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Abstract
In health care, well-being is considered to be composed of multiple interacting dimensions and to regard the subjective (affective and cognitive) evaluation of these dimensions. These dimensions are often referred to as physical, psychological, and social domains of life. Although there are various disease-specific and group-specific conceptual approaches, starting from a universal perspective provides a more inclusive approach to well-being. Indeed, universal approaches to well-being have striking overlaps with dementia-specific approaches. Although many initiatives have been launched to promote person-centered care and attention for well-being in recent decades, the current COVID pandemic showed that the primary focus in (Dutch) long-term care was still on physical health. However, a well-being perspective can be a central base of care: it is a means to include positive aspects, and it can be applied when addressing problems such as challenging behavior in the sense that both are about needs. Furthermore, providing care from this perspective is not only about the well-being of frail people and their loved ones but also about the well-being and needs of the involved professionals. Increasingly, research shows the importance of the quality of the resident-carer relationship, the carer's behavior, and their well-being for improving the well-being of residents. Applying the care approaches 'attentiveness in care' and relationship-centered care can contribute to the well-being of all involved stakeholders as these uphold the reciprocity of care relationships and take the values and attitudes, but also the vulnerability of those involved, into account.
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Affiliation(s)
- Debby L Gerritsen
- Radboud Institute for Health Sciences, Radboudumc Alzheimer Center, Department of Primary and Community care, Radboud University Medical Center, Nijmegen, The Netherlands
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Accelerated atrophy in dopaminergic targets and medial temporo-parietal regions precedes the onset of delusions in patients with Alzheimer's disease. Eur Arch Psychiatry Clin Neurosci 2023; 273:229-241. [PMID: 35554669 PMCID: PMC9958148 DOI: 10.1007/s00406-022-01417-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/11/2022] [Indexed: 12/21/2022]
Abstract
People with Alzheimer's disease (AD) and delusions have worse quality of life and prognosis. However, early markers of delusions have not been identified yet. The present study investigated whether there are any detectable differences in grey matter (GM) volume and cognitive changes in the year before symptom onset between patients with AD who did and did not develop delusions. Two matched samples of AD patients, 63 who did (PT-D) and 63 who did not develop delusions (PT-ND) over 1 year, were identified from the Alzheimer's Disease Neuroimaging Initiative database. The Neuropsychiatric Inventory (NPI) was used to assess the presence of delusions. Sixty-three additional matched healthy controls (HC) were selected. Repeated-measures ANCOVA models were used to investigate group-by-time effects on the volume of selected GM regions of interest and on cognitive performance. No neurocognitive differences were observed between patient groups prior to symptom onset. Greater episodic memory decline and GM loss in bilateral caudate nuclei, medio-temporal and midline cingulo-parietal regions were found in the PT-D compared with the PT-ND group. A pattern of faster GM loss in brain areas typically affected by AD and in cortical and subcortical targets of dopaminergic pathways, paralleled by worsening of episodic memory and behavioural symptoms, may explain the emergence of delusions in patients with AD.
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Thorne TE, Titley HK, Duan Y, Norton PG, Lanius RA, Estabrooks CA. Care aides' perceptions of caring for residents with a history of psychological trauma in Western Canadian care homes. Int J Geriatr Psychiatry 2022; 37. [PMID: 36205024 DOI: 10.1002/gps.5818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore care aide perceptions of caring for residents who aides perceived had past psychological trauma. METHODS Through cognitive interviews, we developed a definition of trauma for four survey questions about caring for residents with psychological trauma. We added these questions to our routine care aide survey in 91 care homes in Western Canada (September 2019 to February 2020). We asked if care aides perceived that they were caring for residents with trauma, how often, types of trauma experienced, and what indication led them to perceive a resident had experienced trauma. We analyzed data using content analysis (open-ended questions) and regression analyses (closed-ended questions). RESULTS Three thousand seven hundred and sixty five care aides responded (70% response rate) to the survey, and 53% perceived caring for one or more residents with a history of psychological trauma in the previous 2 weeks. Within six categories of traumatic events, abuse (35%) and war exposure (26%) were most common. Most common indications of trauma reported by care aides (five categories) were reliving the experience or having intrusive symptoms (28%) and avoidant behaviors (24%). Care aides were more likely to report caring for a resident who they perceived had experienced past psychological trauma if they were younger, spoke English as their first language, self-reported experiencing more aggression from residents, or who worked in not-for-profit homes. CONCLUSIONS This preliminary study supports the need for further study of care aides' perceptions and experiences of caring for residents with past trauma, and the effects of caring for these residents on quality of work life.
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Affiliation(s)
- Trina E Thorne
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Heather K Titley
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Yinfei Duan
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Peter G Norton
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ruth A Lanius
- Department of Psychiatry & Department of Neuroscience, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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A case of neglect. Cortex 2022; 154:254-258. [DOI: 10.1016/j.cortex.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/28/2022] [Accepted: 06/02/2022] [Indexed: 11/21/2022]
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Inamura K, Shinagawa S, Tsuneizumi Y, Nagata T, Tagai K, Nukariya K, Shigeta M. Clinicodemographic and Psychosocial Factors Related to Presentation or Severity of Delusions of Theft among Females with Amnestic Mild Cognitive Impairment and Alzheimer's Disease. Clin Gerontol 2022; 45:673-680. [PMID: 31983299 DOI: 10.1080/07317115.2020.1720884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: We examined the clinicodemographic and psychosocial factors that relate to the presentation and severity of delusions of theft among female patients with amnestic mild cognitive impairment (a-MCI) and Alzheimer's disease (AD).Methods: We enrolled a total of 177 female patients with a-MCI or AD, of whom 40 presented with delusions of theft. We compared the differences in clinicodemographic and psychosocial factors of the 40 patients (delusions of theft group) with 50 age- and Mini-Mental State Examination (MMSE)-matched controls without delusions (control group). Furthermore, we identified the factors associated with the presentation of delusions of theft using a general linear model (GLM). The severity of delusions of theft was calculated using the Neuropsychiatric Inventory Questionnaire, and correlations between the clinicodemographic and psychosocial factors were examined.Results: Between the two groups, the delusions of theft group had lower scores on the Physical Self-Maintenance Scale and instrumental activities of daily living (IADL) and higher scores on the Japanese version of the Zarit Caregiver Burden Interview (ZBI-J) than the control group. GLM analysis revealed that the IADL score was related to the presentation of delusions of theft. The severity of delusions of theft correlated with the MMSE and the ZBI-J scores in the delusions of theft group.Conclusions: The two groups had several differences regarding clinicodemographic and psychosocial factors. Furthermore, lower IADL scores were related to symptom presentation. Symptom severity correlated with cognitive functioning and caregiver burden.Clinical Implications: In the determination of treatment or care, differences in these factors should be considered.
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Affiliation(s)
- Keisuke Inamura
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Yuri Tsuneizumi
- 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
| | - Kazutaka Nukariya
- Department of Psychiatry, The Jikei University School of Medicine, Chiba, Japan
| | - Masahiro Shigeta
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
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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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Ibenthal E, Kehmann M, Backhaus C. Effectiveness of personalized music systems to influence neuropsychiatric symptoms associated with dementia: A quasi-experimental study. Explore (NY) 2021; 18:319-326. [PMID: 33781719 DOI: 10.1016/j.explore.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT Studies have shown that music can improve the neuropsychiatric symptoms in people with dementia. Personalized music has the greatest impact. However, people with dementia in residential care rarely listen to personalized music; in doing so, they themselves as well as their caregivers pass up the positive effects associated with it. As a result, customizable music systems have been developed that allow people with dementia to listen to their favorite music. AIM To determine the effectiveness of personalized music systems on the neuropsychiatric symptoms of people with dementia in residential care and the perceived distress of caregivers. METHOD 14 residents heard personalized music during personal care for eight weeks. Outcomes were derived from pre-post-follow up assessments of residents' neuropsychiatric symptoms and caregivers' distress using the Neuropsychiatric Inventory Questionnaire (NPI-Q). The frequency of the music systems' usage was recorded in log files. A control group of 14 residents received standard care. RESULTS Caregivers used the music systems among the residents with varying frequency. During the intervention, an increasing trend of the severity value of apathy was observed, while the severity values of delusions and nighttime disturbances tended to decrease. However, the trends did not reach statistical significance. Caregivers' perceived distress was not affected. CONCLUSION A practicable solution for providing personalized music to people with dementia in residential care was tested. Possible positive effects were observed for delusions and nighttime disturbances in people with dementia, but a larger study will be required to verify these observations.
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Affiliation(s)
- Elisabeth Ibenthal
- Münster University of Applied Sciences, Bürgerkamp 3, 48565 Steinfurt, Germany.
| | - Maximilian Kehmann
- Münster University of Applied Sciences, Bürgerkamp 3, 48565 Steinfurt, Germany
| | - Claus Backhaus
- Münster University of Applied Sciences, Bürgerkamp 3, 48565 Steinfurt, Germany
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Satake Y, Kanemoto H, Yoshiyama K, Nakahama R, Matsunaga K, Shimosegawa E, Morihara T, Hashimoto M, Ikeda M. Case Report: Usefulness of Biomarkers for Alzheimer's Disease in Two Cases With Very-Late-Onset Schizophrenia-Like Psychosis. Front Psychiatry 2021; 12:742659. [PMID: 34594255 PMCID: PMC8477662 DOI: 10.3389/fpsyt.2021.742659] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/23/2021] [Indexed: 01/04/2023] Open
Abstract
The association between primary psychotic disorders emerging in later life and neurodegenerative diseases, including Alzheimer's disease (AD), is controversial. We present two female non-demented cases of psychosis with onset above the age of 60 years. Cases 1 and 2 were aged was 68 and 81 years, respectively. They suffered from persecutory delusions and scored 28 on the Mini-Mental State Examination (MMSE) at the first examination. Although detailed neuropsychological tests detected amnesia, they had preserved daily life function. Brain magnetic resonance imaging, N-isopropyl-p-[123I] iodoamphetamine (123I-IMP) single-photon emission computed tomography, and cardiac [123I]-metaiodobenzylguanidine (123I-MIBG) scintigraphy showed no specific abnormalities in either case. We diagnosed them with very-late-onset schizophrenia-like psychosis (VLOSLP) because there was no evidence that their psychoses were derived from organic diseases or affective disorders. Upon close inspection, the AD biomarkers, cerebrospinal fluid (CSF) testing and Florbetapir F 18 positron emission tomography (PET), were positive in Case 1 and negative in Case 2. Case 1 scored 25 1 year later and 23 2 years later on the MMSE and was finally diagnosed as AD dementia. These two cases suggest that some clinically diagnosed VLOSLPs may be a prodromal AD. Although VLOSLP is a disease entity supposed to be a primary psychotic disorder, some are probably secondary psychosis with insidious neurodegeneration. Advanced biomarkers such as amyloid PET and CSF may contribute to the detection of secondary psychosis from clinically diagnosed VLOSLP.
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Affiliation(s)
- Yuto Satake
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Kanemoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kenji Yoshiyama
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryoko Nakahama
- Department of Child and Adolescent Psychiatry, Osaka City General Hospital, Osaka, Japan
| | - Keiko Matsunaga
- Department of Molecular Imaging in Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eku Shimosegawa
- Department of Molecular Imaging in Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Morihara
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mamoru Hashimoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osaka, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
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Yu SY, Lian TH, Guo P, Li LX, Ding DY, Li DN, Liu L, Zhao H, Hu Y, Zuo LJ, Gao JH, Yu QJ, Jin Z, Wang RD, Zhu RY, Wang XM, Zhang W. Correlations of apathy with clinical symptoms of Alzheimer's disease and olfactory dysfunctions: a cross-sectional study. BMC Neurol 2020; 20:416. [PMID: 33189129 PMCID: PMC7666513 DOI: 10.1186/s12883-020-01978-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 10/23/2020] [Indexed: 12/14/2022] Open
Abstract
Background Apathy is one of the most common symptoms of Alzheimer’s disease (AD), however, correlations of apathy with demographic variables, cognitive functions, neuropsychiatric symptoms, activity of daily living and olfactory functions in AD patients are still lacking comprehensive investigations. Methods This is a cross-sectional study. Total 124 typical AD patients were consecutively recruited from April 2014 to April 2017. In 124 AD patients, 47 cases (37.9%) were male and 77 cases were female; patients’ age were 43–93 years with an average of 68 years. Patients were divided into AD with apathy (AD-A) and AD with no apathy (AD-NA) groups according to the score of Modified Apathy Evaluation Scale, then were evaluated cognitive functions, neuropsychiatric symptoms and activity of daily living, and tested olfactory functions. Above variables were compared between AD-A and AD-NA groups. Further correlation analyses and linear regression analysis were performed between apathy and above variables. Results Compared with AD-NA group, global cognitive level, verbal memory, verbal fluency and activity of daily living were significantly compromised in AD-A group (P < 0.002); depression and agitation were severely displayed in AD-A group (P < 0.002). Apathy was negatively correlated with global cognitive function, verbal memory, verbal fluency and activity of daily living (P < 0.05). There was no significant difference of olfactory functions between the two groups (P > 0.002), and correlations between apathy and olfactory threshold, olfactory identification and global olfactory function were significant (P < 0.05) but quite weak (|r| < 0.3). Further linear regression analysis showed that only verbal fluency and instrumental activities of daily living were independently associated with apathy. Conclusions Independent correlations among apathy, verbal fluency and instrumental activities of daily living in AD patients might be related to the common brain area involved in their pathogeneses.
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Affiliation(s)
- Shu-Yang Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Teng-Hong Lian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Peng Guo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Li-Xia Li
- Department of General Internal Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Du-Yu Ding
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Dan-Ning Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Li Liu
- Department of General Internal Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Hui Zhao
- Department of General Internal Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yang Hu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Li-Jun Zuo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Jun-Hua Gao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Qiu-Jin Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Zhao Jin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Rui-Dan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Rong-Yan Zhu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xiao-Min Wang
- Department of Physiology, Capital Medical University, Beijing, 100069, China
| | - Wei Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China. .,China National Clinical Research Center for Neurological Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China. .,Center of Parkinson's Disease, Beijing Institute for Brain Disorders, Beijing, 100053, China. .,Beijing Key Laboratory on Parkinson Disease, Beijing, 100053, China.
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Burke AD, Goldfarb D, Bollam P, Khokher S. Diagnosing and Treating Depression in Patients with Alzheimer's Disease. Neurol Ther 2019; 8:325-350. [PMID: 31435870 PMCID: PMC6858899 DOI: 10.1007/s40120-019-00148-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Indexed: 11/24/2022] Open
Abstract
Although cognitive and functional impairment are the hallmark features of Alzheimer's disease (AD), neuropsychiatric symptoms associated with AD account for increased rates of disability and profoundly impact the quality of life of both patients and their caregivers. This narrative review of current evidence provides practical guidance in diagnosing and managing depression in patients with AD using pharmacological and nonpharmacological interventions. After apathy, depression is the second most common neuropsychiatric symptom in AD. Diagnosing late-life depression (LLD), particularly in those affected by AD, is complicated because older patients may not meet the criteria for a major depressive disorder. Clinically, late-life depression and dementia can be indistinguishable. Although these two entities are now thought to be related, the pathologic mechanisms remain unclear. Evidence suggests that LLD may be a prodromal symptom of neurodegenerative disease. The various geropsychiatric measures currently used to diagnose, rate the severity of, and monitor the progress of treatment for depression are imperfect. Neuroimaging represents a promising avenue toward understanding the complex pathophysiologic relationships between dementia and LLD, and will support the pursuit of biomarker-driven diagnosis and treatment. Nonpharmacologic interventions to relieve depression in persons with cognitive impairment and dementia include emotion-oriented therapies, behavioral and cognitive-behavioral modification programs, and structured activity programs. Sensory-stimulation therapies and multisensory approaches show some promise for successfully treating depression in patients with dementia, but further rigorous research is needed to establish their validity. Clinical consensus and research appear to support selective serotonin reuptake inhibitors as a first choice for the pharmacological treatment of depression in patients with dementia. However, initial support for these therapies remains variable, and further investigation is needed. Extra care is required in prescribing to this population because of the generally high level of medical and psychiatric comorbidity and the potential difficulty in assessing the cognitively impaired patient's response.
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Affiliation(s)
- Anna D Burke
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
| | | | - Padmaja Bollam
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA
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Palm R, Sorg CGG, Ströbel A, Gerritsen DL, Holle B. Severe Agitation in Dementia: An Explorative Secondary Data Analysis on the Prevalence and Associated Factors in Nursing Home Residents. J Alzheimers Dis 2019; 66:1463-1470. [PMID: 30412491 PMCID: PMC6294574 DOI: 10.3233/jad-180647] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: The phenomena of severe agitation is not well understood and often not adequately treated. Objective: This article determines the prevalence and associated factors of severe agitation in nursing home residents with dementia. Methods: Secondary data analysis within an observational study in German nursing homes with n = 1,967 participants. We assessed severity of agitation with the Neuropsychiatric Inventory Questionnaire (NPI-Q) and defined the construct of agitation as a composite score of the NPI-Q items agitation/aggression, disinhibition, and irritability/lability; the dependent variable of severe agitation was considered as being present in residents who scored ‘severe’ in at least one of these symptoms. A binary logistic regression model was calculated to estimate associations. Results: The prevalence of severe agitation was 6.3% (n = 124). The strongest associations were found for elation/euphoria (OR 7.6, CI 3.1–18.5), delusions (OR 7.3, CI 4.0–13.2), apathy/indifference (OR 2.8, CI 1.7–4.7), anxiety (OR 2.2, CI 1.2–3.8), nighttime behaviors (OR 2.4, CI 1.4–4.2), motor disturbances (OR 2.4, CI 1.4–4.1), and male sex (OR 2.4. CI 1.3–4.2). Conclusion: Severe agitation in nursing home residents with dementia is a relevant clinical issue as approximately 70% of residents have a dementia. Residents with elation/euphoria and delusions may have a stronger risk of showing severe agitation. We consider delusions as a possible cause of agitation and therefore a prelude to agitation. Although it might be possible that elation/euphoria follows from agitation, we hypothesize that the residents first experience elation/ euphoria and exhibit agitation afterwards.
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Affiliation(s)
- Rebecca Palm
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.,School of Nursing Science, University Witten/Herdecke, Witten, Germany
| | | | - Armin Ströbel
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany
| | - Debby L Gerritsen
- Department of Primary and Community Care and Radboudumc Alzheimer Centre, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bernhard Holle
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.,School of Nursing Science, University Witten/Herdecke, Witten, Germany
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Deardorff WJ, Grossberg GT. Behavioral and psychological symptoms in Alzheimer's dementia and vascular dementia. HANDBOOK OF CLINICAL NEUROLOGY 2019; 165:5-32. [PMID: 31727229 DOI: 10.1016/b978-0-444-64012-3.00002-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent and represent a significant burden for patients and their caregivers. Early recognition and management of these symptoms is crucial as they are associated with increased risk of institutionalization, impairments in daily functioning, reduced quality of life, and more rapid progression to severe dementia. This chapter will discuss the pathophysiology, proposed diagnostic criteria, clinical features, and management of BPSD, including apathy, depression, agitation/aggression, psychosis, and sleep disturbances. Apathy and depression are the most common overall, and apathy is associated with high symptom severity likely because of its greater persistence. Symptoms such as agitation, aggression, hallucinations, and delusions may be especially distressing and dangerous to patients and caregivers. Nonpharmacologic management should be considered first-line therapy in most cases due to the modest and inconsistent evidence base for pharmacologic agents and greater risk of harm. However, the judicious use of pharmacologic agents may be warranted when symptoms are dangerous and/or severely distressing.
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Affiliation(s)
- William James Deardorff
- Department of Psychiatry and Behavioral Neuroscience, St. Louis University School of Medicine, St Louis, MO, United States
| | - George T Grossberg
- Department of Psychiatry and Behavioral Neuroscience, St. Louis University School of Medicine, St Louis, MO, United States.
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Abstract
The elderly with dementing illness often present with psychotic symptoms such as delusions, but the thematic content of delusions in the elderly differs from that of delusions expressed by younger individuals, and can be pathognomonic of early dementia. The aim of this paper is to review the recent literature on the delusion of theft, the most prevalent delusion in the elderly, in order to arrive at a deeper understanding of its sources and to identify successful therapeutic approaches. The literature from 2000 to the present was searched on the Google Scholar database using relevant search terms. Several older classical papers were also referenced. Understanding the origins of the delusion of theft - multiple losses, attempts at attributing such losses to an outside source, attempts at reliving a happier past - helps in devising responses that are comforting to the patient. The distress that often accompanies the delusion of having been robbed can be decreased by nursing home improvements in the handling of personal possessions, by the correction of sensory deficits, and by the provision of activities that distract from loneliness. Attention to stimuli that trigger the delusion helps to limit its occurrence. Medications may help, but can sometimes make matters worse. Understanding that delusional thinking can arise from sensory and cognitive deficits is critical to empathic caregiving and also to the lessening of caregiver burden.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, #605 260 Heath St. West, Toronto, ON, M5P 3L6, Canada.
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14
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Abstract
PURPOSE OF REVIEW Psychosis is a psychiatric condition that has significant overlap with neurologic disease. This article is intended to educate the neurologist on the psychiatric manifestations of psychosis and its evaluation, diagnosis, and treatment. How to differentiate a primary psychiatric cause of psychosis from psychosis secondary to a medical or neurologic condition is also reviewed. RECENT FINDINGS Current research in psychotic disorders has focused increasingly on negative symptoms and cognitive impairment in psychotic illness, as it is now recognized that these cause the greatest impact on functional deficits for patients. A number of new medications have also been introduced to target negative symptoms and cognitive deficits in psychotic illness. These have new implications in terms of treatment overlap with medications being prescribed by providers in psychiatry, neurology, and general practice. SUMMARY This article discusses the current methods for evaluating, diagnosing, and treating psychosis. Psychosis as a primary mental health disorder is a diagnosis of exclusion, as psychosis can be a direct symptom of underlying medical or neurologic disease. Delirium and dementia are the two most important disorders to rule out. This article will help readers be more prepared to assess and treat the patient with psychosis.
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15
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Macaulay S. The Broken Lens of BPSD: Why We Need to Rethink the Way We Label the Behavior of People Who Live With Alzheimer Disease. J Am Med Dir Assoc 2018; 19:177-180. [DOI: 10.1016/j.jamda.2017.11.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 11/29/2022]
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16
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Lanctôt KL, Amatniek J, Ancoli-Israel S, Arnold SE, Ballard C, Cohen-Mansfield J, Ismail Z, Lyketsos C, Miller DS, Musiek E, Osorio RS, Rosenberg PB, Satlin A, Steffens D, Tariot P, Bain LJ, Carrillo MC, Hendrix JA, Jurgens H, Boot B. Neuropsychiatric signs and symptoms of Alzheimer's disease: New treatment paradigms. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2017; 3:440-449. [PMID: 29067350 PMCID: PMC5651439 DOI: 10.1016/j.trci.2017.07.001] [Citation(s) in RCA: 198] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Neuropsychiatric symptoms (NPSs) are hallmarks of Alzheimer's disease (AD), causing substantial distress for both people with dementia and their caregivers, and contributing to early institutionalization. They are among the earliest signs and symptoms of neurocognitive disorders and incipient cognitive decline, yet are under-recognized and often challenging to treat. With this in mind, the Alzheimer's Association convened a Research Roundtable in May 2016, bringing together experts from academia, industry, and regulatory agencies to discuss the latest understanding of NPSs and review the development of therapeutics and biomarkers of NPSs in AD. This review will explore the neurobiology of NPSs in AD and specific symptoms common in AD such as psychosis, agitation, apathy, depression, and sleep disturbances. In addition, clinical trial designs for NPSs in AD and regulatory considerations will be discussed.
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Affiliation(s)
- Krista L. Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute and Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Canada
| | - Joan Amatniek
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California, San Diego, CA, USA
- Department of Medicine, University of California, San Diego, CA, USA
| | - Steven E. Arnold
- Interdisciplinary Brain Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Clive Ballard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- University of Exeter, Exeter, UK
| | - Jiska Cohen-Mansfield
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine and Minerva Center for the Interdisciplinary Study of End of Life, Tel Aviv University, Tel Aviv, Israel
| | - Zahinoor Ismail
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Constantine Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine Institutes, Baltimore, MD, USA
| | | | - Erik Musiek
- Department of Neurology, Hope Center for Neurological Disorders, and Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Ricardo S. Osorio
- Center for Brain Health, NYU Langone Medical Center, New York, NY, USA
| | - Paul B. Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - David Steffens
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
| | | | | | | | | | | | - Brendon Boot
- Department of Neurology, Brigham and Women's Hospital, Harvard University School of Medicine, Boston, MA, USA
- Voyager Therapeutics, Cambridge, MA, USA
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