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Park S, Forester BP, Lapid MI, Harper DG, Hermida AP, Inouye SK, McClintock SM, Nykamp L, Petrides G, Schmitt EM, Seiner SJ, Mueller M, Patrick RE. A Novel Approach to Monitoring Cognitive Adverse Events for Interventional Studies Involving Advanced Dementia Patients: Insights From the Electroconvulsive Therapy for Agitation in Dementia Study. J Geriatr Psychiatry Neurol 2024; 37:234-241. [PMID: 37848185 DOI: 10.1177/08919887231207641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE To develop an individualized method for detecting cognitive adverse events (CAEs) in the context of an ongoing trial of electroconvulsive therapy for refractory agitation and aggression for advanced dementia (ECT-AD study). METHODS Literature search aimed at identifying (a) cognitive measures appropriate for patients with advanced dementia, (b) functional scales to use as a proxy for cognitive status in patients with floor effects on baseline cognitive testing, and (c) statistical approaches for defining a CAE, to develop CAEs monitoring plan specifically for the ECT-AD study. RESULTS Using the Severe Impairment Battery-8 (SIB-8), baseline floor effects are defined as a score of ≤5/16. For patients without floor effects, a decline of ≥6 points is considered a CAE. For patients with floor effects, a decline of ≥30 points from baseline on the Barthel Index is considered a CAE. These values were derived using the standard deviation index (SDI) approach to measuring reliable change. CONCLUSIONS The proposed plan accounts for practical and statistical challenges in detecting CAEs in patients with advanced dementia. While this protocol was developed in the context of the ECT-AD study, the general approach can potentially be applied to other interventional neuropsychiatric studies that carry the risk of CAEs in patients with advanced dementia.
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Affiliation(s)
- Soohyun Park
- Department of Psychiatry, Tufts Medical Center, Boston, MA, USA
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, USA
| | - Brent P Forester
- Department of Psychiatry, Tufts Medical Center, Boston, MA, USA
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, USA
| | - Maria I Lapid
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - David G Harper
- Geriatric Psychiatry Research Program, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Adriana P Hermida
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA, USA
| | - Sharon K Inouye
- Aging Brain Center, Hebrew Senior Life, Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Shawn M McClintock
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Louis Nykamp
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
| | - Georgios Petrides
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Eva M Schmitt
- Aging Brain Center, Hebrew Senior Life, Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, USA
| | - Stephen J Seiner
- Psychiatric Neurotherapeutics Program, McLean Hospital, Belmont, MA, USA
| | - Martina Mueller
- College of Nursing and Department of Public Health Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Regan E Patrick
- Geriatric Psychiatry Research Program, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Qasim HS, Simpson MD. A Narrative Review of Studies Comparing Efficacy and Safety of Citalopram with Atypical Antipsychotics for Agitation in Behavioral and Psychological Symptoms of Dementia (BPSD). PHARMACY 2022; 10:pharmacy10030061. [PMID: 35736776 PMCID: PMC9228736 DOI: 10.3390/pharmacy10030061] [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: 03/13/2022] [Revised: 05/14/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Psychomotor agitation as part of the behavioral and psychological symptoms of dementia (BPSD) is one of the common issues found in aged care facilities. The current inadequate management strategies lead to poor functional and medical outcomes. Psychotropic interventions are the current preferred treatment method, but should these medications be the prescribers’ first preference? This review aims to compare pharmacological interventions for psychomotor agitation, judging them according to their effectuality and justifiability profiles. This is to be achieved by retrieving information from Randomized Control Trials (RCTs) and systematic reviews. Objectives: This review evaluates evidence from RCTs, systematic reviews, and meta-analyses of BPSD patients who have taken agitation treatments. Assessing the efficacy of citalopram, other selective serotonin reuptake inhibitors (SSRIs) and antipsychotic treatments were compared to each other for the purpose of improving agitation outcomes and lowering patient side effects. Methods: This review includes RCT that compared citalopram with one or more atypical antipsychotics or with a placebo, along with systematic reviews comparing citalopram (SSRI) with antipsychotics such as quetiapine, olanzapine, and risperidone. Studies were extracted by searching and accessing databases, such as PubMed, OVID, and Cochrane with restrictions of date from 2000 to 2021 and published in the English language. Conclusion: There are still a limited number of studies including SSRIs for the treatment of agitation in BPSD. SSRIs such as citalopram were associated with a reduction in the symptoms of agitation, and lower risk of adverse effects when compared to antipsychotics. Future studies are required to assess the long-term safety and efficacy of SSRI treatments for agitation in BPSD.
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Tanaka H, Umeda R, Shoumura Y, Kurogi T, Nagata Y, Ishimaru D, Yoshimitsu K, Tabira T, Ishii R, Nishikawa T. Development of an assessment scale for engagement in activities for patients with moderate to severe dementia. Psychogeriatrics 2021; 21:368-377. [PMID: 33650269 DOI: 10.1111/psyg.12678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Various types of therapy, including occupational therapy, are utilised for the treatment of moderate to severe dementia. In order to determine the optimal rehabilitation strategy for such patients and examine the treatment efficacy, an assessment scale for engagement in various group activities that can be easily applied in clinical situations is required. We herein report the development of the Assessment Scale for Engagement in Activities (ASEA) and its clinical utility. METHODS The ASEA was developed by nine occupational therapists and a psychiatrist with experience in developing measures for dementia, in accordance with the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) checklist. This assessment comprises 10 items covering four domains: Engagement in the Activity, Interaction, Arousal, and Affect. Participants with moderate to severe dementia who resided in a psychiatric acute phase hospital in Japan were assessed in terms of engagement in activities using the ASEA and Todai-shiki Observational Rating Scale (TORS), and in terms of cognitive function using the Mini-Mental State Examination (MMSE). We examined the internal consistency, inter- and intra-rater reliability, content validity, and concurrent validity of the ASEA. RESULTS Cronbach's alpha of the ASEA was 0.889. The overall inter-rater reliability was 0.937 (Spearman rank correlation, P < 0.001), and the intraclass correlation (ICC) for each item was 0.490-0.965 (P < 0.018-0.001). The overall test-retest reliability was 0.778 (Spearman's rank correlation, P < 0.001), and the ICC for each item was 0.498-0.863 (P < 0.023-0.001). The test-retest correlations were significant for almost all items, aside from 'Interaction with others' (P = 0.051). The concurrent validity, examined using the TORS and MMSE, was 0.920 and 0.304 (Spearman's rank correlation, P < 0.001-0.006). CONCLUSIONS The ASEA has confirmed reliability and validity, aside from 'Interaction with others' regarding test-retest reliability. Generally, this assessment tool has clinical utility and allows the evaluation of activity engagement among patients with moderate to severe dementia.
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Affiliation(s)
- Hiroyuki Tanaka
- Osaka Prefecture University Graduate School of Comprehensive Rehabilitation, Osaka, Japan
| | - Ren Umeda
- Hokutokai Sawa Hospital Department of Rehabilitation, Osaka, Japan
| | - Yuko Shoumura
- Hokutokai Sawa Hospital Department of Rehabilitation, Osaka, Japan
| | - Tatsunari Kurogi
- Osaka Prefecture University Graduate School of Comprehensive Rehabilitation, Osaka, Japan.,Hokutokai Sawa Hospital Department of Rehabilitation, Osaka, Japan
| | - Yuma Nagata
- Osaka Prefecture University Graduate School of Comprehensive Rehabilitation, Osaka, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daiki Ishimaru
- Osaka Prefecture University Graduate School of Comprehensive Rehabilitation, Osaka, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koji Yoshimitsu
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Takayuki Tabira
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Ryouhei Ishii
- Osaka Prefecture University Graduate School of Comprehensive Rehabilitation, Osaka, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Nishikawa
- Osaka Prefecture University Graduate School of Comprehensive Rehabilitation, Osaka, Japan.,Division of Occupational Therapy, Department of Rehabilitation, Faculty of Health Sciences, Naragakuen University, Nara, Japan
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Mougias AA, Christidi F, Kiosterakis G, Messinis L, Politis A. Dealing with severe dementia in clinical practice: A validity and reliability study of Severe Mini-Mental State Examination in Greek population. Int J Geriatr Psychiatry 2018; 33:1236-1242. [PMID: 29856092 DOI: 10.1002/gps.4915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 11/21/2017] [Indexed: 11/12/2022]
Abstract
ObjectiveConsidering the floor effect problems of many cognitive instruments administered in patients with dementia, we aimed to evaluate the validity and reliability of the Severe Mini‐Mental State Examination (SMMSE) for monitoring patients with moderate to severe dementia in the Greek population.MethodsWe included 210 patients with dementia, mostly diagnosed with Alzheimer's disease, and administered the SMMSE, the Mini‐Mental State Examination (MMSE), the Global Deterioration Scale, and the Katz Activities of Daily Living Scale (ADL). Demographic effects on SMMSE, validity, and reliability properties were initially tested for the total sample; SMMSE diagnostic accuracy was examined between subgroups of patients according to their MMSE performance; longitudinal changes over a 6‐month period were assessed for a subgroup of 100 patients.ResultsNone of the demographic variables correlated with SMMSE score. Reliability analysis revealed high indices regarding internal consistency, inter‐rater, and test‐retest reliability. Validity analysis showed high correlation coefficients between SMMSE, MMSE, Global Deterioration Scale, and Katz Activities of Daily Living Scale (concurrent validity) and excellent discriminant validity of SMMSE to correctly categorize patients based on their MMSE score. In the longitudinal analysis, we found significant differences (1) only on SMMSE for patients with an MMSE = 0 to 6 at baseline and (2) both on SMMSE and MMSE for patients with an MMSE = 7 to 16 at baseline. No differences were detected for patients with an MMSE = 17 to 22 at baseline.ConclusionsWe suggest the SMMSE as quick, reliable, valid, and insensitive to demographic effects psychometric instrument to monitor cognitive changes in patients with profoundly severe dementia.
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Affiliation(s)
- Antonios A Mougias
- Alzheimer Center, Greek Psychogeriatric Association "Nestor", Athens, Greece
| | - Foteini Christidi
- First Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Giorgos Kiosterakis
- Alzheimer Center, Greek Psychogeriatric Association "Nestor", Athens, Greece
| | - Lambros Messinis
- Neuropsychology Section, Department of Neurology, Medical School, University of Patras, Patras, Greece
| | - Antonios Politis
- First Department of Psychiatry, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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