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Galankin TL, Bespalov AY, Moebius HY. Clusterization of Behavioral and Psychological Symptoms of Dementia as Assessed by Neuropsychiatric Inventory: A Case Against the Use of Principal Component Analysis. J Alzheimers Dis 2024; 98:1483-1491. [PMID: 38578888 DOI: 10.3233/jad-231008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
Background The term Behavioral and Psychological Symptoms of Dementia (BPSD) covers a group of phenomenologically and medically distinct symptoms that rarely occur in isolation. Their therapy represents a major unmet medical need across dementias of different types, including Alzheimer's disease. Understanding of the symptom occurrence and their clusterization can inform clinical drug development and use of existing and future BPSD treatments. Objective The primary aim of the present study was to investigate the ability of a commonly used principal component analysis to identify BPSD patterns as assessed by Neuropsychiatric Inventory (NPI). Methods NPI scores from the Aging, Demographics, and Memory Study (ADAMS) were used to characterize reported occurrence of individual symptoms and their combinations. Based on this information, we have designed and conducted a simulation experiment to compare Principal Component analysis (PCA) and zero-inflated PCA (ZI PCA) by their ability to reveal true symptom associations. Results Exploratory analysis of the ADAMS database revealed overlapping multivariate distributions of NPI symptom scores. Simulation experiments have indicated that PCA and ZI PCA cannot handle data with multiple overlapping patterns. Although the principal component analysis approach is commonly applied to NPI scores, it is at risk to reveal BPSD clusters that are a statistical phenomenon rather than symptom associations occurring in clinical practice. Conclusions We recommend the thorough characterization of multivariate distributions before subjecting any dataset to Principal Component Analysis.
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Chen YR, Huang WY, Lee TY, Chu H, Chiang KJ, Jen HJ, Liu D, Chen R, Kang XL, Lai YJ, Chou KR. Efficacy of Blue LED Phototherapy on Sleep Quality and Behavioral and Psychological Symptoms of Dementia: A Double-Blind Randomized Controlled Trial. Gerontology 2023; 69:1175-1188. [PMID: 37527625 DOI: 10.1159/000531968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION People with dementia often experience behavioral and psychological symptoms of dementia (BPSD), which are a major cause of caregiver burden and institutionalization. Therefore, we conducted a double-blind, parallel-group randomized controlled trial to examine the efficacy of blue-enriched light therapy for BPSD in institutionalized older adults with dementia. METHODS Participants were enrolled and randomly allocated into blue-enriched light therapy (N = 30) or the conventional light group (N = 30) for 60 min in 10 weeks with five sessions per week. The primary outcome was sleep quality measured by actigraphy and Pittsburgh Sleep Quality Index (PSQI). The secondary outcome was overall BPSD severity (Cohen-Mansfield Agitation Inventory [CMAI] and Neuropsychiatric Inventory [NPI-NH]). The outcome indicators were assessed at baseline, mid-test, immediate posttest, 1-month, 3-month, and 6-month follow-up. The effects of the blue-enriched light therapy were examined by the generalized estimating equation model. RESULTS Blue-enriched light therapy revealed significant differences in the objective sleep parameters (sleep efficiency: β = 5.81, Waldχ2 = 32.60, CI: 3.82; 7.80; sleep latency: β = -19.82, Waldχ2 = 38.38, CI:-26.09; -13.55), subjective sleep quality (PSQI: β = -2.07, Waldχ2 = 45.94, CI: -2.66; -1.47), and overall BPSD severity (CMAI: β = -0.90, Waldχ2 = 14.38, CI: -1.37; -0.44) (NPI-NH: β = -1.67, Waldχ2 = 30.61, CI: -2.26; -1.08) compared to conventional phototherapy immediate posttest, 1-month, 3-month, and 6-month follow-up. Furthermore, the effects for sleep efficiency and sleep latency lasted for up to 6 months. In the subscale analysis, the differences of the behavioral symptoms changed significantly between the groups in physical/nonaggressive (CI: -1.01; -0.26) and verbal/nonaggressive (CI: -0.97; -0.29). CONCLUSIONS Blue-enriched light therapy is a feasible low-cost intervention that could be integrated as a comprehensive therapy program for BPSD among older adults with dementia.
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Affiliation(s)
- Ying-Ren Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Wen-Yu Huang
- Department of Nursing, Taipei Veterans General Hospital, Yuanshan Branch, I-lan, Taipei, Taiwan
| | - Tso-Ying Lee
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Nursing Research Center, Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kai-Jo Chiang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Xiao Linda Kang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Nursing, University of Pennsylvania, PA, Philadelphia, USA
| | - Yueh-Jung Lai
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
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Zhao Y, Ding Y, Liu L, Chan HYL. Feasibility of a Culturally Specific DEmentia Competence Education for Nursing Home Taskforce (DECENT) Programme: A Mixed-Method Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16679. [PMID: 36554559 PMCID: PMC9779405 DOI: 10.3390/ijerph192416679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
Although educational resources have been developed to build staff's dementia care competence in Western culture, their applicability and cultural relevance to the Chinese population are questionable. To address this gap, the DEmentia Competence Education for Nursing home Taskforce (DECENT) programme was developed and tailored to Chinese staff. This study aimed to evaluate the feasibility and preliminary effects of the DECENT programme. A one-group pretest-posttest study, embedded with a qualitative component, was conducted among 12 healthcare professionals. The DECENT programme comprised eight topics covering essential competencies in dementia care. It was delivered face-to-face by a qualified educator once per week for 60-90 min over 8 weeks. Outcomes were measured at baseline and immediately post-intervention. A satisfaction survey and individual interviews were conducted post-intervention to understand participants' perceptions and experience with the intervention. Nine participants finished the post-intervention assessment. Except for staff's attitudes towards people with dementia, quantitative findings generally demonstrated positive changes following the intervention. Three categories were identified from the qualitative data: well-developed programme, perceived benefits, and barriers. The findings showed that the DECENT programme is feasible and is perceived by nursing home staff as relevant and useful to daily practice. A larger-scale study is needed to evaluate its effectiveness.
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Affiliation(s)
- Yayi Zhao
- School of Nursing, Nanjing University of Chinese Medicine, No. 138 Xianlin Avenue, Xianlin District, Nanjing 210038, China
| | - Yaping Ding
- School of Nursing, Nanjing Medical University, No. 101 Longmian Avenue, Jiangning District, Nanjing 211100, China
| | - Li Liu
- Xiangya Nursing School, Central South University, No. 172 Tongzi Slopes Road, Yuelu District, Changsha 410013, China
| | - Helen Y. L. Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin 999077, Hong Kong SAR, China
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Ni X, Wu F, Song J, An L, Jiang Q, Bai T, Wang J, Yu P, Zhang C, Wu J. Chinese expert consensus on assessment of cognitive impairment in the elderly. Aging Med (Milton) 2022; 5:154-166. [PMID: 36247339 PMCID: PMC9549307 DOI: 10.1002/agm2.12222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/02/2022] [Accepted: 08/22/2022] [Indexed: 11/06/2022] Open
Abstract
Cognitive impairment is a term that refers to the impairment of one or more cognitive domains to varying degrees caused by a variety of reasons. It is under a high prevalence, many risk factors, complex etiology, and great harm to the elderly population. Early screening, diagnosis, and intervention for cognitive impairment in the elderly are of great importance. However, at present, the recognition rate of cognitive impairment for the elderly in China is low, the rate of missed diagnosis is high, and the evaluation is not standardized. This consensus integrates the commonly used cognitive function assessment scales in China and abroad, and aims to popularize the screening of cognitive impairment, standardize the evaluation methods and procedures of cognitive impairment in the elderly, and establish clinical diagnoses, interventions, and follow-up plans in a timely manner.
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Affiliation(s)
- Xiushi Ni
- Department of GeriatricsShanghai General Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Fang Wu
- Department of GeriatricsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Juan Song
- Center of Gerontology and Geriatrics, National Clinical Research Center for GeriatricsWest China Hospital, Sichuan UniversityChengduChina
| | - Lina An
- Department of GeriatricsShanghai General Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Qianwen Jiang
- Department of GeriatricsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tingting Bai
- Department of GeriatricsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | | | | | - Cuntai Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Jinhui Wu
- Center of Gerontology and Geriatrics, National Clinical Research Center for GeriatricsWest China Hospital, Sichuan UniversityChengduChina
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Zhao Y, Liu L, Ding Y, Chan HYL. Effect of a culturally sensitive DEmentia Competence Education for Nursing home Taskforce (DECENT) programme in China: A quasi-experimental study. NURSE EDUCATION TODAY 2022; 116:105434. [PMID: 35728332 DOI: 10.1016/j.nedt.2022.105434] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 04/27/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Existing educational programmes for building capacity in dementia care are developed in the Western culture; their applicability and cultural relevancy to other cultures is questionable. There is a dearth of culturally specific dementia-care educational programme for Chinese communities. OBJECTIVES To evaluate a culturally specific DEmentia Competence Education for Nursing home Taskforce (DECENT) programme in mainland China. DESIGN A multi-site quasi-experimental study. METHODS Nursing homes were pair-matched and allocated into intervention (n = 5) and control group (n = 5). The DECENT programme was delivered face-to-face using multiple pedagogies for 60-90 min per session by a trained educator once per week over 8 weeks. The primary outcome was the sense of competence in dementia care. The secondary outcomes were dementia knowledge, attitudes towards people with dementia, person-centred care in nursing homes and the severity of behavioral and psychological symptoms of dementia of residents with dementia and staff-perceived disturbance. They were measured at baseline (T0), immediately post-intervention (T1) and 3 months after the intervention (T2). RESULTS The intervention group has significantly greater improvement than control group in sense of competence both at T1 (B = 5.24, p < .001) and T2 (B = 4.43, p = .013). Regarding dementia knowledge and person-centred care, intervention group only showed greater improvement than control group at T1 (B = 3.18, p = .001; B = 5.75, p = .018, respectively), but not at T2 (p = .089 and .104, respectively). Group differences in attitudes and severity of behavioral and psychological symptoms of dementia and staff-perceived disturbance were not significant at both time points. CONCLUSIONS The DECENT programme is applicable and beneficial in improving staff's sense of competence in dementia care in Chinese communities, but reinforcement strategies are needed to sustain the effect for maintaining the learnt knowledge and changed person-centred care practice.
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Affiliation(s)
- Yayi Zhao
- School of Nursing, Nanjing University of Chinese Medicine, No. 138 Xianlin Avenue, Qixia District, Nanjing, 210000, Jiangsu Province, China.
| | - Li Liu
- Xiangya Nursing School, Central South University, No. 172 Tongzi Slopes Road, Yuelu District, Changsha, 410000, Hunan Province, China.
| | - Yaping Ding
- School of Nursing, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, Jiangning District, 210000, Jiangsu Province, China.
| | - Helen Y L Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, 999077, Hong Kong Special Administrative Region.
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O’Sullivan JL, Schweighart R, Lech S, Kessler EM, Tegeler C, Teti A, Nordheim J, Gellert P. Concordance of self- and informant-rated depressive symptoms in nursing home residents with Dementia: cross-sectional findings. BMC Psychiatry 2022; 22:241. [PMID: 35382790 PMCID: PMC8981933 DOI: 10.1186/s12888-022-03876-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Depression is highly prevalent in nursing home residents living with moderate to severe dementia. However, assessing depressive symptoms in residents with dementia can be challenging and may vary by rater perspective. We aimed to investigate the concordance of, and factors associated with self- and informant-rated depressive symptoms in nursing home residents with dementia. METHODS Cross-sectional data was collected from N = 162 nursing home residents with dementia (age: 53-100; 74% women). Self-ratings were assessed with the Geriatric Depression Scale, while the depression and anxiety items of the Neuropsychiatric Inventory were used for informant-ratings. Cohen's Kappa was calculated to determine the concordance of both measures and of each with antidepressant medication. Multivariate associations with sociodemographic variables, self- and informant-rated quality of life, dementia stage, neuropsychiatric symptoms, functional status and antidepressant medication were analysed with linear mixed models and generalized estimating equations. RESULTS Concordance between self- and single item informant-rated depressive symptoms was minimal (Cohen's Kappa = .22, p = .02). No concordance was found for self-reported depressive symptoms and the combined informant-rated depression-anxiety score. Self-reported depression was negatively associated with self-rated quality of life (β = -.32; 95%CI: -.45 to -.19, p < .001), informant-rated quality of life (β = -.25; 95%CI: -.43 to -.07, p = .005) and functional status (β = -.16; 95%CI: -.32 to -.01, p = .04), whilst single item informant-rated depression revealed negative associations with informant-rated quality of life (β = -.32; 95%CI: -.52 to -.13, p = .001) and dementia stage (β = -.31; 95%CI: -.52 to -.10, p = .004). The combined informant-rated depression-anxiety score showed negative associations with self-rated quality of life (β = -.12; 95%CI: -.22 to -.03, p = .01) and dementia stage (β = -.37; 95%CI: -.67 to -.07, p = .02) and a positive association with neuropsychiatric symptoms (β = .30; 95%CI: .10 to .51, p = .004). No concordance was found with antidepressant medication. CONCLUSIONS In line with our expectations, low agreement and unique association patterns were found for both measures. These findings indicate that both instruments address different aspects of depression und underline the need for comprehensive approaches when it comes to detecting signs of clinically relevant depressive symptoms in dementia. TRIAL REGISTRATION The trial was registered with the ISRCTN registry (Trial registration number: ISRCTN98947160 ).
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Affiliation(s)
- Julie L. O’Sullivan
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Roxana Schweighart
- grid.449789.f0000 0001 0742 8825Institute for Gerontology, University Vechta, Driverstraße 2, 49377 Vechta, Germany
| | - Sonia Lech
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany ,grid.7468.d0000 0001 2248 7639Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universitätzu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Eva-Marie Kessler
- grid.466457.20000 0004 1794 7698Department of Psychology, MSB Medical School Berlin, Rüdesheimer Str. 50, 14197 Berlin, Germany
| | - Christina Tegeler
- grid.466457.20000 0004 1794 7698Department of Psychology, MSB Medical School Berlin, Rüdesheimer Str. 50, 14197 Berlin, Germany
| | - Andrea Teti
- grid.449789.f0000 0001 0742 8825Institute for Gerontology, University Vechta, Driverstraße 2, 49377 Vechta, Germany
| | - Johanna Nordheim
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Paul Gellert
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
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Lu X, Ye R, Wu J, Rao D, Liao X. Comparing Behavioral and Psychological Symptoms of Dementia and Caregiver Distress Caused Between Older Adults With Dementia Living in the Community and in Nursing Homes. Front Psychiatry 2022; 13:881215. [PMID: 35651819 PMCID: PMC9150772 DOI: 10.3389/fpsyt.2022.881215] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/29/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To investigate differences in behavioral and psychological symptoms of dementia (BPSD) and caregiver distress caused between older adults with dementia living in the community and in nursing homes. DESIGN A comparative cross-sectional study. SETTING AND PARTICIPANTS Participants were recruited from outpatient clinics of a tertiary psychiatric hospital and dementia units of a nursing home in Guangzhou, China. METHODS Neuropsychiatric Inventory was used to assess symptoms and caregiver distress. Dementia severity was determined using the Clinical Dementia Rating. RESULTS This study included 157 community and 112 nursing home residents with dementia. Clinically significant symptoms (item score ≥ 4) were found in 88.5% of the former and 75% of the latter. Caregivers of 79.6% of the former and 26.8% of the latter reported that at least one of these caused them moderate-to-severe distress (distress score ≥ 3). Among the community patients, anxiety was the most frequent "very severe" symptom, while sleep disorders and agitation caused the most frequent "very severe" caregiver distress. After controlling for dementia severity and medication use, family caregiving remained an independent risk predictor for clinically significant symptoms and moderate-to-severe caregiver distress. The prediction of caregiver distress based on symptom scores varied across caregiver types and individual symptoms (R2 0.36-0.82). Group differences in clinically significant symptoms and moderate-to-severe caregiver distress showed at the stage of moderate-to-severe dementia. CONCLUSIONS AND IMPLICATIONS Tailored management strategies to relieve family caregivers' BPSD-induced distress are needed, especially at the stage of moderate-to-severe dementia. An effective service system should be established for supporting family caregivers to cope with BPSD.
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Affiliation(s)
- Xuejiao Lu
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Nursing School, Southern Medical University, Guangzhou, China
| | - Rui Ye
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Nursing School, Southern Medical University, Guangzhou, China
| | - Jialan Wu
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Geriatric Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dongping Rao
- Geriatric Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoyan Liao
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Nursing School, Southern Medical University, Guangzhou, China
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Rangseekajee P, Aphisitphinyo S, Paholpak P, Piyavhatkul N, Vadhanavikkit P, Kaenampornpan M, Paholpak P. Mobile application for monitoring behavioral and psychological symptoms of dementia in patients with moderate to severe dementia. Geriatr Gerontol Int 2021; 21:472-477. [PMID: 33851502 DOI: 10.1111/ggi.14164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/04/2021] [Accepted: 03/15/2021] [Indexed: 11/30/2022]
Abstract
AIM Behavioral and psychological symptoms of dementia (BPSD) are common in patients with moderate-severe dementia and have negative impacts on both patients and caregivers. There is a lack of a tool for caregivers to monitor patients' BPSD by themselves. This study aimed to develop and validate a mobile application for caregivers to use in monitoring BPSD. METHODS A total of 104 pairs of patients with moderate-severe dementia and their caregivers completed the study. The Neuropsychiatric Inventory (NPI) was modified and digitally transformed to a caregiver-rating mobile application to quantify nine domains of BPSD for their frequency and impact on the emotion of the caregivers. Data collected from the application were compared with the paper-and-pencil NPI for prevalence, concurrent validity (Spearman's rho) and internal consistency (Cronbach's alpha). RESULTS The application was able to detect 93% of BPSD compared with the NPI. Concurrent validity was good-very good when compared with the Frequency × Severity score (ρ = 0.77, P < 0.001) and the burden score (ρ = 0.85, P < 0.001) from the NPI. Levels of internal consistency were acceptable for both frequency (α = 0.73) and impact (α = 0.79) scores. 80% of the caregivers reported that the application was "very likely to be helpful in caregiving". CONCLUSIONS The mobile application for monitoring BPSD in patients with moderate-severe dementia had an excellent sensitivity, and good-very good validity and consistency. The caregivers had a positive perception of the application as an aid in caregiving. Geriatr Gerontol Int 2021; 21: 472-477.
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Affiliation(s)
- Poonsri Rangseekajee
- Brain and Mind Wellness Research Group, Khon Kaen University, Khon Kaen, Thailand.,Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sirinapa Aphisitphinyo
- Brain and Mind Wellness Research Group, Khon Kaen University, Khon Kaen, Thailand.,Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pattharee Paholpak
- Brain and Mind Wellness Research Group, Khon Kaen University, Khon Kaen, Thailand.,Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nawanant Piyavhatkul
- Brain and Mind Wellness Research Group, Khon Kaen University, Khon Kaen, Thailand.,Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Papan Vadhanavikkit
- Brain and Mind Wellness Research Group, Khon Kaen University, Khon Kaen, Thailand.,Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Pongsatorn Paholpak
- Brain and Mind Wellness Research Group, Khon Kaen University, Khon Kaen, Thailand.,Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Webster L, Costafreda Gonzalez S, Stringer A, Lineham A, Budgett J, Kyle S, Barber J, Livingston G. Measuring the prevalence of sleep disturbances in people with dementia living in care homes: a systematic review and meta-analysis. Sleep 2021; 43:5601416. [PMID: 31633188 PMCID: PMC7157185 DOI: 10.1093/sleep/zsz251] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/27/2019] [Indexed: 12/16/2022] Open
Abstract
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.
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Affiliation(s)
- Lucy Webster
- Division of Psychiatry, University College London, London, UK
- Corresponding author. Lucy Webster, Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Sergi Costafreda Gonzalez
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - Amy Lineham
- University College London Medical School, London, UK
| | - Jessica Budgett
- Division of Psychiatry, University College London, London, UK
| | - Simon Kyle
- Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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van der Wolf E, van Hooren SAH, Waterink W, Lechner L. Psychiatric and behavioral problems and well-being in gerontopsychiatric nursing home residents. Aging Ment Health 2021; 25:277-285. [PMID: 31847540 DOI: 10.1080/13607863.2019.1695738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Gerontopsychiatric nursing home residents are residents with a chronic mental condition (not dementia), in combination with one or more physical disorders. Psychiatric and behavioral problems are common within this population. The objective of this study is to examine these behaviors and their relationship to the level of both observed and self-rated well-being in the gerontopsychiatric population. METHOD Both gerontopsychiatric residents, and their primary formal caregiver in several nursing homes in The Netherlands were asked to participate in a structured interview concerning psychiatric and behavioral problems and resident well-being. Psychiatric and behavioral problems were measured with the Neuropsychiatric Inventory Questionnaire (NPI-Q) and the Cohen Mansfield Agitation Index (CMAI). Well-being was measured through the self-rated Laurens Well-being Inventory for Gerontopsychiatry (LWIG), and the observer rated Laurens Well-being Observations for Gerontopsychiatry (LWOG). RESULTS A total of 126 residents participated in the study with ages varying from 42 to 90. Different types of chronic mental disorders such as schizophrenia spectrum disorder, bipolar disorders and personality disorders were prevalent in the population. Most psychiatric and behavioral problems are associated with lower observed and self-rated well-being. For irritability and affective problem behaviors the relationship with well-being was the most evident. CONCLUSION In daily care practice the relationship between well-being and psychiatric and behavioral problems should be taken into account in care planning and treatment. To further explore the direction and details of this relationship, more research is needed.
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Affiliation(s)
- Elja van der Wolf
- Laurens, Residential Care Center 'De Oudelandse Hof', Berkel en Rodenrijs, The Netherlands.,Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands
| | - Susan A H van Hooren
- Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands.,Faculty of Healthcare, Zuyd University of Applied Sciences, Heerlen, The Netherlands.,Research Centre for the Arts Therapies, KenVaK, Heerlen, The Netherlands
| | - Wim Waterink
- Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands
| | - Lilian Lechner
- Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands
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11
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Jiao Y, Tian T, Wei S, Wang C, Wu L. Association between serum non-high-density lipoprotein cholesterol and cognitive dysfunction after acute ischemic stroke: a cross-sectional study. Braz J Med Biol Res 2021; 53:e9487. [PMID: 33146286 PMCID: PMC7643927 DOI: 10.1590/1414-431x20209487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 08/19/2020] [Indexed: 12/05/2022] Open
Abstract
This study aimed to explore the association between serum non-high-density lipoprotein cholesterol (non-HDL-C) and cognitive dysfunction risk in patients with acute ischemic stroke (AIS). This cross-sectional study enrolled 583 AIS patients. Biochemical markers and lipid profile were collected after admission. AIS patients were classified into high group (non-HDL-C ≥3.4 mM) and normal group (non-HDL-C <3.4 mM). Mini-Mental State Examination scale (MMSE), Montreal Cognitive Assessment scale (MoCA), Activities of Daily Living (ADL) scale, Neuropsychiatric Inventory (NPI), and Hamilton Depression scale 21 version (HAMD-21) were applied on the third day after admission. Compared with the control group, patients of the high group had higher body mass index and higher frequency of intracranial artery stenosis, and exhibited higher levels of non-HDL-C, total cholesterol, triglycerides, low-density lipoprotein cholesterol, homocysteine, fasting blood glucose, and glycosylated hemoglobin (HbA1c), and lower levels of high-density lipoprotein cholesterol (all P<0.05). Compared with the control group, patients of the high group had significantly lower MMSE and MoCA scores (MMSE: 26.01±4.17 vs 23.12±4.73, P<0.001; MoCA: 22.28±5.28 vs 20.25±5.87, P<0.001) and higher scores on the NPI and HAMD-21 (both P<0.001). MMSE (r=-0.306, P<0.001) and MoCA scores (r=-0.251, P<0.001) were negatively associated with non-HDL-C level. Multivariate regression analysis revealed that non-HDL-C level (OR=1.361, 95%CI: 1.059-1.729, P=0.016) was independently associated with the presence of cognitive dysfunction after adjusting for confounding factors. High serum non-HDL-C level might significantly increase the risk of cognitive dysfunction after AIS.
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Affiliation(s)
- Yinghui Jiao
- Department of Neurology, Weifang People's Hospital, Weifang, Shandong, China
| | - Tian Tian
- Department of Neurology, Weifang People's Hospital, Weifang, Shandong, China
| | - Shasha Wei
- Operating Room, Weifang Brain Hospital, Weifang, Shandong, China
| | - Chengdong Wang
- Prenatal Diagnosis Laboratory, Weifang People's Hospital, Weifang, Shandong, China
| | - Lili Wu
- Department of Neurology, Weifang People's Hospital, Weifang, Shandong, China
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12
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Wu J, Chen S, Wen H, Yi Y, Liao X. Health status, care needs, and assessment for beneficiaries with or without dementia in a public long-term care insurance pilot in Guangzhou, China. BMC Health Serv Res 2020; 20:1127. [PMID: 33287798 PMCID: PMC7720481 DOI: 10.1186/s12913-020-05965-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/24/2020] [Indexed: 11/30/2022] Open
Abstract
Background Chinese government launched a pilot study on public long-term care insurance (LTCI) recently. Guangzhou is one of the fifteen pilot cities, officially started providing LTCI in August 2017. An in-depth analysis of experimental data from the pilot city may provide suggestions for developing a fair and effective LTCI system. This study aimed to evaluate the LTCI pilot by exploring the characteristics and care needs of claimants, and performance of the assessment tool. Methods A retrospective cross-sectional study in which claims data between July 2018 and March 2019 in the Guangzhou pilot was analyzed. LTCI claimants during the study period were included. The care needs were determined based on claimants’ physical function assessed by the Barthel Index and their medical conditions. Rasch analysis was used to explore the performance of the Barthel Index. Results Among 4810 claimants included, 4582 (95.3%) obtained LTCI benefits. Of these beneficiaries, 4357 (95.1%) were ≧ 60 years old, and 791 (17.3%) had dementia. Among 228 (4.7%) unsuccessful claimants, 22 (0.5%) had dementia. The prevalence of stroke was high in beneficiaries with (38.1%) or without dementia (56.6%), as well as in unsuccessful claimants with (40.9%) or without dementia (52.4%). Beneficiaries without dementia needed more support for basic activities of daily living and nursing care than those with dementia, while beneficiaries with dementia were more likely to be institutionalized. Five (22.7%) unsuccessful claimants with dementia and 48 (23.3%) unsuccessful claimants without dementia were disabled in at least two basic self-care activities. Regarding Barthel Index, Rasch analysis showed threshold disordering in “mobility” and “climbing stairs”, and the narrow interval was observed between all the adjacent categories of the ten items (< 1.4 logits). Conclusions Stroke and dementia were two common reasons for needing long-term care in LTCI claimants. The Barthel Index is not suitable for assessing and dividing LTCI claimants, because of inappropriate items and narrow category responses. A comprehensive assessment and grading system is required, together with needs-led care services. The eligibility should be expanded gradually based on balance finance solutions. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05965-1.
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Affiliation(s)
- Jialan Wu
- Department of Nursing, Zengcheng Branch, Nanfang Hospital, Southern Medical University, No. 28 Innovation Avenue, Zengcheng, Guangzhou, 511300, China.,School of Nursing, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, 510515, China
| | - Siman Chen
- Department of Nursing, Zengcheng Branch, Nanfang Hospital, Southern Medical University, No. 28 Innovation Avenue, Zengcheng, Guangzhou, 511300, China.,School of Nursing, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, 510515, China
| | - Huangliang Wen
- Department of Nursing, Zengcheng Branch, Nanfang Hospital, Southern Medical University, No. 28 Innovation Avenue, Zengcheng, Guangzhou, 511300, China.,School of Nursing, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, 510515, China
| | - Yayan Yi
- Department of Nursing, Zengcheng Branch, Nanfang Hospital, Southern Medical University, No. 28 Innovation Avenue, Zengcheng, Guangzhou, 511300, China.,School of Nursing, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, 510515, China
| | - Xiaoyan Liao
- Department of Nursing, Zengcheng Branch, Nanfang Hospital, Southern Medical University, No. 28 Innovation Avenue, Zengcheng, Guangzhou, 511300, China.
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13
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Wang H, Chen S, Lu X, Wu J, Liao X. Validation of the Chinese version of the abnormal eating behavior questionnaire in people with dementia. Geriatr Nurs 2020; 42:72-77. [PMID: 33249318 DOI: 10.1016/j.gerinurse.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022]
Abstract
Abnormal eating behaviors are common in patients with dementia. To comprehensively assess and understand these issues, we validated the Chinese version of the Abnormal Eating Behaviour Questionnaire. Data for psychometric property evaluation were obtained from 129 patients with dementia. Internal consistency, test-retest reliability, dimensionality, and concurrent validity of the instrument were tested. The instrument showed acceptable internal consistency (Cronbach's alpha 0.73), time stability (Intra-class correlation coefficient 0.88, 95% CI: 0.77-0.94), and concurrent validity (ρ = 0.60, P < 0.001). Six factors (eigenvalues > 1, factor loading ≥ 0.3) explaining 55.1% of the variance were obtained through exploratory factor analysis. Overall, 86.8% of the participants showed at least one abnormal eating behavior. The instrument is reliable and valid for assessing abnormal eating behaviors in patients with dementia. Patients with dementia had a high prevalence of abnormal eating behaviors.
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Affiliation(s)
- Hanxiao Wang
- Nanfang Hospital, Southern Medical University, Nursing Department of Zengcheng Branch, No. 28 Innovation Avenue, Zengcheng, Guangzhou 511300, China; Southern Medical University, School of Nursing, No. 1838 Guangzhou Avenue North, Guangzhou 510515, China; Shenzhen People's Hospital, No. 1017 Dongmen North Road, Luohu District, Shenzhen 518020, China
| | - Siman Chen
- Nanfang Hospital, Southern Medical University, Nursing Department of Zengcheng Branch, No. 28 Innovation Avenue, Zengcheng, Guangzhou 511300, China; Southern Medical University, School of Nursing, No. 1838 Guangzhou Avenue North, Guangzhou 510515, China
| | - Xuejiao Lu
- Nanfang Hospital, Southern Medical University, Nursing Department of Zengcheng Branch, No. 28 Innovation Avenue, Zengcheng, Guangzhou 511300, China; Southern Medical University, School of Nursing, No. 1838 Guangzhou Avenue North, Guangzhou 510515, China
| | - Jialan Wu
- Nanfang Hospital, Southern Medical University, Nursing Department of Zengcheng Branch, No. 28 Innovation Avenue, Zengcheng, Guangzhou 511300, China; Southern Medical University, School of Nursing, No. 1838 Guangzhou Avenue North, Guangzhou 510515, China
| | - Xiaoyan Liao
- Nanfang Hospital, Southern Medical University, Nursing Department of Zengcheng Branch, No. 28 Innovation Avenue, Zengcheng, Guangzhou 511300, China.
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Ito E, Berge LI, Husebo BS, Nouchi R, Sandvik RK. The Negative Impact of Psychotropic Drug Use on Quality of Life in Nursing Home Patients at Different Stages of Dementia: Cross-Sectional Analyses from the COSMOS Trial. J Am Med Dir Assoc 2020; 21:1623-1628. [DOI: 10.1016/j.jamda.2020.03.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/27/2020] [Accepted: 03/29/2020] [Indexed: 11/27/2022]
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Psychogeriatric Inventory of Disconcerting Symptoms and Syndromes (PGI-DSS): validity and reliability of a new brief scale compared to the Neuropsychiatric Inventory for Nursing Homes (NPI-NH). Int Psychogeriatr 2020; 32:1085-1095. [PMID: 32329709 DOI: 10.1017/s1041610220000496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To validate the Psychogeriatric Inventory of Disconcerting Symptoms and Syndromes (PGI-DSS), a single scale in A4 format comprising four disconcerting syndromes (violence, refusal, words, and acts). The scale enables an immediate conversion of a qualitative assessment to a quantitative assessment. The PGI-DSS was compared with the Neuro Psychiatric Inventory for Nursing Homes (NPI-NH). DESIGN Cross-sectional descriptive and correlational studies. SETTING Thirty geriatric care units and nursing homes. PARTICIPANTS Raters interviewed nurses and nursing assistants in charge of older adults hospitalized in geriatric care units or living in nursing homes (N = 226). MEASUREMENTS The French version of the PGI-DSS and the French version of the NPI-NH. RESULTS The correlation coefficient between the PGI-DSS and the NPI-NH was 0.70 (p < 0.0001). The PGI-DSS threshold score corresponding to the NPI threshold score was 17 (specificity: 87%, sensitivity: 63%). Four statistical factors, corresponding to the four clinical syndromes, explained 53.4% of the total variance. The internal consistency of the PGI-DSS (Cronbach's alpha = 0.695) was higher than that of the NPI-NH (Cronbach's alpha = 0.474). Test-retest reliability was better for the PGI-DSS than for the NPI-NH. The intraclass correlations were 0.80 [0.73; 0.86] and 0.75 [0.67; 0.83], respectively. Interrater reliability was better for the PGI-DSS than for the NPI-NH. The intraclass correlations were 0.65 [0.55-0.76] and 0.55 [0.43-0.68], respectively. CONCLUSION The PGI-DSS was developed to overcome the limitations of the NPI-NH. New, brief, easy to administer in less than 4 minutes, foldable in four parts, pocket-sized, easy-to-read in the palm of the hand, PGI-DSS could have similar or better statistical properties than the NPI-NH. Whereas the 10 domains in the NPI-NH have clinical utility for clinicians, the four easily understandable syndromes in the PGI-DSS can help avoid inappropriate attitudes and can guide psychosocial interventions. It could likewise improve dialogue between caregivers and clinicians.
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16
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Hui Z, Yang C, Li J, Lee DTF. Effectiveness of an online education intervention on stress and coping of family members after placing a relative with dementia into a residential care facility: protocol of a randomised controlled trial. BMC Geriatr 2020; 20:306. [PMID: 32847494 PMCID: PMC7448481 DOI: 10.1186/s12877-020-01711-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 08/16/2020] [Indexed: 11/21/2022] Open
Abstract
Background After residential care placement, family members may be exposed to stressors like difficulty in role changes, interpersonal conflict with facility staff, and emotional torment. These can threaten family members’ own health and well-being and even influence the extent they involve in their relative’s care. This study aims to evaluate an online education intervention for Chinese family members whose relatives with dementia have been placed into a residential care facility. Methods This protocol describes a two-arm randomised controlled trial. A total of 150 family members of residents with dementia will be recruited from four to six residential care facilities in Xi’an, Shaanxi, China and randomly allocated to either the intervention or control group. Family members in the intervention group will receive a six-week group-based online education intervention, while those in the control group will receive routine care. Family members’ stress, coping, caregiving burden, and family involvement, as well as their relative’s behavioural and psychological symptoms of dementia will be assessed at immediately post-intervention and six-week follow-up. Effectiveness of the intervention will be analysed by generalised estimating equation model, based on the intention-to-treat principle. A process evaluation of the intervention will also be undertaken. Discussion This study will be of great significance in addressing family members’ stressors after institutionalising a relative with dementia and promoting the implementation of family-centred care in practice especially in residential care facilities. Trial registration Chinese Clinical Trial Registry, ChiCTR1900024582, Registered 18 July 2019.
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Affiliation(s)
- Zhaozhao Hui
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Room 601, 6/F, Esther Lee Building, Hong Kong, SAR, China.
| | - Chen Yang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Room 601, 6/F, Esther Lee Building, Hong Kong, SAR, China
| | - Jieqiong Li
- Department of Nursing, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Diana Tze Fan Lee
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Room 601, 6/F, Esther Lee Building, Hong Kong, SAR, China
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Abstract
REASONS FOR THE STUDY The Neuropsychiatric Inventory (NPI) has been used for studies of neuropsychiatric symptoms in neurodegenerative disorders for the past 25 years. This article reviews the history of the development and application of the NPI. MAIN FINDINGS The NPI consists of 10 (or 12) items that are assayed with questions, subquestions, and ratings of frequency and severity. The NPI has been shown to be valid and reliable. The NPI has been translated into approximately 40 languages; it has 4 of versions designed for different clinical applications. The NPI studies show contrasting profiles of behavioral symptoms in different neurologic disorders. The NPI has been used in approximately 350 clinical trials. In economic studies, the NPI captures the cost of behavioral symptoms in dementias. PRINCIPLE CONCLUSIONS The NPI is a useful instrument for capturing behavioral changes in Alzheimer disease and other neurodegenerative disorders.
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Affiliation(s)
- Jeffrey Cummings
- Department of Brain Health, School of integrated Health Sciences, UNLV, Las Vegas, NV, USA,Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, USA
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18
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Yi Y, Ding L, Wen H, Wu J, Makimoto K, Liao X. Is Barthel Index Suitable for Assessing Activities of Daily Living in Patients With Dementia? Front Psychiatry 2020; 11:282. [PMID: 32457659 PMCID: PMC7225343 DOI: 10.3389/fpsyt.2020.00282] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/23/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To evaluate application of the Barthel Index (BI) in assessing basic activities of daily living (ADL) of patients with dementia using Rasch analysis. DESIGN A multi-country cross-sectional study. SETTING AND PARTICIPANTS Nineteen long-term care facilities located in China, Japan, South Korea, and Thailand. A total of 644 patients with dementia were included. METHODS Unidimensionality, global and item fit, local dependence, person-item targeting, threshold disordering, and differential item functioning (DIF) were examined. Negative correlations between scores for DIF items and Neuropsychiatric Inventory Nursing Home version (NPI-NH) were evaluated. RESULTS Item reliability (1.0) and person reliability (.88) were acceptable. The Rasch dimension explained 72.9% of the variance (Eigenvalue = 27), while the first contrast explained 6.6% (Eigenvalue = 2.4). The "mobility" was misfitting to the Rasch model (infit mean square = 1.86). The overall difficulty of the BI exceeded patients' ability (person location = -2.27 logits). The "stairs climbing" and "mobility" showed narrow category thresholds (< 1.4 logits). The location of "controlling bladder" and "toilet use" overlapped. Removing "stairs climbing", collapsing categories with narrow threshold widths in "mobility", and combining "controlling bowel" and "controlling bladder" into one item, improved unidimensionality, and item fit of the scale. Only three items ("grooming", "dressing", and "toilet use") were free from DIF across countries. The scores for "feeding" were negatively related to scores for "disinhibition" (r = -0.46, P < 0.01), and scores for "controlling bowel" were negatively related to scores for "disinhibition" (r = -0.44, P < 0.01), "agitation" (r = -0.32, P < 0.05), and "aggression" (r = -0.27, P < 0.01) in Japanese samples. CONCLUSIONS AND IMPLICATIONS The performance of the BI for assessing patients with dementia might be compromised by misfit items, person-item mistargeting, measurement gaps, redundant items, narrow threshold width, and item bias. Mobility ability might not be helpful for determining capability of basic ADL in the patients. Comparisons of BI scores between countries should be undertaken with caution due to item bias. Neuropsychiatric symptoms might interact with basic ADL abilities of the patients. We will not suggest using the instrument in patients with dementia, without future refining to improve its performance.
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Affiliation(s)
- Yayan Yi
- Department of Nursing, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lin Ding
- Department of Nursing, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Huangliang Wen
- Department of Nursing, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jialan Wu
- Department of Nursing, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kiyoko Makimoto
- Department of Nursing, School of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
| | - Xiaoyan Liao
- Department of Nursing, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Terada S, Yamakawa M, Kang Y, Kobayashi S, Liao XY, Panuthai S, Sung HC, Suzuki M, Makimoto K. Variations and factors associated with psychotropic use in cognitively impaired elderly residing in long-term care facilities in East Asia: a cross-sectional study. Psychogeriatrics 2019; 19:291-299. [PMID: 30666764 DOI: 10.1111/psyg.12395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/21/2018] [Accepted: 12/09/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this cross-sectional study was to compare patterns of psychotropic prescription drug use among cognitively impaired residents in long-term care facilities in East Asia and to explore factors associated with these patterns. METHODS This study included elderly participants with cognitive impairments residing in long-term care facilities with and without dementia care units in Japan, South Korea, China, Taiwan, and Thailand. The Mini-Mental State Examination, the Clinical Dementia Rating, and the Neuropsychiatric Inventory, Nursing Home version were used to assess cognitive status, examine dementia severity, and evaluate behavioural psychological symptoms of dementia, respectively. The rate of psychotropic drug use and the relationship between the number of psychotropic drugs and clinical factors were examined. RESULTS In total, 662 people were analyzed. Facilities with dementia care units had a higher rate of anti-dementia drug use than regular elderly care sites. Among the three dementia care sites, a Japanese hospital and a Korean site had a high rate of antipsychotic use and use of other types of psychotropics, whereas these drugs were used at a low rate in a Chinese nursing home. Patterns of psychotropic drug use may be partially associated with local regulations and facility type. Poly-pharmacy was identified as a common problem at all study sites. CONCLUSIONS Our findings will be beneficial for health-care professionals and policymakers when developing practice guidelines and strategies to regulate overuse of psychotropics and poly-pharmacy. Prospective studies are needed to examine patterns of psychotropic prescriptions and to promote evidence-based practice.
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Affiliation(s)
- Saya Terada
- Division of Health Sciences, Department of Clinical Nursing, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Miyae Yamakawa
- Division of Health Sciences, Department of Clinical Nursing, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Younhee Kang
- Department of Nursing, College of Nursing, Ewha Womans University, Seoul, South Korea
| | - Sayuri Kobayashi
- Department of Nursing, Faculty of Nursing Komazawa Women's University, Tokyo, Japan
| | - Xiao-Yan Liao
- Department of Nursing, Nanfang Hospital, Guangzhou, China
| | | | - Huei-Chuan Sung
- Department of Nursing, Graduate Institute of Long-term Care, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Mizue Suzuki
- Department of Nursing, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Kiyoko Makimoto
- Division of Health Sciences, Department of Clinical Nursing, Graduate School of Medicine, Osaka University, Osaka, Japan.,Department of Nursing, School of Nursing and Rehabilitation, Konan Women's University, Hyogo, Japan
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20
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Makimoto K, Kang Y, Kobayashi S, Liao XY, Panuthai S, Sung HC, Suzuki M, Terada S, Yamakawa M. Prevalence of behavioural and psychological symptoms of dementia in cognitively impaired elderly residents of long-term care facilities in East Asia: a cross-sectional study. Psychogeriatrics 2019; 19:171-180. [PMID: 30394003 DOI: 10.1111/psyg.12380] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/31/2018] [Accepted: 08/27/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to compare the prevalence of behavioural and psychological symptoms of dementia (BPSD) in cognitively impaired elderly residents of long-term care facilities in East Asia and to explore the factors associated with these patterns. METHODS This was a cross-sectional survey of BPSD in cognitively impaired elderly residents of long-term care facilities in Japan, South Korea, China, Taiwan, and Thailand. The Mini-Mental State Examination, Clinical Dementia Rating (CDR), and Neuropsychiatric Inventory, Nursing Home version (NPI-NH), were used to assess cognitive status, dementia severity, and BPSD, respectively. NPI-NH subscale severity scores were multiplied by frequency scores to obtain the subscale scores and aggregated into two groups based on score (clinically insignificant = 1- 3; clinically significant ≥4). RESULTS Data from 662 people were analyzed. Median age, median Mini-Mental State Examination scores, and median CDR scores differed significantly among the seven study sites. The prevalence of BPSD varied from 64% in Taiwan to 100% in dementia care units in Japan, and the median total NPI-NH scores ranged from 2 in Taiwan to 14 in dementia care units in Japan. After stratification of the sample by dementia severity and clinical significance of NPI-NH scores, differences in the prevalence of clinically significant BPSD were mostly observed among facilities dedicated to dementia patients in the CDR 1 group. In the CDR 3 group, the prevalence of some clinically significant BPSD, such as apathy, was high even among study sites with low median total NPI-NH scores. CONCLUSIONS Our findings may suggest referral and selection biases in the study sites. Future prospective studies are needed to address the impact of environmental and care factors on the occurrence of BPSD in Asian countries.
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Affiliation(s)
- Kiyoko Makimoto
- Department of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan.,Department of Nursing, School of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
| | - Younhee Kang
- College of Nursing, Ewha Womans University, Seoul, South Korea
| | | | - Xiao-Yan Liao
- Department of Nursing, Nanfang Hospital, Guangzhou, China
| | | | - Huei-Chuan Sung
- Graduate Institute of Long-term Care, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Mizue Suzuki
- Department of Nursing, School of Medicine, Hamamatsu University, Shizuoka, Japan
| | - Saya Terada
- Department of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Miyae Yamakawa
- Department of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
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21
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Huang C, Zhong Q, Tang L, Wang H, Xu J, Zhou Z. Discovery of 2‐(3,4‐dialkoxyphenyl)‐2‐(substituted pyridazin‐3‐yl)acetonitriles as phosphodiesterase 4 inhibitors with anti‐neuroinflammation potential based on three‐dimensional quantitative structure–activity relationship study. Chem Biol Drug Des 2018; 93:484-502. [DOI: 10.1111/cbdd.13438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 10/10/2018] [Accepted: 10/27/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Chang Huang
- Department of Neuropharmacology and Novel Drug DiscoverySchool of Pharmaceutical SciencesSouthern Medical University Guangzhou China
- Guangdong Provincial Key Laboratory of New Drug ScreeningSchool of Pharmaceutical SciencesSouthern Medical University Guangzhou China
| | - Qiu‐Ping Zhong
- Department of Neuropharmacology and Novel Drug DiscoverySchool of Pharmaceutical SciencesSouthern Medical University Guangzhou China
- Guangdong Provincial Key Laboratory of New Drug ScreeningSchool of Pharmaceutical SciencesSouthern Medical University Guangzhou China
| | - Lv Tang
- Department of Neuropharmacology and Novel Drug DiscoverySchool of Pharmaceutical SciencesSouthern Medical University Guangzhou China
- Guangdong Provincial Key Laboratory of New Drug ScreeningSchool of Pharmaceutical SciencesSouthern Medical University Guangzhou China
| | - Hai‐Tao Wang
- Department of Neuropharmacology and Novel Drug DiscoverySchool of Pharmaceutical SciencesSouthern Medical University Guangzhou China
- Guangdong Provincial Key Laboratory of New Drug ScreeningSchool of Pharmaceutical SciencesSouthern Medical University Guangzhou China
| | - Jiang‐Ping Xu
- Department of Neuropharmacology and Novel Drug DiscoverySchool of Pharmaceutical SciencesSouthern Medical University Guangzhou China
- Guangdong Provincial Key Laboratory of New Drug ScreeningSchool of Pharmaceutical SciencesSouthern Medical University Guangzhou China
| | - Zhong‐Zhen Zhou
- Department of Neuropharmacology and Novel Drug DiscoverySchool of Pharmaceutical SciencesSouthern Medical University Guangzhou China
- Guangdong Provincial Key Laboratory of New Drug ScreeningSchool of Pharmaceutical SciencesSouthern Medical University Guangzhou China
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