki Nakagawa
- Department of Neurobiology, Gifu University Graduate School of Medicine, Gifu, Japan
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Yang Z, Zhou Y. The repetitive transcranial magnetic stimulation in Alzheimer's disease patients with behavioral and psychological symptoms of dementia: a case report. BMC Psychiatry 2023; 23:354. [PMID: 37221495 DOI: 10.1186/s12888-023-04864-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/09/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation is a noninvasive intervention, can significantly reduce behavioral and psychological symptoms and cognitive impairment in AD patients. Only few cases have been reported the adverse reactions after the treatment. This report described the different adverse reactions after repetitive transcranial magnetic stimulation with different parameters. PATIENT PRESENTATION This article reports a patient with dementia complicated with mental behavior disorder who was treated with repetitive transcranial magnetic stimulation (rTMS) in spite of poor drug response. First, 1 Hz rTMS was initiated. After 1 month, the patient showed improved symptoms of mental behavior, decreased cognitive function and prolonged sleep duration. After switched to 10 Hz rTMS, the patient's cognitive function and mental behavior abnormalities improved, and the sleep time returned to normal. However, epilepsy occurred after one session and was changed to 0.8 Hz rTMS treatment. The patient's symptoms improved and did not have seizure. CONCLUSION Repetitive transcranial magnetic stimulation has a positive effect on cognitive function and Behavioral And Psychological Symptoms Of Dementia, and adverse reactions are inevitable. Playing personalized treatment according to the patients can reduce occurrence of adverse reactions.
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Affiliation(s)
- Zhen Yang
- University of South China, Heng Yang, 421001, China
| | - Ying Zhou
- Neurology Department, The First Hospital Of Chang Sha, Chang Sha City, 410000, China.
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Hsieh CJ, Li PS, Wang CH, Lin SL, Hsu TC, Tsai CM. Socially Assistive Robots for People Living with Dementia in Long-Term Facilities: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Gerontology 2023; 69:1027-1042. [PMID: 36871553 PMCID: PMC10407835 DOI: 10.1159/000529849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The purpose of our study was to explore the immediate and long-term effects of socially assistive robots (SARs) on neuropsychiatric symptoms (NPSs), behavioral and psychological symptoms of dementia (BPSD), positive emotional experiences, and social interaction in older people living with dementia. METHODS We set keywords and used Boolean operators to search the CINAHL, Cochrane Library, EMBASE, IEEE Digital Library, MEDLINE, PsycINFO, PubMed, Web of Science, Scopus, and Chinese Electronic Periodical Service from inception to February 2022 for randomized controlled trials. The Cochrane Collaboration bias assessment tool was used to assess article quality, and RevMan 5.4.1 software was used to conduct the meta-analysis. RESULTS A total of 14 studies were included in the meta-analysis. SARs can help people living with dementia reduce their NPS of depression and anxiety, provide happiness from positive emotional experiences, and improve their social interaction through conversation. However, there was no significant improvement in agitation behavior, overall BPSD, or quality of life in people living with dementia. In follow-up, it was found that the effect of SRT was limited. CONCLUSION SARs can reduce depression and increase positive emotions in people living with dementia. They may also reduce the burden on healthcare workers during the COVID-19 pandemic. This research was registered on PROSPERO CRD42020169340.
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Affiliation(s)
- Chia-Jung Hsieh
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Pei-Shan Li
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Hui Wang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Shu-Ling Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Chi Hsu
- Department of Computer Science and Information Engineering, National Ilan University, Ilan, Taiwan
| | - Chia-Mei Tsai
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- School of Nursing, Department of Nursing, Fooyin University, Kaohsiung, Taiwan
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Fisher DW, Dunn JT, Keszycki R, Rodriguez G, Bennett DA, Wilson RS, Dong H. Unique Transcriptional Signatures Correlate with Behavioral and Psychological Symptom Domains in Alzheimer's Disease. Res Sq 2023:rs.3.rs-2444391. [PMID: 36711772 PMCID: PMC9882691 DOI: 10.21203/rs.3.rs-2444391/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Despite the significant burden, cost, and worse prognosis of Alzheimer's disease (AD) with behavioral and psychological symptoms of dementia (BPSD), little is known about the molecular causes of these symptoms. Using antemortem assessments of BPSD in AD, we demonstrate that individual BPSD can be grouped into 4 domain factors in our sample: affective, apathy, agitation, and psychosis. Then, we performed a transcriptome-wide analysis for each domain utilizing bulk RNA-seq of post-mortem anterior cingulate cortex (ACC) tissue. Though all 4 domains are associated with a predominantly downregulated pattern of hundreds of differentially expressed genes (DEGs), most DEGs are unique to each domain, with only 22 DEGs being common to all BPSD domains, including TIMP1. Weighted gene co-expression network analysis (WGCNA) yielded multiple transcriptional modules that were shared between BPSD domains or unique to each domain, and NetDecoder was used to analyze context-dependent information flow through the biological network. For the agitation domain, we found that all DEGs and a highly correlated transcriptional module were functionally enriched for ECM-related genes including TIMP1, TAGLN, and FLNA. Another unique transcriptional module also associated with the agitation domain was enriched with genes involved in post-synaptic signaling, including DRD1, PDE1B, CAMK4, and GABRA4. By comparing context-dependent changes in DEGs between cases and control networks, ESR1 and PARK2 were implicated as two high impact genes associated with agitation that mediated significant information flow through the biological network. Overall, our work establishes unique targets for future study of the biological mechanisms of BPSD and resultant drug development.
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Affiliation(s)
- Daniel W. Fisher
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine
- Department of Psychiatry and Behavioral Sciences,
University of Washington School of Medicine
| | - Jeffrey T. Dunn
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine
| | - Rachel Keszycki
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine
- Mesulam Center for Cognitive Neurology and
Alzheimer’s Disease, Northwestern University Feinberg School of
Medicine
| | - Guadalupe Rodriguez
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine
| | | | | | - Hongxin Dong
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine
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Ouanes S, Rabl M, Clark C, Kirschbaum C, Popp J. Persisting neuropsychiatric symptoms, Alzheimer's disease, and cerebrospinal fluid cortisol and dehydroepiandrosterone sulfate. Alzheimers Res Ther 2022; 14:190. [PMID: 36529757 PMCID: PMC9762003 DOI: 10.1186/s13195-022-01139-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Neuropsychiatric symptoms are important treatment targets in the management of dementia and can be present at very early clinical stages of neurodegenerative diseases. Increased cortisol has been reported in Alzheimer's disease (AD) and has been associated with faster cognitive decline. Elevated cortisol output has been observed in relation to perceived stress, depression, and anxiety. Dehydroepiandrosterone sulfate (DHEAS) has known anti-glucocorticoid effects and may counter the effects of cortisol. OBJECTIVES We aimed to examine whether CSF cortisol and DHEAS levels were associated with (1) neuropsychiatric symptoms at baseline, (2) changes in neuropsychiatric symptoms over 3 years, and (3) whether these associations were related to or independent of AD pathology. METHODS One hundred and eighteen participants on a prospective study in a memory clinic setting, including patients with cognitive impairment (n = 78), i.e., mild cognitive impairment or mild dementia, and volunteers with normal cognition (n = 40), were included. Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory Questionnaire (NPI-Q). CSF cortisol and DHEAS, as well as CSF AD biomarkers, were obtained at baseline. Neuropsychiatric symptoms were re-assessed at follow-up visits 18 and 36 months from baseline. We constructed linear regression models to examine the links between baseline neuropsychiatric symptoms, the presence of AD pathology as indicated by CSF biomarkers, and CSF cortisol and DHEAS. We used repeated-measures mixed ANCOVA models to examine the associations between the neuropsychiatric symptoms' changes over time, baseline CSF cortisol and DHEAS, and AD pathology. RESULTS Higher CSF cortisol was associated with higher NPI-Q severity scores at baseline after controlling for covariates including AD pathology status (B = 0.085 [0.027; 0.144], p = 0.027; r = 0.277). In particular, higher CSF cortisol was associated with higher baseline scores of depression/dysphoria, anxiety, and apathy/indifference. Elevated CSF cortisol was also associated with more marked increase in NPI-Q scores over time regardless of AD status (p = 0.036, η2 = 0.207), but this association was no longer significant after controlling for BMI and the use of psychotropic medications. CSF DHEAS was associated neither with NPI-Q scores at baseline nor with their change over time. Cortisol did not mediate the association between baseline NPI-Q and changes in clinical dementia rating sum of boxes over 36 months. CONCLUSION Higher CSF cortisol may reflect or contribute to more severe neuropsychiatric symptoms at baseline, as well as more pronounced worsening over 3 years, independently of the presence of AD pathology. Our findings also suggest that interventions targeting the HPA axis may be helpful to treat neuropsychiatric symptoms in patients with dementia.
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Affiliation(s)
- Sami Ouanes
- grid.8515.90000 0001 0423 4662Old Age Psychiatry, Department of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland ,grid.413548.f0000 0004 0571 546XDepartment of Psychiatry, Hamad Medical Corporation, PO BOX 3050, Doha, Qatar
| | - Miriam Rabl
- grid.412004.30000 0004 0478 9977Centre for Gerontopsychiatric Medicine, Department of Geriatric Psychiatry, University Hospital of Psychiatry, Minervastrasse 145, P.O. Box 341, 8032 Zurich, Switzerland
| | - Christopher Clark
- grid.412004.30000 0004 0478 9977Centre for Gerontopsychiatric Medicine, Department of Geriatric Psychiatry, University Hospital of Psychiatry, Minervastrasse 145, P.O. Box 341, 8032 Zurich, Switzerland
| | - Clemens Kirschbaum
- grid.4488.00000 0001 2111 7257Biopsychology, Technische Universität Dresden, Andreas Schubert Bau, Dresden, Germany
| | - Julius Popp
- grid.8515.90000 0001 0423 4662Old Age Psychiatry, Department of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland ,grid.412004.30000 0004 0478 9977Centre for Gerontopsychiatric Medicine, Department of Geriatric Psychiatry, University Hospital of Psychiatry, Minervastrasse 145, P.O. Box 341, 8032 Zurich, Switzerland
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11
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Honjo Y, Kawasaki I, Nagai K, Harada S, Ogawa N. Neuropsychiatric Inventory Questionnaire Associated with Cognitive Function, Age, and Duration of Education in Patients with Alzheimer's Disease. Dement Geriatr Cogn Disord 2022; 51:285-290. [PMID: 35820373 DOI: 10.1159/000525670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/14/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Alzheimer's disease (AD) is the most common cognitive disease, and behavioral and psychological symptoms of dementia (BPSD) can place a heavy burden on families. The presence of these symptoms related to AD is commonly assessed using the Neuropsychiatric Inventory Questionnaire (NPI-Q). This study sought to clarify the relationship between scores on the 12-domain NPI-Q and individual factors in patients with AD. METHODS Participants were 218 new outpatients with AD at five memory clinics. Cognitive function was assessed using the Revised Hasegawa Dementia Scale (HDS-R) and Mini-Mental State Examination (MMSE). We examined which individual factors were associated with the total NPI-Q score and the number of domains. We also examined which domains were associated with the factors identified. RESULTS A higher total NPI score was significantly associated with lower scores on both cognitive assessments and a longer duration of education. Exhibiting symptoms on a greater number of domains was significantly associated with lower scores on both cognitive assessments, longer duration of education, and advanced age. The nighttime disturbances domain was significantly associated with lower scores on both cognitive assessments and advanced age. The delusions domain was significantly associated with lower education. CONCLUSIONS BPSD may appear more easily with reduced quality of life and ongoing dissatisfaction. Effective individualized services are important for patients with AD, and therefore, we should account for age, cognitive function, and duration of education in the services provided.
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Affiliation(s)
- Yasuyuki Honjo
- Memory Clinic, Kyoto Kaisei Hospital, Kyoto, Japan.,Memory Clinic, Kyoto Miniren Asukai Hospital, Kyoto, Japan.,Memory Clinic, Seika-town National Health Insurance Hospital, Kyoto, Japan.,Memory Clinic, Kyoto Narabigaoka Hospital, Kyoto, Japan.,Department of Occupational Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
| | - Ippei Kawasaki
- Department of Occupational Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
| | - Kuniaki Nagai
- Department of Occupational Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
| | - Shun Harada
- Department of Occupational Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
| | - Noriyuki Ogawa
- Department of Occupational Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
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12
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Kai A, Ishii S, Ishii T, Fuchino K, Okamura H. Factors Associated with Caregiver Burden and Depressive States among Family Caregivers of Patients Admitted due to Behavioral and Psychological Symptoms of Dementia. Dement Geriatr Cogn Disord 2022; 51:262-270. [PMID: 35767940 DOI: 10.1159/000525354] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/13/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Among those caring for people with dementia (PwD) at home, more than 60% feel a caregiver burden (CB), and one in three are depressed. Reducing feelings of burden and depressive states in caregiving families will improve the living environment for PwD. However, very few studies have focused on effective methods and reducing feelings of burden and depressive states of caregivers. Thus, using data from a previous study, we aimed to determine the factors associated with perceived CB and depressive states experienced by caregivers for PwD with behavioral and psychological symptoms of dementia (BPSD) at home. METHODS We performed single regression analysis on 285 participants' data to determine the association between each item and the Zarit Caregiver Burden Interview and Center for Epidemiologic Studies-Depression Scale scores. We performed multiple regression analysis with variables considered in the single regression analysis as independent variables. RESULTS Severity of BPSD, caregivers' subjective health status (SHS), time of caregiving, and depressive states were related to CB, and caregivers' SHS and CB were related to depressive states. CONCLUSIONS Similar to previous studies, we identified an association between family caregivers' perceived CB and BPSD in PwD. Additionally, we found that caregivers' SHS is commonly associated with both perceived CB and depressive states. This is a new finding. Our results suggest that interventions focusing on family caregivers' health status can help not only to reduce family caregivers' CB and depressive states but also stabilize patients' symptoms and provide home-based care for a longer time.
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Affiliation(s)
- Aoi Kai
- Department of Psychosocial Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinya Ishii
- Department of Medicine for Integrated Approach to Social Inclusion, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Ishii
- Medical Corporation Tijinkai, Maple Hill Hospital, Otake, Japan
| | | | - Hitoshi Okamura
- Department of Psychosocial Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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13
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Roßmeier C, Gast J, Riedl L, Hartmann J, Kohl S, Hartmann F, Diehl-Schmid J. [Deprescribing of antipsychotic drugs for dementia : Recommendations for action on dose reduction and discontinuation attempts]. Nervenarzt 2022; 93:912-920. [PMID: 35771240 PMCID: PMC9243982 DOI: 10.1007/s00115-022-01343-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/06/2022]
Abstract
Hintergrund In Leitlinien zur Behandlung von psychischen und Verhaltenssymptomen bei Demenz („Behavioral and Psychological Symptoms of Dementia“ [BPSD]) wird empfohlen, Antipsychotika im Falle einer notwendigen Therapie zeitlich begrenzt und in möglichst geringer Dosis einzusetzen. Fragestellung Um das Bewusstsein für die Risiken einer Antipsychotikabehandlung bei Patient:innen mit Demenz und die dadurch begründete Notwendigkeit einer zeitlich begrenzten und möglichst niedrig dosierten Antipsychotikabehandlung zu schärfen, wurden Handlungsempfehlungen zum Deprescribing von Antipsychotika bei Menschen mit Demenz entwickelt. Material und Methoden Die Entwicklung der Handlungsempfehlungen erfolgte in einem mehrstufigen Prozess: 1. Literaturrecherche unter besonderer Würdigung von konsentierten Leitlinienempfehlungen und Ergebnissen einer eigenen Interventionsstudie (READY-Studie), 2. Diskussion und Konsentierung in einem Expert:innengremium, 3. Onlineumfrage von in Deutschland tätigen ärztlichen Demenzexpert:innen. Ergebnisse Aus 51 im ersten Entwurf zusammengestellten Aussagen wurden nach der Diskussion im multiprofessionellen Expert:innengremium 32 Aussagen zum „Deprescribing“ (Reduktion und Ausschleichen) von Antipsychotika formuliert. 25 der 32 Aussagen wurden nach Konsentierung in einer Onlineumfrage durch ärztliche Demenzexpert:innen final übernommen. Diskussion In Deutschland gibt es bislang keine konkreten Empfehlungen zur Vorgehensweise bei Reduktion und Absetzen von Antipsychotika, die zur Behandlung von BPSD bei Menschen mit Demenz eingesetzt werden. Die vorgelegte Arbeit soll als Handlungsempfehlung für Haus- und Fachärzt:innen dienen. Bei den Empfehlungen handelt es sich um keine Leitlinien, sie ersetzen nicht die Eigenverantwortlichkeit der Behandelnden und das individuell notwendige Vorgehen in Abhängigkeit von der Behandlungssituation. Zusatzmaterial online Die Onlineversion dieses Beitrags (10.1007/s00115-022-01343-w) enthält zusätzliches Material. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, die Videos finden Sie beim Beitrag unter „Ergänzende Inhalte“.
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Affiliation(s)
- Carola Roßmeier
- Fakultät für Medizin, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland. .,Fachbereich Alterspsychiatrie, kbo-Inn-Salzach-Klinikum GmbH, Gabersee 7, 83512, Wasserburg am Inn, Deutschland.
| | - Jennifer Gast
- Fakultät für Medizin, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Lina Riedl
- Fakultät für Medizin, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Julia Hartmann
- Fakultät für Medizin, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Sarah Kohl
- Fakultät für Medizin, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Florentine Hartmann
- Fakultät für Medizin, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Janine Diehl-Schmid
- Fakultät für Medizin, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.,Fachbereich Alterspsychiatrie, kbo-Inn-Salzach-Klinikum GmbH, Gabersee 7, 83512, Wasserburg am Inn, Deutschland
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14
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Gedde MH, Husebo BS, Mannseth J, Naik M, Selbaek G, Vislapuu M, Berge LI. The impact of medication reviews by general practitioners on psychotropic drug use and behavioral and psychological symptoms in home-dwelling people with dementia: results from the multicomponent cluster randomized controlled LIVE@Home.Path trial. BMC Med 2022; 20:186. [PMID: 35614509 PMCID: PMC9132600 DOI: 10.1186/s12916-022-02382-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There is limited knowledge regarding the process of deprescribing psychotropic drugs to people with dementia (PwD) conducted by general practitioners (GP). We investigated the impact of a multicomponent intervention, emphasizing medication reviews, on psychotropic drugs and behavioral and psychological symptoms (BPSD) in home-dwelling PwD and quantified change in patient-GP communication evaluated by their informal caregivers. METHODS LIVE@Home.Path is a stepped-wedge closed-cohort cluster randomized controlled trial for people with mild to moderate dementia aged ≥65 and their informal caregivers (dyads) in Norway. Complementary to health care as usual (control condition), municipal coordinators implemented the multicomponent LIVE intervention: Learning, Innovation, Volunteer support, and Empowerment (including medication review by the PwD's regular GPs). Block-randomization was used to allocate dyads in three groups receiving the intervention sequentially in periods of 6 months duration. Prepandemic data from the first period is reported, resulting in a 1:2 intervention-to-control ratio. Primary outcome was change in psychotropic drug use. Secondary outcomes were changes in BPSD by Neuropsychiatric Inventory and Cornell Scale of Depression in Dementia and patient-GP communication by an adaption of the Clinical Global Impression of Change. RESULTS Four hundred thirty-eight dyads were screened, 280 included, and 237 participated at 6 months (intervention group n=67; control condition n=170). At baseline, 63% used psychotropic medication regularly: antidementia drugs (47%), antidepressants (13%), hypnotics/sedatives (13%), antipsychotics (5%), and anxiolytics (2%). At 6 months, medication reviews were more frequently conducted in the intervention group compared to control (66% vs 42%, P=0.001). We found no differences regarding a change in drug use and BPSD. Patient-GP communication enhanced in the intervention group (mean score 0.95 [standard deviation 1.68] vs 0.41 [1.34], P=0.022). In the intervention group, control group, and overall sample, the informal caregivers of those who had their medications reviewed reported improved patient-GP communication compared to those who did not. CONCLUSIONS Change in psychotropic drug use and BPSD did not differ, even though patient-GP communication improved with medication reviews. Restricted psychotropic drug use among PwD likely reflects more judicious prescribing practices in recent years. Nevertheless, medication reviews could be cultivated to optimize pharmacologic treatment for this complex population. TRIAL REGISTRATION ClinicalTrials.gov : NCT04043364 ; registered 15/03/2019.
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Affiliation(s)
- Marie H Gedde
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway. .,Haraldsplass Deaconess Hospital, Bergen, Norway.
| | - Bettina S Husebo
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,Municipality of Bergen, Bergen, Norway
| | - Janne Mannseth
- Section for Epidemiology and Medical Statistic, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Mala Naik
- Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Geir Selbaek
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Geriatric Department, Oslo University Hospital, Oslo, Norway
| | - Maarja Vislapuu
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Line Iden Berge
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,NKS Olaviken Gerontopsychiatric Hospital, Askøy, Norway
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15
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Eikelboom WS, Pan M, Ossenkoppele R, Coesmans M, Gatchel JR, Ismail Z, Lanctôt KL, Fischer CE, Mortby ME, van den Berg E, Papma JM. Sex differences in neuropsychiatric symptoms in Alzheimer's disease dementia: a meta-analysis. Alzheimers Res Ther 2022; 14:48. [PMID: 35379344 DOI: 10.1186/s13195-022-00991-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/17/2022] [Indexed: 12/25/2022]
Abstract
Background Neuropsychiatric symptoms (NPS) are common in individuals with Alzheimer’s disease (AD) dementia, but substantial heterogeneity exists in the manifestation of NPS. Sex differences may explain this clinical variability. We aimed to investigate the sex differences in the prevalence and severity of NPS in AD dementia. Methods Literature searches were conducted in Embase, MEDLINE/PubMed, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, PsycINFO, and Google Scholar from inception to February 2021. Study selection, data extraction, and quality assessment were conducted in duplicate. Effect sizes were calculated as odds ratios (OR) for NPS prevalence and Hedges’ g for NPS severity. Data were pooled using random-effects models. Sources of heterogeneity were examined using meta-regression analyses. Results Sixty-two studies were eligible representing 21,554 patients (61.2% females). The majority of the included studies had an overall rating of fair quality (71.0%), with ten studies of good quality (16.1%) and eight studies of poor quality (12.9%). There was no sex difference in the presence of any NPS (k = 4, OR = 1.35 [95% confidence interval 0.78, 2.35]) and overall NPS severity (k = 13, g = 0.04 [− 0.04, 0.12]). Regarding specific symptoms, female sex was associated with more prevalent depressive symptoms (k = 20, OR = 1.60 [1.28, 1.98]), psychotic symptoms (general psychosis k = 4, OR = 1.62 [1.12, 2.33]; delusions k = 12, OR = 1.56 [1.28, 1.89]), and aberrant motor behavior (k = 6, OR = 1.47 [1.09, 1.98]). In addition, female sex was related to more severe depressive symptoms (k = 16, g = 0.24 [0.14, 0.34]), delusions (k = 10, g = 0.19 [0.04, 0.34]), and aberrant motor behavior (k = 9, g = 0.17 [0.08, 0.26]), while apathy was more severe among males compared to females (k = 11, g = − 0.10 [− 0.18, − 0.01]). There was no association between sex and the prevalence and severity of agitation, anxiety, disinhibition, eating behavior, euphoria, hallucinations, irritability, and sleep disturbances. Meta-regression analyses revealed no consistent association between the effect sizes across studies and method of NPS assessment and demographic and clinical characteristics. Discussion Female sex was associated with a higher prevalence and greater severity of several specific NPS, while male sex was associated with more severe apathy. While more research is needed into factors underlying these sex differences, our findings may guide tailored treatment approaches of NPS in AD dementia. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-022-00991-z.
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Freedman M, Binns MA, Serediuk F, Wolf MU, Danieli E, Pugh B, Gale D, Abdellah E, Teleg E, Halper M, Masci L, Lee A, Kirstein A. Virtual Behavioral Medicine Program: A Novel Model of Care for Neuropsychiatric Symptoms in Dementia. J Alzheimers Dis 2022; 86:1169-1184. [PMID: 35180119 PMCID: PMC9108590 DOI: 10.3233/jad-215403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with severe neuropsychiatric symptoms (NPS) due to dementia are often uprooted from their familiar environments in long-term care or the community and transferred to emergency departments, acute care hospitals, or specialized behavioral units which can exacerbate NPS. To address this issue, we developed the Virtual Behavioral Medicine Program (VBM), an innovative model of virtual care designed to support management of patients with NPS in their own environment. OBJECTIVE To determine efficacy of VBM in reducing admission to a specialized inpatient neurobehavioral unit for management of NPS. METHODS We reviewed outcomes in the first consecutive 95 patients referred to VBM. Referrals were classified into two groups. In one group, patients were referred to VBM with a simultaneous application to an inpatient Behavioral Neurology Unit (BNU). The other group was referred only to VBM. The primary outcome was reduction in proportion of patients requiring admission to the BNU regardless of whether they were referred to the BNU or to VBM alone. RESULTS For patients referred to VBM plus the BNU, the proportion needing admission to the BNU was reduced by 60.42%. For patients referred to VBM alone, it was 68.75%. CONCLUSION VBM is a novel virtual neurobehavioral unit for treatment of NPS. Although the sample size was relatively small, especially for the VBM group, the data suggest that this program is a game changer that can reduce preventable emergency department visits and acute care hospital admissions. VBM is a scalable model of virtual care that can be adopted worldwide.
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Affiliation(s)
- Morris Freedman
- Department of Medicine (Neurology), Baycrest Health Sciences, Mt. Sinai Hospital, and University of Toronto, Ontario, Canada.,Rotman Research Institute of Baycrest Centre, Toronto, Ontario, Canada
| | - Malcolm A Binns
- Rotman Research Institute of Baycrest Centre, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | | | - M Uri Wolf
- Department of Psychiatry, Baycrest Health Sciences and University of Toronto, Ontario Canada
| | | | - Bradley Pugh
- Rotman Research Institute of Baycrest Centre, Toronto, Ontario, Canada.,Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Deb Gale
- Department of Psychiatry, Baycrest Health Sciences and University of Toronto, Ontario Canada
| | | | - Ericka Teleg
- Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Mindy Halper
- Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Lauren Masci
- Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Adrienne Lee
- Baycrest Health Sciences, Toronto, Ontario, Canada
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17
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Rijksen DOC, Zuidema SU, de Haas EC. Use of Benzodiazepines and Z-Drugs in Nursing Home Residents with Dementia: Prevalence and Appropriateness. J Alzheimers Dis Rep 2022; 5:871-879. [PMID: 35088036 PMCID: PMC8764627 DOI: 10.3233/adr-210041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Guidelines worldwide recommend restricted prescription of benzodiazepine receptor agonists (BZRAs), i.e., benzodiazepines and Z-drugs, for the treatment of dementia-associated behavioral and psychological symptoms and insomnia. Objective: To assess the prevalence and appropriateness of BZRA use among nursing home residents with dementia. Methods: This is a post-hoc analysis of BZRA prescriptions from two intervention studies on psychotropic drug use, conducted from 2016 to 2018. It includes 1,111 residents of dementia special care units from 24 Dutch long-term care organizations. We assessed the prevalence of use of continuous and as-needed BZRA prescriptions and their association with registered symptoms. Continuous BZRA prescriptions were evaluated for appropriateness, i.e., whether indication, dosage, duration, and evaluation accorded with guidelines for the treatment of challenging behavior in dementia and sleep disorders. Results: The prevalence of BZRA use is 39.2% (95% CI: 36.3%–42.0%): continuous 22.9%; only as-needed 16.3%. Combinations of preferred BZRAs and appropriate indications occur in 19.0% of continuous anxiolytic prescriptions and 44.8% of hypnotic prescriptions. Frequently registered inappropriate indications are aggression/agitation for anxiolytics (continuous: 75.7%; as-needed: 75.2%) and nighttime agitation for hypnotics (continuous: 40.3%; as-needed: 26.7%). None of the continuous prescriptions with appropriate indications were appropriate for all other items. For most of the prescriptions, duration and time to evaluation exceeded 4 weeks. Conclusion: BZRA use in nursing home residents with dementia is highly frequent. A large proportion of prescriptions do not follow the guidelines with regard to indication, exceed the recommended duration and are not evaluated in a timely manner. The discrepancy between evidence-based guidelines and daily practice calls for an exploration of factors maintaining inappropriate use.
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Affiliation(s)
- Dirk O C Rijksen
- Carintreggeland, Center for Specialized Geriatric Care, Hengelo, The Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Esther C de Haas
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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18
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Tongsiri S, Levkoff S, Gallagher-Thompson D, Teri L, Hinton L, Wisetpholchai B, Chuengsatiansup K, Sihapark S, Fritz S, Chen H. Cultural Adaptation of the Reducing Disability in Alzheimer's Disease (RDAD) Protocol for an Intervention to Reduce Behavioral and Psychological Symptoms of Dementia in Thailand. J Alzheimers Dis 2022; 87:1603-1614. [PMID: 35491775 PMCID: PMC10588817 DOI: 10.3233/jad-215253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Reducing Disability in Alzheimer's Disease (RDAD) program is an evidence-based intervention found to be feasible for implementation in community settings in the United States, and effective in reducing depression, one of the major behavioral and psychological symptoms of dementia (BPSD). OBJECTIVE The goal of the study is to culturally adapt the RDAD for persons with dementia living in community settings of Thailand. METHODS Key adaptation steps included: 1) assess the community, 2) understand/select the intervention, 3) consult with experts/stakeholders, 4) decide what needs to be adapted, 5) adapt the original program, 6) train staff, and 7) pilot test the adapted materials. RESULTS Modifications to the original RDAD protocol included changes in number of sessions, mode of delivery, and the specific pleasant activities targeted. The pilot test demonstrated the feasibility and acceptance of the adapted RDAD intervention protocol. Implementers were able to comprehend and implement the core components of the intervention, while family members demonstrated ability to follow instructions, gain knowledge about dementia, and improve skills for setting up realistic goals. CONCLUSION Following the key adaptation steps outlined above, we were able to successfully modify the RDAD for the Thai cultural context, maintaining core components of the original protocol. Program implementers demonstrated their ability to supervise family caregivers and help them gain the knowledge and skills needed to provide care for older adults with dementia. Findings from the pilot studies were incorporated into final training and intervention protocols currently being implemented and evaluated in a randomized implementation trial in Thailand.
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Affiliation(s)
- Sirinart Tongsiri
- Faculty of Medicine, Mahasarakham University, Mahasarakham, Thailand
| | - Sue Levkoff
- College of Social Work, University of South Carolina, Columbia, SC, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Dolores Gallagher-Thompson
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Linda Teri
- Department of Psychosocial and Community Health, University of Washington, Seattle, WA, USA
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA
| | | | | | | | - Stacy Fritz
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Hongtu Chen
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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De Mauleon A, Lelievre A, Hermabessiere S, Rolland Y. Intervention of companion clowns in a special care unit: a 1-year pilot study. Aging Clin Exp Res 2021; 33:3379-3383. [PMID: 34228317 DOI: 10.1007/s40520-021-01916-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
AIMS Our 1-year pilot study aims to compare Behavioral and Psychological Symptoms of Dementia (BPSDs): number and frequency, globally an in sub-domains, and distress, of 20 residents with dementia, during periods with companion clown intervention and BPSDs during periods without companion clown intervention. METHODS A duo of accompanying clowns intervened 24 times for a total of 72 h (two interventions of 3 h each per week for 4 weeks, 3 months of the year spaced 13 weeks apart) in the Special Care Unit. This unit was dedicated to residents with severe BPSDs. BPSDs were measured monthly by Health Care Professional using Neuro-Psychiatric Inventory (NPI). RESULTS Baseline NPI total score of the 20 residents (10 women, mean age 76.9 years; standard deviation, SD 8.1, 70.6% with Alzheimer's disease) was 37.5 (SD = ± 19.7). The total score of the NPI was not significantly different between the periods with the clowns (median total score at 63; 25p-75p = 57-67) and the periods without the clowns (59; 25p-75p = 43-76) (p = 0.08). Compared to the period without clowns, residents presented significantly fewer delusions, hallucinations, euphoria, aberrant motor behavior but significantly more depression, apathy, disinhibition and more appetite disorders (all p value < 0.05). No statistically significant difference was observed on the distress the symptoms caused on the HCP during periods with the clowns. CONCLUSION Accompanying clowns may not significantly reduce the overall BPSD of the residents, but may have beneficial effects in some behavioral issues.
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Affiliation(s)
- Adélaide De Mauleon
- Department of Geriatric Medicine, Gerontopole Alzheimer Clinical & Research Center, University Hospital of Toulouse, Gérontopôle de Toulouse, 224, avenue de Casselardit, INSERM CERPOP 1295, 31059, Cedex 9, Toulouse, France.
| | - Anne Lelievre
- Department of Geriatric Medicine, Gerontopole Alzheimer Clinical & Research Center, University Hospital of Toulouse, Gérontopôle de Toulouse, 224, avenue de Casselardit, INSERM CERPOP 1295, 31059, Cedex 9, Toulouse, France
| | - Sophie Hermabessiere
- Department of Geriatric Medicine, Gerontopole Alzheimer Clinical & Research Center, University Hospital of Toulouse, Gérontopôle de Toulouse, 224, avenue de Casselardit, INSERM CERPOP 1295, 31059, Cedex 9, Toulouse, France
| | - Yves Rolland
- Department of Geriatric Medicine, Gerontopole Alzheimer Clinical & Research Center, University Hospital of Toulouse, Gérontopôle de Toulouse, 224, avenue de Casselardit, INSERM CERPOP 1295, 31059, Cedex 9, Toulouse, France
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Bautrant T, Franqui C, Clément H, Rabault M, Masseboeuf F, Pastore M, Pardo M, Brandi Y, Drouin N, Brice AD, Grino M. A pragmatic trial testing a tailored non pharmacologic therapies on nocturnal behavioral and psychological symptoms associated with dementia. Geriatr Nurs 2021; 43:85-90. [PMID: 34844129 DOI: 10.1016/j.gerinurse.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022]
Abstract
We compared the efficacy of tailored non pharmacological therapies (NPT) on specific nocturnal behavioral and psychological symptoms of dementia (BPSD). This retrospective 1-year study included 84 older dependent patients institutionalized in 7 long-term care home. Dedicated assistants, who were taught by experts how to use NPT, were asked to record the occurrence of each BPSD episode, to choose a given NPT on the basis of their knowledge of the patient and the type of BPSD and to estimate its efficacy. Wandering was the most prevalent BPSD followed by agitation/aggression and screaming. The most used therapy was cognitive stimulation, followed by multisensory stimulation, reminiscence and Montessori-based. Regarding wandering, multisensory stimulation was found to be the most efficacious NPT significantly different from Montessori-based, cognitive stimulation or reminiscence. With regards to agitation/aggression or screaming, Montessori-based was found to be the most efficacious NPT significantly different from multisensory stimulation, reminiscence and cognitive stimulation.
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Affiliation(s)
| | - Caroline Franqui
- Alzheimer Short Stay Unit, State Geriatric Center, Marseille, France
| | | | | | | | | | - Magali Pardo
- EHPAD Les Jardins d'Athéna, La Bouilladisse, France
| | | | | | | | - Michel Grino
- Department of Clinical Research, State Geriatric Center, Marseille, France.
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Fuju T, Yamagami T, Ito M, Naito N, Yamaguchi H. Development and Evaluation of the Behavioral and Psychological Symptoms of Dementia Questionnaire 13-Item Version (BPSD13Q). Dement Geriatr Cogn Dis Extra 2021; 11:222-226. [PMID: 34721499 PMCID: PMC8543349 DOI: 10.1159/000518973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Most behavioral and psychological symptoms of dementia (BPSD) scales have copyright issues and are difficult for care staff to use in daily care settings because they were primarily designed for physicians. Therefore, an easier tool for care staff is required. This study aimed to develop and validate the BPSD questionnaire 13-item version (BPSD13Q). Methods We obtained data from 444 people with dementia living in group homes in Japan using the BPSD plus questionnaire (BPSD + Q; 27-item version) and Neuropsychiatric Inventory Nursing Home version (NPI-NH). We selected appropriate items to make a short-form version of the BPSD + Q and examined the construct validity, internal consistency, and criterion-related validity of the questionnaire. Results By the pilot review, research on correlations with similar items from comparable scales, and factor analysis, we reduced 27 items to 13 items (BPSD13Q). The BPSD13Q and BPSD13Q-distress (BPSD13Q-D) showed good internal consistency (Cronbach's α = 0.76 and 0.80, respectively). Moreover, the BPSD13Q was positively correlated with the NPI-NH (r = 0.72, p < 0.001) and BPSD + Q (r = 0.95, p < 0.001). The BPSD13Q-D was positively correlated with the NPI-NH-caregiver distress (r = 0.74, p < 0.001) and BPSD + Q-distress (r = 0.96, p < 0.001). Conclusion We developed and validated the BPSD13Q, which is a short-form version of the BPSD + Q and is downloadable. The BPSD13Q may make BPSD evaluations easier for the care staff.
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Affiliation(s)
- Taiga Fuju
- Tokyo Center for Dementia Care Research and Practices, Suginami, Japan.,Medical Corporation TAISEIKAI/UCHIDA Hospital, Numata, Japan
| | - Tetsuya Yamagami
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
| | - Mio Ito
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
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Behrens L, Boltz M, Riley K, Eshraghi K, Resnick B, Galik E, Ellis J, Kolanowski A, Van Haitsma K. Process evaluation of an implementation study in dementia care (EIT-4-BPSD): stakeholder perspectives. BMC Health Serv Res 2021; 21:1006. [PMID: 34551782 PMCID: PMC8458006 DOI: 10.1186/s12913-021-07001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Behavioral and psychological symptoms of distress in dementia (BPSD) are major drivers of poor quality of life, caregiver burden, institutionalization, and cost of care in nursing homes. The Evidence Integration Triangle (EIT)-4-BPSD in nursing homes was a pragmatic Hybrid III trial of an implementation strategy to help staff use evidence-based non-pharmacological interventions to prevent and manage BPSD. This study aimed to describe and explore the stakeholders' perceptions of the process to implement the EIT-4-BPSD strategy including its utility, and the barriers and facilitators to implementation in real-world settings. METHODS EIT-4-BPSD was a multi-layer implementation strategy that engaged nursing home stakeholder groups to define community specific goals towards reducing BPSD over a 12-month period. Stakeholder groups from nursing homes that completed all 12-months of the implementation strategy were invited to participate in this process evaluation study. Qualitative data from focus group transcripts were analyzed using a conventional content analysis. Emerging codes were sorted into categories, then organized in meaningful clusters based on the domains of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. RESULTS The EIT-4-BPSD implementation strategy was completed in 21 nursing homes; 93 stakeholders participated in focus groups. Over half of participating nursing homes reported meeting their BPSD goals as expected or more. Challenges, facilitators, and contextual factors reported by stakeholder members explains variability in the implementation of EIT-4-BPSD strategy in 11 key categories: family; staff; organizational; staff, environmental, and resident outcomes; utility of EIT resources; adoption barriers and facilitators; care process adaptations; and future planning. CONCLUSION Stakeholders offered guidance on salient factors influencing the feasibility and utility of EIT-4-BPSD adoption and implementation to consider in future implementation research that aims to improve behavioral well-being in NH residents living with dementia. Engagement of family and staff at all levels of the organization (Management, leadership, and direct care); and measurement of staff, environmental, and resident outcomes were perceived as critical for future implementation success. While regulations, finances, and competing demands on staff time were perceived as reducing implementation success. TRIAL REGISTRATION The Testing the Implementation of EIT-4-BPSD study was registered in the ClinicalTrials.gov ( NCT03014570 ) January 9, 2017.
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Affiliation(s)
- Liza Behrens
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA.
| | - Marie Boltz
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Kiernan Riley
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Karen Eshraghi
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Barbara Resnick
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Elizabeth Galik
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Jeanette Ellis
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Ann Kolanowski
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Kimberly Van Haitsma
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
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Li BSY, Chan CWH, Li M, Wong IKY, Yu YHU. Effectiveness and Safety of Aromatherapy in Managing Behavioral and Psychological Symptoms of Dementia: A Mixed-Methods Systematic Review. Dement Geriatr Cogn Dis Extra 2021; 11:273-297. [PMID: 35082824 PMCID: PMC8739377 DOI: 10.1159/000519915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Behavioral and psychological symptoms of dementia (BPSD) is the most prominent and distressing manifestation for older persons with dementia (PWD) and caregivers. Aromatherapy has demonstrated its effectiveness in managing BPSD in various studies. However, previous studies and systematic reviews have obtained inconsistent findings, and a review of qualitative studies is yet to be conducted. METHOD A mixed-methods systematic review with a convergent segregated approach was performed to evaluate the effectiveness of aromatherapy in improving the BPSD and quality of life (QoL) of PWD and in relieving the distress and burden of caregivers, as well as its safety for PWD. Both published and unpublished quantitative and qualitative studies written in English and Chinese between January 1996 and December 2020 were retrieved from 28 databases, including MEDLINE, EMBASE, and Web of Science, based on the prespecified criteria. The methodological quality was assessed by using critical appraisal tools from the Joanna Briggs Institute. Quantitative synthesis, qualitative synthesis, and integration of quantitative and qualitative evidence were performed. RESULTS A total of 12 randomized controlled trials, 10 quasi-experimental studies, and 2 qualitative studies were included in the review. Some inconsistent findings regarding the effectiveness of aromatherapy in reducing the severity of BPSD were observed. Some studies reported that aromatherapy significantly improved the QoL of PWD and relieved the distress and burden of caregivers, promoted a positive experience among caregivers, and had very low adverse effects on PWD (with aromatherapy inhalation reporting no adverse effects). CONCLUSION Aromatherapy, especially in the inhalation approach, could be a potentially safe and effective strategy for managing BPSD. However, more structuralized and comparable studies with sufficient sample size, adherence monitoring, and sound theoretical basis could be conducted to obtain conclusive findings.
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Affiliation(s)
- Becky Siu Yin Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Ho Man Tin, Hong Kong, China
| | - Carmen Wing Han Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Minjie Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Irene Kit Yee Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Yvonne Hoi Un Yu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Ho Man Tin, Hong Kong, China
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Ochi S, Mori T, Iga JI, Ueno SI. 5-HT 1A Partial Agonist Tandospirone for Behavioral and Psychological Symptoms in Oldest-old Patients with Dementia at a Special Elderly Nursing Home. Clin Psychopharmacol Neurosci 2021; 19:514-520. [PMID: 34294620 PMCID: PMC8316653 DOI: 10.9758/cpn.2021.19.3.514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/24/2020] [Accepted: 10/19/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the efficacy of tandospirone, an azapirone anxiolytic similar to buspirone that is used in Japan, for behavioral and psychological symptoms of dementia (BPSD), especially in oldest-old patients. METHODS This was an open-label observational study involving residents with BPSD in a special elderly nursing home between August 2013 and August 2018. The severity of dementia was assessed using the Clinical Dementia Rating (CDR) scale; as the main outcomes, the severity of BPSD was assessed using the Clinical Global Impressions-Severity scale (CGI-S) and Neuropsychiatric Inventory-12 (NPI-12) at baseline and 4 weeks after the maintenance dose of tandospirone was reached. The administration of tandospirone started at 30 mg, divided into three doses per day. Two weeks later, if the efficacy was sufficient based on the clinical nursing record, that dose was continued; if the efficacy was insufficient, the daily dose was increased from 40 mg/day to a maximum dose of 60 mg/day. RESULTS Thirty-three participants (25 females [76%], mean age 87.1 ± 5.4 years) completed the study. Twenty-three participants (70%) were oldest-old (18 females [78%], mean age 89.9 ± 3.4 years). The mean CDR score was 2.9 ± 0.3 in all participants. Tandospirone treatment showed few or no obvious adverse effects and significantly improved CGI-S scores, as well as total scores and many subscale scores on the NPI-12, in both the sample at large and the oldest-old participants. CONCLUSION This study demonstrated the efficacy and safety of tandospirone for BPSD in oldest-old participants.
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Affiliation(s)
- Shinichiro Ochi
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Japan
| | - Takaaki Mori
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Japan
| | - Jun-ichi Iga
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shu-ichi Ueno
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Japan
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Ordóñez MDLÁ, Ordóñez PDLÁ. Sleep in Persons Living with Alzheimer's Disease and Related Dementias. Nurs Clin North Am 2021; 56:249-263. [PMID: 34023119 DOI: 10.1016/j.cnur.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Over a typical lifespan, the amount of time people spend each day sleeping decreases. Sleep patterns also change as people age. Sleep disorders are common among persons of all ages, and older adults are particularly vulnerable. Development of age-related neurodegenerative diseases, such as Alzheimer's disease and related dementias, is associated with pronounced sleep disruption. This article provides evidence-based guidelines for diagnosis and clinical management of sleep disorders that occur during the course of treatment of Alzheimer's disease and related dementias. The article presents novel interventions and future directions for clinical practice and sleep research, and addresses diversity and inclusivity.
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Affiliation(s)
- María de Los Ángeles Ordóñez
- Louis and Anne Green Memory and Wellness Center of the Christine E. Lynn College of Nursing (CELCON), Florida Atlantic University (FAU), FAU CELCON; Alzheimer's Disease Initiative, Florida Department of Elder Affairs; Federal Advisory Council on Alzheimer's Research, Care, and Services, US Department of Health and Human Services, 777 Glades Rd, Bldg. AZ-79, Boca Raton, FL 33431, USA.
| | - Patricia de Los Ángeles Ordóñez
- Nova Southeastern University (NSU), College of Psychology; Care, Supportive Services, and Outreach Coordinator, Louis and Anne Green Memory; Wellness Center of the Christine E. Lynn College of Nursing (CELCON), Florida Atlantic University (FAU); Alzheimer's Disease Initiative, Florida Department of Elder Affairs, 777 Glades Rd, Bldg. AZ-79, Boca Raton, FL 33431, USA
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Kolberg E, Hjetland GJ, Thun E, Pallesen S, Nordhus IH, Husebo BS, Flo-Groeneboom E. The effects of bright light treatment on affective symptoms in people with dementia: a 24-week cluster randomized controlled trial. BMC Psychiatry 2021; 21:377. [PMID: 34320937 PMCID: PMC8317398 DOI: 10.1186/s12888-021-03376-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/10/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The majority of people with dementia have behavioral and psychological symptoms of dementia (BPSD), including depression, anxiety and agitation. These may be elicited or aggravated by disrupted circadian rhythms. Bright light treatment (BLT) is a promising non-pharmacological approach to the management of BPSD, but previous research has yielded mixed results. METHODS Eight nursing home dementia units (1 unit = 1 cluster) with 78 patients were invited to participate in a cluster randomized controlled trial from September 2017 to April 2018 investigating the effects of BLT on sleep and circadian rhythms (primary outcome) and BPSD (secondary outcome). Ceiling mounted LED-panels were installed in the intervention group (four units), providing light at 1000 lx and 6000 K (vertically at 1.2 m) between 10 a.m. and 3 p.m., with lower values in the mornings and evenings. Standard indoor light was used in the control group (four units). BPSD were assessed with The Cornell Scale for Depression in Dementia (CSDD) and the Neuropsychiatric Inventory Nursing Home Version (NPI-NH). Data collection took place at baseline and after 8, 16 and 24 weeks. Multilevel regression models with and without false discovery rate correction were used for the analysis, with baseline values and dementia stage entered as covariates. RESULTS Sixty-nine patients were included in the study at baseline. Compared to the control group, the intervention group had a larger reduction on the composite scores of both the CSDD (95% CI = - 6.0 - - 0.3) and the NPI-NH (95% CI = - 2.2 - - 0.1), as well as on the NPI-NH Affect sub-syndrome, and the CSDD Mood related signs sub-scale at follow-up after 16 weeks. With FDR correction, the group difference was significant on the CSDD Mood related signs sub-scale (95% CI = - 2.7 - - 0.8) and the NPI-NH Affect sub-syndrome (95% CI = - 1.6 - - 0.2). No differences were found between conditions at weeks 8 or 24. CONCLUSION Compared to the control condition, affective symptoms were reduced after 16 weeks in the group receiving BLT, suggesting BLT may be beneficial for nursing home patients with dementia. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03357328 . Retrospectively registered on November 29, 2017.
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Affiliation(s)
- Eirin Kolberg
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen (UiB), Aarstadveien 17, 5009, Bergen, Norway.
| | - Gunnhild Johnsen Hjetland
- grid.7914.b0000 0004 1936 7443Department of Clinical Psychology, Faculty of Psychology, University of Bergen (UiB), Aarstadveien 17, 5009 Bergen, Norway ,City Department of Health and Care, City of Bergen, Norway
| | - Eirunn Thun
- grid.7914.b0000 0004 1936 7443Department of Clinical Psychology, Faculty of Psychology, University of Bergen (UiB), Aarstadveien 17, 5009 Bergen, Norway
| | - Ståle Pallesen
- grid.7914.b0000 0004 1936 7443Department of Psychosocial Science, Faculty of Psychology, University of Bergen (UiB) Christies gate 12, 5015 Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway ,Optentia, the Vaal Triangle Campus of the North-West University, Vanderbijlpark, South Africa
| | - Inger Hilde Nordhus
- grid.7914.b0000 0004 1936 7443Department of Clinical Psychology, Faculty of Psychology, University of Bergen (UiB), Aarstadveien 17, 5009 Bergen, Norway ,grid.5510.10000 0004 1936 8921Department of Behavioral Medicine, Faculty of Medicine, University of Oslo, (UiO), Oslo, Norway
| | - Bettina S. Husebo
- grid.7914.b0000 0004 1936 7443Centre for Elderly and Nursing Home Medicine (SEFAS), Department of Global Public Health and Primary Care, University of Bergen (UiB), Aarstadveien 17, 5009 Bergen, Norway
| | - Elisabeth Flo-Groeneboom
- grid.7914.b0000 0004 1936 7443Department of Clinical Psychology, Faculty of Psychology, University of Bergen (UiB), Aarstadveien 17, 5009 Bergen, Norway
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Maeda N, Tsutsumi Y, Niwa S. Development of a self-assessment behavioral and psychological symptoms of dementia competency scale for care teams at long-term geriatric care facilities. Geriatr Nurs 2021; 42:628-634. [PMID: 33823420 DOI: 10.1016/j.gerinurse.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
Understanding the behavioral and psychological symptoms of dementia (BPSD) is important for caregivers in long-term geriatric care facilities. In this study performed in 43 long-term care facilities, we evaluated the ability of caregivers to recognize BPSD through the development and validation of self-assessment scales. Reliability and validity of the scales were determined using Cronbach's alpha coefficient, the test/retest method, exploratory factor analysis, confirmatory factor analysis, criteria-related validity, and construct validity. We analyzed cross-sectional data from 310 participants. Factor analysis showed a positive correlation for all scale items (rs = .43-.73). Significant correlations arose from the test/retest method (rs = .48-.76). The α coefficient of all items except one was .70 or more, indicating sufficient reliability. Criteria-related validity (rs = .43-.73) and construct validity (rs = .13-.52) revealed a positive correlation. The BPSD Team Care Self-Assessment Scale is reliable and could ensure BPSD competency in caregivers.
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Affiliation(s)
- Noriko Maeda
- Department of Nursing Science, Faculty of Nursing, Kansai University of Nursing and Health Sciences, Hyogo 656-2131, Japan.
| | - Yumiko Tsutsumi
- The International University of Kagoshima, Kagoshima 891-0197, Japan
| | - Sayoko Niwa
- Course of Nursing, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, 890-0065, Japan
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Gitlin LN, Bouranis N, Kern V, Koeuth S, Marx KA, McClure LA, Lyketsos CG, Kales HC. WeCareAdvisor, an Online Platform to Help Family Caregivers Manage Dementia-Related Behavioral Symptoms: an Efficacy Trial in the Time of COVID-19. ACTA ACUST UNITED AC 2021; 7:33-44. [PMID: 33786370 PMCID: PMC7994055 DOI: 10.1007/s41347-021-00204-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/11/2021] [Accepted: 03/19/2021] [Indexed: 11/13/2022]
Abstract
Dementia-related behavioral and psychology symptoms (BPSD) are undertreated and have negative consequences. However, families do not have access to disease information, tailored problem-solving and effective management strategies, and with COVID-19, are more socially isolated and distressed. To address this dementia care gap, we describe a Phase III efficacy trial testing an online platform, WeCareAdvisor, and design modifications necessitated by COVID-19. WeCareAdvisor provides caregivers with disease information, daily tips, and a systematic approach for describing behaviors, investigating underlying causes, creating tailored strategies, and evaluating their effectiveness (DICE). The trial will enroll 326 caregivers nationwide, randomly assign them to immediately receive WeCareAdvisor (treatment), or a 3-month waitlist (control) and evaluate short (1- and 3-month) and long-term (6-month) outcomes for caregiver distress with and confidence managing BPSD, and BPSD occurrences. We will also evaluate utilization patterns with different prompting conditions: high-intensity (telephone and email reminders), low-intensity (email reminders), or no reminders to use WeCareAdvisor. COVID-19 necessitated design modifications resulting in greater inclusivity of caregivers from diverse races, ethnicities, and geographic areas. Key modifications include shifting from in-home, in-person interviewing to telephone; adjusting tool functionality from operating on a grant-funded iPad to caregivers’ personal internet-capable devices; and expanding recruitment from one metropolitan area to nationwide. Study modifications necessitated by COVID-19 facilitate national outreach, easier tool adoption, and enable more diverse caregivers to participate. This study addresses a critical dementia care need, and design modifications may shorten timeline from efficacy testing to commercialization.
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Youn H, Lee KJ, Kim SG, Cho SJ, Kim WJ, Lee WJ, Hwang JY, Han C, Shin C, Jung HY. The Behavioral Effects of Combination Therapy of Memantine and Acetylcholinesterase Inhibitors Compared with Acetylcholinesterase Inhibitors Alone in Patients with Moderate Alzheimer's Dementia: A Double-Blind Randomized Placebo-Controlled Trial. Psychiatry Investig 2021; 18:233-240. [PMID: 33685036 PMCID: PMC8016683 DOI: 10.30773/pi.2020.0329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/13/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE This study aimed to investigate treatment effects of combination therapy of memantine and acetylcholinesterase inhibitors (AchEIs) compared with AchEIs alone on behavioral and psychological symptoms of dementia (BPSD) in patients with moderate Alzheimer's dementia (AD). METHODS This was a 12-week, double-blind, randomized, placebo-controlled trial. A total of 148 patients with moderate AD participated in this study. Mini-Mental State Examination, Neuropsychiatric Inventory (NPI), Clinician's Interview-Based Impression of Change plus caregiver input, Gottfries-Bråne-Steen Scale, and Zarit Burden Interview were used as assessment scales. RESULTS There were no significant differences in age, sex, or education between AChEIs alone and combination groups. The combination group showed significantly more improvement of NPI-disinhibition score (0.76±2.15) than the AChEIs alone group (-0.14±1.71) after 12 weeks. CONCLUSION Our findings suggest that the combination therapy of memantine and AchEIs might be a beneficial option for reducing disinhibition symptoms of patients with moderate AD compared with AchEIs alone. We believe that clinicians need to consider additional memantine treatment when patients with moderate AD complain disinhibition symptom. A larger clinical trial is needed to further determine the efficacy and advantages of such combination therapy of memantine and AchEIs for treating BPSD of patients with moderate AD.
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Affiliation(s)
- HyunChul Youn
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Kang Joon Lee
- Department of Psychiatry, Ilsanpaik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Shin-Gyeom Kim
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Woo Jung Kim
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Won Joon Lee
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jae Yeon Hwang
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Cheolmin Shin
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Han-Yong Jung
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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Tsujimura H, Osawa M, Makita S. Application of the 18-Item Dementia Elderly Odayaka Scale in Japan: Evaluation before and after Intervention. Dement Geriatr Cogn Dis Extra 2021; 11:10-15. [PMID: 33790934 PMCID: PMC7989727 DOI: 10.1159/000512120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction We have developed the Dementia Elderly Odayaka Scale (DEOS) to evaluate psychosocial aspects in older people. The DEOS can be used to assess well-being, such as personhood and social interaction. Objective The aim of this study was to apply the 18-item DEOS in participants with dementia and to examine the characteristics and usefulness of this scale. Methods Facility staff provided care for the participants while taking into consideration each participant's individuality and strong points. The DEOS was applied at the beginning of the interventions and at 1 and 2 months after the start of the interventions. The changes in the participants' behaviors and their DEOS scores were then evaluated over time. Results We examined 13 participants (2 men, 11 women) between the ages of 68 and 91 years. In 60% of the participants the DEOS score increased over time. When care interventions were tailored toward communication and leadership for the 2 men, according to each of their individualities, we observed increases in their scores for “social interaction” at 1 and 2 months thereafter. We also observed increases in the scores for “Expression of emotions” category in 2 of the 5 cases who received an aromatherapy massage. Discussion/Conclusion The changes in the scores over time and the contents of the field notes were consistent with each other, suggesting that the DEOS can be used both to evaluate the effects of interventions and to plan care that takes advantage of each participant's positive aspects.
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Affiliation(s)
- Hiromi Tsujimura
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
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Hjetland GJ, Pallesen S, Thun E, Kolberg E, Nordhus IH, Flo E. Light interventions and sleep, circadian, behavioral, and psychological disturbances in dementia: A systematic review of methods and outcomes. Sleep Med Rev 2020; 52:101310. [PMID: 32289734 DOI: 10.1016/j.smrv.2020.101310] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 12/21/2022]
Abstract
Dementia is a devastating disease with a global impact, and there is an urgent need for effective interventions to alleviate the accompanying disturbances in behavior, mood, sleep, and circadian rhythms. Bright light treatment (BLT) is a promising non-pharmacological intervention; however, studies have yielded conflicting results. This systematic review provides a comprehensive overview of the effect of BLT in dementia, with a specific focus on how study characteristics might have affected the available results. The included studies were small and comprised time-limited interventions and follow-ups. Light values, adherence to treatment, and time of year were not consistently reported. Varying designs, methods, and population characteristics such as age, gender, dementia diagnosis, circadian phase, and baseline symptoms may have moderated the outcomes and affected review results. The use of crossover designs and too high illumination as placebo lights might have nullified positive effects of BLT. Because some studies had negative outcomes after ambient BLT with high amounts of short wavelengths, more modest light levels should be further investigated. Employing rigorous designs and detailed reporting of intervention characteristics, i.e., the illumination, correlated color temperature, timing, and duration of light utilized, are of utmost importance to establish the optimal treatment approach in this population. Systematic review registration number: PROSPERO CRD42017051004.
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Affiliation(s)
- Gunnhild J Hjetland
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway; City Department of Health and Care, City of Bergen, Norway.
| | - Ståle Pallesen
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway; Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Eirunn Thun
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway; Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway
| | - Eirin Kolberg
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway
| | - Inger H Nordhus
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway; Department of Behavioral Sciences in Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Elisabeth Flo
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway
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Bristol AA, Convery KA, Sotelo V, Schneider CE, Lin SY, Fletcher J, Rupper R, Galvin JE, Brody AA. Protocol for an embedded pragmatic clinical trial to test the effectiveness of Aliviado Dementia Care in improving quality of life for persons living with dementia and their informal caregivers. Contemp Clin Trials 2020; 93:106005. [PMID: 32320844 PMCID: PMC7269690 DOI: 10.1016/j.cct.2020.106005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/27/2020] [Accepted: 04/13/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Persons living with Alzheimer's disease and related dementias (ADRD) frequently experience pain and behavioral and psychological symptoms of dementia (BPSD) which decrease quality of life (QOL) and influence caregiver burden. Home healthcare professionals however may underrecognize or lack the ability to manage BPSD. INTERVENTION This protocol describes an ADRD palliative quality assurance performance improvement program for home healthcare, Aliviado Dementia Care-Home Health Edition. It includes training, mentoring, and a toolbox containing intervention strategies. METHODS This embedded pragmatic clinical trial will utilize a multi-site, cluster randomized control design. Recruitment will occur from three home healthcare agencies located in New Jersey, Utah, and Florida. At each agency, care teams will be randomized as clusters and assigned to either the Aliviado Dementia Care program or usual care. We plan to enroll 345 persons living with ADRD and their informal caregiver dyads. The primary outcome will be to measure QOL in both the person living with ADRD and their informal caregiver, and emergency department visits and hospital admissions. Secondary outcomes in the person living with ADRD will include the examination of pain, BPSD, antipsychotic and analgesic use. Secondary outcomes in caregivers include burden, depressive symptoms, functional health and wellbeing, and healthcare utilization. CONCLUSION This study will be the first large-scale embedded pragmatic clinical trial in home healthcare focused on care quality and outcomes in addressing QOL in ADRD. If proven successful, the intervention can then be disseminated to agencies throughout the country to improve the quality of care for this vulnerable, underserved population. TRIAL REGISTRATION Clinical Trials.gov: NCT03255967.
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Affiliation(s)
| | - Kimberly A Convery
- The Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, United States
| | - Victor Sotelo
- The Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, United States
| | | | - Shih-Yin Lin
- NYU Rory Meyers College of Nursing, United States
| | | | - Randall Rupper
- University of Utah School of Medicine, United States; George E. Wahlen Department of Veterans Affairs Medical Center, VA Salt Lake City Health Care System, Geriatric Research, Education and Clinical Center, Salt Lake City, UT, United States
| | - James E Galvin
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, United States
| | - Abraham A Brody
- The Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, United States.
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Tampi RR, Joshi P, Marpuri P, Tampi DJ. Evidence for using dextromethorphan-quinidine for the treatment of agitation in dementia. World J Psychiatry 2020; 10:29-33. [PMID: 32399396 PMCID: PMC7203083 DOI: 10.5498/wjp.v10.i4.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/03/2020] [Accepted: 03/22/2020] [Indexed: 02/05/2023] Open
Abstract
Behavioral and psychological symptoms including agitation are common in dementia, and are associated with decreased quality of life, increased risk of institutionalization, and greater patient and caregiver distress. Pharmacological agents used for management of behavioral and psychological symptoms of dementia are limited by their tolerability, prompting a need for identifying efficacious and safe pharmacological treatments for managing agitation in dementia. The combination of dextromethorphan and quinidine sulfate is approved for pseudobulbar affect, and may be effective in managing agitation in dementia. A review of literature found only one randomized controlled trial that evaluated the use of dextromethorphan-quinidine for the management of agitation in dementia when compared to placebo. Data from this trial demonstrated that dextromethorphan-quinidine decreased agitation in dementia, and was well tolerated. Although promising, further research is needed before dextromethorphan-quinidine combination can be accepted as a standard treatment for agitation in dementia.
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Affiliation(s)
- Rajesh R Tampi
- Department of Psychiatry and Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH 44106, United States
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195, United States
| | - Pallavi Joshi
- Department of Psychiatry and Behavioral Sciences, Northwell Health-Staten Island University Hospital, Staten Island, NY 10306, United States
| | - Padmapriya Marpuri
- Department of Psychiatry, Einstein Medical Center, Philadelphia, PA 19141, United States
| | - Deena J Tampi
- Diamond Healthcare, Richmond, VA 23219, United States
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Shi J, Wei M, Ni J, Sun F, Sun L, Wang J, Yu T, Wang K, Lv P, Wang Y, Zhang Y, Gao X, Gao X, Luo B, Mao S, Zhang B, Ren X, Yu F, Hu W, Yin P, Wu N, Liu X, Bi Q, Wang Y, Tian J. Tianzhi granule improves cognition and BPSD of vascular dementia: a randomized controlled trial. J Transl Med 2020; 18:76. [PMID: 32054507 PMCID: PMC7017567 DOI: 10.1186/s12967-020-02232-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 01/22/2020] [Indexed: 11/17/2022] Open
Abstract
Background and purpose Tianzhi granule (TZ) is usually used for patients with vascular dementia (VaD) in China. The aim was to assess the effect of TZ by a randomized clinical trial (RCT). Methods A 24-week RCT was conducted in 16 centres. Participants were grouped into TZ, donepezil or placebo. The co-primary outcomes were the Vascular Dementia Assessment Scale-cognitive subscale (VADAS-cog) and Clinician’s Interview-based Impression of Change-plus caregiver information (CIBIC-plus). Results A total of 543 patients with mild to moderate VaD were enrolled, of whom 242 took TZ granules, 241 took donepezil, and 60 took placebo. The least-squares mean changes from baseline and 95% CI were 6.20 (5.31, 7.09) (TZ group), 6.53 (5.63, 7.42) (donepezil group) and 3.47 (1.76, 5.19) (placebo group), both TZ and donepezil showed small but significantly improvement compared with placebo group. The percent of improvement on the global impression which was measured by CIBIC-plus was 73.71% in TZ and 58.18% in placebo, there was significant different between TZ and placebo group (P = 0.004). No significant differences were observed between TZ and donepezil. No significant differences of adverse events were found. Conclusions TZ and donepezil could bring symptomatic benefit for mild to moderate VaD. Trial registration The protocol had retrospectively registered at clinical trial.gov, Unique identifier: NCT02453932, date of registration: May 27, 2015; https://www.clinicaltrials.gov/ct2/show/NCT02453932?term=NCT02453932&rank=1
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Affiliation(s)
- Jing Shi
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100007, China
| | - Mingqing Wei
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100007, China
| | - Jingnian Ni
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100007, China
| | - Feng Sun
- Zhongjing Wanxi Pharmaceutical Co., Ltd., Nanyang, 474550, Henan Province, China
| | - Li Sun
- Department of Neurology, First Hospital of Jilin University, Changchun, 130031, Jilin Province, China
| | - Junfu Wang
- Department of Acupuncture, Kaifeng Hospital of Traditional Chinese Medicine, Kaifeng, 475000, Henan Province, China
| | - Tao Yu
- Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Kai Wang
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui Province, China
| | - Peiyuan Lv
- Department of Neurology, Hebei General Hospital, Shijiazhuang, 050051, Hebei Province, China
| | - Yunfu Wang
- Department of Neurology, Taihe Hospital, Hubei University of Chinese Medicine, Shiyan, 442000, Hubei Province, China
| | - Yulian Zhang
- Department of Neurology, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300250, China
| | - Xuguang Gao
- Department of Neurology, Peking University People's Hospital, Beijing, 100044, China
| | - Xuanzhao Gao
- Department of Neurology, Xinxiang Central Hospital, Xinxiang, 453700, Henan Province, China
| | - Benyan Luo
- Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang Province, China
| | - Shanping Mao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430072, Hubei Province, China
| | - Baorong Zhang
- Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, 310009, Zhejiang Province, China
| | - Xiangyang Ren
- Department of Neurology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, 471009, Henan Province, China
| | - Fengchun Yu
- Department of Neurology, Beijing Haidian Hospital, Beijing, 100080, China
| | - Wenli Hu
- Department of Neurology, Beijing Chao-Yang Hospital Affiliated to Capital Medical University, Beijing, 100020, China
| | - Ping Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China
| | - Nanjin Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China
| | - Xianfeng Liu
- Zhongjing Wanxi Pharmaceutical Co., Ltd., Nanyang, 474550, Henan Province, China
| | - Qi Bi
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Yongyan Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Jinzhou Tian
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100007, China.
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Matsuoka T, Taniguchi S, Imai A, Fujimoto H, Narumoto J. Preliminary study of the role of general hospital psychiatric ward for patients with dementia in Japan. Asian J Psychiatr 2020; 47:101837. [PMID: 31665696 DOI: 10.1016/j.ajp.2019.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 10/25/2022]
Abstract
A psychiatric ward in a general hospital might be suitable for people with dementia because of the comprehensive medical care available. The aim was to investigate the characteristics of 86 patients with dementia admitted to psychiatric ward in a general hospital. About 40% of the patients were admitted due to a diagnosis of dementia and the need for treatment of a physical disease. The expected roles of psychiatric ward in a general hospital for patients with dementia include the acute care of physical and psychological problems and a differential diagnosis.
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Affiliation(s)
- Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | | | - Ayu Imai
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Efjestad AS, Ihle-Hansen H, Hjellvik V, Engedal K, Blix HS. Drug Use before and after Initiating Treatment with Acetylcholinesterase Inhibitors. Dement Geriatr Cogn Dis Extra 2019; 9:196-206. [PMID: 31143200 PMCID: PMC6528096 DOI: 10.1159/000497307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/29/2019] [Indexed: 12/21/2022] Open
Abstract
Background/Aims The aim was to study the prevalence of use of different drugs prescribed for behavioral and psychological symptoms of dementia in persistent users of acetylcholinesterase inhibitors (AChEIs) before and after AChEI initiation, and to compare with the use in the general population. Methods Use of antidepressants, antipsychotics, and analgesics in the 4 years before and 2 years after AChEI initiation was studied based on data from the Norwegian Prescription Database 2004–2016. Results The prevalence of use of antidepressants and antipsychotics the year before AChEI initiation was twice the prevalence in the age-adjusted general population and continued to rise in the first 2 years after initiation of AChEIs. The prevalence of weak analgesics and antipsychotics increased strongly in the last year before AChEI initiation. The increase in the use of antidepressants started at least 4 years before initiation of AChEIs. Opioid use was generally lower than in the general population and was not influenced by AChEI initiation. Conclusion Increased use of antidepressants and antipsychotics was observed both before and after initiation of AChEIs and may indicate that behavioral symptoms occur in a preclinical or early phase of Alzheimer's disease. The prescription pattern of analgesics with a low use of opioids may indicate an undertreatment of pain in people with dementia.
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Gulla C, Flo E, Kjome RLS, Husebo BS. Implementing a novel strategy for interprofessional medication review using collegial mentoring and systematic clinical evaluation in nursing homes (COSMOS). BMC Geriatr 2019; 19:130. [PMID: 31064365 PMCID: PMC6505068 DOI: 10.1186/s12877-019-1139-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 04/18/2019] [Indexed: 11/10/2022] Open
Abstract
Background Multimorbid patients in nursing homes are prescribed long lists of medication, often without sufficient clinical evaluations beforehand. This results in poor clinical effects of the prescribed medication and significant side-effects, especially in patients with impaired cognition. The aim of this paper is to describe the process, content and implementation of a clinical medication review encompassing clinical testing and collegial support to prescribers. Methods The implementation process of a novel approach to medication review in nursing homes was logged thoroughly by structured staff feedback. Staff experienced promotors and barriers to implementation also were collected. The study was part of a cluster randomized controlled trial, in which 36 long-term care units received the COSMOS intervention. Nurses and physicians randomized to the intervention group participated in educational programs, training in clinical evaluation of the patients, and interprofessional medication review with collegial mentoring. Results The intervention group contained 297 patients from 36 nursing home units. There were 105 staff attendees for the education program. The units were served by 21 different physicians. Clinical medication reviews were performed in all units and all patients were assessed prior to the medication reviews. Of the 240 patients with a logged intervention process, 220 (92%) underwent a medication review. The intervention generated enthusiasm and improved communication among nursing staff and between nursing staff and physicians. The interprofessional discussions helped to facilitate difficult decisions pertaining to treatment levels. Reported barriers were lack of time, low engagement of all nursing staff and physicians, and ethical dilemmas. Conclusions Clinical medication reviews were implemented for almost all patients, and every patient was systematically assessed prior to the medication review. The physicians perceived collegial mentoring as an asset, learning from each other facilitated decision making in terms of difficult aspects of prescribing. Knowledge about barriers and promotors can improve implementation of similar interventions in other nursing homes. Trial registration Clinicaltrials.gov (NCT02238652). Registered July 7th 2014.
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Affiliation(s)
- Christine Gulla
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Elisabeth Flo
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Reidun L S Kjome
- Department of Global Public Health and Primary Care/Centre for pharmacy, University of Bergen, Bergen, Norway.
| | - Bettina S Husebo
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Na R, Yang JH, Yeom Y, Kim YJ, Byun S, Kim K, Kim KW. A Systematic Review and Meta-Analysis of Nonpharmacological Interventions for Moderate to Severe Dementia. Psychiatry Investig 2019; 16:325-335. [PMID: 31132836 PMCID: PMC6539264 DOI: 10.30773/pi.2019.02.11.2] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/11/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Due to limited efficacy of medications, non-pharmacological interventions (NPI) are frequently co-administered to people with moderate to severe dementia (PWMSD). This systematic review and meta-analysis investigated the effects of NPI on activities of daily living (ADL), behavioral and psychological symptoms of dementia (BPSD), and cognition and quality of life (QoL) of PWMSD. METHODS A literature search was conducted in the following databases: Cochrane CENTRAL, EMBASE, Medline, CIHNAL, PsycINFO, KoreaMED, KMbase, and KISS. We conducted a meta-analysis on randomized controlled trials and used the generic inverse variance method with a fixed-effects model to calculate the standardized mean difference (SMD). The protocol had been registered (CRD42017058020). RESULTS Ten randomized controlled trials met the inclusion criteria of the current meta-analysis. NPI were effective in improving ADL [SMD=0.28, 95% confidence interval (CI)=0.11-0.45] and reducing depression (SMD=-0.44, 95% CI=-0.70- -0.19). However, NPI were not effective in reducing agitation, anxiety, or overall, or improving cognitive function. In a subgroup analysis, music therapy was effective in reducing overall BPSD (SMD=-0.52, 95% CI=-0.90- -0.13). CONCLUSION Albeit the number of studies was limited, NPI improved ADL and depression in PWMSD.
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Affiliation(s)
- Riyoung Na
- National Institute of Dementia, Seongnam, Republic of Korea
| | - Ji-Hye Yang
- National Institute of Dementia, Seongnam, Republic of Korea
| | - Yusung Yeom
- National Institute of Dementia, Seongnam, Republic of Korea
| | - You Joung Kim
- National Institute of Dementia, Seongnam, Republic of Korea
| | - Seonjeong Byun
- National Institute of Dementia, Seongnam, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kiwon Kim
- National Institute of Dementia, Seongnam, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ki Woong Kim
- National Institute of Dementia, Seongnam, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
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Higami Y, Kabayama M, Kojiya E, Ko G, Yamamoto M, Akiyama M, Kodama K, Nakamura T, Hirotani A, Fukuda T, Tamatani M, Okuda Y, Ikushima M, Baba Y, Nagano M, Rakugi H, Kamide K. [Factors associated with behavioral and psychological symptoms in patients with dementia who received home medical treatment: A cross-sectional study (OHCARE study)]. Nihon Ronen Igakkai Zasshi 2019; 56:468-477. [PMID: 31761853 DOI: 10.3143/geriatrics.56.468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM The present study investigated the behavioral and psychological symptoms of dementia (BPSD) and pharmacological therapy among elderly people with dementia who received home medical treatment. METHODS This study was part of the Osaka Home Care Registry study (OHCARE-study). Participants were >65 years old with dementia. Demographic and medical data, BPSD, and the LTCI [long-term care insurance] care-need level were collected. A multiple logistic regression analysis was performed in order to clarify the factors associated with BPSD. RESULTS Among 110 subjects (82.0±11.3 years old), 64.6% had a diagnosis of dementia, most commonly Alzheimer's dementia. Aside from home medical treatment, 58.1% had a nurse visit, 48.1% received home care, and 40.0% used a day service. The prevalence of BPSD was 53.0%. Those with BPSD most frequently had an LTCI care-need level of 3, and the prevalence of BPSD declined as the level increased after 3. Psychotropic drugs were prescribed in 61.5% of those with BPSD. Antipsychotic drugs were used significantly more frequently in those with nursing care resistance, assault and delusions than in others (all, p <0.005). A multivariate analysis showed that the positive predictor of BPSD was antipsychotic drug use, while negative predictors were an LTCI care-need level and the use of visiting rehabilitation. CONCLUSION The BPSD in elderly dementia patients receiving home medical treatment were clarified. The LTCI care-need level is an independent predictor of BPSD after adjusting for the activities of daily life. Further longitudinal investigations including the BPSD severity and frequency are needed.
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Affiliation(s)
- Yoko Higami
- Osaka Medical College, Faculty of Nursing
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Mai Kabayama
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Eriko Kojiya
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Ga Ko
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Mariko Yamamoto
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Masako Akiyama
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Kana Kodama
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | | | | | | | | | | | | | | | | | - Hiromi Rakugi
- Geriatric and General Medicine, Osaka University Graduate School of Medicine
| | - Kei Kamide
- Division of Health Sciences, Osaka University Graduate School of Medicine
- Geriatric and General Medicine, Osaka University Graduate School of Medicine
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Weise L, Jakob E, Töpfer NF, Wilz G. Study protocol: individualized music for people with dementia - improvement of quality of life and social participation for people with dementia in institutional care. BMC Geriatr 2018; 18:313. [PMID: 30547745 PMCID: PMC6295033 DOI: 10.1186/s12877-018-1000-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with dementia (PwD) experience a range of negative behavioral and psychological symptoms which can lower their quality of life. Because of the increasing prevalence of dementia, interventions that maintain and enhance the quality of life for PwD are needed. Listening to individualized music constitutes a promising non-pharmacological intervention for PwD. However, despite some preliminary results, evidence regarding the effectiveness of such interventions has been mixed and previous studies have shown a number of methodological limitations. In a randomized controlled trial, we address the limitations of previous research and assess the feasibility, efficacy, and acceptability of an individualized music intervention for PwD living in a nursing home. METHODS Residents with dementia from four to five nursing homes in Germany will be randomly assigned to either an intervention or control group. The intervention group will listen to personally-relevant music for 20 min every other day for six weeks. Nursing staff will assess participants' quality of life and problem behavior at the six-week baseline, pretest, posttest, and at the six-week follow-up. Additionally, the participants' behavior will be observed during the intervention period by project staff. The implementation, acceptance, and applicability of the intervention will also be evaluated. DISCUSSION The study results will show whether an individualized music intervention can improve the quality of life for PwD living in a nursing home. Additionally, it will provide valuable insight into the acceptability and implementation of an individualized music intervention in the institutional care setting. If the individualized music intervention proves to be effective and widely applicable, it could be implemented on a large scale in institutional care as an easy-to-administer intervention. TRIAL REGISTRATION German Clinical Trials Register DRKS00013793 ; ISRCTN registry, ISRCTN59052178 , date applied 27 February 2018, date assigned 4 April 2018, retrospectively registered.
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Affiliation(s)
- Lisette Weise
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University of Jena, Humboldtstrasse 11, 07743 Jena, Germany
| | - Elisabeth Jakob
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University of Jena, Humboldtstrasse 11, 07743 Jena, Germany
| | - Nils Frithjof Töpfer
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University of Jena, Humboldtstrasse 11, 07743 Jena, Germany
| | - Gabriele Wilz
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University of Jena, Humboldtstrasse 11, 07743 Jena, Germany
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Mathew R, Pavithran S, Byju P. Neuropsychiatric Manifestations of Cognitively Advanced Idiopathic Normal Pressure Hydrocephalus. Dement Geriatr Cogn Dis Extra 2018; 8:467-475. [PMID: 30631338 PMCID: PMC6323371 DOI: 10.1159/000493914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 09/18/2018] [Indexed: 11/19/2022] Open
Abstract
Background Neuropsychiatric manifestations of patients with idiopathic normal pressure hydrocephalus (iNPH) have not been studied in a systematic way. Aim To study the spectrum of neuropsychiatric abnormalities in patients with iNPH. Patient Selection and Evaluation Patients attending 3 different tertiary care centers during three consecutive time periods spanning from 2010 to 2015 were analyzed for neuropsychiatric manifestations. Patients diagnosed as having probable or possible iNPH as per the consensus criteria were included in the study. Neuropsychiatric manifestations were captured by a comprehensive inventory (Cambridge Behavioral Inventory, CBI). Results The CBI score was available for 41 patients. The mean Mini-Mental State Examination score was 15.37 (SD 7.2) and the Addenbrooke's Cognitive Examination score was 34.95 (SD 19.67), thereby indicating cognitively advanced iNPH. All patients had impairment in one or more items on the CBI. The mean score was 55.46 (SD 27) out of 180, thereby indicating a mild degree of impairment. Among the subscores, impairment with motivation was the most observed abnormality followed by memory impairment. When the CBI total score and subscores were compared, all of them (except motivation) were higher for Alzheimer's disease; however, none was statistically significant. Even though the motivation score was higher for iNPH, the difference did not reach statistical significance. Conclusions It can be concluded that neurobehavioral abnormalities are common in patients with cognitively advanced normal pressure hydrocephalus. However, the intensity of involvement appeared less when compared to Alzheimer's disease. Apathy appears to be the most common impairment.
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Affiliation(s)
- Robert Mathew
- Sree Mookambika Institute for Medical Sciences, Padanilam, Kanyakumari District, Kulasekharam, India.,Anugraham Neurocare, Pattom, Trivandrum, India
| | | | - P Byju
- Department of Neurology, Pushpagiri Institute for Medical Sciences, Thiruvalla, India
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Koyama A, Hashimoto M, Fukuhara R, Ichimi N, Takasaki A, Matsushita M, Ishikawa T, Tanaka H, Miyagawa Y, Ikeda M. Caregiver Burden in Semantic Dementia with Right- and Left-Sided Predominant Cerebral Atrophy and in Behavioral-Variant Frontotemporal Dementia. Dement Geriatr Cogn Dis Extra 2018; 8:128-137. [PMID: 29706989 PMCID: PMC5921212 DOI: 10.1159/000487851] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 02/16/2018] [Indexed: 12/13/2022] Open
Abstract
Background Caregiver burden is a serious concern for family caregivers of dementia patients, but its nature is unclear in patients with semantic dementia (SD). This study aimed to clarify caregiver burden for right- (R > L) and left-sided (L > R) predominant SD versus behavioral-variant frontotemporal dementia (bvFTD) patients. Methods Using the Japanese version of the Zarit Burden Interview (ZBI) and the Neuropsychiatric Inventory, we examined caregiver burden and behavioral and psychological symptoms of dementia (BPSD) in 43 first-visit outpatient/family caregiver dyads (bvFTD, 20 dyads; SD [L > R], 13 dyads; SD [R > L], 10 dyads). Results We found a significant difference in ZBI score between the 3 diagnostic groups. Post hoc tests revealed a significantly higher ZBI score in the bvFTD than in the SD (L > R) group. The ZBI scores in the SD (L > R) and SD (R > L) groups were not significantly different, although the effect size was large. Caregiver burden was significantly correlated with BPSD scores in all groups and was correlated with activities of daily living and instrumental activities of daily living decline in the bvFTD and SD (R > L) groups. Conclusion Caregiver burden was highest in the bvFTD group, comparatively high in the SD (R > L) group, and lowest in the SD (L > R) group. Adequate support and intervention for caregivers should be tailored to differences in caregiver burden between these patient groups.
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Affiliation(s)
- Asuka Koyama
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Mamoru Hashimoto
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Ryuji Fukuhara
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Naoko Ichimi
- Department of Medical Quality and Safety Management, Kumamoto University Hospital, Kumamoto, Japan
| | - Akihiro Takasaki
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Masateru Matsushita
- Center for Medical Education and Research, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomohisa Ishikawa
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hibiki Tanaka
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yusuke Miyagawa
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Manabu Ikeda
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
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Na R, Kim YJ, Kim K, Kim KW. A Systematic Review of Nonpharmacological Interventions for Moderate to Severe Dementia: A Study Protocol for a Systematic Review and Meta-Analysis. Psychiatry Investig 2018; 15:417-423. [PMID: 29669408 PMCID: PMC5912495 DOI: 10.30773/pi.2017.09.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 07/25/2017] [Accepted: 09/06/2017] [Indexed: 11/27/2022] Open
Abstract
The study is designed as a systematic review on nonpharmacological interventions for patients with moderate to severe dementia. This review will be conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. The following databases will be searched: Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, KoreaMED, KMbase, and KISS. The primary outcome will include the effect of the interventions on activities of daily living and behavioral and psychological symptoms of dementia. The literature search will be conducted based on search strategies designed for each database. The reviewers will independently assess the identified studies and extract the data. The risk of bias will be assessed and a meta-analysis will be conducted in accordance with the methodology for meta-analysis described in the Cochrane handbook. This systematic review will provide clinicians and policy makers with reliable evidence for developing and implementing nonpharmacological interventions for moderate to severe patients with dementia.
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Affiliation(s)
- Riyoung Na
- National Institute of Dementia, Seongnam, Republic of Korea
| | - You Joung Kim
- National Institute of Dementia, Seongnam, Republic of Korea
| | - Kiwon Kim
- National Institute of Dementia, Seongnam, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ki Woong Kim
- National Institute of Dementia, Seongnam, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Abstract
Behavioral and psychological symptoms of dementia (BPSD) are universally experienced by people with dementia throughout the course of the illness and cause a significant negative impact on quality of life for patients and caregivers. Nonpharmacologic treatments have been recommended as first-line treatment of BPSD by multiple professional organizations and should target patients with dementia factors, caregiver factors, and environmental factors. Psychotropic medications are often prescribed off-label without significant evidence to support their use. The Describe, Investigate, Create, Evaluate approach can provide a structured method to investigate and treat BPSD with flexibility to use in multiple treatment settings.
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Affiliation(s)
- Lauren B Gerlach
- Program for Positive Aging, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Helen C Kales
- Program for Positive Aging, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
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Kushwaha S, Talwar P, Anthony A, Gupta M, Bala K, Agarwal R, Sharma V, Kukreti R. Clinical Spectrum, Risk Factors, and Behavioral Abnormalities among Dementia Subtypes in a North Indian Population: A Hospital-Based Study. Dement Geriatr Cogn Dis Extra 2017; 7:257-273. [PMID: 29033972 PMCID: PMC5624266 DOI: 10.1159/000478978] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 06/23/2017] [Indexed: 12/27/2022] Open
Abstract
Background As variability in the clinical profile of dementia subtypes had been reported with regional differences across the world, we conducted a retrospective hospital-based study in a North Indian population. Methods We retrieved patient records from 2007 to 2014 for details of clinical evaluation, diagnosis, neuroimaging, biochemical investigations, and follow-up of 1,876 patients with dementia (PwD), and the data were analyzed using descriptive statistics. Results Of the total PwD, Alzheimer disease (AD) accounted for 30% followed by vascular dementia (VaD) 26%, mixed dementia (MD) 21%, Parkinson-related dementia 11%, frontotemporal dementia (FTD) 7%, and infective dementia 5%. Of all PwD excluding the infective group (n = 1,777), 63% were men, 39% were from rural areas, 87% had behavioral abnormalities along with cognitive deficits, and 73% had impaired ADLs. Among dementia subtypes, a positive family history, cardiovascular and metabolic risk factors, and behavioral abnormalities were found to be distributed. However, there existed a predominance of specific behavioral pattern in each subtype. The mean duration of follow-up varied from 2.9 ± 2.3 (VaD) to 3.6 ± 2.1 (AD) and greater than 30% were found to be stable on treatment (except in dementia with Lewy body). Conclusions This large hospital-based study provides a distribution pattern and clinical spectrum of dementia subtypes in a North Indian population.
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Affiliation(s)
- Suman Kushwaha
- Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India
| | - Puneet Talwar
- Genomics and Molecular Medicine Unit, Institute of Genomics and Integrative Biology (IGIB), Council of Scientific and Industrial Research (CSIR), Delhi, India
| | - Aldrin Anthony
- Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India
| | | | - Kiran Bala
- Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India
| | - Rachna Agarwal
- Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India
| | - Vibha Sharma
- Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India
| | - Ritushree Kukreti
- Genomics and Molecular Medicine Unit, Institute of Genomics and Integrative Biology (IGIB), Council of Scientific and Industrial Research (CSIR), Delhi, India
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Yokoi T, Okamura H, Yamamoto T, Watanabe K, Yokoi S, Atae H, Ueda M, Kuwayama T, Sakamoto S, Tomino S, Fujii H, Honda T, Morita T, Yukawa T, Harada N. Effect of wearing fingers rings on the behavioral and psychological symptoms of dementia: An exploratory study. SAGE Open Med 2017; 5:2050312117726196. [PMID: 28856006 PMCID: PMC5570107 DOI: 10.1177/2050312117726196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 07/13/2017] [Indexed: 11/25/2022] Open
Abstract
Objective: This study was conducted to examine the effects of an approach that wears finger rings on elderly females with behavioral and psychological symptoms of dementia. Method: The subjects were seven Japanese dementia patients living in elderly nursing homes. A single-case experimental design was adopted for the study. Each study subject was asked to put rings on her finger (from 9:00 to 19:00) for 7 days. The Neuropsychiatric Inventory, scenes of behavioral and psychological symptoms of dementia, interest in wearing rings, self-awareness, and overall profile were determined to assess the effect on the patients of wearing rings. Results: The majority of nursing care providers stated, based on their assessment, that the “irritability/lability” that was noted during the baseline period disappeared during the ring-wearing intervention period in the three patients who displayed an interest in rings. In the assessment of the self-awareness ability, these three women were aware themselves of their intellect collapsing and were capable of conjecturing their own and others’ minds. It was commonly seen that the nursing staff, even though they had not been asked to do so by the researchers, told the patients, “Mrs. XX, you look so beautiful” when they found a patient wearing rings. Discussion/conclusion: Individuals with low self-esteem are inclined to get angry and display aggression. In subjects with low self-esteem, anger and aggression readily arise when they are slighted by others. Self-esteem is low in those women who are aware of their own status of collapsing intellect. It is concluded that the words of conjuration, “you look so beautiful,” which the wearing of the ring per se by the patient elicited from the caregivers heightened the self-esteem and alleviated “irritability/lability” in the study subjects.
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Affiliation(s)
- Teruo Yokoi
- Department of Physical Therapy, Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Hitoshi Okamura
- Graduate school of Health Science, Hiroshima University, Hiroshima, Japan
| | | | | | - Shigeko Yokoi
- Graduate School of Integrated Arts and Sciences, Hiroshima University, Higashihiroshima, Japan
| | - Hitoshi Atae
- Department of Physical Therapy, Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Masayuki Ueda
- Department of Physical Therapy, Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Takahiro Kuwayama
- Department of Physical Therapy, Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Shigekazu Sakamoto
- Department of Physical Therapy, Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Saaya Tomino
- Department of Physical Therapy, Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Hideo Fujii
- Department of Physical Therapy, Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Takefumi Honda
- Department of Physical Therapy, Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Takayosi Morita
- Department of Physical Therapy, Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Takafumi Yukawa
- Department of Physical Therapy, Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Nobuko Harada
- Department of Physical Therapy, Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
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Tu MC, Huang WH, Hsu YH, Lo CP, Deng JF, Huang CF. Comparison of neuropsychiatric symptoms and diffusion tensor imaging correlates among patients with subcortical ischemic vascular disease and Alzheimer's disease. BMC Neurol 2017; 17:144. [PMID: 28754095 PMCID: PMC5534111 DOI: 10.1186/s12883-017-0911-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 07/05/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The causes of behavioral and psychological symptoms of dementia (BPSD) vary according to the dementia subtype and associated neuropathology. The present study aimed to (i) compare BPSD between patients with subcortical ischemic vascular disease (SIVD) and Alzheimer's disease (AD) across stages, and (ii) explore the associations with diffusion tensor imaging (DTI) in the corpus callosum (CC) and other major fibers. METHODS Twenty-four patients with SIVD and 32 with AD were recruited. Four domains of the Neuropsychiatric Inventory (NPI) (hyperactivity, psychosis, affective, and apathy) and two DTI parameters [fractional anisotropy (FA) and mean diffusivity (MD)] within the genu, body (BCC), and splenium (SCC) of the CC and other major fibers were assessed. RESULTS Overall, the patients with clinical dementia rating (CDR) 1 ~ 2 had higher scores in apathy domain than those with CDR0.5. Among those with CDR1 ~ 2, SIVD had higher scores in apathy domain than AD. MD values in the BCC/SCC were positively correlated with total NPI score and psychosis, hyperactivity, and apathy domains. FA values in the SCC were inversely correlated with total NPI score and psychosis domain. The correlations were modified by age, the CASI, and CDR scores. Stepwise linear regression models suggested that FA value within the left superior longitudinal fasciculus predicted the hyperactivity domain. MD value within the SCC/left uncinate fasciculus and FA value within the GCC/left forceps major predicted the psychosis domain. MD value within the right superior longitudinal fasciculus and CDR predicted the apathy domain. Further analysis suggested distinct patterns of regression models between SIVD and AD patients. CONCLUSION White matter integrity within the BCC/SCC had associations with multi-domains of BPSD. Our study also identified important roles of regions other than the CC to individual domain of BPSD, including the left superior longitudinal fasciculus to the hyperactivity domain, the left uncinate fasciculus/forceps major to the psychosis domain, and the right superior longitudinal fasciculus to the apathy domain. The neuronal substrates in predicting BPSD were different between SIVD and AD patients. Of note, apathy, which was more profound in SIVD, was associated with corresponding fiber disconnection in line with dementia severity and global cognition decline.
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Affiliation(s)
- Min-Chien Tu
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 88, Sec. 1, Fengxing Rd., Tanzi Dist., 427 Taichung City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wen-Hui Huang
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 88, Sec. 1, Fengxing Rd., Tanzi Dist., 427 Taichung City, Taiwan
| | - Yen-Hsuan Hsu
- Department of Psychology, National Chung Cheng University, Chiayi, Taiwan
| | - Chung-Ping Lo
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Radiology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Jie Fu Deng
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 88, Sec. 1, Fengxing Rd., Tanzi Dist., 427 Taichung City, Taiwan
| | - Ching-Feng Huang
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 88, Sec. 1, Fengxing Rd., Tanzi Dist., 427 Taichung City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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Yu EY, Liao ZL, Tan YF, Qiu YJ, Zhu JP, Chen Y, Lin SS, Wu MH. [Efficacy and tolerance of Memantine monotherapy and combination therapy with Reinhartdt And Sea Cucumber Capsule on agitation in moderate to severe Alzheimer disease]. Zhonghua Yi Xue Za Zhi 2017; 97:2091-2094. [PMID: 28763881 DOI: 10.3760/cma.j.issn.0376-2491.2017.27.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the efficacy and tolerance of Memantine combined Reinhartdt And Sea Cucumber Capsule (R.S.C) on treating agitation in patients with moderate-severe Alzheimer disease (AD). Methods: One hundred and fifty-eight moderate-sever AD patients from Sep.2013 to Sep.2014 in Zhejiang Provincial People's Hospital were randomly divided into two groups: group of Memantine combined R. S.C and group of single Memantine. Then Mini-Mental Sate Examination (MMSE) and Neuropsychiatric Inventory (NPI) were used to evaluate cognition symptom, behavioral and psychological symptoms of dementia (BPSD) and agitation symptom at the baseline and the end of 24 weeks.The Treatment Emergent Symptom Scale (TESS) was used to assess adverse reaction and tolerance.At last, the data was analyzed by chi-square test, t-test and covariance test. Result: At the terminal of experience, the total NPI scores and agitation factor decreased markedly in both of the two groups (P<0.05). Among the patients who had agitation symptom at the baseline, the total NPI scores and agitation factor (18±5, 3.7±2.6) in group of Memantine combined R. S.C were notably lower than those in the group of single Memantine (21±6, 5.3±2.5) (P<0.05). The incidence of adverse reaction between the two groups had no significant difference (combined treatment group was 27.7%, single treatment group was 23.2%). One patient dropped out because of skin allergy, and most adverse reactions were tolerant. Conclusions: Both two groups are effective in agitation and BPSD, and Memantine combined R. S.C is better than single treatment.R.S.C dose not aggravate adverse reaction and can be well tolerated.
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Affiliation(s)
- E Y Yu
- Department of Psychiatry, Zhejiang Provincial People's Hospital, Hangzhou 310014, China
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Kolanowski A, Boltz M, Galik E, Gitlin LN, Kales HC, Resnick B, Van Haitsma KS, Knehans A, Sutterlin JE, Sefcik JS, Liu W, Petrovsky DV, Massimo L, Gilmore-Bykovskyi A, MacAndrew M, Brewster G, Nalls V, Jao YL, Duffort N, Scerpella D. Determinants of behavioral and psychological symptoms of dementia: A scoping review of the evidence. Nurs Outlook 2017; 65:515-529. [PMID: 28826872 DOI: 10.1016/j.outlook.2017.06.006] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/20/2017] [Accepted: 06/06/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) are prevalent in people with neurodegenerative diseases. PURPOSE In this scoping review the Kales, Gitlin and Lykestos framework is used to answer the question: What high quality evidence exists for the patient, caregiver and environmental determinants of five specific BPSD: aggression, agitation, apathy, depression and psychosis? METHOD An a priori review protocol was developed; 692 of 6013 articles retrieved in the search were deemed eligible for review. Gough's Weight of Evidence Framework and the Cochrane Collaboration's tool for assessing risk of bias were used. The findings from 56 high quality/low bias articles are summarized. DISCUSSION Each symptom had its own set of determinants, but many were common across several symptoms: neurodegeneration, type of dementia, severity of cognitive impairments, and declining functional abilities, and to a lesser extent, caregiver burden and communication. CONCLUSION Research and policy implications are relevant to the National Plan to Address Alzheimer's Disease.
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Affiliation(s)
| | - Marie Boltz
- College of Nursing, Penn State, University Park, PA
| | | | - Laura N Gitlin
- Department of Community-Public Health, Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, MD; Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Helen C Kales
- The Program for Positive Aging, University of Michigan, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
| | | | - Kimberly S Van Haitsma
- Program for Person Centered Living Systems of Care, College of Nursing, The Pennsylvania State University, University Park, PA; Polisher Research Institute, Madlyn & Leonard Abramson Center for Jewish Life, North Wales, PA
| | - Amy Knehans
- Penn State College of Medicine, Harrell Health Sciences Library, Research & Learning Commons, Hershey, PA
| | | | | | - Wen Liu
- College of Nursing, The University of Iowa, Iowa City, IA
| | | | | | | | - Margaret MacAndrew
- Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Glenna Brewster
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Danny Scerpella
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD
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Regier NG, Gitlin LN. Psychosocial and Environmental Treatment Approaches for Behavioral and Psychological Symptoms in Neurocognitive Disorders: an Update and Future Directions. Curr Treat Options Psychiatry 2017; 4:80-101. [PMID: 37465053 PMCID: PMC10353767 DOI: 10.1007/s40501-017-0105-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Nearly all persons with dementia will exhibit behavioral and psychological symptoms (BPSD) at some point during the course of the disease. These symptoms often pose significant challenges for formal and informal caregivers, and their treatment is unclear. Current guidelines recommend implementing nonpharmacological interventions as the first-line approach to managing BPSD. Given the recent proliferation of research evaluating the use of nonpharmacological interventions for BPSD, there is a continuing need to reevaluate and synthesize the findings in this area. The current review examines the evidence for using psychosocial and environmental strategies, focusing on the past 3 years of research efforts and assessing how this research augments what is known from prior reviews. We conclude that the results in the recent literature concerning the efficacy of psychosocial and environmental treatment approaches to behavioral symptoms in dementia continue to be promising, yet results are also mixed. We recommend the consideration of music therapy and tailored activities when utilizing a nonpharmacological approach, as these appear particularly promising throughout the literature. We also find that multisensory stimulation and animal-assisted therapy warrant further evaluation. In contrast, in this and previous reviews, approaches such as bright light therapy and aromatherapy have consistently been shown to be ineffective and, thus, cannot be recommended with confidence based on the evidence. We discuss limitations of current research studies and make recommendations for future research in the area of psychosocial and environmental interventions for BPSD.
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Affiliation(s)
- Natalie G. Regier
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, 525 North Wolfe Street, SON House Room 301, Baltimore, MD, 21205, USA
- Department of Community and Public Health, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Suite 316, Baltimore, MD, 21205, USA
| | - Laura N. Gitlin
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, 525 North Wolfe Street, SON House Room 301, Baltimore, MD, 21205, USA
- Department of Community and Public Health, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Suite 316, Baltimore, MD, 21205, USA
- Department of Psychiatry, Johns Hopkins School of Medicine, 525 N. Wolfe Street, Suite 316, Baltimore, MD, 21205, USA
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