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Yuan SH, Silverman MJ, Cevasco-Trotter AM, Wang SG. Ten Reasons Why Neurologists Should Refer Patients With Alzheimer Dementia to Music Therapy. Neurol Clin Pract 2024; 14:e200357. [PMID: 39185103 PMCID: PMC11341083 DOI: 10.1212/cpj.0000000000200357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/04/2024] [Indexed: 08/27/2024]
Abstract
Background Alzheimer dementia (AD) constitutes a major societal problem with devastating neuropsychiatric involvement. Pharmaceutical interventions carry a heightened risk of side effects; thus, nonpharmacological interventions such as music-based interventions (MBIs), including music therapy, are recommended. Recent Findings The 2023 Neurology release of the Music Based Intervention Toolkit for Brain Disorders of Aging showcased music's emerging role as an intervention to manage symptoms of various brain disorders while defining the building blocks of MBIs to guide research in the exploration of music's therapeutic potential. Implications for Practice This study extends beyond the research aspects of the MBI Toolkit to clinical applications by providing neurologists with a summary of MBIs, the MBI Toolkit, how board-certified music therapists (MT-BCs) administered music therapy is a unique MBI, and 10 reasons why they should make referrals to music therapy for their patients with AD.
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Affiliation(s)
- Shauna H Yuan
- Department of Neurology (SHY, SGW), University of Minnesota; Minneapolis Veteran's Administration Healthcare System (SHY); College of Liberal Arts (MJS), School of Music, University of Minnesota, Minneapolis; and College of Arts and Sciences (AMC-T), School of Music, University of Alabama, Tuscaloosa
| | - Michael J Silverman
- Department of Neurology (SHY, SGW), University of Minnesota; Minneapolis Veteran's Administration Healthcare System (SHY); College of Liberal Arts (MJS), School of Music, University of Minnesota, Minneapolis; and College of Arts and Sciences (AMC-T), School of Music, University of Alabama, Tuscaloosa
| | - Andrea M Cevasco-Trotter
- Department of Neurology (SHY, SGW), University of Minnesota; Minneapolis Veteran's Administration Healthcare System (SHY); College of Liberal Arts (MJS), School of Music, University of Minnesota, Minneapolis; and College of Arts and Sciences (AMC-T), School of Music, University of Alabama, Tuscaloosa
| | - Sonya G Wang
- Department of Neurology (SHY, SGW), University of Minnesota; Minneapolis Veteran's Administration Healthcare System (SHY); College of Liberal Arts (MJS), School of Music, University of Minnesota, Minneapolis; and College of Arts and Sciences (AMC-T), School of Music, University of Alabama, Tuscaloosa
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Polypharmacy in Treatment of Behavioral Issues in Dementia—Use of Atypical Antipsychotics. Clin Geriatr Med 2022; 38:641-652. [DOI: 10.1016/j.cger.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Millan MJ, Dekeyne A, Gobert A, Brocco M, Mannoury la Cour C, Ortuno JC, Watson D, Fone KCF. Dual-acting agents for improving cognition and real-world function in Alzheimer's disease: Focus on 5-HT6 and D3 receptors as hubs. Neuropharmacology 2020; 177:108099. [PMID: 32525060 DOI: 10.1016/j.neuropharm.2020.108099] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 01/01/2023]
Abstract
To date, there are no interventions that impede the inexorable progression of Alzheimer's disease (AD), and currently-available drugs cholinesterase (AChE) inhibitors and the N-Methyl-d-Aspartate receptor antagonist, memantine, offer only modest symptomatic benefit. Moreover, a range of mechanistically-diverse agents (glutamatergic, histaminergic, monoaminergic, cholinergic) have disappointed in clinical trials, alone and/or in association with AChE inhibitors. This includes serotonin (5-HT) receptor-6 antagonists, despite compelling preclinical observations in rodents and primates suggesting a positive influence on cognition. The emphasis has so far been on high selectivity. However, for a multi-factorial disorder like idiopathic AD, 5-HT6 antagonists possessing additional pharmacological actions might be more effective, by analogy to "multi-target" antipsychotics. Based on this notion, drug discovery programmes have coupled 5-HT6 blockade to 5-HT4 agonism and inhibition of AchE. Further, combined 5-HT6/dopamine D3 receptor (D3) antagonists are of especial interest since D3 blockade mirrors 5-HT6 antagonism in exerting broad-based pro-cognitive properties in animals. Moreover, 5-HT6 and dopamine D3 antagonists promote neurocognition and social cognition via both distinctive and convergent actions expressed mainly in frontal cortex, including suppression of mTOR over-activation and reinforcement of cholinergic and glutamatergic transmission. In addition, 5-HT6 blockade affords potential anti-anxiety, anti-depressive and anti-epileptic properties, and antagonising 5-HT6 receptors may be associated with neuroprotective ("disease-modifying") properties. Finally D3 antagonism may counter psychotic episodes and D3 receptors themselves offer a promising hub for multi-target agents. The present article reviews the status of "R and D" into multi-target 5-HT6 and D3 ligands for improved treatment of AD and other neurodegenerative disorders of aging. This article is part of the special issue entitled 'Serotonin Research: Crossing Scales and Boundaries'.
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Affiliation(s)
- Mark J Millan
- Centre for Therapeutic Innovation in Neuropsychiatry, Institut de Recherche Servier, 78290, Croissy sur Seine, France.
| | - Anne Dekeyne
- Centre for Therapeutic Innovation in Neuropsychiatry, Institut de Recherche Servier, 78290, Croissy sur Seine, France
| | - Alain Gobert
- Centre for Therapeutic Innovation in Neuropsychiatry, Institut de Recherche Servier, 78290, Croissy sur Seine, France
| | - Mauricette Brocco
- Centre for Therapeutic Innovation in Neuropsychiatry, Institut de Recherche Servier, 78290, Croissy sur Seine, France
| | - Clotilde Mannoury la Cour
- Centre for Therapeutic Innovation in Neuropsychiatry, Institut de Recherche Servier, 78290, Croissy sur Seine, France
| | - Jean-Claude Ortuno
- Centre for Excellence in Chemistry, Institut de Recherche Servier, 78290, Croissy sur Seine, France
| | - David Watson
- School of Life Sciences, Queen's Medical Centre, The University of Nottingham, NG7 2UH, England, UK
| | - Kevin C F Fone
- School of Life Sciences, Queen's Medical Centre, The University of Nottingham, NG7 2UH, England, UK
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Subramaniam H. Co-morbidities in dementia: time to focus more on assessing and managing co-morbidities. Age Ageing 2019; 48:314-315. [PMID: 31063580 DOI: 10.1093/ageing/afz007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/04/2019] [Accepted: 01/21/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Hari Subramaniam
- Consultant Psychiatrist, Leicestershire Partnership NHS Trust & Hon Sr Lecturer University of Leicester, UK
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Phillips LJ, Birtley NM, Petroski GF, Siem C, Rantz M. An observational study of antipsychotic medication use among long-stay nursing home residents without qualifying diagnoses. J Psychiatr Ment Health Nurs 2018; 25:463-474. [PMID: 29911331 DOI: 10.1111/jpm.12488] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/09/2018] [Accepted: 06/14/2018] [Indexed: 01/21/2023]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: In the United States, 15.5% of nursing home residents without qualifying diagnoses of schizophrenia, Huntington's' Disease, and/or Tourette Syndrome receive antipsychotic medications. Antipsychotic medications are used off-label (i.e., used in a manner the United States Food and Drug Administration's packaging insert does not specify) to treat neuropsychiatric symptoms, often before attempting nonpharmacologic interventions, despite evidence that this drug class is associated with significant adverse events including death. Less than optimal staffing resources and lack of access to geropsychiatric specialists are barriers to reducing antipsychotic use. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Antipsychotic use occurred in 11.6% of nursing home residents without qualifying or potentially qualifying diagnoses (bipolar disorder and psychotic disorder); antipsychotic use was more prevalent in residents with a dementia diagnosis than those without. One additional registered nurse hour per resident day could reduce the odds of antipsychotic use by 52% and 56% for residents with and without a dementia diagnosis respectively. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Given the influence of total staffing and professional staff mix on risk of antipsychotic use, nursing home administrators may want to consider aspects of facility operation that impact antipsychotic use. More stringent Unites States' survey and certification standards for dementia care implemented in 2017 demand proactive person-centered care that promotes maximal well-being and functioning without risk of harm from inappropriate psychoactive medications. Mental health nurses have requisite training to provide expert person-centered care to nursing home residents with mental illness and geropsychiatric disorders. ABSTRACT Introduction Antipsychotic use in nursing homes varies widely across the United States; inadequate staffing, skill mix, and geropsychiatric training impede sustained improvement. Aim This study identified risk factors of antipsychotic use in long-stay residents lacking qualifying or potentially qualifying diagnoses. Method This secondary analysis used 2015 Minimum Data Set and cost report data from 458 Missouri nursing homes. The full sample (N = 29,679) was split into two subsamples: residents with (N = 15,114) and without (N = 14,565) a dementia diagnosis. Separate logistic regression models were run. Results Almost 15% of the dementia subsample and 8.4% of the nondementia subsample received an antipsychotic medication in the past week. Post-traumatic stress disorder, psychosis indicators, behavioral symptoms, anxiety medication with and without anxiety diagnosis, depression medication with and without depression diagnosis, and nurse staffing were among the strongest predictors of antipsychotic use in both subsamples. Simulation analyses showed decreased odds of receiving an antipsychotic in both subsamples when registered nurse hours matched the national average. Discussion Matching nurse staffing mix to the national average may improve antipsychotic use in nursing homes. Implications Knowledge of antipsychotic use risk factors use can inform care planning and staff education to minimize use of these medications in all but severe cases.
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Affiliation(s)
| | - Nancy M Birtley
- School of Nursing, University of Missouri, Columbia, Missouri
| | - Gregory F Petroski
- Office of Medical Research, School of Medicine, University of Missouri, Columbia, Missouri
| | - Carol Siem
- School of Nursing, University of Missouri, Columbia, Missouri
| | - Marilyn Rantz
- School of Nursing, University of Missouri, Columbia, Missouri
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Messinger-Rapport BJ, Little MO, Morley JE, Gammack JK. Clinical Update on Nursing Home Medicine: 2016. J Am Med Dir Assoc 2017; 17:978-993. [PMID: 27780573 DOI: 10.1016/j.jamda.2016.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/07/2016] [Indexed: 12/31/2022]
Abstract
This is the tenth clinical update. It covers chronic kidney disease, dementia, hypotension, polypharmacy, rapid geriatric assessment, and transitional care.
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Affiliation(s)
| | - Milta O Little
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
| | - Julie K Gammack
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
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Holguín Lew JC, Caamaño Jaraba J, Gómez Alzate A, Hidalgo López C, Marino Mondragón DF, Restrepo Moreno S, Rico Abella LE. [Pharmacological Treatment of Apathy in Parkinson's Disease: a Systematic Review of the Literature]. ACTA ACUST UNITED AC 2017; 46 Suppl 1:9-17. [PMID: 29037342 DOI: 10.1016/j.rcp.2017.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/20/2017] [Indexed: 12/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES Apathy, defined as a deficit for initiating and maintaining action, is a symptom affecting patients with diverse psychiatric and neuropsychiatric diseases, including dementia, sequelae of traumatic brain injury, schizophrenia, depression, and Parkinson's disease (PD). Apathy negatively affects function and quality of life of PD patients, and it is an important cause of caregiver's distress. The pharmacological treatment of apathy in PD is the focus of this systematic review. METHODS A comprehensive search and systematic selection was performed in different databases of original research papers on the treatment of apathy in PD. The results were then consolidated, and a critical analysis was made of the research papers. The results are then discussed according to the methodological standards for systematic reviews of the literature. RESULTS A total of 11 studies were included. Although some studies showed efficacy, all of them had important methodological limitations that hampered the interpretation of results. The results of the examined studies cannot be considered as evidence for guiding clinical decisions. CONCLUSIONS So far, no evidence-based recommendations can be offered for the treatment of apathy in PD. More studies with better methodological quality are needed. It is a potentially fruitful area for research and one badly needed by both PD patients and their caregivers.
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Affiliation(s)
- Jorge Carlos Holguín Lew
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - Jessica Caamaño Jaraba
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Alejandra Gómez Alzate
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Catalina Hidalgo López
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | | | - Liz Evelin Rico Abella
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
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Fox C, Smith T, Maidment I, Hebding J, Madzima T, Cheater F, Cross J, Poland F, White J, Young J. The importance of detecting and managing comorbidities in people with dementia? Age Ageing 2014; 43:741-3. [PMID: 25038831 DOI: 10.1093/ageing/afu101] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Chris Fox
- School of Medicine, University of East Anglia Norwich, Norwich, Norfolk NR47TJ, UK
| | - Toby Smith
- School of Rehabilitation Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Ian Maidment
- School of Life and Health Sciences, Medicines and Devices in Ageing, Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, UK
| | - Jennifer Hebding
- School of Medicine, University of East Anglia Norwich, Norwich, Norfolk NR47TJ, UK
| | - Tairo Madzima
- School of Medicine, University of East Anglia Norwich, Norwich, Norfolk NR47TJ, UK
| | - Francine Cheater
- School of Nursing Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Jane Cross
- School of Rehabilitation Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Fiona Poland
- School of Rehabilitation Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Jacqueline White
- Faculty of Health and Social Care, University of Hull, Hull, Yorkshire, UK
| | - John Young
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford,West Yorkshire, UK
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