Psychotropics for patients with dementia

Antipsychotic drug use and favourable natures of emotional functions in patients with dementia

AIM

To characterise the effects of antipsychotics on brain functions of patients with behavioural psychological symptoms of dementia (BPSD).

METHODS

Studies were performed during 6 weeks of intervention with either a nonantipsychotic drug (group A, n = 38) or an antipsychotic drug (group B, n = 10).

RESULTS

Neuropsychiatric Inventory scores were significantly decreased in both groups. Scores on the Mini-Mental State Examination did not change with intervention. By contrast, favourable natures of emotional functions, scored using the Delightful Emotional Index of 10 items, were significantly lower in the antipsychotic drug treatment group B relative to scores in the nonantipsychotic drug treatment group A.

CONCLUSIONS

Antipsychotics reduce favourite emotions as well as BPSD, and this should be considered in prescribing medications for patients with dementia.

Emotional function in dementia patients

Behavioural and psychological symptoms of dementia, which can be considered as hyperreactivity of the emotional functioning of dementia, can be alleviated or aggravated by the behavioural and psychological symptoms of the caregiver. Comfortable stimulations of emotional function through sensory stimulations are effective methods for alleviating behavioural and psychological symptoms of dementia. Although cognitive function deteriorates with age, emotional function is often retained even in advanced years. Thus, it is recommended that care in patients with dementia be focused mainly on the stimulation of emotional function (e.g. sympathy and empathy, which are human traits), rather than relying solely on the stimulation of cognitive function.

Mini-Emotional State Examination for dementia patients

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Alternative Measures of Self-Rated Health for Predicting Mortality Among Older People: Is Past or Future Orientation More Important?

PURPOSE

The purpose of this study was to compare the prognostic validity of alternative measures of health ratings, including those that tap temporal reflections, on adult mortality.

DESIGN AND METHODS

The study uses a national sample of 1,266 Americans 50-74 years old in 1995, with vital status tracked through 2005, to compare the effect of 3 types of health ratings on mortality: conventional indicator of self-rated health (SRH), age comparison form of SRH, and health ratings that incorporate temporal dimensions. Logistic regression was used to estimate the odds of mortality associated with alternative health ratings while adjusting for health conditions, lifestyle factors, and status characteristics and resources.

RESULTS

Self-rated health was a consistent predictor of mortality, but the respondent's expected health rating-10 years in the future-was an independent predictor. Future health expectations were more important than past (recalled change) in predicting mortality risk: People with more negative expectations of future health were less likely to survive.

IMPLICATIONS

The findings reveal the importance of future time perspective for older people and suggest that it is more useful to query older people about their future health expectations than about how their health has changed.