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Abstract
Until recently, there is considerable mess regarding the nature of anxiety in dementia. However, anxiety is common in this population affecting from 8% to 71% of prevalence, and resulted in poor outcome and quality of life, even after controlling for depression. Because a presentation of anxiety in the context of dementia can be different from typical early-onset anxiety disorder, it is not easy one to identify and quantify anxiety reliably. Moreover, differentiating anxiety from the depression and/or dementia itself also can be formidable task. Anxiety gradually decreases at the severe stages of dementia and this symptom may be more common in vascular dementia than in Alzheimer's disease. Due to the lack of large randomized clinical trials, optimal treatment and the true degree of efficacy of treatment is not clear yet in this population. However, these treatments can reduce adverse impact of anxiety on patients and caregivers. This article provides a brief review for the diagnosis, evaluation and treatment of anxiety in dementia.
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Abstract
Since anxiety in patients with dementia is a complex, understudied phenomenon, this paper presents clinicians' experiences of anxiety in this population. Semi-structured interviews were conducted with seven clinicians experienced with dementia in elderly patients (65 years and above), and then evaluated via qualitative content analysis. Analysis revealed three main categories: A reaction to loss and worries, symptoms of anxiety and depression interfere with each other, and anxiety in dementia-a multidisciplinary task. Anxiety in this population is perhaps best understood as a reaction to loss and worries, and existential in nature by the participants. Care interventions can reduce or prevent anxiety symptoms in this population. However, when anxiety co-exists with depression it might be difficult to attenuate these symptoms through care measures alone. To better identify and treat the condition, valid dementia-specific anxiety-screening instruments are necessary.
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Affiliation(s)
- Alka R Goyal
- Section of Old Age Psychiatry, Vestre Viken Hospital trust, Norway; Norwegian National Advisory Unit on Aging and Health, Norway; Centre of Old Age Psychiatry Research, Innlandet Hospital Trust, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Aging and Health, Norway
| | - Siren Eriksen
- Norwegian National Advisory Unit on Aging and Health, Norway
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Ing-Randolph AR, Phillips LR, Williams AB. Group music interventions for dementia-associated anxiety: A systematic review. Int J Nurs Stud 2015; 52:1775-84. [PMID: 26228591 DOI: 10.1016/j.ijnurstu.2015.06.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/12/2015] [Accepted: 06/26/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This systematic review examines the few published studies using group music interventions to reduce dementia-associated anxiety, the delivery of such interventions, and proposes changes to nursing curriculum for the future. DESIGN Literature review. METHODS All quantitative studies from 1989 to 2014 were searched in CINAHL and PubMed databases. Only published articles written in English were included. Studies excluded were reviews, non-human subjects, reports, expert opinions, subject age less than 65, papers that were theoretical or philosophical in nature, individual music interventions, case studies, studies without quantification of changes to anxiety, and those consisting of less than three subjects. Components of each study are analyzed and compared to examine the risk for bias. RESULTS Eight articles met the inclusion criteria for review. Subject dementia severity ranged from mild to severe among studies reviewed. Intervention delivery and group sizes varied among studies. Seven reported decreases to anxiety after a group music intervention. CONCLUSIONS Group music interventions to treat dementia-associated anxiety is a promising treatment. However, the small number of studies and the large variety in methods and definitions limit our ability to draw conclusions. It appears that group size, age of persons with dementia and standardization of the best times for treatment to effect anxiety decreases all deserve further investigation. In addition, few studies have been conducted in the United States. In sum, while credit is due to the nurses and music therapists who pioneered the idea in nursing care, consideration of patient safety and improvements in music intervention delivery training from a healthcare perspective are needed. Finally, more research investigating resident safety and the growth of nursing roles within various types of facilities where anxiety is highest, is necessary.
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Affiliation(s)
| | - Linda R Phillips
- School of Nursing, University of California at Los Angeles, United States.
| | - Ann B Williams
- School of Nursing, University of California at Los Angeles, United States.
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Diefenbach GJ, Bragdon LB, Blank K. Geriatric anxiety inventory: factor structure and associations with cognitive status. Am J Geriatr Psychiatry 2014; 22:1418-26. [PMID: 23954040 DOI: 10.1016/j.jagp.2013.04.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 04/09/2013] [Accepted: 04/24/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The factor structure and clinical correlates of the Geriatric Anxiety Inventory were determined within a sample of patients with cognitive impairment. METHODS Using a cross-sectional design, data were collected within an outpatient Memory Disorders Center. Clinical participants were diagnosed with either mild dementia (N = 45) or cognitive impairment, no dementia (N = 55). A comparison group of participants without subjective memory complaints (N = 50) was also included. The Geriatric Anxiety Inventory was administered and scored as both the 20-item version and 5-item short form. Measures of cognitive status, depressive symptoms, and functioning were also completed. RESULTS Clinical participants reported more severe anxiety than did participants in the comparison group; however, the two patient groups did not differ. Principal components analysis revealed a four-factor structure of the Geriatric Anxiety Inventory. Item endorsement on factors characterized by excessive worry and difficulty making decisions were associated with a nearly twofold (odds ratio [OR]: 1.86) and nearly sixfold (OR: 5.70) odds of having cognitive impairment, respectively. The short-form version was composed of a single factor, and item endorsement was associated with a twofold increased odds of having cognitive impairment (OR: 2.02). CONCLUSION Psychometric properties of the Geriatric Anxiety Inventory are acceptable among patients with cognitive impairment. Anxiety symptoms were common, and symptoms characterized by excessive worry and difficulty making decisions demonstrated the strongest associations with cognitive status.
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Affiliation(s)
- Gretchen J Diefenbach
- Anxiety Disorders Center, The Institute of Living/Hartford Hospital, Hartford, CT; Yale University School of Medicine, New Haven, CT.
| | - Laura B Bragdon
- Anxiety Disorders Center, The Institute of Living/Hartford Hospital, Hartford, CT
| | - Karen Blank
- Memory Disorders Center, The Institute of Living/Hartford Hospital, Hartford, CT; University of Connecticut Health Science Center, Farmington, CT
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Stanley MA, Calleo J, Bush AL, Wilson N, Snow AL, Kraus-Schuman C, Paukert AL, Petersen NJ, Brenes GA, Schulz PE, Williams SP, Kunik ME. The peaceful mind program: a pilot test of a cognitive-behavioral therapy-based intervention for anxious patients with dementia. Am J Geriatr Psychiatry 2013; 21:696-708. [PMID: 23567399 PMCID: PMC3411894 DOI: 10.1016/j.jagp.2013.01.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 12/05/2011] [Accepted: 12/27/2011] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To assess feasibility and to conduct a preliminary evaluation of outcomes following Peaceful Mind, a cognitive-behavioral therapy-based intervention for anxiety in dementia, relative to usual care. DESIGN Pilot randomized controlled trial including assessments at baseline and 3 and 6 months. SETTING Houston, TX. PARTICIPANTS Thirty-two outpatients diagnosed with mild (47%) or moderate (53%) dementia receiving care through outpatient clinics at the Veterans Affairs medical center, Baylor College of Medicine, Harris County Hospital District, and community day centers for dementia, and their collaterals, who spent at least 8 hours a week with them. INTERVENTION Peaceful Mind included up to 12 weekly in-home sessions (mean: 8.7, SD: 2.27) during the initial 3 months and up to eight brief telephone sessions (mean: 5.4, SD: 3.17) during months 3-6, involving self-monitoring for anxiety, deep breathing, and optional skills (coping self-statements, behavioral activation, and sleep management). Patients learned skills, and collaterals served as coaches. In usual care, patients received diagnostic feedback, and providers were informed of inclusion status. MEASUREMENTS Neuropsychiatric Inventory-Anxiety subscale, Rating Anxiety in Dementia scale, Penn State Worry Questionnaire-Abbreviated, Geriatric Anxiety Inventory, Geriatric Depression Scale, Quality of Life in Alzheimer disease, Patient Health Questionnaire, and Client Satisfaction Questionnaire. RESULTS Feasibility was demonstrated with regard to recruitment, attrition, and treatment characteristics. At 3 months, clinicians rated patients receiving Peaceful Mind as less anxious, and patients rated themselves as having higher quality of life; collaterals reported less distress related to loved ones' anxiety. Although significant positive effects were not noted in other outcomes or at 6-month follow-up, the pilot nature of the trial prohibits conclusions about efficacy. CONCLUSIONS Results support that Peaceful Mind is ready for future comparative clinical trials.
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Affiliation(s)
- Melinda A. Stanley
- VA HSR&D Houston Center of Excellence, Houston, TX
,Michael E. DeBakey VA Medical Center, Houston, TX
,Baylor College of Medicine, Houston, TX
,VA South Central Mental Illness Research, Education and Clinical Center
| | - Jessica Calleo
- VA HSR&D Houston Center of Excellence, Houston, TX
,Baylor College of Medicine, Houston, TX
| | - Amber L. Bush
- VA HSR&D Houston Center of Excellence, Houston, TX
,Baylor College of Medicine, Houston, TX
| | - Nancy Wilson
- VA HSR&D Houston Center of Excellence, Houston, TX
,Baylor College of Medicine, Houston, TX
| | - A. Lynn Snow
- VA South Central Mental Illness Research, Education and Clinical Center
,Center for Mental Health and Aging, The University of Alabama, Tuscaloosa, AL
,Research and Development Service, Tuscaloosa VA Medical Center, Tuscaloosa, AL
| | | | | | - Nancy J. Petersen
- VA HSR&D Houston Center of Excellence, Houston, TX
,Michael E. DeBakey VA Medical Center, Houston, TX
| | | | - Paul E. Schulz
- The University of Texas Health Science Center at Houston, The Mischer Neuroscience Institute and Memorial Hermann Hospital, Houston, TX
| | | | - Mark E. Kunik
- VA HSR&D Houston Center of Excellence, Houston, TX
,Michael E. DeBakey VA Medical Center, Houston, TX
,Baylor College of Medicine, Houston, TX
,VA South Central Mental Illness Research, Education and Clinical Center
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