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Connelly C, Kim K, Liu Y, Zarit SH. Temporal Patterns of Behavioral and Psychological Symptoms of Dementia and Caregiver Distress: Associated Daily and Individual Factors. J Appl Gerontol 2024; 43:786-796. [PMID: 37987697 DOI: 10.1177/07334648231216382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
This study examined daily occurrences of behavioral and psychological symptoms of dementia (BPSD) and whether caregivers' perceived distress towards BPSD varies throughout four phases of the day (i.e., morning, daytime, evening, and night). Family caregivers residing with relatives who were using adult day services (ADS) participated in an 8-day daily diary study (caregiver N = 173; caregiver-day N = 1,359). BPSD occurred most frequently in the evenings. ADS use, sleep disturbances, and dementia severity were significantly associated with BPSD occurrence for some phases of the day. Caregivers' distress towards BPSD occurrences increased throughout the day (i.e., most stressful at night). However, caregivers showed lower reactivity to BPSD at night on days when their relatives used ADS. Evidence of temporal patterns of BPSD in community-dwelling older adults and caregiver distress demonstrated the importance of ADS use for BPSD reactivity and identified potential target windows and associated contextual factors for individualized interventions.
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Affiliation(s)
- Caitlin Connelly
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Kyungmin Kim
- Department of Child Development and Family Studies, Seoul National University, Seoul, South Korea
| | - Yin Liu
- Department of Human Development and Family Sciences, Utah State University, Logan, UT, USA
| | - Steven H Zarit
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
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Buccellato FR, D’Anca M, Tartaglia GM, Del Fabbro M, Scarpini E, Galimberti D. Treatment of Alzheimer's Disease: Beyond Symptomatic Therapies. Int J Mol Sci 2023; 24:13900. [PMID: 37762203 PMCID: PMC10531090 DOI: 10.3390/ijms241813900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
In an ever-increasing aged world, Alzheimer's disease (AD) represents the first cause of dementia and one of the first chronic diseases in elderly people. With 55 million people affected, the WHO considers AD to be a disease with public priority. Unfortunately, there are no final cures for this pathology. Treatment strategies are aimed to mitigate symptoms, i.e., acetylcholinesterase inhibitors (AChEI) and the N-Methyl-D-aspartate (NMDA) antagonist Memantine. At present, the best approaches for managing the disease seem to combine pharmacological and non-pharmacological therapies to stimulate cognitive reserve. Over the last twenty years, a number of drugs have been discovered acting on the well-established biological hallmarks of AD, deposition of β-amyloid aggregates and accumulation of hyperphosphorylated tau protein in cells. Although previous efforts disappointed expectations, a new era in treating AD has been working its way recently. The Food and Drug Administration (FDA) gave conditional approval of the first disease-modifying therapy (DMT) for the treatment of AD, aducanumab, a monoclonal antibody (mAb) designed against Aβ plaques and oligomers in 2021, and in January 2023, the FDA granted accelerated approval for a second monoclonal antibody, Lecanemab. This review describes ongoing clinical trials with DMTs and non-pharmacological therapies. We will also present a future scenario based on new biomarkers that can detect AD in preclinical or prodromal stages, identify people at risk of developing AD, and allow an early and curative treatment.
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Affiliation(s)
- Francesca R. Buccellato
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Marianna D’Anca
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Gianluca Martino Tartaglia
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Elio Scarpini
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Daniela Galimberti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Carcavilla N, Pozo AS, González B, Moral-Cuesta D, Roldán JJ, Erice V, Remírez ADG. Needs of Dementia Family Caregivers in Spain During the COVID-19 Pandemic. J Alzheimers Dis 2021; 80:533-537. [PMID: 33554916 DOI: 10.3233/jad-201430] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
We explored the experience from caregivers of people with dementia (PwD) during mandatory confinement due to the COVID-19 pandemic in Spain. An online survey, which studied the perceptions of the main problems and consequences experienced during confinement, was answered by 106 family caregivers of PwD. Results showed that family caregivers of PwD experienced psychological problems, like anxiety, mood, sleep, or eating disorders during confinement and felt less supported when they had to handle challenging behaviors or offer meaningful activities. An innovative multi-tiered supportive approach is needed which considers a post-pandemic reality and ensures the continuity of quality care for PwD and their family careers.
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Affiliation(s)
- Nuria Carcavilla
- Institute of Neurosciences of Castilla and Leon (INCYL), C/ Pintor Fernando Gallego, Salamanca, Spain.,Dementia Group, Sociedad Navarra de Geriatría y Gerontología, Fundación Colegio de Médicos, Avenida Baja Navarra, 47, 31002 Pamplona, Navarra, Spain
| | - Ana Sofía Pozo
- Dementia Group, Sociedad Navarra de Geriatría y Gerontología, Fundación Colegio de Médicos, Avenida Baja Navarra, 47, 31002 Pamplona, Navarra, Spain.,Geriatrics Service, Complejo Hospitalario de Navarra, C/ Irunlarrea 3, 31008, Pamplona, Navarra, Spain
| | - Belén González
- Dementia Group, Sociedad Navarra de Geriatría y Gerontología, Fundación Colegio de Médicos, Avenida Baja Navarra, 47, 31002 Pamplona, Navarra, Spain.,Geriatrics Service, Complejo Hospitalario de Navarra, C/ Irunlarrea 3, 31008, Pamplona, Navarra, Spain
| | - Débora Moral-Cuesta
- Dementia Group, Sociedad Navarra de Geriatría y Gerontología, Fundación Colegio de Médicos, Avenida Baja Navarra, 47, 31002 Pamplona, Navarra, Spain.,Geriatrics Service, Complejo Hospitalario de Navarra, C/ Irunlarrea 3, 31008, Pamplona, Navarra, Spain
| | - José Joaquín Roldán
- Dementia Group, Sociedad Navarra de Geriatría y Gerontología, Fundación Colegio de Médicos, Avenida Baja Navarra, 47, 31002 Pamplona, Navarra, Spain.,Clínica Psicogeriátrica Josefina Arregui, C/ Zelai, 84, 31800 Alsasua, Navarra, Spain
| | - Victoria Erice
- Dementia Group, Sociedad Navarra de Geriatría y Gerontología, Fundación Colegio de Médicos, Avenida Baja Navarra, 47, 31002 Pamplona, Navarra, Spain.,Asociación de Familiares de personas con Alzheimer y otras demencias de Navarra (AFAN), C/ Pintor Maeztu 2 bajo, 31008, Pamplona, Navarra, Spain
| | - Ana de Ganuza Remírez
- Dementia Group, Sociedad Navarra de Geriatría y Gerontología, Fundación Colegio de Médicos, Avenida Baja Navarra, 47, 31002 Pamplona, Navarra, Spain.,Asociación de Familiares de personas con Alzheimer y otras demencias de Navarra (AFAN), C/ Pintor Maeztu 2 bajo, 31008, Pamplona, Navarra, Spain
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Todd WD. Potential Pathways for Circadian Dysfunction and Sundowning-Related Behavioral Aggression in Alzheimer's Disease and Related Dementias. Front Neurosci 2020; 14:910. [PMID: 33013301 PMCID: PMC7494756 DOI: 10.3389/fnins.2020.00910] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/06/2020] [Indexed: 12/19/2022] Open
Abstract
Patients with Alzheimer's disease (AD) and related dementias are commonly reported to exhibit aggressive behavior and other emotional behavioral disturbances, which create a tremendous caretaker burden. There has been an abundance of work highlighting the importance of circadian function on mood and emotional behavioral regulation, and recent evidence demonstrates that a specific hypothalamic pathway links the circadian system to neurons that modulate aggressive behavior, regulating the propensity for aggression across the day. Such shared circuitry may have important ramifications for clarifying the complex interactions underlying "sundowning syndrome," a poorly understood (and even controversial) clinical phenomenon in AD and dementia patients that is characterized by agitation, aggression, and delirium during the late afternoon and early evening hours. The goal of this review is to highlight the potential output and input pathways of the circadian system that may underlie circadian dysfunction and behavioral aggression associated with sundowning syndrome, and to discuss possible ways these pathways might inform specific interventions for treatment. Moreover, the apparent bidirectional relationship between chronic disruptions of circadian and sleep-wake regulation and the pathology and symptoms of AD suggest that understanding the role of these circuits in such neurobehavioral pathologies could lead to better diagnostic or even preventive measures.
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Affiliation(s)
- William D Todd
- Program in Neuroscience, Department of Zoology and Physiology, University of Wyoming, Laramie, WY, United States
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