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Polden M, Faulkner T, Holland C, Hanna K, Ward K, Ahmed F, Brown H, Barrow H, Main J, Mann S, Pendrill S, Giebel C. The effects of singing interventions on quality of life, mood and levels of agitation in community-dwelling people living with dementia: A quantitative systematic review. DEMENTIA 2024:14713012241273837. [PMID: 39148243 DOI: 10.1177/14713012241273837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Background and Aims: Music-based interventions have been found to benefit people living with dementia and have positive impacts on cognition and well-being. Most people with dementia live in the community and compared to people with dementia in residential care often have less access to music-based interventions. There are many forms of music interventions and singing has shown particular promise; in the realm of music interventions. It is important to determine what aspects of music interventions yield the most benefits for people with dementia. This review aimed to synthesise evidence on the impacts of singing interventions on quality of life, mood and neuropsychiatric symptoms for community-dwelling people with dementia. Methods: We systematically searched three electronic databases (PsycINFO, MEDLINE and Web of Science) for studies reporting on singing interventions with community-dwelling people with dementia. Studies were eligible for inclusion if they reported on a singing intervention with people living with dementia that included an outcome measure of quality of life, mood or agitation. Fourteen publications were identified and included in this review, with a total of n = 361 people with dementia. Results: Despite some inconsistencies across the literature, evidence suggests that singing interventions led to an improvement in mood and a reduction in agitation levels in people living with dementia. There was no strong evidence to suggest that singing interventions led to significant improvements in quality of life. Conclusions: This review highlights the potential of singing interventions as an effective psychosocial intervention for community-dwelling people with dementia. For key developments in this area, we urge that future studies include a control group where possible which will allow for more robust examinations of singing interventions and allow intervention effects to be distinguished from general deterioration in dementia symptoms over time.
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Affiliation(s)
- Megan Polden
- Department of Primary Care & Mental Health, University of Liverpool, UK
- NIHR Applied Research Collaboration North West Coast, UK
- Health Research, Lancaster University, UK
| | - Thomas Faulkner
- Department of Primary Care & Mental Health, University of Liverpool, UK
- Mersey Care NHS Trust, UK
| | - Carol Holland
- Health Research, Lancaster University, UK
- Lyrics and Lunch Charity, UK
| | - Kerry Hanna
- School of Health Sciences, University of Liverpool, UK
| | - Kym Ward
- NIHR Applied Research Collaboration North West Coast, UK
- The Brain Charity, UK
| | | | | | - Hazel Barrow
- NIHR Applied Research Collaboration North West Coast, UK
| | - Jeanette Main
- NIHR Applied Research Collaboration North West Coast, UK
- Lyrics and Lunch Charity, UK
| | - Stella Mann
- NIHR Applied Research Collaboration North West Coast, UK
| | - Steve Pendrill
- NIHR Applied Research Collaboration North West Coast, UK
- Lyrics and Lunch Charity, UK
| | - Clarissa Giebel
- Department of Primary Care & Mental Health, University of Liverpool, UK
- NIHR Applied Research Collaboration North West Coast, UK
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Novotni G, Taneska M, Novotni A, Fischer J, Iloski S, Ivanovska A, Dimitrova V, Novotni L, Milutinović M, Joksimoski B, Chorbev I, Hasani S, Dogan V, Grimmer T, Kurz A. North Macedonia interprofessional dementia care (NOMAD) - personalized care plans for people with dementia and caregiver psychoeducation delivered at home by interprofessional teams. FRONTIERS IN DEMENTIA 2024; 3:1391471. [PMID: 39081604 PMCID: PMC11285573 DOI: 10.3389/frdem.2024.1391471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 03/13/2024] [Indexed: 08/02/2024]
Abstract
Introduction The increasing number of people living with dementia and its burden on families and systems particularly in low- and middle-income countries require comprehensive and efficient post-diagnostic management. This study aimed to explore the acceptability and efficacy of a multi-professional case management and psychoeducation model (North Macedonia Interprofessional Dementia Care, or NOMAD) delivered by mobile teams for people with dementia and their caregivers in North Macedonia. Method We conducted a two-arm randomized controlled trial comparing the intervention with treatment as usual. Participants were recruited from 12 general practitioner (GP) offices in the Skopje region. The NOMAD intervention included the delivery of a personalized care plan over four home visits to dyads of people with dementia and their caregivers by a team including a dementia nurse and a social worker, in collaboration with GPs and dementia experts, and the introduction of a caregiver manual. We assessed caregivers' depressive symptoms, burden, and quality of life and the neuropsychiatric symptoms, daily living activities, and service utilization of people with dementia at baseline and follow-up; we also assessed the acceptability of the intervention by analyzing case notes and attendance rates. Results One hundred and twenty dyads were recruited and randomized to either the control (n = 60) or the intervention group (n = 60). At follow-up, caregivers in the intervention group had, on average, scores that were 2.69 lower for depressive symptoms (95% CI [-4.75, -0.62], p = 0.012), and people with dementia had, on average, 11.32 fewer neuropsychiatric symptoms (95% CI [-19.74, -2.90], p = 0.009) and used, on average, 1.81 fewer healthcare services (95% CI [-2.61, -1.00], p < 0.001) compared to the control group. The completion of the home visits was 100%, but the intervention's acceptability was underpinned by relationship building, GP competencies, and resources to support families with dementia. There were no differences in the caregivers' quality of life and burden levels or daily living activities in people with dementia. NOMAD is the first case management, non-pharmacological, and multi-professional intervention tested in North Macedonia. Discussion The trial showed that it is effective in reducing caregivers' depressive symptoms and neuropsychiatric symptoms in people with dementia and the burden on health and social care services, and it is acceptable for families. Implementing NOMAD in practice will require building primary care capacity and recognizing dementia as a national priority.
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Affiliation(s)
- Gabriela Novotni
- Department of Cognitive Neurology and Neurodegenerative Diseases, University Clinic of Neurology, Skopje, North Macedonia
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
- Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia
| | - Marija Taneska
- Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia
| | - Antoni Novotni
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
- Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia
- University Clinic of Psychiatry, Skopje, North Macedonia
| | - Julia Fischer
- Department for Psychiatry and Psychotherapy, Center for Cognitive Disorders, Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, Munich, Germany
| | - Svetlana Iloski
- Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia
| | - Andrea Ivanovska
- Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia
| | - Vesna Dimitrova
- Faculty of Computer Science and Engineering, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | | | - Miloš Milutinović
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
- University Clinic of Psychiatry, Skopje, North Macedonia
| | - Boban Joksimoski
- Faculty of Computer Science and Engineering, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Ivan Chorbev
- Faculty of Computer Science and Engineering, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Shpresa Hasani
- Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia
| | - Vildan Dogan
- Department for Psychiatry and Psychotherapy, Center for Cognitive Disorders, Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, Munich, Germany
| | - Timo Grimmer
- Department for Psychiatry and Psychotherapy, Center for Cognitive Disorders, Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, Munich, Germany
| | - Alexander Kurz
- Department for Psychiatry and Psychotherapy, Center for Cognitive Disorders, Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, Munich, Germany
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Cho E, Kim S, Heo SJ, Shin J, Hwang S, Kwon E, Lee S, Kim S, Kang B. Machine learning-based predictive models for the occurrence of behavioral and psychological symptoms of dementia: model development and validation. Sci Rep 2023; 13:8073. [PMID: 37202454 DOI: 10.1038/s41598-023-35194-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/14/2023] [Indexed: 05/20/2023] Open
Abstract
The behavioral and psychological symptoms of dementia (BPSD) are challenging aspects of dementia care. This study used machine learning models to predict the occurrence of BPSD among community-dwelling older adults with dementia. We included 187 older adults with dementia for model training and 35 older adults with dementia for external validation. Demographic and health data and premorbid personality traits were examined at the baseline, and actigraphy was utilized to monitor sleep and activity levels. A symptom diary tracked caregiver-perceived symptom triggers and the daily occurrence of 12 BPSD classified into seven subsyndromes. Several prediction models were also employed, including logistic regression, random forest, gradient boosting machine, and support vector machine. The random forest models revealed the highest area under the receiver operating characteristic curve (AUC) values for hyperactivity, euphoria/elation, and appetite and eating disorders; the gradient boosting machine models for psychotic and affective symptoms; and the support vector machine model showed the highest AUC. The gradient boosting machine model achieved the best performance in terms of average AUC scores across the seven subsyndromes. Caregiver-perceived triggers demonstrated higher feature importance values across the seven subsyndromes than other features. Our findings demonstrate the possibility of predicting BPSD using a machine learning approach.
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Affiliation(s)
- Eunhee Cho
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, 50-1, Yonsei-Ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sujin Kim
- Department of Nursing, Yong-In Arts and Science University, Gyeonggi-do, Korea
| | - Seok-Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Jinhee Shin
- College of Nursing, Woosuk University, Jeollabuk-do, Korea
| | - Sinwoo Hwang
- Korea Armed Forces Nursing Academy, Daejeon, Korea
| | - Eunji Kwon
- Korea Armed Forces Nursing Academy, Daejeon, Korea
| | | | | | - Bada Kang
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, 50-1, Yonsei-Ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Laganà V, Bruno F, Altomari N, Bruni G, Smirne N, Curcio S, Mirabelli M, Colao R, Puccio G, Frangipane F, Cupidi C, Torchia G, Muraca G, Malvaso A, Addesi D, Montesanto A, Di Lorenzo R, Bruni AC, Maletta R. Neuropsychiatric or Behavioral and Psychological Symptoms of Dementia (BPSD): Focus on Prevalence and Natural History in Alzheimer's Disease and Frontotemporal Dementia. Front Neurol 2022; 13:832199. [PMID: 35812082 PMCID: PMC9263122 DOI: 10.3389/fneur.2022.832199] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Neuropsychiatric or behavioral and psychological symptoms of dementia (BPSD) represent a heterogeneous group of non-cognitive symptoms that are virtually present in all patients during the course of their disease. The aim of this study is to examine the prevalence and natural history of BPSD in a large cohort of patients with behavioral variant of frontotemporal dementia (bvFTD) and Alzheimer's disease (AD) in three stages: (i) pre-T0 (before the onset of the disease); (ii) T0 or manifested disease (from the onset to 5 years); (iii) T1 or advanced (from 5 years onwards). Six hundred seventy-four clinical records of patients with bvFTD and 1925 with AD, from 2006 to 2018, were studied. Symptoms have been extracted from Neuropsychiatric Inventory (NPI) and from a checklist of BPSD for all periods observed. In our population, BPSD affect up to 90% of all dementia subjects over the course of their illness. BPSD profiles of the two dementia groups were similar but not identical. The most represented symptoms were apathy, irritability/affective lability, and agitation/aggression. Considering the order of appearance of neuropsychiatric symptoms in AD and bvFTD, mood disorders (depression, anxiety) come first than the other BPSD, with the same prevalence. This means that they could be an important “red flag” in detection of dementia. With the increase of disease severity, aberrant motor behavior and wandering were significantly more present in both groups. Differences between BPSD in AD and bvFTD resulted only in prevalence: Systematically, in bvFTD, all the symptoms were more represented than in AD, except for hallucinations, depression, anxiety, and irritability. Given their high frequency and impact on management and overall health care resources, BPSD should not be underestimated and considered as an additional important diagnostic and therapeutic target both in patients with AD and bvFTD.
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Affiliation(s)
- Valentina Laganà
- Association for Neurogenetic Research (ARN), Lamezia Terme, Italy
- *Correspondence: Valentina Laganà
| | - Francesco Bruno
- Association for Neurogenetic Research (ARN), Lamezia Terme, Italy
- Regional Neurogenetic Centre - ASP-CZ, Lamezia Terme, Italy
- Francesco Bruno
| | - Natalia Altomari
- Department of Mathematics and Computer Science, University of Calabria, Rende, Italy
| | - Giulia Bruni
- Regional Neurogenetic Centre - ASP-CZ, Lamezia Terme, Italy
| | - Nicoletta Smirne
- Association for Neurogenetic Research (ARN), Lamezia Terme, Italy
| | - Sabrina Curcio
- Regional Neurogenetic Centre - ASP-CZ, Lamezia Terme, Italy
| | - Maria Mirabelli
- Association for Neurogenetic Research (ARN), Lamezia Terme, Italy
| | - Rosanna Colao
- Regional Neurogenetic Centre - ASP-CZ, Lamezia Terme, Italy
| | | | | | - Chiara Cupidi
- Neurology Unit, Fondazione Istituto Giglio, Cefalù, Italy
| | - Giusy Torchia
- Association for Neurogenetic Research (ARN), Lamezia Terme, Italy
| | - Gabriella Muraca
- Association for Neurogenetic Research (ARN), Lamezia Terme, Italy
| | - Antonio Malvaso
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Desirèe Addesi
- Association for Neurogenetic Research (ARN), Lamezia Terme, Italy
- Department of Internal Medicine, Pugliese Ciaccio Hospital, Catanzaro, Italy
| | - Alberto Montesanto
- Department of Biology, Ecology and Earth Sciences, University of Calabria, Rende, Italy
| | - Raffaele Di Lorenzo
- Association for Neurogenetic Research (ARN), Lamezia Terme, Italy
- Regional Neurogenetic Centre - ASP-CZ, Lamezia Terme, Italy
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Sex-Dependent Signatures, Time Frames and Longitudinal Fine-Tuning of the Marble Burying Test in Normal and AD-Pathological Aging Mice. Biomedicines 2021; 9:biomedicines9080994. [PMID: 34440198 PMCID: PMC8391620 DOI: 10.3390/biomedicines9080994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 12/19/2022] Open
Abstract
The marble burying (MB) test, a classical test based on the natural tendency of rodents to dig in diverse substrates and to bury small objects, is sensitive to some intrinsic and extrinsic factors. Here, under emerging neuroethological quantitative and qualitative analysis, the MB performance of 12-month-old male and female 3xTg-AD mice for Alzheimer’s disease and age-matched counterparts of gold-standard C57BL6 strain with normal aging unveiled sex-dependent signatures. In addition, three temporal analyses, through the (1) time course of the performance, and (2) a repeated test schedule, identified the optimal time frames and schedules to detect sex- and genotype-dependent differences. Besides, a (3) longitudinal design from 12 to 16 months of age monitored the changes in the performance with aging, worsening in AD-mice, and modulation through the repeated test. In summary, the present results allow us to conclude that (1) the marble burying test is responsive to genotype, sex, aging, and its interactions; (2) the male sex was more sensitive to showing the AD-phenotype; (3) longitudinal assessment shows a reduction in females with AD pathology; (4) burying remains stable in repeated testing; (5) the time-course of marbles burying is useful; and (6) burying behavior most likely represents perseverative and/or stereotyped-like behavior rather than anxiety-like behavior in 3xTg-AD mice.
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Surface Functionalization of PLGA Nanoparticles to Increase Transport across the BBB for Alzheimer’s Disease. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11094305] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Alzheimer’s disease (AD) is a chronic neurodegenerative disorder that accounts for about 60% of all diagnosed cases of dementia worldwide. Although there are currently several drugs marketed for its treatment, none are capable of slowing down or stopping the progression of AD. The role of the blood-brain barrier (BBB) plays a key role in the design of a successful treatment for this neurodegenerative disease. Nanosized particles have been proposed as suitable drug delivery systems to overcome BBB with the purpose of increasing bioavailability of drugs in the brain. Biodegradable poly (lactic-co-glycolic acid) nanoparticles (PLGA-NPs) have been particularly regarded as promising drug delivery systems as they can be surface-tailored with functionalized molecules for site-specific targeting. In this review, a thorough discussion about the most recent functionalization strategies based on PLGA-NPs for AD and their mechanisms of action is provided, together with a description of AD pathogenesis and the role of the BBB in brain targeting.
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Tan Z, Qiu J, Zhang Y, Yang Q, Yin X, Li J, Liu G, Li H, Yang G. Tetramethylpyrazine Alleviates Behavioral and Psychological Symptoms of Dementia Through Facilitating Hippocampal Synaptic Plasticity in Rats With Chronic Cerebral Hypoperfusion. Front Neurosci 2021; 15:646537. [PMID: 34025340 PMCID: PMC8134703 DOI: 10.3389/fnins.2021.646537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/06/2021] [Indexed: 12/25/2022] Open
Abstract
Behavioral and psychological symptoms of dementia (BPSD) ubiquitously disturb all patients with dementia at some point in the disease course. Although a plethora of non-pharmacological and pharmacological methods targeting the relief BPSD have been developed, the therapeutic effect is still far from ideal. Here, a rat BPSD model combining the physiological changes with mental insults was successfully established. Meanwhile, our results indicated that TMP attenuated anxious behavior using an elevated plus maze (EPM) test, ameliorated recognitive ability and sociability through a novel object recognition test (NORT) and social interaction test (SIT), and improved learning and memory impairments via a Barnes maze in rats with bilateral common carotid arteries occlusion (BCCAO) plus chronic restraint stress (CRS). Given that hippocampus chronic cerebral hypoperfusion (CCH) always causes damage to the hippocampus, and the majority of cognitive impairments, behaviors, and stress responses are associated with pathology in the hippocampus including anxiety and depression, we paid attention to investigate the role of the hippocampus in BPSD. Our results indicated that Tetramethylpyrazine (TMP) attenuated anxiety and ameliorated recognitive ability, sociability, learning, and memory impairments due to alleviating dendritic and spine deficits, and upregulating the expression of synapse-related proteins (including PSD95, SYN, GAP43, SYP) in the hippocampus. We also found that the underlying mechanism was that TMP could activate the TrkB/ERK/CREB signaling pathway to promote synaptic remodeling in vivo and in vitro. Mechanically, the present study enlarges the therapeutic scope of TMP in neurodegenerative disorders and provides basic knowledge and feasible candidates for treating BPSD, particularly for vascular dementia.
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Affiliation(s)
- Zihu Tan
- Department of Geriatrics, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China.,Hubei Provincial Academy of Traditional Chinese Medicine, Wuhan, China
| | - Jing Qiu
- Department of Geriatrics, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China.,Hubei Provincial Academy of Traditional Chinese Medicine, Wuhan, China
| | - Yuting Zhang
- Clinical College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, China
| | - Qiong Yang
- The First Clinical College, Hubei University of Chinese Medicine, Wuhan, China
| | - Xixi Yin
- Clinical College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, China
| | - Jia Li
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine/Hubei Provincial Collaborative Innovation Center of Preventive Treatment by Acupuncture and Moxibustion, Wuhan, China
| | - Guangya Liu
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine/Hubei Provincial Collaborative Innovation Center of Preventive Treatment by Acupuncture and Moxibustion, Wuhan, China
| | - Hengfei Li
- Hubei Provincial Academy of Traditional Chinese Medicine, Wuhan, China.,Department of Infectious Diseases, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Guang Yang
- Department of Geriatrics, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China.,Hubei Provincial Academy of Traditional Chinese Medicine, Wuhan, China
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8
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Muñiz R, López-Alvarez J, Agüera-Ortiz L, Perea L, Olazarán J. Syndrome-Based Prescription to Optimize Psychotropics: Are CHROME Criteria a Game Changer? Front Psychiatry 2021; 12:662228. [PMID: 33967863 PMCID: PMC8101684 DOI: 10.3389/fpsyt.2021.662228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/29/2021] [Indexed: 12/12/2022] Open
Abstract
A variety of medical and social factors have contributed over the last decades to the overuse of psychotropic drugs in people with dementia. One social factor is probably the frequent failure to provide adequate person-centered care, be it in the community or in institutional settings. This unfortunate reality has been reacted upon with numerous guidelines to reduce prescriptions of the most dangerous drugs (e.g., neuroleptics). Each psychotropic drug prescription can in principle be assessed around three dimensions: (a) adequate, (b) inadequate, and (c) chemical restraint. The CHemical Restraints avOidance MEthodology (CHROME) defined chemical restraint as any prescription based on organizational convenience, rather than justified with medical diagnosis. Two validation studies revealed that one of the main medical reasons of over- and miss-prescriptions was symptom-based prescription. By switching to syndrome-based prescription, a large proportion of drugs could be de-prescribed and some re-adjusted or kept. Paucity of research and weakness of data are not conclusive about the adequacy of specific drugs for the myriad of cases presented by patients with dementia and comorbid conditions. Clinical practice, however, leads us to believe that even under optimal care conditions, psychotropics might still contribute to quality of life if based on an adequate diagnosis. This article explains the rationale that underlies a syndromic approach aimed at optimizing psychotropic treatment in people with dementia whose significant suffering derives from their thought, affective, or behavioral problems. The results of previous validation studies of this new methodology will be discussed and conclusions for future results will be drawn.
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Affiliation(s)
| | - Jorge López-Alvarez
- Maria Wolff Foundation, Madrid, Spain
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luis Agüera-Ortiz
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBERSAM, Madrid, Spain
| | - Luis Perea
- Albertia Servicios Sociosanitarios, Madrid, Spain
| | - Javier Olazarán
- Maria Wolff Foundation, Madrid, Spain
- Memory Disorders Clinic, HM Hospitals, Madrid, Spain
- Neurology Service, University Hospital Gregorio Marañón, Madrid, Spain
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9
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Griffiths AW, Robinson OC, Shoesmith E, Kelley R, Surr CA. Staff experiences of implementing Dementia Care Mapping to improve the quality of dementia care in care homes: a qualitative process evaluation. BMC Health Serv Res 2021; 21:138. [PMID: 33579279 PMCID: PMC7881580 DOI: 10.1186/s12913-021-06152-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 02/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dementia Care Mapping™ (DCM) is a widely used, staff-led, psychosocial intervention to support the implementation of person-centred care. Efficacy evaluations in care homes have produced mixed outcomes, with implementation problems identified. Understanding the experiences of staff trained to lead DCM implementation is crucial to understanding implementation challenges, yet this has rarely been formally explored. This study aimed to examine the experiences of care home staff trained to lead DCM implementation, within a large cluster randomised controlled trial. METHODS Process evaluation including, semi-structured interviews with 27 trained mappers from 16 intervention allocated care homes. Data were analysed using template variant of thematic analysis. RESULTS Three main themes were identified 1) Preparedness to lead - While mappers overwhelmingly enjoyed DCM training, many did not have the personal attributes required to lead practice change and felt DCM training did not adequately equip them to implement it in practice. For many their expectations of the mapper role at recruitment contrasted with the reality once they began to attempt implementation; 2) Transferring knowledge into practice - Due to the complex nature of DCM, developing mastery required regular practice of DCM skills, which was difficult to achieve within available time and resources. Gaining engagement of and transferring learning to the wider staff team was challenging, with benefits of DCM largely limited to the mappers themselves, rather than realised at a care home level; and 3) Sustaining DCM - This required a perception of DCM as beneficial, allocation of adequate resources and support for the process which was often not able to be provided, for the mapper role to fit with the staff member's usual duties and for DCM to fit with the home's ethos and future plans for care. CONCLUSIONS Many care homes may not have staff with the requisite skills to lead practice change using DCM, or the requisite staffing, resources or leadership support required for sustainable implementation. Adaptations to the DCM tool, process and training may be required to reduce its complexity and burden and increase chances of implementation success. Alternatively, models of implementation not reliant on care home staff may be required.
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Affiliation(s)
- Alys Wyn Griffiths
- Centre for Dementia Research, Leeds Beckett University, City Campus, Leeds, LS1 3HE, UK
| | - Olivia C Robinson
- Centre for Dementia Research, Leeds Beckett University, City Campus, Leeds, LS1 3HE, UK
| | - Emily Shoesmith
- Centre for Dementia Research, Leeds Beckett University, City Campus, Leeds, LS1 3HE, UK
| | - Rachael Kelley
- Centre for Dementia Research, Leeds Beckett University, City Campus, Leeds, LS1 3HE, UK
| | - Claire A Surr
- Centre for Dementia Research, Leeds Beckett University, City Campus, Leeds, LS1 3HE, UK.
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de Jong‐Schmit BEM, Poortvliet RKE, Böhringer S, Bogaerts JMK, Achterberg WP, Husebo BS. Blood pressure, antihypertensive medication and neuropsychiatric symptoms in older people with dementia: The COSMOS study. Int J Geriatr Psychiatry 2021; 36:46-53. [PMID: 32748494 PMCID: PMC7756813 DOI: 10.1002/gps.5388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/11/2020] [Accepted: 07/21/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Neuropsychiatric symptoms (NPS) are very common in older patients with dementia. There is increasing evidence that hypoperfusion of the brain plays a role in the development of NPS. The aim of this study is to assess whether there is an association between low systolic blood pressure (SBP) and NPS and if NPS are more prevalent in older people with dementia using antihypertensive medication. METHODS We studied the baseline data from participants in the Communication, Systematic pain treatment, Medication review, Organized activities and Safety study, a multicenter clustered trial with 765 participants from 72 nursing home units from 37 nursing homes in Norway. SBP (lowest quartile vs rest) and use of antihypertensive medication were predictors and Neuropsychiatric Inventory-Nursing Home version (NPI-NH) score (total and clusters) was the outcome. Missing data were imputed, except for missing data in predictors. We used a mixed model analysis adjusted for age, sex and Minimal Mental State Examination (MMSE) score. In a sensitivity analysis, continuous SBP values were used. RESULTS In total, 412 patients were included with a mean age of 86.9 years, 53.9% had a MMSE score of <11. There was no difference in total NPI-NH score between low and high SBP (difference -1.07, Pdj = 0.62). There was no difference between high and low SBP and the NPI clusters. The use of antihypertensive medication was not associated with a different total or cluster NPI-NH score compared to no use (difference -0.99, Padj = 0.95, Pall = 0.37-0.99, respectively). In the sensitivity analyses with the continuous SBP levels, there was no association between SBP and NPI-NH score (estimate 1.00, 95%CI 0.98-1.01, P = 0.25). CONCLUSION We found no association between low SBP and NPS, nor between antihypertensive use and NPS.
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Affiliation(s)
| | | | - Stefan Böhringer
- Department of Medical Statistics and BioinformaticsLeiden University Medical CenterLeidenThe Netherlands
| | - Jonathan M. K. Bogaerts
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenThe Netherlands
| | - Wilco P. Achterberg
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenThe Netherlands
| | - Bettina S. Husebo
- Department of Global Public Health and Primary CareCentre for Elderly and Nursing Home Medicine, University of BergenBergenNorway
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11
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Surr CA, Holloway I, Walwyn RE, Griffiths AW, Meads D, Kelley R, Martin A, McLellan V, Ballard C, Fossey J, Burnley N, Chenoweth L, Creese B, Downs M, Garrod L, Graham EH, Lilley-Kelley A, McDermid J, Millard H, Perfect D, Robinson L, Robinson O, Shoesmith E, Siddiqi N, Stokes G, Wallace D, Farrin AJ. Dementia Care Mapping™ to reduce agitation in care home residents with dementia: the EPIC cluster RCT. Health Technol Assess 2020; 24:1-172. [PMID: 32216870 PMCID: PMC7132533 DOI: 10.3310/hta24160] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The quality of care for people with dementia in care homes is of concern. Interventions that can improve care outcomes are required. OBJECTIVE To investigate the clinical effectiveness and cost-effectiveness of Dementia Care Mapping™ (DCM) for reducing agitation and improving care outcomes for people living with dementia in care homes, versus usual care. DESIGN A pragmatic, cluster randomised controlled trial with an open-cohort design, follow-up at 6 and 16 months, integrated cost-effectiveness analysis and process evaluation. Clusters were not blinded to allocation. The primary end point was completed by staff proxy and independent assessors. SETTING Stratified randomisation of 50 care homes to the intervention and control groups on a 3 : 2 ratio by type, size, staff exposure to dementia training and recruiting hub. PARTICIPANTS Fifty care homes were randomised (intervention, n = 31; control, n = 19), with 726 residents recruited at baseline and a further 261 recruited after 16 months. Care homes were eligible if they recruited a minimum of 10 residents, were not subject to improvement notices, had not used DCM in the previous 18 months and were not participating in conflicting research. Residents were eligible if they lived there permanently, had a formal diagnosis of dementia or a score of 4+ on the Functional Assessment Staging Test of Alzheimer's Disease, were proficient in English and were not terminally ill or permanently cared for in bed. All homes were audited on the delivery of dementia and person-centred care awareness training. Those not reaching a minimum standard were provided training ahead of randomisation. Eighteen homes took part in the process evaluation. INTERVENTION Two staff members from each intervention home were trained to use DCM and were asked to carry out three DCM cycles; the first was supported by an external expert. MAIN OUTCOME MEASURES The primary outcome was agitation (Cohen-Mansfield Agitation Inventory), measured at 16 months. Secondary outcomes included resident behaviours and quality of life. RESULTS There were 675 residents in the final analysis (intervention, n = 388; control, n = 287). There was no evidence of a difference in agitation levels between the treatment arms. The adjusted mean difference in Cohen-Mansfield Agitation Inventory score was -2.11 points, being lower in the intervention group than in the control (95% confidence interval -4.66 to 0.44; p = 0.104; adjusted intracluster correlation coefficient: control = 0, intervention = 0.001). The sensitivity analyses results supported the primary analysis. No differences were detected in any of the secondary outcomes. The health economic analyses indicated that DCM was not cost-effective. Intervention adherence was problematic; only 26% of homes completed more than their first DCM cycle. Impacts, barriers to and facilitators of DCM implementation were identified. LIMITATIONS The primary completion of resident outcomes was by staff proxy, owing to self-report difficulties for residents with advanced dementia. Clusters were not blinded to allocation, although supportive analyses suggested that any reporting bias was not clinically important. CONCLUSIONS There was no benefit of DCM over control for any outcomes. The implementation of DCM by care home staff was suboptimal compared with the protocol in the majority of homes. FUTURE WORK Alternative models of DCM implementation should be considered that do not rely solely on leadership by care home staff. TRIAL REGISTRATION Current Controlled Trials ISRCTN82288852. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Claire A Surr
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Ivana Holloway
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | | | - Alys W Griffiths
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Rachael Kelley
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Adam Martin
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Vicki McLellan
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | | | - Jane Fossey
- Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Natasha Burnley
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | | | | | - Murna Downs
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Lucy Garrod
- Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Elizabeth H Graham
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | - Joanne McDermid
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - Holly Millard
- Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Devon Perfect
- Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Louise Robinson
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Olivia Robinson
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Emily Shoesmith
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Najma Siddiqi
- Department of Health Sciences, Hull York Medical School, University of York, York, UK
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | | | - Daphne Wallace
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Amanda J Farrin
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
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12
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Husebo BS, Heintz HL, Berge LI, Owoyemi P, Rahman AT, Vahia IV. Sensing Technology to Monitor Behavioral and Psychological Symptoms and to Assess Treatment Response in People With Dementia. A Systematic Review. Front Pharmacol 2020; 10:1699. [PMID: 32116687 PMCID: PMC7011129 DOI: 10.3389/fphar.2019.01699] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/31/2019] [Indexed: 01/28/2023] Open
Abstract
Background The prevalence of dementia is expected to rapidly increase in the next decades, warranting innovative solutions improving diagnostics, monitoring and resource utilization to facilitate smart housing and living in the nursing home. This systematic review presents a synthesis of research on sensing technology to assess behavioral and psychological symptoms and to monitor treatment response in people with dementia. Methods The literature search included medical peer-reviewed English language publications indexed in Embase, Medline, Cochrane library and Web of Sciences, published up to the 5th of April 2019. Keywords included MESH terms and phrases synonymous with "dementia", "sensor", "patient", "monitoring", "behavior", and "therapy". Studies applying both cross sectional and prospective designs, either as randomized controlled trials, cohort studies, and case-control studies were included. The study was registered in PROSPERO 3rd of May 2019. Results A total of 1,337 potential publications were identified in the search, of which 34 were included in this review after the systematic exclusion process. Studies were classified according to the type of technology used, as (1) wearable sensors, (2) non-wearable motion sensor technologies, and (3) assistive technologies/smart home technologies. Half of the studies investigated how temporarily dense data on motion can be utilized as a proxy for behavior, indicating high validity of using motion data to monitor behavior such as sleep disturbances, agitation and wandering. Further, up to half of the studies represented proof of concept, acceptability and/or feasibility testing. Overall, the technology was regarded as non-intrusive and well accepted. Conclusions Targeted clinical application of specific technologies is poised to revolutionize precision care in dementia as these technologies may be used both by patients and caregivers, and at a systems level to provide safe and effective care. To highlight awareness of legal regulations, data risk assessment, and patient and public involvement, we propose a necessary framework for sustainable ethical innovation in healthcare technology. The success of this field will depend on interdisciplinary cooperation and the advance in sustainable ethic innovation. Systematic Review Registration PROSPERO, identifier CRD42019134313.
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Affiliation(s)
- Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,Department of Nursing Home Medicine, Municipality of Bergen, Bergen, Norway
| | - Hannah L Heintz
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Line I Berge
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,NKS Olaviken Gerontopsychiatric Hospital, Bergen, Norway
| | - Praise Owoyemi
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Aniqa T Rahman
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Ipsit V Vahia
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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13
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Simonetti A, Pais C, Jones M, Cipriani MC, Janiri D, Monti L, Landi F, Bernabei R, Liperoti R, Sani G. Neuropsychiatric Symptoms in Elderly With Dementia During COVID-19 Pandemic: Definition, Treatment, and Future Directions. Front Psychiatry 2020; 11:579842. [PMID: 33132939 PMCID: PMC7550649 DOI: 10.3389/fpsyt.2020.579842] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/25/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) of dementia, such as anxiety, depression, agitation, and apathy, are complex, stressful, and costly aspects of care, and are associated to poor health outcomes and caregiver burden. A steep worsening of such symptoms has been reported during Coronavirus Disease 2019 (COVID-19) pandemic. However, their causes, their impact on everyday life, and treatment strategies have not been systematically assessed. Therefore, the aim of this review is to provide a detailed description of behavioral and psychopathological alterations in subjects with dementia during COVID-19 pandemic and the associated management challenges. METHODS A PubMed search was performed focusing on studies reporting alterations in behavior and mood and treatment strategies for elderly patients with dementia, in accordance with PRISMA guidelines. The following search strategy was utilized: (COVID* OR coronavirus OR "corona vir*" OR SARS-CoV-2) AND (dementia OR demented OR dement* OR alzheimer* OR "pick's disease" OR "lewy body" OR "mild cognitive" OR mild cognitive impairment OR MCI). RESULTS Apathy, anxiety and agitation are the most frequently NPS during the COVID-19 pandemic and are mainly triggered by protracted isolation. Most treatment strategies rely on pharmacotherapy; technology is increasingly utilized with mixed results. CONCLUSIONS NPS of dementia during COVID-19 appear to arise from social restrictions occurring as a consequence of the pandemic. Implementation of caregiver support and the presence of skilled nursing home staff are required to restore social interaction and adjust technological support to the patients' needs.
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Affiliation(s)
- Alessio Simonetti
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.,Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.,Centro Lucio Bini, Rome, Italy
| | - Cristina Pais
- Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Melissa Jones
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Maria Camilla Cipriani
- Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Delfina Janiri
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.,Centro Lucio Bini, Rome, Italy.,Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Laura Monti
- Service of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Landi
- Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.,Department of Geriatric and Orthopedic Sciences, Catholic University of Sacred Heart, Rome, Italy
| | - Roberto Bernabei
- Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.,Department of Geriatric and Orthopedic Sciences, Catholic University of Sacred Heart, Rome, Italy
| | - Rosa Liperoti
- Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.,Department of Geriatric and Orthopedic Sciences, Catholic University of Sacred Heart, Rome, Italy
| | - Gabriele Sani
- Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.,Department of Neuroscience, Section of Psychiatry, Catholic University of Sacred Heart, Rome, Italy
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14
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Keszycki RM, Fisher DW, Dong H. The Hyperactivity-Impulsivity-Irritiability-Disinhibition-Aggression-Agitation Domain in Alzheimer's Disease: Current Management and Future Directions. Front Pharmacol 2019; 10:1109. [PMID: 31611794 PMCID: PMC6777414 DOI: 10.3389/fphar.2019.01109] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/29/2019] [Indexed: 12/14/2022] Open
Abstract
Behavioral and psychological symptoms of dementia (BPSD) afflict the vast majority of patients with dementia, especially those with Alzheimer's disease (AD). In clinical settings, patients with BPSD most often do not present with just one symptom. Rather, clusters of symptoms commonly co-occur and can, thus, be grouped into behavioral domains that may ultimately be the result of disruptions in overarching neural circuits. One major BPSD domain routinely identified across patients with AD is the hyperactivity-impulsivity-irritiability-disinhibition-aggression-agitation (HIDA) domain. The HIDA domain represents one of the most difficult sets of symptoms to manage in AD and accounts for much of the burden for caregivers and hospital staff. Although many studies recommend non-pharmacological treatments for HIDA domain symptoms as first-line, they demonstrate little consensus as to what these treatments should be and are often difficult to implement clinically. Certain symptoms within the HIDA domain also do not respond adequately to these treatments, putting patients at risk and necessitating adjunct pharmacological intervention. In this review, we summarize the current literature regarding non-pharmacological and pharmacological interventions for the HIDA domain and provide suggestions for improving treatment. As epigenetic changes due to both aging and AD cause dysfunction in drug-targeted receptors, we propose that HIDA domain treatments could be enhanced by adjunct strategies that modify these epigenetic alterations and, thus, increase efficacy and reduce side effects. To improve the implementation of non-pharmacological approaches in clinical settings, we suggest that issues regarding inadequate resources and guidance for implementation should be addressed. Finally, we propose that increased monitoring of symptom and treatment progression via novel sensor technology and the "DICE" (describe, investigate, create, and evaluate) approach may enhance both pharmacological and non-pharmacological interventions for the HIDA domain.
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Affiliation(s)
- Rachel M. Keszycki
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Daniel W. Fisher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA, United States
| | - Hongxin Dong
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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15
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Nakrem S, Stensvik GT, Skjong RJ, Ostaszkiewicz J. Staff experiences with implementing a case conferencing care model in nursing homes: a focus group study. BMC Health Serv Res 2019; 19:191. [PMID: 30917815 PMCID: PMC6438011 DOI: 10.1186/s12913-019-4034-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/22/2019] [Indexed: 01/13/2023] Open
Abstract
Background A majority of nursing home residents have dementia, and many develop neuropsychiatric symptoms. These symptoms are often caused by neuropathological changes in the brain, but modifiable factors related to quality of care also have an impact. A team-based approach to care that include comprehensive geriatric assessments to facilitate clinical decision-making and structured case conference meetings could improve quality of care and quality of life for the residents. Despite recommendations to adopt this approach, dementia care does not reach standards of evidence-based practice. Better implementation strategies are needed to improve care. A cluster randomised controlled trial with a 12-month intervention was conducted, and the experiences of staff from the intervention nursing homes were explored in a qualitative study after the trial was completed. The aim of the present study was to describe: (i) staff’s experiences with the intervention consisting of comprehensive geriatric assessments of nursing home residents and case conferencing, and (ii) enablers and barriers to implementing and sustaining the intervention. Methods Four focus groups with a total of 19 healthcare staff were interviewed, representing four out of eight intervention nursing homes. Thematic content analysis was used to interpret the transcribed data. Results Two major themes emerged: 1) learning experiences and 2) enablers and barriers to implementation. The participants had experienced learning both on an organisational level: improvements in care and an organisation that could adjust and facilitate change; and on an individual level: becoming more conscious of residents’ needs and acquiring skills in resident assessments. Participants described important enabling factors such as managerial support, drivers for change, and feasibility of the intervention for the local nursing home. Barriers to implementing and sustaining the intervention were time constraints, lack of staff training, unsuitable electronic patient record system for care planning and high complexities of care and instabilities that are present in nursing homes. Conclusions Quality improvements in nursing homes are difficult to sustain. In order to offer residents high quality of care that meet their individual needs, it is important for management and nursing home staff to be aware of and understand factors that enable or constrain change.
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Affiliation(s)
- Sigrid Nakrem
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), NO-7491, Trondheim, Norway.
| | - Geir-Tore Stensvik
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), NO-7491, Trondheim, Norway
| | - Rickard Johan Skjong
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), NO-7491, Trondheim, Norway.,Work Environment Unit in Trondheim kommune, Postboks 2300 Torgarden, 7004, Trondheim, Norway
| | - Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research- Barwon Health Partnership, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, 3125, Australia
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16
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Helvik AS, Selbæk G, Šaltytė Benth J, Røen I, Bergh S. The course of neuropsychiatric symptoms in nursing home residents from admission to 30-month follow-up. PLoS One 2018; 13:e0206147. [PMID: 30335840 PMCID: PMC6193723 DOI: 10.1371/journal.pone.0206147] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/08/2018] [Indexed: 12/27/2022] Open
Abstract
Aim The aim of this study was to describe the prevalence and persistence of clinically significant neuropsychiatric symptoms (NPS) in nursing home residents with dementia, and to study the association between severity of dementia and specific neuropsychiatric sub-syndromes over time. Methods In total, 583 residents with dementia were included at admission to a nursing home and followed with biannual assessments until death, or to 30-month follow-up. At the end of the 30-month follow-up, 305 participants had died and 57 had left the study for other reasons, leaving 221 residents in the study. We collected data on demographics, cognition, severity of dementia, NPS, personal activities of daily living (P-ADL), physical health, medication and type of nursing home unit. NPS was assessed using the Neuropsychiatric Inventory (NPI), the Nursing Home version. Results The prevalence and persistence at two consecutive time-points of clinically significant NPS was high during the study period. The mean NPI agitation sub-syndrome score increased during the study period, while the NPI affective and psychosis sub-syndrome scores remained unchanged. More severe dementia was associated with higher NPI agitation, psychosis and affective sub-syndrome scores. The association remained unchanged over time for agitation and psychosis. For the NPI affective sub-syndrome, the association was stronger at the beginning, and declined towards the end of the study period. Conclusion The findings of high prevalence and persistence at two consecutive time points of clinically significant NPS over time, and the associations between severity of dementia and NPI sub-syndromes shed light on the burden and care needs of nursing home residents with dementia after admission to nursing home care. This information is of interest to health care planners and providers to enable them to increase the quality of care for nursing home residents.
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Affiliation(s)
- Anne-Sofie Helvik
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Health Trust, Tønsberg, Norway
- St Olavs University Hospital, Trondheim, Norway
- * E-mail:
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Health Trust, Tønsberg, Norway
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
- HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Irene Røen
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Sverre Bergh
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Health Trust, Tønsberg, Norway
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
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17
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Masopust J, Protopopová D, Vališ M, Pavelek Z, Klímová B. Treatment of behavioral and psychological symptoms of dementias with psychopharmaceuticals: a review. Neuropsychiatr Dis Treat 2018; 14:1211-1220. [PMID: 29785112 PMCID: PMC5953267 DOI: 10.2147/ndt.s163842] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Behavioral and psychological symptoms represent common complications in patients with different types of dementia. Predominantly, they comprise psychosis, agitation and mood disorders, disinhibited behavior, impairment of the sleep and wakefulness rhythm, wandering, perseveration, pathological collecting, or shouting. Their appearance is related to more rapid progression of the disease, earlier institutionalization, use of physical restraints, and higher risk of mortality. Consequently, appearance of behavioral and psychological symptoms of dementia leads to higher costs of care provided and greater distress for caregivers. Clinical guidelines recommend nonpharmacological approaches as the first choice in the treatment of behavioral and psychological symptoms. Pharmacological therapy should be initiated only if the symptoms were not the result of somatic causes, did not respond to nonpharmacological interventions, or were not caused by the prior medication. Acetylcholinesterase inhibitors, memantine, antipsychotic drugs, antidepressants, mood stabilizers, and benzodiazepines are used. This review summarizes the current findings about the efficacy and safety of the treatment of the neuropsychiatric symptoms in dementias with psychopharmaceuticals. Recommendations for treatment with antipsychotics for this indication are described in detail as this drug group is prescribed most often and, at the same time, is related to the highest risk of adverse effects and increased mortality.
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Affiliation(s)
- Jiří Masopust
- Department of Psychiatry, Charles University in Prague, Prague, Czech Republic.,Faculty of Medicine in Hradec Kralove and University Hospital, Hradec Kralove, Czech Republic.,Department of Neurology, Charles University in Prague, Prague, Czech Republic.,National Institute of Mental Health, Klecany, Czech Republic
| | | | - Martin Vališ
- Faculty of Medicine in Hradec Kralove and University Hospital, Hradec Kralove, Czech Republic.,Department of Neurology, Charles University in Prague, Prague, Czech Republic
| | - Zbyšek Pavelek
- Faculty of Medicine in Hradec Kralove and University Hospital, Hradec Kralove, Czech Republic.,Department of Neurology, Charles University in Prague, Prague, Czech Republic
| | - Blanka Klímová
- Department of Applied Linguistics, University of Hradec Kralove, Hradec Kralove, Czech Republic
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18
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Hitch D, Swan J, Pattison R, Stefaniak R. Use of touchscreen tablet technology by people with dementia in homes: A scoping review. J Rehabil Assist Technol Eng 2017; 4:2055668317733382. [PMID: 31186940 PMCID: PMC6453045 DOI: 10.1177/2055668317733382] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/04/2017] [Indexed: 12/03/2022] Open
Abstract
Background The aim of this scoping review was to identify the range, extent and nature
of research around the use of touchscreen tablets by people with dementia in
their home environment, particularly in regards to its use as a means of
supporting participation in meaningful and socially connected activity. Methods A review of both peer-reviewed and grey literature was undertaken across 61
databases, along with reference list checking for articles published between
2010 and 2016. Results Twelve articles were included in this review, predominantly from Western
European cultures and community-based home environments. The studies were
exploratory in nature, with the majority focusing on the development of
applications for people with dementia. Conclusions The study identified a range of exploratory research related to the use of
touchscreen tablets by people with dementia. However, there were significant
gaps within this evidence base, which provide opportunities for further
research using more robust methodologies. Given the ubiquitous nature of
touchscreen tablets in modern communities, further research could facilitate
their use as a minimally stigmatizing and culturally appropriate form of
support for people with dementia.
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Affiliation(s)
- Danielle Hitch
- North Western Mental Health, Melbourne Health, Melbourne, Australia
| | - Jodie Swan
- North Western Mental Health, Melbourne Health, Melbourne, Australia
| | - Ruth Pattison
- North Western Mental Health, Melbourne Health, Melbourne, Australia
| | - Rachel Stefaniak
- North Western Mental Health, Melbourne Health, Melbourne, Australia
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Taipale H, Tolppanen AM, Koponen M, Tanskanen A, Lavikainen P, Sund R, Tiihonen J, Hartikainen S. Risk of pneumonia associated with incident benzodiazepine use among community-dwelling adults with Alzheimer disease. CMAJ 2017; 189:E519-E529. [PMID: 28396328 DOI: 10.1503/cmaj.160126] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Knowledge regarding whether benzodiazepines and similarly acting non-benzodiazepines (Z-drugs) are associated with an increased risk of pneumonia among older adults is lacking. We sought to investigate this association among community-dwelling adults with Alzheimer disease, a condition in which both sedative/hypnotic use and pneumonia are common. METHODS We obtained data on all community-dwelling adults with a recent diagnosis of Alzheimer disease in Finland (2005-2011) from the Medication use and Alzheimer disease (MEDALZ) cohort, which incorporates national registry data on prescriptions, reimbursement, hospital discharges and causes of death. Incident users of benzodiazepines and Z-drugs were identified using a 1-year washout period and matched with nonusers using propensity scores. The association with hospital admission or death due to pneumonia was analyzed with the Cox proportional hazards model and adjusted for use of other psychotropic drugs in a time-dependent manner. RESULTS Among 49 484 eligible participants with Alzheimer disease, 5232 taking benzodiazepines and 3269 taking Z-drugs were matched 1:1 with those not taking these drugs. Collectively, use of benzodiazepines and Z-drugs was associated with an increased risk of pneumonia (adjusted hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.05-1.42). When analyzed separately, benzodiazepine use was significantly associated with an increased risk of pneumonia (adjusted HR 1.28, 95% CI 1.07-1.54), whereas Z-drug use was not (adjusted HR 1.10, 95% CI 0.84-1.44). The risk of pneumonia was greatest within the first 30 days of benzodiazepine use (HR 2.09, 95% CI 1.26-3.48). INTERPRETATION Benzodiazepine use was associated with an increased risk of pneumonia among patients with Alzheimer disease. Risk of pneumonia should be considered when weighing the benefits and risks of benzodiazepines in this population.
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Affiliation(s)
- Heidi Taipale
- Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen, Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen, Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen), Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen, Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku, Finland; Department of Social Research (Sund), Centre for Research Methods, University of Helsinki, Helsinki, Finland; Department of Psychiatry (Hartikainen), Kuopio University Hospital, Kuopio, Finland
| | - Anna-Maija Tolppanen
- Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen, Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen, Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen), Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen, Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku, Finland; Department of Social Research (Sund), Centre for Research Methods, University of Helsinki, Helsinki, Finland; Department of Psychiatry (Hartikainen), Kuopio University Hospital, Kuopio, Finland
| | - Marjaana Koponen
- Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen, Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen, Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen), Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen, Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku, Finland; Department of Social Research (Sund), Centre for Research Methods, University of Helsinki, Helsinki, Finland; Department of Psychiatry (Hartikainen), Kuopio University Hospital, Kuopio, Finland
| | - Antti Tanskanen
- Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen, Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen, Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen), Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen, Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku, Finland; Department of Social Research (Sund), Centre for Research Methods, University of Helsinki, Helsinki, Finland; Department of Psychiatry (Hartikainen), Kuopio University Hospital, Kuopio, Finland
| | - Piia Lavikainen
- Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen, Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen, Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen), Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen, Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku, Finland; Department of Social Research (Sund), Centre for Research Methods, University of Helsinki, Helsinki, Finland; Department of Psychiatry (Hartikainen), Kuopio University Hospital, Kuopio, Finland
| | - Reijo Sund
- Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen, Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen, Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen), Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen, Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku, Finland; Department of Social Research (Sund), Centre for Research Methods, University of Helsinki, Helsinki, Finland; Department of Psychiatry (Hartikainen), Kuopio University Hospital, Kuopio, Finland
| | - Jari Tiihonen
- Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen, Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen, Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen), Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen, Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku, Finland; Department of Social Research (Sund), Centre for Research Methods, University of Helsinki, Helsinki, Finland; Department of Psychiatry (Hartikainen), Kuopio University Hospital, Kuopio, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care (Taipale, Koponen, Lavikainen, Hartikainen); School of Pharmacy (Taipale, Tolppanen, Koponen, Lavikainen, Hartikainen); Department of Forensic Psychiatry (Taipale, Tanskanen, Tiihonen), Niuvanniemi Hospital; Institute of Clinical Medicine (Sund); Research Centre for Comparative Effectiveness and Patient Safety (RECEPS) (Tolppanen), University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience (Tanskanen, Tiihonen), Karolinska Institutet, Stockholm, Sweden; National Institute for Health and Welfare (Tanskanen), Helsinki, Finland; Department of Pharmacology (Lavikainen), Drug Development and Therapeutics, University of Turku, Turku, Finland; Department of Social Research (Sund), Centre for Research Methods, University of Helsinki, Helsinki, Finland; Department of Psychiatry (Hartikainen), Kuopio University Hospital, Kuopio, Finland
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20
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White N, Leurent B, Lord K, Scott S, Jones L, Sampson EL. The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: a longitudinal cohort study. Int J Geriatr Psychiatry 2017; 32:297-305. [PMID: 27019375 PMCID: PMC5324689 DOI: 10.1002/gps.4463] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 02/09/2016] [Accepted: 02/18/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND The acute hospital is a challenging place for a person with dementia. Behavioural and psychological symptoms of dementia (BPSD) are common and may be exacerbated by the hospital environment. Concerns have been raised about how BPSD are managed in this setting and about over reliance on neuroleptic medication. This study aimed to investigate how BPSD are managed in UK acute hospitals. METHOD(S) A longitudinal cohort of 230 patients with dementia admitted to two acute NHS hospitals. BPSD were measured every four days (Behave-AD scale), as well as documentation of pharmacological prescriptions and non-pharmacological management. RESULTS The overall prevalence of BPSD was 75%, with aggression and activity disturbance being the most common. Antipsychotics were prescribed for 28 (12%) patients; 70% of these prescriptions were new on admission. Benzodiazepines were prescribed for 27 (12%) patients, antidepressants were prescribed for 37 (16%) patients, and sedatives were prescribed for 14 (3%) patients. Patients who were prescribed antipsychotics, after adjusting for end of life medication, age and dementia severity, were significantly more likely to die (adjusted hazard ratio 5.78, 95% CI 1.57, 21.26, p = 0.008). Non-pharmacological management was used in 55% of participants, most commonly psychosocial interventions (36%) with little evidence of monitoring their effectiveness. A form of restraint was used during 50 (22%) patients' admissions. CONCLUSIONS Antipsychotic medications and psychosocial interventions were the main methods used to manage BPSD; however, these were not implemented or monitored in a systematic fashion.
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Affiliation(s)
- Nicola White
- Marie Curie Palliative Care Research DepartmentDivision of Psychiatry, UCLLondonUK
| | - Baptiste Leurent
- Marie Curie Palliative Care Research DepartmentDivision of Psychiatry, UCLLondonUK
| | - Kathryn Lord
- Marie Curie Palliative Care Research DepartmentDivision of Psychiatry, UCLLondonUK
| | - Sharon Scott
- Marie Curie Palliative Care Research DepartmentDivision of Psychiatry, UCLLondonUK
| | - Louise Jones
- Marie Curie Palliative Care Research DepartmentDivision of Psychiatry, UCLLondonUK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research DepartmentDivision of Psychiatry, UCLLondonUK
- Barnet Enfield and Haringey Mental Health TrustNorth Middlesex University HospitalLondonUK
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21
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Kim SK, Park M. Effectiveness of person-centered care on people with dementia: a systematic review and meta-analysis. Clin Interv Aging 2017; 12:381-397. [PMID: 28255234 PMCID: PMC5322939 DOI: 10.2147/cia.s117637] [Citation(s) in RCA: 208] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Person-centered care is a holistic and integrative approach designed to maintain well-being and quality of life for people with dementia, and it includes the elements of care, the individual, the carers, and the family. Aim A systematic literature review and meta-analysis were undertaken to investigate the effectiveness of person-centered care for people with dementia. Methods Literature searches were undertaken using six databases including Medline, EMBASE, CINAHL, PsycINFO, Cochrane Database, and KoreaMed using the following keywords: cognition disorder, dementia, person-centered care, patient-centered care, client-centered care, relationship-centered care, and dementia care. The searches were limited to interventional studies written in English and Korean and included randomized controlled studies and noncontrolled studies for people with dementia living in any setting. Results Nineteen interventional studies, including 3,985 participants, were identified. Of these, 17 studies were from long-term care facilities and two studies were from homecare settings. The pooled data from randomized controlled studies favored person-centered care in reducing agitation, neuropsychiatric symptoms, and depression and improving the quality of life. Subgroup analysis identified greater effectiveness of person-centered care when implemented for people with less severe dementia. For agitation, short-term interventions had a greater effect (standardized mean difference [SMD]: −0.434; 95% conference interval [CI]: −0.701 to −0.166) than long-term interventions (SMD: −0.098; 95% CI: −0.190 to 0.007). Individualized activities resulted in a significantly greater beneficial effect than standard care (SMD: 0.513; 95% CI: −0.994 to −0.032). However, long-term, staff education, and cultural change interventions had a greater effect on improving the quality of life for people with dementia (SMD: 0.191; 95% CI: 0.079 to 0.302). Conclusion This systematic review and meta-analysis provided evidence for person-centered care in clinical practice for people with dementia. Person-centered care interventions were shown to reduce agitation, neuropsychiatric symptoms, and depression and to improve the quality of life. Person-centered care interventions can effectively reduce agitation for a short term using intensive and activity-based intervention. However, an educational strategy that promotes learning and skill development of internal care staff is needed to enhance patient’s quality of life and to ensure the sustainability of the effects of behavioral problems. The feasibility and effectiveness of the intervention, the severity of patient disease, and intervention type and duration should be considered as part of an intervention design.
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Affiliation(s)
- Sun Kyung Kim
- Education and Research Center for Evidence Based Nursing Knowledge, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Myonghwa Park
- Education and Research Center for Evidence Based Nursing Knowledge, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
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22
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DiNapoli EA, Scogin F, Bryant AN, Sebastian S, Mundy MJ. Effect of individualized social activities on quality of life among older adults with mild to moderate cognitive impairment in a geriatric psychiatry facility. Aging Ment Health 2016; 20:262-70. [PMID: 25677721 DOI: 10.1080/13607863.2015.1008990] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The study examined the effect of an individualized social activities intervention (ISAI) on quality of life among older adults with mild to moderate cognitive impairment in a geriatric psychiatry facility. METHOD This randomized control trial consisted of 52 older adults (M = 70.63, SD = 5.62) with mild to moderate cognitive impairment in a geriatric inpatient psychiatry facility. A 2 (group condition) × 2 (time of measurement) design was used to compare the control (treatment-as-usual) and intervention (treatment-as-usual plus ISAI) conditions at pre- and post-treatment. ISAI consisted of 30- to 60-minute sessions for up to 15 consecutive days. The Dementia Quality of Life instrument and Neurobehavioral Rating Scale-Revised were used to examine quality of life and behavioral and psychological symptoms of dementia at pre- and post-treatment. RESULTS Intent-to-treat analyses indicated a significant time × group condition interaction on quality of life, with this effect remaining when only completer data were included. There was no evidence of a significant treatment effect on behavioral and psychological symptoms of dementia. CONCLUSION Findings suggest that individualized social activities are a promising treatment for cognitively impaired geriatric inpatients.
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Affiliation(s)
| | - Forrest Scogin
- a Department of Psychology , The University of Alabama , Tuscaloosa , AL , USA
| | - Ami N Bryant
- a Department of Psychology , The University of Alabama , Tuscaloosa , AL , USA
| | - Sabin Sebastian
- b Mary Starke Harper Geriatric Psychiatry Center , Tuscaloosa , AL , USA
| | - Michael J Mundy
- b Mary Starke Harper Geriatric Psychiatry Center , Tuscaloosa , AL , USA
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Surr CA, Walwyn REA, Lilley-Kelly A, Cicero R, Meads D, Ballard C, Burton K, Chenoweth L, Corbett A, Creese B, Downs M, Farrin AJ, Fossey J, Garrod L, Graham EH, Griffiths A, Holloway I, Jones S, Malik B, Siddiqi N, Robinson L, Stokes G, Wallace D. Evaluating the effectiveness and cost-effectiveness of Dementia Care Mapping™ to enable person-centred care for people with dementia and their carers (DCM-EPIC) in care homes: study protocol for a randomised controlled trial. Trials 2016; 17:300. [PMID: 27341812 PMCID: PMC4921015 DOI: 10.1186/s13063-016-1416-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 05/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Up to 90 % of people living with dementia in care homes experience one or more behaviours that staff may describe as challenging to support (BSC). Of these agitation is the most common and difficult to manage. The presence of agitation is associated with fewer visits from relatives, poorer quality of life and social isolation. It is recommended that agitation is treated through psychosocial interventions. Dementia Care Mapping™ (DCM™) is an established, widely used observational tool and practice development cycle, for ensuring a systematic approach to providing person-centred care. There is a body of practice-based literature and experience to suggests that DCM™ is potentially effective but limited robust evidence for its effectiveness, and no examination of its cost-effectiveness, as a UK health care intervention. Therefore, a definitive randomised controlled trial (RCT) of DCM™ in the UK is urgently needed. METHODS/DESIGN A pragmatic, multi-centre, cluster-randomised controlled trial of Dementia Care Mapping (DCM™) plus Usual Care (UC) versus UC alone, where UC is the normal care delivered within the care home following a minimum level of dementia awareness training. The trial will take place in residential, nursing and dementia-specialist care homes across West Yorkshire, Oxfordshire and London, with residents with dementia. A random sample of 50 care homes will be selected within which a minimum of 750 residents will be registered. Care homes will be randomised in an allocation ratio of 3:2 to receive either intervention or control. Outcome measures will be obtained at 6 and 16 months following randomisation. The primary outcome is agitation as measured by the Cohen-Mansfield Agitation Inventory, at 16 months post randomisation. Key secondary outcomes are other BSC and quality of life. There will be an integral cost-effectiveness analysis and a process evaluation. DISCUSSION The protocol was refined following a pilot of trial procedures. Changes include replacement of a questionnaire, whose wording caused some residents distress, to an adapted version specifically designed for use in care homes, a change to the randomisation stratification factors, adaption in how the staff measures are collected to encourage greater compliance, and additional reminders to intervention homes of when mapping cycles are due, via text message. TRIAL REGISTRATION Current Controlled Trials ISRCTN82288852 . Registered on 16 January 2014. Full protocol version and date: v7.1: 18 December 2015.
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Affiliation(s)
- Claire A Surr
- Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, LS1 3HE, UK.
| | - Rebecca E A Walwyn
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, LS2 9PH, UK
| | - Amanda Lilley-Kelly
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, LS2 9PH, UK
| | - Robert Cicero
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, LS2 9PH, UK
| | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9LJ, UK
| | - Clive Ballard
- Wolfson Centre for Age Related Diseases, Kings College London, London, UK
| | - Kayleigh Burton
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, LS2 9PH, UK
| | | | - Anne Corbett
- Wolfson Centre for Age Related Diseases, Kings College London, London, UK
| | - Byron Creese
- Wolfson Centre for Age Related Diseases, Kings College London, London, UK
| | - Murna Downs
- School of Dementia Studies, University of Bradford, Bradford, BD7 1DP, UK
| | - Amanda J Farrin
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, LS2 9PH, UK
| | - Jane Fossey
- Psychological Services, Oxford Health NHS Foundation Trust, Oxford, OX3 7JX, UK
| | - Lucy Garrod
- Psychological Services, Oxford Health NHS Foundation Trust, Oxford, OX3 7JX, UK
| | - Elizabeth H Graham
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, LS2 9PH, UK
| | - Alys Griffiths
- Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, LS1 3HE, UK
| | - Ivana Holloway
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, LS2 9PH, UK
| | - Sharon Jones
- School of Dementia Studies, University of Bradford, Bradford, BD7 1DP, UK
| | - Baber Malik
- Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, LS1 3HE, UK
| | - Najma Siddiqi
- Bradford District Care Foundation Trust, Bradford, UK
| | - Louise Robinson
- Institute for Aging and Health, University of Newcastle, Newcastle upon Tyne, NE1 7RU, UK
| | | | - Daphne Wallace
- School of Dementia Studies, University of Bradford, Bradford, BD7 1DP, UK
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Declercq LD, Vandenberghe R, Van Laere K, Verbruggen A, Bormans G. Drug Development in Alzheimer's Disease: The Contribution of PET and SPECT. Front Pharmacol 2016; 7:88. [PMID: 27065872 PMCID: PMC4814730 DOI: 10.3389/fphar.2016.00088] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/16/2016] [Indexed: 12/13/2022] Open
Abstract
Clinical trials aiming to develop disease-altering drugs for Alzheimer’s disease (AD), a neurodegenerative disorder with devastating consequences, are failing at an alarming rate. Poorly defined inclusion-and outcome criteria, due to a limited amount of objective biomarkers, is one of the major concerns. Non-invasive molecular imaging techniques, positron emission tomography and single photon emission (computed) tomography (PET and SPE(C)T), allow visualization and quantification of a wide variety of (patho)physiological processes and allow early (differential) diagnosis in many disorders. PET and SPECT have the ability to provide biomarkers that permit spatial assessment of pathophysiological molecular changes and therefore objectively evaluate and follow up therapeutic response, especially in the brain. A number of specific PET/SPECT biomarkers used in support of emerging clinical therapies in AD are discussed in this review.
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Affiliation(s)
- Lieven D Declercq
- Laboratory for Radiopharmacy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven Leuven, Belgium
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven Leuven, Belgium
| | - Koen Van Laere
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven Leuven, Belgium
| | - Alfons Verbruggen
- Laboratory for Radiopharmacy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven Leuven, Belgium
| | - Guy Bormans
- Laboratory for Radiopharmacy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven Leuven, Belgium
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Helvik AS, Engedal K, Wu B, Benth JŠ, Corazzini K, Røen I, Selbæk G. Severity of Neuropsychiatric Symptoms in Nursing Home Residents. Dement Geriatr Cogn Dis Extra 2016; 6:28-42. [PMID: 26933438 PMCID: PMC4772643 DOI: 10.1159/000442250] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
We aimed at assessing time shift in the severity of neuropsychiatric symptoms (NPS) in nursing home residents between 2004/2005 and 2010/2011 and associations between NPS and socio-demographic variables, physical health status, dementia severity, and the use of psychotropic drugs. The Neuropsychiatric Inventory Nursing Home Version was used in 2004/2005 (n = 1,163) and 2010/2011 (n = 1,858). Linear mixed model analysis was applied. There was no time shift in the severity of apathy, psychosis, and affective symptoms, but agitation did exhibit a time shift. Agitation was less severe in 2010/2011 than in 2004/2005 in residents with a Clinical Dementia Rating (CDR) sum of boxes score ≤4, and more severe in residents with a CDR sum of boxes score >16. Higher CDR sum of boxes scores and use of psychotropic medication were associated with more severe apathy, agitation, psychosis, and affective symptoms. Poor physical health was associated with more severe apathy, psychosis, and affective symptoms. Women had more severe agitation and less severe affective symptoms than men. A longer stay in a nursing home was associated with more severe agitation and less severe affective symptoms. In conclusion, agitation was less severe in 2010/2011 than in 2004/2005 among nursing home residents with a milder degree of dementia, and more severe in residents with severe dementia.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Norway; St. Olav's University Hospital, Trondheim, Norway; Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway
| | - Bei Wu
- Duke Center for the Study of Aging and Human Development, Duke University School of Nursing, Durham, N.C., USA; Duke Global Health Institute, Durham, N.C., USA
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, Norway; HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway; Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Kirsten Corazzini
- Duke Center for the Study of Aging and Human Development, Duke University School of Nursing, Durham, N.C., USA
| | - Irene Røen
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
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Ortoleva Bucher C, Dubuc N, von Gunten A, Morin D. Du soin pratiqué au quotidien au consensus d’experts : état de l’évidence sur les interventions infirmières et leur priorisation selon le profil clinique des personnes âgées hospitalisées pour des symptômes comportementaux et psychologiques de la démence. Rech Soins Infirm 2016. [DOI: 10.3917/rsi.124.0075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Peisah C, Strukovski JA, Wijeratne C, Mulholland R, Luscombe G, Brodaty H. The development and testing of the quality use of medications in dementia (QUM-D): a tool for quality prescribing for behavioral and psychological symptoms of dementia (BPSD). Int Psychogeriatr 2015; 27:1313-22. [PMID: 25642751 PMCID: PMC4501300 DOI: 10.1017/s1041610214002816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 12/03/2014] [Accepted: 12/10/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) are virtually ubiquitous in dementia. Excessive recourse to use of psychotropics which have high risk to benefit ratio remains a global problem. We aimed to identify components of quality prescribing in BPSD to develop a tool for quality prescribing and to test this tool. METHODS We used Delphi methodology to identify elements of quality prescribing in BPSD. The tool was tested by a range of medical and nursing professionals on 48 patients, in inpatient and ambulatory settings in Northern Sydney Local Health District, Australia. RESULTS Consensual opinion using Delphi method was that quality prescribing in dementia comprised ten factors including failure to use first line non-pharmacological strategies, indication, choice of drug, consent, dosage, mode of administration, titration, polypharmacy, toxicity, and review. These elements formed the quality use of medications in dementia (QUM-D) tool, lower scores of which reflected quality prescribing, with a possible range of scores from 0 to 30. When inter-rater reliability was tested on a subgroup of raters, QUM-D showed high inter-rater reliability. A significant reduction in QUM-D scores was demonstrated from baseline to follow-up, mean difference being 5.3 (SD = 3.8; 95% confidence interval 4.1-6.4; t = 9.5; df = 47; p < 0.001). There was also a significant reduction in score from baseline to follow-up when rated by clinical nurse consultants from a specialized behavior assessment management service (BAMS) (N = 12). CONCLUSION The QUM-D is a tool which may help to improve quality prescribing practices in the context of BPSD. In this setting, we consider quality prescribing, and accordingly the obligations of prescribers, to be an inclusive concept rather than just adding to the mantra of "not prescribing."
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Affiliation(s)
- Carmelle Peisah
- Specialist Mental Health Services for Older People, Mental Health Drug and Alcohol, Northern Sydney Local Health District, Sydney, Australia
- University of Sydney, Sydney, Australia
- University of NSW, Sydney, Australia
| | - Julie-Anne Strukovski
- Specialist Mental Health Services for Older People, Mental Health Drug and Alcohol, Northern Sydney Local Health District, Sydney, Australia
| | | | - Rosalind Mulholland
- Specialist Mental Health Services for Older People, Mental Health Drug and Alcohol, Northern Sydney Local Health District, Sydney, Australia
| | | | - Henry Brodaty
- Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia
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Flo E, Gulla C, Husebo BS. Effective pain management in patients with dementia: benefits beyond pain? Drugs Aging 2015; 31:863-71. [PMID: 25373921 DOI: 10.1007/s40266-014-0222-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This current opinion aims to provide a literature overview of the associations between pain and neuropsychiatric symptoms and the efficacy of pain management for both pain and neuropsychiatric symptoms in patients with dementia. In addition, international guidelines and recommendations for pain management have been collated, and important developing research areas are highlighted. Pain is, in general, under-recognized and undertreated in people with dementia and may therefore trigger or exacerbate neuropsychiatric symptoms. While there is an abundance of pain assessment instruments intended for people with dementia, few have been adequately tested for their feasibility, reliability and validity. In patients with dementia, vocalizations, facial expressions and body movements may be the only valid expressions of pain. Further, pain has been related to the neuropsychiatric symptoms of agitation, aggression, mood syndrome and sleep problems. Unfortunately, health personnel may misinterpret these symptoms as neuropsychiatric symptoms of dementia. A differential assessment of dementia, its presenting neuropsychiatric symptoms and the potential presence of pain is crucial to provide the correct treatment. To achieve this, use of pain assessment tools that are responsive to change and are validated for use in patients with dementia is a prerequisite. To date, there have been few studies, with inconsistent findings on the association between pain and neuropsychiatric symptoms. To ensure a better differential assessment of pain and neuropsychiatric symptoms, and consequently more accurate treatment for patients with dementia, studies with adequate statistical power and high-quality study designs, including randomized controlled trials, are needed.
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Affiliation(s)
- Elisabeth Flo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Pbox 7800, 5020, Bergen, Norway,
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Abstract
Behavioral and psychological symptoms of dementia include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, wandering, and a variety of inappropriate behaviors. One or more of these symptoms will affect nearly all people with dementia over the course of their illness. These symptoms are among the most complex, stressful, and costly aspects of care, and they lead to a myriad of poor patient health outcomes, healthcare problems, and income loss for family care givers. The causes include neurobiologically related disease factors; unmet needs; care giver factors; environmental triggers; and interactions of individual, care giver, and environmental factors. The complexity of these symptoms means that there is no "one size fits all solution," and approaches tailored to the patient and the care giver are needed. Non-pharmacologic approaches should be used first line, although several exceptions are discussed. Non-pharmacologic approaches with the strongest evidence base involve family care giver interventions. Regarding pharmacologic treatments, antipsychotics have the strongest evidence base, although the risk to benefit ratio is a concern. An approach to integrating non-pharmacologic and pharmacologic treatments is described. Finally, the paradigm shift needed to fully institute tailored treatments for people and families dealing with these symptoms in the community is discussed.
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Affiliation(s)
- Helen C Kales
- Section of Geriatric Psychiatry, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA Geriatric Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Laura N Gitlin
- Department of Community Public Health, School of Nursing, Johns Hopkins University, Baltimore, MD, USA Division of Geriatrics and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview and Johns Hopkins University, Baltimore, MD, USA
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Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition. Int Psychogeriatr 2015; 27:7-17. [PMID: 25311499 PMCID: PMC4301197 DOI: 10.1017/s1041610214001963] [Citation(s) in RCA: 199] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Agitation is common across neuropsychiatric disorders and contributes to disability, institutionalization, and diminished quality of life for patients and their caregivers. There is no consensus definition of agitation and no widespread agreement on what elements should be included in the syndrome. The International Psychogeriatric Association formed an Agitation Definition Work Group (ADWG) to develop a provisional consensus definition of agitation in patients with cognitive disorders that can be applied in epidemiologic, non-interventional clinical, pharmacologic, non-pharmacologic interventional, and neurobiological studies. A consensus definition will facilitate communication and cross-study comparison and may have regulatory applications in drug development programs. METHODS The ADWG developed a transparent process using a combination of electronic, face-to-face, and survey-based strategies to develop a consensus based on agreement of a majority of participants. Nine-hundred twenty-eight respondents participated in the different phases of the process. RESULTS Agitation was defined broadly as: (1) occurring in patients with a cognitive impairment or dementia syndrome; (2) exhibiting behavior consistent with emotional distress; (3) manifesting excessive motor activity, verbal aggression, or physical aggression; and (4) evidencing behaviors that cause excess disability and are not solely attributable to another disorder (psychiatric, medical, or substance-related). A majority of the respondents rated all surveyed elements of the definition as "strongly agree" or "somewhat agree" (68-88% across elements). A majority of the respondents agreed that the definition is appropriate for clinical and research applications. CONCLUSIONS A provisional consensus definition of agitation has been developed. This definition can be used to advance interventional and non-interventional research of agitation in patients with cognitive impairment.
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Brunelle-Hamann L, Thivierge S, Simard M. Impact of a cognitive rehabilitation intervention on neuropsychiatric symptoms in mild to moderate Alzheimer's disease. Neuropsychol Rehabil 2014; 25:677-707. [PMID: 25312605 DOI: 10.1080/09602011.2014.964731] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The main goal of this study was to evaluate the impact of a cognitive rehabilitation programme on 12 behavioural and psychological symptoms of dementia (BPSD) in patients with mild to moderate Alzheimer's disease (AD). This six-month single-blind block-randomised cross-over controlled study was conducted with 15 mild to moderate AD participants and their caregivers. All participants received a four-week home-based cognitive rehabilitation programme to learn/re-learn an instrumental activity of daily living. They were assessed up until three months following the end of the intervention. The Neuropsychiatric Inventory (NPI-12) was employed to evaluate patients' BPSD at seven assessment points during the course of the study. A general linear mixed model analysis performed on the NPI data revealed that aberrant motor behaviours (AMB) increased significantly more in the treatment condition than in the control condition. In addition, both groups registered a significant reduction of delusional symptoms during the second half of the study. Employing a multi-symptom approach to assess participants' BPSD, this cross-over randomised controlled study showed that an individualised cognitive rehabilitation intervention was generally well-tolerated by mild to moderate AD patients. Future cognitive rehabilitation studies conducted with this population should pay attention to AMB symptom changes.
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Affiliation(s)
- Laurence Brunelle-Hamann
- a École de psychologie , Université Laval and Centre de recherche de l'Institut Universitaire en Santé Mentale de Québec , Quebec City , QC , Canada
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Bloniecki V, Aarsland D, Cummings J, Blennow K, Freund-Levi Y. Agitation in dementia: relation to core cerebrospinal fluid biomarker levels. Dement Geriatr Cogn Dis Extra 2014; 4:335-43. [PMID: 25298777 PMCID: PMC4176467 DOI: 10.1159/000363500] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The objective of this study was to examine the associations of agitation with the cerebrospinal fluid dementia biomarkers total-tau (T-tau), phosphorylated-tau (P-tau) and Aβ1-42. Methods One hundred patients (mean age ± SD, 78.6 ± 7.5 years) with dementia and neuropsychiatric symptoms, of whom 67% were female, were included. Agitation was measured using the Cohen-Mansfield Agitation Inventory (CMAI; 46.5 ± 11.8 points). Results Total CMAI correlated with T-tau [rs (31) = 0.36, p = 0.04] and P-tau [rs (31) = 0.35, p = 0.05] in patients with Alzheimer's disease (AD; n = 33) but not in the total dementia population (n = 95). Conclusions Our results suggest that tau-mediated pathology including neurofibrillary tangles and the intensity of the disease process might be associated with agitation in AD.
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Affiliation(s)
- Victor Bloniecki
- Division of Clinical Geriatrics, Karolinska University Hospital Huddinge, Stockholm, Mölndal, Sweden
| | - Dag Aarsland
- Center for Alzheimer Research, Division for Neurogeriatrics, Department of Neurobiology, Caring Sciences and Society (NVS), Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Mölndal, Sweden ; Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nev., USA
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Yvonne Freund-Levi
- Division of Clinical Geriatrics, Karolinska University Hospital Huddinge, Stockholm, Mölndal, Sweden
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Reuther S, Holle D, Buscher I, Dortmann O, Müller R, Bartholomeyczik S, Halek M. Effect evaluation of two types of dementia-specific case conferences in German nursing homes (FallDem) using a stepped-wedge design: study protocol for a randomized controlled trial. Trials 2014; 15:319. [PMID: 25118091 PMCID: PMC4141097 DOI: 10.1186/1745-6215-15-319] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/22/2014] [Indexed: 11/24/2022] Open
Abstract
Background Case conferences for people with dementia and challenging behaviors (e.g., apathy) are recommended as useful tools that enable staff in nursing homes to understand the behavior of people with this type of disease. Understanding peoples’ behaviors is the basis for the initiation of targeted interventions to improve the quality of care for people with dementia. Furthermore, case conferences demonstrate positive effects on burnout, dementia-specific burden, and vocational action competence of the staff. The two likely approaches for conducting case conferences include the following: A) using a structured assessment instrument, which guides the staff in understanding the residents’ behaviors and B) using a narrative approach in which the staff must identify the reasons for the residents’ behaviors in an unstructured manner. Case conferences are a complex intervention, and evaluating their multiple effects is challenging. The aim of this study protocol was to describe a likely solution for evaluating this type of complex intervention using a special cluster randomized trial. Methods In this stepped-wedged cluster randomized trial, the two interventions will be sequentially implemented every three months in a group of 12 nursing homes (clusters) with a minimum of 360 residents over 19 months (7 months of intervention for each cluster and follow-up). The primary outcome is the reduction of challenging behavior (measured with the neuropsychiatric inventory-nursing home version [NPI-NH]). Secondary outcomes are residents’ quality of life, prescription of psychotropic medications, staff burnout, dementia-related stress, and vocational action competence. The effectiveness of the study will be accompanied by a process evaluation. The primary data will be analyzed using a Bayesian mixed effect model; the secondary data will be analyzed using descriptive statistics and mixed effects models. Discussion The implementation and effect measurement of complex interventions such as case conferences within a cluster randomized trial are challenging (e.g., complex and intensive training, delayed treatment effect). In this study protocol, the methodological advantages and disadvantages of using the stepped wedge design to answer the research questions are discussed. Trial registration http://www.controlled-trials.com/ISRCTN20203855; registered 10 July 2013.
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Affiliation(s)
- Sven Reuther
- German Center for Neurodegenerative Diseases (DZNE), Witten, Stockumer Str, 12, 58453 Witten, Germany.
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Antidementia drug use among community-dwelling individuals with Alzheimer's disease in Finland: a nationwide register-based study. Int Clin Psychopharmacol 2014; 29:216-23. [PMID: 24608822 PMCID: PMC4047310 DOI: 10.1097/yic.0000000000000032] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The objective of this study was to investigate the prevalence of acetylcholinesterase inhibitor (AChEI) and memantine use, duration of treatment, concomitant use of these drugs, and factors associated with the discontinuation of AChEI therapy during 2006-2009. We utilized data from a nationwide sample of community-dwelling individuals with a clinically verified Alzheimer's disease diagnosed during the year 2005 (n=6858) as a part of the MEDALZ-2005 study. During the 4-year follow-up, 84% used AChEI and 47% used memantine. Altogether, 22% of the sample used both drugs concomitantly. The median duration of the first AChEI use period was 860 (interquartile range 295-1458) days and 1103 (interquartile range 489-1487) days for the total duration of AChEI use. Although 20% of the AChEI users discontinued the use during the first year, over half of them restarted later. The risk of discontinuation was higher for rivastigmine [hazard ratio 1.34 (confidence interval 1.22-1.48)] and galantamine users [hazard ratio 1.23 (confidence interval 1.15-1.37)] compared with donepezil users in the adjusted model. In conclusion, median time for AChEI use was over 3 years and every fifth Alzheimer's disease patient used AChEI and memantine concomitantly during the follow-up. The low rate of discontinuation is consistent with the Finnish Care Guideline but in contrast to the results reported from many other countries.
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Seritan AL, Nguyen DV, Mu Y, Tassone F, Bourgeois JA, Schneider A, Cogswell J, Cook K, Leehey M, Grigsby J, Olichney JM, Adams P, Legg W, Zhang L, Hagerman P, Hagerman RJ. Memantine for fragile X-associated tremor/ataxia syndrome: a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry 2014; 75:264-71. [PMID: 24345444 PMCID: PMC4296896 DOI: 10.4088/jcp.13m08546] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 07/12/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Memantine, an uncompetitive N-methyl-d-aspartate receptor antagonist, is currently approved by the US Food and Drug Administration for the treatment of moderate to severe Alzheimer's disease. Anecdotal reports have suggested that memantine may improve neurologic and cognitive symptoms of individuals with the neurodegenerative disease fragile X-associated tremor/ataxia syndrome (FXTAS); however, its efficacy and safety in this population have not been assessed in a controlled trial. METHOD Individuals with FXTAS aged 34-80 years were enrolled in a randomized, double-blind, placebo-controlled, 1-year trial between September 2007 and August 2012. Inclusion required definite, probable, or possible FXTAS in clinical stages 1-5 according to previously published criteria. Primary outcome measures were the Behavioral Dyscontrol Scale (BDS) score and CATSYS intention tremor severity. RESULTS Ninety-four participants were randomized from 205 screened; of those, 43 and 45 started treatment with memantine (titrated to 10 mg twice daily) and placebo, respectively. Thirty-four participants receiving memantine and 36 receiving placebo completed the 1-year endpoint assessment (n = 70). Intention-to-treat analysis showed no improvement with respect to intention tremor severity (mean [SD] values with memantine vs placebo: 1.05 [0.73] vs 1.89 [2.19], P = .047) or BDS score (16.12 [5.43] vs 15.72 [3.93], P = .727) at follow-up. Post hoc analyses of participants with early FXTAS (stage ≤ 3), those with late FXTAS (stage > 3), and those in different age groups (≤ 65 years and > 65 years) also indicated no significant improvement. More frequent mild adverse events were observed in the placebo group, while more frequent moderate adverse events occurred in the memantine group (P = .007). CONCLUSION This randomized, double-blind, placebo-controlled trial of memantine for individuals with FXTAS showed no benefit compared to placebo with respect to the selected outcome measures. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00584948.
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Affiliation(s)
- Andreea L. Seritan
- Department of Psychiatry and Behavioral Sciences, University of California Davis Medical Center, Sacramento, CA,Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, CA
| | - Danh V. Nguyen
- Department of Medicine, University of California Irvine, Irvine, CA,Institute for Clinical and Translational Science, University of California Irvine, Irvine, CA
| | - Yi Mu
- Department of Public Health Sciences, University of California Davis, Davis CA
| | - Flora Tassone
- Department of Biochemistry and Molecular Medicine, University of California Davis, Davis, CA
| | - James A. Bourgeois
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
| | - Andrea Schneider
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, CA,Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA
| | - Jennifer Cogswell
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, CA
| | - Kylee Cook
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, CA
| | - Maureen Leehey
- Department of Neurology, University of Colorado School of Medicine, Denver, Colorado
| | - Jim Grigsby
- Departments of Psychology and Medicine, University of Colorado Denver, Denver, Colorado
| | - John M. Olichney
- Department of Neurology, University of California Davis, Sacramento, CA,Center for Mind and Brain, University of California Davis, Davis, CA
| | - Patrick Adams
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, CA
| | - Wendi Legg
- Department of Neurology, University of Colorado School of Medicine, Denver, Colorado
| | - Lin Zhang
- Department of Neurology, University of California Davis, Sacramento, CA
| | - Paul Hagerman
- Department of Biochemistry and Molecular Medicine, University of California Davis, Davis, CA
| | - Randi J. Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, CA,Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA
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Dillon C, Serrano CM, Castro D, Leguizamón PP, Heisecke SL, Taragano FE. Behavioral symptoms related to cognitive impairment. Neuropsychiatr Dis Treat 2013; 9:1443-55. [PMID: 24092982 PMCID: PMC3788702 DOI: 10.2147/ndt.s47133] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Neuropsychiatric symptoms (NPS) are core features of Alzheimer's disease and related dementias. On one hand, behavioral symptoms in patients with mild cognitive impairment (MCI) can indicate an increased risk of progressing to dementia. On the other hand, mild behavioral impairment (MBI) in patients who usually have normal cognition indicates an increased risk of developing dementia. Whatever the cause, all dementias carry a high rate of NPI. These symptoms can be observed at any stage of the disease, may fluctuate over its course, are a leading cause of stress and overload for caregivers, and increase rates of hospitalization and early institutionalization for patients with dementia. The clinician should be able to promptly recognize NPI through the use of instruments capable of measuring their frequency and severity to support diagnosis, and to help monitor the treatment of behavioral symptoms. The aims of this review are to describe and update the construct 'MBI' and to revise the reported NPS related to prodromal stages of dementia (MCI and MBI) and dementia stages of Alzheimer's disease and frontotemporal lobar degeneration.
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Affiliation(s)
- Carol Dillon
- CeMiC (Centro de Educación Médica e Investigaciones Clínicas) University Institute, Argentina
| | - Cecilia M Serrano
- CeMiC (Centro de Educación Médica e Investigaciones Clínicas) University Institute, Argentina
| | - Diego Castro
- CeMiC (Centro de Educación Médica e Investigaciones Clínicas) University Institute, Argentina
| | | | - Silvina L Heisecke
- CeMiC (Centro de Educación Médica e Investigaciones Clínicas) University Institute, Argentina
- CONICET (Consejo Nacional de Investigaciones Cientificas y Técnicas), Buenos Aires, Argentina
| | - Fernando E Taragano
- CeMiC (Centro de Educación Médica e Investigaciones Clínicas) University Institute, Argentina
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Yiannopoulou KG, Papageorgiou SG. Current and future treatments for Alzheimer's disease. Ther Adv Neurol Disord 2013; 6:19-33. [PMID: 23277790 PMCID: PMC3526946 DOI: 10.1177/1756285612461679] [Citation(s) in RCA: 381] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Alzheimer's dementia (AD) is increasingly being recognized as one of the most important medical and social problems in older people in industrialized and non-industrialized nations. To date, only symptomatic treatments exist for this disease, all trying to counterbalance the neurotransmitter disturbance. Three cholinesterase inhibitors (CIs) are currently available and have been approved for the treatment of mild to moderate AD. A further therapeutic option available for moderate to severe AD is memantine, an N-methyl-D-aspartate receptor noncompetitive antagonist. Treatments capable of stopping or at least effectively modifying the course of AD, referred to as 'disease-modifying' drugs, are still under extensive research. To block the progression of the disease they have to interfere with the pathogenic steps responsible for the clinical symptoms, including the deposition of extracellular amyloid β plaques and intracellular neurofibrillary tangle formation, inflammation, oxidative damage, iron deregulation and cholesterol metabolism. In this review we discuss current symptomatic treatments and new potential disease-modifying therapies for AD that are currently being studied in phase I-III trials.
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