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Wang Z, Feng Y, Wang Y, Qiu H, Rui Z, Li M, Lv L. Meta-Analysis of the Efficacy and Safety of Olanzapine versus Clozapine when Treating Senile Dementia. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5046761. [PMID: 35991140 PMCID: PMC9388268 DOI: 10.1155/2022/5046761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022]
Abstract
Objective To systematically assess the safety and efficacy of olanzapine versus clozapine when treating senile dementia and to provide evidence-based medicine basis for its promotion and use. Methods PubMed, Embase, ScienceDirect, Cochrane Library, China Knowledge Network Database (CNKI), China VIP Database, Wanfang Database, and China Biomedical Literature Database (CBM) online database were searched for randomized controlled trials (RCT) of olanzapine and clozapine when treating senile dementia. The retrieval time limit is from the establishment of the database to the present. The data were extracted independently by two researchers, and the bias risk of each contained literature was analyzed in accordance with the standard of Cochrane Handbook 5.3. RevMan 5.4 statistical software was used to analyze the collected data by meta-analysis. Results Finally, 6 randomized controlled trial articles were included, with a total of 490 samples. Meta-analysis of clinical efficacy showed that the clinical efficacy was similar and there was no significant difference (P > 0.05). Two articles used Alzheimer's disease pathological behavior rating scale (BEHAVE-AD) to compare the pathological behavior of different stages after treatment. Statistical analysis showed that there was no significant difference between the total score of BEHAVE-AD and the scores of each factor in each week after treatment. The non-treatment adverse reaction scale (TESS) of the study group and the control group was analyzed by meta-analysis. The TESS score of the study group after treatment was significantly lower than that of the control group. The BPRS scores of different stages after treatment were analyzed by meta-analysis, and there was no significant difference in the total score and factor scores of BPRS in each week after treatment. Two clinical trials reported the incidence of neurological symptoms after treatment. Olanzapine and clozapine treatment can effectively reduce the risk of aging. There was no significant difference in the incidence of neurological symptoms in patients with dementia (P > 0.05). According to the analysis of meat products, the incidence of adverse reactions in the study group was significantly lower than that in the control group (P < 0.05). Conclusion Olanzapine and clozapine have similar efficacy when treating mental and behavioral disorders in patients with senile dementia, in which olanzapine is more effective in improving the symptoms of patients with Alzheimer's disease (AD), with less adverse reactions and high safety, which is worth popularizing in clinical practice. However, more studies and follow-up with higher methodological quality and longer intervention time are needed to further verify.
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Affiliation(s)
- Zongqin Wang
- Wuhan Mental Health Center, No. 93 Youyi Road Qiaokou District, China
| | - Yingying Feng
- Wuhan Mental Health Center, No. 93 Youyi Road Qiaokou District, China
| | - Yanyan Wang
- Wuhan Mental Health Center, No. 93 Youyi Road Qiaokou District, China
| | - Hui Qiu
- Wuhan Mental Health Center, No. 93 Youyi Road Qiaokou District, China
| | - Zhongyang Rui
- Wuhan Mental Health Center, No. 93 Youyi Road Qiaokou District, China
| | - Mingxing Li
- Wuhan Mental Health Center, No. 93 Youyi Road Qiaokou District, China
| | - Lihua Lv
- Wuhan Mental Health Center, No. 93 Youyi Road Qiaokou District, China
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Gerlach LB, Maust DT, Kales HC, Chang M, Kim HM, Wiechers IR, Zivin K. Evaluation of Antipsychotic Reduction Efforts in Patients With Dementia in Veterans Health Administration Nursing Homes. Am J Psychiatry 2022; 179:544-552. [PMID: 35615813 PMCID: PMC9349465 DOI: 10.1176/appi.ajp.21060591] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The Veterans Health Administration (VHA) and the Centers for Medicare and Medicaid Services (CMS) each created initiatives to reduce off-label use of antipsychotics in patients with dementia in nursing homes. Although CMS has reported antipsychotic reductions, the impact on prescribing of antipsychotic and other CNS-active medications in the VHA remains unclear. The authors evaluated national trends in antipsychotic and other CNS-active medication prescribing for nursing home patients with dementia in the VHA. METHODS The study sample was all veterans with dementia residing in VHA nursing homes for more than 30 days (N=35,742). Using an interrupted time-series design, the quarterly prevalences of antipsychotic, antidepressant, antiepileptic, anxiolytic, opioid, and memory medication prescribing were evaluated from FY2009 through FY2018. RESULTS Antipsychotic prescribing in VHA nursing homes declined from FY2009 to FY2018 (from 33.7% to 27.5%), with similar declines in anxiolytic prescribing (from 33.5% to 27.1%). During this period, prescribing of antiepileptics, antidepressants, and opioids increased significantly (antiepileptics: from 26.8% to 43.3%; antidepressants: from 56.8% to 63.4%; opioids: from 32.6% to 41.2%). Gabapentin served as the main driver of antiepileptic increases (from 11.1% to 23.5%). Increases in antidepressant prescribing included sertraline, mirtazapine, and trazodone. From FY2009 to FY2018, the overall prescribing of non-antipsychotic psychotropic medications grew from 75.0% to 81.1%. CONCLUSIONS Antipsychotic and anxiolytic prescribing for VHA nursing home residents with dementia declined, although overall prescribing of other psychotropic and opioid medications increased. Policies focused primarily on reducing antipsychotic use without considering use in the context of other medications may contribute to growth in alternative medication classes with even less evidence of benefit and similar risks.
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Affiliation(s)
- Lauren B. Gerlach
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Donovan T. Maust
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Helen C. Kales
- Department of Psychiatry, University of California Davis, Sacramento, California
| | - Myron Chang
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - H. Myra Kim
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan,Center for Statistical Consulting and Research, University of Michigan, Ann Arbor, Michigan
| | - Ilse R. Wiechers
- Office of Mental Health and Suicide Prevention, U.S. Dept. of Veterans Affairs,Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Kara Zivin
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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Tampi RR, Jeste DV. Dementia Is More Than Memory Loss: Neuropsychiatric Symptoms of Dementia and Their Nonpharmacological and Pharmacological Management. Am J Psychiatry 2022; 179:528-543. [PMID: 35921394 DOI: 10.1176/appi.ajp.20220508] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neuropsychiatric symptoms of dementia (NPS) are a group of noncognitive symptoms that occur in over 90% of individuals with dementia. NPS seem to result from a complex interaction among various biological, psychosocial, and environmental factors, and they are associated with greater morbidity and mortality, higher caregiver burden and burnout, high risk of nursing home placement, and increased cost of care for patients with dementia. Use of standardized assessment tools like the Neuropsychiatric Inventory can assist with qualifying and quantifying NPS. In this review, the authors evaluate the evidence for efficacy and safety of nonpharmacological and pharmacological interventions for treating NPS, mostly based on published meta-analyses. Commonly prescribed medications include atypical antipsychotics, acetylcholinesterase inhibitors, memantine, antidepressants, and mood stabilizers. There are also limited data on cannabinoids, repetitive transcranial magnetic stimulation, and ECT in individuals with NPS. Available evidence indicates that several nonpharmacological interventions are beneficial in the management of NPS and are recommended as first-line treatments. Pharmacotherapy should be reserved for the treatment of more severe or refractory NPS or where nonpharmacological management is not feasible. Atypical antipsychotics have shown mostly modest benefit in reducing NPS, and their use is limited by their adverse effect profiles. Recent investigations suggest potential strategies for preventing or at least reducing the risk of dementia and NPS. The authors conclude with brief guidelines for clinical practice as well as future research.
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Affiliation(s)
- Rajesh R Tampi
- Department of Psychiatry, Creighton University School of Medicine, Omaha (Tampi); Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (Tampi); Department of Psychiatry, Department of Neurosciences, and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego (Jeste)
| | - Dilip V Jeste
- Department of Psychiatry, Creighton University School of Medicine, Omaha (Tampi); Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (Tampi); Department of Psychiatry, Department of Neurosciences, and Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego (Jeste)
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Pharmacotechnological Advances for Clinical Translation of Essential Oils for the Treatment of Pain and Agitation in Severe Dementia. Processes (Basel) 2022. [DOI: 10.3390/pr10071340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
The demand for natural products is steadily increasing, and pharmacotechnological engineering is needed to allow rigorous investigation of their efficacy and safety in clinical conditions representing still unmet needs. Among aged patients affected by dementia, up to 80% of residents in nursing homes suffer from chronic pain and 97% from fluctuant neuropsychiatric symptoms (NPS), of which the most challenging is agitation. It is, at least in part, due to undertreated pain and treated with antipsychotics almost doubling the risk of death. In the frame of a scoping review assessing the existence of essential oils undergoing engineering pharmacotechnological processes using solid lipid nanoparticle delivery systems for clinical translation in pain and/or neuropsychiatric symptoms of dementia following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), here we identified that the sole essential oil engineered to overcome the criticisms of aromatherapy clinical trials in pain and dementia is the essential oil of bergamot (BEO). Therefore, we present the process leading to the actually ongoing randomized, double-blind, placebo-controlled NCT04321889 clinical trial to assess the efficacy and safety of intervention with bergamot in the management of agitation and pain in severe dementia to be followed also for the proof of concept of efficacy and safety of other essential oils.
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55
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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]. DER 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] [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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56
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Zhang A, Yang Y, Xu M. Clinical Observation of Computer Vision Technology Combined with Music Therapy in the Treatment of Alzheimer's Disease. Emerg Med Int 2022; 2022:2567340. [PMID: 35811609 PMCID: PMC9259287 DOI: 10.1155/2022/2567340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/25/2022] [Accepted: 06/02/2022] [Indexed: 11/17/2022] Open
Abstract
With the world's population aging, Alzheimer's disease has attracted more and more attention as a common elderly disease. The clinical manifestations of cognitive function decline in Alzheimer's disease are mainly memory decline, which will seriously damage the patient's sense of self-worth. The purpose is to use the method of song recall to conduct individual music therapy intervention for Alzheimer's disease patients, to help Alzheimer's disease patients activate autobiographical memory, trigger positive emotions, improve behavioral symptoms, and delay the development of the disease. This paper proposes to combine computer vision technology with music therapy to obtain relevant data before and after intervention through the literature method, measurement method, case study method and experimental method. It helps AD patients to improve and slow down the forgetting and confusion of autobiographical memory, thereby enhancing the mood and cognition of AD patients. It observes the changes of AD patients before and after intervention by song recall and provides new ideas and practical basis for the application of music therapy in the field of Alzheimer's disease research. The experimental results showed that the subjects' autobiographical memory test (AMT) after 16 sessions of music therapy, from 12 points before the test to 14 points after the test. The scores were significantly positively correlated, and the improvement of autobiographical memory could improve the patient's orientation and memory.
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Affiliation(s)
- Anshuang Zhang
- Department of Creative Arts Psychotherapy, Jeonju University, Jeonju 55068, Republic of Korea
| | - Yunpeng Yang
- Information Office, Shandong Modern College, Jinan 250000, Shandong, China
| | - Ming Xu
- Department of Creative Arts Psychotherapy, Jeonju University, Jeonju 55068, Republic of Korea
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57
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Harris ML, Titler MG. Feasibility and Acceptability of a Remotely Delivered Weighted Blanket Intervention for People Living With Dementia and Their Family Caregivers. J Appl Gerontol 2022; 41:2316-2328. [PMID: 35750505 DOI: 10.1177/07334648221111123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The COVID-19 pandemic amplified the need for interventions to support community-dwelling families living with dementia. This study examined the feasibility and acceptability of a remotely delivered weighted blanket intervention for people living with dementia, and the feasibility of collecting outcome measures specific to people with dementia and caregivers. A prospective, within subjects, pre-post design was used; 21 people with dementia and their caregivers participated. Measures of feasibility (days blanket was used for the recommended duration, injuries/adverse events, enrollment, and withdrawal rate, time to recruit sample) and acceptability (tolerability, satisfaction, and benefit perceived by participants with dementia and caregivers) were examined. Feasibility of collecting measures was examined through missing data. Results indicated high feasibility and acceptability. Collecting caregiver completed outcome measures was feasible, but measures completed by self-report by people with dementia was not. Weighted blankets are a promising tool for this population that warrant further examination to determine efficacy.
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58
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Scuteri D, Contrada M, Loria T, Sturino D, Cerasa A, Tonin P, Sandrini G, Tamburin S, Bruni AC, Nicotera P, Corasaniti MT, Bagetta G. Pain and agitation treatment in severe dementia patients: The need for Italian Mobilization-Observation-Behavior-Intensity-Dementia (I-MOBID2) pain scale translation, adaptation and validation with psychometric testing. Biomed Pharmacother 2022; 150:113013. [PMID: 35658247 DOI: 10.1016/j.biopha.2022.113013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 11/02/2022] Open
Abstract
The 97% of dementia patients develops fluctuant neuropsychiatric symptoms often related to under-diagnosed and unrelieved pain. Up to 80% severe demented nursing home residents experiences chronic pain due to age-related comorbidities. Patients lacking self-report skills risk not to be appropriately treated for pain. Mobilization-Observation-Behavior-Intensity-Dementia (MOBID2) is the sole pain scale to consider the frequent co-occurrence of musculoskeletal and visceral pain and to unravel concealed pain through active guided movements. Accordingly, the Italian real-world setting can benefit from its translation and validation. This clinical study provides a translated, adapted and validated version of the MOBID2, the Italian I-MOBID2. The translation, adaptation and validation of the scale for non-verbal, severe demented patients was conducted according to current guidelines in a cohort of 11 patients over 65 with mini-mental state examination ≤ 12. The I-MOBID2 proves: good face and scale content validity index (0.89); reliable internal consistency (Cronbach's α = 0.751); good to excellent inter-rater (Intraclass correlation coefficient, and test-retest (ICC = 0.902) reliability. The construct validity is high (Rho = 0.748 p < 0.05 for 11 patients, Spearman rank order correlation of the overall pain intensity score with the maximum item score of I-MOBID2 Part 1; rho=0.895 p < 0.01 for 11 patients, for the overall pain intensity score with the maximum item score of I-MOBID2 Part 2) and a good rate of inter-rater and test-retest agreement was demonstrated by Cohen's K = 0.744. The average execution time is of 5.8 min, thus making I-MOBID2 a useful tool suitable also for future development in community setting with administration by caregivers.
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Affiliation(s)
- D Scuteri
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy; Regional Center for Serious Brain Injuries, S. Anna Institute, 88900 Crotone, Italy.
| | - M Contrada
- Regional Center for Serious Brain Injuries, S. Anna Institute, 88900 Crotone, Italy.
| | - T Loria
- Casa Giardino RSA, 88836 Cotronei, Italy.
| | - D Sturino
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy.
| | - A Cerasa
- Regional Center for Serious Brain Injuries, S. Anna Institute, 88900 Crotone, Italy.
| | - P Tonin
- Regional Center for Serious Brain Injuries, S. Anna Institute, 88900 Crotone, Italy.
| | - G Sandrini
- Department of Brain and Behavioral Sciences, University of Pavia, IRCCS C. Mondino Foundation Neurologic Institute, Pavia 27100, Italy.
| | - S Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona 37100, Italy.
| | - A C Bruni
- Regional Neurogenetic Centre, Department of Primary Care, ASP-CZ, Lamezia Terme 88046, Italy.
| | - P Nicotera
- German Center for Neurodegenerative Diseases (DZNE), Bonn 53111, Germany.
| | - M T Corasaniti
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy.
| | - G Bagetta
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy.
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McDade EM. Alzheimer Disease. Continuum (Minneap Minn) 2022; 28:648-675. [PMID: 35678397 DOI: 10.1212/con.0000000000001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Alzheimer disease (AD) is the most common cause of dementia in adults (mid to late life), highlighting the importance of understanding the risk factors, clinical manifestations, and recent developments in diagnostic testing and therapeutics. RECENT FINDINGS Advances in fluid (CSF and blood-based) and imaging biomarkers are allowing for a more precise and earlier diagnosis of AD (relative to non-AD dementias) across the disease spectrum and in patients with atypical clinical features. Specifically, tau- and amyloid-related AD pathologic changes can now be measured by CSF, plasma, and positron emission tomography (PET) with good precision. Additionally, a better understanding of risk factors for AD has highlighted the need for clinicians to address comorbidities to maximize prevention of cognitive decline in those at risk or to slow decline in patients who are symptomatic. Recent clinical trials of amyloid-lowering drugs have provided not only some optimism that amyloid reduction or prevention may be beneficial but also a recognition that addressing additional targets will be necessary for significant disease modification. SUMMARY Recent developments in fluid and imaging biomarkers have led to the improved understanding of AD as a chronic condition with a protracted presymptomatic phase followed by the clinical stage traditionally recognized by neurologists. As clinical trials of potential disease-modifying therapies continue, important developments in the understanding of the disease will improve clinical care now and lead to more effective therapies in the near future.
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60
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Ma H, Lu X, Zhou A, Wang F, Zuo X, Zhan M, Zou Q, Gong S, Chen Y, Lyu J, Jia L, Jia J, Wei C. Clinical Practice Guidelines for the Management of Behavioral and Psychological Symptoms of Dementia: A Systematic Review With AGREE II. Front Neurol 2022; 13:799723. [PMID: 35693007 PMCID: PMC9174457 DOI: 10.3389/fneur.2022.799723] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 04/22/2022] [Indexed: 12/20/2022] Open
Abstract
Background High-quality clinical practice guidelines (CPGs) are important for the effective treatment of behavioral and psychological symptoms of dementia (BPSD). However, recommendations provided by different quality guidelines may lead to varied clinical practice outcomes. Objective To assess the quality of available CPGs for the management of BPSD and summarize the best recommendations for treating BPSD. Methods This was a systematic review of CPGs for the management of BPSD with data obtained from electronic databases and evaluated using the Appraisal of Guidelines for Research and Evaluation II instrument, consisting of six domains: "Scope and purpose", "Stakeholder involvement", "Rigor of development", "Clarity of presentation", "Applicability", and "Editorial independence". The criteria for high-quality guidelines were set as: the score of high-quality guidelines in the "Rigor of development" domain should be ≥60% and as well as a score of >60% in at least three other domains. High-quality guidelines were selected for recommendation extraction, and the final recommendations were formed in combination with the latest meta-analysis and randomized clinical-trial results. Results In term of median scores in each domain for the six included CPGs, "Scope and purpose" (87.5%) scored better than all others, whereas "Applicability" (46.5%) was the domain with the lowest score. Four CPGs (2015 APA, 2018 NICE, 2018 CANADA, 2020 EAN) met the criteria of high-quality guidelines and were used to extract recommendations. From these four CPGs, nine specific recommendations related to the management of BPSD were summarized, of which seven were related to pharmacological treatment and two to non-pharmacological treatment. These recommendations covered the applicability of antipsychotic drugs, medication recommendations, withdrawal times, and several suitable non-pharmacological therapies. Conclusion The quality of CPGs for the management of BPSD requires improvement, especially for the "Applicability" domain. For psychotic-like symptoms in dementia, the use of antipsychotics should be based on the individual's risk-benefit ratio, and the use of atypical antipsychotics seems to be a better choice. Non-pharmacological treatments may be suitable for emotional symptoms and sleep disorders. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020209204.
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Affiliation(s)
- Huixuan Ma
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xinliang Lu
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Aihong Zhou
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Fen Wang
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Xiumei Zuo
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Minmin Zhan
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Qi Zou
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Cooperation of Chinese and Western Medicine Institute, Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Shuting Gong
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yufei Chen
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Jihui Lyu
- Beijing Geriatric Hospital, Beijing, China
| | - Longfei Jia
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Jianping Jia
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Cuibai Wei
- Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
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Yoon JM, Trinkoff AM, Galik E, Storr CL, Lerner NB, Brandt N, Zhu S. Deficiency Citations on Inappropriate Psychotropics Use Related to Care for Behavioral Symptoms of Dementia. J Am Med Dir Assoc 2022; 23:1772-1779. [PMID: 35568094 DOI: 10.1016/j.jamda.2022.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/14/2022] [Accepted: 04/02/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The Centers for Medicare and Medicaid (CMS) initiated the National Partnership to Improve Dementia Care in Nursing Homes in 2012, which helped decrease antipsychotics use. However, inappropriate use of antipsychotics and other psychotropic medications to control behavioral symptoms associated with dementia persists. Nursing homes (NHs) can be flagged for inappropriate psychotropics use as a deficiency of care citation (F-758 tag). The purpose of this study was to comprehensively explore inappropriate psychotropic medication use deficiency, F-758 citations, in caring for NH residents with dementia. DESIGN A mixed-methods study was performed. SETTING AND PARTICIPANTS During the first quarter of 2018 (January-March), 3526 NHs were surveyed, of which 642 received F-758 tags. Of the 642, the sample was confined to the 444 NHs that received the citation for the care of residents with dementia. Information on deficiencies was obtained from 2018 Certification and Survey Provider Enhanced Reporting data. Inspection reports for deficiencies were obtained from Centers for Medicare and Medicaid Nursing Home Compare and ProPublica. METHODS Quantitative analysis was used to examine the frequency of involved psychotropic medications, scope/severity of F-758 deficiency citations, and reasons for the citations. Reasons for F-758 citations by psychotropic medication categories and scope/severity of the citations were also examined using χ2 tests. Qualitative data analysis was conducted using content analysis with an inductive coding approach to summarize the inspection reports. RESULTS Antipsychotics were the most involved drug category for F-758 tag citations. The 3 most common reasons for F-758 citations included failure to identify and/or monitor behavioral symptoms (178 NHs), attempt gradual drug reduction (131 NHs), and maintain 14-day limitations on PRN psychotropic orders (121 NHs). Compared with those with no involvement of antipsychotic drugs, facilities with antipsychotics-related F-758 tags had higher rates of failure to identify/monitor behavioral symptoms (P < .001), attempt gradual drug reduction (P < .001), and provide adequate indications for psychotropics use (P < .001). NHs with F-758 tags related to inappropriate antianxiety medication use had a higher prevalence of failure to maintain 14-day limitation on PRN orders (P < .001) and provide nonpharmacologic interventions (P < .001). CONCLUSIONS AND IMPLICATIONS This study suggests areas for improvement that could potentially reduce inappropriate psychotropics use. Supporting quality of dementia care workforce and improving cooperation within healthcare staff and professionals are recommended to ensure proper nonpharmacologic and pharmacologic interventions.
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Affiliation(s)
- Jung Min Yoon
- Stony Brook University School of Nursing, Stony Brook, NY, USA.
| | | | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Carla L Storr
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Nancy B Lerner
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Nicole Brandt
- University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, MD, USA
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Scuteri D, Sakurada S, Sakurada T, Tonin P, Bagetta G, Nicotera P, Corasaniti MT. Requirements for translation in clinical trials of aromatherapy: the case of the essential oil of bergamot (BEO) for the management of agitation in severe dementia. Curr Pharm Des 2022; 28:1607-1610. [DOI: 10.2174/1381612828666220509152029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/22/2022] [Indexed: 11/22/2022]
Abstract
Abstract:
Due to the tight link between undertreated pain and agitation in dementia patients, aromatherapy can be a useful approach if an essential oil (EO) with powerful analgesic activity is used. The methodological difficulties of most aromatherapy trials have not allowed any definitive conclusion about the effectiveness of aromatherapy in dementia. The objective of the present perspective is to illustrate the long rigorous process leading from preclinical research to clinical translation of the EO of bergamot (BEO) for the management of agitation in dementia. A nanotechnology-based delivery system consisting of odorless alpha-tocopheryl stearate solid lipid nanoparticles (SLN) loaded with EO of bergamot (BEO) (NanoBEO), has been proven active on acute and neuropathic pain models confirming the strong antinociceptive and anti-allodynic efficacy reported for BEO in preclinical studies. In particular, prolonged physicochemical stability of NanoBEO and titration in its main components are remarkable advantages allowing reproducible antinociceptive and anti-itch responses to be measured. Furthermore, the possibility to perform double-blind clinical trials, made impossible so far because of the strong smell of essential oils used in aromatherapy. Demented patients receive limited treatment for chronic pain, particularly neuropathic. The BRAINAID (NCT04321889) trial will assess the effectiveness of NanoBEO on agitation and pain in severely demented patients to offer a safe tool able to provide relief to this fragile population. This double-blind clinical trial will be the first to assess the efficacy and safety of an engineered essential oil and will provide the rationale for the safer treatment of neuropsychiatric symptoms of dementia and pain in clinic.
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Affiliation(s)
- Damiana Scuteri
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy
- Regional Center for Serious Brain Injuries, S. Anna Institute, 88900 Crotone, Italy
| | - Shinobu Sakurada
- Department of Physiology and Anatomy, Tohoku Pharmaceutical University, 981-8558 Sendai, Japan
| | - Tsukasa Sakurada
- Department of Pharmacology, Daiichi University of Pharmacy, 815-8511 Fukuoka, Japan
| | - Paolo Tonin
- Regional Center for Serious Brain Injuries, S. Anna Institute, 88900 Crotone, Italy
| | - Giacinto Bagetta
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy
| | - Pierluigi Nicotera
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Department of Health Sciences, University 'Magna Graecia' of Catanzaro, 88100 Catanzaro, Italy
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63
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Lukas A, Bienas M, Mayer B, Radbruch L, Gnass I. Responsive Behaviors and Pain Management in Hospital Dementia Care: A Before and After Comparison of the “Serial Trial Intervention”. FRONTIERS IN PAIN RESEARCH 2022; 3:810804. [PMID: 35599966 PMCID: PMC9121813 DOI: 10.3389/fpain.2022.810804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose Responsive behavior, often referred to as behavioral and psychological symptoms of dementia (BPSD), is among the most critical disorders in dementia whereby nursing personnel in hospitals are increasingly confronted with such symptoms. The purpose was to reduce the level of BPSD in an acute hospital environment through a stepwise procedure followed by the initiation of a needs-oriented treatment. Methods An open, prospective, interventional study with before-after comparisons was used to implement “Serial Trial Intervention” (STI) in three hospital wards (internal medicine, surgery, geriatric) after its adaption for hospital setting which was supplemented with a detailed pain assessment. Participants were 65 years and older. Potential causes of BPSD were clarified in a stepwise procedure and, if possible, eliminated. The primary outcome was the reduction in BPSD measured by the Neuropsychiatric Inventory (NPI-Q-12) while secondary outcomes were through the use of non-pharmacological and pharmacological interventions. Results No significant reduction in NPI-Q-12 could be found. However, significantly more mobilizations and changes of position were carried out. Higher antipsychotic use was seen in the after-groups presumably due to the higher rates of delirium and cognitive impairment. Furthermore, the data showed no increase in analgesic use. Conclusion No significant reduction in NPI-Q-12 was observed in the before-after study. The use of antipsychotics even increased most probably due to a higher incidence of deliriousness in the after-group. However, STI seemed to improve attention to underlying causes of BPSD as well as pain. Proof that STI leads to NPI-Q-12 reduction in hospitals is still pending.
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Affiliation(s)
- Albert Lukas
- Competence Center of Geriatric Medicine, Helios Medical Center Bonn/Rhein-Sieg, Academic Teaching Hospital, University Bonn, Bonn, Germany
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
- *Correspondence: Albert Lukas
| | - Melanie Bienas
- Competence Center of Geriatric Medicine, Helios Medical Center Bonn/Rhein-Sieg, Academic Teaching Hospital, University Bonn, Bonn, Germany
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, University Ulm, Ulm, Germany
| | - Lukas Radbruch
- Helios Medical Center Bonn/Rhein-Sieg, Palliative Medicine, Academic Teaching Hospital, University Bonn, Bonn, Germany
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Irmela Gnass
- Paracelsus Medical University, Institute for Nursing Science and Practice, Salzburg, Austria
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64
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Scuteri D, Contrada M, Loria T, Tonin P, Sandrini G, Tamburin S, Nicotera P, Bagetta G, Corasaniti MT. Pharmacological Treatment of Pain and Agitation in Severe Dementia and Responsiveness to Change of the Italian Mobilization–Observation–Behavior–Intensity–Dementia (I-MOBID2) Pain Scale: Study Protocol. Brain Sci 2022; 12:brainsci12050573. [PMID: 35624960 PMCID: PMC9139373 DOI: 10.3390/brainsci12050573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023] Open
Abstract
Up to 80% of Alzheimer’s disease (AD) patients in nursing homes experiences chronic pain and 97% develops fluctuant neuropsychiatric symptoms (NPS). Agitation, associated with unrelieved pain, is managed through antipsychotics and may increase the risk of death. Evidence is accumulating in favor of analgesia for a safer, effective therapy of agitation. The Italian version of Mobilization–Observation–Behavior–Intensity–Dementia, I-MOBID2, recently validated in the Italian setting, shows: good scale content validity index (0.89), high construct validity (Spearman rank-order correlation Rho = 0.748), reliable internal consistency (Cronbach’s α coefficient = 0.751), good-excellent inter-rater (intraclass correlation coefficient, ICC = 0.778) and test-retest (ICC = 0.902) reliability, and good inter-rater and test-retest agreement (Cohen’s K = 0.744) with 5.8 min completion time. This study intends to identify the responsiveness of the I-MOBID2 based on COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) recommendations, assessing the a priori hypotheses of (1) the efficacy of painkillers administered to severe AD patients after proper pain assessment and (2) the effect of reduction of the Cohen-Mansfield Agitation Inventory (CMAI) score and of agitation rescue medications. This protocol is approved by Calabria Region Ethics Committee protocol No. 31/2017 and follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines.
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Affiliation(s)
- Damiana Scuteri
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy;
- Regional Center for Serious Brain Injuries, S. Anna Institute, 88900 Crotone, Italy; (M.C.); (P.T.)
- Correspondence:
| | - Marianna Contrada
- Regional Center for Serious Brain Injuries, S. Anna Institute, 88900 Crotone, Italy; (M.C.); (P.T.)
| | | | - Paolo Tonin
- Regional Center for Serious Brain Injuries, S. Anna Institute, 88900 Crotone, Italy; (M.C.); (P.T.)
| | - Giorgio Sandrini
- Department of Brain and Behavioral Sciences, IRCCS C. Mondino Foundation Neurologic Institute, University of Pavia, 27100 Pavia, Italy;
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy;
| | - Pierluigi Nicotera
- German Center for Neurodegenerative Diseases (DZNE), 53111 Bonn, Germany;
| | - Giacinto Bagetta
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy;
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Lee KH, Lee JY, Kim B. Person-Centered Care in Persons Living With Dementia: A Systematic Review and Meta-analysis. THE GERONTOLOGIST 2022; 62:e253-e264. [PMID: 33326573 PMCID: PMC9019632 DOI: 10.1093/geront/gnaa207] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The concept of person-centered care has been utilized/adapted to various interventions to enhance health-related outcomes and ensure the quality of care delivered to persons living with dementia. A few systematic reviews have been conducted on the use of person-centered interventions in the context of dementia care, but to date, none have analyzed intervention effect by intervention type and target outcome. This study aimed to review person-centered interventions used in the context of dementia care and examine their effectiveness. RESEARCH DESIGN AND METHODS A systematic review and meta-analysis were conducted. We searched through 5 databases for randomized controlled trials that utilized person-centered interventions in persons living with dementia from 1998 to 2019. Study quality was assessed using the National Institute for Health and Clinical Excellence checklist. The outcomes of interest for the meta-analysis were behavioral and psychological symptoms in dementia (BPSD) and cognitive function assessed immediately after the baseline measurement. RESULTS In total, 36 studies were systematically reviewed. Intervention types were reminiscence, music, and cognitive therapies, and multisensory stimulation. Thirty studies were included in the meta-analysis. Results showed a moderate effect size for overall intervention, a small one for music therapy, and a moderate one for reminiscence therapy on BPSD and cognitive function. DISCUSSION AND IMPLICATIONS Generally speaking, person-centered interventions showed immediate intervention effects on reducing BPSD and improving cognitive function, although the effect size and significance of each outcome differed by intervention type. Thus, health care providers should consider person-centered interventions as a vital element in dementia care.
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Affiliation(s)
- Kyung Hee Lee
- Yonsei University College of Nursing, Seoul, South Korea
- Mo-Im Kim Nursing Research Institute, Seoul, South Korea
| | - Ji Yeon Lee
- Yonsei University College of Nursing, Seoul, South Korea
| | - Bora Kim
- Yonsei University College of Nursing, Seoul, South Korea
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Benmelouka AY, Ouerdane Y, Outani O, Alnasser YT, Alghamdi BS, Perveen A, Ashraf GM, Ebada MA. Alzheimer's Disease-Related Psychosis: An Overview of Clinical Manifestations, Pathogenesis, and Current Treatment. Curr Alzheimer Res 2022; 19:285-301. [PMID: 35440308 DOI: 10.2174/1567205019666220418151914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/25/2022] [Accepted: 03/06/2022] [Indexed: 11/22/2022]
Abstract
Behavioral and psychotic manifestations, including aggression, delusions, and hallucinations, are frequent comorbidities in patients with debilitating nervous illnesses such as Alzheimer's disease (AD), Amyotrophic Lateral Sclerosis, Multiple Sclerosis, and Parkinson's disease. AD-related psychosis may be linked to a poor disease prognosis, highlighting that early detection and management are mandatory. The manifestations are variable and may be very heterogeneous, imposing a real diagnostic issue. Some assessment tools such as BEHAVE-AD, CERAD-BRSD, and the Psycho-Sensory Hallucinations Scale have been designed to facilitate the diagnosis. The mechanisms behind neurodegeneration-related psychosis are complex and are not fully understood, imposing a burden on researchers to find appropriate management modalities. Familial history and some genetic disturbances may have a determinant role in these delusions and hallucinations in cases with AD. The loss of neuronal cells, atrophy in some regions of the central nervous, and synaptic dysfunction may also contribute to these comorbidities. Furthermore, inflammatory disturbances triggered by pro-inflammatory agents such as interleukins and tumor necrosis factors are stratified among the potential risk factors of the onset of numerous psychotic symptoms in Alzheimer's patients. Little is known about the possible management tools; therefore, it is urgent to conduct well-designed trials to investigate pharmacological and non-pharmacological interventions that can improve the care process of these patients. This review summarizes the current findings regarding the AD-related psychosis symptoms, pathological features, assessment, and management.
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Affiliation(s)
| | | | - Oumaima Outani
- Faculty of Medicine and Pharmacy of Rabat, Mohammed 5 University
| | | | - Badrah S Alghamdi
- Neuroscience Unit, Faculty of Medicine, King Abdulaziz University, Jeddah.,Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah
| | - Asma Perveen
- Glocal University, Mirzapur Pole, Saharanpur, Uttar Pradesh
| | - Ghulam Md Ashraf
- Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah.,Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah
| | - Mahmoud Ahmed Ebada
- Faculty of Medicine, Zagazig University, Zagazig, Al-Sharkia.,Internal Medicine Resident, Ministry of Health and Population of Egypt, Cairo
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Cunha S, Swedrowska M, Bellahnid Y, Xu Z, Sousa Lobo J, Forbes B, Silva A. Thermosensitive in situ hydrogels of rivastigmine-loaded lipid-based nanosystems for nose-to-brain delivery: characterisation, biocompatibility, and drug deposition studies. Int J Pharm 2022; 620:121720. [DOI: 10.1016/j.ijpharm.2022.121720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/10/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
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Movahedpour A, Vakili O, Khalifeh M, Mousavi P, Mahmoodzadeh A, Taheri-Anganeh M, Razmeh S, Shabaninejad Z, Yousefi F, Behrouj H, Ghasemi H, Khatami SH. Mammalian target of rapamycin (mTOR) signaling pathway and traumatic brain injury: A novel insight into targeted therapy. Cell Biochem Funct 2022; 40:232-247. [PMID: 35258097 DOI: 10.1002/cbf.3692] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/28/2022] [Accepted: 02/02/2022] [Indexed: 11/11/2022]
Abstract
Traumatic brain injury (TBI) is one of the most concerning health issues in which the normal brain function may be disrupted as a result of a blow, bump, or jolt to the head. Loss of consciousness, amnesia, focal neurological defects, alteration in mental state, and destructive diseases of the nervous system such as cognitive impairment, Parkinson's, and Alzheimer's disease. Parkinson's disease is a chronic progressive neurodegenerative disorder, characterized by the early loss of striatal dopaminergic neurons. TBI is a major risk factor for Parkinson's disease. Existing therapeutic approaches have not been often effective, indicating the necessity of discovering more efficient therapeutic targets. The mammalian target of rapamycin (mTOR) signaling pathway responds to different environmental cues to modulate a large number of cellular processes such as cell proliferation, survival, protein synthesis, autophagy, and cell metabolism. Moreover, mTOR has been reported to affect the regeneration of the injured nerves throughout the central nervous system (CNS). In this context, recent evaluations have revealed that mTOR inhibitors could be potential targets to defeat a group of neurological disorders, and thus, a number of clinical trials are investigating their efficacy in treating dementia, autism, epilepsy, stroke, and brain injury, as irritating neurological defects. The current review describes the interplay between mTOR signaling and major CNS-related disorders (esp. neurodegenerative diseases), as well as the mTOR signaling-TBI relationship. It also aims to discuss the promising therapeutic capacities of mTOR inhibitors during the TBI.
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Affiliation(s)
| | - Omid Vakili
- Department of Clinical Biochemistry, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoomeh Khalifeh
- Department of Medical Biotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Pegah Mousavi
- Department of Medical Genetics, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Amir Mahmoodzadeh
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mortaza Taheri-Anganeh
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Saeed Razmeh
- Department of Internal Medicine, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Zahra Shabaninejad
- Department of Nanobiotechnology, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Fatemeh Yousefi
- Department of Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Hamid Behrouj
- Behbahan Faculty of Medical Sciences, Behbahan, Iran
| | | | - Seyyed Hossein Khatami
- Department of Clinical Biochemistry, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Technological Solutions for Diagnosis, Management and Treatment of Alzheimer's Disease-Related Symptoms: A Structured Review of the Recent Scientific Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053122. [PMID: 35270811 PMCID: PMC8910738 DOI: 10.3390/ijerph19053122] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 02/04/2023]
Abstract
In people with Alzheimer's disease (PwAD), there is a need for specific tools for the timely diagnosis, management, and treatment of symptoms. New technological solutions, including digital devices, application programs (apps), sensors and virtual reality, represent promising possibilities for objective and reliable assessment, monitoring and intervention strategies in this field. Our structured review presents an up-to-date summary of the technological solutions for the (i) diagnosis, (ii) management and (iii) treatment of AD-related symptoms. To this end, we searched electronic databases (i.e., PubMed, Web of Science, and Cochrane Library) for studies published over the last 10 years. Two authors of the review extracted data of interest. A total of eight manuscripts were included. In the last decade, a series of technological solutions across AD stages have been proposed. These include: (i) innovative strategies for the early detection of deficits in finger dexterity, visuo-spatial abilities (including spatial navigation), divided attention and instrumental autonomy; (ii) tools to activate the patient's responsiveness in terms of alertness and mood improvement; and (iii) useful interventions for retrieving memories, increasing body movements and improving spatial cognition. Methodological limitations, mainly pertaining to the paucity of randomized controlled trials and comprehensive assessments, were observed. Advances in technology currently provide the potential for designing innovative methods for evaluating, controlling and handling AD-related symptoms. The co-creation of technological solutions with all stakeholders represents the best way to design effective strategies for PwAD.
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McDermid J, Da Silva MV, Williams G, Khan Z, Corbett A, Ballard C. A Randomized Controlled Trial of a Digital Adaptation of the WHELD Person-Centered Nursing Home Training Program. J Am Med Dir Assoc 2022; 23:1166-1170. [DOI: 10.1016/j.jamda.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/16/2022]
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Scuteri D, Contrada M, Tonin P, Corasaniti MT, Nicotera P, Bagetta G. Dementia and COVID-19: A Case Report and Literature Review on Pain Management. Pharmaceuticals (Basel) 2022; 15:ph15020199. [PMID: 35215311 PMCID: PMC8879883 DOI: 10.3390/ph15020199] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 01/27/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic imposes an unprecedented lifestyle, dominated by social isolation. In this frame, the population to pay the highest price is represented by demented patients. This group faces the highest risk of mortality, in case of severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection, and they experience rapid cognitive deterioration, due to lockdown measures that prevent their disease monitoring. This complex landscape mirrors an enhancement of neuropsychiatric symptoms (NPSs), with agitation, delirium and reduced motor performances, particularly in non-communicative patients. Due to the consistent link between agitation and pain in these patients, the use of antipsychotics, increasing the risk of death during COVID-19, can be avoided or reduced through an adequate pain treatment. The most suitable pain assessment scale, also feasible for e-health implementation, is the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID-2) pain scale, currently under validation in the Italian real-world context. Here, we report the case of an 85-year-old woman suffering from mild cognitive impairment, subjected to off-label treatment with atypical antipsychotics, in the context of undertreated pain, who died during the pandemic from an extensive brain hemorrhage. This underscores the need for appropriate assessment and treatment of pain in demented patients.
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Affiliation(s)
- Damiana Scuteri
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy;
- Regional Center for Serious Brain Injuries, S. Anna Institute, 88900 Crotone, Italy; (M.C.); (P.T.)
- Correspondence: ; Tel.: +39-0984/493462
| | - Marianna Contrada
- Regional Center for Serious Brain Injuries, S. Anna Institute, 88900 Crotone, Italy; (M.C.); (P.T.)
| | - Paolo Tonin
- Regional Center for Serious Brain Injuries, S. Anna Institute, 88900 Crotone, Italy; (M.C.); (P.T.)
| | | | - Pierluigi Nicotera
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany;
| | - Giacinto Bagetta
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy;
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Woods D, Navarro AE, LaBorde P, Dawson M, Shipway S. Social Isolation and Nursing Leadership in Long-term Care: Moving Forward after COVID-19. Nurs Clin North Am 2022; 57:273-286. [PMID: 35659988 PMCID: PMC8860631 DOI: 10.1016/j.cnur.2022.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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73
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García-Martín V, de Hoyos-Alonso MC, Ariza-Cardiel G, Delgado-Puebla R, García-Domingo P, Hernández-Melo E, de Haro-de Torres JL, del Cura-González I. Neuropsychiatric symptoms and subsyndromes in patients with different stages of dementia in primary care follow-up (NeDEM project): a cross-sectional study. BMC Geriatr 2022; 22:71. [PMID: 35065615 PMCID: PMC8783993 DOI: 10.1186/s12877-022-02762-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/24/2021] [Indexed: 02/08/2023] Open
Abstract
Abstract
Background
The objective was to describe the prevalence and intensity of neuropsychiatric symptoms (NPSs) isolated and grouped into subsyndromes in patients with dementia in primary care (PC) to analyse their distribution based on stages of dementia and the relationship between them and the intensity of symptoms.
Methods
Design: Cross-sectional study. Setting and population: Patients with dementia, not institutionalized, in a PC follow-up. Variables: Sociodemographic and clinical variables. Assessment instruments: The frequency and intensity of NPSs were measured with the Neuropsychiatric Inventory (NPI), and the stages of dementia with the Global Deterioration Scale (GDS). Statistical analysis: The number of NPSs per patient, the mean NPI value, and the prevalence and intensity of NPSs isolated and grouped into subsyndromes were calculated, as were their 95% confidence intervals (CIs). The analyses were performed on an overall basis and by GDS scores. To analyse the association between the NPI and GDS scores, multivariate analysis was performed with a generalized linear model.
Results
Overall, 98.4% (95% CI 94.5;99.8) of the patients presented some type of NPS, with an average of five symptoms per patient. The most frequent symptoms were apathy [69.8% (95% CI 61.1;77.5)], agitation [55.8% (95% CI 46.8;64.5)] and irritability [48.8% (95% CI 39.9;57.8)]. The more intense NPSs were apathy [NPI 3.2 (95% CI 2.5;3.8)] and agitation [NPI 3.2 (95% CI 2.5;4.0)]. For subsyndromes, hyperactivity predominated [86.0% (95% CI 78.8;91.5)], followed by apathy [77.5% (95% CI 69.3;84.4]). By phase of dementia, the most common isolated symptom was apathy (60.7–75.0%). Affective symptoms and irritability predominated in the initial stages, and psychotic symptoms predominated in advanced stages. The mean NPI score was 24.9 (95% CI 21.5;28.4) and increased from 15.6 (95% CI 8.2;23.1) for GDS 3 to 28.9 (95% CI 12.6;45.1) for GDS 7. Patients with in the most advanced stages of dementia presented an NPI score 7.6 (95% CI 6.8;8.3) points higher than the score for mild dementia with adjustment for the other variables.
Conclusions
A high prevalence of NPSs was found among patients with dementia treated in PC. Symptoms change and increase in intensity as the disease progresses. Scales such as the NPI allow these symptoms to be identified, which may facilitate more stage-appropriate management.
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Bareiss SK, Johnston T, Lu Q, Tran TD. The effect of exercise on early sensorimotor performance alterations in the 3xTg-AD model of Alzheimer's disease. Neurosci Res 2022; 178:60-68. [PMID: 35033583 DOI: 10.1016/j.neures.2022.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 01/13/2023]
Abstract
Alzheimer's disease (AD) is characterized by a progressive decline in cognitive function; however, recent evidence suggests that non-cognitive sensorimotor and psychomotor symptoms accompany early stages of the disease in humans and AD models. Although exercise is emerging as an important therapeutic to combat AD progression, little is known about the effect of exercise on sensorimotor domain functions. The purpose of this study was to determine if early sensorimotor symptoms accompany deficits in Morris water maze (MWM) performance in the 3xTg-AD model, and investigate if exercise could protect against early behavioral decline. 3xTg-AD and wild-type (WT) control mice were subjected to 12 weeks of moderate intensity wheel running or remained sedentary. At 6 months of age, animals underwent a series of sensorimotor and MWM testing. 3xTg-AD mice displayed deficits in sensorimotor function (beam traversal, spontaneous activity, and adhesive removal) and MWM performance. Interestingly, 3xTg-AD animals exhibited increased freezing and unusual shaking/tremoring behaviors not displayed by WT controls. Exercise improved beam traversal, adhesive removal, and reduced the unusual motor-related behaviors in 3xTg-AD mice. Our study shows that sensorimotor symptoms coincide with deficits in MWM performance, and suggest that exercise may mitigate deficits associated with early disease in 3xTg-AD mice.
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Affiliation(s)
- Sonja K Bareiss
- Department of Physical Therapy, School of Rehabilitation and Movement Sciences, Bellarmine University, Louisville, KY 40205, United States; Department of Neurological Surgery, University of Louisville, United States; The Harriet and John Wooten Laboratory for Alzheimer's and Neurodegenerative Diseases Research, East Carolina University, United States.
| | - Tyler Johnston
- Department of Physical Therapy, East Carolina University, Greenville, NC 27834, United States.
| | - Qun Lu
- Department of Anatomy and Cell Biology, Brody School of Medicine, United States; The Harriet and John Wooten Laboratory for Alzheimer's and Neurodegenerative Diseases Research, East Carolina University, United States.
| | - Tuan D Tran
- The Harriet and John Wooten Laboratory for Alzheimer's and Neurodegenerative Diseases Research, East Carolina University, United States; Department of Psychology East Carolina University, Greenville, NC 27834, United States.
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Wang T, Chen Y, Zou Y, Pang Y, He X, Chen Y, Liu Y, Feng W, Zhang Y, Li Q, Shi J, Ding F, Marshall C, Gao J, Xiao M. Locomotor Hyperactivity in the Early-Stage Alzheimer’s Disease-like Pathology of APP/PS1 Mice: Associated with Impaired Polarization of Astrocyte Aquaporin 4. Aging Dis 2022; 13:1504-1522. [PMID: 36186142 PMCID: PMC9466968 DOI: 10.14336/ad.2022.0219] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/19/2022] [Indexed: 12/21/2022] Open
Abstract
Non-cognitive behavioral and psychological symptoms often occur in Alzheimer's disease (AD) patients and mouse models, although the exact neuropathological mechanism remains elusive. Here, we report hyperactivity with significant inter-individual variability in 4-month-old APP/PS1 mice. Pathological analysis revealed that intraneuronal accumulation of amyloid-β (Aβ), c-Fos expression in glutamatergic neurons and activation of astrocytes were more evident in the frontal motor cortex of hyperactive APP/PS1 mice, compared to those with normal activity. Moreover, the hyperactive phenotype was associated with mislocalization of perivascular aquaporin 4 (AQP4) and glymphatic transport impairment. Deletion of the AQP4 gene increased hyperactivity, intraneuronal Aβ load and glutamatergic neuron activation, but did not influence working memory or anxiety-like behaviors of 4-month-old APP/PS1 mice. Together, these results demonstrate that AQP4 mislocalization or deficiency leads to increased intraneuronal Aβ load and neuronal hyperactivity in the motor cortex, which in turn causes locomotor over-activity during the early pathophysiology of APP/PS1 mice. Therefore, improving AQP4 mediated glymphatic clearance may offer a new strategy for early intervention of hyperactivity in the prodromal phase of AD.
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Affiliation(s)
- Tianqi Wang
- Jiangsu Province Key Laboratory of Neurodegeneration, Center for Global Health, Nanjing Medical University, Nanjing, 211166, China.
- Brain Institute, the Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Yan Chen
- Jiangsu Province Key Laboratory of Neurodegeneration, Center for Global Health, Nanjing Medical University, Nanjing, 211166, China.
- Brain Institute, the Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Ying Zou
- Jiangsu Province Key Laboratory of Neurodegeneration, Center for Global Health, Nanjing Medical University, Nanjing, 211166, China.
| | - Yingting Pang
- Jiangsu Province Key Laboratory of Neurodegeneration, Center for Global Health, Nanjing Medical University, Nanjing, 211166, China.
| | - Xiaoxin He
- Jiangsu Province Key Laboratory of Neurodegeneration, Center for Global Health, Nanjing Medical University, Nanjing, 211166, China.
- Brain Institute, the Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Yali Chen
- Jiangsu Province Key Laboratory of Neurodegeneration, Center for Global Health, Nanjing Medical University, Nanjing, 211166, China.
- Department of Human Anatomy and Histoembryology, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Yun Liu
- Jiangsu Province Key Laboratory of Neurodegeneration, Center for Global Health, Nanjing Medical University, Nanjing, 211166, China.
| | - Weixi Feng
- Jiangsu Province Key Laboratory of Neurodegeneration, Center for Global Health, Nanjing Medical University, Nanjing, 211166, China.
- Brain Institute, the Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Yanli Zhang
- Jiangsu Province Key Laboratory of Neurodegeneration, Center for Global Health, Nanjing Medical University, Nanjing, 211166, China.
| | - Qian Li
- Jiangsu Province Key Laboratory of Neurodegeneration, Center for Global Health, Nanjing Medical University, Nanjing, 211166, China.
- Brain Institute, the Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Jingping Shi
- Department of Neurology, the Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Fengfei Ding
- Department of Pharmacology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Charles Marshall
- College of Health Sciences, University of Kentucky Center of Excellence in Rural Health, Hazard, KY 41701, USA
| | - Junying Gao
- Jiangsu Province Key Laboratory of Neurodegeneration, Center for Global Health, Nanjing Medical University, Nanjing, 211166, China.
- Correspondence should be addressed to: Dr. Ming Xiao (E-mail: ) or Dr. Junying Gao (), Jiangsu Province Key Laboratory of Neurodegeneration, Nanjing Medical University, Nanjing, China
| | - Ming Xiao
- Jiangsu Province Key Laboratory of Neurodegeneration, Center for Global Health, Nanjing Medical University, Nanjing, 211166, China.
- Brain Institute, the Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, 210029, China.
- Correspondence should be addressed to: Dr. Ming Xiao (E-mail: ) or Dr. Junying Gao (), Jiangsu Province Key Laboratory of Neurodegeneration, Nanjing Medical University, Nanjing, China
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Álvarez-Fernández B, Bernal-López MR, Gómez-Huelgas R. Role of aripiprazole in the management of behavioural and psychological symptoms of dementia: a narrative review. Psychogeriatrics 2022; 22:137-144. [PMID: 34761857 DOI: 10.1111/psyg.12787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/13/2021] [Accepted: 10/26/2021] [Indexed: 11/26/2022]
Abstract
Behavioural and psychological symptoms of dementia affect in a great way quality of life of both patients and their caregivers, which increases the risk of patient institutionalisation when such symptoms are poorly controlled. One of the drugs that are used for controlling behavioural and psychological symptoms of dementia (BPSD) is aripiprazole. This narrative review aims to solve three basic questions. Is aripiprazole useful for the management of these symptoms? Does aripiprazole play a substantial role regarding safety and efficacy, compared with the other pharmacological options available for the same purpose? Has aripiprazole gained importance in treatment regimens of these symptoms, in current clinical practice? We conclude that aripiprazole is effective to manage BPSD. Moreover, it has shown a good safety profile compared with other antipsychotics in advanced disease and frail patients. Thus, aripiprazole has gained importance in current management algorithms for dementia patients mainly due to its efficacy regarding rapid control of agitation and aggressiveness.
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Affiliation(s)
- Baldomero Álvarez-Fernández
- Geriatrics Unit, Department of Internal Medicine, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Malaga (IBIMA), University of Malaga, Malaga, Spain
| | - M Rosa Bernal-López
- Geriatrics Unit, Department of Internal Medicine, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Malaga (IBIMA), University of Malaga, Malaga, Spain.,CIBER Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Ricardo Gómez-Huelgas
- Geriatrics Unit, Department of Internal Medicine, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Malaga (IBIMA), University of Malaga, Malaga, Spain.,CIBER Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
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Heilman KM, Nadeau SE. Emotional and Neuropsychiatric Disorders Associated with Alzheimer's Disease. Neurotherapeutics 2022; 19:99-116. [PMID: 35013934 PMCID: PMC9130428 DOI: 10.1007/s13311-021-01172-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 01/03/2023] Open
Abstract
Alzheimer's disease is associated with impairments in emotional communication including comprehension and production of facial emotional expressions, comprehension of affective prosody, and alexithymia. It is also associated with disorders of emotional experience including mood disorders (depression and anxiety), agitation/aggression, and psychosis. Agitation/aggression and psychosis are particularly disruptive, are associated with earlier institutionalization, and pose a major challenge to institutional management. Treatment of disorders of emotional experience has been primarily pharmacologic (reviewed here in detail) and has relied heavily on antipsychotic medications despite the small effect sizes demonstrated in a large number of randomized controlled trials and the prevalence of serious side effects associated with these drugs. Recent studies suggest that treatment with pimavanserin, an antipsychotic without activity at dopamine receptors, may represent an important advance for treatment of psychotic manifestations, even as the drug appears to pose significant risk. Dextromethorphan/quinidine may represent an important advance in the treatment of agitation/aggression. There is also compelling evidence that sleep disorders, which are common among patients with Alzheimer's disease and are readily treatable, may potentiate psychotic manifestations and agitation/aggression, but further studies are needed.
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Affiliation(s)
- Kenneth M Heilman
- Geriatric Research, Education, and Clinical Center, Malcom Randall VA Medical Center, 1601 SW Archer Road, Gainesville, FL, 32608-1197, USA
- The Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Road, Gainesville, FL, 32608-1197, USA
- Malcom Randall VA Medical Center and the Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Stephen E Nadeau
- Research Service, Malcom Randall VA Medical Center, 1601 SW Archer Road, Gainesville, FL, 32608-1197, USA.
- The Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Road, Gainesville, FL, 32608-1197, USA.
- Malcom Randall VA Medical Center and the Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA.
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Gunasekaran V, Avarachan J, Augustine A, Khayum A, R A. 3-O-Acetyl-11-keto-β-boswellic acid ameliorates acquired, consolidated and recognitive memory deficits through the regulation of hippocampal PPAR γ, MMP9 and MMP2 genes in dementia model. Heliyon 2021; 7:e08523. [PMID: 34926858 PMCID: PMC8646985 DOI: 10.1016/j.heliyon.2021.e08523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 11/03/2021] [Accepted: 11/29/2021] [Indexed: 01/21/2023] Open
Abstract
Pentacyclic Phytomolecule 3-O-Acetyl-11-keto-β-boswellic acid (AKBA) from Frankincense family has proven for the neuroprotection and recognized as an orphan drug for the treatment of cerebral edema. Nonetheless, AKBA have promising indications with Peroxisome proliferator activated receptor gamma (PPARγ) associated to cognitive function not deliberated so far. In order to substantiate the potential role of AKBA on memory function, we examine the contribution of PPARγ activation and its downstream process. Modified method of scopolamine induced dementia rats were treated with AKBA (5, 10&15 mg/kg,i.p) and Donepezil (2.5 mg/kg,i.p). Scopolamine induced short term spatial, working memory and recognition memory impairment was reversed significantly after AKBA treatment. AKBA administration diminished the Acetylcholine esterase (AchE) activity and preserved brain GABA and glutamate mediated neuronal excitability. Further, gene expression study reveals AKBA ameliorates the memory impairment via activating PPARγ and its downstream regulators, matrix metalloproteinase 2 (MMP2) and matrix metalloproteinase 9 (MMP9) genes in hippocampus. This study concludes that the treatment with AKBA can be a novel Phyto-molecule of interest for treating dementia via up-regulating hippocampus genes mediated cholinergic activation.
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Affiliation(s)
- Venkatesh Gunasekaran
- Department of Pharmacology, KMCH College of Pharmacy, Tamil Nadu, India
- Corresponding author.
| | - Jinu Avarachan
- Department of Pharmacology, KMCH College of Pharmacy, Tamil Nadu, India
| | - Anitta Augustine
- Department of Pharmacology, KMCH College of Pharmacy, Tamil Nadu, India
| | - Abdul Khayum
- Department of Pharmacognosy, KMCH College of Pharmacy, Tamil Nadu, India
| | - Arivukkarasu R
- Department of Pharmacology, PSG College of Pharmacy, Tamil Nadu, India
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Dhapola R, Hota SS, Sarma P, Bhattacharyya A, Medhi B, Reddy DH. Recent advances in molecular pathways and therapeutic implications targeting neuroinflammation for Alzheimer's disease. Inflammopharmacology 2021; 29:1669-1681. [PMID: 34813026 PMCID: PMC8608577 DOI: 10.1007/s10787-021-00889-6] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/31/2021] [Indexed: 01/11/2023]
Abstract
Alzheimer's disease (AD) is a major contributor of dementia leading to the degeneration of neurons in the brain with major symptoms like loss of memory and learning. Many evidences suggest the involvement of neuroinflammation in the pathology of AD. Cytokines including TNF-α and IL-6 are also found increasing the BACE1 activity and expression of NFκB resulting in generation of Aβ in AD brain. Following the interaction of Aβ with microglia and astrocytes, other inflammatory molecules also get translocated to the site of inflammation by chemotaxis and exaggerate neuroinflammation. Various pathways like NFκB, p38 MAPK, Akt/mTOR, caspase, nitric oxide and COX trigger microglia to release inflammatory cytokines. PPARγ agonists like pioglitazone increases the phagocytosis of Aβ and reduces inflammatory cytokine IL-1β. Celecoxib and roficoxib like selective COX-2 inhibitors also ameliorate neuroinflammation. Non-selective COX inhibitor indomethacin is also potent inhibitor of inflammatory mediators released from microglia. Mitophagy process is considered quite helpful in reducing inflammation due to microglia as it promotes the phagocytosis of over activated microglial cells and other inflammatory cells. Mitophagy induction is also beneficial in the removal of damaged mitochondria and reduction of infiltration of inflammatory molecules at the site of accumulation of the damaged mitochondria. Targeting these pathways and eventually ameliorating the activation of microglia can mitigate neuroinflammation and come out as a better therapeutic option for the treatment of Alzheimer's disease.
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Affiliation(s)
- Rishika Dhapola
- Department of Pharmacology, Central University of Punjab, Bathinda, 151 401, India
| | | | - Phulen Sarma
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Anusuya Bhattacharyya
- Department of Ophthalmology, Government Medical College & Hospital, Chandigarh, 160 032, India
| | - Bikash Medhi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
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Abstract
OBJECTIVES To examine the psychometric properties of the Chinese version of the Relevant Outcome Scale for Alzheimer's disease (CROSA) among persons with AD (PWAD) and their caregivers in China. DESIGN A single-arm, open-label, multi-center study. SETTING Two tertiary general hospitals in Shanghai. PARTICIPANTS A total of 336 PWAD and their family caregivers. INTERVENTION The PWAD completed a 12-week treatment with memantine after a baseline assessment. MEASUREMENTS The CROSA and the Chinese versions of the Mini-Mental State Examination, the Alzheimer's Disease Assessment Scale-Cognitive Subscale, the Disability Activity of Dementia, the Neuropsychiatric Inventory Questionnaire, the Zarit Caregiver Burden Interview and the Self-Efficacy Questionnaire for Chinese Family Caregivers. RESULTS The Cronbach's alpha for the total scale was 0.900, and the intraclass correlation coefficient and Pearson's correlation coefficient were 0.910 (P < 0.001) and 0.836 (P < 0.001), respectively. Confirmatory factor analysis revealed the two-factor model to be consistent with the original version. For the known-group validity, the total score of the CROSA classified the PWAD into three stages and three MMSE score groups. Moderate to large correlations with the validated scales confirmed the criteria validity of the CROSA, and the convergent validity was confirmed via testing a hypothesized caregiving model; however, only minimal responsiveness was found among the deterioration group after 12 weeks of treatment with memantine. CONCLUSIONS The reliability and validity of the CROSA was good or acceptable for use in daily clinical settings. Further studies are needed to examine the psychometric properties of the scale.
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Effects of the tailored activity program (TAP) on dementia-related symptoms, health events and caregiver wellbeing: a randomized controlled trial. BMC Geriatr 2021; 21:581. [PMID: 34670502 PMCID: PMC8527762 DOI: 10.1186/s12877-021-02511-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background People living with dementia (PLWD) and caregivers are adversely impacted by lack of meaningful activity leading to worse symptoms and impaired quality-of-life. There is a critical need to develop effective and well-tolerated treatments that mitigate clinical symptoms, engage PLWD and support caregiver wellbeing. We tested whether, compared to attention control, the Tailored Activity Program (TAP) reduced clinical symptoms and health-related events, and improved caregiver wellbeing, and if TAP activities were well-tolerated. Methods We conducted a single-blind randomized controlled trial among 250 dyads recruited from Baltimore-Washington DC (2012–2016) with a dementia diagnosis and clinically significant agitation/aggression. Dyads were randomized to TAP (n = 124) or attention control (n = 126), and interviewed at baseline, 3 (endpoint) and 6-months (follow-up) by interviewers masked to group allocation. TAP assessed PLWD abilities/interests, instructed caregivers in using prescribed activities, and provided dementia education and stress reduction techniques. Attention controls received disease education and home safety tips. Both groups had up to 8 home visits over 3-months. The primary outcome was frequency by severity scores for agitation/aggression subscales of Neuropsychiatric Inventory-Clinician using caregiver ratings. Secondary outcomes included number of instrumental (IADL) and activities of daily living (ADL) needing assistance, caregiver wellbeing, and confidence using activities. Health-related events (PLWD death, hospitalizations, caregiver hospitalization, depression) and perceived study benefits were captured over 6 months. PLWD tolerability of prescribed activities was examined. Results Of 250 dyads, most caregivers were female (81.2 %, n = 203), non-spouses (54.4 %, n = 136), white (59.2 %, n = 145) or African American (36.7 %, n = 90) with mean age = 65.4 (SD = 12.6). PLWD were mostly female (63.2 %, n = 158) with mean age = 81.4 (SD = 7.9), and mean MMSE = 14.3 (SD = 7.8). At 3-months, compared to controls, TAP conferred no benefit to agitation/aggression (p = 0.43, d = 0.11), but resulted in less IADL (p = 0.02, d=-0.33), and ADL (p = 0.04, d=-0.30) assistance, improved caregiver wellbeing (p = 0.01, d = 0.39), and confidence using activities (p = 0.02, d = 0.32). By 6-months, 15 PLWD in TAP had ≥ 1 health-related event versus 28 PLWD in control, demonstrating 48.8 % improvement in TAP (p = 0.03). TAP caregivers were more likely to perceive study benefits. Prescribed activities were well-tolerated. Conclusions Although TAP did not benefit agitation/aggression, it impacted important outcomes that matter to families warranting its use in dementia care. Clinical trial registration Clinicaltrials.gov # NCT01892579 at https://clinicaltrials.gov/; Date of clinical trial registration: 04/07/2013; Date first dyad enrolled: 15/11/2013.
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Ge Y, Sainz M, Gore J, Epps F. "Everything is Either Sent by God or Used by God": An Exploratory Study on the Impact of COVID-19 Upon the Religious Lives of Black Families Living with Dementia. JOURNAL OF RELIGION AND HEALTH 2021; 60:3193-3208. [PMID: 34235606 PMCID: PMC8262582 DOI: 10.1007/s10943-021-01332-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
The purpose of this research study was to explore the impact of COVID-19 on church engagement for Black families affected by dementia in the USA. Semi-structured interviews were conducted with current caregivers, church leaders, and persons with dementia (n = 16). The following themes emerged: (a) Ability to continue religious practices, (b) Increased church engagement, (c) Importance of fellowship, (d) Role of technology, and (e) New normal. As the Internet becomes the new church building, online worship services enabled more families affected by dementia to engage. Many church leaders expressed the intent of continuing to provide online worship services post-pandemic. Families highlighted their need to fellowship with other congregants. Technology was perceived as a double-edged sword serving as both a motivator and a barrier to religious engagement. These findings will support faith leaders in understanding the needs of their congregants during the COVID-19 pandemic, such as allowing families living with dementia to continue engaging in religious practices and living in meaningful ways.
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Affiliation(s)
- Yiran Ge
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Office 238, Atlanta, GA, 30322, USA
| | - Mayra Sainz
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Janelle Gore
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Office 238, Atlanta, GA, 30322, USA.
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Liew TM. Neuropsychiatric symptoms in early stage of Alzheimer's and non-Alzheimer's dementia, and the risk of progression to severe dementia. Age Ageing 2021; 50:1709-1718. [PMID: 33770167 DOI: 10.1093/ageing/afab044] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPSs) in early dementia have been suggested to predict a higher risk of dementia progression. However, the literature is not yet clear whether the risk is similar across Alzheimer's dementia (AD) and non-Alzheimer's dementia (non-AD), as well as across different NPSs. This study examined the association between NPSs in early dementia and the risk of progression to severe dementia, specifically in AD and non-AD, as well as across various NPSs. METHOD This cohort study included 7,594 participants who were ≥65 years and had early dementia (global Clinical Dementia Rating [CDR] = 1). Participants completed Neuropsychiatric-Inventory-Questionnaire at baseline and were followed-up almost annually for progression to severe dementia (global CDR = 3) (median follow-up = 3.5 years; interquartile range = 2.1-5.9 years). Cox regression was used to examine progression risk, stratified by AD and non-AD. RESULTS The presence of NPSs was associated with risk of progression to severe dementia, but primarily in AD (HR 1.4, 95% confidence interval [CI]: 1.1-1.6) and not in non-AD (HR 0.9, 95% CI: 0.5-1.5). When comparing across various NPSs, seven NPSs in AD were associated with disease progression, and they were depression, anxiety, apathy, delusions, hallucinations, irritability and motor disturbance (HR 1.2-1.6). In contrast, only hallucinations and delusions were associated with disease progression in non-AD (HR 1.7-1.9). CONCLUSIONS NPSs in early dementia-especially among individuals with AD-can be useful prognostic markers of disease progression. They may inform discussion on advanced care planning and prompt clinical review to incorporate evidence-based interventions that may address disease progression.
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Affiliation(s)
- Tau Ming Liew
- Department of Psychiatry, Singapore General Hospital, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Marcinkowska M, Bucki A, Sniecikowska J, Zagórska A, Fajkis-Zajączkowska N, Siwek A, Gluch-Lutwin M, Żmudzki P, Jastrzebska-Wiesek M, Partyka A, Wesołowska A, Abram M, Przejczowska-Pomierny K, Cios A, Wyska E, Mika K, Kotańska M, Mierzejewski P, Kolaczkowski M. Multifunctional Arylsulfone and Arylsulfonamide-Based Ligands with Prominent Mood-Modulating Activity and Benign Safety Profile, Targeting Neuropsychiatric Symptoms of Dementia. J Med Chem 2021; 64:12603-12629. [PMID: 34436892 PMCID: PMC8436213 DOI: 10.1021/acs.jmedchem.1c00497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
![]()
The current pharmaceutical
market lacks therapeutic agents designed
to modulate behavioral disturbances associated with dementia. To address
this unmet medical need, we designed multifunctional ligands characterized
by a nanomolar affinity for clinically relevant targets that are associated
with the disease pathology, namely, the 5-HT2A/6/7 and
D2 receptors. Compounds that exhibited favorable functional
efficacy, water solubility, and metabolic stability were selected
for more detailed study. Pharmacological profiling revealed that compound 11 exerted pronounced antidepressant activity (MED 0.1 mg/kg),
outperforming commonly available antidepressant drugs, while compound 16 elicited a robust anxiolytic activity (MED 1 mg/kg), exceeding
comparator anxiolytics. In contrast to the existing psychotropic agents
tested, the novel chemotypes did not negatively impact cognition.
At a chronic dose regimen (25 days), 11 did not induce
significant metabolic or adverse blood pressure disturbances. These
promising therapeutic-like activities and benign safety profiles make
the novel chemotypes potential treatment options for dementia patients.
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Affiliation(s)
- Monika Marcinkowska
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Adam Bucki
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Joanna Sniecikowska
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Agnieszka Zagórska
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | | | - Agata Siwek
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Monika Gluch-Lutwin
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Paweł Żmudzki
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | | | - Anna Partyka
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Anna Wesołowska
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Michał Abram
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | | | - Agnieszka Cios
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Elżbieta Wyska
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Kamil Mika
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Magdalena Kotańska
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Paweł Mierzejewski
- Institute of Psychiatry and Neurology, 9 Sobieskiego Street, 02-957 Warsaw, Poland
| | - Marcin Kolaczkowski
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland.,Adamed Pharma S.A., 6A Mariana Adamkiewicza Street, Pienkow, 05-152 Czosnow, Poland
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85
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Brandt N, Kales HC, Saffel D. Safe Management of Dementia-Related Psychosis in Long-Term Care: Empowering Consultant Pharmacists. Sr Care Pharm 2021; 36:1-25. [PMID: 34465414 DOI: 10.4140/tcp.s.2021.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Nicole Brandt
- Executive Director, Peter Lamy Center on Drug Therapy and Aging, Professor, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy Baltimore, Maryland
| | - Helen C Kales
- Professor and Joe P. Tupin Chair, Department of Psychiatry and Behavioral Science, University of California, Davis Health, Sacramento, California
| | - Dana Saffel
- Board Director, ASCP, President and CEO, PharmaCare Strategies, Inc, Santa Rosa Beach, Florida
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86
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Suwa S, Tsujimura M, Yumoto A, Iwata N, Shimamura A. Multidisciplinary pharmacotherapy collaboration for home-based older adults with dementia: a study focusing on physicians, pharmacists, and nursing professionals. Psychogeriatrics 2021; 21:749-762. [PMID: 34212449 DOI: 10.1111/psyg.12735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 05/22/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is imperative that a team consisting of a physician, pharmacist, and nursing professional provides pharmacotherapy support to achieve the optimal effect of pharmacotherapy for older adults with dementia. This study reviewed Japanese publications on the process of pharmacotherapy support practised by various professionals for home-based older adults with dementia and investigated healthcare professionals' perceived importance and practice of pharmacotherapy support. METHODS This study aimed to shed light on basic pharmacotherapy support for behavioural and psychological symptoms among home-based older adults with dementia using multidisciplinary collaboration, through a literature review of Japanese publications. Based on the literature review, 13 items pertaining to basic pharmacotherapy support for home-based older adults with dementia were extracted. A mail-based, self-administered, anonymous questionnaire survey was conducted with professionals including physicians, pharmacists, and nursing professionals who provide pharmacotherapy support to home-based older adults with dementia. Participants rated 13 items on their perceived importance and practice of basic pharmacotherapy support using a four-point Likert scale. RESULTS The results indicated that participants recognised the importance of all 13 items. At least 80% of all professionals indicated that they practised seven out of 13 items. Less than 80% of all professionals indicated they practised the other six items that should be provided after the commencement of pharmacotherapy. A relatively high proportion of nursing professionals (70%) indicated they practised the remaining six items. The 13 items were indeed deemed important for characterising pharmacotherapy support. However, in Japan, suboptimal support is provided following the commencement of medication. This may be because appropriate modifications to dementia care are not made as the patient's condition progresses. CONCLUSIONS It is suggested that multidisciplinary collaboration focusing on the progression of dementia and the process of pharmacotherapy, especially after the commencement of pharmacotherapy, may help provide effective, continuous pharmacotherapy.
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Affiliation(s)
- Sayuri Suwa
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Mayuko Tsujimura
- School of Nursing, Faculty of Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Akiyo Yumoto
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Naoko Iwata
- School of Nursing, Faculty of Medicine, Tokyo Medical University, Tokyo, Japan
| | - Atsuko Shimamura
- Department of Nursing, Faculty of Health Science, Toho University, Chiba, Japan
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87
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Scuteri D, Sandrini G, Tamburin S, Corasaniti MT, Nicotera P, Tonin P, Bagetta G. Bergamot rehabilitation AgaINst agitation in dementia (BRAINAID): Study protocol for a randomized, double-blind, placebo-controlled trial to assess the efficacy of furocoumarin-free bergamot loaded in a nanotechnology-based delivery system of the essential oil in the treatment of agitation in elderly affected by severe dementia. Phytother Res 2021; 35:5333-5338. [PMID: 34435395 PMCID: PMC9290822 DOI: 10.1002/ptr.7223] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/27/2021] [Accepted: 07/03/2021] [Indexed: 12/24/2022]
Abstract
Pain is underdiagnosed and often not adequately treated, contributing to behavioral and psychological symptoms of dementia (BPSD). BPSD are treated with atypical antipsychotics that are associated with severe cerebrocardiovascular effects. Interestingly, treatment of pain may reduce agitation. Research is focusing on nonpharmacological treatment, such as aromatherapy, for pain and BPSD in dementia. This clinical study will assess the effect on agitation in severely demented elderly of BEO loaded in a nanotechnological odorless cream indistinguishable from placebo. This is a protocol for a randomized, double‐blind, placebo‐controlled trial (NCT04321889). A total of 134 patients aged ≥65 years with severe dementia (mini‐mental state examination <12) will be recruited and randomly allocated 1:1 to either BEO or placebo group. After baseline screening, BEO (80 mg) cream or placebo cream will be trans‐dermally applied on both arms twice a day for 4 weeks with a 4‐week follow‐up period. The effect on agitation will be the primary endpoint. Any adverse events will be reported. A double‐blind, clinical trial evaluating efficacy and safety of an essential oil endowed with strong analgesic properties has never been carried out before. This study could form the basis for a safer and more effective treatment of BPSD in severe dementia.
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Affiliation(s)
- Damiana Scuteri
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, Rende, Italy.,S. Anna Institute, Regional Center for Serious Brain Injuries, Crotone, Italy
| | - Giorgio Sandrini
- Department of Brain and Behavioral Sciences, University of Pavia, IRCCS C. Mondino Foundation Neurologic Institute, Pavia, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | | | - Paolo Tonin
- S. Anna Institute, Regional Center for Serious Brain Injuries, Crotone, Italy
| | - Giacinto Bagetta
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, Rende, Italy
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88
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Ong YC, Tang A, Tam W. Effectiveness of robot therapy in the management of behavioural and psychological symptoms for individuals with dementia: A systematic review and meta-analysis. J Psychiatr Res 2021; 140:381-394. [PMID: 34144442 DOI: 10.1016/j.jpsychires.2021.05.077] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/13/2021] [Accepted: 05/29/2021] [Indexed: 12/17/2022]
Abstract
Robot therapy presents a promising alternative in dementia care. However, its effectiveness has not been verified comprehensively. This systematic review and meta-analysis aim at evaluating the effectiveness of robot therapy in the management of behavioural and psychological symptoms for individuals with dementia. Studies assessing the effectiveness of robot therapy were identified using 10 academic research databases: CENTRAL, CINAHL, CNKI, The Cochrane Library, Embase, IEEE Xplore, MEDLINE, PubMed, Scopus, and ProQuest Dissertations & Theses. Additional references were identified from the reference lists of included studies and relevant reviews. Data extraction and risk of bias assessment were conducted independently by two review authors. Meta-analyses and subgroup analyses were performed and the heterogeneity of studies was examined. 18 published articles from 14 studies involving a total of 1256 participants were included. Participants with robot therapy had a significant decrease in agitation (SMD -0.38, 95% CI -0.66, -0.09; p = 0.01) and a significant increase in social interaction (SMD 0.49, 95% CI 0.01, 0.97; p = 0.04) while effects for depression, anxiety, cognitive status, and quality of life were not statistically significant. Results from this review show that robot therapy can effectively reduce agitation and increase social interactions for individuals with dementia. Future clinical practice should consider the potential of robot therapy as an option to be implemented into current dementia programmes. Further large-scale trials are required for the thorough investigation of different intervention formats and robot types, while considering potential confounding factors.
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Affiliation(s)
- Yoke Chin Ong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Arthur Tang
- Department of Software, Sungkyunkwan University, Suwon, Republic of Korea.
| | - Wilson Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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89
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He Y, Li H, Huang J, Huang S, Bai Y, Li Y, Huang W. Efficacy of antidepressant drugs in the treatment of depression in Alzheimer disease patients: A systematic review and network meta-analysis. J Psychopharmacol 2021; 35:901-909. [PMID: 34238048 DOI: 10.1177/02698811211030181] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Depression is considered as one of the most common neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) patients. Prescription of antidepressants is a current clinical practice well-established as the first-line treatment for such patients. Our study was aimed at systematically examining the evidence on the efficacy of antidepressants in the treatment of depression in AD patients. METHODS We conducted a network meta-analysis of randomized controlled trials retrieved by systematic search of the Cochrane Central Register of Controlled Trials, PubMed, Embase, and CNKI databases. Primary outcomes included mean depression score and safety. Secondary outcomes were cognition. The surface under the cumulative ranking curve was performed to estimate a ranking probability for different treatments. RESULTS A total of 25 studies including 14 medications met the inclusion criteria. Compared with placebo, only mirtazapine (standard mean deviation [SMD], -1.94; 95% confidence interval [CI], -3.53 to -0.36; p < 0.05) and sertraline (SMD, -1.16; 95% CI, -2.17 to -0.15; p < 0.05) showed a slightly better effect in treating symptoms of depression. Clomipramine increased risk of adverse events than placebo (odds ratio, 3.01; 95% CI, 1.45 to 4.57; p < 0.05). In terms of cognitive function, there was no statistically significant difference between antidepressants and placebo. CONCLUSION Overall, in the short-term treatment, these data suggest that commonly used antidepressants sertraline and mirtazapine should be considered as an alternative treatment for depression in AD patients. However, more high-quality trials with large samples and longer following-up are proposed.
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Affiliation(s)
- Yanhong He
- Scientific Research Center, Maoming People's Hospital, Maoming, China.,Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Hao Li
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Jinbo Huang
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Sumei Huang
- Scientific Research Center, Maoming People's Hospital, Maoming, China
| | - Yunpeng Bai
- Scientific Research Center, Maoming People's Hospital, Maoming, China
| | - Yingbang Li
- Scientific Research Center, Maoming People's Hospital, Maoming, China
| | - Wendong Huang
- Scientific Research Center, Maoming People's Hospital, Maoming, China
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90
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Kwon CY, Lee B. Acupuncture for Behavioral and Psychological Symptoms of Dementia: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10143087. [PMID: 34300254 PMCID: PMC8303524 DOI: 10.3390/jcm10143087] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 12/31/2022] Open
Abstract
Dementia is an important health issue worldwide, and non-pharmacological strategies for the management of behavioral and psychological symptoms of dementia (BPSD) are considered to be important. This review analyzes the effectiveness and safety of acupuncture for BPSD. Thirteen electronic databases were comprehensively searched to find clinical studies using acupuncture on BPSD, published up to December 2020. Five randomized controlled clinical trials and two before-after studies, mainly on Alzheimer’s disease (AD), were included. Meta-analysis suggested that the total effective rate based on BPSD symptoms in the acupuncture combined with psychotropic drugs group was significantly higher than that in the psychotropic drugs group (risk ratio, 1.27; 95% confidence interval, 1.11 to 1.45; I2 = 51%). In terms of other outcomes related to BPSD, acupuncture as an adjunctive therapy, but not as monotherapy, was associated with significant benefits in most included studies. However, the included studies did not have optimal methodological quality. Our review highlights the limited evidence proving the effectiveness and safety of acupuncture for BPSD in patients with AD. Although some clinical studies have reported the potential benefits of adjuvant acupuncture in managing BPSD, the evidence is not robust and is based on small studies. Therefore, high-quality research in this field is needed.
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Affiliation(s)
- Chan-Young Kwon
- Department of Oriental Neuropsychiatry, Dong-eui University College of Korean Medicine, 52-57 Yangjeong-ro, Busanjin-gu, Busan 47227, Korea
- Correspondence: ; Tel.: +82-51-850-8808
| | - Boram Lee
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul 02447, Korea;
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91
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Cunha S, Forbes B, Sousa Lobo JM, Silva AC. Improving Drug Delivery for Alzheimer's Disease Through Nose-to-Brain Delivery Using Nanoemulsions, Nanostructured Lipid Carriers (NLC) and in situ Hydrogels. Int J Nanomedicine 2021; 16:4373-4390. [PMID: 34234432 PMCID: PMC8256381 DOI: 10.2147/ijn.s305851] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/29/2021] [Indexed: 12/18/2022] Open
Abstract
Current treatments for Alzheimer's disease (AD) attenuate the progression of symptoms and aim to improve the patient's quality of life. Licensed medicines are mostly for oral administration and are limited by the difficulty in crossing the blood-brain barrier (BBB). Here in, the nasal route has been explored as an alternative pathway that allows drugs to be directly delivered to the brain via the nasal cavity. However, clearance mechanisms in the nasal cavity impair the delivery of drugs to the brain and limit their bioavailability. To optimize nose-to-brain delivery, formulations of lipid-based nanosystems, namely nanoemulsions and nanostructured lipid carriers (NLC), formulated in situ gelling hydrogels have been proposed as approaches for nose-to-brain delivery. These formulations possess characteristics that facilitate drug transport directly to the brain, minimizing side effects and maximizing therapeutic benefits. It has been recommended that the manufacture of these drug delivery systems follows the quality by design (QbD) approach based on nasal administration requirements. This review provides an insight into the current knowledge of the AD, highlighting the need for an effective drug delivery to the brain. Considering the mounting interest in the use of nanoemulsions and NLC for nose-to-brain delivery, a description of drug transport pathways in the nasal cavity and the application of these nanosystems and their in situ hydrogels through the intranasal route are presented. Relevant preclinical studies are summarised, and the future prospects for the use of lipid-based nanosystems in the treatment of AD are emphasized.
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Affiliation(s)
- Sara Cunha
- UCIBIO/REQUIMTE, MEDTECH Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, 4050-313, Portugal
| | - Ben Forbes
- Institute of Pharmaceutical Science, Faculty of Life Sciences and Medicine, King’s College London, London, SE1 9NH, UK
| | - José Manuel Sousa Lobo
- UCIBIO/REQUIMTE, MEDTECH Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, 4050-313, Portugal
| | - Ana Catarina Silva
- UCIBIO/REQUIMTE, MEDTECH Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, 4050-313, Portugal
- UFP Energy, Environment and Health Research Unit (FP ENAS), Fernando Pessoa University, Porto, 4249-004, Portugal
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92
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Pisaturo M, Calò F, Russo A, Camaioni C, Giaccone A, Pinchera B, Gentile I, Simeone F, Iodice A, Maggi P, Coppola N. Dementia as Risk Factor for Severe Coronavirus Disease 2019: A Case-Control Study. Front Aging Neurosci 2021; 13:698184. [PMID: 34267649 PMCID: PMC8276052 DOI: 10.3389/fnagi.2021.698184] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/02/2021] [Indexed: 01/19/2023] Open
Abstract
Background The aim of the present study was to investigate the outcome of patients with SARS-CoV-2 infection and dementia. Patients and Methods In a multicenter, observational, 1:2 matched case-control study all 23 patients with a history of dementia, hospitalized with a diagnosis of SARS-CoV-2 infection from February 28th 2020 to January 31st 2021 were enrolled. For each Case, 2 patients without dementia observed in the same period study, pair matched for gender, age (±5 years), PaO2/FiO2 (P/F) ratio at admission (<200, or >200), number of comorbidities (±1; excluding dementia) were chosen (Control group). Results The majority of patients were males (60.9% of Cases and Controls) and very elderly [median age 82 years (IQR: 75.5–85) in the Cases and 80 (IQR: 75.5–83.75) in the Controls]. The prevalence of co-pathologies was very high: all the Cases and 43 (93.5%) Controls showed a Charlson comorbidity index of at least 2. During hospitalization the patients in the Case group less frequently had a moderate disease of COVID-19 (35 vs. 67.4%, p = 0.02), more frequently a severe disease (48 vs. 22%, p = 0.03) and more frequently died (48 vs. 22%, p = 0.03). Moreover, during coronavirus disease 2019 (COVID-19), 14 (60.8%) patients in the Case group and 1 (2.1%; p < 0.000) in the Control group showed signs and symptoms of delirium. Conclusion Patients with dementia are vulnerable and have an increased risk of a severe disease and death when infected with COVID-19.
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Affiliation(s)
- Mariantonietta Pisaturo
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Federica Calò
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Antonio Russo
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Clarissa Camaioni
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Agnese Giaccone
- Infectious Diseases Unit, Federico II University, Naples, Italy
| | - Biagio Pinchera
- Infectious Diseases Unit, Federico II University, Naples, Italy
| | - Ivan Gentile
- Infectious Diseases Unit, Federico II University, Naples, Italy
| | | | - Angelo Iodice
- Infectious Disease Unit, AORN Caserta, Caserta, Italy
| | - Paolo Maggi
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.,Infectious Disease Unit, AORN Caserta, Caserta, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
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93
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Wang DW, Ding SL, Bian XL, Zhou SY, Yang H, Wang P. Diagnostic value of amygdala volume on structural magnetic resonance imaging in Alzheimer’s disease. World J Clin Cases 2021; 9:4627-4636. [PMID: 34222429 PMCID: PMC8223829 DOI: 10.12998/wjcc.v9.i18.4627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/06/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The main clinical manifestation of Alzheimer’s disease (AD) is memory loss, which can be accompanied by neuropsychiatric symptoms at different stages of the disease. Amygdala is closely related to emotion and memory.
AIM To evaluate the diagnostic value of amygdala on structural magnetic resonance imaging (sMRI) for AD.
METHODS In this study, 22 patients with AD and 26 controls were enrolled. Their amygdala volumes were measured by sMRI and analyzed using an automatic analysis software.
RESULTS The bilateral amygdala volumes of AD patients were significantly lower than those of the controls and were positively correlated with the hippocampal volumes. Receiver operating characteristic curve analyses showed that the sensitivity of the left and right amygdala volumes in diagnosing AD was 80.8% and 88.5%, respectively. Subgroup analyses showed that amygdala atrophy was more serious in AD patients with neuropsychiatric symptoms, which mainly included irritability (22.73%), sleep difficulties (22.73%), apathy (18.18%), and hallucination (13.64%).
CONCLUSION Amygdala volumes measured by sMRI can be used to diagnose AD, and amygdala atrophy is more serious in patients with neuropsychiatric symptoms.
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Affiliation(s)
- De-Wei Wang
- Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong Province, China
| | - Shou-Luan Ding
- Center for Evidence-Based Medicine, Institute of Medical Sciences, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong Province, China
| | - Xian-Li Bian
- Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong Province, China
| | - Shi-Yue Zhou
- Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Hui Yang
- Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong Province, China
| | - Ping Wang
- Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong Province, China
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94
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Quail Z, Bolton L, Massey K. Digital delivery of non-pharmacological intervention programmes for people living with dementia during the COVID-19 pandemic. BMJ Case Rep 2021; 14:e242550. [PMID: 34140328 PMCID: PMC8212172 DOI: 10.1136/bcr-2021-242550] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 01/10/2023] Open
Abstract
The COVID-19 pandemic significantly impeded face-to-face health and social care delivery for people living with dementia and their carers. Interruption of meaningful activity engagement along with increased social isolation is known to be associated with loss of skills, increased loneliness, physical deterioration and decline in cognition and mood in people with dementia. To ensure continuity of care for people living with dementia, for whom multimodal, non-pharmacological intervention programmes were being provided, there was an urgent need to adopt a remote delivery model. Guidance on digitally delivered assessment and care specific to non-pharmacological interventions for dementia is lacking. Adoption of technology-enabled care for people with dementia requires overcoming barriers to technology use, adaptation of therapeutic guidelines, adaptation of communication methods and carer support. Despite these challenges, therapists successfully transitioned from in-person to digital delivery of therapeutic interventions with associated benefits of continued meaningful activity engagement discussed.
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Affiliation(s)
- Zara Quail
- Care Visions Healthy Ageing, Care Visions Limited, Stirling, UK
| | - Laura Bolton
- Care Visions Healthy Ageing, Care Visions Limited, Stirling, UK
| | - Karina Massey
- Care Visions Healthy Ageing, Care Visions Limited, Stirling, UK
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95
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Can the PROPER intervention reduce psychotropic drug prescription in nursing home residents with dementia? Results of a cluster-randomized controlled trial. Int Psychogeriatr 2021; 33:577-586. [PMID: 32431251 DOI: 10.1017/s1041610220000629] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the effect of the PROPER intervention in nursing home residents with dementia on the prevalence of psychotropic drug use and neuropsychiatric symptoms. DESIGN A cluster-randomized controlled design with two parallel groups (intervention versus usual care) and assessments at 0, 6, 12, and 18 months. SETTING Thirty-one dementia special care units within 13 long-term care organizations in the Netherlands. PARTICIPANTS Three hundred eighty nursing home residents with dementia. INTERVENTION The PROPER intervention consisted of a structured and repeated multidisciplinary medication review, supported by education and continuous evaluation. MEASUREMENTS Prescriptions of antipsychotics, antidepressants, anxiolytics, and hypnotics, and occurrence of neuropsychiatric symptoms. RESULTS The prescription of any type of psychotropic drugs increased in the intervention group, and decreased in the control group, with an estimated difference of 3.9 percentage points per 6 months (p = 0.01). Effects for the individual drug groups were minor (differences of 1.6 percentage points and below per 6 months) and not statistically significant. The occurrence of neuropsychiatric symptoms remained stable in both the intervention and control groups during the follow-up of 18 months. CONCLUSIONS The PROPER intervention failed to demonstrate effectiveness in reducing the prevalence of psychotropic drugs. It may be interesting to enrich the intervention with components that address personal attitudes and communication between nursing home professionals, not only with respect to the prescription of psychotropic drugs, but also to neuropsychiatric symptoms.The study has been registered in The Netherlands Trial Register (NTR3569).
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96
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Jia J, Xu J, Liu J, Wang Y, Wang Y, Cao Y, Guo Q, Qu Q, Wei C, Wei W, Zhang J, Yu E. Comprehensive Management of Daily Living Activities, behavioral and Psychological Symptoms, and Cognitive Function in Patients with Alzheimer's Disease: A Chinese Consensus on the Comprehensive Management of Alzheimer's Disease. Neurosci Bull 2021; 37:1025-1038. [PMID: 34050523 PMCID: PMC8275730 DOI: 10.1007/s12264-021-00701-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/06/2021] [Indexed: 01/05/2023] Open
Abstract
Alzheimer's disease (AD) is the most common cognitive disorder in the elderly. Its main clinical manifestations are cognitive decline (C), behavioral and psychological symptoms (B), and a decline in the activities of daily living (A), also known as ABC symptoms. Early identification and evaluation of ABC symptoms are helpful for establishing the accurate diagnosis, comprehensive treatment, and prognosis of AD. To guide Chinese clinical practice for optimization of the comprehensive management of AD, in 2018, The Academy of Cognitive Disorder of China gathered 22 neurologists and gerontologists in China to build a consensus on the comprehensive management of AD. Based on a review of the evidence, the consensus summarizes the pathogenesis, pathological changes, clinical manifestations, evaluation, diagnosis, drug and non-drug treatment, and patient care for AD. Focus group discussion was used to establish a flowchart of comprehensive ABC management for AD patients. The new consensus provides a feasible AD management process for clinicians.
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Affiliation(s)
- Jianjun Jia
- Department of Neurology, The Second Medical Center, People's Liberation Army General Hospital, Beijing, 100853, China.
| | - Jun Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Jun Liu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Yongjun Wang
- Cognitive Impairment Department, Shenzhen Kangning Hospital, Shenzhen, 518118, China
| | - Yanjiang Wang
- Department of Neurology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Yunpeng Cao
- Department of Neurology, The First Hospital of China Medical University, Shenyang, 210112, China
| | - Qihao Guo
- Department of Gerontology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Qiuming Qu
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Cuibai Wei
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Wenshi Wei
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Junjian Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Enyan Yu
- Department of Psychology, Chinese Academy of Sciences Cancer Hospital of the University of the Chinese Academy of Sciences, Hangzhou, 310022, China
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97
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Carrarini C, Russo M, Dono F, Barbone F, Rispoli MG, Ferri L, Di Pietro M, Digiovanni A, Ajdinaj P, Speranza R, Granzotto A, Frazzini V, Thomas A, Pilotto A, Padovani A, Onofrj M, Sensi SL, Bonanni L. Agitation and Dementia: Prevention and Treatment Strategies in Acute and Chronic Conditions. Front Neurol 2021; 12:644317. [PMID: 33935943 PMCID: PMC8085397 DOI: 10.3389/fneur.2021.644317] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/12/2021] [Indexed: 01/11/2023] Open
Abstract
Agitation is a behavioral syndrome characterized by increased, often undirected, motor activity, restlessness, aggressiveness, and emotional distress. According to several observations, agitation prevalence ranges from 30 to 50% in Alzheimer's disease, 30% in dementia with Lewy bodies, 40% in frontotemporal dementia, and 40% in vascular dementia (VaD). With an overall prevalence of about 30%, agitation is the third most common neuropsychiatric symptoms (NPS) in dementia, after apathy and depression, and it is even more frequent (80%) in residents of nursing homes. The pathophysiological mechanism underlying agitation is represented by a frontal lobe dysfunction, mostly involving the anterior cingulate cortex (ACC) and the orbitofrontal cortex (OFC), respectively, meaningful in selecting the salient stimuli and subsequent decision-making and behavioral reactions. Furthermore, increased sensitivity to noradrenergic signaling has been observed, possibly due to a frontal lobe up-regulation of adrenergic receptors, as a reaction to the depletion of noradrenergic neurons within the locus coeruleus (LC). Indeed, LC neurons mainly project toward the OFC and ACC. These observations may explain the abnormal reactivity to weak stimuli and the global arousal found in many patients who have dementia. Furthermore, agitation can be precipitated by several factors, e.g., the sunset or low lighted environments as in the sundown syndrome, hospitalization, the admission to nursing residencies, or changes in pharmacological regimens. In recent days, the global pandemic has increased agitation incidence among dementia patients and generated higher distress levels in patients and caregivers. Hence, given the increasing presence of this condition and its related burden on society and the health system, the present point of view aims at providing an extensive guide to facilitate the identification, prevention, and management of acute and chronic agitation in dementia patients.
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Affiliation(s)
- Claudia Carrarini
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Filomena Barbone
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Marianna G Rispoli
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Laura Ferri
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Martina Di Pietro
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Anna Digiovanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Paola Ajdinaj
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Rino Speranza
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Alberto Granzotto
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Institute for Mind Impairments and Neurological Disorders-iMIND, University of California, Irvine, Irvine, CA, United States
| | - Valerio Frazzini
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Institut du Cerveau et de la Moelle épinière, ICM, INSERM UMRS 1127, CNRS UMR 7225, Pitié Salpêtrière Hospital, Paris, France.,AP-HP, GH Pitie-Salpêtrière-Charles Foix, Epilepsy Unit and Neurophysiology Department, Paris, France
| | - Astrid Thomas
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Parkinson's Disease Rehabilitation Centre, FERB ONLUS-S. Isidoro Hospital, Trescore Balneario, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
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98
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Fond G, Llorca PM, Lançon C, Auquier P, Boyer L. [Mortality in schizophrenia: Towards a new health scandal? COVID-19 and schizophrenia]. ANNALES MEDICO-PSYCHOLOGIQUES 2021; 179:353-362. [PMID: 33753948 PMCID: PMC7969983 DOI: 10.1016/j.amp.2021.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Patients with schizophrenia represent a vulnerable population who have been understudied in COVID-19 research. We aimed to establish whether health outcomes and care differed between patients with schizophrenia and patients without a diagnosis of severe mental illness. We conducted a population-based cohort study of all patients with identified COVID-19 and respiratory symptoms who were hospitalized in France between February and June 2020. Cases were patients who had a diagnosis of schizophrenia. Controls were patients who did not have a diagnosis of severe mental illness. The outcomes were in-hospital mortality and intensive care unit (ICU) admission. A total of 50,750 patients were included, of whom 823 were schizophrenia patients (1.6%). The schizophrenia patients had an increased in-hospital mortality (25.6% vs. 21.7%; adjusted odds ratio (aOR) 1.30 [95% CI 1.08-1.56], p = 0.0093) and a decreased ICU admission rate (23.7% vs. 28.4%; aOR 0.75 [95% CI 0.62-0.91], p = 0.0062) compared to controls. Significant interactions between schizophrenia and age for mortality and ICU admission were observed (p = 0.0006 and p < 0.0001). Schizophrenia patients between 65 and 80 years had a significantly higher risk of death than controls of the same age (+7.89%). schizophrenia patients younger than 55 years had more ICU admissions (+13.93%) and schizophrenia patients between 65 and 80 years and older than 80 years had less ICU admissions than controls of the same age (-15.44% and -5.93%, respectively). Our findings report the existence of disparities in health and health care between schizophrenia patients and patients without a diagnosis of severe mental illness. These disparities differed according to the age and clinical profile of schizophrenia patients, suggesting the importance of personalized COVID-19 clinical management and health care strategies before, during and after hospitalization for reducing health disparities in this vulnerable population.
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Affiliation(s)
- Guillaume Fond
- FondaMental Academic Centers of Expertise for Schizophrenia, Créteil, France
- Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, 27, boulevard Jean-Moulin, 13005 Marseille, France
- Aix-Marseille University, Assistance publique Hôpitaux universitaires de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, France
| | - Pierre-Michel Llorca
- FondaMental Academic Centers of Expertise for Schizophrenia, Créteil, France
- CMP B, CHU, EA 7280 Faculté de médecine, Université d'Auvergne, BP 69, 63003 Clermont-Ferrand Cedex 1, France
| | - Christophe Lançon
- FondaMental Academic Centers of Expertise for Schizophrenia, Créteil, France
- Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, 27, boulevard Jean-Moulin, 13005 Marseille, France
- Aix-Marseille University, Assistance publique Hôpitaux universitaires de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, France
| | - Pascal Auquier
- Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, 27, boulevard Jean-Moulin, 13005 Marseille, France
- Aix-Marseille University, Assistance publique Hôpitaux universitaires de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, France
| | - Laurent Boyer
- FondaMental Academic Centers of Expertise for Schizophrenia, Créteil, France
- Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, 27, boulevard Jean-Moulin, 13005 Marseille, France
- Aix-Marseille University, Assistance publique Hôpitaux universitaires de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, France
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99
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Isaac V, Kuot A, Hamiduzzaman M, Strivens E, Greenhill J. The outcomes of a person-centered, non-pharmacological intervention in reducing agitation in residents with dementia in Australian rural nursing homes. BMC Geriatr 2021; 21:193. [PMID: 33743597 PMCID: PMC7980426 DOI: 10.1186/s12877-021-02151-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 03/11/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There is limited best- practice evidence to address behavioral and psychiatric symptoms for those with dementia in Australian rural nursing homes. This study aims to evaluate the outcomes of a person-centered, non-pharmacological dementia care model, 'Harmony in the Bush', based on the Progressively Lowered Stress Threshold principles and person-centered music in rural Australia. METHODS A quasi-experimental (nonrandomized, pre-post) intervention study was conducted in five rural nursing homes in Queensland and South Australia. Seventy-four residents with dementia participated in this intervention study, which yielded a sample power of 80%. Eighty-seven staff completed the Caregiver Stress Inventory at pre-post four-weeks of intervention. Staff training workshops focused on the theory of the Progressively Lowered Stress Threshold principles and delivery of person-centered care plan with integrated music intervention. We used reported changes in agitation of the residents, measured using Cohen- Mansfield Agitation Inventory, and staff's caregiving stress, using Caregivers Stress Inventory. This study adheres to the CONSORT guidelines. RESULTS Mean age of residents with dementia was 82.4 (7.7) years and 69% were females. The mean age of admission was 80.1(8.4) years. Baseline measures indicated that 32.7% had mild- severe pain and 30.5% reported mild-severe sadness. The results showed statistically significant decline in aggressive behaviors, physically non-aggressive behaviors, verbally agitated behavior and hiding and hoarding. There was similar reduction in staff stress in the domains of aggressive behaviors, inappropriate behaviors, resident safety, and resource deficiency. CONCLUSIONS The Harmony in the Bush model is effective in reducing agitation among dementia residents with significant reduction in staff stress levels in nursing homes in rural Australia. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374458.
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Affiliation(s)
- Vivian Isaac
- Rural and Remote Health South Australia, College of Medicine and Public Health, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, SA, 5341, Australia.
| | - Abraham Kuot
- Rural and Remote Health South Australia, College of Medicine and Public Health, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, SA, 5341, Australia
| | - Mohammad Hamiduzzaman
- Rural and Remote Health South Australia, College of Medicine and Public Health, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, SA, 5341, Australia
| | - Edward Strivens
- James Cook University & Clinical Director, Older Persons Health Services, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, 4870, Australia
| | - Jennene Greenhill
- Rural and Remote Health South Australia, College of Medicine and Public Health, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, SA, 5341, Australia
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100
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Abstract
Most patients with dementia have behavioural and psychological symptoms. The first-line treatments for these symptoms are not drugs, but behavioural and psychological interventions Antipsychotic drugs are widely prescribed for people living with dementia. This is despite a high adverse effect burden and limited evidence of efficacy Most behavioural and psychological symptoms will subside spontaneously within six months. Trials of deprescribing are therefore recommended Behaviours should be seen as symptoms that have an underlying cause. Treatment should target these causes, rather than the resultant behaviours
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Affiliation(s)
- Stephen Macfarlane
- Dementia Centre, Hammond Care, Sydney.,Faculty of Medicine and Health Sciences, Monash University, Clayton, Victoria.,School of Public health and Community Medicine, University of New South Wales, Sydney
| | - Colm Cunningham
- Dementia Centre, Hammond Care, Sydney.,Faculty of Medicine and Health Sciences, Monash University, Clayton, Victoria.,School of Public health and Community Medicine, University of New South Wales, Sydney
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