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Yao S, Kendrick KM. Reduced homotopic interhemispheric connectivity in psychiatric disorders: evidence for both transdiagnostic and disorder specific features. PSYCHORADIOLOGY 2022; 2:129-145. [PMID: 38665271 PMCID: PMC11003433 DOI: 10.1093/psyrad/kkac016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 04/28/2024]
Abstract
There is considerable interest in the significance of structural and functional connections between the two brain hemispheres in terms of both normal function and in relation to psychiatric disorders. In recent years, many studies have used voxel mirrored homotopic connectivity analysis of resting state data to investigate the importance of connectivity between homotopic regions in the brain hemispheres in a range of neuropsychiatric disorders. The current review summarizes findings from these voxel mirrored homotopic connectivity studies in individuals with autism spectrum disorder, addiction, attention deficit hyperactivity disorder, anxiety and depression disorders, and schizophrenia, as well as disorders such as Alzheimer's disease, mild cognitive impairment, epilepsy, and insomnia. Overall, other than attention deficit hyperactivity disorder, studies across psychiatric disorders report decreased homotopic resting state functional connectivity in the default mode, attention, salience, sensorimotor, social cognition, visual recognition, primary visual processing, and reward networks, which are often associated with symptom severity and/or illness onset/duration. Decreased homotopic resting state functional connectivity may therefore represent a transdiagnostic marker for general psychopathology. In terms of disorder specificity, the extensive decreases in homotopic resting state functional connectivity in autism differ markedly from attention deficit hyperactivity disorder, despite both occurring during early childhood and showing extensive co-morbidity. A pattern of more posterior than anterior regions showing reductions in schizophrenia is also distinctive. Going forward, more studies are needed to elucidate the functions of these homotopic functional connections in both health and disorder and focusing on associations with general psychopathology, and not only on disorder specific symptoms.
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Affiliation(s)
- Shuxia Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Keith M Kendrick
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, China
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Zhu G, Tong Q, Ye X, Li J, Zhou L, Sun P, Liang F, Zhong S, Cheng R, Zhang J. Phototherapy for Cognitive Function in Patients With Dementia: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2022; 14:936489. [PMID: 35847661 PMCID: PMC9284896 DOI: 10.3389/fnagi.2022.936489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/10/2022] [Indexed: 12/01/2022] Open
Abstract
Background Dementia is a major health burden worldwide. As numerous pharmacological trials for dementia have failed, emerging phototherapy studies have evaluated the efficacy of alternative therapies for cognition. Objective The objective of this study was to evaluate the association between phototherapy and changes in cognitive deficits in patients with dementia. Methods PubMed, Embase, Web of Science, PsycINFO, CINAHL, and Cochrane Central Register of Controlled Trials were searched from inception to 27 March 2022. Inclusion criteria were controlled clinical trials of phototherapy interventions reporting pre-post changes in global cognitive function and subdomains in patients with dementia. Data were extracted by two independent reviewers and pooled in random-effects models. Subgroup and meta-regression analyses were conducted to investigate the sources of heterogeneity. Results Our analyses included 13 studies enrolling a total of 608 participants. Phototherapy showed significant associations with improvements of global cognitive function (standardized mean difference [SMD], 0.63; 95% confidence interval [CI], 0.33-0.94; P < 0.001) and subdomains, especially with respect to attention, executive function, and working memory. Near-infrared (NIR) light-emitting diodes (LEDs) photobiomodulation (SMD, 0.91; 95% CI, 0.46-1.36; P < 0.001) and lasers (SMD, 0.99; 95% CI, 0.56-1.43; P < 0.001) showed more significant associations with improved cognitive functions when compared with normal visible light. In addition, the effect sizes of short-term effects (SMD, 0.63; 95% CI, 0.33-0.94; P < 0.001) were larger than effects assessed in long-term follow-up (SMD, 0.49; 95% CI, -0.24-1.21; P = 0.189). Conclusion In this meta-analysis, phototherapy interventions were associated with cognitive improvement in patients with dementia. NIR LEDs and lasers had advantages over normal visible light. Domain-specific effects were indicated for attention, executive function, and working memory. Short-term improvement after phototherapy was supported, while evidence for long-term benefits was lacking. Stronger evidence for individualized parameters, such as optimal dosing, is needed in the future. Systematic Review Registration [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=267596], identifier [CRD42021267596].
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Affiliation(s)
- Genying Zhu
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- Department of Neurology & Brain Medical Centre, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qifeng Tong
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- College of Rehabilitation, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiangming Ye
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Juebao Li
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Liang Zhou
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Peng Sun
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Feng Liang
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Shuchang Zhong
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Ruidong Cheng
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- Department of Neurology & Brain Medical Centre, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jie Zhang
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- Department of Neurology & Brain Medical Centre, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Agrawal AK, Gowda M, Achary U, Gowda GS, Harbishettar V. Approach to Management of Wandering in Dementia: Ethical and Legal Issue. Indian J Psychol Med 2021; 43:S53-S59. [PMID: 34732955 PMCID: PMC8543604 DOI: 10.1177/02537176211030979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Wandering behavior is one of the most important and challenging management aspects in persons with dementia. Wandering behavior in people with dementia (PwD) is associated with an increased risk of falls, injuries, and fractures, as well as going missing or being lost from a facility. This causes increased distress in caregivers at home and in healthcare facilities. The approach to the comprehensive evaluation of the risk assessment, prevention, and treatment needs more strengthening and effective measures as the prevalence of wandering remains high in the community. Both the caregiver and clinicians need a clear understanding and responsibility of ethical and legal issues while managing and restraining the PwD. Ethical and legal issues especially in the light of the new Indian Mental Healthcare Act of 2017, related to confinement by family members in their homes by family caregivers, seclusion, physical or chemical restraints, other pharmacological and behavioral treatment, highlighting their effectiveness as well as adverse consequences are discussed. This article attempts to address an approach in managing wandering behavior in PwD in light of MHCA, 2017.
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Affiliation(s)
- Adesh Kumar Agrawal
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mahesh Gowda
- Spandana Nursing Home (Postgraduate Institute, DNB Psychiatry), Bengaluru, Karnataka, India
| | - Umesh Achary
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Guru S. Gowda
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Nicosia FM, Williams SL, Dannenbaum TP, Barnes DE. Resilience in the Face of Disaster: Psychosocial Effects of the 2017 Northern California Wildfires in Caregivers and Persons with Cognitive Impairment Participating in an Integrative Group Movement Program at an Adult Day Center. ACTIVITIES, ADAPTATION & AGING 2021. [DOI: 10.1080/01924788.2021.1916716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Francesca M. Nicosia
- San Francisco VA Health Care System, University of California, San Francisco, California, USA
| | - Sienna L. Williams
- San Francisco VA Healthcare System, VA Puget Sound Health Care System, Seattle, Washington, USA
| | | | - Deborah E. Barnes
- San Francisco VA Health Care System, University of California, San Francisco, California, USA
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Tyrrell M, Fossum B, Skovdahl K, Religa D, Hillerås P. Living with a well-known stranger: Voices of family members to older persons with frontotemporal dementia. Int J Older People Nurs 2019; 15:e12264. [PMID: 31577392 DOI: 10.1111/opn.12264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/21/2019] [Accepted: 07/01/2019] [Indexed: 01/10/2023]
Abstract
AIM To describe family members' experiences of living with persons with neuropsychiatric symptoms (NPS) related to frontotemporal dementia (FTD). BACKGROUND The majority of persons with dementia during the disease trajectory develop NPS. Persons with FTD are likely to develop greater levels of NPS than persons with other types of dementias. Research-based knowledge regarding family members' experiences of living with persons with FTD and NPS is limited. METHODS Nine family members of persons with FTD were interviewed. Interviews commenced with completion of the Neuropsychiatric Inventory (NPI). Upon completion of the NPI, questions were posed from an interview guide where study participants provided in-depth information about NPS identified. Interview data were analysed using qualitative content analysis. RESULTS Interviewed family members highlighted that persons with FTD had developed between four and eight co-existing NPS. Irritability and disinhibition were the most common NPS, with variations in severity, frequency and distress. From the interview data, two themes emerged: Living with a well-known stranger and Coping and overstepping social norms. CONCLUSIONS Living with a well-known stranger depicted a new co-existence with a loved one with changes in personality and behaviour, which were not inherent to the person or predictable any more. The presence of NPS can threaten the safety of the person with FTD and their family in real world and on social media. Support offered should focus on the person's physical and psychological needs, not on a diagnosis. IMPLICATIONS FOR PRACTICE From a health care perspective it is important to see the person with FTD and their family as unique individuals with specific needs.
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Affiliation(s)
- Marie Tyrrell
- Sophiahemmet University, Stockholm, Sweden.,NVS, Karolinska Institutet, Stockholm, Sweden
| | - Bjöörn Fossum
- Sophiahemmet University, Stockholm, Sweden.,SöS, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Pernilla Hillerås
- Sophiahemmet University, Stockholm, Sweden.,NVS, Karolinska Institutet, Stockholm, Sweden.,Red Cross University College, Stockholm, Sweden
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Gottesman RT, Stern Y. Behavioral and Psychiatric Symptoms of Dementia and Rate of Decline in Alzheimer's Disease. Front Pharmacol 2019; 10:1062. [PMID: 31616296 PMCID: PMC6768941 DOI: 10.3389/fphar.2019.01062] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/20/2019] [Indexed: 12/20/2022] Open
Abstract
Alzheimer’s disease causes both cognitive and non-cognitive symptoms. There is increasing evidence that the presentation and course of Alzheimer’s disease is highly heterogenous. This heterogeneity presents challenges to patients, their families, and clinicians due to the difficulty in prognosticating future symptoms and functional impairment. Behavioral and psychiatric symptoms are emerging as a significant contributor to this clinical heterogeneity. These symptoms have been linked to multiple areas of neurodegeneration, which may suggest that they are representative of network-wide dysfunction in the brain. However, current diagnostic criteria for Alzheimer’s disease focus exclusively on the cognitive aspects of disease. Behavioral and psychiatric symptoms have been found in multiple studies to be related to disease severity and to contribute to disease progression over time. A better understanding of how behavioral and psychiatric symptoms relate to cognitive aspects of Alzheimer’s disease would help to refine the models of disease and hopefully lead to improved ability to develop therapeutic options for this devastating disease.
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Affiliation(s)
- Reena T Gottesman
- Division of Aging and Dementia, Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Yaakov Stern
- Division of Cognitive Neuroscience, Department of Neurology, Columbia University Medical Center, New York, NY, United States
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7
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Isik AT, Soysal P, Solmi M, Veronese N. Bidirectional relationship between caregiver burden and neuropsychiatric symptoms in patients with Alzheimer's disease: A narrative review. Int J Geriatr Psychiatry 2019; 34:1326-1334. [PMID: 30198597 DOI: 10.1002/gps.4965] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 07/25/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this review is to make a state of the art of the potential influence of neuropsychiatric symptoms (NPs) on caregiver stress and vice versa. METHODS We searched PubMed and Google Scholar for potential eligible articles. RESULTS Patients with Alzheimer's disease (AD) usually need high levels of care in all activities of daily living, most of them provided by family members, friends, or informal caregivers. Caregivers have to cope with both age-related conditions and dementia-related factors. Therefore, caregiving in dementia is more difficult and stressful than caregiving for older adults, affected by other conditions. Neuropsychiatric symptoms, such as anxiety, agitation, disinhibition, aggressive behavior, and sleep disturbances are more closely related to caregiver burden, and associated with more negative outcomes such as decline in their general health, quality of life, and social isolation. Caregiver burden worsens relationship between caregiver and patients with AD. Thus, this relationship may increase the frequency and severity of NPs. Predictors of burden were being a woman, a spouse, and old person with immature coping mechanisms, social isolation, with insufficient knowledge about dementia, poor premorbid relationship with patient, and high levels of negative expressed emotions. CONCLUSION Because of the bidirectional relationship between caregiver burden and NPs, the active management strategies of dementia care should include early identification and treatment risk factors for both caregiver stress and NPs in patients with AD. Therefore, to improve one of them can be exert beneficial for the other.
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Affiliation(s)
- Ahmet Turan Isik
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy.,Centro Neuroscienze Cognitive, University of Padua, Padua, Italy
| | - Nicola Veronese
- Geriatrics Unit, Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy.,Neuroscience Institute, Aging Branch, National Research Council, Padova, Italy
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Halpern R, Seare J, Tong J, Hartry A, Olaoye A, Aigbogun MS. Using electronic health records to estimate the prevalence of agitation in Alzheimer disease/dementia. Int J Geriatr Psychiatry 2019; 34:420-431. [PMID: 30430642 PMCID: PMC7379654 DOI: 10.1002/gps.5030] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 11/03/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Agitation is a common neuropsychiatric symptom of Alzheimer disease (AD). Data are scarce regarding agitation prevalence among community-dwelling patients with AD. OBJECTIVE To estimate agitation prevalence in a sample of US patients with AD/dementia overall and by AD/dementia disease severity, using data from electronic health records (EHR). METHODS This retrospective database study examined community-dwelling patients with ≥1 EHR record indicating AD/dementia from January 2008 to June 2015 and no evidence of non-Alzheimer dementia during the 12-month preindex and postindex periods. Agitation was identified using diagnosis codes for dementia with behavioral disturbance and EHR abstracted notes records indicating agitation symptoms compiled from the International Psychogeriatric Association provisional consensus definition. RESULTS Of 320 886 eligible patients (mean age, 76.4 y, 64.7% female), 143 160 (44.6%) had evidence of agitation during the observation period. Less than 5% of patients with agitation had a diagnosis code for behavioral disturbance. The most prevalent symptom categories among patients with agitation, preindex and postindex, were agitation (31.4% and 41.3%), falling (22.6% and 21.7%), and restlessness (18.3% and 23.3%). Among the 78 827 patients (24.6%) with known AD/dementia severity, agitation prevalence was 61.3%. Agitation during the observation period was most prevalent for moderate-to-severe and severe AD/dementia (74.6% and 68.3%, respectively) and lowest for mild AD/dementia (56.4%). CONCLUSIONS Agitation prevalence was 44.6% overall and 61.3% among patients with staged AD/dementia. Behavioral disturbance appeared to be underdiagnosed. While agitation has previously been shown to be highly prevalent in the long-term care setting, this study indicates that it is also common among community-dwelling patients.
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Affiliation(s)
- Rachel Halpern
- Health Economics and Outcomes ResearchOptumEden PrairieMinnesota
| | - Jerald Seare
- Health Economics and Outcomes ResearchOptumEden PrairieMinnesota
| | - Junliang Tong
- Health Economics and Outcomes ResearchOptumEden PrairieMinnesota
| | - Ann Hartry
- Health Economics and Outcomes ResearchLundbeck LLCDeerfieldIllinois
| | - Anthony Olaoye
- Business AnalyticsOtsuka America PharmaceuticalsPrincetonNew Jersey
| | - Myrlene Sanon Aigbogun
- Health Economics and Outcomes ResearchOtsuka Pharmaceutical Development & Commercialization, Inc.PrincetonNew Jersey
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9
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Ruthirakuhan M, Lanctôt KL, Di Scipio M, Ahmed M, Herrmann N. Biomarkers of agitation and aggression in Alzheimer's disease: A systematic review. Alzheimers Dement 2018; 14:1344-1376. [DOI: 10.1016/j.jalz.2018.04.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 04/12/2018] [Accepted: 04/26/2018] [Indexed: 01/24/2023]
Affiliation(s)
- Myuri Ruthirakuhan
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoONCanada
- Department of Pharmacology and ToxicologyUniversity of TorontoTorontoONCanada
| | - Krista L. Lanctôt
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoONCanada
- Department of Pharmacology and ToxicologyUniversity of TorontoTorontoONCanada
- Geriatric PsychiatrySunnybrook Health Sciences CentreTorontoONCanada
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | - Matteo Di Scipio
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoONCanada
| | - Mehnaz Ahmed
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoONCanada
- Department of Pharmacology and ToxicologyUniversity of TorontoTorontoONCanada
| | - Nathan Herrmann
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoONCanada
- Geriatric PsychiatrySunnybrook Health Sciences CentreTorontoONCanada
- Department of PsychiatryUniversity of TorontoTorontoONCanada
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Slyer JT, Archibald E, Moyo F, Truglio-Londrigan M. Advance care planning and anticipatory decision making in patients with Alzheimer disease. Nurse Pract 2018; 43:23-31. [PMID: 29757832 DOI: 10.1097/01.npr.0000532763.68509.e4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Early advance care planning and anticipatory decision making in the Alzheimer disease (AD) trajectory is a strategy NPs can incorporate to improve managing uncertainty around common decisions. This article explores decisions patients and caregivers face along the AD trajectory and provides resources for patients, caregivers, and NPs.
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Affiliation(s)
- Jason T Slyer
- Jason T. Slyer is a clinical assistant professor at Pace University, College of Health Professions, New York, N.Y., and an NP at Matrix Medical Network, New York, N.Y. Ella Archibald is a family NP at Hospital for Special Surgery, New York, N.Y. Fernea Moyo is an NP at New York Presbyterian Hospital, New York, N.Y. Marie Truglio-Londrigan is a professor at Pace University College of Health Professions, Lienhard School of Nursing, New York, N.Y
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Huang SS, Wang WF, Liao YC. Severity and prevalence of behavioral and psychological symptoms among patients of different dementia stages in Taiwan. ARCH CLIN PSYCHIAT 2017. [DOI: 10.1590/0101-60830000000127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Tyrrell M, Hillerås P, Skovdahl K, Fossum B, Religa D. Voices of Spouses Living with Partners with Neuropsychiatric Symptoms Related to Dementia. DEMENTIA 2017; 18:903-919. [PMID: 28385034 DOI: 10.1177/1471301217693867] [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] [Indexed: 11/17/2022]
Abstract
Persons with dementia, who reside in their own homes, are often cared for by family members. The presence of a family career is said to have a protective effect, postponing admissions to residential care. The majority of persons with dementia develop behavioural and personality changes during the disease trajectory also known as neuropsychiatric symptoms. Quality of life for both the person with neuropsychiatric symptoms and their careers are affected, increasing suffering and risk for hospitalisation and admission to long-term residential care. Family careers to persons with dementia have identified behavioural changes as more distressing than cognitive impairment leading to increased burden of care and admissions to residential care. Knowledge gaps exist regarding how family careers living with persons with dementia experience neuropsychiatric symptoms in a community setting. The aim was to describe spouses' experiences of living with partners who have developed neuropsychiatric symptoms related to dementia in a community setting. Semi-structured interviews were carried out with 14 spouses of partners with dementia. The interviews included completion of the neuropsychiatric inventory. Interview data were analysed using a content analysis approach. The results showed that spouses identified in the neuropsychiatric inventory that partners with dementia had on average five to eight co-existing symptoms. Frequency, severity and distress varied. From the narrative data, the theme living on the edge lacking support and time for self, emerged. The findings of this study suggest that support offered to persons with dementia and their spouses should have a person-centred approach meeting individual needs. Safety and welfare of persons with dementia and their spouses residing in their own homes may be jeopardised in the presence of neuropsychiatric symptoms. A greater awareness is required in the community regarding the well-being of these persons.
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Affiliation(s)
- Marie Tyrrell
- Karolinska Institutet and Sophiahemmet University, Sweden
| | | | | | - Bjöörn Fossum
- Sophiahemmet University and Karolinska Institutet, Sweden
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Stern Y, Gu Y, Cosentino S, Azar M, Lawless S, Tatarina O. The Predictors study: Development and baseline characteristics of the Predictors 3 cohort. Alzheimers Dement 2017; 13:20-27. [PMID: 27219818 PMCID: PMC5118195 DOI: 10.1016/j.jalz.2016.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/18/2016] [Accepted: 04/09/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The Predictors study was designed to predict the length of time to major disease outcomes in Alzheimer's disease (AD) patients. Here, we describe the development of a new, Predictors 3, cohort. METHODS Patients with prevalent or incident AD and individuals at-risk for developing AD were selected from the North Manhattan community and followed annually with instruments comparable to those used in the original two Predictors cohorts. RESULTS The original Predictors cohorts were clinic based and racially/ethnically homogenous (94% white, 6% black; 3% Hispanic). In contrast, the 274 elders in this cohort are community-based and ethnically diverse (39% white, 40% black, 21% other; 78% Hispanic). Confirming previous observations, psychotic features were associated with poorer function and mental status and extrapyramidal signs with poorer function. DISCUSSION This new cohort will allow us to test observations made in our original clinic-based cohorts in patients that may be more representative of the general community.
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Affiliation(s)
- Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - Yian Gu
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Martina Azar
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Siobhan Lawless
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Oksana Tatarina
- Cognitive Neuroscience Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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van der Linde RM, Dening T, Stephan BCM, Prina AM, Evans E, Brayne C. Longitudinal course of behavioural and psychological symptoms of dementia: systematic review. Br J Psychiatry 2016; 209:366-377. [PMID: 27491532 PMCID: PMC5100633 DOI: 10.1192/bjp.bp.114.148403] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 02/27/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND More information about the pattern of behavioural and psychological symptoms of dementia (BPSD) in the course of dementia is needed to inform patients and clinicians and to design future interventions. AIMS To determine the persistence and incidence of BPSD and their relation to cognitive function, in individuals with dementia or in cohorts investigated for dementia onset. METHOD A systematic literature review analysed the baseline prevalence, persistence and incidence of 11 symptoms. The review was conducted according to established guidelines with the exception that we could not exclude the possibilities of bias in the studies examined. RESULTS The 59 included studies showed considerable heterogeneity in their objectives and methods. The symptoms hyperactivity and apathy showed high persistence and incidence; depression and anxiety low or moderate persistence and moderate incidence; and psychotic symptoms low persistence with moderate or low incidence. CONCLUSIONS Despite heterogeneity across studies in terms of setting, focus and length of follow-up, there were clinically relevant differences in the longitudinal courses of different BPSD. Apathy was the only symptom with high baseline prevalence, persistence and incidence during the course of dementia.
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Affiliation(s)
- Rianne M. van der Linde
- Correspondence: R. van der Linde, Department of Public Health and Primary Care, Herchel Smith Building, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK.
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Abstract
We studied 183 patients with advanced dementia who had been admitted to the Geriatric-Internal Medicine Department of a general hospital, with a 1 year follow-up evaluated by Mini-Suffering State Examination (MSSE) scores on first days after admission. The not calm compared to calm patients with advanced dementia had a high suffering level (6.12 ± 2.16 versus 3.21 ± 1.71) with a statistically significant difference (P = 0.001). The not calm patients were sicker, a higher percentage had fever (P = 0.005), elevated levels of white blood cells WBC (P = 0.003) and C-reactive protein (CRP) (P = 0.020). The Kaplan-Meier function analysis showed a shorter survival of not calm versus calm advanced dementia patients, with a statistically significant difference (Log Rank [Mantel-Cox] P = 0.002). Not calm in advanced dementia patients is the first item of the MSSE and is a very important symptom of Aminoff Suffering Syndrome.
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Affiliation(s)
- Bechor Zvi Aminoff
- The Minerva Center for the Interdisciplinary Study of End-of-Life, Tel Aviv University, Ramat Aviv, Israel Geriatric Division, The Chaim Sheba Medical Center, Tel Hashomer, Israel
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A Relationship between Depression and Wandering in Community-Dwelling Elders with Dementia. Dement Neurocogn Disord 2016; 15:1-6. [PMID: 30906332 PMCID: PMC6427960 DOI: 10.12779/dnd.2016.15.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 03/15/2016] [Accepted: 03/15/2016] [Indexed: 11/27/2022] Open
Abstract
Background and Purpose Wandering is one of the most common behavioral and psychological symptoms of dementia, and associated with some of the adverse outcomes in dementia, such as getting lost or even death. The etiology of wandering is not yet clearly known. As depression and wandering are both very common among the patients with dementia, this study examined the relationship between the depression and wandering among the community dwelling patients with dementia. Methods Fifty community dwelling patients diagnosed with dementia were included in this study if they had primary family caregiver, older than age 18 in Seoul, South Korea. The Geriatric Depression Scale, Korean Version (GDS-K), Korean Version of the Mini-Mental State Examination (K-MMSE) and Korean Version of Revised Algase Wandering Scale-Community Version (K-RAWS-CV) were used to measure the severity of depression, cognitive function and wandering. Results Thirty percents of the patients showed wandering. Mean score of GDS-K was significantly higher in wanderers than non-wanderers. Severity of depression was significantly correlated with the total score of K-RAWS-CV and subscales of persistent walking, repetitive walking, eloping behavior, and mealtime impulsivity in whole sample. K-MMSE score also was related to wandering behavior. The prevalence odds ratio for wandering in depressed patients compared with undepressed group was 8.386 (95% confidence interval: 1.978–35.561). Conclusions This study implicates that not only cognitive impairment but also psychosocial aspects should be considered in wandering patients with dementia and suggests assessing the depression in patients would be helpful in identifying the causes of wandering.
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Holston EC. The Electrophysiological Phenomenon of Alzheimer's Disease: A Psychopathology Theory. Issues Ment Health Nurs 2015; 36:603-13. [PMID: 26379134 DOI: 10.3109/01612840.2015.1015696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The current understanding of Alzheimer's disease (AD) is based on the Aβ and tau pathology and the resulting neuropathological changes, which are associated with manifested clinical symptoms. However, electrophysiological brain changes may provide a more expansive understanding of AD. Hence, the objective of this systematic review is to propose a theory about the electrophysiological phenomenon of Alzheimer's disease (EPAD). The review of literature resulted from an extensive search of PubMed and MEDLINE databases. One-hundred articles were purposively selected. They provided an understanding of the concepts establishing the theory of EPAD (neuropathological changes, neurochemical changes, metabolic changes, and electrophysiological brain changes). Changes in the electrophysiology of the brain are foundational to the association or interaction of the concepts. Building on Berger's Psychophysical Model, it is evident that electrophysiological brain changes occur and affect cortical areas to generate or manifest symptoms from onset and across the stages of AD, which may be prior to pathological changes. Therefore, the interaction of the concepts demonstrates how the psychopathology results from affected electrophysiology of the brain. The theory of the EPAD provides a theoretical foundation for appropriate measurements of AD without dependence on neuropathological changes. Future research is warranted to further test this theory. Ultimately, this theory contributes to existing knowledge because it shows how electrophysiological changes are useful in understanding the risk and progression of AD across the stages.
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Affiliation(s)
- Ezra C Holston
- a University of Tennessee-Knoxville , College of Nursing , Knoxville , Tennessee , USA
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Behavioral and psychological symptoms and cognitive decline in patients with amnestic MCI and mild AD: a two-year follow-up study. Int Psychogeriatr 2015; 27:1379-89. [PMID: 25592615 DOI: 10.1017/s104161021400283x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) has been defined as a transitional state between normal aging and dementia. In many cases, MCI represents an early stage of developing cognitive impairment. Patients diagnosed with MCI do not meet the criteria for dementia as their general intellect and everyday activities are preserved, although minor changes in instrumental activities of daily living (ADL) may occur. However, they may exhibit significant behavioral and psychological signs and symptoms (BPS), also frequently observed in patients with Alzheimer's disease (AD). Hence, we wondered to what extent specific BPS are associated with cognitive decline in participants with MCI or AD. METHODS Our sample consisted of 164 participants, including 46 patients with amnestic (single or multi-domain) MCI and 54 patients with AD, as well as 64 control participants without cognitive disorders. Global cognitive performance, BPS, and ADL were assessed using validated clinical methods at baseline and at two-year follow-up. RESULTS The BPS variability over the follow-up period was more pronounced in the MCI group than in patients with AD: some BPS improve, others occur newly or worsen, while others still remain unchanged. Moreover, specific changes in BPS were associated with a rapid deterioration of the global cognitive level in MCI patients. In particular, an increase of euphoria, eating disorders, and aberrant motor behavior, as well as worsened sleep quality, predicted a decline in cognitive functioning. CONCLUSIONS Our findings confirm a higher variability of BPS over time in the MCI group than in AD patients. Moreover, our results provide evidence of associations between specific BPS and cognitive decline in the MCI group that might suggest a risk of conversion of individuals with amnestic MCI to AD.
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Wu MK, Lu YT, Huang CW, Lin PH, Chen NC, Lui CC, Chang WN, Lee CC, Chang YT, Chen SF, Chang CC. Clinical Significance of Cerebrovascular Biomarkers and White Matter Tract Integrity in Alzheimer Disease: Clinical correlations With Neurobehavioral Data in Cross-Sectional and After 18 Months Follow-ups. Medicine (Baltimore) 2015; 94:e1192. [PMID: 26181568 PMCID: PMC4617061 DOI: 10.1097/md.0000000000001192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cerebrovascular risk factors and white matter (WM) damage lead to worse cognitive performance in Alzheimer dementia (AD). This study investigated WM microstructure using diffusion tensor imaging in patients with mild to moderate AD and investigated specific fiber tract involvement with respect to predefined cerebrovascular risk factors and neurobehavioral data prediction cross-sectionally and after 18 months. To identify the primary pathoanatomic relationships of risk biomarkers to fiber tract integrity, we predefined 11 major association tracts and calculated tract specific fractional anisotropy (FA) values. Eighty-five patients with AD underwent neurobehavioral assessments including the minimental state examination (MMSE) and 12-item neuropsychiatric inventory twice with a 1.5-year interval to represent major outcome factors. In the cross-sectional data, total cholesterol, low-density lipoprotein, vitamin B12, and homocysteine levels correlated variably with WM FA values. After entering the biomarkers and WM FA into a regression model to predict neurobehavioral outcomes, only fiber tract FA or homocysteine level predicted the MMSE score, and fiber tract FA or age predicted the neuropsychiatric inventory total scores and subdomains of apathy, disinhibition, and aberrant motor behavior. In the follow-up neurobehavioral data, the mean global FA value predicted the MMSE and aberrant motor behavior subdomain, while age predicted the anxiety and elation subdomains. Cerebrovascular risk biomarkers may modify WM microstructural organization, while the association with fiber integrity showed greater clinical significance to the prediction of neurobehavioral outcomes both cross-sectionally and longitudinally.
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Affiliation(s)
- Ming-Kung Wu
- From the Department of Psychiatry (M-KW, S-FC); Department of Neurology, Cognition and Aging Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine (Y-TL, C-WH, N-CC, W-NC, Y-TC, S-FC, C-CC); Department of Health and Beauty, Shu-Zen College of Medicine and Management (P-HL, Chen-Chang Lee); and Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (Chun-Chung Lui)
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Yoon JH, Kim M, Moon SY, Yong SW, Hong JM. Olfactory function and neuropsychological profile to differentiate dementia with Lewy bodies from Alzheimer's disease in patients with mild cognitive impairment: A 5-year follow-up study. J Neurol Sci 2015; 355:174-9. [PMID: 26076880 DOI: 10.1016/j.jns.2015.06.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) is a well-known precursor of Alzheimer's disease (AD) but often also precedes dementia with Lewy bodies (DLB). The early differentiation of DLB from AD is important to delay disease progression. Olfactory dysfunction is a well-known early sign of both AD and Lewy body disorders, including Parkinson's disease (PD) and DLB. Thus, the aim of the present study was to determine whether olfactory and neuropsychological tests can aid in the differentiation of DLB from AD at the MCI stage. METHODS The present study included 122 MCI patients who were monitored until they developed dementia or until their condition stabilized; the follow-up period averaged 4.9 years (range: 3.9-6.2 years). Baseline olfactory function as measured with the Cross-Cultural Smell Identification (CCSI) test and neuropsychological data were compared. RESULTS During the follow-up period, 32 subjects developed probable AD (MCI-AD), 18 had probable DLB (MCI-DLB), 45 did not convert to dementia (MCI-stable), and eight developed a non-AD/DLB dementia. The mean CCSI score (95% confidence interval [CI]) in patients with MCI-DLB (4.6; 95% CI: 4.0-5.3) was significantly lower than that of MCI-AD patients (6.4; 95% CI: 6.0-6.7, p<0.001) and MCI-stable patients (7.3; 95% CI: 6.9-7.8, p<0.001). The area under the curve of the receiver operating characteristic to discriminate MCI-DLB from MCI-AD using CCSI scores was (0.84; 95% CI: 0.72-0.97). Frontal-executive function and visuospatial ability was worse in patients with MCI-DLB, while verbal recognition memory impairment was greater in those with MCI-AD. CONCLUSION Olfactory and neuropsychological tests can help predict conversion to DLB or AD in patients with MCI.
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Affiliation(s)
- Jung Han Yoon
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea.
| | - Min Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - So Young Moon
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - Seok Woo Yong
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
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Nakatsuka M, Meguro K, Nakamura K, Akanuma K, Yamaguchi S. 'Residence is not home' is a particular type of delusion associated with cognitive decline of Alzheimer's disease. Dement Geriatr Cogn Disord 2015; 38:46-54. [PMID: 24556941 DOI: 10.1159/000357837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although delusion is one of the common symptoms of Alzheimer's disease (AD), the association between cognitive deficits and delusions remains unclear. Considering the heterogeneity of delusion, the correlation may depend upon the type of the delusion. METHODS 142 consecutive first-visit AD outpatients of the Tajiri Clinic (Osaki, Miyagi, Japan) were enrolled in the study. Psychological data included the Mini-Mental State Examination (MMSE), the Cognitive Abilities Screening Instrument (CASI) and the Frequency-Weighted Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD-FW). Correlations to cognitive deficits for each category of delusional content were evaluated. RESULTS More severe delusion of 'residence is not home' was significantly correlated with a lower total MMSE score and poorer orientation as assessed with the CASI. This type of delusion also correlated to activity disturbances and was weakly associated with affective disturbances. CONCLUSION Our findings suggest that the 'residence is not home' delusion is a particular symptom that has a cognitive background, particularly disorientation, and should be discriminated from other delusional phenomena. We should cope with delusions specifying what types of delusions are present since the content of delusions may critically mark the symptomatology of AD. For this purpose, the BEHAVE-AD-FW may be suitable.
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Affiliation(s)
- Masahiro Nakatsuka
- Department of Geriatric Behavioral Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
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The course of neuropsychiatric symptoms in community-dwelling patients with dementia: a systematic review. Int Psychogeriatr 2015; 27:385-405. [PMID: 25403309 DOI: 10.1017/s1041610214002282] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) often occur in patients with dementia. Understanding the course of NPS in dementia is important for healthcare professionals for psycho-educational purposes and adequate and timely interventions to prevent or diminish NPS as much as possible. METHODS We conducted a systematic literature search in several electronic databases. We combined search strings for the terms dementia, community-dwelling, cohort studies and NPS. Screening titles and abstracts, assessing the methodological quality and data-extraction were independently conducted by at least two authors. RESULTS This literature search revealed 6605 unique records of which 23 studies were included in data synthesis. In total 7184 patients participated in the included studies with a mean number of 312. Sixty percent of the participants were female and the mean age of all participants was 74.8 years. Follow-up varied between 1 and 6 years; in 17 studies loss to follow-up was less than 20% per year. NPS are highly prevalent, incident and persistent although frequency parameters vary considerably across studies. Delusions/delusional misidentification, wandering/agitation, aberrant motor behavior/motor hyperactivity and apathy are the most common NPS. For hallucinations, delusions/delusional misidentification, paranoia, aggression, wandering/agitation, aberrant motor behavior/motor hyperactivity, disinhibition, apathy, and sleep disturbance increasing trends in point prevalence rates have been found. CONCLUSIONS NPS in community-dwelling patients are frequent and persistent. The increasing trends of several NPS in the course of dementia require a preventive approach of professional caretakers. For such an approach, a timely diagnosis and adequate professional support to prevent or diminish these problems is necessary.
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24
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Cipriani G, Lucetti C, Nuti A, Danti S. Wandering and dementia. Psychogeriatrics 2014; 14:135-42. [PMID: 24661471 DOI: 10.1111/psyg.12044] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 01/10/2014] [Accepted: 01/21/2014] [Indexed: 11/29/2022]
Abstract
Wandering represents one of many behavioural problems occurring in people with dementia. To consider the phenomenon of wandering behaviour in demented patients, we conducted searches using Medline and Google Scholar to find relevant articles, chapters, and books published since 1975. Search terms used included 'wandering', 'behavioural and psychological symptoms', 'dementia', 'nursing', and 'elopements'. Publications found through this indexed search were reviewed for further relevant references. The term 'wandering' covers different types of behaviour, including aimless movement without a discernible purpose. It is associated with a variety of negatives outcomes. The aetiology of wandering is poorly understood and it remains an unsolved riddle. Wandering is an acutely distressing problem worldwide, both for the patients and caregivers, and it is a major reason for nursing home admission. Evidence on the effectiveness of pharmacological and non-pharmacological interventions is limited. It is possible that management of coexistent psychopathology would help to ameliorate this problematic behavioural disorder.
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Affiliation(s)
- Gabriele Cipriani
- Neurology Unit, Hospital of Viareggio, Lido di Camaiore, Lucca, Italy
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25
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Steinberg M, Hess K, Corcoran C, Mielke MM, Norton M, Breitner J, Green R, Leoutsakos J, Welsh-Bohmer K, Lyketsos C, Tschanz J. Vascular risk factors and neuropsychiatric symptoms in Alzheimer's disease: the Cache County Study. Int J Geriatr Psychiatry 2014; 29:153-9. [PMID: 23681754 PMCID: PMC3883945 DOI: 10.1002/gps.3980] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 04/03/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Knowledge of potentially modifiable risk factors for neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) is important. This study longitudinally explores modifiable vascular risk factors for NPS in AD. METHODS Participants enrolled in the Cache County Study on Memory in Aging with no dementia at baseline were subsequently assessed over three additional waves, and those with incident (new onset) dementia were invited to join the Dementia Progression Study for longitudinal follow-up. A total of 327 participants with incident AD were identified and assessed for the following vascular factors: atrial fibrillation, hypertension, diabetes mellitus, angina, coronary artery bypass surgery, myocardial infarction, cerebrovascular accident, and use of antihypertensive or diabetes medicines. A vascular index (VI) was also calculated. NPS were assessed over time using the Neuropsychiatric Inventory (NPI). Affective and Psychotic symptom clusters were assessed separately. The association between vascular factors and change in NPI total score was analyzed using linear mixed model and in symptom clusters using a random effects model. RESULTS No individual vascular risk factors or the VI significantly predicted change in any individual NPS. The use of antihypertensive medications more than four times per week was associated with higher total NPI and Affective cluster scores. CONCLUSIONS Use of antihypertensive medication was associated with higher total NPI and Affective cluster scores. The results of this study do not otherwise support vascular risk factors as modifiers of longitudinal change in NPS in AD.
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Affiliation(s)
- Martin Steinberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Kyle Hess
- Center for Epidemiologic Studies, Utah State University, Logan, UT
| | - Chris Corcoran
- Center for Epidemiologic Studies, Utah State University, Logan, UT,Department of Mathematics and Statistics, Utah State University, Logan, UT
| | - Michelle M. Mielke
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester MN
| | - Maria Norton
- Center for Epidemiologic Studies, Utah State University, Logan, UT,Department of Family Consumer and Human Development, Utah State University, Logan, UT,Department of Psychology, Utah State University, Logan, UT
| | - John Breitner
- Centre for Studies on Prevention of Alzheimer’s Disease, Douglas Mental Health Institute Research Center; and Department of Psychiatry, McGill University Faculty of Medicine, Montreal, QC, CA
| | - Robert Green
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston MA
| | - Jeannie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Kathleen Welsh-Bohmer
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Constantine Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Joann Tschanz
- Center for Epidemiologic Studies, Utah State University, Logan, UT,Department of Family Consumer and Human Development, Utah State University, Logan, UT
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Neuropsychological Characteristics of Wandering in Patients with Drug-naïve Alzheimer's Disease. Dement Neurocogn Disord 2014. [DOI: 10.12779/dnd.2014.13.3.74] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Lenderking WR, Wyrwich KW, Stolar M, Howard KA, Leibman C, Buchanan J, Lacey L, Kopp Z, Stern Y. Reliability, validity, and interpretation of the dependence scale in mild to moderately severe Alzheimer's disease. Am J Alzheimers Dis Other Demen 2013; 28:738-49. [PMID: 24363071 PMCID: PMC10852813 DOI: 10.1177/1533317513504609] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The Dependence Scale (DS) was designed to measure dependence on others among patients with Alzheimer's disease (AD). The objectives of this research were primarily to strengthen the psychometric evidence for the use of the DS in AD studies. METHODS Patients with mild to moderately severe AD were examined in 3 study databases. Within each data set, internal consistency, validity, and responsiveness were examined, and structural equation models were fit. RESULTS The DS has strong psychometric properties. The DS scores differed significantly across known groups and demonstrated moderate to strong correlations with measures hypothesized to be related to dependence (|r| ≥ .31). Structural equation modeling supported the validity of the DS concept. An anchor-based DS responder definition to interpret a treatment benefit over time was identified. DISCUSSION The DS is a reliable, valid, and interpretable measure of dependence associated with AD and is shown to be related to--but provides information distinct from--cognition, functioning, and behavior.
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Affiliation(s)
- William R. Lenderking
- Evidera, Bethesda, MD, USA, formerly a division of United BioSource Corporation, USA
| | - Kathleen W. Wyrwich
- Evidera, Bethesda, MD, USA, formerly a division of United BioSource Corporation, USA
| | - Marilyn Stolar
- Formerly at United BioSource Corporation, Bethesda, MD, USA
| | | | - Chris Leibman
- Janssen Alzheimer Immunotherapy, South San Francisco, CA, USA
| | - Jacqui Buchanan
- Formerly with Janssen Alzheimer Immunotherapy, South San Francisco, CA, USA
| | - Loretto Lacey
- Formerly with Janssen Alzheimer Immunotherapy, South San Francisco, CA, USA
| | - Zoe Kopp
- Formerly with Pfizer Inc, NY, NY, and currently with Kopp International, Brattleboro, VT, USA
| | - Yaakov Stern
- Department of Neurology, Columbia University, New York, NY, USA
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Creese B, Ballard C, Jones E. Cognitive impairment in studies of 5HTTLPR and psychosis in Alzheimer's disease: a systematic review. Dement Geriatr Cogn Disord 2013; 35:155-64. [PMID: 23392273 DOI: 10.1159/000346733] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2012] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND/AIMS Cognitive impairment is a well-established correlate of psychotic symptoms in Alzheimer's disease (AD-P). We review whether this relationship has confounded previous genetic association studies of 5HTTLPR and AD-P. METHODS We reviewed all studies on 5HTTLPR and conducted a semi-quantitative analysis. RESULTS Three out of 4 studies with low MMSE reported a significant association, while 1 out of 4 with high MMSE reported a significant association. CONCLUSIONS Variation in cognitive impairment in past studies has contributed to the inconsistency in findings. The findings presented here bring a greater clarity to our understanding of the role of 5HTTLPR in AD-P.
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Affiliation(s)
- Byron Creese
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK
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van der Linde RM, Stephan BCM, Matthews FE, Brayne C, Savva GM. The presence of behavioural and psychological symptoms and progression to dementia in the cognitively impaired older population. Int J Geriatr Psychiatry 2013; 28:700-9. [PMID: 22887592 DOI: 10.1002/gps.3873] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 07/18/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Behavioural and psychological symptoms (BPS) are common in the older population and may be an indication of early dementia. We explored the predictive effect of the presence of BPS on the 2-year progression to dementia in a cognitively impaired population aged 65 years and over without dementia at baseline. METHODS Twelve symptoms were measured in 2024 participants without dementia at baseline as part of a population-based longitudinal study of ageing. The risk of progression to dementia was predicted in those with cognitive impairment for each individual BPS and using a BPS composite score. RESULTS Wandering and persecution were independently associated with progression to dementia after adjustment for socio-demographic factors, cognitive domains and other BPS. When stratifying by cognitive function, those with low cognition (MMSE 0-18) and 4 or more BPS were more likely to progress to dementia than those without BPS. CONCLUSIONS We have shown that some psychiatric symptoms are associated with increased short-term progression to dementia in those with low cognition. The predictive effect of BPS in dementia progression has implications for risk stratification of those at high risk of progression to dementia, along with memory impairment, other cognitive impairment and health variables.
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Affiliation(s)
- Rianne M van der Linde
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK.
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Fast R, Schütt T, Toft N, Møller A, Berendt M. An Observational Study with Long-Term Follow-Up of Canine Cognitive Dysfunction: Clinical Characteristics, Survival, and Risk Factors. J Vet Intern Med 2013; 27:822-9. [DOI: 10.1111/jvim.12109] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 03/21/2013] [Accepted: 04/11/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- R. Fast
- Department of Veterinary Clinical and Animal Sciences (DVCAS); Faculty of Health and Medical Sciences; University of Copenhagen (UC); Frederiksberg C Denmark
| | - T. Schütt
- Department of Veterinary Clinical and Animal Sciences (DVCAS); Faculty of Health and Medical Sciences; University of Copenhagen (UC); Frederiksberg C Denmark
| | - N. Toft
- Department of Large Animal Sciences; Faculty of Life Science; University of Copenhagen; Frederiksberg C Denmark
| | - A. Møller
- Centre of Functionally Integrative Neuroscience (CFIN); Aarhus University; Aarhus Denmark
| | - M. Berendt
- Department of Veterinary Clinical and Animal Sciences (DVCAS); Faculty of Health and Medical Sciences; University of Copenhagen (UC); Frederiksberg C Denmark
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Sakai EY, Carpenter BD, Rieger RE. "What's wrong with grandma?": depictions of Alzheimer's disease in children's storybooks. Am J Alzheimers Dis Other Demen 2012; 27:584-91. [PMID: 22992298 PMCID: PMC10845605 DOI: 10.1177/1533317512459796] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
Alzheimer's disease (AD) affects the entire family system, including young children. Yet there are few resources to help children understand AD. Storybooks are used to educate children about other diseases and may be useful in AD as well. In this study, we examined the depiction of AD in 33 English-language children's storybooks written specifically about AD. As a group, storybooks present AD as a brain disease, but provide little information about the diagnostic process or treatments. Clinical presentations are diverse among characters with AD, and no single book presents a comprehensive depiction of the cognitive, behavioral, affective, and functional symptoms of the disease. In fact, the prevalence of some symptoms in this "population" of storybook characters diverges substantially from epidemiological reports. Books designed to familiarize children about AD should be comprehensive and accurate. Current resources, while useful, could be improved to ensure health literacy about AD in young children.
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Abstract
Behavioral symptoms such as repetitive speech, wandering, and sleep disturbances are a core clinical feature of Alzheimer disease and related dementias. If untreated, these behaviors can accelerate disease progression, worsen functional decline and quality of life, cause significant caregiver distress, and result in earlier nursing home placement. Systematic screening for behavioral symptoms in dementia is an important prevention strategy that facilitates early treatment of behavioral symptoms by identifying underlying causes and tailoring a treatment plan. First-line nonpharmacologic treatments are recommended because available pharmacologic treatments are only modestly effective, have notable risks, and do not effectively treat some of the behaviors that family members and caregivers find most distressing. Examples of nonpharmacologic treatments include provision of caregiver education and support, training in problem solving, and targeted therapy directed at the underlying causes for specific behaviors (eg, implementing nighttime routines to address sleep disturbances). Based on an actual case, we characterize common behavioral symptoms and describe a strategy for selecting evidence-based nonpharmacologic dementia treatments. Nonpharmacologic management of behavioral symptoms in dementia can significantly improve quality of life and patient-caregiver satisfaction.
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Holtzer R, Zweig RA, Siegel LJ. Learning From The Past and Planning For The Future: The Challenges Of And Solutions For Integrating Aging Into Doctoral Psychology Training. TRAINING AND EDUCATION IN PROFESSIONAL PSYCHOLOGY 2012; 6:142-150. [PMID: 23483705 PMCID: PMC3590915 DOI: 10.1037/a0029365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The long forecast "elder boom" has begun. Beginning in 2011, ten thousand members of the "baby boom" generation began turning 65 each day. This demographic shift in our society mandates that pre-doctoral programs in clinical psychology incorporate aging as an integral component of their core and elective training. While fully supporting the concept of broad and general training for predoctoral professional psychology programs, we maintain that the infusion of aging into doctoral psychology training curricula has been inadequate. In this manuscript we provide an overview of geropsychology training models and discuss the challenges involved in incorporating aging to the curriculum of pre-doctoral training in clinical psychology. Potential solutions and examples for accelerating infusion of aging knowledge base are discussed in the context of different geropsychology training models. We conclude that providing services to this rapidly growing segment of our population presents both an employment opportunity to broaden the reach of our profession as well as an ethical responsibility to train future professionals who will practice within their area of knowledge and expertise.
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Affiliation(s)
- Roee Holtzer
- Ferkauf Graduate School of Psychology, Yeshiva University
- Department of Neurology, Albert Einstein College of Medicine, Yeshiva University
| | - Richard A. Zweig
- Ferkauf Graduate School of Psychology, Yeshiva University
- Department of Psychiatry, Albert Einstein College of Medicine, Yeshiva University
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Owecki MK, Michalak S, Kozubski W. [Psychopathological syndromes of neurological diseases in the elderly]. Neurol Neurochir Pol 2011; 45:161-8. [PMID: 21574121 DOI: 10.1016/s0028-3843(14)60028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vascular and degenerative diseases of the central nervous system are one of the most common health problems in the elderly. Cognitive dysfunction, mood disorders and behavioural changes as well as psychotic symptoms constitute an invariable part of the clinical manifestation of these diseases. Psychopathological syndromes influence management decisions, commonly being a reason for patients' institutionalization; they are also a cause of suffering of patients and their caregivers and relatives. Relevant diagnosis of psychological symptoms is crucial in establishing adequate therapy, which improves quality of life of patients and their caregivers. The paper provides an overview of the psychopathological presentation of the most common central nervous system diseases in the elderly.
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Affiliation(s)
- Michał K Owecki
- Klinika Neurologii UM w Poznaniu, ul. Przybyszewskiego 49, 60-355 Poznań.
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García-Alberca JM, Lara JP, Berthier ML, Cruz B, Barbancho MÁ, Green C, González-Barón S. Can impairment in memory, language and executive functions predict neuropsychiatric symptoms in Alzheimer's disease (AD)? Findings from a cross-sectional study. Arch Gerontol Geriatr 2011; 52:264-9. [DOI: 10.1016/j.archger.2010.05.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 05/02/2010] [Accepted: 05/03/2010] [Indexed: 11/29/2022]
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Monitoring quality of care for nursing home residents with behavioral and psychological symptoms related to dementia. J Am Med Dir Assoc 2010; 12:660-7. [PMID: 21450223 DOI: 10.1016/j.jamda.2010.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 11/05/2010] [Accepted: 11/08/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Behavioral and psychological symptoms associated with dementia are common in nursing home residents. Quality indicators (QI) assessing quality of care for these residents are minimally risk adjusted and can provide inaccurate information regarding the quality of care provided by the facility. OBJECTIVE Evaluate the performance of a new QI for the incidence of worsening behaviors in nursing home residents with behavioral and psychological symptoms association with dementia. DESIGN Retrospective cohort study. SETTING A total of 381 Minnesota nursing homes with 26,165 residents. DATA SOURCES Minimum Data Set records for the first 2 calendar quarters of 2008. MEASUREMENTS We calculated incidence of worsening behaviors QI by comparing items from the "behavior" section of the Minimum Data Set records from 2 consecutive quarters and reported the incidence rates by both the residents' level of cognitive impairment and the presence or absence of special care unit for dementia (SCU). RESULTS The incidence rates of the worsening behavior QI in SCU ranged from 14% in residents with very severe cognitive impairment (a cognitive performance score = 6) to 30% in those with moderate cognitive impairment (a cognitive performance score = 3). The incidence QI rates among residents residing in conventional unit ranged from 15% among those with very severe cognitive impairment to 20% among those with moderate cognitive impairment. These differences in QI rates between the 2 units were statistically significant with a P value = .001. After risk adjustment for level of cognitive impairment, number of facilities with SCUs that flagged for problem behaviors dropped from 18.4% to 12.4% and the number of conventional units in the low-risk category from 16.8% to 4.7%. CONCLUSION Resident cognitive function and the facility utility of SCU are associated with worsening behavior QI and should be adjusted for in any nursing home quality reporting measure.
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Stallard E, Kinosian B, Zbrozek AS, Yashin AI, Glick HA, Stern Y. Estimation and validation of a multiattribute model of Alzheimer disease progression. Med Decis Making 2010; 30:625-38. [PMID: 21183754 PMCID: PMC4392765 DOI: 10.1177/0272989x10363479] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To estimate and validate a multiattribute model of the clinical course of Alzheimer disease (AD) from mild AD to death in a high-quality prospective cohort study, and to estimate the impact of hypothetical modifications to AD progression rates on costs associated with Medicare and Medicaid services. DATA AND METHODS The authors estimated sex-specific longitudinal Grade of Membership (GoM) models for AD patients (103 men, 149 women) in the initial cohort of the Predictors Study (1989-2001) based on 80 individual measures obtained every 6 mo for 10 y. These models were replicated for AD patients (106 men, 148 women) in the 2nd Predictors Study cohort (1997-2007). Model validation required that the disease-specific transition parameters be identical for both Predictors Study cohorts. Medicare costs were estimated from the National Long Term Care Survey. RESULTS Sex-specific models were validated using the 2nd Predictors Study cohort with the GoM transition parameters constrained to the values estimated for the 1st Predictors Study cohort; 57 to 61 of the 80 individual measures contributed significantly to the GoM models. Simulated, cost-free interventions in the rate of progression of AD indicated that large potential cost offsets could occur for patients at the earliest stages of AD. CONCLUSIONS AD progression is characterized by a small number of parameters governing changes in large numbers of correlated indicators of AD severity. The analysis confirmed that the progression of AD represents a complex multidimensional physiological process that is similar across different study cohorts. The estimates suggested that there could be large cost offsets to Medicare and Medicaid from the slowing of AD progression among patients with mild AD. The methodology appears generally applicable in AD modeling.
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Affiliation(s)
- Eric Stallard
- Department of Sociology and Center for Population Health and Aging, Duke University, Durham, North Carolina, USA
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Gerdner LA, Schoenfelder DP. Evidence-based guideline. Individualized music for elders with dementia. J Gerontol Nurs 2010; 36:7-15. [PMID: 20536115 DOI: 10.3928/00989134-20100504-01] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Serotonin transporter triallelic genotype and response to citalopram and risperidone in dementia with behavioral symptoms. Int Clin Psychopharmacol 2010; 25:37-45. [PMID: 19996755 PMCID: PMC2887732 DOI: 10.1097/yic.0b013e328333ee10] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The risk/benefit ratio of pharmacotherapy for behavioral symptoms of dementia is questionable: second-generation antipsychotics are poorly tolerated, and the efficacy of alternative treatments, for example, selective serotonin-reuptake inhibitors (SSRIs), is uncertain. Biomarkers of treatment response may improve this risk/benefit ratio. The length polymorphism of the serotonin transporter promoter gene (5-HTTLPR/SLC6A4) may moderate tolerability of SSRIs and expression of behavioral symptoms in dementia. We assessed the effect of 5-HTTLPR on tolerability and efficacy of citalopram and risperidone in a 12-week randomized controlled trial, which included nondepressed patients with dementia hospitalized for behavioral or psychotic symptoms. Genotypes including the A/G polymorphism of the L allele (rs25531) were determined in 92 of 103 participants. We used pattern-mixture models to account for dropout. Low-expression alleles (S and Lg) predicted greater early and overall side effects of citalopram and early treatment discontinuation. These results remained unchanged after excluding African-American participants and in covariate analyses. Unexpectedly, low-expression alleles seemed to predict greater early side effects of risperidone (but not early discontinuation) and poorer early response of psychosis symptoms to risperidone. In conclusion, 5-HTTLPR may be a useful biomarker of SSRI intolerance in dementia. Our findings of intolerance of a second-generation antipsychotics and persistence of psychosis in patients with low-expression alleles needs to be replicated.
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Nelson PT, Jicha GA, Kryscio RJ, Abner EL, Schmitt FA, Cooper G, Xu LO, Smith CD, Markesbery WR. Low sensitivity in clinical diagnoses of dementia with Lewy bodies. J Neurol 2009; 257:359-66. [PMID: 19795154 DOI: 10.1007/s00415-009-5324-y] [Citation(s) in RCA: 182] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 08/24/2009] [Accepted: 09/11/2009] [Indexed: 11/30/2022]
Abstract
The success of future neurodegenerative disease (ND) therapies depends partly on accurate antemortem diagnoses. Relatively few prior studies have been performed on large, multicenter-derived datasets to test the accuracy of final clinical ND diagnoses in relation to definitive neuropathological findings. Data were analyzed from the University of Kentucky Alzheimer's Disease Center autopsy series and from the National Alzheimer's Coordinating Center (NACC) registry. NACC data are derived from 31 different academic medical centers, each with strong clinical expertise and infrastructure pertaining to NDs. The final clinical diagnoses were compared systematically with subsequent neuropathology diagnoses. Among subjects meeting final inclusion criteria (N = 2,861 for NACC Registry data), the strength of the associations between clinical diagnoses and subsequent ND diagnoses was only moderate. This was particularly true in the case of dementia with Lewy bodies (DLB): the sensitivity of clinical diagnoses was quite low (32.1% for pure DLB and 12.1% for Alzheimer's disease (AD + DLB) although specificity was over 95%. AD clinical diagnoses were more accurate (85.0% sensitivity and 51.1% specificity). The accuracy of clinical DLB diagnoses became somewhat lower over the past decade, due apparently to increased "over-calling" the diagnosis in patients with severe cognitive impairment. Furthermore, using visual hallucinations, extrapyramidal signs, and/or fluctuating cognition as part of the clinical criteria for DLB diagnosis was of minimal utility in a group (N = 237) with high prevalence of severe dementia. Our data suggest that further work is needed to refine our ability to identify specific aging-related brain disease mechanisms, especially in DLB.
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Affiliation(s)
- Peter T Nelson
- Division of Neuropathology, Department of Pathology, University of Kentucky Medical Center, University of Kentucky, Rm 311, Sanders-Brown Building, 800 S. Limestone, Lexington, KY 40536-0230, USA.
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Clinical findings, functional abilities and caregiver distress in the early stage of dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). Arch Gerontol Geriatr 2009; 49:e101-e104. [DOI: 10.1016/j.archger.2008.10.001] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 09/25/2008] [Accepted: 10/15/2008] [Indexed: 11/23/2022]
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Klugman A, Marshall J, Tabet N. Impact of cerebrovascular pathology on behavioural and neuropsychiatric symptoms in patients with Alzheimer's dementia: findings from a retrospective, naturalistic study. Int J Clin Pract 2009; 63:1024-30. [PMID: 19570120 DOI: 10.1111/j.1742-1241.2009.02079.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIM Cerebrovascular disease (CVD) has been associated with depression and a host of neuropsychiatric conditions including dementia. This study assessed the relationship between cerebrovascular findings reported on MRI brain scans and neuropsychiatric symptoms (NPS) and behavioural problems in patients with Alzheimer's disease (AD). METHODS Medical notes were retrospectively reviewed in patients undergoing brain MRI following referral for cognitive impairment to a memory clinic between January 2004 and June 2008. Patients with AD were graded into four categories of CVD severity based on neuroradiology reports and assessed for behavioural and NPS and activities of daily living using Neuropsychiatric Inventory (NPI), Geriatric Depression Scale (GDS) and Bristol Activities of Daily Living (BADL). Frontal lobe symptoms and parkinsonian features were also evaluated. RESULTS Of the initial 232 patients who underwent MRI 72% were diagnosed with AD. 89% of AD patients had CVD findings reported on MRI. Moderate-to-severe CVD was present in 47% of patients. None of the AD patients satisfied a diagnosis of vascular dementia. There was no significant relationship observed between level of MRI CVD findings and scores on NPI (p = 0.57), GDS (p = 0.26) and BADL (p = 0.46). The level of CVD severity did not appear to influence frontal lobe and parkinsonian assessments (p = 0.60). CONCLUSION The contribution of CVD to the pathogenesis of various NPS is still debated. Our study, based on patients diagnosed with AD in a memory clinic setting, suggests that there is no relationship between the extent of CVD pathology and neuropsychiatric and behavioural measures in AD patients. Further prospective quantitative studies are needed to assess the role of CVD, if any, in neuropsychiatric and behavioural symptoms in AD. It is possible that the relatively small pathological contribution of CVD to the development of these symptoms is obscured by the effect of the wider neurodegeneration encountered in AD.
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Affiliation(s)
- A Klugman
- Cognitive Treatment & Research Unit, Sussex Partnership NHS Foundation Trust, Brighton, Sussex, UK
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Dettmore D, Kolanowski A, Boustani M. Aggression in persons with dementia: use of nursing theory to guide clinical practice. Geriatr Nurs 2009; 30:8-17. [PMID: 19215808 DOI: 10.1016/j.gerinurse.2008.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 02/29/2008] [Accepted: 03/01/2008] [Indexed: 12/21/2022]
Abstract
With approximately four million people in the United States today diagnosed with dementia, one of the most devastating problems faced by caregivers and patients is dealing with aggressive behavior. Aggression occurs in half of persons diagnosed with dementia and is associated with more rapid cognitive decline, increased risk of abuse, and caregiver burden. This paper uses the Need-driven Dementia-compromised Behavior (NDB) model to explain aggression and discusses therapeutic approaches to care that combines non-pharmacological and pharmacological interventions targeting both the management of aggression crisis and preventing its future recurrence. A clinical algorithm guided by the NBD model is provided for practitioners.
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Affiliation(s)
- Diane Dettmore
- Henry P. Becton School of Nursing and Allied Health, Farleigh Dickinson University, Teaneck, NJ, USA
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Mecocci P, Bladström A, Stender K. Effects of memantine on cognition in patients with moderate to severe Alzheimer's disease: post-hoc analyses of ADAS-cog and SIB total and single-item scores from six randomized, double-blind, placebo-controlled studies. Int J Geriatr Psychiatry 2009; 24:532-8. [PMID: 19274640 DOI: 10.1002/gps.2226] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The post-hoc analyses reported here evaluate the specific effects of memantine treatment on ADAS-cog single-items or SIB subscales for patients with moderate to severe AD. METHODS Data from six multicentre, randomised, placebo-controlled, parallel-group, double-blind, 6-month studies were used as the basis for these post-hoc analyses. All patients with a Mini-Mental State Examination (MMSE) score of less than 20 were included. Analyses of patients with moderate AD (MMSE: 10-19), evaluated with the Alzheimer's disease Assessment Scale (ADAS-cog) and analyses of patients with moderate to severe AD (MMSE: 3-14), evaluated using the Severe Impairment Battery (SIB), were performed separately. RESULTS The mean change from baseline showed a significant benefit of memantine treatment on both the ADAS-cog (p < 0.01) and the SIB (p < 0.001) total score at study end. The ADAS-cog single-item analyses showed significant benefits of memantine treatment, compared to placebo, for mean change from baseline for commands (p < 0.001), ideational praxis (p < 0.05), orientation (p < 0.01), comprehension (p < 0.05), and remembering test instructions (p < 0.05) for observed cases (OC). The SIB subscale analyses showed significant benefits of memantine, compared to placebo, for mean change from baseline for language (p < 0.05), memory (p < 0.05), orientation (p < 0.01), praxis (p < 0.001), and visuospatial ability (p < 0.01) for OC. CONCLUSION Memantine shows significant benefits on overall cognitive abilities as well as on specific key cognitive domains for patients with moderate to severe AD.
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Affiliation(s)
- Patrizia Mecocci
- Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy.
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Scherer RK, Scarmeas N, Brandt J, Blacker D, Albert MS, Stern Y. The relation of patient dependence to home health aide use in Alzheimer's disease. J Gerontol A Biol Sci Med Sci 2008; 63:1005-9. [PMID: 18840808 DOI: 10.1093/gerona/63.9.1005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although there has been much research devoted to understanding the predictors of nursing home placement (NHP) in Alzheimer's disease (AD) patients, there is currently a lack of research concerning the predictors of home health care. The objective of this study was to examine whether the Dependence Scale can predict home health aide (HHA) use. METHODS The sample is drawn from the Predictors Study, a large, multicenter cohort of patients with probable AD, prospectively followed annually for up to 7 years in three university-based AD centers in the United States. Markov analyses (n=75) were used to calculate annual transition probabilities for the "new onset" of HHA use (instances where an HHA was absent at the previous visit, but present at the next visit) as a function of HHA presence at the preceding year's visit and dependence level at that preceding year's visit. RESULTS The dependence level at the previous year's visit was a significant predictor of HHA use at the next year's visit. Three specific items of the Dependence Scale (needing household chores done for oneself, needing to be watched or kept company when awake, and needing to be escorted when outside) were significant predictors of the presence of an HHA. CONCLUSION The Dependence Scale is a valuable tool for predicting HHA use in AD patients. Obtaining a better understanding of home health care in AD patients may help delay NHP and have a positive impact on the health and well-being of both the caregiver and the patient.
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Affiliation(s)
- Rachel K Scherer
- Cognitive Neuroscience Division, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Columbia University Medical Center, 630 West 168th St., P&S Box 16, New York, NY 10032, USA
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Zhu CW, Leibman C, McLaughlin T, Zbrozek AS, Scarmeas N, Albert M, Brandt J, Blacker D, Sano M, Stern Y. Patient dependence and longitudinal changes in costs of care in Alzheimer's disease. Dement Geriatr Cogn Disord 2008; 26:416-23. [PMID: 18946219 PMCID: PMC2631662 DOI: 10.1159/000164797] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To examine the incremental effect of patients' dependence on others, on cost of medical and nonmedical care, and on informal caregiving hours over time. METHODS Data are obtained from 172 patients from the Predictors Study, a large, multicenter cohort of patients with probable Alzheimer disease (AD) followed annually for 4 years in 3 University-based AD centers in the USA. Enrollment required a modified Mini-Mental State Examination score >or=30. We examined the effects of patient dependence (measured by the Dependence Scale, DS) and function (measured by the Blessed Dementia Rating Scale, BDRS) on medical care cost, nonmedical care cost, and informal caregiving time using random effects regression models. RESULTS A one-point increase in DS score was associated with a 5.7% increase in medical cost, a 10.5% increase in nonmedical cost, and a 4.1% increase in caregiving time. A one-point increase in BDRS score was associated with a 7.6% increase in medical cost, a 3.9% increase in nonmedical cost and an 8.7% increase in caregiving time. CONCLUSIONS Both functional impairment and patient dependence were associated with higher costs of care and caregiving time. Measures of functional impairment and patient dependence provide unique and incremental information on the overall impact of AD on patients and their caregivers.
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Affiliation(s)
- Carolyn W. Zhu
- Geriatric Research, Education, and Clinical Center (GRECC) and Research Enhancement Awards Program (REAP), James J. Peters VA Medical Center, Bronx, N.Y., USA,Brookdale Department of Geriatrics, Mount Sinai School of Medicine, New York, N.Y., USA,*Carolyn W. Zhu, Geriatric Research, Education, and Clinical Center (GRECC), James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468 (USA), Tel. +1 718 584 9000, ext. 3810, Fax +1 718 741 4211, E-Mail
| | | | | | | | - Nikolaos Scarmeas
- Cognitive Neuroscience Division, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, New York, N.Y., USA,Gertrude H. Sergievsky Center and the Department of Neurology, Columbia University Medical Center, New York, N.Y., USA
| | - Marilyn Albert
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Md., USA
| | - Jason Brandt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Md., USA
| | - Deborah Blacker
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Mass., USA
| | - Mary Sano
- Geriatric Research, Education, and Clinical Center (GRECC) and Research Enhancement Awards Program (REAP), James J. Peters VA Medical Center, Bronx, N.Y., USA,Department of Psychiatry, Mount Sinai School of Medicine, New York, N.Y., USA
| | - Yaakov Stern
- Cognitive Neuroscience Division, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, New York, N.Y., USA,Gertrude H. Sergievsky Center and the Department of Neurology, Columbia University Medical Center, New York, N.Y., USA
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Abstract
BACKGROUND Many people with dementia exhibit some behavioral or psychological symptoms, e.g. aggressive or aberrant motor behavior, depression or hallucinations, at some time during the course of the disorder. The aim of the present study was to describe the probability of the occurrence of these symptoms of dementia in relation to the level of cognitive impairment. METHODS 3404 people with cognitive impairment were selected from two large cross-sectional surveys of those in geriatric care settings, conducted in 1982 and 2000 in the county of Västerbotten, Sweden. Symptoms were assessed using the Multi-Dimensional Dementia Assessment Scale (MDDAS), subsumed with a rotated factor analysis, and investigated in relation to level of cognitive impairment, measured using the Gottfries cognitive scale. RESULTS The passiveness factor had an almost linear correlation to the level of cognitive impairment (r2 = 0.237). Non-linear correlations, with highest prevalences in middle-stage cognitive impairment, were found for aggressive behavior (r2 = 0.057), wandering behavior (r2 = 0.065), restless behavior (r2 = 0.143), verbally disruptive/attention-seeking behavior (r2 = 0.099), regressive/inappropriate behavior (r2 = 0.058), hallucinatory symptoms (r2 = 0.021) and depressive symptoms (r2 = 0.029). CONCLUSION The relations between the behavioral and psychological symptoms of dementia and level of cognitive impairment were non-linear, with higher prevalence rates in the middle stages of dementia, apart from the symptom of passiveness, which increased almost linearly with the severity of cognitive impairment.
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Molinari V, King-Kallimanis B, Volicer L, Brown L, Schonfeld L. Wandering behavior in veterans with psychiatric diagnoses residing in nursing homes. Int J Geriatr Psychiatry 2008; 23:748-53. [PMID: 18181238 DOI: 10.1002/gps.1972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate nursing home residents with psychiatric diagnoses who wander and who are not diagnosed with dementia. METHOD A national cross-sectional study was conducted in a male Veterans Administration Nursing Home Care Unit population using a retrospective review of the MDS. RESULTS Eleven thousand six hundred and nineteen residents were identified as having a psychiatric diagnosis without significant cognitive impairment; just under 1% (n = 113) wandered. Using rare events logit regression, we determined that a diagnosis of schizophrenia/bipolar disorder or comorbid psychiatric conditions were associated with increased risk of wandering compared to residents diagnosed with anxiety/depression. Psychiatric wanderers were also more likely to, have symptoms of delirium, exhibit socially inappropriate behavior, manifest problems in decision-making, take anti-psychotic medications, and to be more independent in locomotion. CONCLUSIONS Psychiatric wanderers may be conceptualized better as exhibiting ambulatory concomitants of unremitted neurological/psychiatric symptoms or medication side effects of their treatment. Findings have implications for addressing treatable causes of wandering.
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Affiliation(s)
- Victor Molinari
- Department of Aging and Mental Health, University of South Florida, FL 33612-3899, USA.
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Home health and informal care utilization and costs over time in Alzheimer's disease. Home Health Care Serv Q 2008; 27:1-20. [PMID: 18510196 DOI: 10.1300/j027v27n01_01] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To (1) compare home health and informal (unpaid) services utilization among patients with Alzheimer's disease (AD), (2) examine longitudinal changes in services use, and (3) estimate possible interdependence of home health and informal care utilization. METHODS The sample is drawn from the Predictors Study, a large, multicenter cohort of patients with probable AD, prospectively followed annually for up to 7 years in three university-based AD centers. Bivariate probit models estimated the effects of patient characteristics on home health and informal care utilization. RESULTS A large majority of the patients (80.6%) received informal care with a smaller proportion (18.6%) receiving home health services. Home health services utilization increased from 9.9% at baseline to 34.5% in year 4. Among users, number of days that services were provided in three-month recall increased from 21.9 to 56 days over time. Home health services utilization was significantly associated with function, depressive symptoms, being female, and not living with a spouse. Informal care utilization was significantly associated with cognition, function, comorbidities, and living with a spouse or child. CONCLUSIONS Home health and informal care utilization relate differently to patient characteristics. Utilization of home health care or informal care was not influenced by utilization of the other.
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