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Swann P, Mirza-Davies A, O'Brien J. Associations Between Neuropsychiatric Symptoms and Inflammation in Neurodegenerative Dementia: A Systematic Review. J Inflamm Res 2024; 17:6113-6141. [PMID: 39262651 PMCID: PMC11389708 DOI: 10.2147/jir.s385825] [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: 04/15/2024] [Accepted: 08/30/2024] [Indexed: 09/13/2024] Open
Abstract
Background Neuropsychiatric symptoms are common in dementia and linked to adverse outcomes. Inflammation is increasingly recognized as playing a role as a driver of early disease progression in Alzheimer's disease (AD) and related dementias. Inflammation has also been linked to primary psychiatric disorders, however its association with neuropsychiatric symptoms in neurodegenerative dementias remains uncertain. Methods We conducted a systematic literature review investigating associations between inflammation and neuropsychiatric symptoms in neurodegenerative dementias, including AD, Lewy body, Frontotemporal, Parkinson's (PD) and Huntington's disease dementias. Results Ninety-nine studies met our inclusion criteria, and the majority (n = 59) investigated AD and/or mild cognitive impairment (MCI). Thirty-five studies included PD, and only 6 investigated non-AD dementias. Inflammation was measured in blood, CSF, by genotype, brain tissue and PET imaging. Overall, studies exhibited considerable heterogeneity and evidence for specific inflammatory markers was inconsistent, with lack of replication and few longitudinal studies with repeat biomarkers. Depression was the most frequently investigated symptom. In AD, some studies reported increases in peripheral IL-6, TNF-a associated with depressive symptoms. Preliminary investigations using PET measures of microglial activation found an association with agitation. In PD, studies reported positive associations between TNF-a, IL-6, CRP, MCP-1, IL-10 and depression. Conclusion Central and peripheral inflammation may play a role in neuropsychiatric symptoms in neurodegenerative dementias; however, the evidence is inconsistent. There is a need for multi-site longitudinal studies with detailed assessments of neuropsychiatric symptoms combined with replicable peripheral and central markers of inflammation.
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Affiliation(s)
- Peter Swann
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Anastasia Mirza-Davies
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - John O'Brien
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, Cambridge, UK
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Wertman E. Essential New Complexity-Based Themes for Patient-Centered Diagnosis and Treatment of Dementia and Predementia in Older People: Multimorbidity and Multilevel Phenomenology. J Clin Med 2024; 13:4202. [PMID: 39064242 PMCID: PMC11277671 DOI: 10.3390/jcm13144202] [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: 06/10/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Dementia is a highly prevalent condition with devastating clinical and socioeconomic sequela. It is expected to triple in prevalence by 2050. No treatment is currently known to be effective. Symptomatic late-onset dementia and predementia (SLODP) affects 95% of patients with the syndrome. In contrast to trials of pharmacological prevention, no treatment is suggested to remediate or cure these symptomatic patients. SLODP but not young onset dementia is intensely associated with multimorbidity (MUM), including brain-perturbating conditions (BPCs). Recent studies showed that MUM/BPCs have a major role in the pathogenesis of SLODP. Fortunately, most MUM/BPCs are medically treatable, and thus, their treatment may modify and improve SLODP, relieving suffering and reducing its clinical and socioeconomic threats. Regrettably, the complex system features of SLODP impede the diagnosis and treatment of the potentially remediable conditions (PRCs) associated with them, mainly due to failure of pattern recognition and a flawed diagnostic workup. We suggest incorporating two SLODP-specific conceptual themes into the diagnostic workup: MUM/BPC and multilevel phenomenological themes. By doing so, we were able to improve the diagnostic accuracy of SLODP components and optimize detecting and favorably treating PRCs. These revolutionary concepts and their implications for remediability and other parameters are discussed in the paper.
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Affiliation(s)
- Eli Wertman
- Department of Neurology, Hadassah University Hospital, The Hebrew University, Jerusalem 9190500, Israel;
- Section of Neuropsychology, Department of Psychology, The Hebrew University, Jerusalem 9190500, Israel
- Or’ad: Organization for Cognitive and Behavioral Changes in the Elderly, Jerusalem 9458118, Israel
- Merhav Neuropsychogeriatric Clinics, Nehalim 4995000, Israel
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[Reasons for hospitalization of people with dementia-A scoping review]. Z Gerontol Geriatr 2023; 56:42-47. [PMID: 35420353 PMCID: PMC9876850 DOI: 10.1007/s00391-021-02013-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/28/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hospitalization represents a high burden for people with dementia, which can accelerate the decline of cognitive and motor skills. Behavioral changes and orientation problems may be increased in people with dementia during hospitalization. Some hospitalizations are potentially preventable by improved outpatient care. OBJECTIVE To provide an up to date overview of the most common reasons for hospitalization of people with dementia or mild cognitive impairment. MATERIAL AND METHODS A systematic literature search was conducted in the databases PubMed®, CINAHL and PsycINFO® in May 2020 to conduct the scoping review. Studies in German and English published between July 2010 and May 2020 were included. RESULTS The most common reasons for hospitalization, which were named in the 14 included studies, were infectious diseases, especially respiratory infections and urinary tract infections, cardiovascular diseases (in general or specific, e.g. heart failure) and injuries, poisoning, fractures and falls, and gastrointestinal diseases. CONCLUSION Most of the most common reasons for hospitalization are ambulatory care-sensitive hospital cases. Strengthening outpatient care for people with dementia may help prevent hospitalizations.
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Ayhan Y, Yoseph SA, Miller BL. Management of Psychiatric Symptoms in Dementia. Neurol Clin 2022; 41:123-139. [DOI: 10.1016/j.ncl.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hill JD, Schmucker AM, Siman N, Goldfeld KS, Cuthel AM, Chodosh J, Bouillon-Minois JB, Grudzen CR. Emergency and post-emergency care of older adults with Alzheimer's disease/Alzheimer's disease related dementias. J Am Geriatr Soc 2022; 70:2582-2591. [PMID: 35612546 PMCID: PMC9489611 DOI: 10.1111/jgs.17833] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The emergency department (ED) is a critical juncture in the care of persons living with dementia (PLwD), as they have a high rate of hospital admission, ED revisits, and subsequent inpatient stays. We examine ED disposition of PLwD compared with older adults with non-dementia chronic disease as well as healthcare utilization and survival. METHODS Medicare claims data were used to identify community-dwelling older adults 66+ years old from 34 hospitals with either Alzheimer's disease/Alzheimer's disease related dementias (AD/ADRD) or a non-AD/ADRD chronic condition between January 1, 2014, and December 31, 2018. We compared ED disposition at the index visit, as well as healthcare utilization and mortality in the 12 months following an index ED visit, and adjusted for age, gender, and risk of mortality. RESULTS There were 29,626 patients in the AD/ADRD sample, and 317,046 in the comparison sample. The AD/ADRD sample was older (82.4 years old [SD: 8.2] vs. 76.0 years old [SD: 7.7]) and had more female patients (59.9% vs. 54.7%). The AD/ADRD sample was more likely to experience ED disposition to acute care (OR 1.039, p < 0.001, 95% CI 1.029-1.050), to have an ED revisit (OR 1.077, p < 0.001, 95% CI 1.066-1.087), and an inpatient stay in the subsequent 12 months (OR 1.085, p < 0.001, 95% CI 1.075-1.095). ED disposition to hospice was low in both samples (0.2%). AD/ADRD patients had a higher risk of mortality (OR 1.099, p < 0.001, 95% CI 1.091-1.107) and high short-term mortality (31.9% within 12 months) than those without AD/ADRD (15.3% within 12 months). CONCLUSIONS PLwD who visit the ED have high short-term mortality. Despite this, disposition to acute care, ED revisits, and inpatient stays, rather than hospice, remain the predominant mode of care delivery. Transition directly from the ED to hospice for PLwD is rare.
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Affiliation(s)
- Jacob D. Hill
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Abigail M. Schmucker
- Department of Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nina Siman
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Keith S. Goldfeld
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Allison M. Cuthel
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Joshua Chodosh
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- Department of Medicine, Division of Geriatrics and Palliative Care, NYU Langone Health, NY, USA
| | - Jean-Baptiste Bouillon-Minois
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
- CHU Clermont-Ferrand, Emergency Department, Clermont-Ferrand, F-63000, France
| | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Ishimaru D, Kanemoto H, Hotta M, Nagata Y, Satake Y, Taomoto D, Ikeda M. Case Report: Treatment of Delusions of Theft Based on the Assessment of Photos of Patients' Homes. Front Psychiatry 2022; 13:825710. [PMID: 35370805 PMCID: PMC8968168 DOI: 10.3389/fpsyt.2022.825710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The occurrence of behavioral and psychological symptoms of dementia is affected by individualized context. However, details regarding delusion of theft have been poorly documented. This report describes a useful assessment to understand the environmental context of delusion through two cases of Alzheimer's disease (AD).Familial interview was conducted to assess the phenomenological features. Photos of patients' homes were used to increase the assessment accuracy and check the individualized environmental contexts; this is known as Photo Assessment of Living Environment (PA-LE). CASE DESCRIPTION Case 1 was of an 88-year-old woman whose Mini-Mental State Examination (MMSE) score was 23/30. She believed that one neighbor stole her wallet and stored it on a shelf in the living room. She sometimes placed it in other places, such as under the bed as safekeeping. The delusion often occurred when getting ready to go shopping. PA-LE confirmed that the room and shelf were not cluttered, although the incorrect storage place seemed to be hard-to-find.Case 2 was of a 78-year-old woman. The MMSE score was 20/30. She believed that some neighbors stole her garden items. The delusion was limited to her garden, yet the items were varied. Auditory hallucinations exacerbated her belief that the neighbors intruded the garden. PA-LE confirmed that the garden was cluttered with several duplicated items. Moreover, the patient inaccurately remembered the condition of the garden.Non-pharmacological approaches were tailored to the patients' environmental and psychological states, referring to the interview and PA-LE. This included environmental adjustment or increasing self-esteem. Antipsychotics were also prescribed. Environmental and psychological triggers of delusion were improved by the interventions, and the patients had uneventful courses without active delusions. CONCLUSION Evaluating patients' homes using photos could detect the environmental context of delusion of theft among patients with AD and assist in the management.
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Affiliation(s)
- Daiki Ishimaru
- Department of Medical Technology, Osaka University Hospital, Suita, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hideki Kanemoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Maki Hotta
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuma Nagata
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuto Satake
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Daiki Taomoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
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Hozumi A, Tagai K, Shinagawa S, Kamimura N, Shigenobu K, Kashibayashi T, Azuma S, Yoshiyama K, Hashimoto M, Ikeda M, Shigeta M, Kazui H. Clinical profiles of people with dementia exhibiting with neuropsychiatric symptoms admitted to mental hospitals: A multicenter prospective survey in Japan. Geriatr Gerontol Int 2021; 21:825-829. [PMID: 34310003 DOI: 10.1111/ggi.14248] [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: 03/30/2021] [Revised: 06/12/2021] [Accepted: 07/06/2021] [Indexed: 11/27/2022]
Abstract
AIMS Patients with severe behavioral and psychological symptoms of dementia (BPSD) are often admitted to mental hospitals, while, inpatient care could also lead to prolonged hospital stay. The present study aims to survey clinical profiles of patients who required inpatient treatment for BPSD, and then establish the criteria for introducing inpatient treatment through assessment by certified psychiatrists. METHODS We performed a prospective survey about clinical characteristics of people with dementia who required treatment of BPSD at 12 mental medical institutions. All patients were assessed by certified psychiatrists to determine the optimal treatment settings: outpatient or inpatient. The multivariate logistic regression analysis was performed to specify factors contributed to the judgement of clinicians. Subsequently, the receiver operating characteristic curve analysis was conducted to explore a score derived from the Neuropsychiatric Inventory to divide patients into outpatient or inpatient groups. RESULTS The present study included 386 patients, of which 242 were admitted to mental hospitals. BPSD were classified into four domains, and aggressive BPSD was significantly associated with assessment for inpatient treatment; the adjusted odds ratio was approximately 2 regardless of dementia severity. Furthermore, the composite score of agitation, irritability and aberrant behavior showed the highest area under the curve value (=0.706), which differentiated inpatients from outpatients with a sensitivity of 76% and a specificity of 54%. CONCLUSIONS Aggressive BPSD was the risk factor for inpatient treatment. The composite score of the Neuropsychiatric Inventory subdomain-related aggressive BPSD could be a screening tool to introduce inpatient treatment for BPSD. Geriatr Gerontol Int 2021; 21: 825-829.
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Affiliation(s)
- Asami Hozumi
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan.,Fukkokai Soubu Hospital, Chiba, Japan
| | - Kenji Tagai
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Naoto Kamimura
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, Kochi, Japan
| | | | - Tetsuo Kashibayashi
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, Kochi, Japan
| | - Shingo Azuma
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Psychiatry, Mizuma Hospital, Kaizuka, Japan
| | - Kenji Yoshiyama
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mamoru Hashimoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masahiro Shigeta
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroaki Kazui
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, Kochi, Japan
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Kobayashi N, Shinagawa S, Nagata T, Tagai K, Shimada K, Ishii A, Oka N, Shigeta M, Kondo K. Blood DNA Methylation Levels in the WNT5A Gene Promoter Region: A Potential Biomarker for Agitation in Subjects with Dementia. J Alzheimers Dis 2021; 81:1601-1611. [PMID: 33967051 PMCID: PMC8293647 DOI: 10.3233/jad-210078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Behavioral and psychological symptoms of dementia (BPSD) cause a heavy burden for both patient and caregivers. These symptoms are diverse, and their mechanism is still unclear. Agitation is the most common and difficult to treat among BPSD. In recent years, while changes in DNA methylation levels have been receiving attention as a biomarker of aging and dementia, associations with BPSD have not been examined. Objective: Focusing on agitation, the objective of the present study was to identify a region where changes in DNA methylation levels are associated with agitation. Methods: Using genome-wide DNA methylation analysis data for 7 dementia subjects with agitation, 5 dementia subjects without agitation, and 4 normal elderly controls, we determined a signaling pathway in the WNT5A gene promoter region to be associated with agitation. Based on this result, we measured DNA methylation levels in this region for 26 dementia subjects with agitation and 82 dementia subjects without agitation by means of methylation-sensitive high-resolution melting (MS-HRM) analysis. Results: The WNT5A DNA methylation level in dementia subjects with agitation was significantly lower than in those without agitation (p = 0.001). Changes in WNT5A DNA methylation levels were not influenced by age, sex, body mass index, APOE ɛ4, medication, or inflammatory cytokines. Conclusion: Our results suggested an association of agitation with Wnt signaling, in particular with changes in WNT5A DNA methylation levels, which could be a potentially useful biomarker for predicting the appearance of agitation. It may contribute to the elucidation of the mechanism of BPSD.
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Affiliation(s)
- Nobuyuki Kobayashi
- Department of Virology, The Jikei University School of Medicine, Tokyo, Japan.,Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Tomoyuki Nagata
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenji Tagai
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuya Shimada
- Department of Virology, The Jikei University School of Medicine, Tokyo, Japan
| | - Azusa Ishii
- Department of Virology, The Jikei University School of Medicine, Tokyo, Japan
| | - Naomi Oka
- Department of Virology, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Shigeta
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuhiro Kondo
- Department of Virology, The Jikei University School of Medicine, Tokyo, Japan
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The Rise of Dementia With Lewy Bodies: Nursing Interventions and Implications. J Neurosci Nurs 2020; 52:311-315. [PMID: 32925559 DOI: 10.1097/jnn.0000000000000540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Age and dementia with Lewy bodies (DLB) are highly associated. As the elderly population in the United States increases, so will the incidence of DLB. Nurses increasingly can expect to care for this population. This article will examine and explain the current literature describing the state of DLB as well as best practices for nursing care of physical, psychosocial, and educational needs of DLB patients, families, and caregivers. METHODS CINAHL Complete and Google Scholar were used to search for relevant literature within the last 6 years. The following keywords were used alone or in combination: "Lewy," "Lewy body," "dementia," "aging," "caregiver," "support," and "nursing." RESULTS Eighty articles were reviewed and 26 were chosen, along with 1 government website, for this review article. Dementia with Lewy bodies is defined, and the presentation is described. Behavioral and psychological, motor, autonomic, and cognitive symptoms most common and those considered to be hallmarks are explained. Diagnosis and both pharmacologic and nonpharmacologic treatments, along with nursing implications and interventions, are provided. CONCLUSION Early recognition of signs and symptoms of DLB helps to provide timely diagnosis and appropriate treatment. The importance of knowledge acquisition for nurses to better care for DLB patients and their families is addressed throughout the article.
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Abdeljalil AB, de Mauléon A, Baziard M, Vellas B, Lapeyre-Mestre M, Soto M. Antidepressant Use and Progression of Mild to Moderate Alzheimer's Disease: Results from the European ICTUS Cohort. J Am Med Dir Assoc 2020; 22:433-439. [PMID: 32736994 DOI: 10.1016/j.jamda.2020.06.028] [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: 02/11/2020] [Revised: 05/02/2020] [Accepted: 06/09/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Neuropsychiatric symptoms (NPS) are a core and troubling feature among patients with Alzheimer disease (AD). Because of growing safety warnings against antipsychotics, the use of antidepressants (ATD) in AD has increased extensively. We investigated the potential long-term associations between ATD exposure and functional and cognitive progression in patients with mild to moderate AD. DESIGN Two-year prospective multicenter cohort ICTUS (Impact of Cholinergic Treatment USe) study with biannual assessments. SETTING Twenty-nine memory clinics from 12 European countries. PARTICIPANTS Community-dwelling patients with mild to moderate AD. METHODS Global cognitive function was measured using the Mini Mental State Examination (MMSE) and the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog). Functional impairment was measured using the Activities of Daily Living (ADL). Assessments were performed biannually for 2 years. Antidepressant exposure was defined by an ATD prescription for a minimum period of 6 months. Linear mixed models were used to study the associations between ATD exposure and cognitive and functional progression. RESULTS Antidepressant exposure was not associated with cognitive decline [MMSE: β-coefficients of the linear mixed models (Coef) = 0.06, 95% confidence interval (CI) -0.65 to 0.76, P = .87; ADAS-Cog: Coef = -13.9, 95% CI -34.80 to 7.03, P = .19] or with functional decline (ADL: Coef = -0.05, 95% CI -0.21 to 0.09, P = .48) at 2-year follow-up. Antipsychotic exposure at baseline was associated with a greater functional decline in the ADL score (Coef = -0.39, 95% CI - 0.68 to 0.10, P < .01). CONCLUSIONS AND IMPLICATIONS Antidepressant exposure was not associated with a faster rate of cognitive or functional decline in patients with mild to moderate AD. Antidepressants might be appropriate alternatives to antipsychotics in the management of NPS in mild to moderate AD.
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Affiliation(s)
- Anne-Bahia Abdeljalil
- Department of Geriatric Medicine, Institute of Ageing, Toulouse University Hospital, Toulouse, France; University of Toulouse III, F-31073, Toulouse, France.
| | - Adélaïde de Mauléon
- Department of Geriatric Medicine, Institute of Ageing, Toulouse University Hospital, Toulouse, France; University of Toulouse III, F-31073, Toulouse, France
| | - Marion Baziard
- Department of Geriatric Medicine, Institute of Ageing, Toulouse University Hospital, Toulouse, France; University of Toulouse III, F-31073, Toulouse, France
| | - Bruno Vellas
- Department of Geriatric Medicine, Institute of Ageing, Toulouse University Hospital, Toulouse, France; University of Toulouse III, F-31073, Toulouse, France; Inserm URM 1027, F-31073, Toulouse, France
| | - Maryse Lapeyre-Mestre
- University of Toulouse III, F-31073, Toulouse, France; Inserm URM 1027, F-31073, Toulouse, France; Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Maria Soto
- Department of Geriatric Medicine, Institute of Ageing, Toulouse University Hospital, Toulouse, France; University of Toulouse III, F-31073, Toulouse, France; Inserm URM 1027, F-31073, Toulouse, France
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Schneider CE, Bristol AA, Brody AA. A Scoping Review of Dementia Symptom Management in Persons with Dementia Living in Home-based Settings. CURRENT GERIATRICS REPORTS 2019; 8:291-301. [PMID: 33552845 DOI: 10.1007/s13670-019-00307-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background A large proportion of our older adults live with Alzheimer's Disease and Related Dementias and the number of those diagnosed in the future is expected to increase dramatically as the population ages. Persons with dementia bring unique healthcare challenges due to the manifestation of behavioral and psychological symptoms associated with the disease. The lack of geriatric clinicians as well as a properly trained non-geriatric specialist workforce capable of addressing the symptoms persons with dementia exacerbate the challenge of providing effective care. Pharmacological interventions are contraindicated for treatment of most behavioral psychological symptoms of dementia (BPSD). The Centers for Medicare and Medicaid Services now requires that nonpharmacological interventions be used as a first-line treatment. It has not been determined what nonpharmacological intervention for BPSD are most effective and what the infrastructure would entail for such interventions for PWD living at home. Purpose of Review The purpose of this study is to examine the literature focusing on interventions aimed towards managing persons' symptoms of dementia living in home-based settings. A scoping review examining the literature published on this topic over the last three years was conducted. Recent Findings One thousand twenty four articles were found, of which nine met inclusion criteria. Five articles used occupational based therapy, two used exercise therapy and one article was found utilizing aromatherapy and music therapy.
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Affiliation(s)
- Catherine E Schneider
- Hartford Institute for Geriatric Nursing, Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010
| | - Alycia A Bristol
- Hartford Institute for Geriatric Nursing, Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010, P: 212-992-7170
| | - Abraham A Brody
- Hartford Institute for Geriatric Nursing, Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010, P: 212-992-7341
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