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Garcia JM, Sehgal J, Thompson JL, Woods SP, Medina LD. The Relationship Between Apathy and Cognitive Impairment Among Hispanic/Latin Americans: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses Systematic Review. J Geriatr Psychiatry Neurol 2024; 37:175-193. [PMID: 37855134 DOI: 10.1177/08919887231207640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVES The primary aim was to evaluate apathy assessment measures in relation to cognitive impairment among Hispanic/Latin Americans. METHODS A systematic review on the relationship between apathy and cognitive impairment among Hispanic/Latin Americans across normal aging and neurocognitive disorders was conducted according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and using APA PsycInfo, Embase, and PubMed databases. Inclusion criteria required (1) a sample of English or Spanish-speaking adults ages 18 years and older, (2) with measures of apathy, (3) assessment of cognitive functioning or diagnosis of neurocognitive disorder, (4) with at least 18.5% Hispanic/Latin American represented in the sample. RESULTS Only 14 papers met criteria to be included in this review. Of the 12 cross-sectional studies, 9 demonstrated significant associations between increased apathy and cognitive impairment, 1 demonstrated a descriptive difference between apathy and cognitive status (ie, no hypothesis test conducted), while 2 demonstrated null effects. These cross-sectional studies consisted of community and clinic samples of participants across North and South America. Two longitudinal studies conducted in North America demonstrated non-significant associations of apathy with cognitive status. CONCLUSIONS The Neuropsychiatric Inventory (NPI) and Neuropsychiatric Inventory Questionnaire (NPI-Q) apathy subscales were the most used measures for apathy in this review (85.7% of included studies). However, validity evidence from a review of apathy measures has warranted caution against the use of the NPI outside the context of screening for apathy. This potential measurement bias with Hispanic/Latin Americans apathy research limits conclusions drawn from the present review.
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Affiliation(s)
- Joshua M Garcia
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Jai Sehgal
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | | | - Luis D Medina
- Department of Psychology, University of Houston, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Kuroda Y, Sugimoto T, Satoh K, Nakagawa T, Saito T, Noguchi T, Komatsu A, Uchida K, Fujita K, Ono R, Arai H, Sakurai T. Relationship between mortality and vitality in patients with mild cognitive impairment/dementia: An 8-year retrospective study. Geriatr Gerontol Int 2024; 24 Suppl 1:221-228. [PMID: 38239023 DOI: 10.1111/ggi.14794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/23/2023] [Accepted: 12/16/2023] [Indexed: 03/27/2024]
Abstract
AIM The study aimed to investigate the association of vitality, as measured using the vitality index (Vix), with the survival outcomes of older adults with mild cognitive impairment (MCI) or dementia. METHODS We analyzed data from 3731 patients in the National Center for Geriatrics and Gerontology - Life Stories of Individuals with Dementia cohort from July 2010 to September 2018. The main focus was to correlate Vix scores with the time from the initial visit to death. Vix was categorized into "moderately to severely impaired" (0-7 points), "mildly impaired" (8-9 points), and "normal" (10 points) groups. Survival outcomes were assessed using a Cox proportional hazards model, adjusted for various factors. We conducted a mediation analysis to evaluate the effect of body mass index (BMI), instrumental activities of daily living (IADL), and basic activities of daily living (BADL) on the association between vitality and mortality. Stratified analysis was also conducted for the Mini-Mental State Examination groups. RESULTS We included 2740 patients with an average follow-up of 1315 days. The mortality rate was 15.7%. The Vix distribution was 16% at 0-7 points; 40%, 8-9 points; and 44%, 10 points. Patients in the "moderately to severely impaired" category, characterized by lower Vix scores, exhibited notably higher mortality rates. Mediation effects emphasized the significant roles of BMI, IADL, and BADL in influencing survival outcomes. CONCLUSIONS Vitality significantly influences patient survival rates. The association between vitality and mortality seems to be mediated by IADL and BADL, which has significant clinical implications. Geriatr Gerontol Int 2024; 24: 221-228.
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Affiliation(s)
- Yujiro Kuroda
- Department of Prevention and Care Science, Center for Development of Advanced Medicine for Dementia, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Taiki Sugimoto
- Department of Prevention and Care Science, Center for Development of Advanced Medicine for Dementia, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kenichi Satoh
- Faculty of Data Science, Shiga University, Hikone, Japan
| | - Takeshi Nakagawa
- Department of Social Science, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Tami Saito
- Department of Social Science, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Taiji Noguchi
- Department of Social Science, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ayane Komatsu
- Department of Social Science, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kazuaki Uchida
- Department of Prevention and Care Science, Center for Development of Advanced Medicine for Dementia, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kosuke Fujita
- Department of Prevention and Care Science, Center for Development of Advanced Medicine for Dementia, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Rei Ono
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Settsu, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takashi Sakurai
- Department of Prevention and Care Science, Center for Development of Advanced Medicine for Dementia, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Cognitive and Behavioral Science, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Zhu CW, Grossman HT, Elder GA, Rosen H, Sano M. Apathy in Lewy body disease and its effects on functional impairment over time. Front Neurol 2024; 15:1339190. [PMID: 38313558 PMCID: PMC10835801 DOI: 10.3389/fneur.2024.1339190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
Background and objectives Apathy strongly affects function in Alzheimer's disease and frontotemporal dementia, however its effect on function in Lewy Body Disease (LBD) has not been well-described. This study aims to (1) examine the prevalence and persistence of apathy in a large, national cohort of well-characterized patients with LBD, and (2) estimate the effect of apathy on function over time. Methods Study included 676 participants with mild cognitive impairment (MCI) or dementia in the National Alzheimer's Coordinating Center Uniform Data Set. Participants were followed for an average of 3.4 ± 1.7 years and consistently had a primary diagnosis of LBD. Apathy was defined by clinician judgment, categorized into four mutually exclusive profiles: (1) never apathetic across all visits, (2) at least one but <50% of visits with apathy (intermittent apathy), (3) ≥50% but not all visits with apathy (persistent apathy), and (4) always apathy across all visits. Dementia severity was measured by baseline Clinical Dementia Rating score. Parkinsonism was defined by the presence of bradykinesia, resting tremor, rigidity, gait, and postural instability. Functional impairment was assessed using the Functional Assessment Questionnaire (FAQ). Results Baseline characteristics of the sample were: average age = 72.9 ± 6.9, years of education = 15.6 ± 3.4, Mini Mental State Exam (MMSE) = 24.4 ± 5.4, Geriatric Depression Scale (GDS) = 3.8 ± 3.2, FAQ = 12.0 ± 9.1. 78.8% were male and 89% were non-Hispanic white. Prevalence of apathy increased from 54.4% at baseline to 65.5% in year 4. 77% of participants had apathy at some point during follow-up. Independent of cognitive status and parkinsonian features, FAQ was significantly higher in participants with intermittent/persistent and always apathetic than never apathetic. Annual rate of decline in FAQ was faster in participants who were always apathetic than never apathy. Discussion In this large national longitudinal cohort of LBD patients with cognitive impairment, apathy was strongly associated with greater functional impairment at baseline and faster rate of decline over time. The magnitude of these effects were clinically important and were observed beyond the effects on function from participants' cognitive status and parkinsonism, highlighting the importance of specifically assessing for apathy in LBD.
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Affiliation(s)
- Carolyn W. Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- James J. Peters VA Medical Center, Bronx, NY, United States
- Department of Psychiatry, Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Hillel T. Grossman
- James J. Peters VA Medical Center, Bronx, NY, United States
- Department of Psychiatry, Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Gregory A. Elder
- James J. Peters VA Medical Center, Bronx, NY, United States
- Department of Psychiatry, Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Howie Rosen
- Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, United States
| | - Mary Sano
- James J. Peters VA Medical Center, Bronx, NY, United States
- Department of Psychiatry, Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Nijsten JMH, Plouvier AOA, Smalbrugge M, Koopmans RTCM, Leontjevas R, Gerritsen DL. The development and feasibility evaluation of a program to identify and manage apathy in people with dementia: the SABA program. Aging Ment Health 2024; 28:227-237. [PMID: 37382202 DOI: 10.1080/13607863.2023.2228252] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES To develop and evaluate feasibility of a program for family and professional caregivers to identify and manage apathy in people with dementia: the Shared Action for Breaking through Apathy program (SABA). METHODS A theory- and practice-based intervention was developed and tested among ten persons with apathy and dementia in two Dutch nursing homes from 2019 to 2021. Feasibility was evaluated with interviews with family caregivers (n = 7) and professional caregivers (n = 4) and two multidisciplinary focus groups with professional caregivers (n = 5 and n = 6). RESULTS SABA was found feasible for identifying and managing apathy. Caregivers mentioned increased knowledge and awareness regarding recognizing apathy and its impact on their relationship with the person with apathy. They experienced increased skills to manage apathy, a greater focus on small-scale activities and increased appreciation of small moments of success. The content, form and accessibility of the program's materials were considered facilitating by all stakeholders, as was the compatibility of the procedures with the usual way of working. The expertise and involvement of stakeholders, staff stability and the support of an ambassador and/or manager were facilitating, while insufficient collaboration was a barrier. Organizational and external aspects like not prioritizing apathy, staff discontinuity, and the Covid-19 pandemic were perceived as barriers. A stimulating physical environment with small-scale living rooms, and access to supplies for activities were considered facilitating. CONCLUSIONS SABA empowers family and professional caregivers to successfully identify and manage apathy. For implementation, it is important to take into account the facilitators and barriers resulting from our study.
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Affiliation(s)
- Johanna M H Nijsten
- Research Institute for Medical Innovation, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Archipel Landrijt, Expertise Center for Specialized Care, Eindhoven, The Netherlands
| | - Annette O A Plouvier
- Research Institute for Medical Innovation, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Raymond T C M Koopmans
- Research Institute for Medical Innovation, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Waalboog, location Joachim and Anna, Center for Specialised Geriatric Care, Nijmegen, The Netherlands
| | - Ruslan Leontjevas
- Research Institute for Medical Innovation, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Debby L Gerritsen
- Research Institute for Medical Innovation, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
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Nijsten JMH, Smalbrugge M, Plouvier AOA, Koopmans RTCM, Leontjevas R, Gerritsen DL. Identifying and managing apathy in people with dementia living in nursing homes: a qualitative study. BMC Geriatr 2023; 23:727. [PMID: 37946109 PMCID: PMC10636808 DOI: 10.1186/s12877-023-04422-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Although apathy is common in people with dementia and has profound negative effects, it is rarely diagnosed nor specifically treated in nursing homes. The aim of this study is to explore experiences in identifying and managing apathy from the perspectives of people with dementia and apathy (PwA), family caregivers (FCs) and professional caregivers (PCs). METHODS Descriptive qualitative study with purposive sampling, comprising eleven semi-structured in-depth interviews with PwA, FCs or PCs and focus groups with twelve PCs in Dutch nursing homes. Seventeen additional in-depth interviews with caregivers were held, after signals of increasing apathy during the first Covid-19 lockdown. Using an inductive approach, data was analysed thematically to explore the experiences in identifying and managing apathy from the perspective of different stakeholders. RESULTS Three themes were identified: 1) the challenge to appraise signals, 2) the perceived impact on well-being, 3) applied strategies to manage apathy. Although participants described apathy in line with diagnostic criteria, they were unfamiliar with the term apathy and had difficulties in appraising signals of apathy. Also, the perceived impact of apathy varied per stakeholder. PwA had difficulties reflecting on their internal state. FCs and PCs experienced apathy as challenging when it reduced the well-being of PwA or when they themselves experienced ambiguity, frustration, insecurity, disappointment or turning away. Dealing with apathy required applying specific strategies that included stimulating meaningful contact, adjusting one's expectations, and appreciating little successes. CONCLUSIONS When addressing apathy in nursing homes, it is important to consider that a) all stakeholders experience that appraising signals of apathy is challenging; b) apathy negatively influences the well-being of people with dementia and especially their FCs and PCs; and c) FCs and PCs can successfully, albeit temporarily, manage apathy by using specific strategies.
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Affiliation(s)
- Johanna M H Nijsten
- Radboud University, Nijmegen, The Netherlands.
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Centre, Nijmegen, The Netherlands.
- Radboud Alzheimer Centre, Nijmegen, The Netherlands.
- Archipel, Landrijt Expertise Centre for Specialized Care, Eindhoven, The Netherlands.
| | - Martin Smalbrugge
- Department of Medicine for Older People, UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Annette O A Plouvier
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Centre, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Nijmegen, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Centre, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Nijmegen, The Netherlands
- Waalboog, Joachim and Anna, Centre for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Ruslan Leontjevas
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Centre, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Nijmegen, The Netherlands
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Centre, Nijmegen, The Netherlands
- Radboud Alzheimer Centre, Nijmegen, The Netherlands
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Pless A, Ware D, Saggu S, Rehman H, Morgan J, Wang Q. Understanding neuropsychiatric symptoms in Alzheimer's disease: challenges and advances in diagnosis and treatment. Front Neurosci 2023; 17:1263771. [PMID: 37732300 PMCID: PMC10508352 DOI: 10.3389/fnins.2023.1263771] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) affect up to 97% of AD patients, with an estimated 80% of current AD patients experiencing these symptoms. Common AD-associated NPS include depression, anxiety, agitation, aggression, and apathy. The severity of NPS in AD is typically linked to the disease's progression and the extent of cognitive decline. Additionally, these symptoms are responsible for a significant increase in morbidity, mortality, caregiver burden, earlier nursing home placement, and greater healthcare expenditure. Despite their high prevalence and significant impact, there is a notable lack of clinical research on NPS in AD. In this article, we explore and analyze the prevalence, symptom manifestations, challenges in diagnosis, and treatment options of NPS associated with AD. Our literature review reveals that distinguishing and accurately diagnosing the NPS associated with AD remains a challenging task in clinical settings. It is often difficult to discern whether NPS are secondary to pathophysiological changes from AD or are comorbid psychiatric conditions. Furthermore, the availability of effective pharmaceutical interventions, as well as non-pharmacotherapies for NPS in AD, remains limited. By highlighting the advance and challenges in diagnosis and treatment of AD-associated NPS, we aspire to offer new insights into the complexity of identifying and treating these symptoms within the context of AD, and contribute to a deeper understanding of the multifaceted nature of NPS in AD.
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Affiliation(s)
- Andrew Pless
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Destany Ware
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Shalini Saggu
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Hasibur Rehman
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - John Morgan
- Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Qin Wang
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
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Theleritis C, Siarkos K, Politis A, Smyrnis N, Papageorgiou C, Politis AM. A Systematic Review of Pharmacological Interventions for Apathy in Aging Neurocognitive Disorders. Brain Sci 2023; 13:1061. [PMID: 37508993 PMCID: PMC10377475 DOI: 10.3390/brainsci13071061] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVE Apathy, a frequent neuropsychiatric symptom in aging neurocognitive disorders, has been associated with cognitive decline and functional disability. Therefore, timely provision of pharmacological interventions for apathy is greatly needed. DESIGN A systematical literature review of existing studies was conducted up to 30 May 2023 in several databases (PubMed, PsychInfo, Cochrane, Google Scholar, etc.) that included randomized controlled trials (RCTs) and meta-analyses assessing pharmacological treatments for apathy in aging neurocognitive disorders. The quality of the studies was appraised. RESULTS In patients with Alzheimer's Disease (AD), donepezil, galantamine, rivastigmine, methylphenidate, and gingko biloba were proven efficacious for apathy, while rivastigmine, cognitive enhancer IRL752 and piribedil were found to be beneficial in patients with Parkinson's Disease (PD) and agomelatine in patients with Frontotemporal Dementia (FD). The extensive proportion of RCTs in which apathy was used as a secondary outcome measure, along with the considerable methodological heterogeneity, did not allow the evaluation of group effects. CONCLUSIONS Pharmacological interventions for apathy in aging neurocognitive disorders are complex and under-investigated. The continuation of systematic research efforts and the provision of individualized treatment for patients suffering from these disorders is vital.
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Affiliation(s)
- Christos Theleritis
- First Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 74 Vas. Sofias Ave., 11528 Athens, Greece
| | - Kostas Siarkos
- First Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 74 Vas. Sofias Ave., 11528 Athens, Greece
| | - Anastasios Politis
- Second Department of Neurosurgery, National and Kapodistrian University of Athens, Attikon Hospital, 1 Rimini Str., 12462 Athens, Greece
| | - Nikolaos Smyrnis
- Second Department of Psychiatry, National and Kapodistrian University of Athens, Attikon Hospital, 1 Rimini Str., 12462 Athens, Greece
| | - Charalabos Papageorgiou
- First Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 74 Vas. Sofias Ave., 11528 Athens, Greece
| | - Antonios M Politis
- First Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, 74 Vas. Sofias Ave., 11528 Athens, Greece
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21218, USA
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Blondeau R, Giguère M, Rousseau J. [Les effets de l'environnement de soins sur les comportements réactifs des personnes ayant des troubles neurocognitifs vivant en centre d'hébergement : Une revue de la portée]. Can J Aging 2023; 42:33-55. [PMID: 36345714 DOI: 10.1017/s0714980822000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Les personnes âgées atteintes de troubles neurocognitifs (démences) vivant en centre d'hébergement adoptent fréquemment des comportements réactifs qui limitent leur engagement dans des occupations. La présente étude vise à identifier des moyens d'intervention centrés sur l'engagement des personnes âgées ayant un trouble neurocognitif avec l'environnement humain et non humain en centre d'hébergement afin de diminuer leurs comportements réactifs, en particulier les comportements d'errance, d'apathie et d'agitation. Cette revue de la portée est basée sur la méthode proposée par Levac et ses collaborateurs (2010). Parmi les 21 études retenues, la plupart s'intéressent à des interventions ciblant l'environnement non humain (n=9) ou ciblant simultanément l'environnement humain et non humain (n=9). Plusieurs de ces interventions sont efficaces pour diminuer les comportements réactifs et permettent aux personnes âgées de s'engager avec leur environnement. Le support de l'environnement humain semble toutefois nécessaire à l'utilisation optimale de plusieurs interventions.
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Affiliation(s)
- Raphaëlle Blondeau
- École de réadaptation, Faculté de médecine, Université de Montréal (Pavillon Parc), 7077 avenue du Parc, Montréal, Québec, H3N 1X7, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (Pavillon André-Roch Lecours), 4565 chemin Queen-Mary, Montréal, Québec, H3W 1W5, Canada
| | - Mélanie Giguère
- École de réadaptation, Faculté de médecine, Université de Montréal (Pavillon Parc), 7077 avenue du Parc, Montréal, Québec, H3N 1X7, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (Pavillon André-Roch Lecours), 4565 chemin Queen-Mary, Montréal, Québec, H3W 1W5, Canada
| | - Jacqueline Rousseau
- École de réadaptation, Faculté de médecine, Université de Montréal (Pavillon Parc), 7077 avenue du Parc, Montréal, Québec, H3N 1X7, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (Pavillon André-Roch Lecours), 4565 chemin Queen-Mary, Montréal, Québec, H3W 1W5, Canada
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Kouloutbani K, Venetsanou F, Karteroliotis KE, Politis A. Physical Exercise as a Nonpharmacological Intervention for the Treatment of Neuropsychiatric Symptoms in Persons With Dementia: A Meta-analysis of Randomized Controlled Trials. Alzheimer Dis Assoc Disord 2023; 37:73-81. [PMID: 36821178 DOI: 10.1097/wad.0000000000000544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/28/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are prevalent in dementia and affect both patients and caregivers in multiple ways. Because of the complications of drug treatments, nonpharmacological interventions, such as exercise, are of particular value. This study aimed to investigate the effect of exercise on the NPS of dementia and draw recommendations for the disease management. METHODS Meta-analyses were conducted on the findings of randomized controlled trials identified during an initial systematic review of the literature, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The included studies examined the effect of exercise interventions on patients with dementia or mild cognitive impairment using valid assessment tools. The quality of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation analysis. RESULTS The meta-analyses revealed that exercise significantly limits NPS [mean difference: -5.28, (95% CI, -9.46, -1.11), P = 0.01] and symptoms of depression [standardized mean difference: -0.16, (95% CI, -0.29, -0.02), P = 0.02], and has a beneficial effect on agitation symptoms. The Grading of Recommendations, Assessment, Development, and Evaluation analysis results showed that exercise has a moderate and high confidence positive effect on NPS and depression, respectively. CONCLUSIONS Exercise could be an alternative approach for nonpharmacological treatment of NPS in dementia. Therefore, exercise could be utilized as a treatment of choice or to support existing treatment regimens.
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Affiliation(s)
- Komanthi Kouloutbani
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Dafni
| | - Fotini Venetsanou
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Dafni
| | | | - Antonios Politis
- First Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
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Yang Q, Wang Y, Yang M, Ge S, Cheng S, Wang C, Zhang W, Tian C, Mao J. Apathy co-occurs with subjective cognitive decline among community-dwelling older adults. Geriatr Nurs 2022; 48:177-182. [PMID: 36257223 DOI: 10.1016/j.gerinurse.2022.09.018] [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: 08/16/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the relationship between apathy and subjective cognitive decline (SCD) in community-dwelling older adults. METHODS A total of 211 participants without objective cognitive impairment were included in this study. Their SCD, apathy, sleep quality, depression, and anxiety were assessed by face-to-face interviews. Multivariate logistic regression was constructed to examine the independent relationship between apathy and SCD with adjustment for confounders. RESULTS The participants' average SCD-questionnaire and apathy evaluation scale-self scores were 7.13 and 30.65, respectively. Nearly half of the participants were categorized as having SCD. A quarter of participants were identified as apathetic. The apathy score was significantly associated with an increased risk of SCD (odds ratio 1.05, 95% confidence interval 1.01-1.10) after controlling for covariates. CONCLUSION Apathy was independently and significantly associated with SCD in community-dwelling older adults without objective cognitive impairment. Thus early intervention on apathy is important to protect elderly cognitive functioning.
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Affiliation(s)
- Qing Yang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuxin Wang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mengshu Yang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Song Ge
- Department of Natural Sciences, University of Houston-Downtown, Houston, TX, US
| | - Shiyao Cheng
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chuwen Wang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenya Zhang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chong Tian
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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11
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Dening T, Baber W, Chang M, Yates J. The struggle of apathy in dementia. Aging Ment Health 2022; 26:1909-1911. [PMID: 34850646 DOI: 10.1080/13607863.2021.2008309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Tom Dening
- Institute of Mental Health & School of Medicine, University of Nottingham, Nottingham, UK
| | - Waqaar Baber
- Institute of Mental Health & School of Medicine, University of Nottingham, Nottingham, UK
| | - Marybeth Chang
- Institute of Mental Health & School of Medicine, University of Nottingham, Nottingham, UK
| | - Jen Yates
- Institute of Mental Health & School of Medicine, University of Nottingham, Nottingham, UK
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12
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Ayhan Y, Yoseph SA, Miller BL. Management of Psychiatric Symptoms in Dementia. Neurol Clin 2022; 41:123-139. [DOI: 10.1016/j.ncl.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Stensvik GT, Helvik AS, Haugan G, Steinsbekk A, Salvesen Ø, Nakrem S. The short-term effect of a modified comprehensive geriatric assessment and regularly case conferencing on neuropsychiatric symptoms in nursing homes: a cluster randomized trial. BMC Geriatr 2022; 22:316. [PMID: 35410145 PMCID: PMC8996560 DOI: 10.1186/s12877-022-02976-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/24/2022] [Indexed: 11/30/2022] Open
Abstract
Aims To investigate the short-term effect of implementing a modified comprehensive geriatric assessment and regularly case conferencing in nursing homes on neuropsychiatric symptoms. Background Neuropsychiatric symptoms are common and may persist over time in nursing home residents. Evidence of effective interventions is scarce. Design A parallel cluster-randomised controlled trial. Methods The intervention was monthly standardised case conferencing in combination with a modified comprehensive geriatric assessment. The control group received care as usual. Main outcome measure. The total score on the short version of the Neuropsychiatric Inventory (NPI-Q, 12-items). Results A total of 309 residents at 34 long-term care wards in 17 nursing homes (unit of randomisation) were included. The intervention care units conducted on average two case conference-meetings (range 1–3), discussing a mean of 4.8 (range 1–8) residents. After 3 months, there were no difference of NPI-Q total score between the intervention (-0.4) and the control group (0.5) (estimated mean difference = -1.0, 95% CI -2.4 to 0.5, p = 0.19). There was a difference in favour of the intervention group on one of the secondary outcome measures, the apathy symptoms (-0.5 95% CI: -0.9 to -0.1, p = 0.03). Conclusion In this study there were no short-term effect of case conferencing and modified comprehensive geriatric assessments after three months on the total score on neuropsychiatric symptoms. The intervention group had less apathy at 3 months follow-up compared to those receiving care as usual. The findings suggest that a more comprehensive intervention is needed to improve the total Neuropsychiatric symptoms burden and complex symptoms. Trial registration Due to delays in the organisation, the study was registered after study start, i.e. retrospectively in Clinicaltrials.gov # NCT02790372 at https://clinicaltrials.gov/; Date of clinical trial registration: 03/06/2016.
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Affiliation(s)
- Geir-Tore Stensvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Anne-Sofie Helvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Norwegian National Advisory Unit On Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Gørill Haugan
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Norwegian Centre for E-health Research, Tromsø, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sigrid Nakrem
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Yang Y, Kwan RYC, Zhai HM, Xiong Y, Zhao T, Fang KL, Zhang HQ. Effect of horticultural therapy on apathy in nursing home residents with dementia: a pilot randomized controlled trial. Aging Ment Health 2022; 26:745-753. [PMID: 33818221 DOI: 10.1080/13607863.2021.1907304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: This study aimed to examine (1) the feasibility of the study procedures (i.e. recruitment, retention, attendance, and assessment completion rates), and (2) the effects of horticultural therapy (HT) on apathy, cognitive ability, quality of life, and functional capacity.Methods: This was a parallel-group, match-paired, randomized controlled trial. Thirty-two participants were allocated to either the experimental or the control group. Data were collected at baseline (T0), immediately postintervention (T1), and 3 months postintervention (T2). The Apathy Evaluation Scale-informant version (AES-I); Mini-Mental State Examination (MMSE); Quality of Life in Alzheimer's disease (QoL-AD) scale; Barthel index (BI) were used to measure apathy, cognitive ability, quality of life, and functional capacity, respectively.Results: The recruitment, retention, attendance and assessment completion rates were 22.7%, 87.5%, 100% and 100%, respectively. The between-group differences in AES-I (p = 0.007) and MMSE (p = 0.034) scores were statistically significant at T1. In the experimental group, the AES-I (p = 0.001), MMSE (p = 0.010), and QoL-AD (p = 0.017) scores were significantly different over time. In the post hoc pair-wise analysis, the AES-I scores of the experimental group observed at T1 were significantly lower than that at T0 (p = 0.032). In the control group, the MMSE scores (p = 0.001) were significantly different over time.Conclusion: HT is feasible for residents with dementia and apathy. The HT program effectively reduced apathy and promoted cognitive function, but its effects on quality of life and functional capacity were not observed.
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Affiliation(s)
- Yi Yang
- Department of Nursing, Medical School, Taizhou University, Taizhou, Zhejiang, China
| | - Rick Y C Kwan
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Hui-Min Zhai
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Yong Xiong
- Nursing Department, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Ting Zhao
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Kai-Ling Fang
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Hui-Qing Zhang
- Guangzhou Youhao Senior Apartment, Guangzhou, Guangdong, China
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15
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Grossman HT, Sano M, Aloysi A, Elder GA, Neugroschl J, Schimming C, Soleimani L, Zhu CW. Prevalent, persistent, and impairing: Longitudinal course and impact of apathy in Alzheimer's disease. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 13:e12169. [PMID: 35141391 PMCID: PMC8817116 DOI: 10.1002/dad2.12169] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/15/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Understanding of the natural history of apathy and its impact on patient function is limited. This study examines, in a large, national sample of Alzheimer's disease (AD) patients with long follow-ups: (1) prevalence, incidence, and persistence of apathy, and (2) impact of apathy on function across dementia severity. METHODS A longitudinal study of 9823 well-characterized AD patients in the National Alzheimer's Coordinating Center Uniform Data Set. RESULTS Apathy was highly prevalent across disease severity with cumulative prevalence of 48%, 74%, and 82% in Clinical Dementia Rating (CDR) 0.5, 1.0, and 2.0, respectively. Persistence of apathy from clinician judgment varied from visit to visit at earlier disease stages but remained high at moderate dementia. Independent of cognition, persistent apathy was strongly associated with accelerated rate of functional decline. DISCUSSION Findings point to important targets for the treatment and management of apathy, include functional outcomes, and study designs that account for variable persistence of the apathy syndrome.
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Affiliation(s)
- Hillel T. Grossman
- James J. Peters VA Medical CenterBronxNew YorkUSA
- Department of PsychiatryIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
| | - Mary Sano
- James J. Peters VA Medical CenterBronxNew YorkUSA
- Department of PsychiatryIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
| | - Amy Aloysi
- Department of PsychiatryIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
- Department of NeurologyIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
| | - Gregory A. Elder
- Department of PsychiatryIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
- Department of NeurologyIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
| | - Judith Neugroschl
- Department of PsychiatryIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
| | - Corbett Schimming
- James J. Peters VA Medical CenterBronxNew YorkUSA
- Department of PsychiatryIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
| | - Laili Soleimani
- Department of PsychiatryIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
| | - Carolyn W. Zhu
- James J. Peters VA Medical CenterBronxNew YorkUSA
- Department of PsychiatryIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
- Brookdale Department of Geriatrics and Palliative MedicineIcahn School of Medicine at Mount SinaiBronxNew YorkUSA
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16
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The effectiveness of physical exercise interventions in the management of neuropsychiatric symptoms in dementia patients: a systematic review. Int Psychogeriatr 2022; 34:177-190. [PMID: 33818342 DOI: 10.1017/s1041610221000193] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The management of neuropsychiatric symptoms (NPS) in patients with dementia is a major challenge. Since no effective therapy has been found to date and drug treatments are associatedwith significant side effects, there seems to be a pressing need for alternative non-pharmacological interventions. OBJECTIVES The current study aims to investigate and compare the effect of different types of physical exercise on the NPS. METHODS A systematic review of the literature was conducted according to the PRISMA guidelines. Five databases (SCOPUS, PubMed, SPORT Discus, Web of science and ScienceDirect) were searched using the appropriate algorithm. What was sought out was randomized control trials (RCTs) that applied physical activity interventions with specific characteristics (type, frequency, intensity, and duration) in patients with dementia or mild cognitive impairment, studied the effect of exercise on their NPS and compared this effect with a control group that did not follow an exercise program. RESULTS From 512 articles, 13 studies were included in this review, involving a total of 1,925 patients. The results were analyzed and synthesized according to the type of exercise applied - aerobic exercise, multidimensional interventions and muscular strength training programs. In particular, the results showed that repetitive aerobic exercise three to five times a week had a positive effect on NPS, whereas multidimensional interventions combining different types of exercise did not appear to be as effective. Strength training programs have been found to significantly reduce depression symptoms and behavioral problems in demented patients with mobility problems. CONCLUSIONS There is clear evidence that physical activity and especially aerobic exercise may be effective in the management of NPS. However, it is necessary to apply specific practical recommendations and specially designed programs to incorporate physical exercise into the daily routine of these patients.
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17
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A tablet-based intervention for activating nursing home residents with dementia: results from a cluster-randomized controlled trial. Int Psychogeriatr 2022; 34:129-141. [PMID: 34183087 DOI: 10.1017/s1041610221000818] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To investigate global and momentary effects of a tablet-based non-pharmacological intervention for nursing home residents living with dementia. DESIGN Cluster-randomized controlled trial. SETTING Ten nursing homes in Germany were randomly allocated to the tablet-based intervention (TBI, 5 units) or conventional activity sessions (CAS, 5 units). PARTICIPANTS N = 162 residents with dementia. INTERVENTION Participants received regular TBI (n = 80) with stimulating activities developed to engage people with dementia or CAS (n = 82) for 8 weeks. MEASUREMENTS Apathy Evaluation Scale (AES-I, primary outcome), Quality of Life in Alzheimer's Disease scale, QUALIDEM scale, Neuropsychiatric Inventory, Geriatric Depression Scale, and psychotropic medication (secondary outcomes). Momentary quality of life was assessed before and after each activity session. Participants and staff were blinded until the collection of baseline data was completed. Data were analyzed with linear mixed-effects models. RESULTS Levels of apathy decreased slightly in both groups (mean decrease in AES-I of .61 points, 95% CI -3.54, 2.33 for TBI and .36 points, 95% CI -3.27, 2.55 for CAS). Group difference in change of apathy was not statistically significant (β = .25; 95% CI 3.89, 4.38, p = .91). This corresponds to a standardized effect size (Cohen's d) of .02. A reduction of psychotropic medication was found for TBI compared to CAS. Further analyses revealed a post-intervention improvement in QUALIDEM scores across both groups and short-term improvements of momentary quality of life in the CAS group. CONCLUSIONS Our findings suggest that interventions involving tailored activities have a beneficial impact on global and momentary quality of life in nursing home residents with dementia. Although we found no clear advantage of TBI compared to CAS, tablet computers can support delivery of non-pharmacological interventions in nursing homes and facilitate regular assessments of fluctuating momentary states.
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Apathy as a Treatment Target in Alzheimer's Disease: Implications for Clinical Trials. Am J Geriatr Psychiatry 2022; 30:119-147. [PMID: 34315645 DOI: 10.1016/j.jagp.2021.06.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 12/11/2022]
Abstract
Apathy is one of the most prevalent, stable and persistent neuropsychiatric symptom across the neurocognitive disorders spectrum. Recent advances in understanding of phenomenology, neurobiology and intervention trials highlight apathy as an important target for clinical intervention. We conducted a comprehensive review and critical evaluation of recent advances to determine the evidence-based suggestions for future trial designs. This review focused on 4 key areas: 1) pre-dementia states; 2) assessment; 3) mechanisms/biomarkers and 4) treatment/intervention efficacy. Considerable progress has been made in understanding apathy as a treatment target and appreciating pharmacological and non-pharmacological apathy treatment interventions. Areas requiring greater investigation include: diagnostic procedures, symptom measurement, understanding the biological mechanisms/biomarkers of apathy, and a well-formed approach to the development of treatment strategies. A better understanding of the subdomains and biological mechanisms of apathy will advance apathy as a treatment target for clinical trials.
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19
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Manera V, Agüera-Ortiz L, Askenazy F, Dubois B, Corveleyn X, Cross L, Febvre-Richards E, Fabre R, Fernandez N, Foulon P, Gros A, Gueyraud C, Lebourhis M, Malléa P, Martinez L, Pancrazi MP, Payne M, Robert V, Tamagno L, Thümmler S, Robert P. In-Person and Remote Workshops for People With Neurocognitive Disorders: Recommendations From a Delphi Panel. Front Aging Neurosci 2022; 13:747804. [PMID: 35126087 PMCID: PMC8814601 DOI: 10.3389/fnagi.2021.747804] [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: 07/26/2021] [Accepted: 12/07/2021] [Indexed: 12/01/2022] Open
Abstract
Workshops using arts and board games are forms of non-pharmacological intervention widely employed in seniors with neurocognitive disorders. However, clear guidelines on how to conduct these workshops are missing. The objective of the Art and Game project (AGAP) was to draft recommendations on the structure and content of workshops for elderly people with neurocognitive disorders and healthy seniors, with a particular focus on remote/hybrid workshops, in which at least a part of the participants is connected remotely. Recommendations were gathered using a Delphi methodology. The expert panel (N = 18) included experts in the health, art and/or board games domains. They answered questions via two rounds of web-surveys, and then discussed the results in a plenary meeting. Some of the questions were also shared with the general public (N = 101). Both the experts and the general public suggested that organizing workshops in a hybrid format (some face-to-face sessions, some virtual session) is feasible and interesting for people with neurocognitive disorders. We reported guidelines on the overall structure of workshops, practical tips on how to organize remote workshops, and a SWOT analysis of the use of remote/hybrid workshops. The guidelines may be employed by clinicians to decide, based on their needs and constraints, what interventions and what kind of workshop format to employ, as well as by researcher to standardize procedures to assess the effectiveness of non-pharmacological treatments for people with neurocognitive disorders.
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Affiliation(s)
- Valeria Manera
- Cognition Behaviour Technology (CoBTeK) Lab, Université Côte d’Azur, Nice, France
- *Correspondence: Valeria Manera,
| | - Luis Agüera-Ortiz
- Servicio de Psiquiatría, Instituto de Investigación (i + 12), Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Florence Askenazy
- Cognition Behaviour Technology (CoBTeK) Lab, Université Côte d’Azur, Nice, France
- University Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, Nice, France
| | - Bruno Dubois
- Institut de la mémoire et de la Maladie d’Alzheimer (IM2A), INSERM, U1127, AP-HP, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
- Institut du Cerveau et de la Moelle Épinière (ICM), INSERM, U1127, AP-HP, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Xavier Corveleyn
- Laboratoire d’Anthropologie et de Psychologie Cliniques, Cognitives et Sociales (LAPCOS), Université Côte d’Azur, Nice, France
- Maison des Sciences de l’Homme et de la Société Sud-Est (MSHS Sud-Est), Nice, France
| | - Liam Cross
- Department of Psychology, Edge Hill University, Liverpool, United Kingdom
| | - Emma Febvre-Richards
- Whiti o Rehua School of Art, College of Creative Arts, Massey University, Wellington, New Zealand
| | - Roxane Fabre
- Cognition Behaviour Technology (CoBTeK) Lab, Université Côte d’Azur, Nice, France
- Public Health Department, Nice University Hospital, Côte d’Azur University, Nice, France
| | | | - Pierre Foulon
- GENIOUS Healthcare–Mindmaze Group Co., Lausanne, Switzerland
| | - Auriane Gros
- Cognition Behaviour Technology (CoBTeK) Lab, Université Côte d’Azur, Nice, France
| | - Cedric Gueyraud
- Centre National de Formation aux Métiers du Jeu et du Jouet (FM2J), Caluire-et-Cuire, France
| | | | | | - Léa Martinez
- Asmodee Research, Asmodee, Guyancourt, France
- Centre de Recherches sur la Cognition et l’Apprentissage, Université de Poitiers, Poitiers, France
| | | | - Magali Payne
- Cognition Behaviour Technology (CoBTeK) Lab, Université Côte d’Azur, Nice, France
- Centre Hospitalier Universitaire de Nice, Service Clinique Gériatrique du Cerveau et du Mouvement, Université Côte d’Azur, Nice, France
- Centre Mémoire de Ressources et de Recherche, Université Côte d’Azur, Nice, France
| | | | | | - Susanne Thümmler
- Cognition Behaviour Technology (CoBTeK) Lab, Université Côte d’Azur, Nice, France
- University Department of Child and Adolescent Psychiatry, Children’s Hospitals of Nice CHU-Lenval, Nice, France
| | - Philippe Robert
- Cognition Behaviour Technology (CoBTeK) Lab, Université Côte d’Azur, Nice, France
- Centre Hospitalier Universitaire de Nice, Service Clinique Gériatrique du Cerveau et du Mouvement, Université Côte d’Azur, Nice, France
- Centre Mémoire de Ressources et de Recherche, Université Côte d’Azur, Nice, France
- Association Innovation Alzheimer, Nice, France
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20
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Sommerlad A, Park HK, Marston L, Livingston G. Apathy in UK Care Home Residents with Dementia: Longitudinal Course and Determinants. J Alzheimers Dis 2022; 87:731-740. [PMID: 35342090 DOI: 10.3233/jad-215623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Apathy in dementia is common and associated with worse disease outcomes. OBJECTIVE To describe the longitudinal course of apathy in dementia and identify associated sociodemographic and disease-related factors. METHODS Prospective cohort study of UK care home residents with dementia. At baseline, 4, 8, 12, and 16 months, care home staff rated apathy using the Neuropsychiatric Inventory (clinically-significant apathy if≥4), dementia severity, and provided other sociodemographic information about each participant. We examined the prevalence and persistence of apathy and, in mixed linear models, its association with time, age, sex, dementia severity, antipsychotic use, and baseline apathy and other neuropsychiatric symptoms. RESULTS Of 1,419 included participants (mean age 85 years (SD 8.5)), 30% had mild dementia, 33% moderate, and 37% severe. The point prevalence of clinically-significant apathy was 21.4% (n = 304) and the 16-month period prevalence was 47.3% (n = 671). Of participants with follow-up data, 45 (3.8%) were always clinically-significantly apathetic, 3 (0.3%) were always sub-clinically apathetic, and 420 (36.2%) were never apathetic until death or end of follow-up. In adjusted models, apathy increased over time and was associated with having more severe dementia, worse baseline apathy and other neuropsychiatric symptoms. CONCLUSION It is important for clinicians to know that most people with dementia are not apathetic, though it is common. Most of those with significant symptoms of apathy improve without specific treatments, although some also relapse, meaning that intervention may not be needed. Future research should seek to target those people with persistent severe apathy and test treatments in this group.
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Affiliation(s)
- Andrew Sommerlad
- Division of Psychiatry, University College London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Hee Kyung Park
- Division of Psychiatry, University College London, UK
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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21
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Yang Y, Kwan RYC, Zhai HM, Xu XY, Huang CX, Liang SJ, Liu J. The association among apathy, leisure activity participation, and severity of dementia in nursing home residents with Alzheimer's disease: A cross-sectional study. Geriatr Nurs 2021; 42:1373-1378. [PMID: 34583236 DOI: 10.1016/j.gerinurse.2021.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to examine 1) the relationship between apathy and leisure activity participation in nursing home residents with Alzheimer disease (AD) and 2) the moderator effect of the severity of dementia on this relationship. Data were collected from 290 residents with AD using the Apathy Evaluation Scale-informant version (AES-I), Leisure Activities Questionnaire (LAQ), and Clinical Dementia Rating scale (CDR). The multiple linear regression model showed that leisure activity participation (β=-0.452, p<0.001) was negatively associated with apathy, while the severity of dementia (β=0.515, p<0.001) was positively associated with apathy. The severity of dementia moderated the effect of leisure activity participation on apathy (β=-0.108, p=0.015). The results indicate that the effects of leisure activity participation on apathy diminish with the aggravation of AD. The severity of dementia should be considered when designing and delivering leisure activity interventions to manage apathy in nursing home residents with AD.
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Affiliation(s)
- Yi Yang
- Department of Nursing, Medical School, Taizhou University, Taizhou, Zhejiang, China
| | - Rick Y C Kwan
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Hui-Min Zhai
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China;.
| | - Xin-Yi Xu
- School of Nursing, Hebei Medical University, China
| | - Chuang-Xia Huang
- Obstetrics Department, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Si-Jing Liang
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Juan Liu
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
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Saredakis D, Keage HA, Corlis M, Ghezzi ES, Loffler H, Loetscher T. The Effect of Reminiscence Therapy Using Virtual Reality on Apathy in Residential Aged Care: Multisite Nonrandomized Controlled Trial. J Med Internet Res 2021; 23:e29210. [PMID: 34542418 PMCID: PMC8491119 DOI: 10.2196/29210] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/23/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023] Open
Abstract
Background Apathy is a frequent and underrecognized neurological disorder symptom. Reduced goal-directed behavior caused by apathy is associated with poor outcomes for older adults in residential aged care. Recommended nonpharmacological treatments include person-centered therapy using information and communication technology. Virtual reality (VR) in the form of head-mounted displays (HMDs) is a fully immersive technology that provides access to a wide range of freely available content. The use of VR as a therapy tool has demonstrated promise in the treatment of posttraumatic stress disorder and anxiety. In addition, VR has been used to improve conditions including depression, anxiety, cognitive function, and balance in older adults with memory deficits, Alzheimer disease, and Parkinson disease. Research using VR for the symptoms of apathy in older adults living in residential aged care facilities is limited. Objective This study aims to examine whether using HMDs as a tool for reminiscence therapy improves the symptoms of apathy compared with using a laptop computer and physical items with older adults living in residential aged care. Methods In this multisite trial, 43 participants were allocated to one of three groups: reminiscence therapy intervention using VR in the form of HMDs, reminiscence therapy using a laptop computer supplemented by physical items if required (active control), and a usual care (passive control) group. The primary outcome was apathy, and the secondary outcomes included cognition and depression. The side effects of using HMDs were also measured in the VR group. Results Mixed model analyses revealed no significant group interaction over time in outcomes between the VR and laptop groups (estimate=−2.24, SE 1.89; t40=−1.18; P=.24). Pooled apathy scores in the two intervention groups compared with the passive control group also revealed no significant group interaction over time (estimate=−0.26, SE 1.66; t40=−0.16; P=.88). There were no significant secondary outcomes. Most participants in the VR group stated that they would prefer to watch content in VR than on a flat screen (Χ22=11.2; P=.004), side effects from HMD use were negligible to minimal according to the Simulator Sickness Questionnaire cutoff scores. Conclusions Although there were no significant results in outcome measures, this study found that participants engaged in the research and enjoyed the process of reminiscing using both forms of technology. It was found that VR can be implemented in an aged care setting with correct protocols in place. Providing residents in aged care with a choice of technology may assist in increasing participation in activities. We cannot dismiss the importance of immediate effects while the therapy was in progress, and this is an avenue for future research. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12619001510134; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378564. International Registered Report Identifier (IRRID) RR2-DOI: 10.1136/bmjopen-2020-046030
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Affiliation(s)
- Dimitrios Saredakis
- UniSA Justice & Society, University of South Australia, Adelaide, South Australia, Australia
| | - Hannah Ad Keage
- UniSA Justice & Society, University of South Australia, Adelaide, South Australia, Australia
| | - Megan Corlis
- UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Erica S Ghezzi
- UniSA Justice & Society, University of South Australia, Adelaide, South Australia, Australia
| | - Helen Loffler
- Helping Hand Aged Care, Adelaide, South Australia, Australia
| | - Tobias Loetscher
- UniSA Justice & Society, University of South Australia, Adelaide, South Australia, Australia
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Conversational System as Assistant Tool in Reminiscence Therapy for People with Early-Stage of Alzheimer's. Healthcare (Basel) 2021; 9:healthcare9081036. [PMID: 34442173 PMCID: PMC8391369 DOI: 10.3390/healthcare9081036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/31/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022] Open
Abstract
Reminiscence therapy is a non-pharmacological intervention that helps mitigate unstable psychological and emotional states in patients with Alzheimer’s disease, where past experiences are evoked through conversations between the patients and their caregivers, stimulating autobiographical episodic memory. It is highly recommended that people with Alzheimer regularly receive this type of therapy. In this paper, we describe the development of a conversational system that can be used as a tool to provide reminiscence therapy to people with Alzheimer’s disease. The system has the ability to personalize the therapy according to the patients information related to their preferences, life history and lifestyle. An evaluation conducted with eleven people related to patient care (caregiver = 9, geriatric doctor = 1, care center assistant = 1) shows that the system is capable of carrying out a reminiscence therapy according to the patient information in a successful manner.
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Li B, Huang X, Meng C, Wan Q, Sun Y. Physical Activity and its Influencing Factors in Community-Dwelling Older Adults With Dementia: A Path Analysis. Clin Nurs Res 2021; 31:301-309. [PMID: 34293953 DOI: 10.1177/10547738211033928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dementia is prevalent in worldwide, and increases the care burden and potential costs. Physical activity (PA) has been increasingly shown to be beneficial for them. This was a cross-sectional observational study aiming to investigate the status of PA among community-dwelling older adults with dementia in Beijing or Hangzhou, China, and verify the relationships between neuropsychiatric symptoms, activities of daily living (ADL), caregivers' fear of patients' falling and their PA using a path analysis approach. The level of PA among 216 included people with dementia was low. PA was related to the neuropsychiatric symptoms, with ADL and caregivers' fear of patients' falling have mediation roles. The findings indicated that person-centered strategies related to the management of these symptoms might be helpful to improve ADL, relieve caregivers' concerns about them falling and consequently foster positive participation in PA.
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Affiliation(s)
- Bei Li
- Peking University First Hospital, Beijing, China
| | - Xiuxiu Huang
- Nursing School of Peking University, Beijing, China
| | | | - Qiaoqin Wan
- Nursing School of Peking University, Beijing, China
| | - Yongan Sun
- Peking University First Hospital, Beijing, China
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25
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Fahed M, Steffens DC. Apathy: Neurobiology, Assessment and Treatment. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2021; 19:181-189. [PMID: 33888648 PMCID: PMC8077060 DOI: 10.9758/cpn.2021.19.2.181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/22/2022]
Abstract
Apathy is a highly prevalent, disabling and treatment resistant syndrome. It is defined as a quantitative reduction of goal- directed activity in comparison to the patient’s previous level of in multiple dimensions including behavior/cognition, emotion and social interaction. It has been described in major depressive disorder, Alzheimer’s disease, frontotemporal dementia, Parkinson’s Disease, cerebrovascular disease, and vascular dementia, among others. This review will address the neuropsychology and associated neurobiological underpinnings of apathy in the above conditions, identify specific methods to assess apathy clinically, and review the literature on managing apathy across these various disorders.
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Affiliation(s)
- Mario Fahed
- Department of Psychiatry, University of Connecticut, School of Medicine, Farmington, CT, USA
| | - David C Steffens
- Department of Psychiatry, University of Connecticut, School of Medicine, Farmington, CT, USA
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26
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Robert P, Albrengues C, Fabre R, Derreumaux A, Pancrazi MP, Luporsi I, Dubois B, Epelbaum S, Mercier G, Foulon P, Bremond F, Manera V. Efficacy of serious exergames in improving neuropsychiatric symptoms in neurocognitive disorders: Results of the X-TORP cluster randomized trial. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12149. [PMID: 34013018 PMCID: PMC8112479 DOI: 10.1002/trc2.12149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/24/2020] [Accepted: 01/06/2021] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the efficacy of a serious exergame in improving the neuropsychiatric symptoms of patients with neurocognitive disorders. METHODS X-Torp is a serious exergame combining motor and cognitive activities. Ninety-one subjects (mean age = 81.7 years, mean Mini-Mental State Examination = 18.3) were recruited in 16 centers. Centers were randomized into intervention and control centers. Subjects underwent assessment for cognitive and behavioral symptoms at baseline (BL), the end of the intervention (W12), and 12 weeks after the end of the intervention (W24). RESULTS The comparison of neuropsychiatric symptoms between BL and W12 and W24 showed that subjects of the intervention group improved in apathy between BL and W12. Mixed analysis (time BL, W12, W24 x group) indicated a significant increase in apathy and neuropsychiatric symptoms in the control subjects. DISCUSSION The use of X-Torp improved neuropsychiatric symptoms, particularly apathy. Future studies should more consistently use behavioral and neuropsychiatric symptoms as outcome measures.
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Affiliation(s)
- Philippe Robert
- CoBTeK LabUniversité Côte d'AzurNiceFrance
- Centre mémoire CMRRCentre Hospitalier Universitaire de NiceNiceFrance
- Association Innovation AlzheimerNiceFrance
| | - Claire Albrengues
- Centre mémoire CMRRCentre Hospitalier Universitaire de NiceNiceFrance
| | - Roxane Fabre
- Département de Santé PubliqueCentre Hospitalier Universitaire de NiceNiceFrance
| | - Alexandre Derreumaux
- CoBTeK LabUniversité Côte d'AzurNiceFrance
- Centre mémoire CMRRCentre Hospitalier Universitaire de NiceNiceFrance
| | | | | | - Bruno Dubois
- Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A) SalpetrièreParisFrance
| | - Stéphane Epelbaum
- Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A) SalpetrièreParisFrance
| | - Grégoire Mercier
- UMR CEPELUniversité de MontpellierMontpellierFrance
- DIM, CHU de MontpellierHôpital La ColombiereMontpellierFrance
| | - Pierre Foulon
- Company GENIOUS Healthcare—Mindmaze GroupLausanneSwitzerland
| | | | - Valeria Manera
- CoBTeK LabUniversité Côte d'AzurNiceFrance
- Association Innovation AlzheimerNiceFrance
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Mouriz-Corbelle R, Caamaño-Ponte J, Dosil C, Picón E, Facal D. Apathy and agitation in institutionalized older adults: an empirically derived classification. Psychogeriatrics 2021; 21:272-278. [PMID: 33598981 DOI: 10.1111/psyg.12659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Apathy and agitation are often recognized as the most problematic behavioural and psychological symptoms in care settings. In this study, we analyze the relationship between apathy and agitation symptoms other and their relationship with demographic, cognitive, and neuropsychiatric variables and psychotropic medication use. METHODS A retrospective study was conducted at a gerontological care centre in Láncara, Spain. Participants were 196 residents of the gerontological care centre, including 143 with a diagnosis of dementia. Apathy and agitation were assessed with the Apathy Scale for Institutionalized Patients with Dementia, Nursing Home version, and the Spanish version of the Cohen-Mansfield Agitation Inventory, respectively. Two-stage hierarchical cluster analysis (hierarchical cluster analysis in a first exploratory stage and K-means clustering to obtain the final solution in the second stage) was conducted to assign residents to different groups based on apathy and agitation scores. RESULTS In cluster 1, a certain level of apathy, the highest levels of agitation, and the most frequent intake of atypical antipsychotics and clomethiazole were observed. The highest levels of apathy and the most frequent intake of memantine were seen in cluster 2. The lowest levels of agitation and apathy and the highest levels of cognitive performance were found in cluster 3. CONCLUSIONS In this study, subjects with dementia were in a state of high agitation and eventual apathy, had low cognitive status, and were very old. Patients with this profile require well-designed non-pharmacological interventions.
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Affiliation(s)
- Romina Mouriz-Corbelle
- Gerontological Therapeutic Complex "A Veiga", Serge Lucense, Lugo, Spain.,Department of Developmental Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Caamaño-Ponte
- Gerontological Therapeutic Complex "A Veiga", Serge Lucense, Lugo, Spain
| | - Carlos Dosil
- Gerontological Therapeutic Complex "A Veiga", Serge Lucense, Lugo, Spain.,Department of Developmental Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Eduardo Picón
- Department of Methodology of Behavioral Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - David Facal
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
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Baber W, Chang CYM, Yates J, Dening T. The Experience of Apathy in Dementia: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063325. [PMID: 33807061 PMCID: PMC8005167 DOI: 10.3390/ijerph18063325] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/18/2021] [Accepted: 03/20/2021] [Indexed: 12/15/2022]
Abstract
We aimed to explore and gain an understanding into how people with dementia experience apathy, and consequently suggest effective interventions to help them and their carers. Twelve participants (6 dyads of 6 people with dementia and their family carers) were recruited from “memory cafes” (meeting groups for people with dementia and their families), social groups, seminars, and patient and public involvement (PPI) meetings. People with dementia and their carers were interviewed separately and simultaneously. Quantitative data were collected using validated scales for apathy, cognition, anxiety, and depression. The interviews were semi-structured, focusing on the subjective interpretation of apathy and impacts on behaviour, habits, hobbies, relationships, mood, and activities of daily living. Interviews were recorded and transcribed. Transcripts were analysed using interpretative phenomenological analysis (IPA), which generated codes and patterns that were collated into themes. Four major themes were identified, three of which highlighted the challenging aspects of apathy. One described the positive aspects of the individuals’ efforts to overcome apathy and remain connected with the world and people around them. This study is the first to illustrate the subjective experience of apathy in dementia, portraying it as a more complex and active phenomenon than previously assumed. Apathy and its effects warrant more attention from clinicians, researchers, and others involved in dementia care.
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Abstract
Neuropsychiatric disturbances represent a common and uniquely challenging consequence of stroke. These disorders arise at the intersection of lesion-related brain dysfunction and psychological distress related to the event and its aftermath, making it difficult to identify what symptom is a direct physiological consequence of the stroke. Depression, anxiety, fatigue, apathy, emotionalism, and anger are the most common of these syndromes, and posttraumatic stress disorder related to the stroke event has become increasingly recognized as a relevant entity. Mania, obsessive-compulsive disorder, and psychosis are less commonly encountered but potentially highly debilitating conditions that may be underrecognized. Early identification and treatment may mitigate functional impairment and improve quality of life. Evidence-based guidelines from the general population are often relied upon to guide treatment. Further research is needed to understand and tailor treatment of these disorders in the poststroke population.
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Affiliation(s)
- Katlyn Nemani
- Departments of Neurology and Psychiatry, NYU Langone Health, New York, New York
| | - Lindsey Gurin
- Departments of Neurology, Psychiatry, and Rehabilitation Medicine, NYU Langone Health, New York, New York
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30
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Raimo S, Santangelo G, Trojano L. The emotional disorders associated with multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:197-220. [PMID: 34389118 DOI: 10.1016/b978-0-12-822290-4.00009-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Multiple sclerosis (MS) is associated with a high prevalence of emotional and mood disorders. Emotional disorders may worsen during illness progression and affect the quality of life of patients and their families. MS is often associated with depression, with an increased risk of suicide, poor adherence to treatment, decreased functional status, and quality of life. The diagnosis and treatment of emotional and mood disorders in these patients is often challenging since several symptoms of these disorders overlap with those of MS. Other prevalent emotional disorders in MS include bipolar disorder, anxiety disorders, emotional blunting (apathy), and pseudobulbar affect. Early recognition and treatment of these comorbidities could contribute to the reduction of disability and even to decreased mortality. The aim of this chapter is to provide an up-to-date review of mood and emotional disorders that are often associated with MS, focusing on their epidemiology, clinical features, pathogenesis, assessment, and treatment. The interplay between the psychosocial impact of the chronic disability and the demyelinating structural lesions of the brain in precipitating emotional and mood disorders is discussed, as well as its implications for diagnosis and treatment.
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Affiliation(s)
- Simona Raimo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy.
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Luigi Trojano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
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31
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Regier NG, Hodgson NA, Gitlin LN. Neuropsychiatric symptom profiles of community-dwelling persons living with dementia: Factor structures revisited. Int J Geriatr Psychiatry 2020; 35:1009-1020. [PMID: 32363605 PMCID: PMC8942615 DOI: 10.1002/gps.5323] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/18/2020] [Accepted: 04/25/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Most persons living with dementia (PLWD) will develop neuropsychiatric symptoms (NPS) at some point. NPS are often clustered into subsyndromes with other related symptoms, but the evidence supporting commonly used clusters is insufficient. We reexamine behavioral clusters in community-dwelling PLWD and identify associated risk factors and potential contributors. METHODS This study used baseline data from a longitudinal behavioral intervention study of 250 community-dwelling older adults with dementia and their caregivers. Using exploratory factor analysis (principal component analysis [PCA]), the factor structure of NPS frequency scores of the Neuropsychiatric Inventory (NPI-C) was evaluated. Multiple linear regressions assessed the association of the derived behavioral clusters with caregiver burden, caregiver depression, and quality of life of the PLWD. RESULTS PCA yielded eight behavioral clusters (factors): 1 = Aggression/Rejection of Care, 2 = Apathy/Withdrawal, 3 = Restlessness/Agitation, 4 = Anxiety, 5 = Impulsivity/Disinhibition, 6 = Psychosis, 7 = Circadian Disturbance, and 8 = Depression. In multiple linear regressions, caregiver burden was significantly influenced by the anxiety cluster, caregiver depression was significantly influenced by the apathy/withdrawal cluster, and quality of life of the PLWD was significantly associated with the anxiety and circadian disturbance clusters. CONCLUSIONS Our eight derived behavioral clusters suggest that commonly accepted clusters of NPS may not reflect the clinical reality for community-dwelling PLWD. Behavioral clusters appear to differentially impact and put caregivers and PLWD at risk such that personalized intervention strategies are warranted. J Am Geriatr Soc 68:-, 2020.
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Affiliation(s)
- Natalie G. Regier
- Johns Hopkins University School of Nursing, Baltimore, MD,Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD
| | - Nancy A. Hodgson
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Laura N. Gitlin
- Johns Hopkins University School of Nursing, Baltimore, MD,Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD,Drexel College of Nursing and Health Professions, Philadelphia, PA
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32
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Cai Y, Li L, Xu C, Wang Z. The Effectiveness of Non-Pharmacological Interventions on Apathy in Patients With Dementia: A Systematic Review of Systematic Reviews. Worldviews Evid Based Nurs 2020; 17:311-318. [PMID: 32767834 DOI: 10.1111/wvn.12459] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Apathy is one of the behavioral and psychological symptoms of dementia (BPSD), which is the most frequent and can accelerate the progress of dementia. AIMS To systematically review the evidence of effectiveness of non-pharmacological interventions on apathy in patients with dementia. METHODS Databases including the Cochrane Library, Joanna Briggs Institute (JBI) Library, PubMed, EMBASE, CINAHL, PsycINFO, Psychology and Behavioral Sciences Collection, CNKI, and Wan Fang Data were searched for systematic reviews of the effectiveness of non-pharmacological interventions on apathy in patients with dementia. AMSTAR 2 was applied to assess the methodological quality of reviews. RESULTS Nine systematic reviews were included. The average level of overall confidence for included systematic reviews was low. Among all the non-pharmacological interventions involved in this review, the effectiveness of multisensory stimulation, music therapy, cognitive stimulation, and pet therapy was relatively robust. The effects of reminiscence therapy, therapeutic conversation, progressive muscle relaxation, art therapy, exercise therapy, occupational therapy, dementia special care units, nursing staff education, and comprehensive interventions need to be validated further. Meanwhile, the current evidence failed to support the effects of psychomotor therapy and validation therapy on apathy. LINKING EVIDENCE TO ACTION Non-pharmacological interventions for apathy in patients with dementia are acceptable. In spite of requirements for adequate and high-quality original studies and quantitative systematic reviews to validate the efficacy of non-pharmacological interventions, multisensory stimulation, music therapy, cognitive stimulation, and pet therapy are deemed the most helpful according to evidences available.
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Affiliation(s)
- Yan Cai
- School of Nursing, Peking University, Beijing, China.,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Liyu Li
- School of Nursing, Peking University, Beijing, China
| | - Chang Xu
- School of Nursing, Peking University, Beijing, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, China
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Magierski R, Sobow T, Schwertner E, Religa D. Pharmacotherapy of Behavioral and Psychological Symptoms of Dementia: State of the Art and Future Progress. Front Pharmacol 2020; 11:1168. [PMID: 32848775 PMCID: PMC7413102 DOI: 10.3389/fphar.2020.01168] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/17/2020] [Indexed: 12/12/2022] Open
Abstract
The core symptoms of different dementia subtypes are the behavioral and psychological symptoms of dementia (BPSD) and its neuropsychiatric symptoms (NPS). BPSD symptoms may occur at any stage in the case of dementia due to Alzheimer's disease (AD), whereas they tend to occur early on in the case of its behavioral variant frontotemporal dementia or dementia with Lewy bodies and are essential for diagnosis. BPSD treatment consists of non-pharmacological as well as pharmacological interventions, with non-pharmacological interactions being suggested as first-line treatment. Agitation, psychotic features, apathy, depression, and anxiety may not respond to acetylcholinesterase inhibitors or memantine in AD cases; therefore, antipsychotics, antidepressants, sedative drugs or anxiolytics, and antiepileptic drugs are typically prescribed. However, such management of BPSD can be complicated by hypersensitivity to antipsychotic drugs, as observed in DLB, and a lack of effective pro-cognitive treatment in the case of frontotemporal dementia. The present paper reviews current knowledge of the management of BPSD and its limitations and discusses on-going clinical trials and future therapeutic options.
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Affiliation(s)
- Radoslaw Magierski
- Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
| | - Tomasz Sobow
- Dialog Therapy Centre, Warsaw & Institute of Psychology, University of Lodz, Lodz, Poland
| | - Emilia Schwertner
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Dorota Religa
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Tema Aging, Karolinska University Hospital, Stockholm, Sweden
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34
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Leidi-Maimone B, Notter-Bielser ML, Laouadi MH, Perrin S, Métraux H, Damian D, Chavan CF, Nsir M, Cibelli G, Tâche MJ, Montandon ML, Ghika J, Démonet JF, Dürst AV, Guevara AB. How non-drug interventions affect the quality of life of patients suffering from progressive cognitive decline and their main caregiver. Aging (Albany NY) 2020; 12:10754-10771. [PMID: 32516129 PMCID: PMC7346059 DOI: 10.18632/aging.103291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/27/2020] [Indexed: 11/25/2022]
Abstract
Background: In the absence of cure for age-related neurodegenerative diseases, non-drug interventions (NDIs) represent useful options. Quality of life (QOL) is a multidimensional concept progressively affected by cognitive decline. How single or multiple NDIs impact QOL is unknown. Results: We found no significant effect of multiple over single NDI on QOL. Socio-demographic variables influenced patients’ (age, gender, caregivers’ occupational status, management of patients’ financial affairs) and caregivers’ (gender, occupational status, patients’ severity of cognitive decline) QOL. When dyads interrupted interventions after 6 months, their QOL was lower and caregivers’ anxiety, depression and physical symptoms were higher at the end of the study. Conclusions: While the type and number of interventions do not appear to be critical, the continuity of adapted interventions in the long-term might be important for maintaining QOL of patients and caregivers. Methods: This is a multicenter (7 Swiss Memory Clinics), quasi-experimental, one-year follow-up study including 148 subjects (mild cognitive impairment or mild dementia patients and their caregivers). Primary outcome was the effect of multiple vs single NDIs on QOL. Secondary outcome included NDIs effect on patients’ cognitive impairment and functional autonomy, caregivers’ burden, severity of patients’ neuropsychiatric symptoms and dyads’ anxiety and depression.
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Affiliation(s)
| | | | - Marie-Hélène Laouadi
- Leenaards Memory Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Sarah Perrin
- Leenaards Memory Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Service of Old Age Psychiatry, Department of Psychiatry (SUPAA), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Hélène Métraux
- Vaud Association for Help and Home Care (AVASAD, Association Vaudoise d'Aide et de Soins à Domicile), Lausanne, Switzerland
| | - Daniel Damian
- Leenaards Memory Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Camille F Chavan
- Memory Center of the Neuropsychology and Aphasiology Unit, Fribourg Hospital (HFR), Fribourg, Switzerland
| | - Mélanie Nsir
- Nord Broye Memory Center, Montagny-près-Yverdon, Switzerland
| | | | | | - Marie-Louise Montandon
- Memory Center of the Geneva University Hospitals (HUG), Geneva, Switzerland.,CU ROMENS, Switzerland
| | - Joseph Ghika
- Valais Hospital Memory Center, Sierre, Switzerland
| | - Jean-François Démonet
- Leenaards Memory Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,CU ROMENS, Switzerland
| | - Anne-Véronique Dürst
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Andrea Brioschi Guevara
- Leenaards Memory Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,CU ROMENS, Switzerland
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Manera V, Abrahams S, Agüera-Ortiz L, Bremond F, David R, Fairchild K, Gros A, Hanon C, Husain M, König A, Lockwood PL, Pino M, Radakovic R, Robert G, Slachevsky A, Stella F, Tribouillard A, Trimarchi PD, Verhey F, Yesavage J, Zeghari R, Robert P. Recommendations for the Nonpharmacological Treatment of Apathy in Brain Disorders. Am J Geriatr Psychiatry 2020; 28:410-420. [PMID: 31495772 DOI: 10.1016/j.jagp.2019.07.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 11/18/2022]
Abstract
Apathy is a common neuropsychiatric syndrome observed across many neurocognitive and psychiatric disorders. Although there are currently no definitive standard therapies for the treatment of apathy, nonpharmacological treatment (NPT) is often considered to be at the forefront of clinical management. However, guidelines on how to select, prescribe, and administer NPT in clinical practice are lacking. Furthermore, although new Information and Communication Technologies (ICT) are beginning to be employed in NPT, their role is still unclear. The objective of the present work is to provide recommendations for the use of NPT for apathy, and to discuss the role of ICT in this domain, based on opinions gathered from experts in the field. The expert panel included 20 researchers and healthcare professionals working on brain disorders and apathy. Following a standard Delphi methodology, experts answered questions via several rounds of web-surveys, and then discussed the results in a plenary meeting. The experts suggested that NPT are useful to consider as therapy for people presenting with different neurocognitive and psychiatric diseases at all stages, with evidence of apathy across domains. The presence of a therapist and/or a caregiver is important in delivering NPT effectively, but parts of the treatment may be performed by the patient alone. NPT can be delivered both in clinical settings and at home. However, while remote treatment delivery may be cost and time-effective, it should be considered with caution, and tailored based on the patient's cognitive and physical profile and living conditions.
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Affiliation(s)
- Valeria Manera
- Université Côte d'Azur, CoBTeK lab (VM, FB, RD, AG, AK,AT, RZ, PR), Nice, France; Association Innovation Alzheimer (VM, PR), Nice, France.
| | - Sharon Abrahams
- School of Philosophy, Psychology and Language Sciences (SA), University of Edinburgh, Edinburgh, United Kingdom; Euan MacDonald Centre for Motor Neurone Disease Research (SA, RR), University of Edinburgh, Edinburgh, United Kingdom
| | - Luis Agüera-Ortiz
- Department of Psychiatry (LA-O), Instituto de Investigación Sanitaria (imas12), Hospital Universitario 12 de Octubre & CIBERSAM, Madrid, Spain
| | - François Bremond
- Université Côte d'Azur, CoBTeK lab (VM, FB, RD, AG, AK,AT, RZ, PR), Nice, France; INRIA (FB, AK), STARS Team, Sophia Antipolis, France
| | - Renaud David
- Université Côte d'Azur, CoBTeK lab (VM, FB, RD, AG, AK,AT, RZ, PR), Nice, France; Centre Hospitalier Universitaire (CHU) de Nice (RD, PR), CMRR, Nice, France
| | - Kaci Fairchild
- Department of Veterans Affairs (KF, JY), VA Palo Alto Health Care System, CA; Department of Psychiatry and Behavioral Sciences (KF, JY), Stanford University School of Medicine, CA
| | - Auriane Gros
- Université Côte d'Azur, CoBTeK lab (VM, FB, RD, AG, AK,AT, RZ, PR), Nice, France
| | - Cécile Hanon
- Psychiatric Department, Regional Resource Center of Old Age Psychiatry Corentin-Celton Hospital (CH), Academic Hospital West Paris, AP-HP, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences (MH, PL), John Radcliffe Hospital Oxford OX3 9DU, United Kingdom; Department of Experimental Psychology (MH, PL), University of Oxford, Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging (MH, PL), University of Oxford, Oxford, United Kingdom
| | - Alexandra König
- Université Côte d'Azur, CoBTeK lab (VM, FB, RD, AG, AK,AT, RZ, PR), Nice, France; INRIA (FB, AK), STARS Team, Sophia Antipolis, France
| | - Patricia L Lockwood
- Nuffield Department of Clinical Neurosciences (MH, PL), John Radcliffe Hospital Oxford OX3 9DU, United Kingdom; Department of Experimental Psychology (MH, PL), University of Oxford, Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging (MH, PL), University of Oxford, Oxford, United Kingdom
| | - Maribel Pino
- Broca Living Lab (MP), AP-HP, Paris Descartes University, Sorbonne Paris Cite, Paris, France
| | - Ratko Radakovic
- Euan MacDonald Centre for Motor Neurone Disease Research (SA, RR), University of Edinburgh, Edinburgh, United Kingdom; Faculty of Medicine and Health Sciences (RR), University of East Anglia, Norwich, United Kingdom; Alzheimer Scotland Dementia Research Centre (RR), University of Edinburgh, Edinburgh, United Kingdom
| | - Gabriel Robert
- EA4712 "Comportement et Noyaux Gris Centraux" (GR), Université de Rennes1, France
| | - Andrea Slachevsky
- Geroscience Center for Brain Health and Metabolism (GERO) (AS), Faculty of Medicine, University of Chile, Santiago, Chile; Neuropsychology and Clinical Neuroscience Laboratory (LANNEC) (AS), Physiopathology Department - ICBM, Chile; Neuroscience and East Neuroscience Departments (AS), Faculty of Medicine, University of Chile, Chile; Memory and Neuropsychiatric Clinic (CMYN) Neurology Department (AS), Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile; Servicio de Neurología (AS), Departamento de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Florindo Stella
- Laboratório de Neurociências LIM27 (FS), Departamento e Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil; UNESP - Universidade Estadual Paulista (FS), Biosciences Institute, Campus of Rio Claro, Rio Claro, SP, Brazil
| | - Anaïs Tribouillard
- Université Côte d'Azur, CoBTeK lab (VM, FB, RD, AG, AK,AT, RZ, PR), Nice, France; ISTR (AT), Institute of Rehabilitation Sciences and Techniques, University of Lyon 1, Lyon, France; Specialised Alzheimer Team (AT), SSIAD Quimper, France
| | | | - Frans Verhey
- Department of Psychiatry and Neuropsychology (FV), Maastricht University, School for Mental Health and Neuroscience (MHeNs), Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Jerome Yesavage
- Department of Veterans Affairs (KF, JY), VA Palo Alto Health Care System, CA; Department of Psychiatry and Behavioral Sciences (KF, JY), Stanford University School of Medicine, CA
| | - Radia Zeghari
- Université Côte d'Azur, CoBTeK lab (VM, FB, RD, AG, AK,AT, RZ, PR), Nice, France
| | - Philippe Robert
- Université Côte d'Azur, CoBTeK lab (VM, FB, RD, AG, AK,AT, RZ, PR), Nice, France; Association Innovation Alzheimer (VM, PR), Nice, France; Centre Hospitalier Universitaire (CHU) de Nice (RD, PR), CMRR, Nice, France
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Zeghari R, Manera V, Fabre R, Guerchouche R, König A, Phan Tran MK, Robert P. The “Interest Game”: A Ludic Application to Improve Apathy Assessment in Patients with Neurocognitive Disorders. J Alzheimers Dis 2020; 74:669-677. [DOI: 10.3233/jad-191282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Radia Zeghari
- Université Côte d’Azur, CoBTeK Laboratory, Nice, France
- Association IA (Alzheimer-Affect-Autism), Nice, France
| | - Valeria Manera
- Université Côte d’Azur, CoBTeK Laboratory, Nice, France
- Association IA (Alzheimer-Affect-Autism), Nice, France
| | - Roxane Fabre
- Université Côte d’Azur, CoBTeK Laboratory, Nice, France
- Centre Hospitalier Universitaire de Nice, Département de Santé Publique, Nice, France
| | | | - Alexandra König
- Université Côte d’Azur, CoBTeK Laboratory, Nice, France
- Inria Sophia Antipolis, STARS team, Sophia Antipolis, France
| | - Minh Khue Phan Tran
- Université Côte d’Azur, CoBTeK Laboratory, Nice, France
- Inria Sophia Antipolis, STARS team, Sophia Antipolis, France
| | - Philippe Robert
- Université Côte d’Azur, CoBTeK Laboratory, Nice, France
- Association IA (Alzheimer-Affect-Autism), Nice, France
- Centre Hospitalier Universitaire de Nice, Resource & Research Memory Centre, Nice
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Schüssler S, Zuschnegg J, Paletta L, Fellner M, Lodron G, Steiner J, Pansy-Resch S, Lammer L, Prodromou D, Brunsch S, Holter M, Carnevale L, Russegger S. Effects of a Humanoid Socially Assistive Robot Versus Tablet Training on Psychosocial and Physical Outcomes of Persons With Dementia: Protocol for a Mixed Methods Study. JMIR Res Protoc 2020; 9:e14927. [PMID: 32022697 PMCID: PMC7055795 DOI: 10.2196/14927] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/12/2019] [Accepted: 09/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background New technologies, like socially assistive robots (SARs), may have the potential to support caregivers at home. Still, the evidence for people with dementia in home care is unclear because a lot of studies are performed in a laboratory or institutional setting, and mainly use robots in prototype stages. Objective This study aims to explore the effects of the refined, commercially-available, humanoid SAR Pepper combined with a tablet PC–based dementia training program (Coach Pepper) versus an exclusively tablet PC–based dementia training program on psychosocial and physical outcomes of people with dementia living at home, including caregivers and dementia trainers. We hypothesize that Coach Pepper has a more positive effect on the primary outcome motivation (stable or decreased apathy) of people with dementia. Methods A mixed methods study will be performed, including a randomized controlled, parallel, 2-arm study with a complementary qualitative part. This sample includes 40 PWD living at home and 40 relatives, each complemented with five professional caregivers and dementia trainers. The intervention group will receive Coach Pepper (a SAR connected with a tablet PC–based dementia training program), and the control group will receive exclusively tablet PC–based training without the SAR. The duration of the intervention will be three weeks per household. Data will be collected at baseline and during and after the intervention by standardized questionnaires, sensor data of the robot, and tablet PC, as well as semistructured interviews, focus groups, and observation. Results To date, no results are available for this study protocol. The study intervention started in May 2019 and will end in Spring 2020. Conclusions The intervention of this study can be seen as a nonpharmacological intervention, including cognitive and physical training by a robot. This study will help to further refine SAR for the specific needs of people with dementia living at home. International Registered Report Identifier (IRRID) DERR1-10.2196/14927
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Affiliation(s)
- Sandra Schüssler
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Julia Zuschnegg
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Lucas Paletta
- Institut Digital, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
| | - Maria Fellner
- Institut Digital, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
| | - Gerald Lodron
- Institut Digital, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
| | - Josef Steiner
- Sozialverein Deutschlandsberg, Deutschlandsberg, Austria
| | | | - Lara Lammer
- Humanizing Technologies GmbH, Vienna, Austria
| | | | | | - Magdalena Holter
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | | | - Silvia Russegger
- Institut Digital, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
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Jedele JM, Curyto K, Ludwin BM, Karel MJ. Addressing Behavioral Symptoms of Dementia Through STAR-VA Implementation: Do Outcomes Vary by Behavior Type? Am J Alzheimers Dis Other Demen 2020; 35:1533317520911577. [PMID: 32237994 PMCID: PMC10623909 DOI: 10.1177/1533317520911577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The STAR-VA program in Veterans Health Administration Community Living Centers (CLCs, nursing home settings) trains teams to implement a psychosocial intervention with residents with behavioral symptoms of dementia (BSD). METHODS Across 71 CLCs, 302 residents selected as training cases had target behaviors categorized into one of 5 types: physically aggressive (PA), physically nonaggressive, verbally aggressive, verbally nonaggressive, and behavior deficit (BD). RESULTS Across all groups, there were significant declines in team-rated behavior frequency (36%) and severity (44%), agitation (10%), distress behaviors (42%), depression (17%), and anxiety (20%). The magnitude of changes varied across behavior category. For example, those with a PA target behavior experienced a greater percentage decline in agitation and distress behavior scores, and those with a BD target behavior experienced a greater percentage decline in depressive and anxiety symptoms. CONCLUSIONS STAR-VA, a multicomponent intervention, is generally effective across various types of behavioral symptoms associated with dementia.
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Affiliation(s)
- Jenefer M. Jedele
- Serious Mental Illness Treatment Resource Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Ann Arbor, MI, USA
| | - Kim Curyto
- Center for Integrated Healthcare, VA Western NY Healthcare System, Department of Veterans Affairs, Batavia, NY, USA
| | - Brian M. Ludwin
- New England Geriatric Research Education and Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA
- VA Boston Healthcare System, Department of Veterans Affairs, Brockton, MA, USA
| | - Michele J. Karel
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, DC, USA
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Han Y, Jia J, Li X, Lv Y, Sun X, Wang S, Wang Y, Wang Z, Zhang J, Zhou J, Zhou Y. Expert Consensus on the Care and Management of Patients with Cognitive Impairment in China. Neurosci Bull 2019; 36:307-320. [PMID: 31792911 DOI: 10.1007/s12264-019-00444-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/25/2019] [Indexed: 12/14/2022] Open
Abstract
The cognitive disease consensus was prepared by panels of health and public representatives based on actual clinical practice in Geriatric Departments in Chinese hospitals and a systematic literature review. This consensus reflects the medical knowledge accumulated by those experts and provides information about professional medical care and advice. A multidisciplinary panel of specialists (neurologists, psychiatrists, and nursing specialists) reports an expert consensus on the medical knowledge accumulated from those experts and provides information about professional medical care and advice. The recommendations focus on the care and management of older adults with mild cognitive impairment, the objectives and methods of maintaining cognition and training, the assessments and measures of daily care for patients at different stages of dementia, the assessments and coping strategies for the behavioral and psychological symptoms of dementia, principles and suggestions for an appropriate living environment, arrangements for recreational activities, the care and management of patients with end-stage dementia, and suggestions for addressing stress in caregivers.
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Affiliation(s)
| | - Yuliang Han
- The 305 Hospital of People's Liberation Army, Beijing, 100017, China
| | - Jianjun Jia
- The Second Medical Center, People's Liberation Army (PLA) General Hospital, Beijing, 100853, China.
| | - Xia Li
- Shanghai Mental Health Center, Shanghai JiaoTong University School of Medicine, Shanghai, 200030, China
| | - Yang Lv
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, 630014, China
| | - Xuan Sun
- The Second Medical Center, PLA General Hospital, Beijing, 100853, China
| | - Shanshan Wang
- The Second Medical Center, PLA General Hospital, Beijing, 100853, China
| | - Yongjun Wang
- Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen, 518020, China
| | - Zhiwen Wang
- Peking University School of Nursing, Beijing, 100191, China
| | - Jintao Zhang
- The 960th Hospital of People's Liberation Army, Taian, 271000, China
| | - Jiong Zhou
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yuying Zhou
- HuanHu Hospital of Nankai University, Tianjin, 300350, China
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40
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Theleritis CG, Siarkos KT, Politis AM. Unmet Needs in Pharmacological Treatment of Apathy in Alzheimer's Disease: A Systematic Review. Front Pharmacol 2019; 10:1108. [PMID: 31680942 PMCID: PMC6797825 DOI: 10.3389/fphar.2019.01108] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/29/2019] [Indexed: 01/15/2023] Open
Abstract
Background: Apathy is one of the most prevalent neuropsychiatric symptoms encountered in Alzheimer’s disease (AD) and may be an early sign in the development of dementia persisting over the disease course. It has been associated with poor disease outcome, impaired daily functioning, and significant caregiver distress. Early diagnosis and timely treatment of apathy in AD are of great importance. However, approved agents for apathy are still missing. Methods: Within this context, we conducted an extensive electronic search in the databases included in the National Library of Medicine, PsychInfo, and Google Scholar for studies that have investigated the effect of pharmacological treatments in apathy in AD. There were no limitations regarding study design and all care settings were considered for inclusion. Structured measures for level of evidence and study quality were employed to evaluate the results. Results: A total of 1,607 records were identified; 1,483 records remained after the removal of duplicates and were screened; 166 full-text articles were selected and assessed for eligibility and a remaining 90 unique studies and relevant reviews were included in the qualitative synthesis. Acetylcholinesterase inhibitors, gingko biloba, and methylphenidate were found to be successful in reducing apathy in patients with AD. Methodological heterogeneity in the studies and the small amount of studies where apathy was the primary outcome are limiting factors to assess for group effects. Conclusions: Pharmacological treatment of apathy in AD is an underexplored field. Standardized and systematic efforts are needed to establish a possible treatment benefit. Elucidating the pathophysiology of apathy and its components or subtypes will inform disease models and mechanistic drug studies that can quantify a benefit from specific agents for specific AD groups.
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Affiliation(s)
- Christos G Theleritis
- Division of Geriatric Psychiatry, First Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas T Siarkos
- Division of Geriatric Psychiatry, First Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios M Politis
- Division of Geriatric Psychiatry, First Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States
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A pilot study of community-based occupational therapy for persons with dementia (COTID-IT Program) and their caregivers: evidence for applicability in Italy. Aging Clin Exp Res 2019; 31:1299-1304. [PMID: 30488182 DOI: 10.1007/s40520-018-1078-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the applicability in Italy of a community-based occupational therapy program (COTID) on occupational performance of persons with dementia and their caregivers. METHODS Prospective cohort study: twenty-seven older persons with mild-to-moderate dementia living in the community and their primary caregivers were included. Ten sessions of occupational therapy over 5 weeks were delivered. Main outcome measures were the level of performance and satisfaction perceived by people with dementia during the participation in significant activities assessed with the Canadian Occupational Performance Measure (COPM); caregiver burden assessed with the sense of competence questionnaire (SCQ). RESULTS The average age of the population was 80.59 ± 8.46 in persons with dementia and 57.78 ± 13.47 in the caregivers. There was a significant improvement in the caregivers' burden in the SCQ (pre treatment 77.19 ± 13.27 vs 82.56 ± 12.57 post treatment; p = .005). Persons with dementia showed a significant improvement in the COPM performance (4.56 ± 1.44 vs 6.68 ± 1.59; p = .000) as well as in the satisfaction (5.08 ± 1.84 vs 7.04 ± 1.71; p = .000). No significant variations were registered in the overall cognitive functions, behavioral and psychological symptoms of dementia, daily functioning, depressive symptoms, perceived quality of life and global health of people with dementia. There was also no difference in the quality of life, global health, depression or burden in the caregivers. CONCLUSIONS The study shows that the COTID program is applicable in the Italian context. The findings suggest a positive effect on patients and caregivers providing a preliminary support for the program implementation at a national level.
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Balzotti A, Filograsso M, Altamura C, Fairfield B, Bellomo A, Daddato F, Vacca RA, Altamura M. Comparison of the efficacy of gesture-verbal treatment and doll therapy for managing neuropsychiatric symptoms in older patients with dementia. Int J Geriatr Psychiatry 2019; 34:1308-1315. [PMID: 30136743 PMCID: PMC6766963 DOI: 10.1002/gps.4961] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/25/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND The prevalence of neuropsychiatric symptoms (NPS) diminishes the quality of life and increases the care burden in patients with dementia. Despite the clinical importance of dementia-associated NPS, no protocols for treating NPS are already well established. Attention has turned to the effectiveness of nonpharmacological treatments for NPS since their potential safe alternative to pharmacotherapy. OBJECTIVE This study is aimed to compare the effects in older individuals with dementia living in a residential care, of two intervention programs, the gesture-verbal treatment (GVT), a treatment implemented by us on a previous method for word retrieval in individuals with aphasia, and the better-known doll therapy (DT). The GVT would act on both receptive and expressive language skills, the DT on attachment and emotional connections. METHODS We evaluated NPS by the neuropsychiatric inventory in a total of 30 patients divided into 3 groups, the GVT, the DT, and control groups, using a pre-post design. The treatment groups completed 12-week nonpharmacological interventions in addition to standard rehabilitative therapies, while the control group participated only in standard rehabilitative therapies. RESULTS The DT group showed significant improvements in agitation, irritability, apathy, depression, and delusions relative to controls. The GVT group showed significant improvements in apathy and depression with respect to controls. The DT intervention ameliorated symptoms of agitation compared to the GVT intervention whereas the GVT intervention improved apathy compared to the DT intervention. CONCLUSION Improved understanding of the potential therapeutic benefits of different treatments for neuropsychiatric symptoms is crucial for establishing nonpharmacological interventions in dementia.
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Affiliation(s)
- Angela Balzotti
- Department of Clinical and Experimental Medicine, Psychiatry UnitUniversity of FoggiaFoggiaItaly
| | - Marianna Filograsso
- Residenza Sociosanitaria Assistenziale per Anziani “Aurelia e Silvestro Storelli”BisceglieItaly
| | - Claudia Altamura
- Department of Clinical and Experimental Medicine, Psychiatry UnitUniversity of FoggiaFoggiaItaly
| | - Beth Fairfield
- Department of Psychological, Health and Territorial SciencesUniversity of ChietiChietiItaly,Center of Excellence on Aging and Translational Medicine (CeSI‐MeT)University of ChietiChietiItaly
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, Psychiatry UnitUniversity of FoggiaFoggiaItaly
| | - Fabio Daddato
- Residenza Sociosanitaria Assistenziale per Anziani “Aurelia e Silvestro Storelli”BisceglieItaly
| | - Rosa Anna Vacca
- Institute of Biomembranes Bioenergetics and Molecular Biotechnologies, Italian National Research Council (CNR)BariItaly
| | - Mario Altamura
- Department of Clinical and Experimental Medicine, Psychiatry UnitUniversity of FoggiaFoggiaItaly
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Rozum WJ, Cooley B, Vernon E, Matyi J, Tschanz JT. Neuropsychiatric symptoms in severe dementia: Associations with specific cognitive domains the Cache County Dementia Progression Study. Int J Geriatr Psychiatry 2019; 34:1087-1094. [PMID: 30945374 PMCID: PMC6812503 DOI: 10.1002/gps.5112] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 03/18/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To examine the prevalence of neuropsychiatric symptoms (NPS) and cognitive correlates in severe dementia. METHODS A population-based sample of 56 individuals with severe dementia (85.7% Alzheimer's type; 67.9% female) were assessed with the Severe Cognitive Impairment Profile (SCIP) and the Neuropsychiatric Inventory (NPI). Descriptive statistics displayed the frequency of NPS and bivariate and multiple regression analyses examined the associations between cognitive domains on the SCIP and NPS total, domain, and cluster scores. RESULTS NPS were common in severe dementia with 98% of the sample exhibiting at least one symptom. Most common were delusions, apathy, agitation/aggression, and aberrant motor behavior, affecting 50% or more of participants. SCIP comportment was significantly associated with NPI total score and apathy (r = -.350 and -.292, respectively). All SCIP domains except for arithmetic, visuospatial, comportment, and motor behavior were significantly associated with agitation/aggression (r = -.285 to -.350). These associations remained in individual multiple regression models. CONCLUSION In severe dementia, impairment in specific cognitive domains was associated with more severe NPS. Environmental manipulations to reduce processing demands in persons with severe dementia may be a useful strategy to target agitation and aggressive behaviors.
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Affiliation(s)
| | | | | | | | - JoAnn T. Tschanz
- Department of Psychology, Utah State University;,Center for Epidemiologic Studies, Utah State University
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Zucchella C, Sinforiani E, Tamburin S, Federico A, Mantovani E, Bernini S, Casale R, Bartolo M. The Multidisciplinary Approach to Alzheimer's Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment. Front Neurol 2018; 9:1058. [PMID: 30619031 PMCID: PMC6300511 DOI: 10.3389/fneur.2018.01058] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/21/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Alzheimer's disease (AD) and dementia are chronic diseases with progressive deterioration of cognition, function, and behavior leading to severe disability and death. The prevalence of AD and dementia is constantly increasing because of the progressive aging of the population. These conditions represent a considerable challenge to patients, their family and caregivers, and the health system, because of the considerable need for resources allocation. There is no disease modifying intervention for AD and dementia, and the symptomatic pharmacological treatments has limited efficacy and considerable side effects. Non-pharmacological treatment (NPT), which includes a wide range of approaches and techniques, may play a role in the treatment of AD and dementia. Aim: To review, with a narrative approach, current evidence on main NPTs for AD and dementia. Methods: PubMed and the Cochrane database of systematic reviews were searched for studies written in English and published from 2000 to 2018. The bibliography of the main articles was checked to detect other relevant papers. Results: The role of NPT has been largely explored in AD and dementia. The main NPT types, which were reviewed here, include exercise and motor rehabilitation, cognitive rehabilitation, NPT for behavioral and psychological symptoms of dementia, occupational therapy, psychological therapy, complementary and alternative medicine, and new technologies, including information and communication technologies, assistive technology and domotics, virtual reality, gaming, and telemedicine. We also summarized the role of NPT to address caregivers' burden. Conclusions: Although NPT is often applied in the multidisciplinary approach to AD and dementia, supporting evidence for their use is still preliminary. Some studies showed statistically significant effect of NPT on some outcomes, but their clinical significance is uncertain. Well-designed randomized controlled trials with innovative designs are needed to explore the efficacy of NPT in AD and dementia. Further studies are required to offer robust neurobiological grounds for the effect of NPT, and to examine its cost-efficacy profile in patients with dementia.
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Affiliation(s)
| | - Elena Sinforiani
- Alzheimer's Disease Assessment Unit, Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy
| | - Stefano Tamburin
- Neurology Unit, University Hospital of Verona, Verona, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Angela Federico
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sara Bernini
- Alzheimer's Disease Assessment Unit, Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto Casale
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA, Bergamo, Italy
| | - Michelangelo Bartolo
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA, Bergamo, Italy
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Effects of Physical Exercise on Depressive Symptoms in Patients With Cognitive Impairment: A Systematic Review and Meta-Analysis. J Nerv Ment Dis 2018; 206:809-823. [PMID: 30273278 DOI: 10.1097/nmd.0000000000000887] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We aimed to evaluate the efficacy of physical exercise in ameliorating depressive symptoms in patients with cognitive impairment. The databases of PubMed, EMBASE, Web of Science, the Cochrane Library, PsycINFO, China National Knowledge Infrastructure, WanFang, and WeiPu (VIP) were searched to identify randomized controlled trials (RCTs) that involved physical exercise for patients with cognitive impairment. A random effects model and a fixed effects model were used to calculate the pooled effect size. Twenty-one studies were identified. The meta-analysis showed that physical exercise significantly ameliorated depressive symptoms (standardized mean difference [SMD] = -0.23; 95% confidence interval [CI], -0.39 to -0.07; p = 0.004). In addition, beneficial improvements in neuropsychiatric symptoms (mean difference, -4.62; 95% CI, -9.07 to -0.16, p = 0.04), quality of life (SMD = 0.23; 95% CI, 0.01-0.46; p = 0.04), and activities of daily living (SMD = 0.27; 95% CI, 0.12-0.43; p = 0.0005) were observed in our study. No significant improvements were found in anxiety or apathy. Nevertheless, further high-quality, multicenter RCTs are needed to identify the clinical value of our results.
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