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Yin Z, Li Y, Bao Q, Zhang X, Xia M, Zhong W, Wu K, Yao J, Chen Z, Sun M, Zhao L, Liang F. Comparative efficacy of multiple non-pharmacological interventions for behavioural and psychological symptoms of dementia: A network meta-analysis of randomised controlled trials. Int J Ment Health Nurs 2024; 33:487-504. [PMID: 38012101 DOI: 10.1111/inm.13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/14/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
Non-pharmacological interventions can improve the behavioural and psychological symptoms of dementia (BPSD). However, the optimal non-pharmacological treatments remain controversial. This study aimed to compare the efficacy of multiple non-pharmacological methods and identify the optimal therapy for BPSD. Potential randomised controlled trials (RCTs) were searched and selected from 15 databases and sources from the inception of the databases until 1 October 2022. Two independent authors implemented study screening, data extraction, and methodological quality assessment. Primary outcome was reduction of Neuropsychiatric Inventory (NPI). The secondary outcome were changes of Cornell Scale for Depression in Dementia (CSDD), the Cohen-Mansfield Agitation Inventory (CMAI), the Quality of Life in Alzheimer's Disease (QoL-AD), the Abilities of Daily Living scale, and the Apathy Evaluation Scale. Meta-analyses were performed using STATA v15.0 and ADDIS v1.16.8. The GRADE approaches were utilised to evaluate evidence quality. The present study included 43 RCTs with 4978 participants. The global methodological quality of the RCTs was moderate. Regarding NPI reduction, with moderate-certainty evidence, exercise plus treatment as usual (TAU) outperformed TAU (mean difference [MD]: -7.13; 95% confidence interval [CI]: -13.22, -0.76) and ranked as the optimal treatment. For reduction in CSDD, with low- to moderate-certainty evidence, massage plus TAU (MD: -15.26; 95% CI: -20.13, -10.52) and music plus TAU (MD: -2.40; 95% CI: -4.62, -0.12) were associated with greater reduction compared with TAU. For reduction in CMAI, with moderate-certainty evidence, aromatherapy plus massage (MD: -15.84; 95% CI: -29.76, -2.42) and massage plus music (MD: -13.12; 95% CI: -25.43, -0.76) were significantly more effective than TAU. For improvement in QoL-AD, with critically low- to low-certainty evidence, there were no statistical differences between any of non-pharmacological treatments and TAU. Due to the limited number of included studies, network meta-analysis was not performed for other outcomes. In conclusion, non-pharmacological treatments are effective for overall symptoms, depression, and agitation. Exercise plus treatment as usual may be an optimal non-pharmacological intervention for improving the overall BPSD. This may help to guide patients, doctors, and policymakers.
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Affiliation(s)
- Zihan Yin
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Yaqin Li
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qiongnan Bao
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Xinyue Zhang
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Manze Xia
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Wanqi Zhong
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Kexin Wu
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Jin Yao
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Zhenghong Chen
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Mingsheng Sun
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Ling Zhao
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Fanrong Liang
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
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Rajendran K, Krishnan UM. Mechanistic insights and emerging therapeutic stratagems for Alzheimer's disease. Ageing Res Rev 2024; 97:102309. [PMID: 38615895 DOI: 10.1016/j.arr.2024.102309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 04/16/2024]
Abstract
Alzheimer's disease (AD), a multi-factorial neurodegenerative disorder has affected over 30 million individuals globally and these numbers are expected to increase in the coming decades. Current therapeutic interventions are largely ineffective as they focus on a single target. Development of an effective drug therapy requires a deep understanding of the various factors influencing the onset and progression of the disease. Aging and genetic factors exert a major influence on the development of AD. Other factors like post-viral infections, iron overload, gut dysbiosis, and vascular dysfunction also exacerbate the onset and progression of AD. Further, post-translational modifications in tau, DRP1, CREB, and p65 proteins increase the disease severity through triggering mitochondrial dysfunction, synaptic loss, and differential interaction of amyloid beta with different receptors leading to impaired intracellular signalling. With advancements in neuroscience tools, new inter-relations that aggravate AD are being discovered including pre-existing diseases and exposure to other pathogens. Simultaneously, new therapeutic strategies involving modulation of gene expression through targeted delivery or modulation with light, harnessing the immune response to promote clearance of amyloid deposits, introduction of stem cells and extracellular vesicles to replace the destroyed neurons, exploring new therapeutic molecules from plant, marine and biological sources delivered in the free state or through nanoparticles and use of non-pharmacological interventions like music, transcranial stimulation and yoga. Polypharmacology approaches involving combination of therapeutic agents are also under active investigation for superior therapeutic outcomes. This review elaborates on various disease-causing factors, their underlying mechanisms, the inter-play between different disease-causing players, and emerging therapeutic options including those under clinical trials, for treatment of AD. The challenges involved in AD therapy and the way forward have also been discussed.
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Affiliation(s)
- Kayalvizhi Rajendran
- School of Chemical & Biotechnology, SASTRA Deemed University, Thanjavur, Tamilnadu 613401, India; Centre for Nanotechnology & Advanced Biomaterials, SASTRA Deemed University, Thanjavur, Tamilnadu 613401, India
| | - Uma Maheswari Krishnan
- School of Chemical & Biotechnology, SASTRA Deemed University, Thanjavur, Tamilnadu 613401, India; Centre for Nanotechnology & Advanced Biomaterials, SASTRA Deemed University, Thanjavur, Tamilnadu 613401, India; School of Arts, Sciences, Humanities & Education, SASTRA Deemed University, Thanjavur, Tamilnadu 613401, India.
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Jesto S, Considine J, Street M. Nonpharmacological nursing interventions for behavioural and psychological symptoms of dementia in acute and subacute settings: A systematic review. Int J Nurs Pract 2024; 30:e13213. [PMID: 37837249 DOI: 10.1111/ijn.13213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 04/25/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Behavioural and psychological symptoms of dementia are a group of non-cognitive symptoms such as agitation, physical aggression, depression, sexual disinhibition and psychosis. Therapeutic approaches vary because of the multifactorial and complex symptomology. The researchers of this study aimed to systematically review the nonpharmacological interventions for BPSD used by nurses in acute and subacute hospital settings. DESIGN The PRISMA guidelines guided this systematic review. The review was registered with PROSPERO (CRD42020184015). METHOD The databases Cumulative Index of Nursing and Allied Health Literature (CINAHL) complete, Medline complete, Excerpta Medica (Embase®) and PsycINFO published by the American Psychological Association (APA) were searched for studies published in English to October 2021. Quality appraisal was performed independently by three reviewers using the Critical Appraisal Skills Program tools. Data were synthesized using a narrative approach. RESULTS Two studies were identified that focused on interventions used by nurses; findings were positive for the use of nonpharmacological interventions to manage BPSD. CONCLUSION Current evidence suggests that nonpharmacological interventions are the best practices to manage BPSD. However, limited, and low-quality evidence suggests that further investigation is required to understand the factors contributing to the lack of use of nonpharmacological interventions by nurses in acute and subacute hospital settings.
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Affiliation(s)
- Sahaya Jesto
- School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia
| | - Julie Considine
- School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Burwood, Vic., Australia
- Centre for Quality and Patient Safety-Eastern Health Partnership, Box Hill, Vic., Australia
| | - Maryann Street
- School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Burwood, Vic., Australia
- Centre for Quality and Patient Safety-Eastern Health Partnership, Box Hill, Vic., Australia
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Cummings J, Sano M, Auer S, Bergh S, Fischer CE, Gerritsen D, Grossberg G, Ismail Z, Lanctôt K, Lapid MI, Mintzer J, Palm R, Rosenberg PB, Splaine M, Zhong K, Zhu CW. Reduction and prevention of agitation in persons with neurocognitive disorders: an international psychogeriatric association consensus algorithm. Int Psychogeriatr 2024; 36:251-262. [PMID: 36876335 PMCID: PMC10480345 DOI: 10.1017/s104161022200103x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To develop an agitation reduction and prevention algorithm is intended to guide implementation of the definition of agitation developed by the International Psychogeriatric Association (IPA). DESIGN Review of literature on treatment guidelines and recommended algorithms; algorithm development through reiterative integration of research information and expert opinion. SETTING IPA Agitation Workgroup. PARTICIPANTS IPA panel of international experts on agitation. INTERVENTION Integration of available information into a comprehensive algorithm. MEASUREMENTS None. RESULTS The IPA Agitation Work Group recommends the Investigate, Plan, and Act (IPA) approach to agitation reduction and prevention. A thorough investigation of the behavior is followed by planning and acting with an emphasis on shared decision-making; the success of the plan is evaluated and adjusted as needed. The process is repeated until agitation is reduced to an acceptable level and prevention of recurrence is optimized. Psychosocial interventions are part of every plan and are continued throughout the process. Pharmacologic interventions are organized into panels of choices for nocturnal/circadian agitation; mild-moderate agitation or agitation with prominent mood features; moderate-severe agitation; and severe agitation with threatened harm to the patient or others. Therapeutic alternatives are presented for each panel. The occurrence of agitation in a variety of venues-home, nursing home, emergency department, hospice-and adjustments to the therapeutic approach are presented. CONCLUSIONS The IPA definition of agitation is operationalized into an agitation management algorithm that emphasizes the integration of psychosocial and pharmacologic interventions, reiterative assessment of response to treatment, adjustment of therapeutic approaches to reflect the clinical situation, and shared decision-making.
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Affiliation(s)
- Jeffrey Cummings
- Joy Chambers-Grundy Professor of Brain Science, Director, Chambers-Grundy Center for Transformative Neuroscience, Co-Director, Pam Quirk Brain Health and Biomarker Laboratory, Department of Brain Health, School of Integrated Health Sciences. University of Nevada Las Vegas (UNLV)
| | - Mary Sano
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NYC NY and James J. Peters VAMC, Bronx NY
| | - Stefanie Auer
- Centre for Dementia Studies, University for Continuing Education Krems, Austria
| | - Sverre Bergh
- The research centre for age-related functional decline and disease, Innlandet hospital trust, Ottestad, Norway
| | - Corinne E. Fischer
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Canada
| | - Debby Gerritsen
- Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Radboud Alzheimer Center, Nijmegen, the Netherlands
| | - George Grossberg
- Department of Psychiatry & Behavioral Neuroscience, Division of Geriatric Psychiatry St Louis University School of Medicine
| | - Zahinoor Ismail
- Departments Psychiatry, Neurology, Epidemiology, and Pathology, Hotchkiss Brain Institute & O’Brien Institute for Public Health University of Calgary
| | - Krista Lanctôt
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute; and Departments of Psychiatry and Pharmacology/Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maria I Lapid
- Mayo Clinic Department of Psychiatry and Psychology, Rochester, MN, USA
| | - Jacobo Mintzer
- Psychiatrist, Ralph. H. Johnson VA Medical Center, Charleston, SC and Professor, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Rebecca Palm
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Paul B. Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Michael Splaine
- Owner Splaine Consulting, Managing Partner, Recruitment Partners LLC
| | - Kate Zhong
- Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas
| | - Carolyn W. Zhu
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, NYC, NY and James J. Peters VAMC, Bronx NY
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Helbling M, Grandjean ML, Srinivasan M. Effects of multisensory environment/stimulation therapy on adults with cognitive impairment and/or special needs: A systematic review and meta-analysis. SPECIAL CARE IN DENTISTRY 2024; 44:381-420. [PMID: 37515496 DOI: 10.1111/scd.12906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/30/2023] [Accepted: 07/12/2023] [Indexed: 07/31/2023]
Abstract
AIM This review aimed to evaluate the effects of multisensory environments/stimulation (MSE/MSS) therapy, on the behavior and psychological symptoms in adults with cognitive impairment and/or special needs. METHODS Online database searches were performed to identify studies reporting on the effects of MSS/MSE therapy in adults (>18 years). Data were extracted for the following investigated outcomes including anxiety, depression, mood, behavioral attributes, biomedical parameters, cognition, motor skills, quality of life (QoL), pain, and end of life quality. Two reciprocally blinded investigators extracted the data. Inter-investigator reliability (𝝹) was calculated. A meta-analysis and a qualitative analysis were performed on the information extracted. RESULTS Thirty-six studies were included for data extraction and analysis. Meta-analysis of the included studies revealed a significant improvement with the MSE/MSS therapy, for agitation (p = .018), anxiety (p = .023), cognition (p < .001), and depression (p < .001). MSS/MSE therapy demonstrated a tendency for the improvement of the QoL in adults (p = .05). CONCLUSION MSE/MSS therapies are beneficial in cognitively impaired adults and improve their anxiety, depression, cognitive and other behavioral attributes such as agitative behaviors. Promoting these therapies in geriatric care may help to improve/reduce the challenging/care-resistant behaviors in adults and facilitate effective provision of the necessary care.
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Affiliation(s)
- Meret Helbling
- Clinic of General-, Special Care- and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Marie-Laure Grandjean
- Clinic of General-, Special Care- and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Murali Srinivasan
- Clinic of General-, Special Care- and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Zhang Z, Yu P, Yin M, Chang HC, Thomas SJ, Wei W, Song T, Deng C. Developing an ontology of non-pharmacological treatment for emotional and mood disturbances in dementia. Sci Rep 2024; 14:1937. [PMID: 38253678 PMCID: PMC10803746 DOI: 10.1038/s41598-023-46226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/30/2023] [Indexed: 01/24/2024] Open
Abstract
Emotional and mood disturbances are common in people with dementia. Non-pharmacological interventions are beneficial for managing these disturbances. However, effectively applying these interventions, particularly in the person-centred approach, is a complex and knowledge-intensive task. Healthcare professionals need the assistance of tools to obtain all relevant information that is often buried in a vast amount of clinical data to form a holistic understanding of the person for successfully applying non-pharmacological interventions. A machine-readable knowledge model, e.g., ontology, can codify the research evidence to underpin these tools. For the first time, this study aims to develop an ontology entitled Dementia-Related Emotional And Mood Disturbance Non-Pharmacological Treatment Ontology (DREAMDNPTO). DREAMDNPTO consists of 1258 unique classes (concepts) and 70 object properties that represent relationships between these classes. It meets the requirements and quality standards for biomedical ontology. As DREAMDNPTO provides a computerisable semantic representation of knowledge specific to non-pharmacological treatment for emotional and mood disturbances in dementia, it will facilitate the application of machine learning to this particular and important health domain of emotional and mood disturbance management for people with dementia.
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Affiliation(s)
- Zhenyu Zhang
- Centre for Digital Transformation, School of Computing and Information Technology, University of Wollongong, Northfield Ave, Wollongong, NSW, 2522, Australia
| | - Ping Yu
- Centre for Digital Transformation, School of Computing and Information Technology, University of Wollongong, Northfield Ave, Wollongong, NSW, 2522, Australia.
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.
| | - Mengyang Yin
- Centre for Digital Transformation, School of Computing and Information Technology, University of Wollongong, Northfield Ave, Wollongong, NSW, 2522, Australia
- Systems and Reporting Residential Care, Catholic Healthcare Ltd, Wollongong, Australia
| | - Hui Chen Chang
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- School of Nursing, University of Wollongong, Wollongong, Australia
| | - Susan J Thomas
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Wenxi Wei
- School of Nursing, University of Wollongong, Wollongong, Australia
| | - Ting Song
- Centre for Digital Transformation, School of Computing and Information Technology, University of Wollongong, Northfield Ave, Wollongong, NSW, 2522, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Chao Deng
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, Australia
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Svedin F, Blomberg O, Farrand P, Brantnell A, von Essen L, Åberg AC, Woodford J. Effectiveness, acceptability, and completeness and quality of intervention reporting of psychological interventions for people with dementia or mild cognitive impairment: protocol for a mixed-methods systematic review. BMJ Open 2023; 13:e077180. [PMID: 38086581 PMCID: PMC10729069 DOI: 10.1136/bmjopen-2023-077180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/25/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Mental health difficulties such as anxiety and depression have negative impacts on psychological well-being and are common in people with dementia and mild cognitive impairment. However, access to psychological treatments is limited. This mixed-method systematic review will: (1) examine the effectiveness of psychological interventions to improve mental health and psychological well-being in people with dementia or mild cognitive impairment; (2) examine the effectiveness of these psychological interventions to improve mental health and psychological well-being in informal caregivers; (3) examine potential clinical and methodological moderators associated with effectiveness; (4) explore factors associated with the acceptability of psychological interventions from the perspective of key stakeholders; and (5) examine the completeness and quality of intervention reporting. METHODS AND ANALYSIS Electronic databases (ASSIA, CENTRAL, CINAHL, EMBASE, PsycINFO and MEDLINE) will be systematically searched and supplemented with expert contact, reference and citation checking, and grey literature searches. If possible, we will conduct a meta-analysis to examine the overall effectiveness of psychological interventions to improve mental health and psychological well-being in people with dementia or mild cognitive impairment and their informal caregivers; and examine potential clinical and methodological moderators associated with effectiveness. We will conduct a deductive framework synthesis, informed by the theoretical framework of acceptability, to explore factors associated with the acceptability of psychological interventions from the perspective of key stakeholders. In accordance with Joanna Briggs Institute guidance, we will adopt a convergent segregated approach to data synthesis and integration of quantitative and qualitative findings. We will examine the completeness and quality of intervention reporting according to the Template for Intervention Description and Replication checklist and guide. ETHICS AND DISSEMINATION No primary data will be collected, and therefore, ethical approval is not required. Results will be disseminated through a peer-reviewed publication, academic conferences, and plain language summaries. PROSPERO REGISTRATION NUMBER CRD42023400514.
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Affiliation(s)
- Frida Svedin
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Oscar Blomberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Paul Farrand
- Clinical Education Development and Research (CEDAR), University of Exeter, Exeter, UK
| | - Anders Brantnell
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Civil and Industrial Engineering, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Cristina Åberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Dalarna University, Falun, Sweden
| | - Joanne Woodford
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Ishimaru D, Tanaka H, Nagata Y, Ogawa Y, Fukuhara K, Nishikawa T. Aspects of Rest-Activity Rhythms Associated With Behavioral and Psychological Symptoms in Moderate and Severe Dementia: Results of a Cross-sectional Analysis. Alzheimer Dis Assoc Disord 2023; 37:322-327. [PMID: 37824629 DOI: 10.1097/wad.0000000000000584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Disturbances in rest-activity rhythms (RAR) are commonly observed in patients with dementia; however, the influence thereof on behavioral and psychological symptoms of dementia (BPSD) remains unexplored. This study aimed to determine whether there is an association between RAR and BPSD among patients with moderate and severe dementia. METHODS RAR analyses of 64 participants were performed using actigraphy. BPSD was assessed using the Neuropsychiatric Inventory-Nursing Home (NPI-NH) scale, and other clinical variables were assessed by the Mini-Mental State Examination, Cognitive Test for Severe Dementia, and Hyogo Activities of Daily Living Scale. Correlations among RAR, sleep time, and BPSD were analyzed. A stepwise multiple linear regression analysis was conducted to examine the association of RAR and sleep time with BPSD. The demographic variables were also adjusted. Variables were compared between two groups with aberrant and nonaberrant activity peak timing. RESULTS Correlation analysis showed that longer maximum durations of activity and shorter daytime sleep were associated with higher NPI-NH scores. Stepwise multiple linear regression analysis showed that maximum activity duration predicted the NPI-NH score after adjustment for the demographic variables. There was no significant difference in any variables between the groups with aberrant and nonaberrant activity peak timing. CONCLUSION RAR is associated with BPSD in moderate-to-severe dementia, which should be considered with regard to treatment.
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Affiliation(s)
- Daiki Ishimaru
- Department of Rehabilitation Science, Graduate School of Rehabilitation Science, Osaka Metropolitan University
- Department of Medical Technology, Osaka University Hospital
- Department of Psychiatry, Course of Integrated Medicine, Osaka University, Graduate School of Medicine
| | - Hiroyuki Tanaka
- Department of Rehabilitation Science, Graduate School of Rehabilitation Science, Osaka Metropolitan University
| | - Yuma Nagata
- Department of Rehabilitation Science, Graduate School of Rehabilitation Science, Osaka Metropolitan University
- Department of Psychiatry, Course of Integrated Medicine, Osaka University, Graduate School of Medicine
| | - Yasuhiro Ogawa
- Department of Occupational Therapy, Morinomiya University of Medical Sciences, Osaka
| | - Keita Fukuhara
- Department of Rehabilitation Science, Graduate School of Rehabilitation Science, Osaka Metropolitan University
- Division of Clinical Therapeutics, Naragakuen University Graduate School of Rehabilitation Sciences, Nara, Japan
| | - Takashi Nishikawa
- Department of Rehabilitation Science, Graduate School of Rehabilitation Science, Osaka Metropolitan University
- Division of Clinical Therapeutics, Naragakuen University Graduate School of Rehabilitation Sciences, Nara, Japan
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Gillis K, van Diermen L, Lahaye H, De Witte M, De Wit Y, Roelant E, Lips D, Zhiri A, Hockley J, Van Bogaert P. Effect of need-based care on behavioural and psychological symptoms in residents with dementia and formal caregivers' distress in nursing homes: a three-arm cluster randomized controlled trial. Eur Geriatr Med 2023; 14:1083-1096. [PMID: 37405630 DOI: 10.1007/s41999-023-00825-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 06/19/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE To evaluate to what extent the standardized concept of need-based care on Behavioural and Psychological Symptoms of Dementia (BPSD), and formal caregiver distress, is superior when compared to spending more time or standard care with residents with BPSD. METHODS A longitudinal cluster randomized controlled study in 23 nursing homes in Belgium with 3 parallel groups was set up. A total of 481 residents with dementia participated. Formal caregivers in the need-based care group treated residents who displayed agitated or aggressive behaviour with a non-pharmacological intervention, tailored to unmet needs, twice a week with re-evaluation every 8 weeks. In the time group, formal caregivers spent 'extra time'. In the standard care group, it was 'care as usual'. Outcomes were measured at four different time points with the Doloplus-2 (to assess pain behaviour), Cohen-Mansfield Agitation Inventory (CMAI) for agitation, the Neuropsychiatric Inventory (NPI-NH) for BPSD and formal caregivers' distress. RESULTS Need-based interventions had a significant effect on residents' levels of pain behaviour. In the need-based care group, scores on overall BPSD (agitation and aggression, depression, euphoria, irritability, sleep and night-time behaviour) improved significantly from baseline when compared to other timepoints. No significant different interactions over time were found between all three groups for categorized versions of NPI scores (ever versus never). CONCLUSION Need-based care reduced the level of BPSD in residents with dementia as well as formal caregivers' distress. The study supports the importance of tailored non-pharmacological interventions in the residential care for people with dementia. TRIAL REGISTRY Trial registration number B300201942084 (18/11/2019).
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Affiliation(s)
- Katrin Gillis
- Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium.
- Centre for Research and Innovation in Care, Antwerp University, Universiteitsplein 1, 2600, Wilrijk, Belgium.
| | - Linda van Diermen
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Campus Drie Eiken, Universiteitsplein 1, 2610, Wilrijk, Belgium
- Psychiatric Centre Bethanië, Andreas Vesaliuslaan 39, 2980, Zoersel, Belgium
| | - Hilde Lahaye
- Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium
| | - Marianne De Witte
- Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium
- , Curando Vzw, Pensionaatstraat 58A, Ruiselede, Belgium
| | - Yentl De Wit
- Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium
- Department of Geriatrics, Ghent University Hospital, C. Heymanslaan, 10, 9000, Ghent, Belgium
| | - Ella Roelant
- Center for Statistics, StatUa, University of Antwerp, Prinsstraat 13, Antwerp, Belgium
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, Edegem, Belgium
| | - Dirk Lips
- , Curando Vzw, Pensionaatstraat 58A, Ruiselede, Belgium
| | - Abdesselam Zhiri
- R&D Department, Pranarôm International S.A. 37, Avenue des Artisans, 7822, Ghislenghien, Belgium
- Plant Biotechnology Research Unit, Université Libre de Bruxelles (ULB), Plant Biotechnology Research Unit, CP 300, Rue Prof. Jeener & Brachet 12, 6041, Gosselies, Belgium
| | - Jo Hockley
- Primary Palliative Care Research Group, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | - Peter Van Bogaert
- Centre for Research and Innovation in Care, Antwerp University, Universiteitsplein 1, 2600, Wilrijk, Belgium
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10
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Diehl K, Kratzer A, Gräßel E. Under What Conditions Can People With Severe Dementia in Nursing Homes Benefit From a Multicomponent Psychosocial Intervention? DAS GESUNDHEITSWESEN 2023; 85:S218-S225. [PMID: 37751758 DOI: 10.1055/a-2132-6878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
BACKGROUND The majority of psychosocial interventions are considered effective in the treatment of dementia symptoms. However, there are hardly any evaluated concepts for people with severe dementia. An RCT study of patients with severe dementia in nursing homes during the Covid-19 pandemic found no effect of the newly developed multi-component intervention MAKS-s (motor, activities of daily living, cognitive, social version for persons with severe dementia) on patients' quality of life, behavioural and psychological symptoms. MATERIAL AND METHODS At the end of the controlled phase, 6 months after beginning of the study, the nursing staff of the control groups were also trained in MAKS-s. They were then free to decide whether and how often they wanted to use MAKS-s (open phase). By means of a written follow-up survey, conducted with trained therapists, after another 6 months, predictors for positive effects of the intervention on people with severe dementia were to be identified. The survey also aimed to identify predictors of therapy fidelity. Data acquisition based on a self-developed questionnaire, assessing the therapists' subjective ratings of the three areas of structure, process and outcome quality of the MAKS-s intervention. Apart from descriptive evaluations, the predictors of benefit for people with severe dementia were analysed using a linear regression model and the predictors of therapy fidelity by using a binary logistic regression model. RESULTS The more pronounced the normative restrictions due to the Covid-19 pandemic were, the more frequently manual deviations were observed. Fewer deviations from the manual were significantly associated with positive effects on people with severe dementia. CONCLUSION The results indicate the importance of therapy fidelity for the success of MAKS-s intervention. Therapy fidelity is decisive for the extent of the positive effects of MAKS-s, experienced by the therapists. Furthermore, the survey results show that activity-restricting pandemic policies in nursing homes negatively influenced the perceived effectiveness.
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Affiliation(s)
- Kristina Diehl
- Zentrum für Medizinische Versorgungsforschung, Psychiatrische und Psychotherapeutische Klinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen- Nürnberg, Erlangen, Germany
| | - André Kratzer
- Zentrum für Medizinische Versorgungsforschung, Psychiatrische und Psychotherapeutische Klinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen- Nürnberg, Erlangen, Germany
| | - Elmar Gräßel
- Zentrum für Medizinische Versorgungsforschung, Psychiatrische und Psychotherapeutische Klinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen- Nürnberg, Erlangen, Germany
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11
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Chae HJ, Lee SH. Effectiveness of online-based cognitive intervention in community-dwelling older adults with cognitive dysfunction: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2023; 38:e5853. [PMID: 36468299 PMCID: PMC10107881 DOI: 10.1002/gps.5853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 11/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) or mild dementia imposes a substantial burden on patients, families, and social systems. For MCI or mild dementia patient, cognitive training is required to prevent progression to dementia. With advances in digital health, cognitive interventions using information and communication technology (ICT) have become essential for maintaining independence and functioning in dementia patients. OBJECTIVES This study aimed to examine the effectiveness of an ICT-based cognitive intervention in community-dwelling older adults with MCI or mild dementia. METHODS A literature search was performed in four databases: Ovid-Medline, Ovid-EMBASE, Cochrane Library, and CINAHL. We selected studies published up to April 15, 2021, on topics related to cognitive interventions using ICT in older adults with MCI or mild dementia. RESULTS Forty-four studies were included in the analysis. Our meta-analysis showed that ICT-based cognitive interventions significantly improved the Mini-Mental State Examination score in the intervention group compared with that in the control group. Additionally, cognitive training using ICT was significantly effective for a period of more than 30 min, more than 6 weeks, and multi-domain content. Moreover, a significant reduction in depression was found in the intervention group compared with that in the control group. CONCLUSIONS ICT-based cognitive intervention had a positive effect on cognitive function, depression, and quality of life in older adults with MCI or mild dementia. Application of ICT-based cognitive training to community-dwelling older adults with MCI or mild dementia should be expanded, and nurses should play a pivotal role in mediating between these older adults.
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Affiliation(s)
- Hee Jae Chae
- Department of Nursing Science, College of Nursing, Gachon University, Incheon, Korea
| | - Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon, Korea
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12
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Non-pharmacological, psychosocial MAKS-s intervention for people with severe dementia in nursing homes: results of a cluster-randomised trial. BMC Geriatr 2022; 22:1001. [PMID: 36577973 PMCID: PMC9795142 DOI: 10.1186/s12877-022-03695-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Severe dementia is one of the most challenging conditions when caring for people in nursing homes. A manualised non-pharmacological, psychosocial group intervention especially adapted to the needs of people with severe dementia (PWSDs) is currently still lacking. To close this gap, we adapted the evidence-based multicomponent non-pharmacological MAKS intervention (Motor stimulation, ADL stimulation, Cognitive [german: Kognitive] stimulation, and Social functioning in a group setting) to the special needs of PWSDs called the MAKS-s intervention, where the s stands for severe dementia. METHODS In a prospective, multicentre, cluster-randomised trial with a waitlist control group design, 26 nursing homes comprising 152 PWSDs were randomly assigned to either the MAKS-s intervention group (IG) or control group (CG) - 121 PWSDs were still alive after the 6-month intervention period (t6) and included in the intention-to-treat (ITT) sample. The two primary outcomes, behavioural and psychological symptoms (BPSDs, measured with NPI-NH) and quality of life (QoL, measured with QUALIDEM), and the secondary outcome, activities of daily living (ADLs, measured with ADCS-ADL-sev), were assessed at baseline (t0) and at t6. Mixed ANOVAs were computed to investigate possible effects of the MAKS-s intervention on the outcomes. RESULTS In the ITT sample, BPSDs and QoL did not change significantly over time, and group assignment did not affect them, although the IG participants had significantly better overall QoL than the CG participants. ADLs decreased significantly over time, but group assignment did not affect them. Analyses in the per protocol (PP) sample showed comparable results, with the exception that the IG participants showed a significantly greater increase in BPSDs than the CG participants did. DISCUSSION Under the situational conditions of the Covid-19 pandemic, no beneficial effects of the MAKS-s intervention on BPSDs, QoL, or ADLs were observed. This finding also means that under 'normal circumstances' (i.e., if there had been no pandemic), we could not make any statements about the effect or non-effect of MAKS-s. In order to be able to address the hypotheses formulated here, the study will have to be repeated incorporating helpful experiences of the present study. TRIAL REGISTRATION https://doi.org/10.1186/ISRCTN15722923 (Registered prospectively, 07. August 2019).
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13
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Boongird C, Tearneukit W, Wongpipathpong W, McKay GJ, Thakkinstian A. Efficacy of pharmacotherapy and non-pharmacotherapy of Alzheimer dementia: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e32382. [PMID: 36550893 PMCID: PMC9771260 DOI: 10.1097/md.0000000000032382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Alzheimer disease (AD) is the most common cause of dementia worldwide. Despite the publication of numerous systematic reviews and meta-analyses that have summarized the evidence associated with pharmacotherapies (PTs) and non-pharmacotherapies (NPTs) for the wide range of interventions available for AD treatment, their comparative safety and efficacy remains insufficiently defined. METHODS Systematic reviews of randomized controlled trials (RCTs) will be selected according to the following criteria: conducted in elderly patients aged 60 years or older with AD living in community or institutionalized settings, applied pairwise meta-analysis (PMA) or network meta-analysis (NMA) approaches providing pooled relative treatment effects for at least 1 pair of PTs or NPTs, and providing at least 1 of the following outcomes for patients/caregivers: cognitive, functional status, behavior, quality of life (QoL), and caregiver stress or burden. All article screening, data extraction, and risk of bias assessment will be completed independently by 2 reviewers. Relative treatment rankings will be reported with mean ranks and surface under the cumulative ranking curves. RESULTS AND CONCLUSION We will determine the most efficacious treatment strategies for AD patients from the most highly ranked treatments. These results will help to guide clinical decision-making and improve patient care.
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Affiliation(s)
- Chitima Boongird
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
- * Correspondence: Chitima Boongird, Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 111 Moo 14, Bang Pla, Bang Phi, Samut Prakan 10540, Thailand (e-mail: )
| | | | - Wannisa Wongpipathpong
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Gareth J McKay
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Boccardi M, Handels R, Gold M, Grazia A, Lutz MW, Martin M, Nosheny R, Robillard JM, Weidner W, Alexandersson J, Thyrian JR, Winblad B, Barbarino P, Khachaturian AS, Teipel S. Clinical research in dementia: A perspective on implementing innovation. Alzheimers Dement 2022; 18:2352-2367. [PMID: 35325508 DOI: 10.1002/alz.12622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 01/31/2023]
Abstract
The increasing global prevalence of dementia demands concrete actions that are aimed strategically at optimizing processes that drive clinical innovation. The first step in this direction requires outlining hurdles in the transition from research to practice. The different parties needed to support translational processes have communication mismatches; methodological gaps hamper evidence-based decision-making; and data are insufficient to provide reliable estimates of long-term health benefits and costs in decisional models. Pilot projects are tackling some of these gaps, but appropriate methods often still need to be devised or adapted to the dementia field. A consistent implementation perspective along the whole translational continuum, explicitly defined and shared among the relevant stakeholders, should overcome the "research-versus-adoption" dichotomy, and tackle the implementation cliff early on. Concrete next steps may consist of providing tools that support the effective participation of heterogeneous stakeholders and agreeing on a definition of clinical significance that facilitates the selection of proper outcome measures.
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Affiliation(s)
- Marina Boccardi
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock-Greifswald Standort, Rostock, Germany
| | - Ron Handels
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Division of Neurogeriatrics, Dept for Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | | | - Alice Grazia
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock-Greifswald Standort, Rostock, Germany.,Department of Psychosomatic Medicine, Rostock Universitätsmedizin, Rostock, Germany
| | - Michael W Lutz
- Department of Neurology Duke University School of Medicine, Durham, North Carolina, USA
| | - Mike Martin
- Gerontology Center, University of Zurich, Zürich, Switzerland
| | - Rachel Nosheny
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA.,San Francisco Veteran's Administration Medical Center, San Francisco, California, USA
| | - Julie M Robillard
- The University of British Columbia; BC Children's & Women's Hospitals, Vancouver, Canada
| | | | | | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock-Greifswald Standort, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology of Healthcare, University Medicine of Greifswald, Greifswald, Germany
| | - Bengt Winblad
- Division of Neurogeriatrics, Dept for Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | | | - Ara S Khachaturian
- Alzheimer's & Dementia: The Journal of the Alzheimer's Association, Rockville, Maryland, USA.,Campaign to Prevent Alzheimer's Disease, Rockville, Maryland, USA
| | - Stefan Teipel
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock-Greifswald Standort, Rostock, Germany.,Department of Psychosomatic Medicine, Rostock Universitätsmedizin, Rostock, Germany
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15
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Chen HY, Li MC, Liao D, Li C, Ji QM, Guo P, Su Z, Yang YH, Xiao WH, Zhai WH. The Effect of Computer-Assisted Cognitive Remediation Therapy on Cognitive Function, Social Function and Quality of Life in Patients with Vascular Dementia. J Multidiscip Healthc 2022; 15:2473-2479. [PMID: 36324875 PMCID: PMC9620993 DOI: 10.2147/jmdh.s378079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/12/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Our study aimed to investigate the effects of computer-assisted cognitive remediation therapy (CCRT) on cognitive function, social function and quality of life in patients with vascular dementia (VD). METHODS Ninety-eight patients with VD were treated with CCRT in four 45-minute sessions per week over a course of 40 sessions to exercise four cognitive functions, including flexibility, working memory, plan execution and social cognition. The Mini-Mental State Examination (MMSE), Social Disability Screening Schedule (SDSS), Personal and Social Performance Scale (PSP), and Generic Quality of Life Inventory-74 (GQOL-74) were used to assess before and after treatment. RESULTS (1) The scores of orientation (5.60 ± 1.35), calculation (2.20 ± 0.79), verbal ability (7.10 ± 0.36), spatial ability (0.78 ± 0.42), immediate memory (2.42 ± 0.53), short-term memory (1.17 ± 0.78) and MMSE (23.36 ± 2.98) were all improved after treatment (P < 0.05) compared with those before treatment; (2) The scores of SDSS, PSP and Activities of Daily Living (ADL) after treatment were 8.23 ± 0.94, 81.36 ± 14.23, and 32.7 ± 12.1, and all of which improved (P < 0.05); (3) The scores of physical health were 68.24 ± 7.44, mental health were 69.75 ± 7.15, social function were 69.08 ± 7.43, material life were 37.46 ± 4.85 and the total score were 230.79 ± 9.56, all of which improved (P < 0.05). CONCLUSION For patients with VD, CCRT can improve their cognitive function, social function, daily life ability and quality of life.
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Affiliation(s)
- Hai-Ying Chen
- Department of Psychiatry, Wuhan Wudong Hospital, Wuhan, People’s Republic of China
| | - Ming-Chao Li
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, People’s Republic of China
| | - Dan Liao
- Department of Psychiatry, Wuhan Wudong Hospital, Wuhan, People’s Republic of China,Correspondence: Dan Liao; Chi Li, Department of Psychiatry, Wuhan Wudong Hospital, No. 46 of Wudong Street, Qingshan District, Wuhan, 430084, People’s Republic of China, Tel +86 27 5052 8367, Fax +86 27 8643 8247, Email
| | - Chi Li
- Department of Psychiatry, Wuhan Wudong Hospital, Wuhan, People’s Republic of China
| | - Qiu-Ming Ji
- Department of Psychiatry, Wuhan Wudong Hospital, Wuhan, People’s Republic of China
| | - Ping Guo
- Department of Psychiatry, Wuhan Wudong Hospital, Wuhan, People’s Republic of China
| | - Zou Su
- Department of Psychiatry, Wuhan Wudong Hospital, Wuhan, People’s Republic of China
| | - Yu-Hong Yang
- Department of Psychiatry, Wuhan Wudong Hospital, Wuhan, People’s Republic of China
| | - Wen-Hao Xiao
- Department of Psychiatry, Wuhan Wudong Hospital, Wuhan, People’s Republic of China
| | - Wen-Hui Zhai
- Department of Psychiatry, Wuhan Wudong Hospital, Wuhan, People’s Republic of China
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16
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Fastame MC, Mulas I, Putzu V, Asoni G, Viale D, Mameli I, Pau M. The efficiency of activities of daily living (ADLs) skills in late adulthood: A mediational approach. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-12. [PMID: 35981564 DOI: 10.1080/23279095.2022.2111261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The term "Activities of Daily Living" (ADLs) refers to a set of fundamental tasks (i.e., toileting, bathing, personal care, eating, grooming, and getting dressed) considered necessary for living and being autonomous in everyday life. Although in the clinical setting ADLs efficiency is a marker to diagnose dementia, limited evidence on the mechanism implicating muscular function and cognitive alterations in ADLs skills in late adulthood exists. This study primarily intended to determine the extent to which executive functions mediate between muscular strength, as assessed through handgrip strength (HGS) measurement, and ADLs skills of older community-dwellers. A further goal was to explore the impact of gender and cognitive status on ADLs and HGS scores, using education as a covariate. Three hundred and thirty-four older participants, 199 females and 135 males (Mage = 77.5 years, SD = 5.6 years, age range = 63-93 years) completed a battery of tests assessing ADLs, HGS, and executive functions. The results showed that 34-56% of the variance in the ADLs condition was explained by HGS and executive functioning. Furthermore, cognitively healthy participants exhibited better ADLs skills, whereas cognitively impaired individuals, both males and females, exhibited poorer HGS efficiency. In conclusion, in clinical settings, the concurrent evaluation of ADLs skills, motor, and higher-order cognitive processes should be encouraged to detect individuals needing a person-tailored intervention to boost their quality of life.
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Affiliation(s)
- Maria Chiara Fastame
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, Cagliari, Italy
| | - Ilaria Mulas
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Valeria Putzu
- Center for Cognitive Disorders and Dementia, ASSL Cagliari, Cagliari, Italy
| | - Gesuina Asoni
- Center for Cognitive Disorders and Dementia, ASSL Cagliari, Cagliari, Italy
| | - Daniela Viale
- Center for Cognitive Disorders and Dementia, ASSL Cagliari, Cagliari, Italy
| | - Irene Mameli
- Center for Cognitive Disorders and Dementia, ASSL Cagliari, Cagliari, Italy
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
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Jebelli J, Hamper MC, Van Quelef D, Caraballo D, Hartmann J, Kumi-Diaka J. The Potential Therapeutic Effects of Low-Dose Ionizing Radiation in Alzheimer's Disease. Cureus 2022; 14:e23461. [PMID: 35371871 PMCID: PMC8958987 DOI: 10.7759/cureus.23461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 01/20/2023] Open
Abstract
Dementia is an umbrella term used to describe a loss of cognitive function which results in the interference of an individual's daily life and activities. The most common form of dementia is Alzheimer's disease. Alzheimer’s is classified as a progressive, debilitating neurodegenerative disease that results in disturbances to a patient’s higher executive function, memory, language, and visuospatial orientation. Despite extensive research on Alzheimer’s dementia, including both available and potential therapeutic modalities, this neurodegenerative disease is incurable and will continue to pose a major public health concern. Current treatment options for Alzheimer’s focus on symptom management and/or delaying the progression of the disease. Therefore, new treatment strategies must be developed to combat such a deadly disease. One field of medicine that has garnered significant interest from researchers to potentially treat Alzheimer’s is low-dose ionizing radiation. Various reports suggest that the brain’s exposure to low doses of ionizing radiation may serve as a therapeutic modality for combating neurodegenerative diseases, including Alzheimer’s dementia. This article serves as a review of the current available treatments for Alzheimer’s disease and discusses recent studies that provide evidence for the potential use of low-dose ionizing radiation as a therapeutic in the treatment of Alzheimer’s disease.
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18
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A tablet-based intervention for activating nursing home residents with dementia: results from a cluster-randomized controlled trial. Int Psychogeriatr 2022; 34:129-141. [PMID: 34183087 DOI: 10.1017/s1041610221000818] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To investigate global and momentary effects of a tablet-based non-pharmacological intervention for nursing home residents living with dementia. DESIGN Cluster-randomized controlled trial. SETTING Ten nursing homes in Germany were randomly allocated to the tablet-based intervention (TBI, 5 units) or conventional activity sessions (CAS, 5 units). PARTICIPANTS N = 162 residents with dementia. INTERVENTION Participants received regular TBI (n = 80) with stimulating activities developed to engage people with dementia or CAS (n = 82) for 8 weeks. MEASUREMENTS Apathy Evaluation Scale (AES-I, primary outcome), Quality of Life in Alzheimer's Disease scale, QUALIDEM scale, Neuropsychiatric Inventory, Geriatric Depression Scale, and psychotropic medication (secondary outcomes). Momentary quality of life was assessed before and after each activity session. Participants and staff were blinded until the collection of baseline data was completed. Data were analyzed with linear mixed-effects models. RESULTS Levels of apathy decreased slightly in both groups (mean decrease in AES-I of .61 points, 95% CI -3.54, 2.33 for TBI and .36 points, 95% CI -3.27, 2.55 for CAS). Group difference in change of apathy was not statistically significant (β = .25; 95% CI 3.89, 4.38, p = .91). This corresponds to a standardized effect size (Cohen's d) of .02. A reduction of psychotropic medication was found for TBI compared to CAS. Further analyses revealed a post-intervention improvement in QUALIDEM scores across both groups and short-term improvements of momentary quality of life in the CAS group. CONCLUSIONS Our findings suggest that interventions involving tailored activities have a beneficial impact on global and momentary quality of life in nursing home residents with dementia. Although we found no clear advantage of TBI compared to CAS, tablet computers can support delivery of non-pharmacological interventions in nursing homes and facilitate regular assessments of fluctuating momentary states.
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Heilman KM, Nadeau SE. Emotional and Neuropsychiatric Disorders Associated with Alzheimer's Disease. Neurotherapeutics 2022; 19:99-116. [PMID: 35013934 PMCID: PMC9130428 DOI: 10.1007/s13311-021-01172-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 01/03/2023] Open
Abstract
Alzheimer's disease is associated with impairments in emotional communication including comprehension and production of facial emotional expressions, comprehension of affective prosody, and alexithymia. It is also associated with disorders of emotional experience including mood disorders (depression and anxiety), agitation/aggression, and psychosis. Agitation/aggression and psychosis are particularly disruptive, are associated with earlier institutionalization, and pose a major challenge to institutional management. Treatment of disorders of emotional experience has been primarily pharmacologic (reviewed here in detail) and has relied heavily on antipsychotic medications despite the small effect sizes demonstrated in a large number of randomized controlled trials and the prevalence of serious side effects associated with these drugs. Recent studies suggest that treatment with pimavanserin, an antipsychotic without activity at dopamine receptors, may represent an important advance for treatment of psychotic manifestations, even as the drug appears to pose significant risk. Dextromethorphan/quinidine may represent an important advance in the treatment of agitation/aggression. There is also compelling evidence that sleep disorders, which are common among patients with Alzheimer's disease and are readily treatable, may potentiate psychotic manifestations and agitation/aggression, but further studies are needed.
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Affiliation(s)
- Kenneth M Heilman
- Geriatric Research, Education, and Clinical Center, Malcom Randall VA Medical Center, 1601 SW Archer Road, Gainesville, FL, 32608-1197, USA
- The Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Road, Gainesville, FL, 32608-1197, USA
- Malcom Randall VA Medical Center and the Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Stephen E Nadeau
- Research Service, Malcom Randall VA Medical Center, 1601 SW Archer Road, Gainesville, FL, 32608-1197, USA.
- The Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Road, Gainesville, FL, 32608-1197, USA.
- Malcom Randall VA Medical Center and the Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA.
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20
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Lekchand Dasriya V, Samtiya M, Dhewa T, Puniya M, Kumar S, Ranveer S, Chaudhary V, Vij S, Behare P, Singh N, Aluko RE, Puniya AK. Etiology and management of Alzheimer's disease: Potential role of gut microbiota modulation with probiotics supplementation. J Food Biochem 2021; 46:e14043. [PMID: 34927261 DOI: 10.1111/jfbc.14043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/11/2021] [Accepted: 12/13/2021] [Indexed: 12/15/2022]
Abstract
Alzheimer's disease (AD) is the leading type of dementia in aging people and is a progressive condition that causes neurodegeneration, resulting in confusion, memory loss, and deterioration of mental functions. AD happens because of abnormal twisting of the microtubule tau protein in neurons into a tangled neurofibrillary structure. Different factors responsible for AD pathogenesis include heavy metals, aging, cardiovascular disease, and environmental and genetic factors. Market available drugs for AD have several side effects that include hepato-toxicity, accelerated cognitive decline, worsened neuropsychiatric symptoms, and triggered suicidal ideation. Therefore, an emerging alternative therapeutic approach is probiotics, which can improve AD by modulating the gut-brain axis. Probiotics modulate different neurochemical pathways by regulating the signalling pathways associated with inflammation, histone deacetylation, and microglial cell activation and maturation. In addition, probiotics-derived metabolites (i.e., short-chain fatty acid, neurotransmitters, and antioxidants) have shown ameliorative effects against AD. Probiotics also modulate gut microbiota, with a beneficial impact on neural signalling and cognitive activity, which can attenuate AD progression. Therefore, the current review describes the etiology and mechanism of AD progression as well as various treatment options with a focus on the use of probiotics. PRACTICAL APPLICATIONS: In an aging population, dementia concerns are quite prevalent globally. AD is one of the most commonly occurring cognition disorders, which is linked to diminished brain functions. Scientific evidence supports the findings that probiotics and gut microbiota can regulate/modulate brain functions, one of the finest strategies to alleviate such disorders through the gut-brain axis. Thus, gut microbiota modulation, especially through probiotic supplementation, could become an effective solution to ameliorate AD.
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Affiliation(s)
| | - Mrinal Samtiya
- Department of Nutrition Biology, Central University of Haryana, Mahendergarh, India
| | - Tejpal Dhewa
- Department of Nutrition Biology, Central University of Haryana, Mahendergarh, India
| | - Monica Puniya
- Food Safety and Standards Authority of India, FDA Bhawan, New Delhi, India
| | - Sanjeev Kumar
- Department of Life Science and Bioinformatics, Assam University, Silchar, India
| | - Soniya Ranveer
- Dairy Microbiology Division, ICAR-National Dairy Research Institute, Karnal, India
| | - Vishu Chaudhary
- Department of Microbiology, Punjab Agriculture University, Ludhiana, India
| | - Shilpa Vij
- Dairy Microbiology Division, ICAR-National Dairy Research Institute, Karnal, India
| | - Pradip Behare
- Dairy Microbiology Division, ICAR-National Dairy Research Institute, Karnal, India
| | - Namita Singh
- Department of Bio and Nano Technology, Guru Jambheshwar University of Science and Technology, Hisar, India
| | - Rotimi E Aluko
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anil Kumar Puniya
- Dairy Microbiology Division, ICAR-National Dairy Research Institute, Karnal, India
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Seok JW, Shin J, Kang B, Lee H, Cho E, Lee KH. Non-pharmacological interventions using information and communication technology for behavioral and psychological symptoms of dementia: A systematic review and meta-analysis protocol. J Adv Nurs 2021; 78:282-293. [PMID: 34812533 DOI: 10.1111/jan.15109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 11/27/2022]
Abstract
AIM To review and examine the effectiveness of non-pharmacological interventions on behavioural and psychological symptoms of dementia using information and communication technology. DESIGN This is a systematic review and meta-analysis. METHODS The databases including PubMed, CINAHL with Full Text (EBSCOhost), PsycINFO, Embase, and the Cochrane Library will be searched for all published studies. Studies will be screened and selected with criteria described in PICOS format. Risk of bias will be assessed by the National Institute for Health and Clinical Excellence checklist. Data will be extracted from eligible studies and used to perform a meta-analysis examining the overall effects and effects on individual outcomes. Additionally, we will conduct meta-regression to examine the association between explanatory variables and behavioural and psychological symptoms. This study has been funded since June 2020. DISCUSSION This study will be the first to reveal the effects of non-pharmacological interventions using information and communication technology on behavioural and psychological symptoms of dementia. Furthermore, this study will provide updated and valid evidence of interventions using this for managing behavioural and psychological symptoms of dementia. IMPACT Although non-pharmacological interventions using information and communication technology for older adults living with dementia are continuously developing, their direct effect remains unclear. This study will evaluate the effectiveness of these interventions on behavioural and psychological symptoms of dementia and provide the evidence to implement these interventions among older adults living with dementia. Thus, caregivers and nursing staff can manage behavioural and psychological symptoms of dementia more effectively by incorporating information and communication technology.
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Affiliation(s)
- Jo Woon Seok
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Jinhee Shin
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Bada Kang
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Hyangkyu Lee
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Eunhee Cho
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Kyung Hee Lee
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
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Hui EK, Tischler V, Wong GHY, Lau WYT, Spector A. Systematic review of the current psychosocial interventions for people with moderate to severe dementia. Int J Geriatr Psychiatry 2021; 36:1313-1329. [PMID: 34350626 DOI: 10.1002/gps.5554] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/15/2021] [Accepted: 03/30/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Dementia, a global epidemic, currently affects 50 million individuals worldwide. There are currently limited effective treatments for moderate to severe dementia, and most treatments focus on reducing symptoms rather than improving positive factors. It is unclear if improvements are not possible due to disease severity. This review examines the efficacy of the current psychosocial interventions for people with moderate to severe dementia, focusing on improving cognition and quality of life (QoL) to evaluate what treatments are working and whether improvements are possible. METHODS A systematic search was conducted using six key databases to identify psychosocial interventions for people with moderate to severe dementia, measuring cognition or QoL in randomized controlled trials (RCTs), published between 2000 and 2020. RESULTS The search identified 4193 studies, and 74 articles were assessed for full-text review. Fourteen RCTs were included and appraised with the Physiotherapy Evidence Database Scale. The included RCTs were moderate in quality. CONCLUSIONS Aromatherapy and reminiscence therapy showed the strongest evidence in improving QoL. There was some evidence that aerobic exercise enhanced cognition, and a multicomponent study improved QoL. However, a quality assessment, using pre-specified criteria, indicated many methodological weaknesses. While we found improvements in cognition and QoL for moderate to severe dementia, results must be interpreted with caution. Future interventions with rigorous study designs are a pressing need and required before we can recommend specific interventions.
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Affiliation(s)
- Esther K Hui
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Victoria Tischler
- European Center for Environment and Human Health, The University of Exeter, Truro, UK
| | - Gloria H Y Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - W Y Tiffany Lau
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Aimee Spector
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Late-life depression, subjective cognitive decline, and their additive risk in incidence of dementia: A nationwide longitudinal study. PLoS One 2021; 16:e0254639. [PMID: 34260630 PMCID: PMC8279395 DOI: 10.1371/journal.pone.0254639] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 07/01/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Late-life depression and subjective cognitive decline (SCD) are significant risk factors for dementia. However, studies with a large sample size are needed to clarify their independent and combined risks for subsequent dementia. Methods This nationwide population-based cohort study included all individuals aged 66 years who participated in the National Screening Program between 2009 and 2013 (N = 939,099). Subjects were followed from the day they underwent screening to the diagnosis of dementia, death, or the last follow-up day (December 31, 2017). Results Depressive symptom presentation, recent depressive disorder, and SCD independently increased dementia incidence with adjusted hazard ratio (aHR) of 1.286 (95% CI:1.255–1.318), 1.697 (95% CI:1.621–1.776), and 1.748 (95% CI: 689–1.808) respectively. Subjects having both SCD and depression had a higher risk (aHR = 2.466, 95% CI:2.383–2.551) of dementia than having depression (aHR = 1.402, 95% CI:1.364–1.441) or SCD (aHR = 1.748, 95% CI:1.689–1.808) alone. Conclusions Depressive symptoms, depressive disorder, and SCD are independent risk factors for dementia. Co-occurring depression and SCD have an additive effect on the risk of dementia; thus, early intervention and close follow up are necessary for patients with co-occurring SCD and depression.
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Wang SM, Park SS, Park SH, Kim NY, Kang DW, Na HR, Bae YY, Lee JW, Han S, Lim HK. Pre-transplant Dementia is Associated with Poor Survival After Hematopoietic Stem Cell Transplantation: A Nationwide Cohort Study with Propensity Score Matched Control. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2021; 19:294-302. [PMID: 33888658 PMCID: PMC8077055 DOI: 10.9758/cpn.2021.19.2.294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/14/2020] [Accepted: 10/26/2020] [Indexed: 01/07/2023]
Abstract
Objective No previous study examined impact of dementia in the outcome of allogeneic hematopoietic stem cell transplantation (HSCT). We aimed to investigate overall survival (OS) of patients with dementia after receiving HSCT. Methods Among 8,230 patients who underwent HSCT between 2002 and 2018, 5,533 patients younger than 50 years were first excluded. Remaining patients were divided into those who were and were not diagnosed with dementia before HSCT (dementia group n = 31; no dementia n = 2,666). Thereafter, among 2,666 participants without dementia, 93 patients were selected via propensity-matched score as non-dementia group. Patients were followed from the day they received HSCT to the occurrence of death or the last follow-up day (December 31, 2018), whichever came first. Results With median follow-up of 621 days for dementia group and 654 days for non-dementia group, 2 year-OS of dementia group was lower than that of non-dementia group (53.3% [95% confidence interval, 95% CI, 59.0−80.2%] vs. 68.8% [95% CI, 38.0−68.2%], p = 0.076). In multivariate analysis, dementia had significant impacts on OS (hazard risk = 2.539, 95% CI, 1.166−4.771, p = 0.017). Conclusion Our results indicated that patients diagnosed with dementia before HSCT have 2.539 times higher risk of mortality after transplantation than those not having dementia. With number of elderly needing HSCT is increasing, further work to establish treatment guidelines for the management of HSCT in people with dementia is needed.
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Affiliation(s)
- Sheng-Min Wang
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Soo Park
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - See Hyun Park
- Department of Pharmacology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nak-Young Kim
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Woo Kang
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae-Ran Na
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Yi Bae
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Wook Lee
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seunghoon Han
- Department of Pharmacology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Kook Lim
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Outcomes of clinical utility in amyloid-PET studies: state of art and future perspectives. Eur J Nucl Med Mol Imaging 2021; 48:2157-2168. [PMID: 33594474 PMCID: PMC8175294 DOI: 10.1007/s00259-020-05187-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/28/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To review how outcomes of clinical utility are operationalized in current amyloid-PET validation studies, to prepare for formal assessment of clinical utility of amyloid-PET-based diagnosis. METHODS Systematic review of amyloid-PET research studies published up to April 2020 that included outcomes of clinical utility. We extracted and analyzed (a) outcome categories, (b) their definition, and (c) their methods of assessment. RESULTS Thirty-two studies were eligible. (a) Outcome categories were clinician-centered (found in 25/32 studies, 78%), patient-/caregiver-centered (in 9/32 studies, 28%), and health economics-centered (5/32, 16%). (b) Definition: Outcomes were mainly defined by clinical researchers; only the ABIDE study expressly included stakeholders in group discussions. Clinician-centered outcomes mainly consisted of incremental diagnostic value (25/32, 78%) and change in patient management (17/32, 53%); patient-/caregiver-centered outcomes considered distress after amyloid-pet-based diagnosis disclosure (8/32, 25%), including quantified burden of procedure for patients' outcomes (n = 8) (1/8, 12.5%), impact of disclosure of results (6/8, 75%), and psychological implications of biomarker-based diagnosis (75%); and health economics outcomes focused on costs to achieve a high-confidence etiological diagnosis (5/32, 16%) and impact on quality of life (1/32, 3%). (c) Assessment: all outcome categories were operationalized inconsistently across studies, employing 26 different tools without formal rationale for selection. CONCLUSION Current studies validating amyloid-PET already assessed outcomes for clinical utility, although non-clinician-based outcomes were inconsistent. A wider participation of stakeholders may help produce a more thorough and systematic definition and assessment of outcomes of clinical utility and help collect evidence informing decisions on reimbursement of amyloid-PET.
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Galik EM, Resnick B, Holmes SD, Vigne E, Lynch K, Ellis J, Zhu S, Barr E. A Cluster Randomized Controlled Trial Testing the Impact of Function and Behavior Focused Care for Nursing Home Residents With Dementia. J Am Med Dir Assoc 2021; 22:1421-1428.e4. [PMID: 33454311 DOI: 10.1016/j.jamda.2020.12.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purpose of this study was to test the effectiveness of the Function and Behavior Focused Care for the Cognitively Impaired (FBFC-CI) intervention on function, physical activity, and behavioral symptoms among nursing home residents with dementia, and to explore the adoption of the intervention at the facility level. DESIGN This study was a clustered, randomized controlled trial with a repeated measures design that was implemented in 12 nursing homes randomized to either treatment (FBFC-CI) or educational control [Function and Behavior Focused Care Education (FBFC-ED)]. SETTING AND PARTICIPANTS Twelve nursing homes (6 treatment and 6 control) and 336 residents (173 treatment and 163 control) with moderate to severe cognitive impairment. MEASURES Outcomes included functional ability (Barthel Index), physical activity (actigraphy and survey), behavioral symptoms (Resistiveness to Care Scale, Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia), and psychotropic medication use. RESULTS The participants were 82.6 (SD = 10.1) years of age, mostly female, and were moderate to severely cognitively impaired (Mini-Mental State Exam of 7.8, SD = 5.1). There was a significantly greater increase in time spent in total activity (P = .004), moderate activity (P = .012), light activity (P = .002), and a decrease in resistiveness to care (P = .004) in the treatment versus control group at 4 months. There was no change in mood, agitation, and the use of psychotropic medications. There was some evidence of adoption of the intervention at treatment sites. CONCLUSIONS AND IMPLICATIONS This study provides some support for the use of the FBFC-CI Intervention to increase time spent in physical activity and decrease resistive behaviors during care commonly noted among nursing home residents with moderate to severe cognitive impairment.
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Affiliation(s)
| | - Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Sarah D Holmes
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Erin Vigne
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Karen Lynch
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Jeanette Ellis
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Erik Barr
- University of Maryland School of Nursing, Baltimore, MD, USA
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Parajuli DR, Kuot A, Hamiduzzaman M, Gladman J, Isaac V. Person-centered, non-pharmacological intervention in reducing psychotropic medications use among residents with dementia in Australian rural aged care homes. BMC Psychiatry 2021; 21:36. [PMID: 33441109 PMCID: PMC7805083 DOI: 10.1186/s12888-020-03033-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/29/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND High rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with dementia in the 'Harmony in the Bush Dementia Study'. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention. METHODS Our larger study (12 weeks period) was a quasi-experimental design conducted in five rural nursing homes in Australia. Medication charts (n = 31) were collected retrospectively from three rural aged care facilities. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up. RESULTS The median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n = 27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer's disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medications, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents' medication charts data covering 3-months pre- and post-intervention, however, these changes were not statistically significant. Additionally, there was a decreasing trend in the use of inappropriate medications. Psychotropic medications were prescribed in up to 43% and anti-dementia medications in 44% of participants for more than 6 months. Three themes extracted from qualitative data include decrease behavioral and psychiatric symptoms of dementia due to medication weaning or dose tapering, other strategies to reduce medication use, and environmental or noise control. CONCLUSIONS Our findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications in rural nursing homes as supported by findings from both quantitative and qualitative data. TRIAL REGISTRATION ANZCTR, ACTRN12618000263291 . Registered on 20th February 2018.
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Affiliation(s)
- Daya Ram Parajuli
- College of Medicine and Public Health, Flinders Rural Health South Australia, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, Australia.
| | - Abraham Kuot
- College of Medicine and Public Health, Flinders Rural Health South Australia, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, Australia
| | - Mohammad Hamiduzzaman
- College of Medicine and Public Health, Flinders Rural Health South Australia, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, Australia
| | - Justin Gladman
- College of Medicine and Public Health, Flinders Rural Health South Australia, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, Australia
| | - Vivian Isaac
- College of Medicine and Public Health, Flinders Rural Health South Australia, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, Australia
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Bogolepova A, Vasenina E, Gomzyakova N, Gusev E, Dudchenko N, Emelin A, Zalutskaya N, Isaev R, Kotovskaya Y, Levin O, Litvinenko I, Lobzin V, Martynov M, Mkhitaryan E, Nikolay G, Palchikova E, Tkacheva O, Cherdak M, Chimagomedova A, Yakhno N. Clinical Guidelines for Cognitive Disorders in Elderly and Older Patients. Zh Nevrol Psikhiatr Im S S Korsakova 2021. [DOI: 10.17116/jnevro20211211036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kwon HS, Yang HR, Yun K, Baek JS, Kim YU, Park S, Choi H. The Effect of Cognitive Training in a Day Care Center in Patients with Early Alzheimer's Disease Dementia: A Retrospective Study. Psychiatry Investig 2020; 17:829-834. [PMID: 32777919 PMCID: PMC7449833 DOI: 10.30773/pi.2020.0170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/14/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the effect of cognitive training programs on the progression of dementia in patients with early stage Alzheimer's disease dementia (ADD) at the day care center. METHODS From January 2015 to December 2018, a total of 119 patients with early ADD were evaluated. All subjects were classified into two groups according to participate in cognitive training program in addition to usual standard clinical care. Changes in scores for minimental status examination-dementia screening (MMSE-DS) and clinical dementia rating-sum of boxes (CDR-SOB) during the 12 months were compared between two groups. Multivariable logistic regression analyses were performed. RESULTS As compared to case-subjects (n=43), the MMSE-DS and CDR-SOB scores were significantly worse at 12 months in the control-subjects (n=76). A statistically significant difference between the two groups was observed due to changes in MMSE-DS (p=0.012) and CDR-SOB (p<0.001) scores. Multivariable logistic regression analysis showed that the cognitive training program (odds ratio and 95% confidence interval: 0.225, 0.070-0.725) was independently associated with less progression of ADD. CONCLUSION The cognitive training program was associated with benefits in maintaining cognitive function for patients with earlystage ADD that were receiving medical treatment.
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Affiliation(s)
- Hyuk Sung Kwon
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Ha-Rin Yang
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Kyungtaek Yun
- Namyangju City Public Health Center, Namyangju, Republic of Korea
| | - Jong Sook Baek
- Namyangju City Public Health Center, Namyangju, Republic of Korea
| | - Young Un Kim
- Namyangju City Public Health Center, Namyangju, Republic of Korea
| | - Seongho Park
- Department of Neurology, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Hojin Choi
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
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Park HK, Song MK, Kim JH, Han JY. A randomized controlled trial to evaluate the effectiveness and safety of electro acupuncture and transcranial direct current stimulation with computerized cognitive rehabilitation in patients with vascular cognitive impairment. Medicine (Baltimore) 2020; 99:e21263. [PMID: 32702911 PMCID: PMC7373529 DOI: 10.1097/md.0000000000021263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Vascular cognitive impairment (VCI) refers to all cognitive disorders caused by cerebrovascular disorders. For the treatment, many types of pharmacologic and nonpharmacologic treatments are used but their underlying mechanisms and effects are unclear. Regarding nonpharmacologic treatment, electroacupuncture (EA), transcranial direct current stimulation (tDCS), and computerized cognitive rehabilitation treatment (CCRT) are effective. Here, we report the protocol for a randomized controlled trial of the effect and safety of combination therapy of EA or tDCS and CCRT in patients with VCI. METHODS This study will be a prospective, outcome assessor-blinded, parallel-arm, randomized controlled clinical trial. Participants with cognitive impairment caused by stroke after 3 months of onset (n = 45) will be randomly assigned to a CCRT, combination therapy with EA and computerized cognitive rehabilitation treatment, or combination therapy with tDCS and computerized cognitive rehabilitation treatment group. All groups will receive treatment 3 times per week for 8 weeks, giving a total of 24 treatments. The CCRT group will perform a training task like shopping, calculating, and others and involving computerized cognitive assessment and brain training system (RehaCom) for 30 minutes. The combination therapy with EA and computerized cognitive rehabilitation treatment group will receive EA using 8 acupuncture points - baekhoe, sinjeong, both sides of pungji, 4 sites of sishencong - and will be applied using an EA stimulator and receive CCRT for 30 minutes at the same time. The combination therapy with tDCS and computerized cognitive rehabilitation treatment group will receive tDCS treatment and receive CCRT for 30 minutes at the same time. The primary outcome will be evaluated using the Lowenstein occupational therapy cognitive assessment, while other scales assessing walking ability, activities of daily living, and quality of life are considered secondary outcome measures. Outcomes will be evaluated before intervention, at the end of intervention 8 weeks after the first intervention, and 4 weeks after completion of the intervention program. DISCUSSION This study aims to examine the effect and safety of combination therapy with EA or tDCS and CCRT in patients with VCI. This study can be useful in developing new treatment technologies using collaborative research with combined traditional Korean and conventional medicines. TRIAL REGISTRATION This trial has been registered with cris.nih.go.kr (registration number, KCT 0003644 Registered 01 April 2019, http://cris.nih.go.kr).
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Affiliation(s)
- Hyeng Kyu Park
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju City
| | - Min Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju City
| | - Jae Hong Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Dongshin University, Naju City, Republic of Korea
| | - Jae Young Han
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju City
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Caregivers' Experience of Caring for a Family Member with Alzheimer's Disease: A Content Analysis of Longitudinal Social Media Communication. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124412. [PMID: 32575455 PMCID: PMC7345212 DOI: 10.3390/ijerph17124412] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 11/17/2022]
Abstract
Background: The population aging together with an increased incidence of Alzheimer’s disease (AD) should also be accompanied by a growing interest in healthcare research. Therefore, this study examines the nature of the caregiver’s work, its mental and physical demands, experience and questions, and the relationship between the person with AD, the caregiver, and family members. Methods: As social media has become the place where people share family situations, a Facebook private discussion group of caregivers was chosen as the analytical data source. The study documented the daily-life situations of one-hundred dyads based on 2110 posts published during a six-month or longer period. A content analysis classified communication into 35 categories of basic, instrumental, and extended activities of daily livings (ADLs) and newly designed caregiver’s daily issues (CDIs). Results: The frequently discussed topics were related to exhaustion and feelings of “giving up” by caregivers and interpersonal communication and help from family members. The highest support was found for the topics of aging and dying and family events. Conclusion: The communications of caregivers were diverse and rather associated with co-occupational ADLs and CDIs than basic or instrumental ADLs. The support of the group was mainly provided in coping with fundamental life changes.
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Behavioral Interventions for Alzheimer’s Management Using Technology: Home-Based Monitoring. CURRENT GERIATRICS REPORTS 2020. [DOI: 10.1007/s13670-020-00312-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Yiannopoulou KG, Papageorgiou SG. Current and Future Treatments in Alzheimer Disease: An Update. J Cent Nerv Syst Dis 2020; 12:1179573520907397. [PMID: 32165850 PMCID: PMC7050025 DOI: 10.1177/1179573520907397] [Citation(s) in RCA: 352] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/24/2020] [Indexed: 01/08/2023] Open
Abstract
Disease-modifying treatment strategies for Alzheimer disease (AD) are still under extensive research. Nowadays, only symptomatic treatments exist for this disease, all trying to counterbalance the neurotransmitter disturbance: 3 cholinesterase inhibitors and memantine. To block the progression of the disease, therapeutic agents are supposed to interfere with the pathogenic steps responsible for the clinical symptoms, classically including the deposition of extracellular amyloid β plaques and intracellular neurofibrillary tangle formation. Other underlying mechanisms are targeted by neuroprotective, anti-inflammatory, growth factor promotive, metabolic efficacious agents and stem cell therapies. Recent therapies have integrated multiple new features such as novel biomarkers, new neuropsychological outcomes, enrollment of earlier populations in the course of the disease, and innovative trial designs. In the near future different specific agents for every patient might be used in a “precision medicine” context, where aberrant biomarkers accompanied with a particular pattern of neuropsychological and neuroimaging findings could determine a specific treatment regimen within a customized therapeutic framework. In this review, we discuss potential disease-modifying therapies that are currently being studied and potential individualized therapeutic frameworks that can be proved beneficial for patients with AD.
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Affiliation(s)
| | - Sokratis G Papageorgiou
- Cognitive Disorders/Dementia Unit, 2nd Neurological Department, National and Kapodistrian University of Athens, Attikon General University Hospital, Athens, Greece
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Gilson A, Dodds D, Kaur A, Potteiger M, Ford Ii JH. Using Computer Tablets to Improve Moods for Older Adults With Dementia and Interactions With Their Caregivers: Pilot Intervention Study. JMIR Form Res 2019; 3:e14530. [PMID: 31482847 PMCID: PMC6751094 DOI: 10.2196/14530] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/09/2019] [Accepted: 07/28/2019] [Indexed: 12/16/2022] Open
Abstract
Background Persons living with dementia represent a significant and growing segment of the older adult (aged 65 years and older) population. They are often challenged expressively and may experience difficulties with sharing their feelings or moods. Availability of, and easy access to, tablets facilitates the use of information and communication technologies (ICTs) as a delivery mechanism for nonpharmacological interventions, especially for persons living with dementia. Evidence of the impact of ICTs in different community settings on mood with older adults and the impact of engagement on their caregivers is needed to promote broader adoption and sustainment of these technologies in the United States. Objective This study aimed to determine the extent of the effects of tablets on positive mood change and examine the effects of study variables on care recipients’ mood changes and caregivers’ daily interactions. Methods The tablet intervention was developed and evaluated in five programs. The primary outcome was caregivers’ assessment of care recipients’ mood (n=1089) before and after a tablet engagement session using an eight-point mood visual analog scale. Session influence on caregivers’ daily activities was captured for a subsample of participants (n=542). Frequency distributions were computed for each study variables. Chi-square tests of association were calculated to determine the association of the variables on mood changes for all care recipients, as well as those being treated in skilled nursing facilities and in-home, and then for those that affected caregivers’ daily activities. Results The study sample comprised 1089 care recipient and caregiver engagement sessions. Cumulatively, 50.78% (553/1089) of care recipients showed a transition from negative to positive moods, whereas another 41.78% (455/1089) maintained an already-positive mood after the caregiver engagement session. Chi-square analyses demonstrated that positive mood changes resulted from using music (χ210=72.9; P<.001), using YouTube as the sole app (χ212=64.5; P<.001), using multiple engagement strategies (χ22=42.8; P<.001), and when cared for in a skilled nursing facility (χ24=236.8; P<.001) across the entire care recipient sample. In addition, although many features of the engagement session positively influenced the caregivers’ day, the largest effect was observed when care recipients’ mood was considered to have improved following the session (χ24=234.7; P<.001). Conclusions The study is one of the first in the United States to explore the impact of ICTs, in particular managed tablets and Web-based video services that can be used on a tablet through an app, on improving mood in persons living with dementia, and enhancing caregivers’ perceptions about their care recipient interactions. Importantly, these pilot data substantiate ICTs as part of a personalized engagement approach, as beneficial alternatives to pharmaceutical interventions for mood enhancement. However, a more comprehensive study that explores the ICT’s impact on additional clinical outcomes is needed to confirm these preliminary findings.
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Affiliation(s)
- Aaron Gilson
- University of Wisconsin-Madison, School of Pharmacy, Madison, WI, United States
| | | | - Arveen Kaur
- University of Wisconsin-Madison, School of Pharmacy, Madison, WI, United States
| | | | - James H Ford Ii
- University of Wisconsin-Madison, School of Pharmacy, Madison, WI, United States
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Behavioral Disturbances in Dementia and Beyond: Time for a New Conceptual Frame? Int J Mol Sci 2019; 20:ijms20153647. [PMID: 31349706 PMCID: PMC6695658 DOI: 10.3390/ijms20153647] [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: 05/28/2019] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 12/13/2022] Open
Abstract
Alzheimer’s disease and vascular dementia are estimated to be the most common causes of dementia, although mixed dementia could represent the most prevalent form of dementia in older adults aged more than 80 years. Behavioral disturbances are common in the natural history of dementia. However, so far, there is a paucity of studies that investigated the causal association between behavioral psychological symptoms of dementia and dementia sub-types, due to the high heterogeneity of methodology, study design and type of clinical assessment. To understand the scant evidence on such a relevant clinical issue, it could be hypothesized that a new shifting paradigm could result in a better identification of the relationship between behavioral disturbances and dementia. This narrative review provides an update of evidence on the behavioral patterns associated with different dementia sub-types and offers a potential future perspective as common ground for the development of new translational studies in the field of behavioral disturbances in dementia and the appropriateness of psychoactive treatments.
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