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Kaufmann L, Gruenbaum T, Janssen R, Weiss EM, Benke T, Dal-Bianco P, Defrancesco M, Ransmayr G, Schmidt R, Stögmann E, Marksteiner J. Predictive value of somatic and functional variables for cognitive deterioration for early-stage patients with Alzheimer's Disease: Evidence from a prospective registry on dementia. PLoS One 2024; 19:e0307111. [PMID: 39141602 PMCID: PMC11324136 DOI: 10.1371/journal.pone.0307111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 06/30/2024] [Indexed: 08/16/2024] Open
Abstract
Alzheimer's disease (AD) imposes a major burden on affected individuals, their caregivers and health-care systems alike. Though quite many risk factors for disease progression have been identified, there is a lack of prospective studies investigating the interplay and predictive value of a wide variety of patient variables associated with cognitive deterioration (defined as key feature of AD progression). Study participants were patients with probable and possible AD, that were assessed at four time points over a period of two years (T1-T4). The main results were threefold: (i) over time, significant changes were observed regarding patients' cognitive functioning, activities of daily living and caregiver load (but not depression, pain, neuropsychiatric symptoms); (ii) intercorrelations between caregiver load and patients' cognitive and functional variables were high, correlation patterns remaining rather stable across time; (iii) cognitive functioning at T4 was best predicted by patients' age, sex, atrial fibrillation and activities of daily living at T1; and (iv) across all four assessment points, cognitive functioning was best predicted by time (i.e., disease duration), age, sex, activities of daily living and depression. Overall, even in early stages of AD and during a short two-year period, functional changes were significant and tightly intertwined with caregiver load, thus stressing the need to consider caregiver load when diagnosing and treating patients with AD. A novel and clinically relevant finding is that even in early stages of AD, cognitive deterioration was best predicted by a combination of patients' demographic, somatic and functional variables.
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Affiliation(s)
- Liane Kaufmann
- Department of Neurology and Clinical Neuropsychology, Ernst von Bergmann Klinikum, Potsdam, Germany
| | - Tilman Gruenbaum
- Department of Neurology and Clinical Neuropsychology, Ernst von Bergmann Klinikum, Potsdam, Germany
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Roman Janssen
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
- LaPsyDÉ, Université Paris Cité, Paris, France
| | | | - Thomas Benke
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Michaela Defrancesco
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerhard Ransmayr
- Department of Neurology 2, Kepler University Hospital, Med Campus III, Linz, Austria
| | - Reinhold Schmidt
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
| | | | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, General Hospital, Hall, Austria
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Tsay SF, Chang CY, Shueh Hung S, Su JY, Kuo CY, Mu PF. Pain prediction model based on machine learning and SHAP values for elders with dementia in Taiwan. Int J Med Inform 2024; 188:105475. [PMID: 38743995 DOI: 10.1016/j.ijmedinf.2024.105475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 04/06/2024] [Accepted: 05/04/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Pain conditions are common in elderly individuals, including those with dementia. However, symptoms associated with dementia may lead to poor recognition, assessment and management of pain. In this study, we incorporated the variables based on questionnaires into a machine learning algorithm to build a prediction model for the pain index of elderly individuals with dementia. MATERIALS AND METHODS In this study, 113 cases were collected through questionnaires and used to build prediction models for the patient's pain index. Three machine learning algorithms were incorporated for comparison in this study. To interpret the prediction model, SHapley additive explanations values were used to depict the ranking importance of variables and the relationship between features and pain index. RESULTS In the comparison of models, random forests with feature selection outperformed in terms of root mean square error and mean absolute error. A total of 11 features were selected based on embedded method. The results showed that the Karnofsky scale played a key role in predicting pain index for elderly individuals with dementia and was positively associated with pain index. Arthritis is the most important disease to predicting the pain index. CONCLUSIONS Our findings provided the key insights to predict the pain index of elderly patients with dementia. In the future, it can be used to develop an application system or webpage, which can reduce the use of labour and improve the efficiency.
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Affiliation(s)
- Shwu-Feng Tsay
- Department of Nursing and Health Care, Ministry of Health and Welfare, No. 488, Sec. 6, Zhongxiao E. Rd., Nangang District, Taipei City 115, Taiwan; School of Nursing, National Taiwan University, No.1, Sec. 1, Jen Ai Rd, Taipei City 100, Taiwan; Department of Health Services Administration, College of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung City 406, Taiwan
| | - Cheng-Yu Chang
- Department of Nursing, National Yang Ming Chiao Tung University Hospital, No.169, Siaoshe Rd., Yilan City, Yilan County 26058, Taiwan; Institute of Clinical Nursing, School of Nursing, National Yang Ming Chiao Tung University, No. 155, Section 2, Linong St, Beitou District, Taipei City 112304, Taiwan
| | - Sing Shueh Hung
- Hung Sing Shueh Home Care Center, No. 92-7, Sec. 1, Xingshe St., Xinshe Dist., Taichung City 426016, Taiwan
| | - Jui-Yuan Su
- Department of Nursing, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan; School of Nursing, National Taipei University of Nursing and Health Sciences. No. 365, Ming-te Rd., Peitou Dist., Taipei City 112303, Taiwan
| | - Chao-Yang Kuo
- Smart Healthcare Interdisciplinary College, National Taipei University of Nursing and Health Sciences, No. 365, Ming-te Rd., Peitou Dist., Taipei City 112303, Taiwan.
| | - Pei-Fan Mu
- Institute of Clinical Nursing, School of Nursing, National Yang Ming Chiao Tung University, No. 155, Section 2, Linong St, Beitou District, Taipei City 112304, Taiwan.
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Feng PC, Khan MA, Yeh TT, Shieh WY, Tsai HH. Physiological Biomarkers for Assessment of Pain during Routine Blood Tests for Older Adults with Dementia in Long-Term Residential Care. J Am Med Dir Assoc 2024; 25:105050. [PMID: 38830593 DOI: 10.1016/j.jamda.2024.105050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE Evaluating pain in individuals with dementia can be difficult when verbal communication is limited. Vocalization has emerged as a potential avenue for assessments of pain in nonverbal populations. This study aimed to evaluate if physiological assessments of vocalization were correlated with observational assessments of pain during routine blood tests for persons with dementia. DESIGN A cross-sectional descriptive study. SETTING AND PARTICIPANTS Sixty older adults (aged ≥65 years old) with dementia requiring routine finger puncture and peripheral venipuncture for routine blood tests were recruited by purposive sampling from 3 long-term care facilities in Taiwan. METHODS Observational assessments were conducted with the Pain Assessment in Advanced Dementia (PAINAD) instrument; physiological biomarkers of vocalization were assessed with a noninvasive sensing device and microphone (NISDM). Assessments were conducted simultaneously in one session during situations of increasing pain levels: at rest, making a sound, finger puncture, and peripheral venipuncture. PAINAD scores were compared with signal recording measures from the NISDM. Analysis of variance and Pearson correlation coefficient assessed correlations between observational and physiological measures. RESULTS Most participants were female (63.3%); mean age was 81.27 years (SD = 9.69); Clinical Dementia Rating was 2.23 ± 0.70; and Mini-Mental State Examination was 7.07 ± 6.95. Signal recording measures using the NISDM during finger puncture and venipuncture were significantly greater compared with measures at rest and making sound, indicating higher signal levels were associated with pain. PAINAD scores were significantly correlated with physiological measures for vocalization variables of sound amplitude (r = 0.49, P < .001), shimmer (r = 0.63, P < .001), and inhalation-to-exhalation amplitude ratio (r = 0.48, P < .001). CONCLUSIONS AND IMPLICATIONS Elevated vocalizations detected with the NISDM were correlated with increased pain scores on the PAINAD instrument. Physiological measures of pain using novel vocalization biomarkers have the potential to enhance the quality of care for individuals with dementia and limited communication abilities.
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Affiliation(s)
- Po-Chung Feng
- Master Degree Program in Health and Long-term Care Industry, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Mohammad Anwar Khan
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Ting Yeh
- Master Degree Program in Health and Long-term Care Industry, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Wann-Yun Shieh
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Hsin Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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Ewy DF. Ethical Obligation of Adequate Pain Management in Long Term Care Residents with Dementia. Kans J Med 2024; 17:87-89. [PMID: 39091369 PMCID: PMC11291185 DOI: 10.17161/kjm.vol17.22135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/06/2024] [Indexed: 08/04/2024] Open
Affiliation(s)
- Donna F Ewy
- Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
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Hedman C, Fürst P, Strang P, Schelin MEC, Lundström S, Martinsson L. Pain prevalence and pain relief in end-of-life care - a national registry study. BMC Palliat Care 2024; 23:171. [PMID: 39004730 PMCID: PMC11247729 DOI: 10.1186/s12904-024-01497-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Despite pain control being a top priority in end-of-life care, pain continues to be a troublesome symptom and comprehensive data on pain prevalence and pain relief in patients with different diagnoses are scarce. METHODS The Swedish Register of Palliative Care (SRPC) was used to retrieve data from 2011 to 2022 about pain during the last week of life. Data were collected regarding occurrence of pain, whether pain was relieved and occurrence of severe pain, to examine if pain differed between patients with cancer, heart failure, chronic obstructive pulmonary disease (COPD) and dementia. Binary logistic regression models adjusted for sex and age were used. RESULTS A total of 315 000 patients were included in the study. Pain during the last week of life was more commonly seen in cancer (81%) than in dementia (69%), heart failure (68%) or COPD (57%), also when controlled for age and sex, p < 0.001. Severe forms of pain were registered in 35% in patients with cancer, and in 17-21% in non-cancer patients. Complete pain relief (regardless of pain intensity) was achieved in 73-87% of those who experienced pain, depending on diagnosis. The proportion of patients with complete or partial pain relief was 99.8% for the whole group. CONCLUSIONS The occurrence of pain, including severe pain, was less common in patients with heart failure, COPD or dementia, compared to patients with cancer. Compared with cancer, pain was more often fully relieved for patients with dementia, but less often in heart failure and COPD. As severe pain was seen in about a third of the cancer patients, the study still underlines the need for better pain management in the imminently dying. TRIAL REGISTRATION No trial registration was made as all patients were deceased and all data were retrieved from The Swedish Register of Palliative Care database.
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Affiliation(s)
- Christel Hedman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna (L1:00), Stockholm, SE-171 76, Sweden.
- R & D Department, Stockholms Sjukhem Foundation, Mariebergsgatan 22, Stockholm, SE-112 19, Sweden.
- Department of Clinical Sciences Lund, Lund University, BMC I12, Lund, SE-221 84, Sweden.
| | - Per Fürst
- R & D Department, Stockholms Sjukhem Foundation, Mariebergsgatan 22, Stockholm, SE-112 19, Sweden
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Blickagången 16, Huddinge, SE-141 83, Sweden
| | - Peter Strang
- R & D Department, Stockholms Sjukhem Foundation, Mariebergsgatan 22, Stockholm, SE-112 19, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Anna Steckséns gata 30A, Stockholm, D2:04, SE-171 64, Sweden
| | - Maria E C Schelin
- Department of Clinical Sciences Lund, Lund University, BMC I12, Lund, SE-221 84, Sweden
| | - Staffan Lundström
- R & D Department, Stockholms Sjukhem Foundation, Mariebergsgatan 22, Stockholm, SE-112 19, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Anna Steckséns gata 30A, Stockholm, D2:04, SE-171 64, Sweden
| | - Lisa Martinsson
- Department of Diagnostics and Intervention Oncology, Umeå University, Umeå, SE-901 87, Sweden
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Yang Q, Yi R, Wang N, Zhang P. Perception, behavior and experience of nursing assistants towards pain of older adults with dementia: A qualitative study. Geriatr Nurs 2024; 56:100-107. [PMID: 38340431 DOI: 10.1016/j.gerinurse.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/11/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
Nursing assistants are strategically positioned to detect and interpret behavioral alterations indicative of pain in residents suffering from dementia. Despite this, extant literature is scarce regarding their experiences in administering pain care to this demographic. Utilizing a phenomenological approach, this study engaged 17 nursing assistants selected via purposive sampling for semi-structured interviews. Data analysed by the Colaizzi 7-step method. Four emergent themes were discerned: perception of pain; strategies for coping with pain; emotional and psychological responses to pain-related caregiving; challenges and needs in pain-related caregiving. Nursing assistants play a unique and crucial role in the identification of pain, reporting and providing feedback to healthcare professionals, and implementing non-pharmacological interventions. However, these roles have not been fully utilized. Enhancements in pain management could be facilitated by decreasing staff turnover, augmenting educational and training programs, and incorporating empathy-focused situational training. The provision of mental health services is also recommended to ameliorate caregiving-induced stress.
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Affiliation(s)
- Qing Yang
- School of Nursing, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou 510515, China
| | - Ruxue Yi
- School of Nursing, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou 510515, China
| | - Nana Wang
- Department of Nursing, Guangzhou Elderly Care Center, No. 1288 Guangcongshi Road, Baiyun District, Guangzhou 510550, China
| | - Ping Zhang
- School of Nursing, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou 510515, China.
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Adamo D, Mignogna MD, Wang XQ, Femminella GD. Editorial: Chronic pain in neuropsychiatric diseases. Front Hum Neurosci 2023; 17:1213217. [PMID: 37378350 PMCID: PMC10292928 DOI: 10.3389/fnhum.2023.1213217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Affiliation(s)
- Daniela Adamo
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Michele D. Mignogna
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, University of Sport, Shanghai University, Shanghai, China
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