Assessment of Psychoemotional and Behavioral Status in Patients with Dementia

[Modern concept of pain syndrome and dental anxiety pathophysiology and prevention]

The work presents a wide range of etiological factors and pathogenesis of formation and development of the pain symptom. The conceptual model of pain which consists of the uniform process including four main complementary levels is presented: nociception, algesis, suffering and painful behavior.

Review of the effect of music interventions on symptoms of anxiety and depression in older adults with mild dementia

BACKGROUND

Treatment of anxiety and depression, the most common psychiatric symptoms in older adults with mild dementia, requires innovative approaches due to the high cost and significant side effects associated with traditional pharmacological interventions. Alternative non-pharmacological therapies, such as music, when used in conjunction with pharmacological treatment, have the potential to alleviate symptoms of anxiety and depression in older adults diagnosed with mild dementia. The purpose of this review was to examine the evidence of music's efficacy in improving symptoms of anxiety and depression in older adults with mild dementia.

METHODS

Four databases (Medline, CINAHL, PsychInfo, PubMed) were searched using the terms "music," "music therapy," "music intervention," "singing," "dementia," "anxiety," and/or "depression," identifying ten studies that met the inclusion and exclusion criteria.

RESULTS

The poor methodological rigor of the studies precluded reaching consensus on the efficacy of a music intervention in alleviating symptoms of anxiety and depression in older adults with mild dementia.

CONCLUSIONS

There was inconclusive evidence as to whether music interventions are effective in alleviating symptoms of anxiety and depression in older adults with mild dementia due to the poor methodological rigor. However, with improved designs guided by a deeper understanding of how music engages the aging brain, music may emerge as an important adjunct therapy to improving the lives of older adults with mild dementia.

Mini-Emotional State Examination for dementia patients

AIM

Emotional functions, as well as cognitive functions, are critical factors to assess in the care and management for dementia patients. In addition to the Mini-Mental State Examination (MMSE), we have developed a Mini-Emotional State Examination (MESE) for the examination of emotional functions in patients with dementia.

METHODS

MESE consists of a two-part questionnaire. The first probes emotional functions within the five senses (visual, auditory, tactile, smell and taste). The second explores more complex and comprehensive emotional functions including feelings of tenderness, violence, happiness and sadness, as well as emotional responses to more general human, moral and social phenomena. The questionnaire comprises 30 questions and is scaled to a 30-point healthy maximum. A total of 40 dementia patients in Sendai Tomizawa Hospital were tested with MESE.

RESULTS

MESE point scores were roughly parallel to the scores on the MMSE, but MESE scores were widely distributed, independent of MMSE score. MESE scores in nine patients exceeded 23 points.

CONCLUSION

The difference in distribution of MMSE and MESE scores show that cognitive and emotional functions are independently affected in dementia, and therefore assessment of both these functions should be cared taken into consideration in the care and management of dementia patients.

Psychometric properties of the Depressive Symptom Assessment for Older Adults in individuals with moderate or severe dementia

Many older adults with moderate or severe dementia also have depression, but identifying depressive symptoms in these individuals can be challenging. The Depressive Symptom Assessment for Older Adults (DSA), a newly developed instrument designed to evaluate older adults for depression, regardless of their cognitive status, facilitates longitudinal evaluation. This investigation examined the psychometric properties of the DSA in older adults (n = 68) with moderate or severe dementia. Internal consistency for the overall instrument and three of the six subscales, inter-rater reliability, and concurrent validity were established. Preliminary factor analysis yielded two strong factors; however, the other four factors were conceptually unclear. Although the DSA performed well statistically, the instrument may have over-identified depressive symptoms related to disagreeable behavior and lethargy and may have under-identified other depressive symptoms.

Content validation of the depressive symptom assessment for older adults

The goal of this study was to evaluate the content validity of the Depressive Symptom Assessment for Older Adults (DSA), an interviewer-rated instrument designed to comprehensively measure depression in older adults regardless of their cognitive status. Seniors who were not currently depressed but had been either previously depressed or had an older adult family member who was depressed (n = 7) served as content validation experts for this two phased study. In Phase 1 of the content validation process, 19 of the questions had 100% agreement, 20 of the questions had 86% agreement, 13 of the questions had 71% agreement, 5 of the questions had 57% agreement, and 2 of the questions had 43% agreement. In Phase 2 of the content validation process, 42 of the questions had 100% agreement, 11 of the questions had 86% agreement, and 1 of the questions had 71% agreement. The DSA provides mental health nurses with a comprehensive instrument to assess older adults for depression.