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Hart XM, Gründer G, Ansermot N, Conca A, Corruble E, Crettol S, Cumming P, Hefner G, Frajerman A, Howes O, Jukic M, Kim E, Kim S, Manisalco I, Moriguchi S, Müller DJ, Nakajima S, Osugo M, Paulzen M, Ruhe HG, Scherf-Clavel M, Schoretsanitis G, Serretti A, Spina E, Spigset O, Steimer W, Süzen HS, Uchida H, Unterecker S, Vandenberghe F, Verstuyft C, Zernig G, Hiemke C, Eap CB. Optimisation of pharmacotherapy in psychiatry through therapeutic drug monitoring, molecular brain imaging and pharmacogenetic tests: focus on antipsychotics. World J Biol Psychiatry 2024:1-123. [PMID: 38913780 DOI: 10.1080/15622975.2024.2366235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 06/06/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND For psychotic disorders (i.e. schizophrenia), pharmacotherapy plays a key role in controlling acute and long-term symptoms. To find the optimal individual dose and dosage strategy, specialized tools are used. Three tools have been proven useful to personalize drug treatments: therapeutic drug monitoring (TDM) of drug levels, pharmacogenetic testing (PG), and molecular neuroimaging. METHODS In these Guidelines, we provide an in-depth review of pharmacokinetics, pharmacodynamics, and pharmacogenetics for 50 antipsychotics. Over 30 international experts in psychiatry selected studies that have measured drug concentrations in the blood (TDM), gene polymorphisms of enzymes involved in drug metabolism, or receptor/transporter occupancies in the brain (positron emission tomography (PET)). RESULTS Study results strongly support the use of TDM and the cytochrome P450 (CYP) genotyping and/or phenotyping to guide drug therapies. Evidence-based target ranges are available for titrating drug doses that are often supported by PET findings. CONCLUSION All three tools discussed in these Guidelines are essential for drug treatment. TDM goes well beyond typical indications such as unclear compliance and polypharmacy. Despite its enormous potential to optimize treatment effects, minimize side effects and ultimately reduce the global burden of diseases, personalized drug treatment has not yet become the standard of care in psychiatry.
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Affiliation(s)
- X M Hart
- Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - G Gründer
- Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- German Center for Mental Health (DZPG), partner site Mannheim - Heidelberg - Ulm
| | - N Ansermot
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - A Conca
- Dipartimento di Psichiatria, Comprensorio Sanitario di Bolzano, Bolzano, Italy
| | - E Corruble
- Université Paris-Saclay, AP-HP, Service Hospitalo-Universitaire de Psychiatrie, Hôpital de Bicêtre
- Equipe MOODS, Inserm U1018, CESP (Centre de Recherche en Epidémiologie et Sante des Populations), Le Kremlin-Bicêtre, France
| | - S Crettol
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - P Cumming
- Department of Nuclear Medicine, Bern University Hospital, Bern, Switzerland
- School of Psychology and Counseling, Queensland University of Technology, Brisbane, Australia
| | - G Hefner
- Vitos Clinic for Forensic Psychiatry, Forensic Psychiatry, Eltville, Germany
| | - A Frajerman
- Université Paris-Saclay, AP-HP, Service Hospitalo-Universitaire de Psychiatrie, Hôpital de Bicêtre
- Equipe MOODS, Inserm U1018, CESP (Centre de Recherche en Epidémiologie et Sante des Populations), Le Kremlin-Bicêtre, France
| | - O Howes
- Department of Psychosis Studies, IoPPN, King's College London, De Crespigny Park, London, SE5 8AF, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - M Jukic
- Department of Physiology, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia and Pharmacogenetics Section, Department of Physiology and Pharmacology, Karolinska Institutet, Solna, Sweden
| | - E Kim
- Department of Psychiatry, Seoul National University College of Medicine, Republic of Korea
| | - S Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Republic of Korea
| | - I Manisalco
- Dipartimento di Psichiatria, Comprensorio Sanitario di Bolzano, Bolzano, Italy
| | - S Moriguchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - D J Müller
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - S Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - M Osugo
- Department of Psychosis Studies, IoPPN, King's College London, De Crespigny Park, London, SE5 8AF, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - M Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University
- JARA - Translational Brain Medicine, Aachen, Germany; Alexianer Center for Mental Health, Aachen, Germany
| | - H G Ruhe
- Department of psychiatry, Radboudumc, Nijmegen, Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
| | - M Scherf-Clavel
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - G Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland
| | - A Serretti
- Department of Medicine and Surgery, Kore University of Enna, Italy
| | - E Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - O Spigset
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - W Steimer
- Institute of Clinical Chemistry and Pathobiochemistry, Technical University Munich, Munich, Germany
| | - H S Süzen
- Department of Pharmaceutic Toxicology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
| | - H Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - S Unterecker
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - F Vandenberghe
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - C Verstuyft
- Department of Molecular Genetics, Pharmacogenetics and Hormonology Bicêtre University Hospital Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, F-94275, France
- CESP, MOODS Team, INSERM UMR 1018, Medicine Faculty, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - G Zernig
- Department of Pharmacology, Medical University Innsbruck; Private Practice for Psychotherapy and Court-Certified Witness, Hall in Tirol, Austria
| | - C Hiemke
- Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Germany
| | - C B Eap
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Department of Psychiatry, Centre for Psychiatric Neuroscience, Lausanne University Hospital, University of Lausanne, 1008 Prilly, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, University of Lausanne, Lausanne, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Lausanne, Switzerland
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Siwek A, Marcinkowska M, Głuch-Lutwin M, Mordyl B, Wolak M, Jastrzębska-Więsek M, Wilczyńska-Zawal N, Wyska E, Szafrańska K, Karcz T, Ostrowska O, Bucki A, Kołaczkowski M. Dual 5-HT 6/SERT ligands for mitigating neuropsychiatric symptoms of dementia exerting neuroprotection against amyloid-β toxicity, memory preservation, and antidepressant-like properties. Eur J Med Chem 2024; 275:116601. [PMID: 38901106 DOI: 10.1016/j.ejmech.2024.116601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/07/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
In light of the biological targets alterations in dementia patients suffering from neuropsychiatric symptoms, particularly in the 5-HT6 receptor and SERT transporters, this study aimed to develop dual-acting molecules targeting both these targets. By combining a 5-substituted indole with piperazine scaffolds, we synthesized molecules with nanomolar affinities for these sites, avoiding interaction with off-targets detrimental to dementia patients. Preliminary pharmacodynamic and ADMET assays let the identification of compound 15 as a lead molecule. In vitro studies showed that 15 provided neuroprotection against Aβ toxicity and reduced the levels of proapoptotic enzymes: caspase 3 and 7. In vivo, 15 reversed MK-801-induced memory deficits and exhibited antidepressant-like effects. Further studies showed that acute administration of compound 15 at a dose of 5 mg/kg increased BDNF levels, which are crucial for supporting neuronal survival and potentially slowing cognitive decline in dementia. These findings suggest 15's potential as a therapeutic for behavioral and psychological symptoms of dementia (BPSD), warranting further investigation.
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Affiliation(s)
- Agata Siwek
- Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna St., 30-688, Krakow, Poland.
| | - Monika Marcinkowska
- Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna St., 30-688, Krakow, Poland
| | - Monika Głuch-Lutwin
- Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna St., 30-688, Krakow, Poland
| | - Barbara Mordyl
- Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna St., 30-688, Krakow, Poland
| | - Małgorzata Wolak
- Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna St., 30-688, Krakow, Poland
| | | | - Natalia Wilczyńska-Zawal
- Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna St., 30-688, Krakow, Poland
| | - Elżbieta Wyska
- Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna St., 30-688, Krakow, Poland
| | - Katarzyna Szafrańska
- Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna St., 30-688, Krakow, Poland
| | - Tadeusz Karcz
- Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna St., 30-688, Krakow, Poland
| | - Olga Ostrowska
- Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna St., 30-688, Krakow, Poland
| | - Adam Bucki
- Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna St., 30-688, Krakow, Poland
| | - Marcin Kołaczkowski
- Jagiellonian University Medical College, Faculty of Pharmacy, 9 Medyczna St., 30-688, Krakow, Poland; Adamed Pharma S.A., Pienkow, 6A Mariana Adamkiewicza St., 05-152, Czosnów, Poland
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Kelberman MA, Winther KE, Medvedeva YM, Donaldson ZR. Aging leads to sex-dependent effects on pair bonding and increased number of oxytocin-producing neurons in monogamous prairie voles. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.17.594752. [PMID: 38798336 PMCID: PMC11118570 DOI: 10.1101/2024.05.17.594752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Pair bonds powerfully modulate health, which becomes particularly important when facing the detrimental effects of aging. To examine the impact of aging on relationship formation and response to loss, we examined behavior in 6-, 12-, and 18-month male and female prairie voles, a monogamous species that forms mating-based pair bonds. We found that older males (18-months) bonded quicker than younger voles, while similarly aged female voles increased partner directed affiliative behaviors. Supporting sex differences in bonding behaviors, we found that males were more likely to sample both partner and novel voles while females were more likely to display partner preference during the initial 20 minutes of the test. Using partner separation to study loss, we observed an erosion of partner preference only in 12-month females, but an overall decrease in partner-directed affiliation in females across all groups, but not in males. Finally, we found that the number of oxytocin, but not vasopressin, cells in the paraventricular hypothalamus increased during aging. These results establish prairie voles as a novel model to study the effects of normal and abnormal aging on pair bonding. Highlights 18-month male voles demonstrate accelerated bond formation18-month female voles increase partner-directed huddling after 2 wksBonds erode faster in 12-month female voles after partner separationFemale behavior from partner preference tests is reflected in free interactionThe number of paraventricular hypothalamus oxytocin cells increase during aging.
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Amiri P, Samadani M, Khazaee PR, Bahaadinbeigy K. Development of the Dardashna Checklist for Identifying Triggers of Behavioral Change in Individuals With Dementia: A Qualitative Study. J Gerontol Nurs 2024; 50:37-46. [PMID: 38170462 DOI: 10.3928/00989134-20231212-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The purpose of the current qualitative study was to describe the development of the Dardashna Checklist to clinically identify behavior change triggers in individuals with dementia. Semi-structured, in-depth, face-to-face interviews were conducted with four physicians and four experienced caregivers involved in the care of individuals with dementia. From analysis of participants' interviews, themes extracted included Triggers of Behavioral Change in Individuals With Dementia and Types of Behavioral Changes, using the checklist structure as a guide. The information gathered by this checklist conveys important messages to experienced physicians or caregivers who want to help less experienced caregivers or individuals with dementia. In this case, physicians' prescriptions and the responses of other experienced caregivers will be more targeted and useful. This checklist will help facilitate clinical care decisions, improve quality of life, reduce expenses and side effects of medications, and improve communication among persons with dementia, their caregivers, and health care providers. [Journal of Gerontological Nursing, 50(1), 37-46.].
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Johnson CE, Duncan MJ, Murphy MP. Sex and Sleep Disruption as Contributing Factors in Alzheimer's Disease. J Alzheimers Dis 2024; 97:31-74. [PMID: 38007653 PMCID: PMC10842753 DOI: 10.3233/jad-230527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
Alzheimer's disease (AD) affects more women than men, with women throughout the menopausal transition potentially being the most under researched and at-risk group. Sleep disruptions, which are an established risk factor for AD, increase in prevalence with normal aging and are exacerbated in women during menopause. Sex differences showing more disrupted sleep patterns and increased AD pathology in women and female animal models have been established in literature, with much emphasis placed on loss of circulating gonadal hormones with age. Interestingly, increases in gonadotropins such as follicle stimulating hormone are emerging to be a major contributor to AD pathogenesis and may also play a role in sleep disruption, perhaps in combination with other lesser studied hormones. Several sleep influencing regions of the brain appear to be affected early in AD progression and some may exhibit sexual dimorphisms that may contribute to increased sleep disruptions in women with age. Additionally, some of the most common sleep disorders, as well as multiple health conditions that impair sleep quality, are more prevalent and more severe in women. These conditions are often comorbid with AD and have bi-directional relationships that contribute synergistically to cognitive decline and neuropathology. The association during aging of increased sleep disruption and sleep disorders, dramatic hormonal changes during and after menopause, and increased AD pathology may be interacting and contributing factors that lead to the increased number of women living with AD.
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Affiliation(s)
- Carrie E. Johnson
- University of Kentucky, College of Medicine, Department of Molecular and Cellular Biochemistry, Lexington, KY, USA
| | - Marilyn J. Duncan
- University of Kentucky, College of Medicine, Department of Neuroscience, Lexington, KY, USA
| | - M. Paul Murphy
- University of Kentucky, College of Medicine, Department of Molecular and Cellular Biochemistry, Lexington, KY, USA
- University of Kentucky, Sanders-Brown Center on Aging, Lexington, KY, USA
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Reyna NC, Clark BJ, Hamilton DA, Pentkowski NS. Anxiety and Alzheimer's disease pathogenesis: focus on 5-HT and CRF systems in 3xTg-AD and TgF344-AD animal models. Front Aging Neurosci 2023; 15:1251075. [PMID: 38076543 PMCID: PMC10699143 DOI: 10.3389/fnagi.2023.1251075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/25/2023] [Indexed: 02/12/2024] Open
Abstract
Dementia remains one of the leading causes of morbidity and mortality in older adults. Alzheimer's disease (AD) is the most common type of dementia, affecting over 55 million people worldwide. AD is characterized by distinct neurobiological changes, including amyloid-beta protein deposits and tau neurofibrillary tangles, which cause cognitive decline and subsequent behavioral changes, such as distress, insomnia, depression, and anxiety. Recent literature suggests a strong connection between stress systems and AD progression. This presents a promising direction for future AD research. In this review, two systems involved in regulating stress and AD pathogenesis will be highlighted: serotonin (5-HT) and corticotropin releasing factor (CRF). Throughout the review, we summarize critical findings in the field while discussing common limitations with two animal models (3xTg-AD and TgF344-AD), novel pharmacotherapies, and potential early-intervention treatment options. We conclude by highlighting promising future pharmacotherapies and translational animal models of AD and anxiety.
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Affiliation(s)
- Nicole C. Reyna
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
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Goel AV, Rivera-Hernandez M. Quality at nursing homes with high proportion of residents with cognitive impairment. Geriatr Nurs 2023; 50:65-71. [PMID: 36641858 DOI: 10.1016/j.gerinurse.2022.12.018] [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: 10/03/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION There is limited data on staffing ratings at nursing homes (NHs) serving residents with dementia, despite staffing impacting quality of care. METHODS Residents' cognitive impairment status, staffing rating, and facility characteristics were obtained for 11,469 NHs, using data from the Centers for Medicare & Medicaid Services and Long-term Care: Facts on Care in the U.S. The association between the proportion of residents with cognitive impairment and nurse staffing rating was analyzed using multiple logistic regression in a cross-sectional study design. RESULTS NHs with a high proportion of residents with cognitive impairment were 41% less likely to have a high staffing rating or high RN staffing rating (95% CI: 0.52-0.67) compared to NHs with a low proportion. DISCUSSION NHs that serve a higher proportion of residents with cognitive impairment have lower staffing ratings, and this disparity is more pronounced in NHs with more minority residents. Increasing staffing levels is a necessary policy measure to improve care in these facilities.
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Affiliation(s)
- Anuva V Goel
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
| | - Maricruz Rivera-Hernandez
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
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Challenges of Agitation in Dementia: A Plea for Early Discussion. Harv Rev Psychiatry 2023; 31:22-27. [PMID: 36608080 PMCID: PMC9855747 DOI: 10.1097/hrp.0000000000000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Behavioral and psychological symptoms of dementia (BPSD) occur frequently among people with dementia and are known precipitants for placement in care facilities. Despite the social, financial, and psychological impact on dementia care, education and discussions on BPSD have not been routinely included in advance care planning (ACP). As a result, families can face great challenges in making complex medical decisions when their loved ones are admitted to the geriatric psychiatric inpatient unit with refractory BPSD. We present the case of an 83-year-old gentleman with BPSD to illustrate universal struggles in dementia care experienced by many families, which could have been alleviated by education and discussions around BPSD earlier in the patient's dementia course. A literature search did not yield any articles that mention discussions of BPSD in ACP. The lack of literature referencing BPSD in ACP supports our clinical experiences with the case and highlights the need for improvement in current dementia care. We propose a guideline for providers to facilitate conversations around BPSD as an integral part of ACP, including discussions of four key points related to the progressive nature of dementia, the commonality of BPSD, the lack of FDA-approved treatment for BPSD, and the difficulty in balancing agitation and sedation to allow safe placement. We firmly believe it is important to start discussion on BPSD as part of ACP as early as possible. Early education and discussion will help to facilitate meaningful care decisions as patients and families navigate the challenges associated with this progressive disease.
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Prent N, Jonker FA, Schouws SNTM, Jonker C. The risk of criminal behavior in the elderly and patients with neurodegenerative disease. HANDBOOK OF CLINICAL NEUROLOGY 2023; 197:181-196. [PMID: 37633709 DOI: 10.1016/b978-0-12-821375-9.00004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
Behavioral changes are commonly observed in patients with dementia and can lead to criminal offenses, even without a history of criminal or antisocial behavior. Due to the growth of the aging population, this poses a rising problem to deal with for the criminal justice system and in general for society. Criminal behavior may include minor crimes such as theft or traffic violations, but also serious crimes such as physical abuse, sexual offense, or murder. In the assessment of criminal behavior among elderly (first-time) offenders, it is important to be aware of possible neurodegenerative diseases at the time of the crime. This book chapter provides an overview on criminal behavior in the elderly and specifically discusses existing literature on patients suffering from a neurodegenerative disease, including Alzheimer disease, vascular dementia, frontotemporal dementia, Parkinson disease, and Huntington disease. Each section is introduced by a true case to illustrate how the presence of a neurodegenerative disease may affect the criminal judgment. The chapter ends with a summary, multifactorial model of crime risk, future perspectives, and concluding remarks.
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Affiliation(s)
- Naomi Prent
- Department of Clinical, Neuro-, and Developmental Psychology, Section Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands; Department of Neuropsychiatry, Altrecht Mental Health Institute, Woerden, The Netherlands.
| | - Frank A Jonker
- Department of Clinical, Neuro-, and Developmental Psychology, Section Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands; Department of Neuropsychiatry, Altrecht Mental Health Institute, Woerden, The Netherlands
| | | | - Cees Jonker
- Department Epidemiology and Biostatistics, Amsterdam UMC, Amsterdam, The Netherlands
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The Role of Dietary Lipids in Cognitive Health: Implications for Neurodegenerative Disease. Biomedicines 2022; 10:biomedicines10123250. [PMID: 36552006 PMCID: PMC9775642 DOI: 10.3390/biomedicines10123250] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022] Open
Abstract
Neurodegenerative diseases are a group of disorders characterised by progressive loss of brain function. The most common of these is Alzheimer's disease, a form of dementia. Intake of macro- and micro-nutrients impacts brain function, including memory, learning, mood, and behaviour. Lipids, particularly phospholipids and sphingolipids, are crucial structural components of neural tissues and significantly affect cognitive function. The importance of functional foods in preventing cardiovascular disease is well-documented in the current literature. However, the significance of such foods for central nervous system health and neurodegenerative diseases is less recognized. Gut microbiome composition affects cognitive health and function, and dietary lipids are known to influence gut health. Thus, this review will discuss different sources of dietary lipids and their effect on cognitive functioning and their interaction with the gut microbiome in the context of neurodegenerative disease.
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Weng X, Shen C, Van Scoy LJ, Boltz M, Joshi M, Wang L. End-of-Life Costs of Cancer Patients With Alzheimer's Disease and Related Dementias in the U.S. J Pain Symptom Manage 2022; 64:449-460. [PMID: 35931403 DOI: 10.1016/j.jpainsymman.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT End-of-Life (EOL) care consumes a substantial amount of healthcare resources, especially among older persons with cancer. Having Alzheimer's Disease and Related Dementias (ADRD) brings additional complexities to these patients' EOL care. OBJECTIVES To examine the Medicare expenditures at the EOL (last 12 months of life) among beneficiaries having cancer and ADRD vs. those without ADRD. METHODS A retrospective cohort study used 2004-2016 Surveillance, Epidemiology, and End Results-Medicare data. Patient populations were deceased Medicare beneficiaries with cancer (breast, lung, colorectal, and prostate) and continuously enrolled for 12 months before death. Beneficiaries with ADRD were propensity score matched with non-ADRD counterparts. Generalized Estimating Equation Model was deployed to estimate monthly Medicare expenditures. Generalized Linear Models were constructed to assess total EOL expenditures. RESULTS Eighty six thousand three hundred ninety-six beneficiaries were included (43,198 beneficiaries with ADRD and 43,198 beneficiaries without ADRD). Beneficiaries with ADRD utilized $64,901 at the EOL, which was roughly $407 more than those without ADRD ($64,901 vs. $64,494, P = 0.31). Compared to beneficiaries without ADRD, those with ADRD had 11% higher monthly expenditure and 7% higher in total expenditures. Greater expenditure was incurred on inpatient (5%), skilled nursing facility (SNF) (119%), home health (42%), and hospice (44%) care. CONCLUSION Medicare spending at the EOL per beneficiary was not statistically different between cohorts. However, specific types of service (i.e., inpatient, SNF, home health, and hospice) were significantly higher in the ADRD group compared to their non-ADRD counterparts. This study underscored the potential financial burden and informed Medicare about allocation of resources at the EOL.
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Affiliation(s)
- Xingran Weng
- Department of Public Health Sciences, Penn State College of Medicine (X.W., C.S., L.J.V.S., L.W.), Hershey, Pennsylvania, USA.
| | - Chan Shen
- Department of Public Health Sciences, Penn State College of Medicine (X.W., C.S., L.J.V.S., L.W.), Hershey, Pennsylvania, USA; Division of Outcomes, Research and Quality, Department of Surgery, Penn State College of Medicine (C.S.), Hershey, Pennsylvania, USA
| | - Lauren J Van Scoy
- Department of Public Health Sciences, Penn State College of Medicine (X.W., C.S., L.J.V.S., L.W.), Hershey, Pennsylvania, USA; Department of Medicine, Penn State College of Medicine (L.J.V.S.), Hershey, Pennsylvania, USA; Department of Humanities, Penn State College of Medicine (L.J.V.S.), Hershey, Pennsylvania, USA
| | - Marie Boltz
- Ross and Carole Nese Penn State College of Nursing (M.B.), University Park, Pennsylvania, USA
| | - Monika Joshi
- Division of Hematology-Oncology, Department of Medicine, Penn State Cancer Institute (M.J.), Hershey, Pennsylvania, USA
| | - Li Wang
- Department of Public Health Sciences, Penn State College of Medicine (X.W., C.S., L.J.V.S., L.W.), Hershey, Pennsylvania, USA
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Hermush V, Ore L, Stern N, Mizrahi N, Fried M, Krivoshey M, Staghon E, Lederman VE, Bar-Lev Schleider L. Effects of rich cannabidiol oil on behavioral disturbances in patients with dementia: A placebo controlled randomized clinical trial. Front Med (Lausanne) 2022; 9:951889. [PMID: 36148467 PMCID: PMC9486160 DOI: 10.3389/fmed.2022.951889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAlmost 90% of patients with dementia suffer from some type of neurobehavioral symptom, and there are no approved medications to address these symptoms.ObjectiveTo evaluate the safety and efficacy of the medical cannabis oil “Avidekel” for the reduction of behavioral disturbances among patients with dementia.Materials and methodsIn this randomized, double-blind, single-cite, placebo-controlled trial conducted in Israel (ClinicalTrials.gov: NCT03328676), patients aged at least 60, with a diagnosis of major neurocognitive disorder and associated behavioral disturbances were randomized 2:1 to receive either “Avidekel,” a broad-spectrum cannabis oil (30% cannabidiol and 1% tetrahydrocannabinol: 295 mg and 12.5 mg per ml, respectively; n = 40) or a placebo oil (n = 20) three times a day for 16 weeks. The primary outcome was a decrease, as compared to baseline, of four or more points on the Cohen-Mansfield Agitation Inventory score by week 16.ResultsFrom 60 randomized patients [mean age, 79.4 years; 36 women (60.0%)], 52 (86.7%) completed the trial (all eight patients who discontinued treatment were from the investigational group). There was a statistically significant difference in the proportion of subjects who had a Cohen-Mansfield Agitation Inventory score reduction of ≥ 4 points at week 16: 24/40 (60.0%) and 6/20 (30.0%) for investigational and control groups, respectively (χ2 = 4.80, P = 0.03). There was a statistically significant difference in the proportion of subjects who had a Cohen-Mansfield Agitation Inventory score reduction of ≥ 8 points at week 16: 20/40 (50%) and 3/20 (15%), respectively (χ2 = 6.42, P = 0.011). The ANOVA repeated measures analysis demonstrated significantly more improvement in the investigational group compared to the control group at weeks 14 and 16 (F = 3.18, P = 0.02). Treatment was mostly safe, with no significant differences in the occurrence of adverse events between the two groups.ConclusionIn this randomized controlled trial, ‘Avidekel’ oil significantly reduced agitation over placebo in patients suffering from behavioral disturbances related to dementia, with non-serious side-effects. Further research is required with a larger sample size.
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Affiliation(s)
- Vered Hermush
- Geriatric Wing, Laniado Hospital, Netanya, Israel
- Technion School of Medicine, Haifa, Israel
- *Correspondence: Vered Hermush,
| | - Liora Ore
- Department of Graduate Studies in Health Systems Management, The Max Stern Yezreel Valley College, Jezreel Valley, Israel
| | - Noa Stern
- Geriatric Wing, Laniado Hospital, Netanya, Israel
- Technion School of Medicine, Haifa, Israel
| | | | - Malki Fried
- Geriatric Wing, Laniado Hospital, Netanya, Israel
| | | | - Ella Staghon
- Geriatric Wing, Laniado Hospital, Netanya, Israel
| | | | - Lihi Bar-Lev Schleider
- Research Department, Tikun-Olam Cannbit Pharmaceuticals, Tel Aviv, Israel
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
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Basu I, Mukhopadhyay S. Neuropsychiatric symptoms of dementia and caregivers' burden: a study among Indian caregivers. Dement Neuropsychol 2022; 16:332-340. [PMID: 36619839 PMCID: PMC9762380 DOI: 10.1590/1980-5764-dn-2022-0017] [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: 03/07/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 01/11/2023] Open
Abstract
Dementia is considered a most serious and disabling condition, affecting both the individual suffering from it and their caregiver. Objective The study aimed to evaluate the relationship between neuropsychiatric problems of dementia and caregiver burden. Methods A total of 138 caregivers of people with dementia participated in this cross-sectional study. The caregivers completed the questionnaires containing sociodemographic information as well as neuropsychiatric problems of dementia and caregiver burden. Results The findings showed that all of the care-recipients were suffering from some kind of neuropsychiatric symptoms, the most common being apathy, anxiety, motor disturbance, and hallucination. Out of 12 symptoms, 11 were significantly associated with caregivers' burden. The most important finding is that the severity of neuropsychiatric symptoms is highly responsible for severe caregivers' burden. Conclusions The identification of neuropsychiatric symptoms of dementia that influence caregiver burden is very critical for both caregivers' and care-recipients' health perspective. These findings can also be utilized to create care settings for demented people and help determine policies in the future.
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Affiliation(s)
- Ipsita Basu
- Indian Statistical Institute, Biological Anthropology Unit,
Kolkata, West Bengal, India
| | - Susmita Mukhopadhyay
- Indian Statistical Institute, Biological Anthropology Unit,
Kolkata, West Bengal, India
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14
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Paul R, Bera S, Devi M, Paul S. Inhibition of Aβ 16–22 Peptide Aggregation by Small Molecules and Their Permeation through POPC Lipid Bilayer: Insight from Molecular Dynamics Simulation Study. J Chem Inf Model 2022; 62:5193-5207. [DOI: 10.1021/acs.jcim.1c01366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Rabindranath Paul
- Department of Chemistry, Indian Institute of Technology, Guwahati, Assam, India 781039
| | - Siddhartha Bera
- Department of Chemistry, Indian Institute of Technology, Guwahati, Assam, India 781039
| | - Madhusmita Devi
- Department of Chemistry, Indian Institute of Technology, Guwahati, Assam, India 781039
| | - Sandip Paul
- Department of Chemistry, Indian Institute of Technology, Guwahati, Assam, India 781039
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15
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The effectiveness of physical exercise interventions in the management of neuropsychiatric symptoms in dementia patients: a systematic review. Int Psychogeriatr 2022; 34:177-190. [PMID: 33818342 DOI: 10.1017/s1041610221000193] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The management of neuropsychiatric symptoms (NPS) in patients with dementia is a major challenge. Since no effective therapy has been found to date and drug treatments are associatedwith significant side effects, there seems to be a pressing need for alternative non-pharmacological interventions. OBJECTIVES The current study aims to investigate and compare the effect of different types of physical exercise on the NPS. METHODS A systematic review of the literature was conducted according to the PRISMA guidelines. Five databases (SCOPUS, PubMed, SPORT Discus, Web of science and ScienceDirect) were searched using the appropriate algorithm. What was sought out was randomized control trials (RCTs) that applied physical activity interventions with specific characteristics (type, frequency, intensity, and duration) in patients with dementia or mild cognitive impairment, studied the effect of exercise on their NPS and compared this effect with a control group that did not follow an exercise program. RESULTS From 512 articles, 13 studies were included in this review, involving a total of 1,925 patients. The results were analyzed and synthesized according to the type of exercise applied - aerobic exercise, multidimensional interventions and muscular strength training programs. In particular, the results showed that repetitive aerobic exercise three to five times a week had a positive effect on NPS, whereas multidimensional interventions combining different types of exercise did not appear to be as effective. Strength training programs have been found to significantly reduce depression symptoms and behavioral problems in demented patients with mobility problems. CONCLUSIONS There is clear evidence that physical activity and especially aerobic exercise may be effective in the management of NPS. However, it is necessary to apply specific practical recommendations and specially designed programs to incorporate physical exercise into the daily routine of these patients.
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16
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Polzer ER, Nearing KA, Knoepke CE, Matlock DD, Betz ME. Firearm access and dementia: A qualitative study of reported behavioral disturbances and responses. J Am Geriatr Soc 2022; 70:439-448. [PMID: 34590304 PMCID: PMC8821127 DOI: 10.1111/jgs.17496] [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: 04/07/2021] [Revised: 09/01/2021] [Accepted: 09/05/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Cognitive impairment and behavioral changes associated with Alzheimer's disease and related dementias (ADRDs) can impair safe firearm handling ability, an issue that can be challenging for ADRD caregivers to address. In this qualitative analysis, we sought to explore behavioral disruptions that raise concerns about firearm access in dementia and how caregivers react and respond. METHODS Secondary qualitative analysis using data from semi-structured, one-on-one interviews originally conducted as part of a study to develop firearm safety educational materials for ADRD caregivers. Interviewees were English-speaking adults (≥18 years) from three stakeholder groups: ADRD caregivers (professional or informal), medical professionals (geriatricians, neurologists), and firearm professionals (retailers, range employees, instructors). For secondary analysis, transcripts of interviews were recoded and analyzed after an inductive-deductive thematic analysis process. RESULTS Among 24 participants, 17 (70%) were female and 20 (83%) white; 13 (54%) had personal or professional experience with ADRD caregiving; and 5 (21%) had a firearm affiliation. Major themes were: (1) behavioral disturbances that make caregivers concerned about firearm access; (2) caregiver emotional responses to and difficulties associated with these disturbances; and (3) caregiver actions (planned or actual) to limit firearms access. CONCLUSION Various behavioral disturbances and emotional burdens can trigger ADRD caregiver concern about firearms access, but strategies exist for restricting or safeguarding firearms in the home. Study findings suggest a need for caregiver support on this topic, including counseling by healthcare providers, advance planning for older firearm owners, and development of community resources.
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Affiliation(s)
- Evan R. Polzer
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO, 80045
| | - Kathryn A. Nearing
- Division of Geriatrics and Multidisciplinary Center on Aging, University of Colorado, School of Medicine, Aurora, CO, 80045,VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, 80045
| | - Christopher E. Knoepke
- Division of Cardiology, University of Colorado, School of Medicine, Aurora, CO, 80045, Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado, School of Medicine, Aurora, CO, 80045
| | - Daniel D. Matlock
- Division of Geriatrics and Multidisciplinary Center on Aging, University of Colorado, School of Medicine, Aurora, CO, 80045, Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado, School of Medicine, Aurora, CO, 80045,Division of Geriatric Medicine, University of Colorado, School of Medicine, Aurora, CO, 80045
| | - Marian E. Betz
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO, 80045,VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, 80045
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17
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Parker K, Vincent B, Rhee Y, Choi BJ, Robinson-Lane SG, Hamm JM, Klawitter L, Jurivich DA, McGrath R. The estimated prevalence of no reported dementia-related diagnosis in older Americans living with possible dementia by healthcare utilization. Aging Clin Exp Res 2022; 34:359-365. [PMID: 34524654 PMCID: PMC8925882 DOI: 10.1007/s40520-021-01980-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Screening for dementia in relevant healthcare settings may help in identifying low cognitive functioning for comprehensive cognitive assessments and subsequent dementia treatment after diagnosis. AIMS This study sought to estimate the prevalence of no reported dementia-related diagnosis in a nationally-representative sample of older Americans with a cognitive impairment consistent with dementia (CICD) by healthcare utilization. METHODS The unweighted analytical sample included 1514 Americans aged ≥ 65 years that were identified as having a CICD without history of stroke, cancers, neurological conditions, or brain damage who participated in at least one-wave of the 2010-2016 waves of the Health and Retirement Study. An adapted Telephone Interview of Cognitive Status assessed cognitive functioning. Those with scores ≤ 6 had a CICD. Dementia-related diagnosis was self-reported. Respondents indicated if they visited a physician, received home healthcare, or experienced an overnight nursing home stay in the previous two years. RESULTS The prevalence of no reported dementia-related diagnosis in persons with a CICD who visited a physician was 89.9% (95% confidence interval (CI): 85.4%-93.1%). Likewise, the prevalence of no reported diagnosis in those with a CICD who received home healthcare was 84.3% (CI: 75.1-90.5%). For persons with a CICD that had an overnight nursing home stay, the prevalence of no reported dementia-related diagnosis was 83.0% (CI: 69.1-91.4%). DISCUSSION Although the prevalence of no reported dementia-related diagnosis in individuals with a CICD differed across healthcare settings, the prevalence was generally high nonetheless. CONCLUSIONS We recommend increased awareness and efforts be given to dementia screenings in various clinical settings.
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Affiliation(s)
- Kelly Parker
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, NDSU Dept 2620, PO Box 6050, Fargo, ND 58108, USA
| | - Brenda Vincent
- Department of Statistics, North Dakota State University, Fargo, ND, USA
| | - Yeong Rhee
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, NDSU Dept 2620, PO Box 6050, Fargo, ND 58108, USA,Department of Statistics, North Dakota State University, Fargo, ND, USA,Department of Public Health, North Dakota State University, Fargo, ND, USA
| | - Bong-Jin Choi
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, NDSU Dept 2620, PO Box 6050, Fargo, ND 58108, USA,Department of Statistics, North Dakota State University, Fargo, ND, USA,Department of Public Health, North Dakota State University, Fargo, ND, USA
| | | | - Jeremy M. Hamm
- Department of Psychology, North Dakota State University, Fargo, ND, USA
| | - Lukus Klawitter
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, NDSU Dept 2620, PO Box 6050, Fargo, ND 58108, USA
| | - Donald A. Jurivich
- Department of Geriatrics, University of North Dakota, Grand Forks, ND, USA
| | - Ryan McGrath
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, NDSU Dept 2620, PO Box 6050, Fargo, ND, 58108, USA. .,Fargo VA Healthcare System, Fargo, ND, USA.
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18
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Gonzales MM, Krishnamurthy S, Garbarino V, Daeihagh AS, Gillispie GJ, Deep G, Craft S, Orr ME. A geroscience motivated approach to treat Alzheimer's disease: Senolytics move to clinical trials. Mech Ageing Dev 2021; 200:111589. [PMID: 34687726 PMCID: PMC9059898 DOI: 10.1016/j.mad.2021.111589] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/04/2021] [Accepted: 10/18/2021] [Indexed: 12/29/2022]
Abstract
The pathogenic processes driving Alzheimer's disease (AD) are complex. An incomplete understanding of underlying disease mechanisms has presented insurmountable obstacles for developing effective disease-modifying therapies. Advanced chronological age is the greatest risk factor for developing AD. Intervening on biological aging may alter disease progression and represents a novel, complementary approach to current strategies. Toward this end, cellular senescence has emerged as a promising target. This complex stress response harbors damaged cells in a cell cycle arrested, apoptosis-resistant cell state. Senescent cells accumulate with age where they notoriously secrete molecules that contribute to chronic tissue dysfunction and disease. Thus, benefits of cell survival in a senescent fate are countered by their toxic secretome. The removal of senescent cells improves brain structure and function in rodent models at risk of developing AD, and in those with advanced Aβ and tau pathology. The present review describes the path to translating this promising treatment strategy to AD clinical trials. We review evidence for senescent cell accumulation in the human brain, considerations and strategies for senescence-targeting trials specific to AD, approaches to detect senescent brain cells in biofluids, and summarize the goals of the first senolytic trials for the treatment of AD (NCT04063124 and NCT04685590). This article is part of the Special Issue - Senolytics - Edited by Joao Passos and Diana Jurk.
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Affiliation(s)
- Mitzi M Gonzales
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Sudarshan Krishnamurthy
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; Bowman Gray Center for Medical Education, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Valentina Garbarino
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ali S Daeihagh
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gregory J Gillispie
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gagan Deep
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Suzanne Craft
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Miranda E Orr
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA; Salisbury VA Medical Center, Salisbury, NC, USA.
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19
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Fillit H, Aigbogun MS, Gagnon‐Sanschagrin P, Cloutier M, Davidson M, Serra E, Guérin A, Baker RA, Houle CR, Grossberg G. Impact of agitation in long-term care residents with dementia in the United States. Int J Geriatr Psychiatry 2021; 36:1959-1969. [PMID: 34286877 PMCID: PMC9291552 DOI: 10.1002/gps.5604] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/15/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To describe characteristics and compare clinical outcomes including falls, fractures, infections, and neuropsychiatric symptoms (NPS) among long-term care residents with dementia with and without agitation. METHODS A cross-sectional secondary analysis of administrative healthcare data was conducted whereby residents with dementia residing in a long-term care facility for ≥12 months were identified from the AnalytiCare LLC database (10/2010-06/2014) and were classified into mutually exclusive cohorts (Agitation Cohort or No-Agitation Cohort) based on available agitation-related symptoms. Entropy balancing was used to balance demographic and clinical characteristics between the two cohorts. The impact of agitation on clinical outcomes was compared between balanced cohorts using weighted logistic regression models. RESULTS The study included 6,265 long-term care residents with dementia among whom, 3,313 were included in the Agitation Cohort and 2,952 in the No-Agitation Cohort. Prior to balancing, residents in the Agitation Cohort had greater dementia-related cognitive impairment and clinical manifestations compared to the No-Agitation Cohort. After balancing, residents with and without agitation, respectively, received a median of five and four distinct types of medications (including antipsychotics). Further, compared to residents without agitation, those with agitation were significantly more likely to have a recorded fall (OR = 1.58), fracture (OR = 1.29), infection (OR = 1.18), and other NPS (OR = 2.11). CONCLUSIONS Agitation in long-term care residents with dementia was associated with numerically higher medication use and an increased likelihood of experiencing falls, fractures, infections, and additional NPS compared to residents without agitation, highlighting the unmet need for effective management of agitation symptoms in this population.
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Affiliation(s)
- Howard Fillit
- Geriatric Medicine, Palliative Care and NeuroscienceIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Myrlene S. Aigbogun
- Health Economics and Outcomes ResearchOtsuka Pharmaceutical Development and Commercialization Inc.PrincetonNJUSA
| | | | | | | | | | | | - Ross A. Baker
- Health Economics and Outcomes ResearchOtsuka Pharmaceutical Development and Commercialization Inc.PrincetonNJUSA
| | - Christy R. Houle
- Health Economics and Outcomes ResearchLundbeck PharmaceuticalsDeerfieldILUSA
| | - George Grossberg
- Geriatric PsychiatrySaint Louis University School of MedicineSaint LouisMOUSA
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20
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Gonzales MM, Krishnamurthy S, Garbarino V, Daeihagh AS, Gillispie GJ, Deep G, Craft S, Orr ME. A geroscience motivated approach to treat Alzheimer’s disease: Senolytics move to clinical trials. Mech Ageing Dev 2021. [DOI: 10.1016/j.mad.2021.111589
expr 868687188 + 807217478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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21
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Sultana M, Campbell K, Jennings M, Montero-Odasso M, Orange JB, Knowlton J, St George A, Bryant D. Virtual Reality Experience Intervention May Reduce Responsive Behaviors in Nursing Home Residents with Dementia: A Case Series. J Alzheimers Dis 2021; 84:883-893. [PMID: 34602467 DOI: 10.3233/jad-210010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND People with advanced dementia often exhibit responsive behaviors such as apathy, depression, agitation, aggression, and psychosis. Non-pharmacological approaches (e.g., listening to music, watching television, doing arts and crafts) are now considered as a first-line strategy to manage responsive behaviors in clinical practice due to the potential risks associated with the antipsychotic medications. To date, no evaluations of immersive non-head mounted virtual reality (VR) experience as a non-pharmacologic approach for people with advanced dementia living in nursing homes have been reported. OBJECTIVE To evaluate the feasibility (acceptance and safety) of VR experience. METHODS A single site case series (nonrandomized and unblinded) with a convenience sample (N = 24; age = 85.8±8.6 years; Cognitive Performance Scale score = 3.4±0.6) measuring depression and agitation before and after the intervention. The intervention was a 30-min long research coordinator- facilitated VR experience for two weeks (10 sessions). RESULTS The intervention was feasible (attrition rate = 0% ; adverse events = 0). A reduction in depression and in agitation was observed after the intervention. However, we suggest extreme caution in interpreting this result considering the study design and small sample size. CONCLUSION This study provides the basis for conducting a randomized controlled trial to evaluate the effect of VR experience on responsive behaviors in nursing homes. Since our intervention uses a smart remote-controlled projector without a headset, infectious exposure can be avoided following the COVID-19 pandemic-induced physical distancing policy in care homes.
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Affiliation(s)
- Munira Sultana
- Health and Rehabilitation Sciences, Western University, London, ON, Canada.,Gait & Brain Lab, Parkwood Institute, London, ON, Canada
| | - Karen Campbell
- International Skin Tear Advisory Panel, Ottawa, ON, Canada.,Primacare Living Solutions Inc.TM, Toronto, ON, Canada.,Master of Clinical Science - Advanced Health Care Practice, Western University, London, ON, Canada
| | - Morgan Jennings
- Health and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Manuel Montero-Odasso
- Gait & Brain Lab, Parkwood Institute, London, ON, Canada.,Department of Medicine and Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.,Geriatric Medicine, St. Joseph's Health Care, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - J B Orange
- Lawson Health Research Institute, London, ON, Canada
| | - Jill Knowlton
- Primacare Living Solutions Inc.TM, Toronto, ON, Canada
| | | | - Dianne Bryant
- Lawson Health Research Institute, London, ON, Canada.,School of Physical Therapy and Schulich School of Medicine & Dentistry (Orthopaedic Surgery), Western University, London, ON, Canada.,Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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22
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Marcinkowska M, Bucki A, Sniecikowska J, Zagórska A, Fajkis-Zajączkowska N, Siwek A, Gluch-Lutwin M, Żmudzki P, Jastrzebska-Wiesek M, Partyka A, Wesołowska A, Abram M, Przejczowska-Pomierny K, Cios A, Wyska E, Mika K, Kotańska M, Mierzejewski P, Kolaczkowski M. Multifunctional Arylsulfone and Arylsulfonamide-Based Ligands with Prominent Mood-Modulating Activity and Benign Safety Profile, Targeting Neuropsychiatric Symptoms of Dementia. J Med Chem 2021; 64:12603-12629. [PMID: 34436892 PMCID: PMC8436213 DOI: 10.1021/acs.jmedchem.1c00497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
![]()
The current pharmaceutical
market lacks therapeutic agents designed
to modulate behavioral disturbances associated with dementia. To address
this unmet medical need, we designed multifunctional ligands characterized
by a nanomolar affinity for clinically relevant targets that are associated
with the disease pathology, namely, the 5-HT2A/6/7 and
D2 receptors. Compounds that exhibited favorable functional
efficacy, water solubility, and metabolic stability were selected
for more detailed study. Pharmacological profiling revealed that compound 11 exerted pronounced antidepressant activity (MED 0.1 mg/kg),
outperforming commonly available antidepressant drugs, while compound 16 elicited a robust anxiolytic activity (MED 1 mg/kg), exceeding
comparator anxiolytics. In contrast to the existing psychotropic agents
tested, the novel chemotypes did not negatively impact cognition.
At a chronic dose regimen (25 days), 11 did not induce
significant metabolic or adverse blood pressure disturbances. These
promising therapeutic-like activities and benign safety profiles make
the novel chemotypes potential treatment options for dementia patients.
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Affiliation(s)
- Monika Marcinkowska
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Adam Bucki
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Joanna Sniecikowska
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Agnieszka Zagórska
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | | | - Agata Siwek
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Monika Gluch-Lutwin
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Paweł Żmudzki
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | | | - Anna Partyka
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Anna Wesołowska
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Michał Abram
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | | | - Agnieszka Cios
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Elżbieta Wyska
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Kamil Mika
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Magdalena Kotańska
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
| | - Paweł Mierzejewski
- Institute of Psychiatry and Neurology, 9 Sobieskiego Street, 02-957 Warsaw, Poland
| | - Marcin Kolaczkowski
- Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland.,Adamed Pharma S.A., 6A Mariana Adamkiewicza Street, Pienkow, 05-152 Czosnow, Poland
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Ordóñez MDLÁ, Ordóñez PDLÁ. Sleep in Persons Living with Alzheimer's Disease and Related Dementias. Nurs Clin North Am 2021; 56:249-263. [PMID: 34023119 DOI: 10.1016/j.cnur.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Over a typical lifespan, the amount of time people spend each day sleeping decreases. Sleep patterns also change as people age. Sleep disorders are common among persons of all ages, and older adults are particularly vulnerable. Development of age-related neurodegenerative diseases, such as Alzheimer's disease and related dementias, is associated with pronounced sleep disruption. This article provides evidence-based guidelines for diagnosis and clinical management of sleep disorders that occur during the course of treatment of Alzheimer's disease and related dementias. The article presents novel interventions and future directions for clinical practice and sleep research, and addresses diversity and inclusivity.
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Affiliation(s)
- María de Los Ángeles Ordóñez
- Louis and Anne Green Memory and Wellness Center of the Christine E. Lynn College of Nursing (CELCON), Florida Atlantic University (FAU), FAU CELCON; Alzheimer's Disease Initiative, Florida Department of Elder Affairs; Federal Advisory Council on Alzheimer's Research, Care, and Services, US Department of Health and Human Services, 777 Glades Rd, Bldg. AZ-79, Boca Raton, FL 33431, USA.
| | - Patricia de Los Ángeles Ordóñez
- Nova Southeastern University (NSU), College of Psychology; Care, Supportive Services, and Outreach Coordinator, Louis and Anne Green Memory; Wellness Center of the Christine E. Lynn College of Nursing (CELCON), Florida Atlantic University (FAU); Alzheimer's Disease Initiative, Florida Department of Elder Affairs, 777 Glades Rd, Bldg. AZ-79, Boca Raton, FL 33431, USA
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24
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Design, synthesis, and biological evaluation of novel indanone-based hybrids as multifunctional cholinesterase inhibitors for Alzheimer's disease. J Mol Struct 2021. [DOI: 10.1016/j.molstruc.2020.129787] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Adolfo CS, Albougami ASB, Roque MY, Almazan JU. Nursing care toward older adults with dementia: An integrative review. Scand J Caring Sci 2021; 36:173-182. [PMID: 33686669 DOI: 10.1111/scs.12974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/15/2020] [Accepted: 01/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dementia among older adults is receiving increase attention due to its neurodegenerative pathologies and poses a significant challenge for healthcare services systems. Caring for older adults with dementia is frequently challenging. This integrative review appraised and synthesised the existing literature describing the nursing care given to older adults with dementia. METHODS An integrative review was used using six electronic databases (CINAHL, Medline, Science direct-Elsevier, Proquest, Pubmed and Web of Science). The search terms that were included in various combinations using mesh terms were as follows: nurse* OR nursing staff* AND caring OR care OR caring behavior OR affectionate OR compassionate AND older person* OR aging* OR elder* OR geriatric patient* OR older adult* OR gerontology* OR aged* OR old age. A standardised review by Kmet et al. instrument was utilised for appraising the quality of selected 13 articles. RESULTS The results were presented based on the two major themes: challenges in providing care and identifying and managing older adults' difficult behaviours. CONCLUSION The findings of an integrative review can be used as a foundation for formulating recommendations for how dementia care by nurses can be improved and highlighting where policy development and further research are needed.
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Affiliation(s)
- Cris S Adolfo
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | | | - Mark Y Roque
- College of Nursing, Taibah University, Madinah, Saudi Arabia
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Banko SJ, Harrison C, Rittereiser J, Jurkovitz C, Ellison JM. Cause for Concern: Behavioral and Psychological Symptoms of Dementia in Delaware's Long-Term Care Facilities. DELAWARE MEDICAL JOURNAL 2021; 93:82-87. [PMID: 36035807 PMCID: PMC9410563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Much of the suffering and expense associated with treatment of persons with dementia (Major Neurocognitive Disorder) arises from associated noncognitive behavioral and psychological symptoms of dementia (BPSD). Although a consensus on the prevalence of BPSD is lacking, evidence suggests that most people with dementia will manifest one or more of these symptoms during the disorder's progression. BPSD raise the cost of care by leading to more frequent emergency room visits, more and longer hospitalizations, and earlier admission to long-term care facilities (LTCF). Treatment of BPSD presents a stressful challenge in LTCFs. We sought to investigate the care burden of BPSD in Delaware's LTCFs and to gather data that can inform management approaches. METHODS Using REDCap, we created an anonymous cross-sectional survey designed for completion by LTCF administrators. The Delaware Health Care Facilities Association (DHCFA) and Delaware's Division of Services for Aging and Adults with Physical Disabilities (DSAAPD) encouraged participation. A link to the survey was emailed to the administrators of 81 facilities in Delaware. The resulting data were evaluated using descriptive statistics. RESULTS Forty-four of the 81 facilities surveyed opened the survey link. Thirty-eight facilities answered at least some of the questions, and 19 surveys were fully completed. The reported average prevalence of BPSD among Delaware LTCF residents with dementia was 49.3% (SD 28.9). The five most frequently reported BPSD symptoms were anxiety, agitation, wandering, dysphoria/depression, and appetite/eating abnormalities. All facilities reported employing a spectrum of pharmacologic and non-pharmacologic management strategies. Twenty-two of 24 respondents (91.7%) reported that behavioral health consultation was available at their facilities and 18 of 20 respondents (90.0%) indicated that they provided training on how to manage residents with BPSD. CONCLUSION BPSD are a pervasive concern among Delaware's LTCFs. LTCFs may benefit from the development of training programs and dissemination of treatment guidelines incorporating evidence-based interventions and their implementation in managing BPSD to improve care, decrease stress on residents and caregivers, and reduce some avoidable health care costs.
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Affiliation(s)
| | | | | | - Claudine Jurkovitz
- Value Institute at ChristianaCare; Delaware ACCEL-Center for Translational Research (CTR)
| | - James M Ellison
- ChristianaCare Swank Center for Memory Care and Geriatric Consultation
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Kanojia U, Chaturbhuj SG, Sankhe R, Das M, Surubhotla R, Krishnadas N, Gourishetti K, Nayak PG, Kishore A. Beta-Caryophyllene, a CB2R Selective Agonist, Protects Against Cognitive Impairment Caused by Neuro-inflammation and Not in Dementia Due to Ageing Induced by Mitochondrial Dysfunction. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2021; 20:963-974. [PMID: 33530917 DOI: 10.2174/1871527320666210202121103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/09/2020] [Accepted: 11/30/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Dementia is a neurodegenerative disorder majorly evidenced by cognitive impairment. Although there are many types of dementia, the common underlying etiological factors in all the types are neuro-inflammation or aging induced apoptosis. β-caryophyllene, a cannabinoid type-2 receptor agonist, has been reported to have promising neuroprotective effects in cerebral ischemia and neuro-inflammation. OBJECTIVE In the present study, we evaluated the effects of β-caryophyllene against animal models of dementia whose etiology mimicked neuro-inflammation and aging. METHODS Two doses (50 and 100 mg/kg of body weight) of β-caryophyllene given orally were tested against AlCl3-induced dementia in male Sprague Dawley (SD) rats using the Morris water maze test. Subsequently, the effect of the drug was assessed for episodic memory in female SD rats using novel object recognition task in doxorubicin-induced neuro-inflammation and chemobrain model. Moreover, its effects were evaluated in D-galactose-induced mitochondrial dysfunction leading to dementia. RESULTS β-caryophyllene, at both doses, showed significant improvement in memory when assessed using parameters like target quadrant entries, escape latency and path efficiency in the Morris water maze test for spatial memory. In the doxorubicin-induced chemobrain model, β-caryophyllene at 100 mg/kg significantly elevated acetylcholinesterase and catalase levels and lowered lipid peroxidation compared to the disease control. In the novel object recognition task, β-caryophyllene at 100 mg/kg significantly improved recognition index and discrimination index in the treated animals compared to the disease control, with a significant increase in catalase and a decrease in lipid peroxidation in both hippocampus and frontal cortex. However, in the D-galactose-induced mitochondrial dysfunction model, β-caryophyllene failed to show positive effects when spatial memory was assessed. It also failed to improve D-galactose-induced diminished mitochondrial complex I and II activities. CONCLUSION Hence, we conclude that β-caryophyllene at 100 mg/kg protects against dementia induced by neuro-inflammation with no effect on neuronal aging induced by mitochondrial dysfunction.
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Affiliation(s)
- Urja Kanojia
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - Shrikant Gyaneshwar Chaturbhuj
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - Runali Sankhe
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - Maushami Das
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - Raviteja Surubhotla
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - Nandakumar Krishnadas
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - Karthik Gourishetti
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - Pawan Ganesh Nayak
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - Anoop Kishore
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
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Farugia TL, Cuni-Lopez C, White AR. Potential Impacts of Extreme Heat and Bushfires on Dementia. J Alzheimers Dis 2021; 79:969-978. [PMID: 33459654 DOI: 10.3233/jad-201388] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Australia often experiences natural disasters and extreme weather conditions such as: flooding, sandstorms, heatwaves, and bushfires (also known as wildfires or forest fires). The proportion of the Australian population aged 65 years and over is increasing, alongside the severity and frequency of extreme weather conditions and natural disasters. Extreme heat can affect the entire population but particularly at the extremes of life, and patients with morbidities. Frequently identified as a vulnerable demographic in natural disasters, there is limited research on older adults and their capacity to deal with extreme heat and bushfires. There is a considerable amount of literature that suggests a significant association between mental disorders such as dementia, and increased vulnerability to extreme heat. The prevalence rate for dementia is estimated at 30%by age 85 years, but there has been limited research on the effects extreme heat and bushfires have on individuals living with dementia. This review explores the differential diagnosis of dementia, the Australian climate, and the potential impact Australia's extreme heat and bushfires have on individuals from vulnerable communities including low socioeconomic status Indigenous and Non-Indigenous populations living with dementia, in both metropolitan and rural communities. Furthermore, we investigate possible prevention strategies and provide suggestions for future research on the topic of Australian bushfires and heatwaves and their impact on people living with dementia. This paper includes recommendations to ensure rural communities have access to appropriate support services, medical treatment, awareness, and information surrounding dementia.
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Affiliation(s)
- Taya L Farugia
- Mental Health Program, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Carla Cuni-Lopez
- Mental Health Program, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Anthony R White
- Mental Health Program, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
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Petersen JD, Siersma VD, Wehberg S, Nielsen CT, Viberg B, Waldorff FB. Clinical management of hip fractures in elderly patients with dementia and postoperative 30-day mortality: A population-based cohort study. Brain Behav 2020; 10:e01823. [PMID: 32892489 PMCID: PMC7667308 DOI: 10.1002/brb3.1823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/06/2020] [Accepted: 08/10/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Patients with dementia have an increased 30-day mortality after hip fracture. We investigated clinical management including time to surgery, out-of-hours admission and surgery, surgery on weekends, surgery volume per ward, and anesthesia technique for this excess mortality risk. METHOD This register- and population-based study comprised 12,309 older adults (age 70+) admitted to hospital for a first-time hip fracture in 2013-2014, of whom 11,318 underwent hip fracture surgery. Cox proportional hazards regression models were applied for the analysis. RESULTS The overall postoperative 30-day mortality was 11.4%. Patients with dementia had a 1.5 times increased mortality risk than those without (HR = 1.50 [95% CI 1.31-1.72]). We observed no time-to-surgery difference by patient dementia status; additionally, the excess mortality risk in patients with dementia could not be explained by the clinical management factors we examined. CONCLUSIONS Increased mortality in patients with dementia could not be explained by the measured preoperative clinical management. Suboptimal handling of postoperative complication and rehabilitation are to be investigated for their role in the witnessed increased mortality for patients with dementia.
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Affiliation(s)
- Jindong Ding Petersen
- Research Unit for General Practice, Department of Public Heath, University of Southern Denmark, Odense, Denmark.,Department of Mental Health Vejle, Mental Health Services in the Region of Southern Denmark, Vejle, Denmark
| | - Volkert Dirk Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sonja Wehberg
- Research Unit for General Practice, Department of Public Heath, University of Southern Denmark, Odense, Denmark
| | - Connie Thurøe Nielsen
- Department of Mental Health Vejle, Mental Health Services in the Region of Southern Denmark, Vejle, Denmark
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - Part of Hospital Lillebaelt, Kolding, Denmark
| | - Frans Boch Waldorff
- Research Unit for General Practice, Department of Public Heath, University of Southern Denmark, Odense, Denmark
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Hofhansel L, Weidler C, Votinov M, Clemens B, Raine A, Habel U. Morphology of the criminal brain: gray matter reductions are linked to antisocial behavior in offenders. Brain Struct Funct 2020; 225:2017-2028. [PMID: 32591929 PMCID: PMC7473962 DOI: 10.1007/s00429-020-02106-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/16/2020] [Indexed: 12/16/2022]
Abstract
Aggression and psychopathy are multifaceted conditions determined interpersonal and antisocial factors. Only a few studies analyze the link between these separate factors and specific brain morphology distinctively. A voxel-based morphometry (VBM) analysis was performed on 27 violent offenders and 27 controls aiming to associate sub-features of aggressive and psychopathic behavior with specific gray matter volumes. Trait aggression was assessed using two self-report tests (Aggression Questionnaire, AQ, and Reactive-Proactive-Aggression Questionnaire, RPQ) and psychopathy with the Psychopathy Checklist-Revised (PCL-R). Total and sub-scale scores of these tests were correlated to the brain morphometry of the offenders group in separate analyses. It was found that psychopathic behavior was negatively correlated with prefrontal gray matter volume and that this result was primarily driven by the antisocial behavior sub-scale of the PCL-R. Furthermore, less gray matter in right superior frontal and left inferior parietal regions with increasing antisocial behavior could be observed. One cluster comprising the right middle and superior temporal gyrus was negatively correlated with both, reactive aggression and antisocial behavior. These results outline (1) the importance of distinctively analyzing sub-features that contribute to aggressive and psychopathic behavior, given that the negative correlation of psychopathy global scores with prefrontal volume was driven by one single facet of the PCL-R scale (antisocial behavior). Moreover, these results indicate (2) fronto-temporo-parietal network deficits in antisocial, criminal offenders, with a particular strong effect in the temporal lobe.
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Affiliation(s)
- Lena Hofhansel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
- Institute of Neuroscience and Medicine (INM-10), Research Center Jülich, Jülich, Germany.
| | - Carmen Weidler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Mikhail Votinov
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Neuroscience and Medicine (INM-10), Research Center Jülich, Jülich, Germany
| | - Benjamin Clemens
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Adrian Raine
- Departments of Criminology, Psychiatry, and Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Neuroscience and Medicine (INM-10), Research Center Jülich, Jülich, Germany
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Rubino A, Sanon M, Ganz ML, Simpson A, Fenton MC, Verma S, Hartry A, Baker RA, Duffy RA, Gwin K, Fillit H. Association of the US Food and Drug Administration Antipsychotic Drug Boxed Warning With Medication Use and Health Outcomes in Elderly Patients With Dementia. JAMA Netw Open 2020; 3:e203630. [PMID: 32343351 PMCID: PMC7189225 DOI: 10.1001/jamanetworkopen.2020.3630] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
IMPORTANCE Atypical antipsychotics (AAPs) are often used off-label to manage dementia-associated neuropsychiatric symptoms. In 2005, the US Food and Drug Administration (FDA) issued a boxed warning for the use of AAPs in elderly patients. The long-term association of this warning with health outcomes is unknown to date. OBJECTIVE To assess the long-term association of the 2005 FDA boxed warning on AAPs with psychiatric medication and opioid use, health events, and quality of life among elderly individuals with dementia. DESIGN, SETTING, AND PARTICIPANTS For this cross-sectional study, data were analyzed from the household component of the Medical Expenditure Panel Survey (MEPS), the National Ambulatory Medical Care Survey (NAMCS), and the National Hospital Ambulatory Medical Care Survey (NHAMCS) fielded between January 1, 1996, and December 31, 2014. This interrupted time-series analysis applied to 3-year moving means derived from the 1996-2014 MEPS, NAMCS, and NHAMCS. All survey respondents included in this analysis were 65 years or older and had dementia. Data analysis was performed from December 1, 2017, to March 15, 2018. EXPOSURES The 2005 FDA boxed warning on AAPs. MAIN OUTCOMES AND MEASURES Use of psychiatric medications and opioids, prevalence of cerebrovascular and cardiovascular events, prevalence of falls and/or fractures, 2-year mortality, and health-related quality of life assessed by the Medical Outcomes Study 12-Item Short-Form Health Survey scores. RESULTS A total of 2430 (MEPS) and 5490 (NAMCS and NHAMCS) respondents were identified, corresponding to weighted populations of 22 996 526 (MEPS) and 65 502 344 (NAMCS and NHAMCS) noninstitutionalized elderly individuals with dementia (mean [SD] age, 81.06 [1.13] years; 63.1% female). In the MEPS sample, compared with before 2005, AAP use (from an annual slope of 0.99 to -0.18 percentage points), cerebrovascular events (0.75 to -0.50 percentage points), and falls and/or fractures (-1.72 to -0.40 percentage points) decreased and opioid use (0.04 to 1.29 percentage points), antiepileptic use (-0.42 to 1.21 percentage points), cardiovascular events (-0.13 to 1.30 percentage points), and 2-year mortality risk (-0.68 to 0.18 percentage points) increased. Health-related quality of life remained relatively unchanged. The NAMCS and NHAMCS sample yielded similar findings. CONCLUSIONS AND RELEVANCE These data suggest that the 2005 FDA boxed warning was associated with some unintended negative patient outcomes.
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Affiliation(s)
| | - Myrlene Sanon
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, New Jersey
| | | | | | | | | | | | - Ross A. Baker
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, New Jersey
| | - Ruth A. Duffy
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, New Jersey
| | | | - Howard Fillit
- Mount Sinai Medical Center, New York City, New York
- Alzheimer’s Drug Discovery Foundation, New York, New York
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Marcinkowska M, Śniecikowska J, Fajkis N, Paśko P, Franczyk W, Kołaczkowski M. Management of Dementia-Related Psychosis, Agitation and Aggression: A Review of the Pharmacology and Clinical Effects of Potential Drug Candidates. CNS Drugs 2020; 34:243-268. [PMID: 32052375 PMCID: PMC7048860 DOI: 10.1007/s40263-020-00707-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Along with cognitive decline, 90% of patients with dementia experience behavioral and psychological symptoms of dementia, such as psychosis, aggression, agitation, and depression. Atypical antipsychotics are commonly prescribed off-label to manage certain symptoms, despite warnings from the regulatory agencies regarding the increased risk of mortality associated with their use in elderly patients. Moreover, these compounds display a limited clinical efficacy, mostly owing to the fact that they were developed to treat schizophrenia, a disease characterized by neurobiological deficits. Thus, to improve clinical efficacy, it has been suggested that patients with dementia should be treated with exclusively designed and developed drugs that interact with pharmacologically relevant targets. Within this context, numerous studies have suggested druggable targets that might achieve therapeutically acceptable pharmacological profiles. Based on this, several different drug candidates have been proposed that are being investigated in clinical trials for behavioral and psychological symptoms of dementia. We highlight the recent advances toward the development of therapeutic agents for dementia-related psychosis and agitation/aggression and discuss the relationship between the relevant biological targets and their etiology. In addition, we review the compounds that are in the early stage of development (discovery or preclinical phase) and those that are currently being investigated in clinical trials for dementia-related psychosis and agitation/aggression. We also discuss the mechanism of action of these compounds and their pharmacological utility in patients with dementia.
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Affiliation(s)
- Monika Marcinkowska
- Department of Medicinal Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna Street, Kraków, 30-688, Poland.
| | - Joanna Śniecikowska
- Department of Medicinal Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna Street, Kraków, 30-688 Poland ,Adamed Pharma S.A., Czosnow, Poland
| | - Nikola Fajkis
- Department of Medicinal Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna Street, Kraków, 30-688 Poland
| | - Paweł Paśko
- Department of Medicinal Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna Street, Kraków, 30-688 Poland
| | - Weronika Franczyk
- Department of Medicinal Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna Street, Kraków, 30-688 Poland
| | - Marcin Kołaczkowski
- Department of Medicinal Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna Street, Kraków, 30-688 Poland ,Adamed Pharma S.A., Czosnow, Poland
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Huis In Het Veld JG, van Asch IFM, Willemse BM, Verkade PJ, Pot AM, Blom MM, Groot Zwaaftink RBM, Francke AL. Process Evaluation of Nurse-Led Online Self-Management Support for Family Caregivers to Deal With Behavior Changes of a Relative With Dementia (Part 1): Mixed Methods Study. J Med Internet Res 2019; 21:e13002. [PMID: 31605517 PMCID: PMC6914225 DOI: 10.2196/13002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 06/07/2019] [Accepted: 07/05/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Coping with behavioral changes is a daily challenge for family caregivers in all phases of dementia, and assistance is needed for it. An online self-management support intervention was therefore developed and conducted involving the following elements: (1) email contact with a specialized dementia nurse, (2) online videos, and (3) e-bulletins containing information about behavior changes and how to manage them. OBJECTIVE The aim of this study was to understand (1) family caregivers' actual use of various elements of the online self-management support, (2) family caregivers' evaluation and satisfaction with the various elements, and (3) nurses' usage and evaluations of the online support through the tailored email contacts. METHODS A mixed methods design was used in this process evaluation, combining quantitative and qualitative methods including analyses of dementia nurses' registration forms, the number of clicks on online videos and e-bulletins, evaluation questions answered by family caregivers in a survey questionnaire, semistructured interviews with family caregivers and nurses, and analysis of the content of the email contacts. RESULTS The actual use of various elements of the online self-management support by family caregivers varied: 78% (21/27) of family caregivers had an email contact with the specialist nurse, 80% (43/54) of family caregivers clicked on an online video, and 37% (30/81) clicked on an e-bulletin. Family caregivers showed positive evaluations and satisfaction. The tailor-made approach in the personal email contacts in particular was valued by the family caregivers. Nurses' evaluations about providing self-management support online were mixed as it was a relatively new task for them. CONCLUSIONS An important insight is that not all participants made optimum use of the various elements of the intervention. Nurses also said that the email contacts were more often used to express feelings about coping with behavioral changes. More research is needed to investigate the reasons why people accept, adopt, and adhere to online interventions to reduce cases where they are not used and to back them up appropriately with tailored (online) information and advice for their personal situations.
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Affiliation(s)
- Judith G Huis In Het Veld
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Iris F M van Asch
- Netherlands Institute of Mental Health and Addiction, Trimbos Institute, Utrecht, Netherlands
| | - Bernadette M Willemse
- Netherlands Institute of Mental Health and Addiction, Trimbos Institute, Utrecht, Netherlands
| | | | | | - Marco M Blom
- Dutch Alzheimer's Society, Amersfoort, Netherlands
| | | | - Anneke L Francke
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
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Auampradit N, Vapattanawong P, Punpuing S, Sunpuwan M, Jirapramukpitak T. A Longitudinal Study of Changes in Cognition Among Older Thais: Studying From the Kanchanaburi Demographic Surveillance System. Gerontol Geriatr Med 2019; 5:2333721419862885. [PMID: 31321256 PMCID: PMC6628515 DOI: 10.1177/2333721419862885] [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: 05/09/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives: To examine the impacts of changes in social determinants of
health (SDH) toward changes in cognition. Methods: Longitudinal data came
from the Kanchanaburi Demographic Surveillance System (KDSS) collected in 2007 and 2011.
Cognitive impairment was measured by category fluency and delayed recall. Generalized
estimating equation (GEE) was used to investigate changes in cognition by taking SDH and
other variables including age, gender, marital status, education, and depression into the
model. Results: GEE revealed longitudinal effects of wealth index and working
status against cognition. Older Thais living with richest wealth index (odds ratio [OR] =
0.54; 95% confidence interval [CI] = 0.31-0.94) and still being employed (OR = 0.65; 95%
CI = 0.47-0.89) were less likely to have cognitive impairment. Discussion:
Poorer wealth index and being unemployed were served as a risk factor for cognitive
impairment over time. Increasing age was still the major risk for cognitive
impairment.
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Affiliation(s)
| | - Patama Vapattanawong
- Institute for Population and Social Research, Mahidol University, Bangkok, Thailand
| | - Sureeporn Punpuing
- Institute for Population and Social Research, Mahidol University, Bangkok, Thailand
| | - Malee Sunpuwan
- Institute for Population and Social Research, Mahidol University, Bangkok, Thailand
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Otero P, Torres ÁJ, Vázquez FL, Blanco V, Ferraces MJ, Díaz O. Does the Disease of the Person Receiving Care Affect the Emotional State of Non-professional Caregivers? Front Psychol 2019; 10:1144. [PMID: 31156524 PMCID: PMC6529816 DOI: 10.3389/fpsyg.2019.01144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/30/2019] [Indexed: 11/26/2022] Open
Abstract
Research on mental health of non-professional caregivers has focused on caregivers of people with specific diseases, especially dementia. Less is known about caregivers of people with other diseases. The aims of this study were (a) to determine the caregivers’ emotional state in a random sample of caregivers of people in situations of dependency, (b) to analyze the association between each disease of the care-recipient (a variety of 23 diseases included in the International Classification of Diseases) and the emotional state of the caregiver, and (c) based on the theoretical model, to analyze the relationship of the different study variables in the appearance of the emotional distress of the caregiver. A sample of 491 non-professional caregivers was selected randomly (89.0% women, average age 55.3 years). Trained psychologists collected sociodemographic and care-related characteristics and evaluated the global emotional distress, somatic symptoms, anxiety-insomnia, social dysfunction, depression, probable mental disorder case, self-esteem, and social support. It was found that (a) the caregivers showed moderate emotional distress, and 33.8% presented a probable mental disorder. (b) Caring for a care-recipient with cat’s cry syndrome or epilepsy was related to suffering from social dysfunction, and caring for a care-recipient with autism was related to having a probable mental health case. (c) Social support mediated the relationship between social class, daily hours of care, monthly family income, self-esteem and global emotional distress. There is an important impact on the emotional state of the caregivers. This impact was similar in caregivers of care-recipients with different diseases, except in caregivers caring for a care-recipient with cat’s cry syndrome or epilepsy (related to social dysfunction), and in caregivers caring for a care-recipient with autism (related to having a probable mental health case).
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Affiliation(s)
- Patricia Otero
- Department of Psychology, University of A Coruña, A Coruña, Spain
| | - Ángela J Torres
- Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Fernando L Vázquez
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Vanessa Blanco
- Department of Evolutive and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - María J Ferraces
- Department of Social, Basic and Methodological Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Olga Díaz
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
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Abstract
SUMMARYBaillonet al’s Cochrane review included 430 participants with agitation in dementia from five randomised controlled trials. Overall, the reviewers found that valproate was no better than placebo for the treatment of agitation in people with dementia; however, the quality of the studies included was very variable. Adverse effects and events were higher in the treatment group compared with the controls, although these finding were largely based on low-quality data with incomplete reporting; thus, valproate's safety profile is of concern. This review demonstrates that there is insufficient evidence to change current treatment guidelines.DECLARATION OF INTERESTNone.
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37
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Simon KC, Yucus C, Castle J, Chesis R, Lai R, Hillman L, Tideman S, Garduno L, Meyers S, Frigerio R, Maraganore DM. Building of EMR Tools to Support Quality and Research in a Memory Disorders Clinic. Front Neurol 2019; 10:161. [PMID: 30899241 PMCID: PMC6416163 DOI: 10.3389/fneur.2019.00161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/07/2019] [Indexed: 12/14/2022] Open
Abstract
The electronic medical record (EMR) presents an opportunity to standardize patient data collection based on quality guidelines and conduct practice-based research. We describe the development of a customized EMR “toolkit” that standardizes patient data collection with hundreds of discrete fields that supports Best Practices for treating patients with memory disorders. The toolkit also supports practice-based research. We describe the design and successful implementation of a customized EMR toolkit to support Best Practices in the care of patients with memory disorders. We discuss applications, including quality improvement projects and current research initiatives, using the toolkit. This toolkit is being shared with other departments of Neurology as part of the Neurology Practice-Based Research Network. Data collection is ongoing, including longitudinal follow-up. This toolkit will generate data that will allow for descriptive and hypothesis driven research as well-quality improvement among patients seen in a memory clinic.
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Affiliation(s)
- Kelly Claire Simon
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Chad Yucus
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL, United States
| | - James Castle
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Richard Chesis
- Health Information Technology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Rebekah Lai
- Health Information Technology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Laura Hillman
- Health Information Technology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Samuel Tideman
- Health Information Technology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Lisette Garduno
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Steven Meyers
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Roberta Frigerio
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL, United States
| | - Demetrius M Maraganore
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL, United States
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Aigbogun MS, Stellhorn R, Hartry A, Baker RA, Fillit H. Treatment patterns and burden of behavioral disturbances in patients with dementia in the United States: a claims database analysis. BMC Neurol 2019; 19:33. [PMID: 30819136 PMCID: PMC6396493 DOI: 10.1186/s12883-019-1260-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/19/2019] [Indexed: 01/10/2023] Open
Abstract
Background Although patients with dementia frequently experience neuropsychological symptoms (NPS) such as agitation, which profoundly impacts patients, caregivers, and the healthcare system, few studies have evaluated the associated burden of agitation or agitation-related symptoms in dementia. Methods This retrospective analysis of claims data from the Truven Health MarketScan® database (2012–2015) compared clinical characteristics, treatment patterns, healthcare resource utilization, and costs among patients with dementia with behavioral disturbances (BD) versus patients with dementia without BD. Existing BD diagnosis codes 294.11 or 294.21 were used as a means to identify patients with agitation/agitation-related symptoms. Results From a starting sample of 6.4 million beneficiaries, 103,402 patients with dementia were identified, of whom 16,440 (16%) had BD during an average of 17 months of follow-up. Patients with BD had significantly more medical and psychiatric comorbidities and greater comedication use (i.e., antidementia drugs, antidepressants, and antipsychotics; all values, P < .0001) compared with patients without BD. A significantly greater number of hospitalizations, hospital days, outpatient hospital/clinic visits, number of skilled nursing visits, and number of patients with hospice visit were reported during follow-up in patients with BD compared with patients without BD (all values, P < 0.0001). Costs were also significantly higher among patients with BD versus those patients without BD ($42,284 vs. $32,640, respectively; P < 0.0001). Conclusions Patients with dementia with BD had a higher prevalence of comorbidities, greater use of comedications, and greater healthcare utilization and costs than patients with dementia without BD. Electronic supplementary material The online version of this article (10.1186/s12883-019-1260-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Myrlene Sanon Aigbogun
- Health Outcomes, Otsuka Pharmaceutical Development & Commercialization, Inc, 508 Carnegie Center, Princeton, New Jersey, 08540, USA.
| | - Robert Stellhorn
- Health Outcomes, Otsuka Pharmaceutical Development & Commercialization, Inc, 508 Carnegie Center, Princeton, New Jersey, 08540, USA
| | - Ann Hartry
- Health Economics and Outcomes Research, Lundbeck, LLC, Deerfield, IL, USA
| | - Ross A Baker
- Global Medical Affairs, Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | - Howard Fillit
- Mount Sinai Medical Center, New York City, USA.,Alzheimer's Drug Discovery Foundation, New York, NY, USA
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39
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Eslami M, Nezafat N, Negahdaripour M, Ghasemi Y. Computational approach to suggest a new multi-target-directed ligand as a potential medication for Alzheimer’s disease. J Biomol Struct Dyn 2019; 37:4825-4839. [DOI: 10.1080/07391102.2018.1564701] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Mahboobeh Eslami
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Navid Nezafat
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Manica Negahdaripour
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Younes Ghasemi
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Medical Biotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
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40
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Deví Bastida J, Jodas Clemente L, Jofre Font S, Arroyo Cardona E. [Premorbid personality as a risk factor in the appearance of psychological and behavioural symptoms of dementia: Systematic review]. Rev Esp Geriatr Gerontol 2018; 54:168-180. [PMID: 30482462 DOI: 10.1016/j.regg.2018.08.006] [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: 12/05/2017] [Revised: 06/14/2018] [Accepted: 08/02/2018] [Indexed: 10/27/2022]
Abstract
The aetiology of behavioural and psychological symptoms of dementia (BPSD) is defined by a diversity of factors, and recent studies suggest that premorbid personality could be a risk factor for BPSD. This study aimed to review studies on the relationship between premorbid personality and BPSD. Studies were identified using PsycInfo, MedLine, and PubMed. The searches combined terms for premorbid personality, dementia and BPSD. Ten studies have been included in this review. Eight out of ten studies show a relationship between premorbid personality and BPSD. Neuroticism is associated with behavioural disturbances and anxiety. Extraversion is associated with wandering. Low agreeableness is associated with affective disturbance and aggression-related behaviours and high agreeableness is associated with wandering. The studies found no congruent results for openness and conscientiousness. In conclusion, premorbid personality may increase the risk of developing BPSD during the course of the disease. Even so, the relationship between personality and BPSD is complex due to multifactorial aetiology.
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Affiliation(s)
- Josep Deví Bastida
- Departamento de Psicología Clínica y de la Salud, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España; Departament de Benestar i Familia - SISPAP/Grup Mutuam, Residencia y Centro de Día Sant Cugat, Sant Cugat del Vallés, Barcelona, España.
| | - Laia Jodas Clemente
- Asociación Multidisciplinar de Psicogeriatría y Demencias (AMPIDE), Sant Cugat del Vallés, Barcelona, España
| | - Susanna Jofre Font
- Sanitas Mayores Consell de Cent (Sanitas parte de Bupa), Barcelona, España
| | - Enric Arroyo Cardona
- Departament de Benestar i Familia - SISPAP/Grup Mutuam, Residencia y Centro de Día Sant Cugat, Sant Cugat del Vallés, Barcelona, España; Centro de Asistencia Primaria Sant Cugat - Mutua de Terrassa, Sant Cugat del Vallés, Barcelona, España
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41
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Voorhees JR, Remy MT, Cintrón-Pérez CJ, El Rassi E, Kahn MZ, Dutca LM, Yin TC, McDaniel LM, Williams NS, Brat DJ, Pieper AA. (-)-P7C3-S243 Protects a Rat Model of Alzheimer's Disease From Neuropsychiatric Deficits and Neurodegeneration Without Altering Amyloid Deposition or Reactive Glia. Biol Psychiatry 2018; 84:488-498. [PMID: 29246437 PMCID: PMC6415524 DOI: 10.1016/j.biopsych.2017.10.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND In addition to cognitive deficits, Alzheimer's disease (AD) is associated with other neuropsychiatric symptoms, including severe depression. Indeed, depression often precedes cognitive deficits in patients with AD. Unfortunately, the field has seen only minimal therapeutic advances, underscoring the critical need for new treatments. P7C3 aminopropyl carbazoles promote neuronal survival by enhancing nicotinamide adenine dinucleotide flux in injured neurons. Neuroprotection with P7C3 compounds has been demonstrated in preclinical models of neurodegeneration by virtue of promoting neuronal survival independently of early disease-specific pathology, resulting in protection from cognitive deficits and depressive-like behavior. We hypothesize that P7C3 compounds might be uniquely applicable to patients with AD, given the comorbid presentation of depression and cognitive deficits. METHODS Aging male and female wild-type and TgF344-AD rats, a well-characterized preclinical AD model, were administered (-)-P7C3-S243 daily for 9 and 18 months, beginning at 6 months of age. Behavioral phenotypes related to cognition and depression were assessed at 15 and 24 months, and brain pathology and biochemistry were assessed at 24 months. RESULTS (-)-P7C3-S243 safely protected aging male and female wild-type and TgF344-AD rats from cognitive deficits and depressive-like behavior. Depressive-like behavior occurred earlier than cognitive deficits in TgF344-AD rats, consistent with AD in many patients. Treatment with (-)-P7C3-S243 blocked neurodegeneration in TgF344-AD rats, without altering amyloid deposition or indicators of neuroinflammation. CONCLUSIONS Neuronal cell death-specific treatment approaches, such as P7C3 compounds, may represent a new treatment approach for patients experiencing the combination of cognitive deficits and depression associated with AD.
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Affiliation(s)
- Jaymie R Voorhees
- Department of Psychiatry, University of Iowa Carver College of Medicine Iowa City, IA, USA,Interdisciplinary Graduate Program in Human Toxicology, University of Iowa Carver College of Medicine Iowa City, IA, USA
| | - Matthew T Remy
- Department of Psychiatry, University of Iowa Carver College of Medicine Iowa City, IA, USA
| | - Coral J Cintrón-Pérez
- Department of Psychiatry, University of Iowa Carver College of Medicine Iowa City, IA, USA
| | - Eli El Rassi
- Department of Psychiatry, University of Iowa Carver College of Medicine Iowa City, IA, USA
| | - Michael Z Kahn
- Department of Psychiatry, University of Iowa Carver College of Medicine Iowa City, IA, USA
| | - Laura M Dutca
- The Iowa City Department of Veterans Affairs Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States Departments of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA, USA
| | - Terry C Yin
- Department of Psychiatry, University of Iowa Carver College of Medicine Iowa City, IA, USA
| | - Latisha M McDaniel
- Department of Psychiatry, University of Iowa Carver College of Medicine Iowa City, IA, USA
| | - Noelle S Williams
- Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Dan J Brat
- Departments of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Andrew A Pieper
- Department of Psychiatry, Iowa Neuroscience Institute, University of Iowa Carver College of Medicine, Iowa City, Iowa; Department of Neurology, Iowa Neuroscience Institute, University of Iowa Carver College of Medicine, Iowa City, Iowa; Free Radical and Radiation Biology Program, Iowa Neuroscience Institute, University of Iowa Carver College of Medicine, Iowa City, Iowa; Department of Radiation Oncology, Holden Comprehensive Cancer Center, Iowa Neuroscience Institute, University of Iowa Carver College of Medicine, Iowa City, Iowa; Pappajohn Biomedical Institute, Iowa Neuroscience Institute, University of Iowa Carver College of Medicine, Iowa City, Iowa; Interdisciplinary Graduate Program in Human Toxicology, Department of Occupational and Environmental Health, University of Iowa College of Public Health, Iowa City, Iowa; Iowa City VA Health Care System, Iowa City, Iowa; Weill Cornell Autism Research Program, Weill Cornell Medical College New York, New York.
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42
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Tretter F. From mind to molecules and back to mind-Metatheoretical limits and options for systems neuropsychiatry. CHAOS (WOODBURY, N.Y.) 2018; 28:106325. [PMID: 30384654 DOI: 10.1063/1.5040174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/01/2018] [Indexed: 06/08/2023]
Abstract
Psychiatric illnesses like dementia are increasingly relevant for public health affairs. Neurobiology promises progress in diagnosis and treatment of these illnesses and exhibits a rapid increase of knowledge by new neurotechnologies. In order to find generic patterns in huge neurobiological data sets and by exploring formal brain models, non-linear science offers many examples of fruitful insights into the complex dynamics of neuronal information processing. However, it should be minded that neurobiology neither can bridge the explanatory gap between brain and mind nor can substitute psychological and psychiatric categories and knowledge. For instance, volition is impaired in many mental disorders. In experimental setups, a "preactional" brain potential was discovered that occurs 0.5 s before a consciously evoked motor action. Neglecting the specific experimental conditions, this finding was over-interpreted as the empirical falsification of the philosophical (!) concept of "free volition/will." In contrast, the psychology of volition works with models that are composed of several stage-related hierarchically nested mental process cycles that were never tested in obviously "theory-free" neurobiology. As currently neurobiology shows a network turn (or systemic turn), this is one good reason to enhance systemic approaches in theoretical psychology, independently from neurobiology that still lacks "theory." Cybernetic control loop models and system models should be integrated and elaborated and in turn could give new impulses to neuropsychology and neuropsychiatry that conceptually can more easily connect to a network-oriented neurobiology. In this program, the conceptual background of nonlinear science is essential to bridge gaps between neurobiology and psychiatry, defining a real "theoretical" field of neuropsychiatry.
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Affiliation(s)
- Felix Tretter
- Bertalanffy Center for the Study of Systems Science, Paulanergasse 13 / door 5, A 1040 Vienna, Austria
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43
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Martínez-Raga J, Amore M, Di Sciascio G, Florea RI, Garriga M, Gonzalez G, Kahl KG, Karlsson PA, Kuhn J, Margariti M, Pacciardi B, Papageorgiou K, Pompili M, Rivollier F, Royuela Á, Safont G, Scharfetter J, Skagen B, Tajima-Pozo K, Vidailhet P. 1st International Experts' Meeting on Agitation: Conclusions Regarding the Current and Ideal Management Paradigm of Agitation. Front Psychiatry 2018; 9:54. [PMID: 29535649 PMCID: PMC5835036 DOI: 10.3389/fpsyt.2018.00054] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Agitation is a heterogeneous concept without a uniformly accepted definition, however, it is generally considered as a state of cognitive and motor hyperactivity characterized by excessive or inappropriate motor or verbal activity with marked emotional arousal. Not only the definition but also other aspects of agitated patients' care are still unsolved and need consensus and improvement. To help the discussion about agitation among experts and improve the identification, management, and treatment of agitation, the 1st International Experts' Meeting on Agitation was held in October 2016 in Madrid. It was attended by 20 experts from Europe and Latin America with broad experience in the clinical management of agitated patients. The present document summarizes the key conclusions of this meeting and highlights the need for an updated protocol of agitation management and treatment, the promotion of education and training among healthcare professionals to improve the care of these patients and the necessity to generate clinical data of agitated episodes.
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Affiliation(s)
- José Martínez-Raga
- Hospital Universitario Doctor Peset, University of Valencia & CEU Cardenal Herrera University, Valencia, Spain
| | | | - Guido Di Sciascio
- Azienda Ospedaliero Universitaria "Consorziale Policlinico" di Bari, Bari, Italy
| | | | | | - Gabriel Gonzalez
- Hospital de Emergencias Psiquiátricas Torcuato de Alvear, Buenos Aires, Argentina
| | - Kai G Kahl
- Medizinische Hochschule, Hannover, Germany
| | | | - Jens Kuhn
- Johanniter Krankenhaus, Evangelisches Klinikum Niederrhein, Oberhausen, Germany
| | - Maria Margariti
- Medical School of Athens, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | | | | | | | | | - Ángel Royuela
- Complejo asistencial Universitario de Palencia, Palencia, Spain
| | - Gemma Safont
- Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
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44
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Evidence and decision algorithm for the withdrawal of antipsychotic treatment in the elderly with dementia and neuropsychiatric symptoms. Eur J Clin Pharmacol 2017; 73:1389-1398. [DOI: 10.1007/s00228-017-2314-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/26/2017] [Indexed: 11/26/2022]
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45
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Porter CN, Miller MC, Lane M, Cornman C, Sarsour K, Kahle-Wrobleski K. The influence of caregivers and behavioral and psychological symptoms on nursing home placement of persons with Alzheimer's disease: A matched case-control study. SAGE Open Med 2016; 4:2050312116661877. [PMID: 27606063 PMCID: PMC4999794 DOI: 10.1177/2050312116661877] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 06/27/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Behavioral and psychological symptoms of dementia in individuals with Alzheimer's disease and caregiver characteristics may influence the decision to provide care at home or in a nursing home, though few studies examine this association near the actual time of nursing home placement. Using a matched case-control design, this study investigates the association between (1) total Neuropsychiatric Inventory score, (2) the Neuropsychiatric Inventory-4 (an agitation/aggression subscale), and (3) individual domains of the Neuropsychiatric Inventory and nursing home placement. METHODS Data from the South Carolina Alzheimer's disease Registry provides an opportunity to expand the literature by looking at cases at the time of nursing home care eligibility/placement and allowing for propensity-score-matched controls. Cases (n = 352) entered a nursing home within 6 months of study initiation; controls (n = 289) remained in the community. Registry data were combined with caregiver survey data, including the Neuropsychiatric Inventory. Conditional logistic regression was applied. RESULTS A 10% increase in the Neuropsychiatric Inventory score implied a 30% increase in odds of nursing home admission (odds ratio: 1.30; 95% confidence interval: 1.14-1.50), having married or male caregivers predicted nursing home placement. Cases versus controls were significantly more likely to have behavioral and psychological symptoms of dementia related to agitation/aggression 1 month prior to nursing home admission. CONCLUSION Interventions targeting behavioral and psychological symptoms of dementia without available effective interventions in individuals with Alzheimer's disease and caregiver support services are necessary to prevent or delay nursing home admission.
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Affiliation(s)
| | - Margaret C Miller
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Marcia Lane
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Carol Cornman
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Khaled Sarsour
- Department of Epidemiology, Genentech Incorporated, San Francisco, CA, USA
| | - Kristin Kahle-Wrobleski
- Global Patient Outcomes & Real World Evidence, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
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