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Aini N, Chen R, Chu H, Chang CY, Lin HC, Jen HJ, Liu D, Lee TY, Chou KR. The Effects of Light Therapy on Sleep, Depression, Neuropsychiatric Behaviors, and Cognition Among People Living With Dementia: A Meta-Analysis of Randomized Controlled Trials. Am J Geriatr Psychiatry 2024; 32:681-706. [PMID: 38216355 DOI: 10.1016/j.jagp.2023.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE Alterations in the suprachiasmatic nucleus due to underlying pathologies disrupt the circadian rhythms in people living with dementia (PLWD). Circadian rhythms significantly impact sleep, emotional, and cognitive functions, with its synchronization depending on light exposure. We performed a meta-analysis to evaluate the effects of light therapy on sleep, depression, neuropsychiatric behaviors, and cognition among PLWD. METHODS A systematic search was conducted in Cochrane, ClinicalTrials.gov, Embase, EBSCOhost, Ovid-MEDLINE, PubMed, Scopus, Web of Science, and CINAHL databases. The pooled effect size was calculated using the Hedges' g with random-effects model adopted in comprehensive meta-analysis software. The Cochrane risk of bias (RoB 2.0) tool evaluated the quality of studies, while Cochrane's Q and I² tests assessed heterogeneity. RESULTS A total of 24 studies with 1,074 participants were included. Light therapy demonstrated small-to-medium effects on improving sleep parameters: total sleep time (Hedges' g = 0.19), wake after sleep onset (Hedges' g = 0.24), sleep efficiency (Hedges' g = 0.31), sleep latency (Hedges' g = 0.35), circadian rhythm (acrophase: Hedges' g = 0.36; amplitude: Hedges' g = 0.43), number of night awakenings (Hedges' g = 0.37), sleep disturbance (Hedges'g = 0.45), and sleep quality (Hedges' g = 0.60). Light therapy showed small-to-medium effect on reducing depression (Hedges' g = -0.46) with medium-to-large effect on cyclical function (Hedges' g = -0.68) and mood-related signs and symptoms (Hedges' g = -0.84) subscales. Light therapy also demonstrated small effect on reducing neuropsychiatric behaviors (Hedges' g = -0.34) with medium-to-large effect on agitation (Hedges' g = -0.65), affective symptom (Hedges' g = -0.70), psychosis (Hedges' g = -0.72), and melancholic behavior (Hedges' g = -0.91) subscales. Additionally, light therapy also improved cognition (Hedges' g = 0.39). CONCLUSION Light therapy could be used as a supportive therapy to improve sleep, depression, cognition, and neuropsychiatric behaviors among PLWD.
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Affiliation(s)
- Nur Aini
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Nursing Department, Faculty of Health Sciences (NA), University of Muhammadiyah Malang, Indonesia
| | - Ruey Chen
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Department of Nursing (RC, HJJ, KRC), Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Post-Baccalaureate Program in Nursing (RC), College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine (HC), School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Neurology (HC), Tri-Service General Hospital, Taipei, Taiwan
| | - Ching-Yi Chang
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan
| | - Hui-Chen Lin
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Research Center in Nursing Clinical Practice (HCL, DL, KRC), Wan Fang Hospital Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Department of Nursing (RC, HJJ, KRC), Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Doresses Liu
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Research Center in Nursing Clinical Practice (HCL, DL, KRC), Wan Fang Hospital Taipei Medical University, Taipei, Taiwan; Department of Nursing (DL), Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tso-Ying Lee
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Department of Nursing, Nursing Research Center (TYL), Taipei Medical University Hospital, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing (NA, RC, CYC, HCL, HJJ, DL, TYL, KRC), Taipei Medical University, Taipei, Taiwan; Department of Nursing (RC, HJJ, KRC), Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Research Center in Nursing Clinical Practice (HCL, DL, KRC), Wan Fang Hospital Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center (KRC), Taipei Medical University Hospital, Taipei, Taiwan; Neuroscience Research Center (KRC), Taipei Medical University, Taipei, Taiwan.
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Hwang Y, Massimo L, Aryal S, Hirschman KB, Cacchione PZ, Hodgson NA. Does cognitive impairment moderate the relationship between social isolation and anxiety? A 5-year longitudinal study of a nationally representative sample of community residing older adults. BMC Geriatr 2024; 24:63. [PMID: 38225544 PMCID: PMC10790424 DOI: 10.1186/s12877-024-04685-z] [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: 04/19/2023] [Accepted: 01/08/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Anxiety is common in older adults and social isolation is one of the leading factors associated with their anxiety. However, what is unknown is how the relationship between social isolation and anxiety differs by cognitive status. Therefore, this study was conducted to (1) compare the level of social isolation and anxiety in older adults who developed probable dementia and mild cognitive impairment (MCI) to those who maintained normal cognitive function over 5 years; and (2) determine if cognitive impairment moderates the relationship between changes in social isolation and changes in anxiety over 5 years. METHODS A secondary data analysis was conducted using the National Social Life, Health, and Aging Project (NSHAP): Wave 2 (2010-2011) and Wave 3 (2015-2016). The participants were categorized into three groups: Participants who developed probable dementia over 5 years (4.3%), developed probable MCI (19.1%), or maintained normal cognitive function (76.6%). Weighted linear regression analyses with a group interaction were used to examine the moderating effect of cognitive impairment on the relationship between changes in social isolation and anxiety. RESULTS At the 5-year follow up, there were statistically significant differences in social isolation between the three groups (p = 0.043). Regression analyses showed that increased social isolation over time was related to increased anxiety over 5 years regardless of cognitive status after controlling for covariates (p = 0.017). CONCLUSIONS The relationship between social isolation and anxiety was a universal phenomenon regardless of cognitive status. Tailored interventions targeting both people with or without cognitive impairment are needed to lessen social isolation and anxiety.
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Affiliation(s)
- Yeji Hwang
- College of Nursing and Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongno-gu, 03080, Seoul, Korea.
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
| | - Lauren Massimo
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Subhash Aryal
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Karen B Hirschman
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Nancy A Hodgson
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Mattos MK, Zawar I, Manning C, Patrie J, Quigg MS. Interrelationship of Sleep Disturbances and Cognitive Status on Mortality. Am J Alzheimers Dis Other Demen 2024; 39:15333175241252527. [PMID: 38721926 PMCID: PMC11196890 DOI: 10.1177/15333175241252527] [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] [Indexed: 06/27/2024]
Abstract
Sleep disturbances may promote the development and advancement of Alzheimer's disease. Our purpose was to determine if sleep disturbances were associated with earlier mortality while accounting for cognition. The National Alzheimer's Coordinating Center database was used to evaluate mortality risk conferred by sleep, and the Montreal Cognitive Assessment score determined cognitive status. Demographics, sleep disturbances, cognitive status, and comorbid/other neuropsychiatric conditions were examined as predictors of survival time via Cox regression. The sample (N = 31,110) had a median age [interquartile range] of 72 [66, 79] years, MoCA score of 23 [16, 26], and survival time of 106.0 months [104.0,108.0]; 10,278 (33%) died during follow-up; 21% (n = 6461) experienced sleep disturbances. Sleep disturbances impacted survival time depending on cognition, with the greatest effect in transition from normal to cognitive impairment (P < .001). Findings support that sleep disturbances negatively impact survival time, and the impact of sleep disturbances on survival time is interrelated with cognition.
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Affiliation(s)
- Meghan K. Mattos
- School of Nursing, University of Virginia, Charlottesville, VA 22908, USA
- School of Medicine, Division of Geriatrics, University of Virginia, Charlottesville, VA, USA
| | - Ifrah Zawar
- Comprehensive Epilepsy Program, Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Carol Manning
- Memory Disorders Program, Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - James Patrie
- Division of Biostatistics, Department of Public Health, University of Virginia, Charlottesville, VA, USA
| | - Mark S. Quigg
- Comprehensive Epilepsy Program, Department of Neurology, University of Virginia, Charlottesville, VA, USA
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Hwang Y, Kim J. Influence of caregivers' psychological well-being on the anxiety and depression of care recipients with dementia. Geriatr Nurs 2024; 55:44-51. [PMID: 37972435 DOI: 10.1016/j.gerinurse.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023]
Abstract
This study was conducted to examine how caregivers' psychological well-being influences the anxiety or depression of care recipients with dementia. A secondary data analysis was conducted using 666 dyads of older adults with dementia and their caregivers. The odds that care recipients with dementia would experience anxiety increased when caregivers had a negative relationship with care recipients (OR = 1.22, p = 0.042), lower perception of the positive aspects of caregiving (OR = 0.86, p = 0.047), or anxiety (OR = 2.41, p = 0.036). The odds that care recipients with dementia would experience depression increased when caregivers had a greater perception of the negative aspects of caregiving (OR = 1.15, p = 0.023) or anxiety (OR = 2.21, p = 0.045). Since care recipients with dementia and their caregivers spend considerable time together daily, caregivers' psychological well-being can impact care recipients' anxiety and depression.
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Affiliation(s)
- Yeji Hwang
- Seoul National University, College of Nursing and Research Institute of Nursing Science, Seoul, Korea.
| | - Jayeong Kim
- Seoul National University, College of Nursing and Research Institute of Nursing Science, Seoul, Korea
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Galankin TL, Bespalov AY, Moebius HY. Clusterization of Behavioral and Psychological Symptoms of Dementia as Assessed by Neuropsychiatric Inventory: A Case Against the Use of Principal Component Analysis. J Alzheimers Dis 2024; 98:1483-1491. [PMID: 38578888 DOI: 10.3233/jad-231008] [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: 04/07/2024]
Abstract
Background The term Behavioral and Psychological Symptoms of Dementia (BPSD) covers a group of phenomenologically and medically distinct symptoms that rarely occur in isolation. Their therapy represents a major unmet medical need across dementias of different types, including Alzheimer's disease. Understanding of the symptom occurrence and their clusterization can inform clinical drug development and use of existing and future BPSD treatments. Objective The primary aim of the present study was to investigate the ability of a commonly used principal component analysis to identify BPSD patterns as assessed by Neuropsychiatric Inventory (NPI). Methods NPI scores from the Aging, Demographics, and Memory Study (ADAMS) were used to characterize reported occurrence of individual symptoms and their combinations. Based on this information, we have designed and conducted a simulation experiment to compare Principal Component analysis (PCA) and zero-inflated PCA (ZI PCA) by their ability to reveal true symptom associations. Results Exploratory analysis of the ADAMS database revealed overlapping multivariate distributions of NPI symptom scores. Simulation experiments have indicated that PCA and ZI PCA cannot handle data with multiple overlapping patterns. Although the principal component analysis approach is commonly applied to NPI scores, it is at risk to reveal BPSD clusters that are a statistical phenomenon rather than symptom associations occurring in clinical practice. Conclusions We recommend the thorough characterization of multivariate distributions before subjecting any dataset to Principal Component Analysis.
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Hwang Y, McPhillips MV, Huang L, Perez GA, Hodgson NA. Better caregiver mastery is associated with less anxiety in individuals with cognitive impairment. BMC Nurs 2023; 22:307. [PMID: 37674161 PMCID: PMC10483800 DOI: 10.1186/s12912-023-01471-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND When caregivers have a high level of caregiver mastery, their care recipients with cognitive impairment have less behavioral health problems. However, the relationship between caregiver mastery and anxiety among care recipients over time is unknown. Therefore, this study was conducted to examine that better caregiver mastery is associated with less anxiety in individuals with cognitive impairment over time. METHODS A secondary data analysis was conducted using the Healthy Patterns Clinical Trial (NCT03682185) dataset and guided by Factors Associated with Behavioral and Psychological Symptoms of Dementia conceptual framework. This study included 154 dyads of individuals with cognitive impairment and their caregivers. Multiple linear regression analyses were performed on changes in anxiety. Model 1 included variables at the level of neurodegeneration (i.e., cognitive impairment and age). Model 2 added patient factors (i.e., sleep problems and depression) with the Model 1. Finally, Model 3 included caregiver factor (i.e., caregiver mastery) with the Model 2 to examine how changes in caregiver mastery influence changes in anxiety of care recipients. RESULTS Model 3 was statistically significant; after controlling for variables at the level of neurodegeneration associated with cognitive impairment and patient factors, improvement of caregiver mastery over time (β =-0.230, p = 0.015) was related to decreased anxiety over time (R2 = 0.1099). CONCLUSIONS Caregivers with high caregiver mastery may have better knowledge on how to care for their loved ones and how to manage their neuropsychiatric symptoms. Therefore, improving the level of caregiver mastery by providing psychoeducational programs and resources that family caregivers need will help reduce the frequency of anxiety in individuals with cognitive impairment.
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Affiliation(s)
- Yeji Hwang
- College of Nursing and Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
| | | | - Liming Huang
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - G Adriana Perez
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Nancy A Hodgson
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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García-Martín V, de Hoyos-Alonso MC, Delgado-Puebla R, Ariza-Cardiel G, Del Cura-González I. Burden in caregivers of primary care patients with dementia: influence of neuropsychiatric symptoms according to disease stage (NeDEM project). BMC Geriatr 2023; 23:525. [PMID: 37644410 PMCID: PMC10463529 DOI: 10.1186/s12877-023-04234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Caregiver burden is related to personal factors and patient characteristics and is greater when neuropsychiatric symptoms (NPSs) are present. OBJECTIVE Estimate the prevalence of burden among caregivers of dementia patients and its association with NPSs and identify NPSs causing greater caregiver distress according to dementia stage. METHODS A cross-sectional observational study in caregivers of noninstitutionalized dementia patients was conducted. Caregiver variables were sociodemographic, time of care, NPS-associated distress based on the Neuropsychiatric Inventory Caregiver Distress Scale (NPI-D) and burden based on the Zarit Burden Interview (ZBI). Patient variables were time since disease onset, Global Deterioration Scale (GDS) disease stage, functional assessment and NPS presence and intensity according to the Neuropsychiatric Inventory (NPI). The mean ZBI score, prevalence of burden and NPI-D score with 95% CIs at each dementia stage were estimated. Factors associated with burden were identified by multivariate analysis. RESULTS Of the 125 caregivers included, 77.6% were women, with a mean age of 60.7 (± 14.3) years; 78.4% (95%CI: 71.0; 86.0) experienced burden. The mean ZBI score was 12.3 (95%CI: 11.6; 12.9) and increased according to NPS number (p = 0.042). The NPSs causing the most burden were disinhibition (93.5%), irritability (87.3%) and agitation (86.1%). Agitation, apathy, and sleep disorders were the NPSs generating the greatest overall caregiver distress; depression (max NPI-D 1.9), hyperactivity (max NPI-D 2.1), and psychosis symptoms (max NPI-D 1.6) generated the greatest distress at stage GDS 3, stages GDS 4-5, and stages GDS 6-7, respectively. The NPI score (OR = 1.0, 95%CI 1.0; 1.1), intensity of irritability (OR = 1.2, 95%CI 1.0; 1.6), disinhibition (OR = 2.6, 95%CI 1.1; 5.8) and hyperactivity subsyndrome (OR = 1.1, 95%CI 1.0; 1.2) were associated with caregiver burden. Other associated factors were female gender (OR = 6.0, 95%CI 1.6; 22.8), ≥ 8 h daily care (OR = 5.6, 95%CI 1.4; 22.8), working outside the home (OR = 7.6, 95%CI 1.8; 31.8), living with the patient (OR = 4.5, 95%CI 1.1; 19.6), kinship (OR = 5.4, 95%CI 1.0; 28.2) and lower patient education (OR = 8.3, 95%CI 2.3; 30.3). CONCLUSIONS The burden on caregivers of dementia patients is high and associated with NPS presence and intensity. Disinhibition and irritability caused the highest burden. Depression, hyperactivity and psychosis produce more distress in mild, mild-moderate and severe dementia, respectively.
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Affiliation(s)
- Victoria García-Martín
- Epidemiology and Public Health, Universidad Rey Juan Carlos (Rey Juan Carlos University), Madrid, Spain.
| | - M Canto de Hoyos-Alonso
- Pedro Laín Entralgo Health Care Center, Primary Care Management, Madrid Health Service, Alcorcón, Madrid, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
| | - Rosalía Delgado-Puebla
- Primary Care Management, Horta Health Care Center, Catalonia Health Service, Barcelona, Catalonia, Spain
| | - Gloria Ariza-Cardiel
- Family and Community Medicine Teaching Unit Oeste, Primary Care Management, Madrid Health Service, Móstoles, Madrid, Spain
| | - Isabel Del Cura-González
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
- Research Unit, Primary Care Management, Madrid Health Service, Madrid, Spain
- Department of Medical Specialties and Public Health, Universidad Rey Juan Carlos (Rey Juan Carlos University), Alcorcón, Madrid, Spain
- Ageing Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Instituto Investigación Sanitaria Gregorio Marañón IiSGM, Madrid, Spain
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Patrick KS, Gunstad J, Martin JT, Chapman KR, Drost J, Spitznagel MB. Specific agitation behaviours in dementia differentially contribute to aspects of caregiver burden. Psychogeriatrics 2022; 22:688-698. [PMID: 35853570 PMCID: PMC9544824 DOI: 10.1111/psyg.12871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/26/2022] [Accepted: 06/06/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Agitation is a common symptom in dementia and linked to caregiver burden, but both agitation and burden are multidimensional constructs. The current study sought to determine whether specific presentations of agitation differentially relate to aspects of caregiver burden. METHODS Medical record data from an outpatient memory clinic were extracted for 609 persons with dementia, including caregiver-reported burden and care recipient agitation. RESULTS Exploratory factor analysis yielded three domains of agitation on the Cohen Mansfield Agitation Inventory ('Physically Aggressive', 'Physically Non-Aggressive', 'Verbally Agitated') and four domains of burden on the Zarit Burden Interview ('Impact on Life', 'Guilt/Uncertainty', 'Embarrassment/Frustration', 'Overwhelm'). Regression analyses demonstrated all domains of agitation positively predicted overall burden. Regarding specific aspects of burden, Physically Aggressive behaviours predicted Embarrassment/Frustration. Physically Non-Aggressive behaviours predicted Impact on Life and Guilt/Uncertainty. Verbally Agitated behaviours predicted all burden dimensions. CONCLUSIONS Results suggest specific aspects of agitation may differentially contribute to facets of caregiver burden.
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Affiliation(s)
- Karlee S Patrick
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - John T Martin
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - Kimberly R Chapman
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jennifer Drost
- Summa Health System Department of Geriatrics, Akron, Ohio, USA
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Shaw CA, Ward C, Gordon J, Williams KN, Herr K. Elderspeak communication and pain severity as modifiable factors to rejection of care in hospital dementia care. J Am Geriatr Soc 2022; 70:2258-2268. [PMID: 35642656 PMCID: PMC9378618 DOI: 10.1111/jgs.17910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/10/2022] [Accepted: 03/25/2022] [Indexed: 11/28/2022]
Abstract
Background Rejection of care (RoC) occurs when persons living with dementia (PLWD) withstand or oppose the efforts of their caregiver. Improvements in hospital dementia care are needed, and one way to address this need is by identifying factors that lead to RoC, particularly those that are modifiable. Elderspeak communication is an established antecedent to RoC among PLWD in nursing homes. The purpose of this study was to extend these results to acute care settings by determining the impact of elderspeak communication by nursing staff on RoC by hospitalized PLWD. Methods Care encounters between nursing staff and PLWD were audio‐recorded, transcribed verbatim, and coded for semantic, pragmatic, and prosodic features of elderspeak. RoC behaviors was scored in real‐time using the Resistiveness to Care Scale. A Bayesian repeated‐measures hurdle model was used to evaluate the association between elderspeak and both the presence and severity of RoC. Results Eighty‐eight care encounters between 16 PLWD and 53 nursing staff were audio‐recorded for elderspeak and scored for RoC. Nearly all (96.6%) of the encounters included some form of elderspeak. Almost half of the care encounters (48.9%) included RoC behaviors. A 10% decrease in elderspeak was associated with a 77% decrease in odds of RoC (OR = 0.23, 95% CI = 0.03, 0.68) and a 16% decrease (eβ= 0.84, CI = 0.73, 0.96) in the severity of RoC. A one‐unit decrease in pain severity was associated with 73% reduced odds of RoC (OR = 0.27, CI = 0.12, 0.45) and a 28% decrease (eβ= 0.72, CI = 0.64, 0.80) in the severity of RoC. Conclusions Both elderspeak by nursing staff and RoC by PLWD are present and pervasive in acute care. Pain and elderspeak are two modifiable factors of RoC in hospitalized PLWD. Person‐centered interventions are needed that address communication practices and pain management for hospitalized PLWD.
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Affiliation(s)
- Clarissa A Shaw
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Caitlin Ward
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA.,Department of Mathematics and Statistics, Faculty of Science, University of Calgary, Calgary, Alberta, Canada
| | - Jean Gordon
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, Iowa, USA
| | - Kristine N Williams
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Keela Herr
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
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Hwang Y, Massimo L, Aryal S, Hodgson NA. The relationship between social isolation and anxiety in people with cognitive impairment in the United States. Int J Geriatr Psychiatry 2022; 37. [PMID: 34997619 DOI: 10.1002/gps.5679] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/02/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Social isolation among older adults with cognitive impairment is understudied. The purpose of this study is to examine the relationship between social isolation and anxiety in people with cognitive impairment in the United States. METHODS/DESIGN Secondary data analyses were conducted using the National Social Life, Health, and Aging Project (NSHAP) Wave 2 (2010-2011) dataset which includes a nationally representative sample of American older adults living at home. A total of 1343 people who had probable cognitive impairment measured by a Montreal Cognitive Assessment (MoCA) score of 22 or less were selected. Anxiety was measured using the anxiety measure of Hospital Anxiety and Depression Scale (HADS-A) and social isolation was measured using Perceived Social Isolation Scale. A weighted multivariable linear regression analysis and weighted F tests were used to examine the relationship between social isolation and anxiety. RESULTS We observed that greater social isolation was related to increased anxiety in people with cognitive impairment (coefficients = 0.7242, t = 2.51, p = 0.015), adjusting for severity of cognitive impairment, race, pain, depression, activities of daily living, and instrumental activities of daily living. Weighted F tests showed that persons with clinically significant anxiety (HADS-A ≥ 8) had higher levels of loneliness, including feeling a lack of companionship, feeling left out, and greater social isolation. CONCLUSIONS The results of our study suggest that people with cognitive impairment can feel social isolation and it may contribute to their anxiety. Health care professionals, family, and friends of people with cognitive impairment should pay greater attention to social isolation of their loved ones.
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Affiliation(s)
- Yeji Hwang
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Lauren Massimo
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Subhash Aryal
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Nancy A Hodgson
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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García-Martín V, de Hoyos-Alonso MC, Ariza-Cardiel G, Delgado-Puebla R, García-Domingo P, Hernández-Melo E, de Haro-de Torres JL, del Cura-González I. Neuropsychiatric symptoms and subsyndromes in patients with different stages of dementia in primary care follow-up (NeDEM project): a cross-sectional study. BMC Geriatr 2022; 22:71. [PMID: 35065615 PMCID: PMC8783993 DOI: 10.1186/s12877-022-02762-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/24/2021] [Indexed: 02/08/2023] Open
Abstract
Abstract
Background
The objective was to describe the prevalence and intensity of neuropsychiatric symptoms (NPSs) isolated and grouped into subsyndromes in patients with dementia in primary care (PC) to analyse their distribution based on stages of dementia and the relationship between them and the intensity of symptoms.
Methods
Design: Cross-sectional study. Setting and population: Patients with dementia, not institutionalized, in a PC follow-up. Variables: Sociodemographic and clinical variables. Assessment instruments: The frequency and intensity of NPSs were measured with the Neuropsychiatric Inventory (NPI), and the stages of dementia with the Global Deterioration Scale (GDS). Statistical analysis: The number of NPSs per patient, the mean NPI value, and the prevalence and intensity of NPSs isolated and grouped into subsyndromes were calculated, as were their 95% confidence intervals (CIs). The analyses were performed on an overall basis and by GDS scores. To analyse the association between the NPI and GDS scores, multivariate analysis was performed with a generalized linear model.
Results
Overall, 98.4% (95% CI 94.5;99.8) of the patients presented some type of NPS, with an average of five symptoms per patient. The most frequent symptoms were apathy [69.8% (95% CI 61.1;77.5)], agitation [55.8% (95% CI 46.8;64.5)] and irritability [48.8% (95% CI 39.9;57.8)]. The more intense NPSs were apathy [NPI 3.2 (95% CI 2.5;3.8)] and agitation [NPI 3.2 (95% CI 2.5;4.0)]. For subsyndromes, hyperactivity predominated [86.0% (95% CI 78.8;91.5)], followed by apathy [77.5% (95% CI 69.3;84.4]). By phase of dementia, the most common isolated symptom was apathy (60.7–75.0%). Affective symptoms and irritability predominated in the initial stages, and psychotic symptoms predominated in advanced stages. The mean NPI score was 24.9 (95% CI 21.5;28.4) and increased from 15.6 (95% CI 8.2;23.1) for GDS 3 to 28.9 (95% CI 12.6;45.1) for GDS 7. Patients with in the most advanced stages of dementia presented an NPI score 7.6 (95% CI 6.8;8.3) points higher than the score for mild dementia with adjustment for the other variables.
Conclusions
A high prevalence of NPSs was found among patients with dementia treated in PC. Symptoms change and increase in intensity as the disease progresses. Scales such as the NPI allow these symptoms to be identified, which may facilitate more stage-appropriate management.
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Bergamini G, Coloma P, Massinet H, Steiner MA. What evidence is there for implicating the brain orexin system in neuropsychiatric symptoms in dementia? Front Psychiatry 2022; 13:1052233. [PMID: 36506416 PMCID: PMC9732550 DOI: 10.3389/fpsyt.2022.1052233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/07/2022] [Indexed: 11/26/2022] Open
Abstract
Neuropsychiatric symptoms (NPS) affect people with dementia (PwD) almost universally across all stages of the disease, and regardless of its exact etiology. NPS lead to disability and reduced quality of life of PwD and their caregivers. NPS include hyperactivity (agitation and irritability), affective problems (anxiety and depression), psychosis (delusions and hallucinations), apathy, and sleep disturbances. Preclinical studies have shown that the orexin neuropeptide system modulates arousal and a wide range of behaviors via a network of axons projecting from the hypothalamus throughout almost the entire brain to multiple, even distant, regions. Orexin neurons integrate different types of incoming information (e.g., metabolic, circadian, sensory, emotional) and convert them into the required behavioral output coupled to the necessary arousal status. Here we present an overview of the behavioral domains influenced by the orexin system that may be relevant for the expression of some critical NPS in PwD. We also hypothesize on the potential effects of pharmacological interference with the orexin system in the context of NPS in PwD.
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Affiliation(s)
- Giorgio Bergamini
- CNS Pharmacology and Drug Discovery, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | - Preciosa Coloma
- Clinical Science, Global Clinical Development, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | - Helene Massinet
- CNS Pharmacology and Drug Discovery, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
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Oliveira AM, Radanovic M, Mello PCHD, Buchain PC, Vizzotto ADB, Harder J, Stella F, Gitlin LN, Piersol CV, Valiengo LLC, Forlenza OV. Adjunctive Therapy to Manage Neuropsychiatric Symptoms in Moderate and Severe Dementia: Randomized Clinical Trial Using an Outpatient Version of Tailored Activity Program. J Alzheimers Dis 2021; 83:475-486. [PMID: 34334394 DOI: 10.3233/jad-210142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) such as aggression, apathy, agitation, and wandering may occur in up to 90%of dementia cases. International guidelines have suggested that non-pharmacological interventions are as effective as pharmacological treatments, however without the side effects and risks of medications. An occupational therapy method, called Tailored Activity Program (TAP), was developed with the objective to treat NPS in the elderly with dementia and has been shown to be effective. OBJECTIVE Evaluate the efficacy of the TAP method (outpatient version) in the treatment of NPS in individuals with dementia and in the burden reduction of their caregivers. METHODS This is a randomized, double-blind, controlled clinical trial for the treatment of NPS in dementia. Outcome measures consisted of assessing the NPS of individuals with dementia, through the Neuropsychiatric Inventory-Clinician rating scale (NPI-C), and assessing the burden on their caregivers, using the Zarit Scale. All the participants were evaluated pre-and post-intervention. RESULTS 54 individuals with dementia and caregivers were allocated to the experimental (n = 28) and control (n = 26) groups. There was improvement of the following NPS in the experimental group: delusions, agitation, aggressiveness, depression, anxiety, euphoria, apathy, disinhibition, irritability, motor disturbance, and aberrant vocalization. No improvement was observed in hallucinations, sleep disturbances, and appetite disorders. The TAP method for outpatient settings was also clinically effective in reducing burden between caregivers of the experimental group. CONCLUSION The use of personalized prescribed activities, coupled with the caregiver training, may be a clinically effective approach to reduce NPS and caregiver burden of individuals with dementia.
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Affiliation(s)
- Alexandra Martini Oliveira
- Serviço de Terapia Ocupacional, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil.,Laboratorio de Neurociencias (LIM-27), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Marcia Radanovic
- Laboratorio de Neurociencias (LIM-27), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | | | - Patricia Cardoso Buchain
- Serviço de Terapia Ocupacional, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | | | - Janaína Harder
- Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Florindo Stella
- Laboratorio de Neurociencias (LIM-27), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Laura N Gitlin
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.,Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD, USA.,Drexel College of Nursing and Health Professions, Philadelphia, PA, USA
| | | | - Leandro L C Valiengo
- Laboratorio de Neurociencias (LIM-27), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Orestes Vicente Forlenza
- Laboratorio de Neurociencias (LIM-27), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
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Hwang Y, Hodgson N. Associations between caregiver mastery and anxiety in persons living with dementia: A study of dyads living in community. Geriatr Nurs 2021; 42:993-997. [PMID: 34256159 DOI: 10.1016/j.gerinurse.2021.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022]
Abstract
Anxiety is common in persons living with dementia (PLWD), and particularly burdensome for caregivers. Little is known about how caregiver factors such as caregiver mastery can influence anxiety in PLWD. This study was conducted to examine the relationship between caregiver mastery and anxiety in PLWD. Secondary data analysis was conducted using baseline data from a randomized controlled trial of 170 dyads of community residing PLWD and their caregivers. Logistic regression analyses were used for data analyses. After controlling for covariates (e.g., age, cognitive impairment, sleep impairment, and depression), a higher level of caregiver mastery was related to lower odds of anxiety presentation in PLWD (OR=0.870, 95% CI=0.759-0.998, p=0.046). As caregiver mastery is related to anxiety in PLWD, a comprehensive education program for caregivers that can improve their caregiving skills and mastery is suggested to improve anxiety in PLWD.
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Affiliation(s)
- Yeji Hwang
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States.
| | - Nancy Hodgson
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States
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15
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Scerpella DL, Bouranis NG, Webster MJ, Dellapina M, Koeuth S, Parker LJ, Kales HC, Gitlin LN. Using Geographic Information Systems (GIS) for Targeted National Recruitment of Community-Dwelling Caregivers Managing Dementia-Related Behavioral and Psychological Symptoms: A Recruitment Approach for a Randomized Clinical Trial. JOURNAL OF GEOGRAPHIC INFORMATION SYSTEM 2021; 13:302-317. [PMID: 34484851 PMCID: PMC8415725 DOI: 10.4236/jgis.2021.133017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Over 16 million caregivers of people living with dementia require support in a range of issues, including self-care, disease education, and guidance for how to manage behavioral and psychological symptoms of dementia (BPSD). Non-pharmacological interventions are needed to address these areas, and online applications have been shown to be safe and effective. To ensure the efficacy of such interventions, racially, ethnically, geographically, and socioeconomically diverse participants must be recruited to increase the generalizability of study outcomes. This protocol paper describes a recruitment plan using Geographic Information Systems (GIS) to reach a representative sample of caregivers across the United States for a national Phase III clinical study. Using publicly available census data from the American Community Survey (ACS), combined with location data for local aging resources such as Area Agencies on Aging (AAA), recruitment will be derived from data analysis conducted in ESRI ArcGIS v10.7.1. Datasets including age, gender, income, and education will be assessed nationally at the county and census tract spatial scale in a nine-step process to develop recruitment priority areas containing high concentrations of eligible participants living in the community. Overall, the current protocol will demonstrate the value of GIS in tailoring targeted outreach strategies to recruit community-dwelling populations through local resource institutions. This novel approach may have far-reaching implications in future recruitment initiatives and help to secure racially/ethnically diverse samples.
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Affiliation(s)
| | - Nicole G Bouranis
- College of Nursing and Health Professions, Drexel University, Philadelphia, USA
| | - Melinda J Webster
- College of Nursing and Health Professions, Drexel University, Philadelphia, USA
| | - Maria Dellapina
- College of Nursing and Health Professions, Drexel University, Philadelphia, USA
| | - Sokha Koeuth
- College of Nursing and Health Professions, Drexel University, Philadelphia, USA
| | - Lauren J Parker
- School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Helen C Kales
- Department of Psychiatry, University of California-Davis, Sacramento, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, USA
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16
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Gitlin LN, Bouranis N, Kern V, Koeuth S, Marx KA, McClure LA, Lyketsos CG, Kales HC. WeCareAdvisor, an Online Platform to Help Family Caregivers Manage Dementia-Related Behavioral Symptoms: an Efficacy Trial in the Time of COVID-19. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2021; 7:33-44. [PMID: 33786370 PMCID: PMC7994055 DOI: 10.1007/s41347-021-00204-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/11/2021] [Accepted: 03/19/2021] [Indexed: 11/13/2022]
Abstract
Dementia-related behavioral and psychology symptoms (BPSD) are undertreated and have negative consequences. However, families do not have access to disease information, tailored problem-solving and effective management strategies, and with COVID-19, are more socially isolated and distressed. To address this dementia care gap, we describe a Phase III efficacy trial testing an online platform, WeCareAdvisor, and design modifications necessitated by COVID-19. WeCareAdvisor provides caregivers with disease information, daily tips, and a systematic approach for describing behaviors, investigating underlying causes, creating tailored strategies, and evaluating their effectiveness (DICE). The trial will enroll 326 caregivers nationwide, randomly assign them to immediately receive WeCareAdvisor (treatment), or a 3-month waitlist (control) and evaluate short (1- and 3-month) and long-term (6-month) outcomes for caregiver distress with and confidence managing BPSD, and BPSD occurrences. We will also evaluate utilization patterns with different prompting conditions: high-intensity (telephone and email reminders), low-intensity (email reminders), or no reminders to use WeCareAdvisor. COVID-19 necessitated design modifications resulting in greater inclusivity of caregivers from diverse races, ethnicities, and geographic areas. Key modifications include shifting from in-home, in-person interviewing to telephone; adjusting tool functionality from operating on a grant-funded iPad to caregivers' personal internet-capable devices; and expanding recruitment from one metropolitan area to nationwide. Study modifications necessitated by COVID-19 facilitate national outreach, easier tool adoption, and enable more diverse caregivers to participate. This study addresses a critical dementia care need, and design modifications may shorten timeline from efficacy testing to commercialization.
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