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Wang PH, Lin HW, Nguyen TTT, Hu CJ, Huang LK, Tam KW, Kuan YC. Efficacy of Aromatherapy Against Behavioral and Psychological Disturbances in People With Dementia: A Meta-Analysis of Randomized Controlled Trials. J Am Med Dir Assoc 2024; 25:105199. [PMID: 39128826 DOI: 10.1016/j.jamda.2024.105199] [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: 03/21/2024] [Revised: 07/06/2024] [Accepted: 07/08/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVES Behavioral and psychological symptoms of dementia (BPSD) are common in people with dementia. Aromatherapy may reduce the frequency and severity of BPSD. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of aromatherapy in relieving BPSD and improving functional ability in people with dementia. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS Patients with dementia receiving aromatherapy. METHODS A literature search was conducted using PubMed, Embase, and Cochrane Library for RCTs published before March 2024 comparing aromatherapy with control treatments in patients with dementia. RESULTS There were 15 trials involving 821 patients. Overall, significant reduction in BPSD was observed after 1 month of aromatherapy treatment. Among 15 trials, 9 reported the Cohen-Mansfield Agitation Inventory (CMAI) score, and 7 evaluated the Neuropsychiatric Inventory (NPI) score. The meta-analysis showed significant improvement in CMAI score [weighted mean difference (WMD) -6.31, 95% CI -9.52 to -3.11] and NPI score (WMD -8.07, 95% CI -13.53 to -2.61) in patients receiving 3 to 4 weeks of aromatherapy compared with the control group. Four of the 15 trials reported improvement in depressive mood and 3 trials reported no significant improvement in functional ability. CONCLUSIONS AND IMPLICATIONS In conclusion, aromatherapy is a safe and viable nonpharmacologic treatment to improve BPSD in people with dementia and its combination with massage showed higher efficacy.
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Affiliation(s)
- Po-Hao Wang
- Department of Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ho-Wei Lin
- Department of Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan; Department of General Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Truc Tran Thanh Nguyen
- Taiwan International Graduate Program in Interdisciplinary Neuroscience, National Taiwan University and Academia Sinica, Taipei, Taiwan; Memory and Dementia Unit, Hospital 30-4, Ho Chi Minh City, Vietnam
| | - Chaur-Jong Hu
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan; Dementia Center and Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Li-Kai Huang
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan; Dementia Center and Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ka-Wai Tam
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
| | - Yi-Chun Kuan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan; Dementia Center and Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
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Talebzadeh A, Botteldooren D, Thomas P, Stewart S, Van de Velde D, De Vriendt P, Devos P, Iaboni A. Effect of Soundscape Augmentation on Behavioral Symptoms in People With Dementia: A Pilot Randomized Controlled Trial. Innov Aging 2024; 8:igae069. [PMID: 39350940 PMCID: PMC11441324 DOI: 10.1093/geroni/igae069] [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: 02/27/2024] [Indexed: 10/04/2024] Open
Abstract
Background and Objectives Sound is an important environmental factor that influences the expression of behavioral and psychological symptoms of dementia. Recent research on the effect of soundscape has shown promising results in improving environmental impact on people with dementia. However, no controlled studies have aimed to quantify the effects of soundscape intervention on resident outcomes. The aim of this study was to assess the feasibility and impact of a soundscape intervention on people with dementia and behavioral symptoms. Research Design and Methods Pilot single-blind repeated-measures randomized controlled trial of an augmented soundscape intervention. Participants were people with dementia in a hospital-based specialized dementia unit. Participants were randomized to an augmented soundscape intervention delivered in their room in the morning and evening or treatment as usual, with 2 baseline weeks and 4 weekly post-randomization assessments of the primary and secondary behavioral outcomes. Results The soundscape intervention was feasible in terms of recruitment, retention, and delivery of the intervention. There were improvements in the neuropsychiatric inventory total scores over time in both groups (-5.89, 95%CI -8.45 to -3.28, p < .001), but no differences between groups. There were no significant group, time, or group × time differences for the Pittsburgh Agitation Scale (PAS) total score. For the PAS-resisting care subscale, there was a significant group × time difference, with a greater reduction in the soundscape group over the study period (-0.81, 95% CI -1.59 to -0.03, p = .042). Discussion and Implications In this pilot study, soundscape augmentation was a feasible and effective nonpharmacological approach to reducing resistance to care in people with dementia, although it did not improve neuropsychiatric symptoms more globally. Further studies with larger samples and of longer duration are needed to investigate the long-term effects of augmented sonic environments on people with dementia. Clinical Trials Registration Number NCT04809545.
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Affiliation(s)
- Arezoo Talebzadeh
- Department of Information Technology, WAVES-Ghent University, Ghent, Belgium
| | - Dick Botteldooren
- Department of Information Technology, WAVES-Ghent University, Ghent, Belgium
| | - Pieter Thomas
- Department of Information Technology, WAVES-Ghent University, Ghent, Belgium
| | - Steven Stewart
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Dominique Van de Velde
- Faculty of Mediciness and Health Care Sciences, Department of Rehabilitation Sciences, Occupational Therapy Research Group, Ghent University, Ghent, Belgium
| | - Patricia De Vriendt
- Faculty of Mediciness and Health Care Sciences, Department of Rehabilitation Sciences, Occupational Therapy Research Group, Ghent University, Ghent, Belgium
- Occupational Therapy Department, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Paul Devos
- Department of Information Technology, WAVES-Ghent University, Ghent, Belgium
| | - Andrea Iaboni
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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van der Ploeg ES, Bitane RM, Schoones JW, Achterberg WP, Smaling HJA. Mind-body practices for people living with dementia and their family carers: a systematic review. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2024; 0:jcim-2024-0142. [PMID: 39005049 DOI: 10.1515/jcim-2024-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/17/2024] [Indexed: 07/16/2024]
Abstract
INTRODUCTION People with dementia and their family carers may benefit from non-pharmacological interventions, including mind-body (MB-) practices, which can improve physical and mental health by inducing relaxation. This systematic review provides an overview of availability and effects of MB-practices. CONTENT The authors performed a systematic search in PubMed, Embase, Emcare, Web of Science, Cochrane Library, PsycINFO, China National Knowledge Infrastructure and Academic Search Premier on February 1, 2024. Research papers on MB-practices for people with dementia and/or their family carers in English, Chinese, Japanese, German, French and Dutch were included if a full text was available. Selection of included articles, data extraction and methodological quality assessments were conducted by two researchers. SUMMARY Of the 130 included studies, 100 (77 %) were of high quality. Traditional Chinese Medicine (TCM) and touch interventions for people with dementia, and meditations for family carers resulted in improvements in respectively cognition and neuropsychiatric symptoms, and mental health. Lack of evidence for other MB-practices is related to small numbers of studies, fragmented use of outcome measures and mixed findings. OUTLOOK MB-practices showed promising results. We recommend implementation and further research of TCM- and touch interventions for people with dementia as well as meditations for family carers. We suggest a cross-over of the promising results of one group to be studied in the other group.
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Affiliation(s)
- Eva S van der Ploeg
- Department of Public Health and Primary Care, 4501 Leiden University Medical Center , Leiden, The Netherlands
| | - Rutger M Bitane
- Department of Public Health and Primary Care, 4501 Leiden University Medical Center , Leiden, The Netherlands
| | - Jan W Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, 4501 Leiden University Medical Center , Leiden, The Netherlands
- University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Hanneke J A Smaling
- Department of Public Health and Primary Care, 4501 Leiden University Medical Center , Leiden, The Netherlands
- University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands
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Yin Z, Li Y, Bao Q, Zhang X, Xia M, Zhong W, Wu K, Yao J, Chen Z, Sun M, Zhao L, Liang F. Comparative efficacy of multiple non-pharmacological interventions for behavioural and psychological symptoms of dementia: A network meta-analysis of randomised controlled trials. Int J Ment Health Nurs 2024; 33:487-504. [PMID: 38012101 DOI: 10.1111/inm.13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/14/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
Non-pharmacological interventions can improve the behavioural and psychological symptoms of dementia (BPSD). However, the optimal non-pharmacological treatments remain controversial. This study aimed to compare the efficacy of multiple non-pharmacological methods and identify the optimal therapy for BPSD. Potential randomised controlled trials (RCTs) were searched and selected from 15 databases and sources from the inception of the databases until 1 October 2022. Two independent authors implemented study screening, data extraction, and methodological quality assessment. Primary outcome was reduction of Neuropsychiatric Inventory (NPI). The secondary outcome were changes of Cornell Scale for Depression in Dementia (CSDD), the Cohen-Mansfield Agitation Inventory (CMAI), the Quality of Life in Alzheimer's Disease (QoL-AD), the Abilities of Daily Living scale, and the Apathy Evaluation Scale. Meta-analyses were performed using STATA v15.0 and ADDIS v1.16.8. The GRADE approaches were utilised to evaluate evidence quality. The present study included 43 RCTs with 4978 participants. The global methodological quality of the RCTs was moderate. Regarding NPI reduction, with moderate-certainty evidence, exercise plus treatment as usual (TAU) outperformed TAU (mean difference [MD]: -7.13; 95% confidence interval [CI]: -13.22, -0.76) and ranked as the optimal treatment. For reduction in CSDD, with low- to moderate-certainty evidence, massage plus TAU (MD: -15.26; 95% CI: -20.13, -10.52) and music plus TAU (MD: -2.40; 95% CI: -4.62, -0.12) were associated with greater reduction compared with TAU. For reduction in CMAI, with moderate-certainty evidence, aromatherapy plus massage (MD: -15.84; 95% CI: -29.76, -2.42) and massage plus music (MD: -13.12; 95% CI: -25.43, -0.76) were significantly more effective than TAU. For improvement in QoL-AD, with critically low- to low-certainty evidence, there were no statistical differences between any of non-pharmacological treatments and TAU. Due to the limited number of included studies, network meta-analysis was not performed for other outcomes. In conclusion, non-pharmacological treatments are effective for overall symptoms, depression, and agitation. Exercise plus treatment as usual may be an optimal non-pharmacological intervention for improving the overall BPSD. This may help to guide patients, doctors, and policymakers.
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Affiliation(s)
- Zihan Yin
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Yaqin Li
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qiongnan Bao
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Xinyue Zhang
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Manze Xia
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Wanqi Zhong
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Kexin Wu
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Jin Yao
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Zhenghong Chen
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Mingsheng Sun
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Ling Zhao
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Fanrong Liang
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
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Packheiser J, Hartmann H, Fredriksen K, Gazzola V, Keysers C, Michon F. A systematic review and multivariate meta-analysis of the physical and mental health benefits of touch interventions. Nat Hum Behav 2024; 8:1088-1107. [PMID: 38589702 PMCID: PMC11199149 DOI: 10.1038/s41562-024-01841-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/29/2024] [Indexed: 04/10/2024]
Abstract
Receiving touch is of critical importance, as many studies have shown that touch promotes mental and physical well-being. We conducted a pre-registered (PROSPERO: CRD42022304281) systematic review and multilevel meta-analysis encompassing 137 studies in the meta-analysis and 75 additional studies in the systematic review (n = 12,966 individuals, search via Google Scholar, PubMed and Web of Science until 1 October 2022) to identify critical factors moderating touch intervention efficacy. Included studies always featured a touch versus no touch control intervention with diverse health outcomes as dependent variables. Risk of bias was assessed via small study, randomization, sequencing, performance and attrition bias. Touch interventions were especially effective in regulating cortisol levels (Hedges' g = 0.78, 95% confidence interval (CI) 0.24 to 1.31) and increasing weight (0.65, 95% CI 0.37 to 0.94) in newborns as well as in reducing pain (0.69, 95% CI 0.48 to 0.89), feelings of depression (0.59, 95% CI 0.40 to 0.78) and state (0.64, 95% CI 0.44 to 0.84) or trait anxiety (0.59, 95% CI 0.40 to 0.77) for adults. Comparing touch interventions involving objects or robots resulted in similar physical (0.56, 95% CI 0.24 to 0.88 versus 0.51, 95% CI 0.38 to 0.64) but lower mental health benefits (0.34, 95% CI 0.19 to 0.49 versus 0.58, 95% CI 0.43 to 0.73). Adult clinical cohorts profited more strongly in mental health domains compared with healthy individuals (0.63, 95% CI 0.46 to 0.80 versus 0.37, 95% CI 0.20 to 0.55). We found no difference in health benefits in adults when comparing touch applied by a familiar person or a health care professional (0.51, 95% CI 0.29 to 0.73 versus 0.50, 95% CI 0.38 to 0.61), but parental touch was more beneficial in newborns (0.69, 95% CI 0.50 to 0.88 versus 0.39, 95% CI 0.18 to 0.61). Small but significant small study bias and the impossibility to blind experimental conditions need to be considered. Leveraging factors that influence touch intervention efficacy will help maximize the benefits of future interventions and focus research in this field.
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Affiliation(s)
- Julian Packheiser
- Social Neuroscience, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany.
- Social Brain Lab, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Art and Sciences, Amsterdam, the Netherlands.
| | - Helena Hartmann
- Social Brain Lab, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Art and Sciences, Amsterdam, the Netherlands
- Center for Translational and Behavioral Neuroscience, University Hospital Essen, Essen, Germany
- Clinical Neurosciences, Department for Neurology, University Hospital Essen, Essen, Germany
| | - Kelly Fredriksen
- Social Brain Lab, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Art and Sciences, Amsterdam, the Netherlands
| | - Valeria Gazzola
- Social Brain Lab, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Art and Sciences, Amsterdam, the Netherlands
| | - Christian Keysers
- Social Brain Lab, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Art and Sciences, Amsterdam, the Netherlands
| | - Frédéric Michon
- Social Brain Lab, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Art and Sciences, Amsterdam, the Netherlands
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Stylianopoulou E, Daviti A, Giourou V, Gerasimidi E, Nikolaou A, Kourkoutas Y, Grigoriou ME, Paleologou KE, Skavdis G. Assessment of the Anti-Amyloidogenic Properties of Essential Oils and Their Constituents in Cells Using a Whole-Cell Recombinant Biosensor. Brain Sci 2023; 14:35. [PMID: 38248250 PMCID: PMC10812981 DOI: 10.3390/brainsci14010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/24/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
Essential oils exhibit numerous medicinal properties, including antimicrobial, anti-inflammatory and antioxidant effects. Recent studies also indicate that certain essential oils demonstrate anti-amyloidogenic activity against β-amyloid, the protein implicated in Alzheimer's disease. To investigate whether the anti-aggregating properties of essential oils extend to α-synuclein, the protein involved in Parkinson's disease, we constructed and employed a whole-cell biosensor based on the split-luciferase complementation assay. We validated our biosensor by using baicalein, a known inhibitor of α-synuclein aggregation, and subsequently we tested eight essential oils commonly used in food and the hygienic industry. Two of them, citron and sage, along with their primary components, pure linalool (the main constituent in citron essential oil) and pure eucalyptol (1,8-cineole, the main constituent in sage essential oil), were able to reduce α-syn aggregation. These findings suggest that both essential oils and their main constituents could be regarded as potential components in functional foods or incorporated into complementary Parkinson's disease therapies.
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Affiliation(s)
- Electra Stylianopoulou
- Laboratory of Developmental Biology & Molecular Neurobiology, Department of Molecular Biology & Genetics, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.S.); (A.D.); (E.G.); (M.E.G.)
- Laboratory of Molecular Regulation & Diagnostic Technology, Department of Molecular Biology & Genetics, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Anastasia Daviti
- Laboratory of Developmental Biology & Molecular Neurobiology, Department of Molecular Biology & Genetics, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.S.); (A.D.); (E.G.); (M.E.G.)
| | - Venetia Giourou
- Laboratory of Molecular Regulation & Diagnostic Technology, Department of Molecular Biology & Genetics, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Eleni Gerasimidi
- Laboratory of Developmental Biology & Molecular Neurobiology, Department of Molecular Biology & Genetics, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.S.); (A.D.); (E.G.); (M.E.G.)
| | - Anastasios Nikolaou
- Laboratory of Applied Microbiology & Biotechnology, Department of Molecular Biology & Genetics, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.N.); (Y.K.)
| | - Yiannis Kourkoutas
- Laboratory of Applied Microbiology & Biotechnology, Department of Molecular Biology & Genetics, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.N.); (Y.K.)
| | - Maria E. Grigoriou
- Laboratory of Developmental Biology & Molecular Neurobiology, Department of Molecular Biology & Genetics, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.S.); (A.D.); (E.G.); (M.E.G.)
| | - Katerina E. Paleologou
- Laboratory of Developmental Biology & Molecular Neurobiology, Department of Molecular Biology & Genetics, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.S.); (A.D.); (E.G.); (M.E.G.)
| | - George Skavdis
- Laboratory of Molecular Regulation & Diagnostic Technology, Department of Molecular Biology & Genetics, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
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Julião M, Bruera E, Silva C, Calado J, Cruz M, Vaz M, Paiva BSR. "Mãos de Conforto" (Hands of Comfort): A novel non-pharmacological intervention to ease agitation in elderly persons with dementia. Palliat Support Care 2023; 21:946-952. [PMID: 36788747 DOI: 10.1017/s147895152300007x] [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: 02/16/2023]
Abstract
Behavioral symptoms associated with dementia, such as agitation, are frequent and associated with well-known negative consequences for patients, their carers, and their environment. Pharmacological treatments for agitation using sedatives and antipsychotics are known to have several undesirable side effects and modest efficacy. Non-pharmacological alternatives are recommended as first-line options for agitation in persons with dementia with few side effects, but there is limited evidence of efficacy. We developed a novel and simple non-pharmacological alternative for agitation in dementia residents based on a Brazilian intervention using warm water surgical gloves used in patients with COVID-19 in intensive care units during the pandemic. We coined it "Mãos de Conforto" - Hands of Comfort. We report a series of 7 cases in 3 residents with dementia who whore Hands of Comfort.
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Affiliation(s)
- Miguel Julião
- Department of Palliative Medicine, Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, Rio de Mouro, Portugal
- Inválidos do Comércio IPSS, Lisboa, Portugal
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - José Calado
- Inválidos do Comércio IPSS, Lisboa, Portugal
| | - Mário Cruz
- Inválidos do Comércio IPSS, Lisboa, Portugal
- Escola de Psicologia e Ciências da Vida, Universidade Lusófona, Lisboa, Portugal
- USF Tapada, ACeS Sintra, Sintra, Portugal
| | - Marília Vaz
- Inválidos do Comércio IPSS, Lisboa, Portugal
| | - Bianca Sakamoto Ribeiro Paiva
- Research Group on Palliative Care and Health-Related Quality of Life, Barretos Cancer, Hospital - Barretos (SP), São Paulo, Brazil
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Ting YY, Tien Y, Huang HP. Effects of aromatherapy on agitation in patients with dementia in the community: A quasi-experimental study. Geriatr Nurs 2023; 51:422-428. [PMID: 37148590 DOI: 10.1016/j.gerinurse.2023.04.010] [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: 03/28/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 05/08/2023]
Abstract
The behavioral and psychological symptoms of dementia (BPSD) are experienced by up to 90% of patients with dementia throughout dementia. This study aims to investigate the effect of aromatherapy on agitation in patients with dementia in the community. This prospective cohort study was conducted at a single day-care center for patients with dementia located in northern Taiwan with 2-week and 4-week follow-ups, comparing the severity of agitation between 3 measure points as the primary outcome. The aromatherapy was performed over 5 consecutive days for 4 weeks. Throughout the four-week observation were analyzed by GEE. Significant differences were found in the Chinese version of Cohen-Mansfield Agitation Inventory (CCMAI) total agitation score (ß=-3.622, p=0.037) and physically non-aggressive behavior subscale (ß=-4.005, p=0.004) between aromatherapy group and control group. The severity of dementia-related agitation, especially the severity of physically non-aggressive behavior in demented patients, could be significantly reduced by a four-week intervention of aromatherapy.
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Affiliation(s)
- Yi-Yun Ting
- Graduate Institute of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Yun Tien
- Deparement of Psychiatry, Taoyuan Psychiatric Center, Taoyuan City, Taiwan
| | - Hsiang-Ping Huang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.
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Sun FC, Lin LC, Chang SC, Li HC, Cheng CH, Huang LY. Reliability and Validity of a Chinese Version of the Cohen–Mansfield Agitation Inventory-Short Form in Assessing Agitated Behavior. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159410. [PMID: 35954767 PMCID: PMC9368134 DOI: 10.3390/ijerph19159410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/20/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022]
Abstract
Background: Patients with dementia often present agitated behaviors. The Cohen–Mansfield Agitation Inventory-short form (CMAI-SF) is one of the most widely used instruments to evaluate agitated behaviors that affect patients’ quality of life and impose burden on caregivers. However, there is no simplified Chinese version of the CMAI-SF (C-CMAI-SF) in clinical settings. Purpose: This study aimed to develop a Chinese version of the C-CMAI-SF and examine its validity and reliability. Methods: This cross-sectional study included three phases. In Phase I, the original CMAI-SF was translated to Chinese. In Phase II, experts were invited to examine the content validity index (CVI). Phase III was conducted to test the validity and reliability of the C-CMAI-SF. Results: The scale showed good validity and reliability with a scale-level CVI of 0.89, Cronbach’s alpha (measure of internal consistency) of 0.874, and test–retest correlation coefficient of 0.902 (for 257 individuals). Using factor analysis, three factors were identified. Regarding concurrent validity, the C-CMAI-SF score was correlated with the Neuropsychiatric Inventory (agitation aggression subscale) and the Cornell Scale for Depression in Dementia (agitation subscale). Conclusions: The study demonstrated that the C-CMAI-SF is a valid and reliable instrument for evaluating agitated behaviors in people with dementia. Relevance to clinical practice: The C-CMAI-SF is an easy and quick tool used to identify and evaluate agitated behaviors in busy clinical settings.
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Affiliation(s)
- Feng-Ching Sun
- Department of Nursing, Kaohsiung Municipal United Hospital, Kaohsiung 80457, Taiwan; (F.-C.S.); (L.-Y.H.)
- College of Nursing, Fooyin University, Kaohsiung 83102, Taiwan
| | - Li-Chan Lin
- College of Nursing, Asia University, Taichung 41354, Taiwan;
| | - Shu-Chen Chang
- Department of Nursing, Changhua Christian Hospital, Changhua 50006, Taiwan;
- College of Nursing and Health Sciences, Da-Yeh University, Changhua 515006, Taiwan
| | - Hui-Chi Li
- College of Nursing, Asia University, Taichung 41354, Taiwan;
- Correspondence:
| | - Chia-Hsin Cheng
- Department of Nursing, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Ling-Ya Huang
- Department of Nursing, Kaohsiung Municipal United Hospital, Kaohsiung 80457, Taiwan; (F.-C.S.); (L.-Y.H.)
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Liu YC, Liao CN, Song CY. Effects of manual massage given by family caregivers for patients with dementia: A preliminary investigation. Geriatr Nurs 2022; 46:112-117. [PMID: 35662019 DOI: 10.1016/j.gerinurse.2022.05.006] [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] [Received: 04/11/2022] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To explore the effects of a 10-week manual massage intervention given by caregivers of patients with dementia on the behavioral and psychological symptoms of dementia (BPSD) and caregiver burden. METHODS Twelve pairs of participants-patients with dementia and their family caregivers-were recruited. Before the intervention, caregivers received a four-hour full body manual massage training course. Thereafter, the caregivers gave a 30-min massage to the patients once a week for a 10-week period. The Cornell Scale for Depression in Dementia, Cohen-Mansfield Agitation Inventory, and Zarit Burden Scale were administered pre- and post-intervention. RESULTS Total scores on all questionnaires significantly decreased after the intervention (p < .05). Moreover, two subscale scores of the Cornell Scale for Depression in Dementia-behavioral disturbance and physical signs-reduced significantly (p < .05). CONCLUSIONS This study provides preliminary evidence on the benefits of manual massage given by caregivers for the management of BPSD and caregiver burden.
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Affiliation(s)
- Yi-Chien Liu
- Department of Neurology, Cardinal Tien Hospital, New Taipei, Taiwan; Medical school of Fu-Jen University, New Taipei, Taiwan
| | - Chih-Ning Liao
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chen-Yi Song
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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11
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Assess of Combinations of Non-Pharmacological Interventions for the Reduction of Irritability in Patients with Dementia and their Caregivers: A Cross-Over RCT. Brain Sci 2022; 12:brainsci12060691. [PMID: 35741577 PMCID: PMC9221291 DOI: 10.3390/brainsci12060691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction: Dementia is a very common disorder that affects people over 65 years old all over the world. Apart from the cognitive decline, Behavioral and Psychological Symptoms of Dementia (BPSD) are a crucial matter in dementia, because they affect up to 90% of the patients during the course of their illness. Irritability has been found to be a common BPSD and one of the most distressing behaviors for the caregivers. The aim of the current study was to explore the efficacy of a combination of non-pharmacological interventions to treat irritability. Methods: Sixty patients with different types and stages of dementia with irritability were participated in a cross-over RCT. Three non-pharmacological interventions were used; (a) Validation Therapy (VT)/Psycho-educational program, (b) Aromatherapy/massage and (c) Music Therapy (MT). The study assessed the three non-pharmacological interventions in order to find the most effective combination of the interventions. This study did not compare pharmacological and non-pharmacological treatments. The interventions lasted for five days. There was no drop-out rate. All patients were assessed at baseline using Mini Mental State of Examination (MMSE), Addenbrooke’s Cognitive Examination Revised (ACE-R), Geriatric Depression Scale (GDS), Functional Rating Scale for symptoms in dementia (FRSSD), and Neuropsychiatric Inventory (NPI) (sub questions for irritability). Only NPI used for the assessment after each intervention. The analyses used categorical variables, Wilcoxon signed-rank test, Chi-square test and z value score. Results: The most effective combination of non-pharmacological interventions was Aromatherapy/massage (p = 0.003)-VT plus Psycho-educational program (p = 0.014) plus MT (p = 0.018). The same combination was the most effective for the caregivers’ burden, too (p = 0.026). Conclusions: The above combination of non-pharmacological interventions can reduce irritability in patients with dementia and caregivers’ burden.
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12
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Levy I, Gavrieli S, Hefer T, Attias S, Schiff A, Oliven R, Wisberg-Levi S, Hanchinsky R, Schiff E. Acupuncture Treatment of Delirium in Older Adults Hospitalized in Internal Medicine Departments: An Open-Label Pragmatic Randomized-Controlled Trial. J Geriatr Psychiatry Neurol 2022; 35:333-343. [PMID: 33685268 DOI: 10.1177/0891988721996804] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acupuncture seems to improve cognitive function in experimental models and to reduce agitation in dementia. The addition of acupuncture to standard-of-care (SOC) may improve clinical outcomes related to delirium in hospitalized older adults. METHODS This pragmatic open-label randomized-controlled trial evaluated 81 older adults hospitalized in an internal medicine ward and diagnosed with delirium. Fifty were randomized to daily acupuncture combined with SOC and 31 to SOC only for up to 1 week. Delirium was diagnosed using Confusion Assessment Method (CAM) tool, and its severity was assessed by the long CAM-Severity (CAM-S) tool. The primary study outcome was delirium resolution evaluated as time-to-first delirium remission (over 7 days) and the number of days spent delirium-free. RESULTS Time-to-first delirium remission was shorter in the acupuncture arm as compared to the SOC only arm (p < 0.001). A multivariate Cox regression analysis showed a shorter time-to-first remission of delirium in the acupuncture arm as compared with SOC arm [Hazard Ratio 0.267 (95% CI 0.098-0.726, p = 0.010)]. In the 7 days of evaluation, a significantly higher number of delirium-free days was found in the acupuncture arm compared to the SOC arm (p < 0.001), and CAM-S sum from day 2 to day 7 of evaluation was significantly lower in the acupuncture group compared to the control group (p = 0.002). No adverse safety event was found in the acupuncture group. CONCLUSION Acupuncture seems to be safe and effective in the treatment of delirium in older patients hospitalized in internal medicine departments.
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Affiliation(s)
- Ilana Levy
- Internal Medicine B Department, 37772Bnai Zion Medical Center, Haifa, Israel.,Complementary Medicine Department, 37772Bnai Zion Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Hematology Unit, 37772Bnai Zion Medical Center, Haifa, Israel
| | - Sagi Gavrieli
- Complementary Medicine Department, 37772Bnai Zion Medical Center, Haifa, Israel
| | - Talia Hefer
- Internal Medicine B Department, 37772Bnai Zion Medical Center, Haifa, Israel
| | - Samuel Attias
- Complementary Medicine Department, 37772Bnai Zion Medical Center, Haifa, Israel.,School of Public Health, University of Haifa, Haifa, Israel
| | - Ariel Schiff
- Faculty of Medicine, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Ron Oliven
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Internal Medicine C Department, 37772Bnai Zion Medical Center, Haifa, Israel.,Geriatric Unit, 37772Bnai Zion Medical Center, Haifa, Israel
| | - Shikma Wisberg-Levi
- Internal Medicine B Department, 37772Bnai Zion Medical Center, Haifa, Israel
| | - Rina Hanchinsky
- Internal Medicine C Department, 37772Bnai Zion Medical Center, Haifa, Israel
| | - Elad Schiff
- Internal Medicine B Department, 37772Bnai Zion Medical Center, Haifa, Israel.,Complementary Medicine Department, 37772Bnai Zion Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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13
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Hayden L, Passarelli C, Shepley SE, Tigno W. A scoping review: Sensory interventions for older adults living with dementia. DEMENTIA 2022; 21:1416-1448. [PMID: 35230906 DOI: 10.1177/14713012211067027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This scoping review focused on the existing scholarly literature exploring sensory interventions and immersive environments developed for, and used by, older adults living with dementia. The purpose of the scoping review is 1) to understand the various sensory interventions that have been developed, used, and have provided data to show how such interventions are expected to impact the lives of individuals living with dementia; and 2) to understand how the field is moving forward. We chose to map the literature to understand the types of interventions, the types of outcomes measured, and the contexts of their implementation. Our search was constrained to references from 1990 to 1 June 2019 in the following databases: Academic Search Complete, CINAHL Complete, MEDLINE, PsycINFO databases, and Summon Search discovery layer. We screened 2305 articles based on their titles and abstracts, and 465 were sent to full text review, of which 170 were included in our full text extraction. Once the data were extracted, we created emic categories, which emerged from the data, for data that were amenable to categorization (e.g., study setting, intervention type, and outcome type). We developed ten different categories of interventions: art, aromatics, light, multi-component interventions, multisensory rooms, multisensory, music, nature, touch, and taste. Sensory interventions are a standard psychosocial approach to managing the personal expressions commonly experienced by people living with dementia. Our findings can help providers, caregivers, and researchers better design interventions for those living with dementia, to help them selectively choose interventions for particular outcomes and settings. Two areas emerging in the field are nature interventions (replacing traditional "multisensory rooms" with natural environments that are inherently multisensory and engaging) and multi-component interventions (where cognitive training programs are enhanced by adding sensory components).
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14
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Lin CJ, Yeh ML, Wu SF, Chung YC, Lee JCH. Acupuncture-related treatments improve cognitive and physical functions in Alzheimer's disease: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil 2022; 36:609-635. [PMID: 35229686 DOI: 10.1177/02692155221079117] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine acupuncture-related treatments' effects and duration on improving cognitive function, physical function, and quality of life in patients with Alzheimer's disease. DATA SOURCES Eight electronic databases were searched for eligible randomized controlled trials from database inception to January 2021, including Medline, PubMed, EBSCO, Embase, Cochrane, Airiti Library, China National Knowledge Infrastructure, and China Journal Full-text Database. REVIEW METHODS A systematic review and meta-analysis were conducted on acupuncture types, cognitive function, activity of daily life, muscle strength and quality of life. RESULTS Sixty-six studies in total with 4191 participants, the overall risk of bias was classified 60% as low and 24% as high. Acupuncture-related treatments for cognitive function and self-care ability revealed a moderate effect size, with a significant difference in noninvasive and invasive remedies (p < 0.001). Cognitive function showed significant differences in 6, 8, 12, and 24 weeks while self-care ability in the latter two weeks (p < 0.001). Meta-regression analysis showed cognitive function increased by 0.05 points (p = 0.002) and self-care ability decreased by 0.02 points (p = 0.04) after weekly treatment. There was a significant difference in muscle strength (p = 0.0003). CONCLUSION Acupuncture-related treatments effectively improved cognitive function with the treatment lasted 6 weeks at least, but self-care ability started showing effects after 12 weeks of treatment. The improvement of muscle strength was also confirmed. Acupuncture-related treatments, particularly noninvasive ones, have few complications and high safety, perhaps providing patients and caregivers diversified choices and clinical care guidelines for reference.
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Affiliation(s)
- Chuan-Ju Lin
- 145469Hsinchu Cathay General Hospital, Hsinchu, Taiwan; National Taipei University of Nursing and Health Sciences, Taipei
| | - Mei-Ling Yeh
- 38028National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shu-Fang Wu
- 38028National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yu-Chu Chung
- 117141Yuanpei University of Medical Technology, Hsinchu
| | - Justin Chen-Hao Lee
- 38028National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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15
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Bilal Ahmed S, Obieta A, Santos T, Ahmad S, Elliot Ibrahim J. Effects of Nonpharmacological Interventions on Disruptive Vocalisation in Nursing Home Patients With Dementia—A Systematic Review. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:718302. [PMID: 36188852 PMCID: PMC9397760 DOI: 10.3389/fresc.2021.718302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022]
Abstract
Background Vocally disruptive behaviour is a common and difficult to treat condition in older residents with dementia. The aim of this systematic review is to evaluate the efficacy of nonpharmacological interventions in its management in persons with dementia residing in a nursing home. Methodology A systematic search was conducted using Ovid MEDLINE, CINAHL, and Cochrane databases and reference lists from relevant publications on various nonpharmacological approaches to manage vocally disruptive behaviour in nursing home residents. The method of appraisal was through the National Institutes of Health scoring for the Quality Assessment of controlled intervention studies. Inclusion criteria included residents of nursing homes over the age of 65 with dementia and disruptive vocalisation. Only randomised controlled trials published in English were included. Results A total of 5,606 articles were identified, which cover 501 trials, of which 23 were selected. There were fourteen studies observed to have an impact of clinical and statistical significance with interventions including (i) a multidimensional approach with different nonpharmacological interventions, (ii) multisensory stimulation, (iii) staff education and training, (iv) personalised bathing, and (v) pain recognition and appropriate management. Seven studies demonstrated no observable effect whereas two showed worsening in vocally disruptive behaviour. Conclusions Many aspects of vocally disruptive behaviour management are poorly understood. Limited empirical evidence supports the use of several nonpharmacological interventions to reduce it. There is more robust evidence to support the use of a tailored approach to management over the universal approach.
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Affiliation(s)
- Saad Bilal Ahmed
- Department of Geriatrics, Ballarat Health Services Ballarat, Queen Elizabeth Centre, Ballarat Central, VIC, Australia
- *Correspondence: Saad Bilal Ahmed
| | - Alfredo Obieta
- Department of Geriatrics, Ballarat Health Services Ballarat, Queen Elizabeth Centre, Ballarat Central, VIC, Australia
| | - Tamsin Santos
- Department of Geriatrics, Ballarat Health Services Ballarat, Queen Elizabeth Centre, Ballarat Central, VIC, Australia
| | - Saara Ahmad
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - Joseph Elliot Ibrahim
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Melbourne, VIC, Australia
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Liu KY, Elliott T, Knowles M, Howard R. Heart rate variability in relation to cognition and behavior in neurodegenerative diseases: A systematic review and meta-analysis. Ageing Res Rev 2022; 73:101539. [PMID: 34883203 PMCID: PMC8783051 DOI: 10.1016/j.arr.2021.101539] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/05/2021] [Accepted: 12/03/2021] [Indexed: 12/24/2022]
Abstract
Neurodegenerative diseases, which frequently present with neuropsychiatric symptoms related to prefrontal cortical dysfunction, can alter the integrity of the neural networks involved in central autonomic nervous system regulation, which is proposed to be indexed by heart rate variability (HRV). We systematically reviewed the characteristics, methodology and outcomes of 27 studies of HRV in relation to measures of cognition and behavior in neurodegenerative conditions, and assessed the strength of this relationship, cross-sectionally, across 18 studies. A significant, moderate effect was observed (r = 0.25), such that higher HRV was related to better cognitive and behavioral scores, which was not influenced by mean age or cognitive status. There was no evidence of small-study effects but we could not rule out publication bias, and other factors may have contributed to heterogeneity between studies. Our findings support the proposal that HRV may be a marker of self-regulatory processes in neurodegenerative conditions, and further research on this association is needed in relation to neuropsychiatric symptoms and alongside neuroimaging methods. Heart rate variability is proposed to be influenced by a neural network involved in autonomic regulation. Neurodegenerative processes alter the integrity of the central autonomic network. We reviewed studies of HRV and cognition/behavior in neurodegenerative diseases. We found a moderate correlation between HRV and measures of cognition/behavior.
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Cha H, Kim S, Kim H, Kim G, Kwon KY. Effect of intensive olfactory training for cognitive function in patients with dementia. Geriatr Gerontol Int 2021; 22:5-11. [PMID: 34749425 DOI: 10.1111/ggi.14287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/06/2021] [Accepted: 09/14/2021] [Indexed: 01/22/2023]
Abstract
AIM Recent evidence has revealed an association between neurodegenerative disorders and olfactory dysfunction. However, whether olfactory training can improve cognitive impairment in patients with dementia requires further study. The present study aimed to resolve this by developing an intensive olfactory training (IOT) protocol and assessing its impact on each of the cognitive domains in patients with dementia. METHODS Patients were prospectively recruited between June 2020 and September 2020. Baseline evaluations included demographic data, olfactory function test, depression scale and detailed cognitive function tests. Thirty-four patients in the experimental group underwent IOT twice a day with a 40-odor set for 15 days, while 31 individuals in the control group received conservative management. Follow-up evaluations using the depression scale and detailed cognitive function tests were performed after IOT. RESULTS Baseline characteristics were not different between the two groups. The IOT group showed significant improvements in depression, attention, memory and language functions, but not global cognition, frontal executive, or visuospatial functions compared with the control group. CONCLUSION This study shows the ability of IOT to alleviate depression and improve some cognitive functions in patients with dementia. These results suggest that IOT may be an effective non-pharmacological approach for improving the symptoms of dementia. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2021; ••: ••-••.
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Affiliation(s)
- Hyegyeong Cha
- Department of Nursing, Namseoul University, Cheonan-si, Republic of Korea
| | - Sisook Kim
- Department of Nursing, Namseoul University, Cheonan-si, Republic of Korea
| | - Hansong Kim
- Namgung Hospital, Cheongju-si, Republic of Korea
| | - Gaeyoung Kim
- Department of Nursing, Graduate School of Chung-Ang University, Seoul, Republic of Korea
| | - Kyum-Yil Kwon
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Republic of Korea
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18
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Li BSY, Chan CWH, Li M, Wong IKY, Yu YHU. Effectiveness and Safety of Aromatherapy in Managing Behavioral and Psychological Symptoms of Dementia: A Mixed-Methods Systematic Review. Dement Geriatr Cogn Dis Extra 2021; 11:273-297. [PMID: 35082824 PMCID: PMC8739377 DOI: 10.1159/000519915] [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: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Behavioral and psychological symptoms of dementia (BPSD) is the most prominent and distressing manifestation for older persons with dementia (PWD) and caregivers. Aromatherapy has demonstrated its effectiveness in managing BPSD in various studies. However, previous studies and systematic reviews have obtained inconsistent findings, and a review of qualitative studies is yet to be conducted. METHOD A mixed-methods systematic review with a convergent segregated approach was performed to evaluate the effectiveness of aromatherapy in improving the BPSD and quality of life (QoL) of PWD and in relieving the distress and burden of caregivers, as well as its safety for PWD. Both published and unpublished quantitative and qualitative studies written in English and Chinese between January 1996 and December 2020 were retrieved from 28 databases, including MEDLINE, EMBASE, and Web of Science, based on the prespecified criteria. The methodological quality was assessed by using critical appraisal tools from the Joanna Briggs Institute. Quantitative synthesis, qualitative synthesis, and integration of quantitative and qualitative evidence were performed. RESULTS A total of 12 randomized controlled trials, 10 quasi-experimental studies, and 2 qualitative studies were included in the review. Some inconsistent findings regarding the effectiveness of aromatherapy in reducing the severity of BPSD were observed. Some studies reported that aromatherapy significantly improved the QoL of PWD and relieved the distress and burden of caregivers, promoted a positive experience among caregivers, and had very low adverse effects on PWD (with aromatherapy inhalation reporting no adverse effects). CONCLUSION Aromatherapy, especially in the inhalation approach, could be a potentially safe and effective strategy for managing BPSD. However, more structuralized and comparable studies with sufficient sample size, adherence monitoring, and sound theoretical basis could be conducted to obtain conclusive findings.
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Affiliation(s)
- Becky Siu Yin Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Ho Man Tin, Hong Kong, China
| | - Carmen Wing Han Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Minjie Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Irene Kit Yee Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Yvonne Hoi Un Yu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Ho Man Tin, Hong Kong, China
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Cha H, Kim S, Seo MS, Kim HS. Effects of olfactory stimulation on cognitive function and behavior problems in older adults with dementia: A systematic literature review. Geriatr Nurs 2021; 42:1210-1217. [PMID: 34425423 DOI: 10.1016/j.gerinurse.2021.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 12/20/2022]
Abstract
The aim of this study was to examine the effects of olfactory stimulation on both cognitive and behavioral symptoms in neurodegenerative diseases. The criteria for selection of participants in the study included neurodegenerative disease, interventions using olfactory stimulation, and measured cognitive or psychological symptoms. 5301 articles were identified, excluding duplicate papers. Seven original articles were selected according to the full article review and eligibility criteria. The final selected studies were all quasi-experimental studies and were published between 2002 and 2015. To assess the risk of bias, we used Cochrane Collaboration's tool, Non-randomized Studies-of Interventions (ROBINS-I). Although olfactory stimulation reported various effects on behavioral and psychological symptoms, it is still in its infancy. We propose standardization of olfactory stimulation and olfactory training. In patients with neurodegenerative diseases, it is necessary to consider the symptoms and severity of olfactory stimulation.
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Affiliation(s)
- Hyegyeong Cha
- Department of Nursing, Namseoul University, Cheonan-si, Republic of Korea.
| | - Sisook Kim
- Department of Nursing, Sangji University, Wonju-si, Republic of Korea.
| | - Min-Sook Seo
- Department of Nursing, Sangji University, Wonju-si, Republic of Korea.
| | - Han-Song Kim
- Department of Nursing, Namseoul University, Cheonan-si, Republic of Korea.
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Xiao S, Wang Y, Duan S, Li B. Effects of aromatherapy on agitation and aggression in cognitive impairment: A meta-analysis. J Clin Nurs 2021. [PMID: 34355444 DOI: 10.1111/jocn.15984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/30/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the effectiveness of aromatherapy on agitation and aggression in patients with cognitive impairment. BACKGROUND The impact of aromatherapy on agitation and aggression has been evaluated in various studies, but there is uncertainty about their impact. DESIGN A meta-analysis of randomised controlled trials was undertaken. METHODS This meta-analysis was conducted under PRISMA guidelines. Following eight electronic literature databases were searched: Web of Science, PubMed, PsycINFO, Embase, Cochrane Library, Chinese Wanfang database, CNKI and VIP digital database from the inception of the databases up to 27 February 2021. Two reviewers assessed the risk of bias of the included studies independently using the Cochrane Collaboration tool. Overall, meta-analysis and three subgroup analyses regarding the type of aroma preparations, delivery mode and session length were performed using RevMan5.3 and stata14.0. Publication bias was assessed by visual inspection of the funnel plot asymmetry and Egger's regression test. RESULTS Fifteen studies comprising 693 participants were included. The meta-analysis indicated that aromatherapy could ameliorate agitation and aggression for cognitive impairment. The subgroup analysis based on the type of aroma preparations showed that lavender oil could significantly improve agitation and aggression. Most delivery modes of aromatherapy, including smearing and inhalation, were effective. Moreover, less length (≤4 weeks) aromatherapy showed a better effect on agitation behaviour than aromatherapy more than 4 weeks. CONCLUSIONS Despite the meta-analysis indicating that aromatherapy could alleviate agitation and aggression especially short-term (≤4 weeks) aromatherapy inhalation in different conditions, further researches are needed to investigate the appropriate dosage of essential oils and the side effects. More well-designed randomised controlled trials containing participants from more countries are needed to verify our findings before we can make strong recommendations. RELEVANCE TO CLINICAL PRACTICE This meta-analysis suggested that aromatherapy should be considered as a complementary programme for patients with cognitive impairment patients. Medical workers could apply aromatherapy into daily routine cares for cognitive impairment patients.
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Affiliation(s)
- Shudan Xiao
- School of Nursing and Health, Henan University, Kaifeng, China
| | - Ying Wang
- School of Nursing and Health, Henan University, Kaifeng, China
| | - Shumin Duan
- The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Bo Li
- School of Nursing and Health, Henan University, Kaifeng, China
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Bayram S, Altınbaş Akkaş Ö, Usta E. Effect of acupressure on agitation in the elderly with dementia who receive institutional care: A pilot study. Perspect Psychiatr Care 2021; 57:980-988. [PMID: 33044041 DOI: 10.1111/ppc.12642] [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] [Received: 04/06/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This pilot study was carried out to determine the effect of acupressure on agitation in the elderly with dementia who receive institutional care. METHODS The study sample consisted of 38 elderly individuals (acupressure group [AG] = 19, usual-care group = 19). Acupressure application was performed on four points. The results were measured at the beginning (T0 ), the week after acupressure was completed (T1 ), and 2 weeks after acupressure was completed (T2 ). FINDINGS The change in the total Cohen-Mansfield Agitation Inventory score across the groups at T1 , T2 , and T3 was statistically significant in favor of AG. PRACTICAL IMPLICATIONS The acupressure used in this study can be used for managing agitation in the elderly with dementia.
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Affiliation(s)
- Serap Bayram
- Department of Health Care Services, Vocational School of Health Services, Düzce University, Düzce, Turkey
| | - Özlem Altınbaş Akkaş
- Department of Nursing, Faculty of Health Sciences, Düzce University, Düzce, Turkey
| | - Esra Usta
- Department of Health Care Services, Vocational School of Health Services, Düzce University, Düzce, Turkey
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Kwon CY, Lee B. Complementary and alternative medicines for behavioral and psychological symptoms of dementia: A protocol of overview of systematic reviews. Medicine (Baltimore) 2021; 100:e26397. [PMID: 34160423 PMCID: PMC8238314 DOI: 10.1097/md.0000000000026397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Dementia is causing a huge medical and socioeconomic burden. Along with strategies to delay cognitive decline in dementia, behavioral and psychological symptoms of dementia (BPSD) are major contributing factor to the burden of dementia, and have been an important clinical issue for successful management of dementia. However, pharmacological strategies such as antipsychotics raise concerns in terms of risk-to-benefit ratio in managing BPSD. Therefore, there is a need for an effective and safe alternative in BPSD management. From this point of view, various complementary and alternative medicines (CAMs) are attracting attention in BPSD management. Therefore, the overview will make it possible to evaluate the feasibility of using CAM as a potential treatment strategy for BPSD in terms of evidence-based medicine. METHODS AND ANALYSIS Comprehensive searching will be performed in 13 bibliographic databases from their inception dates to November 2021. Systematic reviews and/or meta-analyses that examined the effectiveness and safety of CAM modalities including herbal medicine, acupuncture, acupressure, aromatherapy, meditation, and relaxation on BPSD, will be included. The methodological quality of included reviews will be assessed by using the A MeaSurement Tool to Assess systematic Reviews-2. Two independent researchers will conduct study search, study selection, data extraction, and quality assessment processes. RESULTS The results of overview will be disseminated by the publication of a manuscript in a peer-reviewed journal or presentation at a relevant conference. CONCLUSION The findings of this overview will help to solve the major public health problem related to dementia, and will provide patients with dementia, their caregivers, clinicians, and health policy makers credible evidence in mitigating the burden of dementia. ETHICS AND DISSEMINATION As this protocol is for an overview of systematic reviews and meta-analyses, ethical approval is not required. PROTOCOL REGISTRATION NUMBER Open Science Framework registry (https://osf.io/g5f3m).
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Affiliation(s)
- Chan-Young Kwon
- Department of Oriental Neuropsychiatry, Dong-eui University College of Korean Medicine, Busan
| | - Boram Lee
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
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Fazlollah A, Babatabar Darzi H, Heidaranlu E, Moradian ST. The effect of foot reflexology massage on delirium and sleep quality following cardiac surgery: A randomized clinical trial. Complement Ther Med 2021; 60:102738. [PMID: 34029674 DOI: 10.1016/j.ctim.2021.102738] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Delirium is the most common neurologic disorder after cardiac surgery and affects both short and long-term outcomes. This study was conducted to evaluate the effect of foot reflexology massage on the incidence of delirium and sleep quality in patients undergoing cardiac surgery. METHODS In this randomized clinical trial, 60 patients who were candidates for CABG surgery were randomly assigned into two equal groups (n = 30); intervention and control groups. In the intervention group, foot reflexology massage was done on each foot for 15 min, for two consecutive days. Delirium observation screening scale, the Richard Campbell sleep questionnaire (RSCQ), and pain intensity using VAS were compared. RESULTS in the second postoperative day, delirium was observed in 8 (26.7 %) and 7 (23.3 %) of patients in the intervention and control groups, respectively (p > 0.05). The measured odds ratio for the effect of massage on delirium is 0.83 (95 %CI 0.71-2.69, p = 0.76). The difference in RSCQ scores was not significant between groups of intervention and control (68.32 ± 10.41 VS. 62.80 ± 11.86, P = 0.06). The pain intensity was lower in the intervention group (P < 0.001). CONCLUSION Foot reflexology was not effective in reducing delirium and improving the sleep quality, but the pain intensity was decreased. It seems that the precise pathology and predicting model of delirium should be identified, and appropriate interventions should be planned accordingly.
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Affiliation(s)
| | - Hosein Babatabar Darzi
- Atherosclerosis Research Center & Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Esmail Heidaranlu
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Seyed Tayeb Moradian
- Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Harris ML, Titler MG, Struble LM. Acupuncture and Acupressure for Dementia Behavioral and Psychological Symptoms: A Scoping Review. West J Nurs Res 2020; 42:867-880. [PMID: 31802723 PMCID: PMC7272277 DOI: 10.1177/0193945919890552] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Due to the dangers associated with psychotropic medications, there is an urgent need for non-pharmacologic therapies to treat behavioral and psychological symptoms of dementia (BPSD). Acupuncture and acupressure are safe and well-tolerated non-pharmacologic therapies for this population, but currently no review has explored acutherapy for management of distressing dementia symptoms. This review synthesizes research on acupuncture and acupressure for BPSD. Upon searching five databases, 15 studies met inclusion/exclusion criteria. Nine examined acupressure, six acupuncture, and eight were randomized controlled trials. The percent of studies demonstrating statistically significant improvements in symptoms were: activities of daily living (ADLs; 75%), agitation (100%), anxiety (67%), depression (100%), mood (100%), neuropsychological disturbances (67%), and sleep disturbances (100%). Variations in study design, intervention procedures, and outcomes limit interpretations about effectiveness. It is recommended that further research be done to examine the efficacy of these therapies and promote generalizability.
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Affiliation(s)
| | - Marita G Titler
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Laura M Struble
- University of Michigan School of Nursing, Ann Arbor, MI, USA
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Abstract
BACKGROUND Medications licensed for the treatment of dementia have limited efficacy against cognitive impairment or against the distressed behaviours (behavioural and psychological symptoms, or behaviour that challenges) which are also often the most distressing aspect of the disorder for caregivers. Complementary therapies, including aromatherapy, are attractive to patients, practitioners and families, because they are perceived as being unlikely to cause adverse effects. Therefore there is interest in whether aromatherapy might offer a safe means of alleviating distressed behaviours in dementia. OBJECTIVES To assess the efficacy and safety of aromatherapy for people with dementia. SEARCH METHODS We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group Specialized Register, on 5 May 2020 using the terms: aromatherapy, lemon, lavender, rose, aroma, alternative therapies, complementary therapies, essential oils. In addition, we searched MEDLINE, Embase, PsycINFO (all via Ovid SP), Web of Science Core Collection (via Thompson Web of Science), LILACS (via BIREME), CENTRAL (via the Cochrane Library), ClinicalTrials.gov and the World Health Organization (WHO) trials portal (ICTRP) on 5 May 2020. SELECTION CRITERIA We included randomised controlled trials which compared fragrance from plants in an intervention defined as aromatherapy for people with dementia with placebo aromatherapy or with treatment as usual. All doses, frequencies and fragrances of aromatherapy were considered. Participants in the included studies had a diagnosis of dementia of any subtype and severity. DATA COLLECTION AND ANALYSIS Two reviewers independently selected studies for inclusion, extracted data and assessed risk of bias in included studies, involving other authors to reach consensus decisions where necessary. We did not perform any meta-analyses because of heterogeneity between studies, but presented a narrative synthesis of results from the included trials. Because of the heterogeneity of analysis methods and inadequate or absent reporting of data from some trials, we used statistical significance (P ≤ or > 0.5) as a summary metric when synthesising results across studies. As far as possible, we used GRADE methods to assess our confidence in the results of the trials, downgrading for risk of bias and imprecision. MAIN RESULTS We included 13 studies with 708 participants. All participants had dementia and in the 12 trials which described the setting, all were resident in institutional care facilities. Nine trials recruited participants because they had significant agitation or other behavioural and psychological symptoms in dementia (BPSD) at baseline. The fragrances used were lavender (eight studies); lemon balm (four studies); lavender and lemon balm, lavender and orange, and cedar extracts (one study each). For six trials, assessment of risk of bias and extraction of results was hampered by poor reporting. Four of the other seven trials were at low risk of bias in all domains, but all were small (range 18 to 186 participants; median 66), reducing our confidence in the results. Our primary outcomes were agitation, overall behavioural and psychological symptoms, and adverse effects. Ten trials assessed agitation using various scales. Among the five trials for which our confidence in the results was moderate or low, four trials reported no significant effect on agitation and one trial reported a significant benefit of aromatherapy. The other five trials either reported no useable data or our confidence in the results was very low. Eight trials assessed overall BPSD using the Neuropsychiatric Inventory and we had moderate or low confidence in the results of five of them. Of these, four reported significant benefit from aromatherapy and one reported no significant effect. Adverse events were poorly reported or not reported at all in most trials. No more than two trials assessed each of our secondary outcomes of quality of life, mood, sleep, activities of daily living, caregiver burden. We did not find evidence of benefit on these outcomes. Three trials assessed cognition: one did not report any data and the other two trials reported no significant effect of aromatherapy on cognition. Our confidence in the results of these studies was low. AUTHORS' CONCLUSIONS We have not found any convincing evidence that aromatherapy (or exposure to fragrant plant oils) is beneficial for people with dementia although there are many limitations to the data. Conduct or reporting problems in half of the included studies meant that they could not contribute to the conclusions. Results from the other studies were inconsistent. Harms were very poorly reported in the included studies. In order for clear conclusions to be drawn, better design and reporting and consistency of outcome measurement in future trials would be needed.
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Affiliation(s)
- Emily L Ball
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Bethan Owen-Booth
- Occupational Therapy, Glyndŵr University Wrexham, Wrexham, UK
- Stroke Unit, Glan Clwyd Hospital, BCUHB, Rhyl, UK
| | - Amy Gray
- Medicine of the Elderly, Health Education England North East, Newcastle upon Tyne, UK
| | - Susan D Shenkin
- Geriatric Medicine, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Jonathan Hewitt
- 3rd Floor, Academic Building, Llandough Hospital., Cardiff University and Aneurin Bevan Health Board, Cardiff, UK
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Han Y, Jia J, Li X, Lv Y, Sun X, Wang S, Wang Y, Wang Z, Zhang J, Zhou J, Zhou Y. Expert Consensus on the Care and Management of Patients with Cognitive Impairment in China. Neurosci Bull 2019; 36:307-320. [PMID: 31792911 DOI: 10.1007/s12264-019-00444-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/25/2019] [Indexed: 12/14/2022] Open
Abstract
The cognitive disease consensus was prepared by panels of health and public representatives based on actual clinical practice in Geriatric Departments in Chinese hospitals and a systematic literature review. This consensus reflects the medical knowledge accumulated by those experts and provides information about professional medical care and advice. A multidisciplinary panel of specialists (neurologists, psychiatrists, and nursing specialists) reports an expert consensus on the medical knowledge accumulated from those experts and provides information about professional medical care and advice. The recommendations focus on the care and management of older adults with mild cognitive impairment, the objectives and methods of maintaining cognition and training, the assessments and measures of daily care for patients at different stages of dementia, the assessments and coping strategies for the behavioral and psychological symptoms of dementia, principles and suggestions for an appropriate living environment, arrangements for recreational activities, the care and management of patients with end-stage dementia, and suggestions for addressing stress in caregivers.
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Affiliation(s)
| | - Yuliang Han
- The 305 Hospital of People's Liberation Army, Beijing, 100017, China
| | - Jianjun Jia
- The Second Medical Center, People's Liberation Army (PLA) General Hospital, Beijing, 100853, China.
| | - Xia Li
- Shanghai Mental Health Center, Shanghai JiaoTong University School of Medicine, Shanghai, 200030, China
| | - Yang Lv
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, 630014, China
| | - Xuan Sun
- The Second Medical Center, PLA General Hospital, Beijing, 100853, China
| | - Shanshan Wang
- The Second Medical Center, PLA General Hospital, Beijing, 100853, China
| | - Yongjun Wang
- Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen, 518020, China
| | - Zhiwen Wang
- Peking University School of Nursing, Beijing, 100191, China
| | - Jintao Zhang
- The 960th Hospital of People's Liberation Army, Taian, 271000, China
| | - Jiong Zhou
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yuying Zhou
- HuanHu Hospital of Nankai University, Tianjin, 300350, China
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Bray J, Brooker DJ, Garabedian C. What is the evidence for the activities of Namaste Care? A rapid assessment review. DEMENTIA 2019; 20:247-272. [DOI: 10.1177/1471301219878299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives To assess the quality of research evidence for the different activity components for the psycho-social Namaste Care intervention for care home residents with advanced dementia. Design Namaste Care is a multi-component intervention delivered on a daily basis to people living with advanced dementia or people at end of life with dementia. A significant part of its operationalisation within care homes is the delivery of a number of activities delivered by trained in-house Namaste Care workers to a group of residents with similar high dependency needs. The Namaste Care workers focus on touch, music, nature, sensory experience, aromas and interactions with objects delivered in a way to enhance feelings of enjoyment and wellbeing. This review evaluated the evidence for using these activities with people living with advanced dementia. A systematic search of peer-reviewed research articles was conducted between November 2016 and September 2018 using search terms of activities used in Namaste Care. The quality of each accepted article was rated using the Rapid Evidence Assessment scale. Results The initial literature search returned 1341 results: 127 articles including 42 reviews were included. The majority of activity interventions yielded between 10 and 20 peer-reviewed papers. The use of smells and aromas, interacting with animals and dolls, the use of various forms of music (e.g. background music, singing, personalised music), nature, lighting, various forms of touch/massage and sensory interventions (including Snoezelen) all appear to have proven efficacy with people living with advanced dementia. Conclusions There is generally a limited number of research papers and reviews in this area, but overall there is a good evidence base for including these activities within Namaste Care for people living with advanced dementia.
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Affiliation(s)
- Jennifer Bray
- Association for Dementia Studies, University of Worcester, UK
| | - Dawn J Brooker
- Association for Dementia Studies, University of Worcester, UK
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Aromatherapy improves nausea, pain, and mood for patients receiving pediatric palliative care symptom-based consults: A pilot design trial. Palliat Support Care 2019; 18:158-163. [PMID: 31423959 DOI: 10.1017/s1478951519000555] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The role of aromatherapy in supportive symptom management for pediatric patients receiving palliative care has been underexplored. This pilot study aimed to measure the impact of aromatherapy using validated child-reported nausea, pain, and mood scales 5 minutes and 60 minutes after aromatherapy exposure. METHODS The 3 intervention arms included use of a symptom-specific aromatherapy sachet scent involving deep breathing. The parallel default control arm (for those children with medical exclusion criteria to aromatherapy) included use of a visual imagery picture envelope and deep breathing. Symptom burden was sequentially assessed at 5 and 60 minutes using the Baxter Retching Faces scale for nausea, the Wong-Baker FACES scale for pain, and the Children's Anxiety and Pain Scale (CAPS) for anxious mood. Ninety children or adolescents (mean age 9.4 years) at a free-standing children's hospital in the United States were included in each arm (total n = 180). RESULTS At 5 minutes, there was a mean improvement of 3/10 (standard deviation [SD] 2.21) on the nausea scale; 2.6/10 (SD 1.83) on the pain scale; and 1.6/5 (SD 0.93) on the mood scale for the aromatherapy cohort (p < 0.0001). Symptom burden remained improved at 60 minutes post-intervention (<0.0001). Visual imagery with deep breathing improved self-reports of symptoms but was not as consistently sustained at 60 minutes. SIGNIFICANCE OF RESULTS Aromatherapy represents an implementable supportive care intervention for pediatric patients receiving palliative care consults for symptom burden. The high number of children disqualified from the aromatherapy arm because of pulmonary or allergy indications warrants further attention to outcomes for additional breathing-based integrative modalities.
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Berkheimer SD, Qian C, Malmstrom TK. Snoezelen Therapy as an Intervention to Reduce Agitation in Nursing Home Patients With Dementia: A Pilot Study. J Am Med Dir Assoc 2019; 18:1089-1091. [PMID: 29169738 DOI: 10.1016/j.jamda.2017.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/13/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Scott D Berkheimer
- Department of Internal Medicine, Division of Geriatric Medicine, Saint Louis University, Saint Louis, Missouri
| | - Chen Qian
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University Chengdu, Sichuan, China
| | - Theodore K Malmstrom
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, Saint Louis, Missouri
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Levy I, Attias S, Gavrieli S, Oliven R, Neerland BE, Devlin JW, Ben-Arye E, Greenberg D, Schiff E. The study protocol for a randomized, controlled trial of acupuncture versus a sham procedure versus standard care alone for the treatment of delirium in acutely hospitalized older adults with a medical illness. Maturitas 2019; 124:72-80. [PMID: 31097183 DOI: 10.1016/j.maturitas.2019.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/13/2019] [Accepted: 03/02/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Many hospitalized older adults experience delirium, but treatment options are limited. Acupuncture has been shown to improve cognitive function and reduce agitation in dementia. We hypothesize that acupuncture, when compared with a sham intervention, will reduce the duration and severity of delirium, normalize delirium biomarkers, and improve clinical outcomes related to delirium in acutely hospitalized older adults with a medical illness. METHODS This three-arm, prospective, randomized, clinical trial will evaluate adults aged over 65 years who are acutely hospitalized to an internal-medicine ward and diagnosed with delirium or subsyndromal delirium. The 288 patients (96 in each of three groups) will be randomly allocated to receive either daily true acupuncture with usual care, a daily sham procedure with usual care, or usual care only in a 1:1:1 distribution for up to one week or until the patient is delirium-free for over 48 h. Other delirium and clinical interventions will remain unchanged. Delirium will be diagnosed using DSM-5 criteria and its severity will be assessed using the long Confusion Assessment Method Severity (CAM-S) tool. OUTCOMES The primary study outcome will be the daily CAM-S score over 7 days between the three groups. Secondary outcomes will include time to first resolution of the delirium (over 7 days), the proportion of days spent delirium-free, daily antipsychotic use, daily pain scores, sleep quality, morning serum cortisol and T3 levels, and midnight urinary cortisol/creatinine ratio, all determined twice a week, and delirium-related complications. Hospital mortality, duration of hospital stay and functional status at discharge will also be compared between the three groups. Adverse events potentially related to acupuncture will be evaluated daily. The cost-effectiveness of acupuncture will be estimated. CONCLUSION This novel randomized study will evaluate both the specific and the non-specific effects of acupuncture on delirium, and related outcomes, and its safety. Potential mechanism(s) of action for acupuncture in reducing delirium will be explored and healthcare-related costs estimated. Positive study results may prove pivotal in facilitating a multimodal, non-pharmacologic, integrative approach to delirium treatment among older, medical inpatients.
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Affiliation(s)
- Ilana Levy
- Internal Medicine B Department, Bnai Zion Medical Center, Haifa, Israel.
| | - Samuel Attias
- Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel; School of Public Health, University of Haifa, Haifa, Israel
| | - Sagi Gavrieli
- Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel
| | - Ron Oliven
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Internal Medicine C Department, Bnai Zion Medical Center, Haifa, Israel; Geriatric Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Bjorn E Neerland
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - John W Devlin
- Northeastern University, School of Pharmacy, Boston, MA, United States; Tufts Medical Center, 1867, Boston, MA, United States
| | - Eran Ben-Arye
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel
| | - Dan Greenberg
- Department of Health Systems Management, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Elad Schiff
- Internal Medicine B Department, Bnai Zion Medical Center, Haifa, Israel; Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Abstract
Purpose of Review Agitation is common among older adults with dementia; its origin may be multi-factorial, and it is often difficult to treat. In this paper, we summarize current knowledge and offer considerations on pharmacologic management of behavioral and psychological symptoms of dementia (BPSD). Recent Findings We reviewed human studies published from 2013 to 2018 evaluating pharmacologic management of BPSD manifestations including depressive symptoms, mania, psychosis, and other BPSD, as well as severe agitation without determination of underlying cause. After non-pharmacological management is exhausted, the choice of pharmacological options depends on patient comorbidities, specific BPSD presentation, and patient tolerance of medications. Summary Depending on manifestations of BPSD, low- to moderate-quality evidence supports the use of anti-depressants, anti-psychotics, or anti-epileptics in conjunction with cholinesterase inhibitors. The current evidence base needs to be augmented with future research that focuses on real-world medication use alongside head-to-head evaluation of medication effectiveness rather than comparison to placebo.
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Comparative efficacy and safety of therapy for the behavioral and psychological symptoms of dementia: a systemic review and Bayesian network meta-analysis. J Neurol 2019; 266:2363-2375. [DOI: 10.1007/s00415-019-09200-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 01/10/2019] [Accepted: 01/12/2019] [Indexed: 10/27/2022]
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Margenfeld F, Klocke C, Joos S. Manual massage for persons living with dementia: A systematic review and meta-analysis. Int J Nurs Stud 2019; 96:132-142. [PMID: 30679034 DOI: 10.1016/j.ijnurstu.2018.12.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 10/21/2018] [Accepted: 12/04/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The number of persons living with dementia will increase. So far, pharmacological management is limited because of small effect sizes and side effects of the drugs. Therefore, it is important to assess non-pharmacological treatment options such as massage, which have nearly no side effects and are easy for caregivers to apply. OBJECTIVES To conduct a systematic review with meta-analysis, aiming to pool the evidence for the efficacy of manual massage for persons living with dementia. DESIGN A systematic review and meta-analysis. DATA SOURCES EMBASE, Medline, PubMed, PSYinfo, BIOSIS, EBM, PSYCINDEX, Osteopathic Research Web, and OSTMED.DR were searched, regardless of publication year, through August 2017. REVIEW METHODS Randomized controlled trials (RCTs) evaluating manual massage in patients with dementia with or without using (aromatic) oil were included. The intervention of the control group had to guarantee no physical contact between caregiver and patient. Only studies assessing behavioural and psychological symptoms of dementia, cognitive abilities or depressive symptoms with validated instruments were included. Two reviewers independently extracted data and assessed risk of bias using The Cochrane Collaboration's 'Risk of bias' tool. Continuous outcomes are given as standardized mean difference (SMD), with 95% confidence intervals (CI) if different scaling of outcome measurement was used, and as mean difference (MD), with 95% confidence intervals (CI) for identical scaling. Data were pooled using the random-effects model. Sensitivity analysis considered type of massage, oil and outcome. Funnel plots were performed. RESULTS Eleven RCTs, with a total of 825 persons living with dementia, were eligible for qualitative synthesis and nine for quantitative synthesis. Two studies, with a total of 95 participants, had a high risk of bias. A pooled analysis of the mean change showed a benefit of manual massage compared to the control group using the Cohen Mansfield Agitation Inventory (SMD = -0.56, 95% CI [-0.95, -0.17], P = 0.005), which included six studies with 395 participants, and using the Cornell Scale of Depression in Dementia (MD = -6.14 [-8.66, -3.61], P < 0.00001), which included three studies with 193 participants. No significant effect could be demonstrated using the Neuropsychiatric Inventory and Mini Mental State Examination. Subgroup analysis of 'acupressure' did not show significant group differences. CONCLUSIONS Manual massage may serve as a non-pharmacological strategy to improve behavioural and psychological symptoms in persons living with dementia. Thus, healthcare professionals and family caregivers should be encouraged to apply massage to their patients and relatives. More research is needed, however, to provide clearer recommendations with respect to frequency and types of massage.
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Affiliation(s)
- Felix Margenfeld
- Institute for General Practice and Interprofessional Healthcare, Eberhardt-Karls-University Tübingen, Osianderstraße 5, 72076, Tübingen, Germany; National Graduate College 'Optimisation strategies in Dementia - OptiDem', Karl and Veronica Carstens-Foundation, Essen, Germany.
| | - Carina Klocke
- Institute for General Practice and Interprofessional Healthcare, Eberhardt-Karls-University Tübingen, Osianderstraße 5, 72076, Tübingen, Germany; National Graduate College 'Optimisation strategies in Dementia - OptiDem', Karl and Veronica Carstens-Foundation, Essen, Germany
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Healthcare, Eberhardt-Karls-University Tübingen, Osianderstraße 5, 72076, Tübingen, Germany; National Graduate College 'Optimisation strategies in Dementia - OptiDem', Karl and Veronica Carstens-Foundation, Essen, Germany
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Zucchella C, Sinforiani E, Tamburin S, Federico A, Mantovani E, Bernini S, Casale R, Bartolo M. The Multidisciplinary Approach to Alzheimer's Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment. Front Neurol 2018; 9:1058. [PMID: 30619031 PMCID: PMC6300511 DOI: 10.3389/fneur.2018.01058] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/21/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Alzheimer's disease (AD) and dementia are chronic diseases with progressive deterioration of cognition, function, and behavior leading to severe disability and death. The prevalence of AD and dementia is constantly increasing because of the progressive aging of the population. These conditions represent a considerable challenge to patients, their family and caregivers, and the health system, because of the considerable need for resources allocation. There is no disease modifying intervention for AD and dementia, and the symptomatic pharmacological treatments has limited efficacy and considerable side effects. Non-pharmacological treatment (NPT), which includes a wide range of approaches and techniques, may play a role in the treatment of AD and dementia. Aim: To review, with a narrative approach, current evidence on main NPTs for AD and dementia. Methods: PubMed and the Cochrane database of systematic reviews were searched for studies written in English and published from 2000 to 2018. The bibliography of the main articles was checked to detect other relevant papers. Results: The role of NPT has been largely explored in AD and dementia. The main NPT types, which were reviewed here, include exercise and motor rehabilitation, cognitive rehabilitation, NPT for behavioral and psychological symptoms of dementia, occupational therapy, psychological therapy, complementary and alternative medicine, and new technologies, including information and communication technologies, assistive technology and domotics, virtual reality, gaming, and telemedicine. We also summarized the role of NPT to address caregivers' burden. Conclusions: Although NPT is often applied in the multidisciplinary approach to AD and dementia, supporting evidence for their use is still preliminary. Some studies showed statistically significant effect of NPT on some outcomes, but their clinical significance is uncertain. Well-designed randomized controlled trials with innovative designs are needed to explore the efficacy of NPT in AD and dementia. Further studies are required to offer robust neurobiological grounds for the effect of NPT, and to examine its cost-efficacy profile in patients with dementia.
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Affiliation(s)
| | - Elena Sinforiani
- Alzheimer's Disease Assessment Unit, Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy
| | - Stefano Tamburin
- Neurology Unit, University Hospital of Verona, Verona, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Angela Federico
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sara Bernini
- Alzheimer's Disease Assessment Unit, Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto Casale
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA, Bergamo, Italy
| | - Michelangelo Bartolo
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA, Bergamo, Italy
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Zalomonson S, Freud T, Punchik B, Samson T, Lebedinsky S, Press Y. The Results of a Crossover Placebo-Controlled Study of the Effect of Lavender Oil on Behavioral and Psychological Symptoms of Dementia. Rejuvenation Res 2018; 22:246-253. [PMID: 30328781 DOI: 10.1089/rej.2018.2123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Studies of the effect of aromatherapy on patients with behavioral and psychological symptoms of dementia (BPSD) have yielded contradictory results. One possible explanation for this lack of consistent results is the site of application of the oil. The aim of the study was to evaluate the effect of lavender oil on the rate of BPSD when applied close to and away from the olfactory system. A crossover placebo-controlled study was conducted in the two psychogeriatric long term care departments. Patients in Department A received lavender oil on their face during the first month and on their foot in the second month, sunflower seed oil on their foot in the third month and on their face in the fourth month. Patients in Department B received sunflower seed oil on their face during the first month and on their foot in the second month, and lavender oil on their foot in the third month and on their face in the fourth month. Forty-two patients completed the study. Their mean age was 76.1 ± 11.2 years. After 4 months of treatment, the mean Neuropsychiatric Inventory score in Department A dropped from 13.1 ± 8.3 (median 12.0) to 3.5 ± 3.8 (median 2.0; p < 0.0001) and in Department B it dropped from 9.7 ± 9.6 (median 6.0) to 1.4 ± 2.5 (median 0; p < 0.0001). This reduction was not associated with the type of oil or the site of application. Based on these results, lavender oil has no advantage over sunflower seed oil in the reduction of BPSD, regardless of the place of application.
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Affiliation(s)
- Svetlana Zalomonson
- 1 Mental Health Center Beer-Sheva, Ministry of Health, Affiliated to the Faculty of Medical Science Ben-Gurion University of the Negev, Beer-Sheva, Israel.,2 Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Freud
- 3 Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Boris Punchik
- 2 Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,3 Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tali Samson
- 2 Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,3 Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Svetlana Lebedinsky
- 4 Clinical Pharmacy Services, Pharmacy Department, Clalit Health Services, Beer-Sheva, Israel
| | - Yan Press
- 2 Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,3 Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,5 Department of Geriatrics, Soroka Medical Hospital, Beer-Sheva, Israel
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Hirano N, Sakamoto K. Linalool odor stimulation improves heat stress tolerance and decreases fat accumulation in nematodes. Biosci Biotechnol Biochem 2018; 83:1-7. [PMID: 30200822 DOI: 10.1080/09168451.2018.1518699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
Aromatherapy uses plant essential oils and fragrant ingredients for relaxation, sleep assistance, and improvement of restlessness related to dementia. Certain aromatic substances increase the life span and stress tolerance of nematodes. We investigated effects of exposure to linalool, a linear chain monoterpenic alcohol that is present in the essential oils of many plants, and its optical isomer, l-linalool, in Caenorhabditis elegans. Nematodes were repelled by the odor of both linalool and l-linalool; however, linalool odor stimulation decreased fat accumulation and increased motility after thermal stress. Analysis of a gene-deficient mutant revealed that the DAF-16 insulin-signaling pathway, which is involved in heat stress tolerance, was enhanced by linalool treatment. Linalool stimulation increased the expression of downstream genes such as sod-3 and hsp-12.6 via DAF-16. We conclude that linalool odor induces a repelling behavior in nematodes, improves heat stress tolerance through the DAF-16 signaling pathway, and affects fat accumulation.
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Affiliation(s)
- Naoko Hirano
- a Graduate School of Life and Environmental Sciences , University of Tsukuba , Tsukuba , Ibaraki , Japan
| | - Kazuichi Sakamoto
- a Graduate School of Life and Environmental Sciences , University of Tsukuba , Tsukuba , Ibaraki , Japan
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Kwan RYC, Leung MCP, Lai CKY. A Randomized Controlled Trial Examining the Effect of Acupressure on Agitation and Salivary Cortisol in Nursing Home Residents with Dementia. Dement Geriatr Cogn Disord 2018; 44:92-104. [PMID: 28768251 DOI: 10.1159/000478739] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Acupressure has been used to manage agitation in people with dementia because it is safe and inexpensive. However, its effect on agitation and at the biochemical level is uncertain. METHODS This randomized controlled trial examined the effect of acupressure on agitation, as measured by the Cohen-Mansfield Agitation Inventory (CMAI); and on salivary cortisol, as measured at baseline (T0) and in the 3rd (T1), 5th (T2), and 8th (T3) weeks. There were 119 agitated residents with dementia randomized into 3 groups: acupressure (n = 39), sham (n = 41), and usual-care group (n = 39). RESULTS A downward trend in agitation over time was noted in the acupressure group, which almost reached a level of significance in interaction effects between groups and time points (p = 0.052). Post hoc pairwise tests in the acupressure group showed that acupressure significantly reduced agitation at T2 (mean difference -6.84, 95% CI -10.60, -3.08) compared to baseline. Significant interaction effects between groups and time points were observed on the level of salivary cortisol (p = 0.022). CONCLUSION Acupressure is a multicomponent intervention that can reduce agitation. Acupoint activation may not be a significant component in reducing agitation, although this result may have been limited by the inadequate sample size. Acupressure is effective in reducing salivary cortisol in people with dementia.
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Affiliation(s)
- Rick Yiu Cho Kwan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR, China
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Olley R, Morales A. Systematic review of evidence underpinning non-pharmacological therapies in dementia. AUST HEALTH REV 2018; 42:361-369. [DOI: 10.1071/ah16212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 03/27/2017] [Indexed: 11/23/2022]
Abstract
Objective
Dementia is one of the most common illnesses worldwide, and is one of the most important causes of disability in older people. Currently, dementia affects over 35 million people around the globe. It is expected that this number will increase to 65.7 million by 2030. Early detection, diagnosis and treatment to control the principal behaviour symptoms may help reduce these numbers and delay the progression to more advanced and dangerous stages of this disorder with resultant increase quality of life for those affected. The main goal of the present systematic literature review was to examine contemporary evidence relating to non-pharmacological therapy in the treatment of dementia.
Methods
To achieve the study goal, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used.
Results
This study identified the five most common behaviours in patients with dementia as aggression, wandering, agitation, apathy and sleep disturbances. Two non-pharmacological therapies were the most studied treatment: music therapy and aromatherapy. Ten other non-pharmacological therapies were also identified, but these lack a sufficient evidence-base.
Conclusion
Although all the therapies identified could be used as part of the treatment of behavioural symptoms, there is insufficient evidence relating to the indications, appropriate use and effectiveness of these therapies to apply in each behavioural treatment. Thus, the present study has demonstrated a significant research gap.
What is known about the topic?
Despite the widespread use of many different types of therapies, there is limited evidence regarding the efficacy of non-pharmaceutical therapies deployed in the management of behaviours of concern manifested by some people who suffer with dementia in all its forms.
What does this paper add?
This systematic review examines contemporary evidence from the literature to determine whether there is an evidence base available that would underpin the use of these therapies. This report on a PRISMA systematic review of the available literature demonstrates that only two therapies have some evidence to underpin the use of these non-pharmaceutical therapies and that a significant research gap is exists.
What are the implications for practitioners?
The implications for practitioners is that significant research effort is required to determine the efficacy of many of the therapies that are currently deployed, and thus many of the therapies used lack an evidence base at this time.
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Fung JKKM, Tsang HWH. Management of behavioural and psychological symptoms of dementia by an aroma-massage with acupressure treatment protocol: A randomised clinical trial. J Clin Nurs 2017; 27:1812-1825. [PMID: 28986942 DOI: 10.1111/jocn.14101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2017] [Indexed: 02/05/2023]
Abstract
AIMS AND OBJECTIVES This study evaluates the clinical effectiveness of a multicomponent aroma-massage with an acupressure treatment protocol and compared it to cognitive training for the management of behavioural and psychological symptoms of dementia. BACKGROUND Pharmacological interventions have been unsatisfactory in managing behavioural and psychological symptoms of dementia; thus, complementary and alternative medicine has been extensively researched to identify an adjunct safe and cost-effective intervention. DESIGN This randomised clinical trial utilised a three-arm parallel group design. Cognitive training was used as a conventional intervention to manage behavioural and psychological symptoms of dementia, whereas exercise was considered "treatment as usual" in this study; both were used as comparisons with the experimental protocol. There were three treatment groups: Group 1: aroma-massage with acupressure + exercise, Group 2: cognitive training + exercise and Group 3: aroma-massage with acupressure + cognitive training. METHOD Sixty older adults were recruited and randomly assigned to the three groups (20 each). Using the 29-item Chinese Version of the Cohen-Mansfield Agitation Inventory, Neuropsychiatric Inventory, Mini-mental State Examination and Barthel Index-20, the outcome measures were assessed at preintervention, postintervention and the 3-month follow-up to assess behaviour, Activities of Daily Living, cognition, and behavioural and psychological symptoms of dementia severity and distress. Multiple comparisons performed through repeated measures were analysed to detect between-group differences and within-subject differences, as well as the interaction effects between groups and times. RESULTS The Group 1 and 3 participants showed a significant reduction in the severity and distress caused by behavioural and psychological symptoms of dementia, whereas Group 2 did not demonstrate similar effects. CONCLUSIONS This clinical study suggests that aroma-massage with acupressure is as effective as cognitive training and can enhance cognitive training in reducing the severity and distress of behavioural and psychological symptoms of dementia. RELEVANCE TO CLINICAL PRACTICE Aroma-massage with acupressure may serve as an adjunct therapy to reduce behavioural and psychological symptoms of dementia. This therapy is safe, cost-effective and can be implemented by caregivers and family members who are not professionally trained.
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Affiliation(s)
- Jo Kamen Ka-Man Fung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Hector Wing-Hong Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Ijaopo EO. Dementia-related agitation: a review of non-pharmacological interventions and analysis of risks and benefits of pharmacotherapy. Transl Psychiatry 2017; 7:e1250. [PMID: 29087372 PMCID: PMC5682601 DOI: 10.1038/tp.2017.199] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 07/07/2017] [Accepted: 07/14/2017] [Indexed: 12/24/2022] Open
Abstract
Unsurprisingly, the subject of dementia has been a rising matter of public health concerns as people now live longer. World Alzheimer Report 2015, estimate that about 46.8 million people worldwide have dementia. These numbers are projected to almost double every 20 years, reaching 74.7 million in 2030 and 131.5 million in 2050. The modality for treating agitation and other behavioral symptoms in dementia patients has been a challenge. Many years on, there has been no FDA-approved pharmacotherapy in treating dementia-related agitation. This review discusses the current knowledge of non-pharmacological interventions, and analyzes the risks and benefits of pharmacotherapy in the management of dementia-related agitation, as well as providing an anecdotal of the author's clinical experience. This article aims to provide opportunity for increase awareness for clinicians, particularly those with no specialty training in geriatrics medicine but see dementia patients with agitation and other behavioral symptoms from time to time. Likewise, it hopefully will benefit the readers of medical journals to update their existing knowledge on matters relating to the management of dementia-related agitation.
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Affiliation(s)
- E O Ijaopo
- Department of Medicine, Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, West Midlands, UK
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42
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Wu J, Wang Y, Wang Z. The effectiveness of massage and touch on behavioural and psychological symptoms of dementia: A quantitative systematic review and meta-analysis. J Adv Nurs 2017; 73:2283-2295. [DOI: 10.1111/jan.13311] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Jie Wu
- School of Nursing; Peking University; Beijing China
| | - Yi Wang
- School of Nursing; Peking University; Beijing China
| | - Zhiwen Wang
- School of Nursing; Peking University; Beijing China
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43
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Levy I, Attias S, Ben-Arye E, Bloch B, Schiff E. Complementary medicine for treatment of agitation and delirium in older persons: a systematic review and narrative synthesis. Int J Geriatr Psychiatry 2017; 32:492-508. [PMID: 28239906 DOI: 10.1002/gps.4685] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/24/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Agitation and delirium frequently occur in cognitively impaired older people. We conducted a systematic review with narrative synthesis of the literature aiming to assess effectiveness of complementary and alternative medicine (CAM) modalities to address these conditions. METHODS Following preliminary search, we included 40 original researches on CAM treatment of delirium and agitation in older persons. Then, the quality of these studies was assessed using the Downs and Black Checklist and Quality Assessment Tool for Studies with Diverse Designs, and the effect sizes were calculated. We subsequently conducted a narrative synthesis of the main findings, including theory development, preliminary synthesis, exploration of relationships within and between studies, and assessment of synthesis robustness. RESULTS Forty articles that met the inclusion criteria were analyzed. Sixteen of these were randomized controlled trials. One article specifically addressed CAM treatment of delirium in patients without dementia, and the remaining 39 articles described treatments of agitated older persons with dementia. Thirty-five of the 40 included studies suggested that the investigated CAM therapies may ameliorate the severity of agitation and delirium. The physiological surrogates of agitation assessed in these studies included cortisol level, chromogranin A level, and heart rate variability. Very few of the studies systematically assessed safety issues, although no major adverse effects were reported. CONCLUSION Overall, the systematic review of the literature suggests that several CAM modalities are potentially beneficial in the treatment of agitation and delirium among older persons. We suggest that promising CAM modalities should be further explored through large-scale randomized controlled trials in different clinical settings. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ilana Levy
- Internal Medicine B Department, Bnai Zion Medical Center, Haifa, Israel
| | - Samuel Attias
- Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel.,School of Public Health, University of Haifa, Haifa, Israel
| | - Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin Medical Center, Clalit Health Services, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Boaz Bloch
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Psychiatric Department, HaEmek Medical Center, Afula, Israel
| | - Elad Schiff
- Internal Medicine B Department, Bnai Zion Medical Center, Haifa, Israel.,Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Lee SH, Hsu WT, Lai CC, Esmaily-Fard A, Tsai YW, Chiu CC, Wang J, Chang SS, Lee CC. Use of antipsychotics increases the risk of fracture: a systematic review and meta-analysis. Osteoporos Int 2017; 28:1167-1178. [PMID: 28083669 DOI: 10.1007/s00198-016-3881-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/11/2016] [Indexed: 01/19/2023]
Abstract
UNLABELLED Our systematic review and meta-analysis of observational studies indicated that the use of antipsychotics was associated with a nearly 1.5-fold increase in the risk of fracture. First-generation antipsychotics (FGAs) appeared to carry a higher risk of fracture than second-generation antipsychotics (SGAs). INTRODUCTION The risk of fractures associated with the use of antipsychotic medications has inconsistent evidence between different drug classes. A systematic review and meta-analysis was conducted to evaluate whether there is an association between the use of antipsychotic drugs and fractures. METHODS Searches were conducted through the PubMed and EMBASE databases to identify observational studies that had reported a quantitative estimate of the association between use of antipsychotics and fractures. The summary risk was derived from random effects meta-analysis. RESULTS The search yielded 19 observational studies (n = 544,811 participants) with 80,835 fracture cases. Compared with nonuse, use of FGAs was associated with a significantly higher risk for hip fractures (OR 1.67, 95% CI, 1.45-1.93), and use of second generation antipsychotics (SGAs) was associated with an attenuated but still significant risk for hip fractures (OR 1.33, 95% CI, 1.11-1.58). The risk of fractures associated with individual classes of antipsychotic users was heterogeneous, and odds ratios ranged from 1.24 to 2.01. Chlorpromazine was associated with the highest risk (OR 2.01, 95% CI 1.43-2.83), while Risperidone was associated with the lowest risk of fracture (OR 1.24, 95% CI 0.95-1.83). CONCLUSIONS FGA users were at a higher risk of hip fracture than SGA users. Both FGAs and SGAs were associated with an increased risk of fractures, especially among the older population. Therefore, the benefit of the off-label use of antipsychotics in elderly patients should be weighed against any risks for fracture.
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Affiliation(s)
- S-H Lee
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Department of Medicine, College of Medicine, National Yang Ming University, Taipei, Taiwan
| | - W-T Hsu
- Health Economics and Outcome Research Group, Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan
| | - C-C Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - A Esmaily-Fard
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Y-W Tsai
- Department of Family Medicine, Chang Gung Memorial Hospital, University College of Medicine, Taoyuan, Taiwan
| | - C-C Chiu
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
| | - J Wang
- University of Nevada School of Medicine, Las Vegas, Nevada, USA
| | - S-S Chang
- Department of Family Medicine, Chang Gung Memorial Hospital, No.5. Fu-Hsing street, Kuei Shan Hsiang, Taoyuan, Hsien, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - C C Lee
- Health Economics and Outcome Research Group, Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan.
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Noll E, Shodhan S, Madariaga MC, Page CR, Santangelo D, Guo X, Al Bizri E, Pryor AD, Romeiser J, Bennett-Guerrero E. Randomized trial of acupressure to improve patient satisfaction and quality of recovery in hospitalized patients: study protocol for a randomized controlled trial. Trials 2017; 18:110. [PMID: 28270180 PMCID: PMC5341349 DOI: 10.1186/s13063-017-1839-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 02/12/2017] [Indexed: 01/08/2023] Open
Abstract
Background Acupressure therapy may be potentially beneficial in improving postoperative symptoms like postoperative nausea and vomiting (PONV), pain and sleep disorder and improving postoperative quality of recovery. The primary aim of this study is to investigate the efficacy of acupressure therapy on postoperative patient satisfaction and quality of recovery in hospitalized patients after surgical treatment. Methods/design This three-group, parallel, superiority, blinded, randomized controlled trial will test the hypothesis that a combination of PC6, LI4 and HT7 acupressure is superior to sham or no intervention for improving postoperative quality of recovery in hospitalized patients. A minimum of 150 patients will be randomly allocated to one of the three experimental groups: control (no visit), light touch (sham acupressure) or active acupressure therapy in a 1:1:1 ratio. Interventions will be performed three times a day for 2 days. Patient satisfaction, quality of recovery, PONV and pain will be measured during the 3 days following randomization. The study protocol was approved by the Stony Brook University Institutional Review Board on 21 March 2016. Written informed consent will be recorded from every consented patient. Discussion This study has the potential to improve the recovery of hospitalized patients by adding knowledge on the efficacy of acupressure therapy in this setting. A multipoint acupressure protocol will be compared to both a no intervention group and a light touch group, providing insight into different aspects of the placebo effect. Trial registration ClinicalTrial.gov, NCT02762435. Registered on 14 April 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1839-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eric Noll
- Department of Anesthesiology Stony Brook Medicine, Stony Brook, NY, USA. .,Institut de Chirurgie Guidee par l'Image, IHU Hopitaux Universitaire de Strasbourg, Strasbourg, France. .,Service d'Anesthesie Reanimation Hautepierre - CCOM - CMCO, Hopitaux Universitaires de Strasbourg, Strasbourg, France. .,C.C.O.M., 10 avenue Achille Baumann, 67400, Illkirch-Graffenstaden, France.
| | - Shivam Shodhan
- Department of Anesthesiology Stony Brook Medicine, Stony Brook, NY, USA
| | | | | | - Diane Santangelo
- Department of Anesthesiology Stony Brook Medicine, Stony Brook, NY, USA
| | - Xiaojun Guo
- Department of Anesthesiology Stony Brook Medicine, Stony Brook, NY, USA
| | - Ehab Al Bizri
- Department of Anesthesiology Stony Brook Medicine, Stony Brook, NY, USA
| | - Aurora D Pryor
- Department of Surgery Stony Brook Medicine, Stony Brook, NY, USA
| | - Jamie Romeiser
- Department of Anesthesiology Stony Brook Medicine, Stony Brook, NY, USA
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Regier NG, Gitlin LN. Psychosocial and Environmental Treatment Approaches for Behavioral and Psychological Symptoms in Neurocognitive Disorders: an Update and Future Directions. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2017; 4:80-101. [PMID: 37465053 PMCID: PMC10353767 DOI: 10.1007/s40501-017-0105-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Nearly all persons with dementia will exhibit behavioral and psychological symptoms (BPSD) at some point during the course of the disease. These symptoms often pose significant challenges for formal and informal caregivers, and their treatment is unclear. Current guidelines recommend implementing nonpharmacological interventions as the first-line approach to managing BPSD. Given the recent proliferation of research evaluating the use of nonpharmacological interventions for BPSD, there is a continuing need to reevaluate and synthesize the findings in this area. The current review examines the evidence for using psychosocial and environmental strategies, focusing on the past 3 years of research efforts and assessing how this research augments what is known from prior reviews. We conclude that the results in the recent literature concerning the efficacy of psychosocial and environmental treatment approaches to behavioral symptoms in dementia continue to be promising, yet results are also mixed. We recommend the consideration of music therapy and tailored activities when utilizing a nonpharmacological approach, as these appear particularly promising throughout the literature. We also find that multisensory stimulation and animal-assisted therapy warrant further evaluation. In contrast, in this and previous reviews, approaches such as bright light therapy and aromatherapy have consistently been shown to be ineffective and, thus, cannot be recommended with confidence based on the evidence. We discuss limitations of current research studies and make recommendations for future research in the area of psychosocial and environmental interventions for BPSD.
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Affiliation(s)
- Natalie G. Regier
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, 525 North Wolfe Street, SON House Room 301, Baltimore, MD, 21205, USA
- Department of Community and Public Health, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Suite 316, Baltimore, MD, 21205, USA
| | - Laura N. Gitlin
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, 525 North Wolfe Street, SON House Room 301, Baltimore, MD, 21205, USA
- Department of Community and Public Health, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Suite 316, Baltimore, MD, 21205, USA
- Department of Psychiatry, Johns Hopkins School of Medicine, 525 N. Wolfe Street, Suite 316, Baltimore, MD, 21205, USA
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Effects of aromatherapy on agitation and related caregiver burden in patients with moderate to severe dementia: A pilot study. Geriatr Nurs 2016; 38:231-237. [PMID: 27912905 DOI: 10.1016/j.gerinurse.2016.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 11/01/2016] [Accepted: 11/07/2016] [Indexed: 11/21/2022]
Abstract
We examined the effects of aromatherapy on agitation in patients with dementia and evaluated related caregiver burden. Patients and their caregivers from two hospitals in Turkey were selected and divided into an intervention group (n = 14) and a control group (n = 14). Patients were stratified according to their dementia phase and intake of antipsychotic medication. The intervention group received aromatherapy via massage and inhalation at home for 4 weeks. The control group received no intervention. Data were collected using the Neuropsychiatric Inventory (NPI), the Cohen-Mansfield Agitation Inventory (CMAI) and the Zarit Burden Interview (ZBI). At 2 and 4 weeks, the NPI scores were significantly lower in the intervention group (p < 0.05). At 4 weeks, the CMAI and ZBI scores were significantly lower in the intervention group (p < 0.05). In conclusion, after aromatherapy, agitation, neuropsychiatric symptoms, and caregiver distress significantly reduced, and aromatherapy prevented caregiver burden increase.
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[Guideline-adherent inpatient psychiatric psychotherapeutic treatment of behavioral and psychological symptoms of dementia : Normative definition of personnel requirements]. DER NERVENARZT 2016; 88:1010-1019. [PMID: 27581115 DOI: 10.1007/s00115-016-0195-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Dementia is of increasing medical and societal relevance. Hospitalization of dementia patients is mostly due to behavioral and psychological symptoms of dementia (BPSD). There is a need for sufficient qualified personnel in hospitals in order to be able to effectively treat these symptoms. OBJECTIVES This study aims at identifying the personnel requirements for guideline-conform, evidence-based inpatient treatment concepts for patients with BPSD and to compare these with the resources defined by the German psychiatric personnel regulations (Psych-PV). Furthermore, it was the aim to identify how often patients with dementia received non-pharmacological therapy during inpatient treatment. METHODS Based on the current scientific evidence for treatment of BPSD, a schedule for a multimodal non-pharmacological treatment was defined and based on this the corresponding personnel requirements were calculated. Using the treatment indicators in psychiatry and psychosomatics (VIPP) database as a reference, it was calculated on what proportion of treatment days patients were classified into G1 according to the German Psych-PV and at least once received more than two treatment units per week. RESULTS For the implementation of a guideline-oriented and evidence-based treatment plan, a higher need for personnel resources than that provided by the Psych-PV was detected in all areas. Currently patients with dementia who received at least more than two treatment units per week during inpatient hospitalization, were classified into G1 according to German Psych-PV on 17.9 % of treatment days. CONCLUSION Despite evidence for the efficacy of non-pharmacological treatment measures on BPSD, these forms of treatment cannot be sufficiently provided under the current conditions. The realization of a new quality controlled therapeutic concept is necessary to enable optimized treatment of patients with BPSD.
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Nonpharmacological Interventions to Reduce Behavioral and Psychological Symptoms of Dementia: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2015; 2015:218980. [PMID: 26693477 PMCID: PMC4676992 DOI: 10.1155/2015/218980] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/04/2015] [Indexed: 12/20/2022]
Abstract
Introduction. Behavioral and psychological symptoms of dementia (BPSD) are defined as a group of symptoms of disturbed perceptive thought content, mood, or behavior that include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, and wandering. Care of patients with BPSD involves pharmacological and nonpharmacological interventions. We reviewed studies of nonpharmacological interventions published in the last 10 years. Methods. We performed a systematic review in Medline and Embase databases, in the last 10 years, until June 2015. Key words used were (1) non-pharmacological interventions, (2) behavioral symptoms, (3) psychological symptoms, and (4) dementia. Results. We included 20 studies published in this period. Among these studies, program activities were more frequent (five studies) and the symptoms more responsive to the interventions were agitation. Discussion. Studies are heterogeneous in many aspects, including size sample, intervention, and instruments of measures. Conclusion. Nonpharmacological interventions are able to provide positive results in reducing symptoms of BPSD. Most studies have shown that these interventions have important and significant efficacy.
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