Evaluation of a mobile team dedicated to behavioural disorders as recommended by the Alzheimer Cooperative Valuation in Europe joint action: observational cohort study

Non-Pharmacological Interventions for Feeding and Eating Disorders in Persons with Dementia: Systematic Review and Evidence Summary

BACKGROUND

Feeding and eating disorders related to cognitive and psycho-behavioral symptoms are strongly associated with health status in persons with dementia (PWD). Non-pharmacological interventions have been the priority selection to address this significant issue. However, the direct targets of non-pharmacological interventions are unclear and there is no consistent evidence of recommendations on the intervention of different dementia stages and the settings of intervention practice.

OBJECTIVE

To provide caregivers with a set of self-help non-pharmacological interventions for feeding and eating disorders in PWD.

METHODS

Based on the process of evidence summary, a systematic literature search was performed on dementia websites and seven databases. Two researchers screened the studies independently and appraise the quality. The evidence was graded by Joanna Briggs Institute Grades of Recommendation.

RESULTS

Twenty-eight articles were included. Twenty-three non-pharmacological intervention recommendations were categorized into six themes containing oral nutritional supplementation, assistance with eating and drinking, person-centered mealtime care, environmental modification, education or training, and multi-component intervention. These interventions corresponded to three direct targets including improving engagement, making up for loss ability, and increasing food intake directly. They were applied to different stages of dementia and most interventions were targeted at PWD in long-term care institutions.

CONCLUSION

This article summarized the direct targets and the specific implementation of recommendations at different stages of dementia to provide caregivers with self-help non-pharmacological interventions. The practice of recommendations was more applicable to institutionalized PWD. When applied to PWD at home, caregivers need to identify the specific feeding and eating conditions at different stages and adopted the interventions in conjunction with the wishes of the PWD and professional advice.

Measuring the prevalence of sleep disturbances in people with dementia living in care homes: a systematic review and meta-analysis

Study Objectives

Sleep disturbances are a feature in people living with dementia, including getting up during the night, difficulty falling asleep, and excessive daytime sleepiness and may precipitate a person with dementia moving into residential care. There are varying estimates of the frequency of sleep disturbances, and it is unknown whether they are a problem for the individual. We conducted the first systematic review and meta-analysis on the prevalence and associated factors of sleep disturbances in the care home population with dementia.

Methods

We searched Embase, MEDLINE, and PsycINFO (29/04/2019) for studies of the prevalence or associated factors of sleep disturbances in people with dementia living in care homes. We computed meta-analytical estimates of the prevalence of sleep disturbances and used meta-regression to investigate the effects of measurement methods, demographics, and study characteristics.

Results

We included 55 studies of 22,780 participants. The pooled prevalence on validated questionnaires of clinically significant sleep disturbances was 20% (95% confidence interval, CI 16% to 24%) and of any symptom of sleep disturbance was 38% (95% CI 33% to 44%). On actigraphy using a cutoff sleep efficiency of <85% prevalence was 70% (95% CI 55% to 85%). Staff distress, resident agitation, and prescription of psychotropic medications were associated with sleep disturbances. Studies with a higher percentage of males had a higher prevalence of sleep disturbance.

Conclusions

Clinically significant sleep disturbances are less common than those measured on actigraphy and are associated with residents and staff distress and the increased prescription of psychotropics. Actigraphy appears to offer no benefit over proxy reports in this population.

Information and Communication Technologies, a Promising Way to Support Pharmacotherapy for the Behavioral and Psychological Symptoms of Dementia

Health care systems face an expansion in the number of older individuals with a high prevalence of neurodegenerative diseases and related behavioral and psychological symptoms of dementia (BPSDs). Health care providers are expected to develop innovative solutions to manage and follow up patients over time in the community. To date, we are unable to continuously and accurately monitor the nature, frequency, severity, impact, progression, and response to treatment of BPSDs after the initial assessment. Technology could address this need and provide more sensitive, less biased, and more ecologically valid measures. This could provide an opportunity to reevaluate therapeutic strategies more quickly and, in some cases, to treat earlier, when symptoms are still amenable to therapeutic solutions or even prevention. Several studies confirm the relationship between sensor-based data and cognition, mood, and behavior. Most scientific work on mental health and technologies supports digital biomarkers, not so much as diagnostic tools but rather as monitoring tools, an area where unmet needs are significant. In addition to the implications for clinical care, these real-time measurements could lead to the discovery of new early biomarkers in mental health. Many also consider digital biomarkers as a way to better understand disease processes and that they may contribute to more effective pharmaceutical research by (i) targeting the earliest stage, (ii) reducing sample size required, (iii) providing more objective measures of behaviors, (iv) allowing better monitoring of noncompliance, (v) and providing a better understanding of failures. Finally, communication technologies provide us with the opportunity to support and renew our clinical and research practices.

The management of sleep disorders in dementia: an update

PURPOSE OF REVIEW

Sleep disorders in dementia cause distress and may lead to families being unable to care for someone with dementia at home. Recent Cochrane reviews found no interventions of proven effectiveness. There was no effect of light therapy and moderate evidence that melatonin was ineffective both given without knowledge of the patient's circadian rhythm. The current article updates this review by considering newer publications on interventions for sleep disorders or abnormalities of the sleep-wake cycle in people with dementia living in the community.

RECENT FINDINGS

We searched electronically for new primary research, reviews and meta-analyses and identified 258 articles published between 15/12/2015 and 14/06/2017 on sleep and dementia; 43 of them on nonpharmacological or pharmacological treatments. Fifteen articles reported on the management of sleep disturbances in people with dementia, living at home. Those using pharmacological treatments (melatonin, psychotropic medications, donepezil, memantine) encompassed a meta-analysis, two double-blind RCTs, two uncontrolled trials, two population-based studies, and one case report. The studies of behavioural interventions comprised five uncontrolled trials, one case series, and one qualitative study. We also included three recent reviews on the management of sleep disturbances in Alzheimer's disease; pharmacotherapies for sleep disturbances in dementia, and dementia prevention, intervention and care. None of these found a treatment that showed definitive effectiveness, although there is preliminary work about nonpharmacological interventions, which can be built on.

SUMMARY

Clinically effective, safe treatment of sleep disturbances in dementia remains an unresolved challenge. Given the importance of sleep and the many consequences of its disruption, well designed controlled trials are needed to determine acceptable and cost-effective treatment strategies that work for sleep disturbances.