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Zhang Z, Yu P, Yin M, Chang HC, Thomas SJ, Wei W, Song T, Deng C. Developing an ontology of non-pharmacological treatment for emotional and mood disturbances in dementia. Sci Rep 2024; 14:1937. [PMID: 38253678 PMCID: PMC10803746 DOI: 10.1038/s41598-023-46226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/30/2023] [Indexed: 01/24/2024] Open
Abstract
Emotional and mood disturbances are common in people with dementia. Non-pharmacological interventions are beneficial for managing these disturbances. However, effectively applying these interventions, particularly in the person-centred approach, is a complex and knowledge-intensive task. Healthcare professionals need the assistance of tools to obtain all relevant information that is often buried in a vast amount of clinical data to form a holistic understanding of the person for successfully applying non-pharmacological interventions. A machine-readable knowledge model, e.g., ontology, can codify the research evidence to underpin these tools. For the first time, this study aims to develop an ontology entitled Dementia-Related Emotional And Mood Disturbance Non-Pharmacological Treatment Ontology (DREAMDNPTO). DREAMDNPTO consists of 1258 unique classes (concepts) and 70 object properties that represent relationships between these classes. It meets the requirements and quality standards for biomedical ontology. As DREAMDNPTO provides a computerisable semantic representation of knowledge specific to non-pharmacological treatment for emotional and mood disturbances in dementia, it will facilitate the application of machine learning to this particular and important health domain of emotional and mood disturbance management for people with dementia.
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Affiliation(s)
- Zhenyu Zhang
- Centre for Digital Transformation, School of Computing and Information Technology, University of Wollongong, Northfield Ave, Wollongong, NSW, 2522, Australia
| | - Ping Yu
- Centre for Digital Transformation, School of Computing and Information Technology, University of Wollongong, Northfield Ave, Wollongong, NSW, 2522, Australia.
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.
| | - Mengyang Yin
- Centre for Digital Transformation, School of Computing and Information Technology, University of Wollongong, Northfield Ave, Wollongong, NSW, 2522, Australia
- Systems and Reporting Residential Care, Catholic Healthcare Ltd, Wollongong, Australia
| | - Hui Chen Chang
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- School of Nursing, University of Wollongong, Wollongong, Australia
| | - Susan J Thomas
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Wenxi Wei
- School of Nursing, University of Wollongong, Wollongong, Australia
| | - Ting Song
- Centre for Digital Transformation, School of Computing and Information Technology, University of Wollongong, Northfield Ave, Wollongong, NSW, 2522, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Chao Deng
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, Australia
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Brunn M, Kratz T, Padget M, Clément MC, Smyrl M. Why are there so many hospital beds in Germany? Health Serv Manage Res 2023; 36:75-81. [PMID: 35331042 DOI: 10.1177/09514848221080691] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The place of hospitals in health systems is undergoing rapid change worldwide due to the high cost of hospital care and the changing health needs of the population. The Covid-19 pandemic has recently drawn public attention towards hospital capacity and has added new urgency to discussions on the future role of hospitals. In this context, recent experience in Germany provides valuable information for health systems seeking to manage hospital capacity. Despite reform efforts to reduce hospital capacity, Germany has the highest rates of intensive care beds among high-income countries and the highest overall hospital capacity in Europe. The capacity of the German hospital system can be explained in large part by the high number of elderly in-patients. This, in turn, is driven by (1) a fragmented ambulatory care system; (2) physicians admitting and maintaining elderly patients in hospital at a high rate; (3) a hospital market adding incentives to admit patients; and (4) a political commitment to egalitarian access and universal care. Additionally, recent policies to reduce hospital capacity have had limited impact because hospitals have not responded to financial incentives in the expected manner. Countries looking to learn from Germany's hospital capacity must therefore consider systemic features, political commitments, and unintended policy consequences.
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Affiliation(s)
| | - Torsten Kratz
- 14921Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany
| | | | | | - Marc Smyrl
- 214002Montpellier University Faculty of Law and Political Science, Montpellier, France
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Roßmeier C, Gast J, Riedl L, Hartmann J, Kohl S, Hartmann F, Diehl-Schmid J. [Deprescribing of antipsychotic drugs for dementia : Recommendations for action on dose reduction and discontinuation attempts]. DER NERVENARZT 2022; 93:912-920. [PMID: 35771240 PMCID: PMC9243982 DOI: 10.1007/s00115-022-01343-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/06/2022]
Abstract
Hintergrund In Leitlinien zur Behandlung von psychischen und Verhaltenssymptomen bei Demenz („Behavioral and Psychological Symptoms of Dementia“ [BPSD]) wird empfohlen, Antipsychotika im Falle einer notwendigen Therapie zeitlich begrenzt und in möglichst geringer Dosis einzusetzen. Fragestellung Um das Bewusstsein für die Risiken einer Antipsychotikabehandlung bei Patient:innen mit Demenz und die dadurch begründete Notwendigkeit einer zeitlich begrenzten und möglichst niedrig dosierten Antipsychotikabehandlung zu schärfen, wurden Handlungsempfehlungen zum Deprescribing von Antipsychotika bei Menschen mit Demenz entwickelt. Material und Methoden Die Entwicklung der Handlungsempfehlungen erfolgte in einem mehrstufigen Prozess: 1. Literaturrecherche unter besonderer Würdigung von konsentierten Leitlinienempfehlungen und Ergebnissen einer eigenen Interventionsstudie (READY-Studie), 2. Diskussion und Konsentierung in einem Expert:innengremium, 3. Onlineumfrage von in Deutschland tätigen ärztlichen Demenzexpert:innen. Ergebnisse Aus 51 im ersten Entwurf zusammengestellten Aussagen wurden nach der Diskussion im multiprofessionellen Expert:innengremium 32 Aussagen zum „Deprescribing“ (Reduktion und Ausschleichen) von Antipsychotika formuliert. 25 der 32 Aussagen wurden nach Konsentierung in einer Onlineumfrage durch ärztliche Demenzexpert:innen final übernommen. Diskussion In Deutschland gibt es bislang keine konkreten Empfehlungen zur Vorgehensweise bei Reduktion und Absetzen von Antipsychotika, die zur Behandlung von BPSD bei Menschen mit Demenz eingesetzt werden. Die vorgelegte Arbeit soll als Handlungsempfehlung für Haus- und Fachärzt:innen dienen. Bei den Empfehlungen handelt es sich um keine Leitlinien, sie ersetzen nicht die Eigenverantwortlichkeit der Behandelnden und das individuell notwendige Vorgehen in Abhängigkeit von der Behandlungssituation. Zusatzmaterial online Die Onlineversion dieses Beitrags (10.1007/s00115-022-01343-w) enthält zusätzliches Material. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, die Videos finden Sie beim Beitrag unter „Ergänzende Inhalte“.
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Affiliation(s)
- Carola Roßmeier
- Fakultät für Medizin, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland. .,Fachbereich Alterspsychiatrie, kbo-Inn-Salzach-Klinikum GmbH, Gabersee 7, 83512, Wasserburg am Inn, Deutschland.
| | - Jennifer Gast
- Fakultät für Medizin, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Lina Riedl
- Fakultät für Medizin, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Julia Hartmann
- Fakultät für Medizin, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Sarah Kohl
- Fakultät für Medizin, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Florentine Hartmann
- Fakultät für Medizin, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Janine Diehl-Schmid
- Fakultät für Medizin, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.,Fachbereich Alterspsychiatrie, kbo-Inn-Salzach-Klinikum GmbH, Gabersee 7, 83512, Wasserburg am Inn, Deutschland
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4
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Personalized Management and Treatment of Alzheimer's Disease. Life (Basel) 2022; 12:life12030460. [PMID: 35330211 PMCID: PMC8951963 DOI: 10.3390/life12030460] [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: 02/22/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
Alzheimer’s disease (AD) is a priority health problem with a high cost to society and a large consumption of medical and social resources. The management of AD patients is complex and multidisciplinary. Over 90% of patients suffer from concomitant diseases and require personalized therapeutic regimens to reduce adverse drug reactions (ADRs), drug−drug interactions (DDIs), and unnecessary costs. Men and women show substantial differences in their AD-related phenotypes. Genomic, epigenetic, neuroimaging, and biochemical biomarkers are useful for predictive and differential diagnosis. The most frequent concomitant diseases include hypertension (>25%), obesity (>70%), diabetes mellitus type 2 (>25%), hypercholesterolemia (40%), hypertriglyceridemia (20%), metabolic syndrome (20%), hepatobiliary disorder (15%), endocrine/metabolic disorders (>20%), cardiovascular disorder (40%), cerebrovascular disorder (60−90%), neuropsychiatric disorders (60−90%), and cancer (10%). Over 90% of AD patients require multifactorial treatments with risk of ADRs and DDIs. The implementation of pharmacogenetics in clinical practice can help optimize the limited therapeutic resources available to treat AD and personalize the use of anti-dementia drugs, in combination with other medications, for the treatment of concomitant disorders.
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Walker N, Crutch SJ, West J, Jones FW, Brotherhood EV, Harding E, Camic PM. Singing and music making: physiological responses across early to later stages of dementia. Wellcome Open Res 2022; 6:150. [PMID: 35243005 PMCID: PMC8864187.3 DOI: 10.12688/wellcomeopenres.16856.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Music based interventions have been found to improve wellbeing for people with dementia. More recently there has been interest in physiological measures to provide additional information about how music and singing impact this population. Methods: This multiple-case study design explored physiological responses (heart rate-HR, electrodermal activity-EDA, movement, and skin temperature-ST) of nine people with mild-to-moderate using simulation modelling analysis. Results: In study 1, the singing group showed an increase in EDA (p < 0.01 for 8/9 participants) and HR (p < 0.01 for 5/9 participants) as the session began. HR (p < 0.0001 for 5/9 participants) and ST (p < 0.0001 for 6/9 participants) increased during faster tempos. EDA (p < 0.01 all), movement (p < 0.01 for 8/9 participants) and engagement were higher during singing compared to a baseline control. In study 2 EDA (p < 0.0001 for 14/18 data points [3 music conditions across 6 participants]) and ST (p < 0.001 for 10/18 data points) increased and in contrast to the responses during singing, HR decreased as the sessions began (p < 0.002 for 9/18 data points). EDA was higher during slower music (p < 0.0001 for 13/18 data points), however this was less consistent in more interactive sessions than the control. There were no consistent changes in HR and movement responses during different music genre. Conclusions: Physiological measures provide valuable information about the experiences of people with dementia participating in musical activities, particularly for those with verbal communication difficulties. Future research should consider using physiological measures. video-analysis and observational measures to explore further how engagement in specific activities, wellbeing and physiology interact.
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Affiliation(s)
- Nina Walker
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, Kent, UK
| | - Sebastian J. Crutch
- Dementia Research Centre, Department of Neurodegeneration, Queen Square Institute of Neurology, University College London, London, UK
| | - Julian West
- Open Academy, The Royal Academy of Music, London, UK
| | - Fergal W. Jones
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, Kent, UK
| | - Emilie V. Brotherhood
- Dementia Research Centre, Department of Neurodegeneration, Queen Square Institute of Neurology, University College London, London, UK
| | - Emma Harding
- Dementia Research Centre, Department of Neurodegeneration, Queen Square Institute of Neurology, University College London, London, UK
| | - Paul M. Camic
- Dementia Research Centre, Department of Neurodegeneration, Queen Square Institute of Neurology, University College London, London, UK
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Cacabelos R, Naidoo V, Martínez-Iglesias O, Corzo L, Cacabelos N, Pego R, Carril JC. Pharmacogenomics of Alzheimer's Disease: Novel Strategies for Drug Utilization and Development. Methods Mol Biol 2022; 2547:275-387. [PMID: 36068470 DOI: 10.1007/978-1-0716-2573-6_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Alzheimer's disease (AD) is a priority health problem in developed countries with a high cost to society. Approximately 20% of direct costs are associated with pharmacological treatment. Over 90% of patients require multifactorial treatments, with risk of adverse drug reactions (ADRs) and drug-drug interactions (DDIs) for the treatment of concomitant diseases such as hypertension (>25%), obesity (>70%), diabetes mellitus type 2 (>25%), hypercholesterolemia (40%), hypertriglyceridemia (20%), metabolic syndrome (20%), hepatobiliary disorder (15%), endocrine/metabolic disorders (>20%), cardiovascular disorder (40%), cerebrovascular disorder (60-90%), neuropsychiatric disorders (60-90%), and cancer (10%).For the past decades, pharmacological studies in search of potential treatments for AD focused on the following categories: neurotransmitter enhancers (11.38%), multitarget drugs (2.45%), anti-amyloid agents (13.30%), anti-tau agents (2.03%), natural products and derivatives (25.58%), novel synthetic drugs (8.13%), novel targets (5.66%), repository drugs (11.77%), anti-inflammatory drugs (1.20%), neuroprotective peptides (1.25%), stem cell therapy (1.85%), nanocarriers/nanotherapeutics (1.52%), and other compounds (<1%).Pharmacogenetic studies have shown that the therapeutic response to drugs in AD is genotype-specific in close association with the gene clusters that constitute the pharmacogenetic machinery (pathogenic, mechanistic, metabolic, transporter, pleiotropic genes) under the regulatory control of epigenetic mechanisms (DNA methylation, histone/chromatin remodeling, microRNA regulation). Most AD patients (>60%) are carriers of over ten pathogenic genes. The genes that most frequently (>50%) accumulate pathogenic variants in the same AD case are A2M (54.38%), ACE (78.94%), BIN1 (57.89%), CLU (63.15%), CPZ (63.15%), LHFPL6 (52.63%), MS4A4E (50.87%), MS4A6A (63.15%), PICALM (54.38%), PRNP (80.7059), and PSEN1 (77.19%). There is also an accumulation of 15 to 26 defective pharmagenes in approximately 85% of AD patients. About 50% of AD patients are carriers of at least 20 mutant pharmagenes, and over 80% are deficient metabolizers for the most common drugs, which are metabolized via the CYP2D6, CYP2C9, CYP2C19, and CYP3A4/5 enzymes.The implementation of pharmacogenetics can help optimize drug development and the limited therapeutic resources available to treat AD, and personalize the use of anti-dementia drugs in combination with other medications for the treatment of concomitant disorders.
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Affiliation(s)
- Ramón Cacabelos
- Department of Genomic Medicine, International Center of Neuroscience and Genomic Medicine, EuroEspes Biomedical Research Center, Corunna, Spain.
| | - Vinogran Naidoo
- Department of Neuroscience, International Center of Neuroscience and Genomic Medicine, EuroEspes Biomedical Research Center, Corunna, Spain
| | - Olaia Martínez-Iglesias
- Department of Medical Epigenetics, International Center of Neuroscience and Genomic Medicine, EuroEspes Biomedical Research Center, Corunna, Spain
| | - Lola Corzo
- Department of Medical Biochemistry, International Center of Neuroscience and Genomic Medicine, EuroEspes Biomedical Research Center, Corunna, Spain
| | - Natalia Cacabelos
- Department of Medical Documentation, International Center of Neuroscience and Genomic Medicine, EuroEspes Biomedical Research Center, Corunna, Spain
| | - Rocío Pego
- Department of Neuropsychology, International Center of Neuroscience and Genomic Medicine, EuroEspes Biomedical Research Center, Corunna, Spain
| | - Juan C Carril
- Department of Genomics and Pharmacogenomics, International Center of Neuroscience and Genomic Medicine, EuroEspes Biomedical Research Center, Corunna, Spain
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Affiliation(s)
- Helen Güther
- Department für Humanmedizin, Universität Witten/Herdecke, Stockumer Str. 12, 58453, Witten, Germany.
| | - Heike Baranzke
- Department für Humanmedizin, Bergische Universität Wuppertal, Wuppertal, Germany
| | - Ulrike Höhmann
- Department für Humanmedizin, Universität Witten/Herdecke, Stockumer Str. 12, 58453, Witten, Germany
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Walker N, Crutch SJ, West J, Jones FW, Brotherhood EV, Harding E, Camic PM. Singing and music making: physiological responses across early to later stages of dementia. Wellcome Open Res 2021; 6:150. [PMID: 35243005 PMCID: PMC8864187.2 DOI: 10.12688/wellcomeopenres.16856.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Music based interventions have been found to improve the wellbeing of people living with dementia. More recently there has been interest in physiological measures to provide additional information about how music and singing impact this population. Methods: This multiple-case study design explored physiological responses (heart rate-HR, electrodermal activity-EDA, movement, and skin temperature-ST) of nine people with mild-to-moderate dementia during a singing group, and six people in the later stages of dementia during an interactive music group. The interactive music group was also video recorded to provide information about engagement. Data were analysed using simulation modelling analysis. Results: The singing group showed an increase in EDA (p < 0.01 for 8/9 participants) and HR (p < 0.01 for 5/9 participants) as the session began. HR (p < 0.0001 for 5/9 participants) and ST (p < 0.0001 for 6/9 participants) increased during faster paced songs. EDA (p < 0.01 all), movement (p < 0.01 for 8/9 participants) and engagement were higher during an interactive music group compared to a control session (music listening). EDA (p < 0.0001 for 14/18 participants) and ST (p < 0.001 for 10/18 participants) increased and in contrast to the responses during singing, HR decreased as the sessions began (p < 0.002 for 9/18 participants). EDA was higher during slower music (p < 0.0001 for 13/18 participants), however this was less consistent in more interactive sessions than the control. There were no consistent changes in HR and movement responses during different styles of music. Conclusions: Physiological measures may provide valuable information about the experiences of people with dementia participating in arts and other activities, particularly for those with verbal communication difficulties. Future research should consider using physiological measures with video-analysis and observational measures to explore further how engagement in specific activities, wellbeing and physiology interact.
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Affiliation(s)
- Nina Walker
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, Kent, UK
| | - Sebastian J. Crutch
- Dementia Research Centre, Department of Neurodegeneration, Queen Square Institute of Neurology, University College London, London, UK
| | - Julian West
- Open Academy, The Royal Academy of Music, London, UK
| | - Fergal W. Jones
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, Kent, UK
| | - Emilie V. Brotherhood
- Dementia Research Centre, Department of Neurodegeneration, Queen Square Institute of Neurology, University College London, London, UK
| | - Emma Harding
- Dementia Research Centre, Department of Neurodegeneration, Queen Square Institute of Neurology, University College London, London, UK
| | - Paul M. Camic
- Dementia Research Centre, Department of Neurodegeneration, Queen Square Institute of Neurology, University College London, London, UK
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Teut M, Ortiz M. Integrative Medicine and Ageing. Complement Med Res 2021; 28:383-386. [PMID: 34482303 DOI: 10.1159/000519159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/19/2021] [Indexed: 12/29/2022]
Affiliation(s)
- Michael Teut
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Miriam Ortiz
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Chekani F, Pike J, Jones E, Husbands J, Khandker RK. Impact of Dementia-Related Behavioral Symptoms on Healthcare Resource Use and Caregiver Burden: Real-World Data from Europe and the United States. J Alzheimers Dis 2021; 81:1567-1578. [PMID: 34057080 PMCID: PMC8293640 DOI: 10.3233/jad-201483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Dementia is commonly accompanied by neurobehavioral symptoms; however, the relationship between such symptoms and health-related outcomes is unclear. OBJECTIVE To investigate the impact of specific neurobehavioral symptoms in dementia on healthcare resource use (HCRU), patient quality of life (QoL), and caregiver burden. METHODS Data were taken from the 2015/16 Adelphi Real World Dementia Disease Specific Programme™, a point-in-time survey of physicians and their consulting dementia patients. Multiple regression analyses were used to examine associations between patient symptom groups and health-related outcomes. RESULTS Each patient symptom group of interest (patients with agitation/aggression and related symptoms [AARS] with psychosis, patients with AARS without psychosis, and patients with other behavioral symptoms) had a positive association with HCRU variables (i.e., HCRU was greater), a negative association with proxy measures of patient QoL (i.e., QoL was decreased), and a positive association with caregiver burden (i.e., burden was greater) compared with patients with no behavioral symptoms (control group). The magnitude of effect was generally greatest in patients with AARS with psychosis. Regression analysis covariates that were found to be most often significantly related to the outcomes were dementia severity and the patients' living situation (i.e., whether they were in nursing homes or living in the community). CONCLUSION Combinations of behavioral symptoms, particularly involving AARS plus psychosis, may have a detrimental impact on health-related outcomes such as HCRU, patient QoL, and caregiver burden in dementia. Our results have implications for intervention development in patients who report clusters of symptoms and caregivers, and for identifying at-risk individuals.
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Affiliation(s)
- Farid Chekani
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | | | | - Rezaul K Khandker
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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Walker N, Crutch SJ, West J, Jones FW, Brotherhood EV, Harding E, Camic PM. Singing and music making: physiological responses across early to later stages of dementia. Wellcome Open Res 2021; 6:150. [PMID: 35243005 PMCID: PMC8864187 DOI: 10.12688/wellcomeopenres.16856.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Music based interventions have been found to improve the wellbeing of people living with dementia. More recently there has been interest in physiological measures to provide additional information about how music and singing impact this population. Methods: This multiple-case study design explored physiological responses (heart rate-HR, electrodermal activity-EDA, movement, and skin temperature-ST) of nine people with mild-to-moderate dementia during a singing group, and six people in the later stages of dementia during an interactive music group. The interactive music group was also video recorded to provide information about engagement. Data were analysed using simulation modelling analysis. Results: The singing group showed an increase in EDA (p < 0.01 for 8/9 participants) and HR (p < 0.01 for 5/9 participants) as the session began. HR (p < 0.0001 for 5/9 participants) and ST (p < 0.0001 for 6/9 participants) increased during faster paced songs. EDA (p < 0.01 all), movement (p < 0.01 for 8/9 participants) and engagement were higher during an interactive music group compared to a control session (music listening). EDA (p < 0.0001 for 14/18 participants) and ST (p < 0.001 for 10/18 participants) increased and in contrast to the responses during singing, HR decreased as the sessions began (p < 0.002 for 9/18 participants). EDA was higher during slower music (p < 0.0001 for 13/18 participants), however this was less consistent in more interactive sessions than the control. There were no consistent changes in HR and movement responses during different styles of music. Conclusions: Physiological measures may provide valuable information about the experiences of people with dementia participating in arts and other activities, particularly for those with verbal communication difficulties. Future research should consider using physiological measures with video-analysis and observational measures to explore further how engagement in specific activities, wellbeing and physiology interact.
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Affiliation(s)
- Nina Walker
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, Kent, UK
| | - Sebastian J. Crutch
- Dementia Research Centre, Department of Neurodegeneration, Queen Square Institute of Neurology, University College London, London, UK
| | - Julian West
- Open Academy, The Royal Academy of Music, London, UK
| | - Fergal W. Jones
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, Kent, UK
| | - Emilie V. Brotherhood
- Dementia Research Centre, Department of Neurodegeneration, Queen Square Institute of Neurology, University College London, London, UK
| | - Emma Harding
- Dementia Research Centre, Department of Neurodegeneration, Queen Square Institute of Neurology, University College London, London, UK
| | - Paul M. Camic
- Dementia Research Centre, Department of Neurodegeneration, Queen Square Institute of Neurology, University College London, London, UK
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Gimeno I, Val S, Cardoso Moreno MJ. Relation among Caregivers' Burden, Abuse and Behavioural Disorder in People with Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031263. [PMID: 33572503 PMCID: PMC7908463 DOI: 10.3390/ijerph18031263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/24/2021] [Accepted: 01/29/2021] [Indexed: 11/16/2022]
Abstract
Dementia produces a loss of independence to carry out the activities of daily life. The great demand for care that these people need usually falls on the family through informal care. This study aims to analyse the burden showed by the informal caregiver of a person with dementia. In addition, we analyse whether this burden present in informal caregivers could be related to abusive behaviour. We also study the relationship between the stage of the disease, the appearance of behavioural disorders and the level of burden in the caregiver using the Scales of Zarit, CASE and FAST. The data showed that 45.50 per cent of caregivers have light burden or burden. After the research, it was identified that the presence of behavioural disorders in patients with dementia showed a correlation with the increase in both the main caregiver burden and abuse. An increase in the level of burden is followed by an increase in the level of abuse (r = 0.844; p = 0.000). Furthermore, we analysed several conditions that could have a correlation with this burden and abuse. It was found that burden in the caregiver could be linked with the presence of behavioural disorders, like aggression (r = 0.577; p = 0.008) and irritability (r = 0.600; p = 0.005) at the moderate stage of the disease. On the other hand, there is a positive correlation between the probability that people with dementia suffer abuse in the moderate stage of the disease and the presence of aggression (r = 0.732; p = 0.000), lack of inhibition (r = 0.571; p = 0.009) and irritability (r = 0.827; p = 0.000). Taking this data into account, burden and abuse seem to be linked to the presence of behavioural disorders in patients with dementia in the moderate stage.
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Affiliation(s)
- Ignacio Gimeno
- Department of Psychology and Sociology, Faculty of Health of Sciences, University of Zaragoza, 50009 Zaragoza, Spain;
| | - Sonia Val
- EINA, Design and Manufacturing Engineering Department, University of Zaragoza, 50009 Zaragoza, Spain;
| | - María Jesús Cardoso Moreno
- Department of Psychology and Sociology, Faculty of Health of Sciences, University of Zaragoza, 50009 Zaragoza, Spain;
- Correspondence:
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Kratz T, Diefenbacher A. Psychopharmacological Treatment in Older People: Avoiding Drug Interactions and Polypharmacy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:508-518. [PMID: 31452508 DOI: 10.3238/arztebl.2019.0508] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 03/18/2019] [Accepted: 06/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND As the elderly population increases, so, too, does the number of multimorbid patients and the risk of polypharmacy. The consequences include drug interactions, undesired side effects of medication, health impairment, and the need for hospital- ization. 5-10% of hospital admissions among the elderly are attributable to undesired side effects of medication. METHODS This review is based on publications retrieved by a selective search in PubMed and the Cochrane Library that employed the search terms "drug interaction," "undesired side effect," "polypharmacy," "pharmacokinetics," and "pharmacody- namics." RESULTS Elderly patients are particularly at risk of polypharmacy, both because of the prevalence of multimorbidity in old age and because of physicians' uncritical implementation of guidelines. The more drugs a person takes, the greater the risk of drug interactions and undesired side effects. Age-associated changes in pharmacokinetics and pharmacodynamics elevate this risk as well. Physicians prescribing drugs for elderly patients need to know about the drugs' catabolic pathways, protein binding, and inductive and inhibitory effects on cytochrome P450 in order to avoid drug interactions and polypharmacy. CONCLUSION Multiple aids and instruments are available to ensure practical and reasonable drug monitoring, so that the risks of drug interactions and undesired side effects can be detected early and avoided.
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Affiliation(s)
- Torsten Kratz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus "Königin Elisabeth" Herzberge, Berlin
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Ortner M, Stange M, Schneider H, Schroeder C, Buerger K, Müller C, Dorn B, Goldhardt O, Diehl-Schmid J, Förstl H, Steimer W, Grimmer T. Serum Concentrations of Cholinesterase Inhibitors in Patients With Alzheimer's Dementia Are Frequently Below the Recommended Levels. Front Pharmacol 2020; 11:691. [PMID: 32508640 PMCID: PMC7253642 DOI: 10.3389/fphar.2020.00691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 04/27/2020] [Indexed: 01/14/2023] Open
Abstract
Background Acetylcholinesterase inhibitors (AChE-I) are recommended for the treatment of cognitive symptoms but also of behavioral and psychological symptoms in dementia. They are widely used not only in Alzheimer's disease, but also in other forms of dementia. Efficacy of treatment might depend on serum concentration of the respective AChE-I. Objective In patients with mild to moderate Alzheimer's dementia, we measured serum concentrations of hepatically metabolized donepezil and renally excreted rivastigmine and investigated possible modifiers. Additionally, we looked at correlations between serum concentrations and efficacy for both drugs. Methods Serum concentrations of donepezil and rivastigmine were measured by liquid chromatography – tandem mass spectrometry (LC-MS/MS). Real-time quantitative polymerase chain reaction (PCR). Allele specific PCR were performed to determine CYP2D6 genotype and gene dose. Clinical efficacy was assessed by changes of the subtest wordlist delayed recall of the Consortium to Establish a Registry for Alzheimer's Disease-Neuropsychological Assessment Battery (CERAD-NAB). Results Sixty-seven patients treated with a stable dosage of donepezil 10 mg (n=41) or rivastigmine 9.5 mg (n=26) were included. Mean serum concentration of donepezil and rivastigmine were 41.2 and 6.5 ng/ml, respectively. Serum concentrations were below the recommended range in 73% of the subjects in the donepezil group and in 65% of the participants in the rivastigmine group. When applying a dose-related reference, ranges 63% of patients in the donepezil group and 32% in the rivastigmine group had concentrations below the expected range. Gene dose, sex, and duration of treatment significantly predicted donepezil serum concentration (p=0.046, p=0.001, p=0.030 respectively). Only for rivastigmine did the serum concentration significantly contribute to the regression model predicting changes on the subtest word list delayed recall (β=0.472; p=0.019). Conclusions Serum concentrations of about two thirds of the patients were below the recommended range. When not looking at absolute values but at the dose-related reference ranges, these numbers improved but still 32%, respectively 63% of patients had low serum concentrations. High serum concentrations of rivastigmine predicted clinical response to cognition. Therapeutic drug monitoring might help to identify the cause of poor clinical response to cognition and behavioral and psychological symptoms in patients with AChE-I treatment.
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Affiliation(s)
- Marion Ortner
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marion Stange
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Heike Schneider
- Institute for Clinical Chemistry and Pathobiochemistry, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Charlotte Schroeder
- Institute for Clinical Chemistry and Pathobiochemistry, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Katharina Buerger
- Institut for Stroke and Dementia Research, University of Munich, Munich, Germany.,DZNE - German Center for Neurodegenerative Diseases, Munich, Germany
| | - Claudia Müller
- Institut for Stroke and Dementia Research, University of Munich, Munich, Germany
| | - Bianca Dorn
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Oliver Goldhardt
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans Förstl
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Werner Steimer
- Institute for Clinical Chemistry and Pathobiochemistry, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Bickel H, Hendlmeier I, Baltasar Heßler J, Nora Junge M, Leonhardt-Achilles S, Weber J, Schäufele M. The Prevalence of Dementia and Cognitive Impairment in Hospitals. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:733-740. [PMID: 30565543 PMCID: PMC6318438 DOI: 10.3238/arztebl.2018.0733] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 04/04/2018] [Accepted: 08/13/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The care of elderly patients with comorbid dementia poses an increasing challenge in the acute inpatient setting, yet there remains a lack of representative studies on the prevalence and distribution of dementia in general hospitals. METHODS We conducted a cross-sectional study of patients aged 65 and older in randomly selected general hospitals in southern Germany. Patients were excluded if they were in an intensive care unit or isolation unit or if they were on specialized wards for psychiatry, neurology, or geriatric medicine. The findings are derived from patient interviews, neuropsychological testing, standardized rating scales, questioning of nursing staff, and the patients' medical records. RESULTS 1469 patients on 172 inpatient wards of 33 hospitals were studied. 40.0% of them (95% confidence interval, [36.2; 43.7]) had at least mild cognitive impairment. The point-prevalence of dementing illnesses was 18.4% [16.3; 20.7]. Delirium, most often on the basis of dementia, was present in 5.1% [3.9; 6.7]. 60.0% had no cognitive impairment. Dementia was more common among patients of very advanced age, those who were dependent on nursing care, those who lived in old-age or nursing homes, and those with a low level of education. Among patients with dementia, only 36.7% had a documented diagnosis of dementia in the medical record. Patients with dementia were treated more often for dehydration, electrolyte disturbances, urinary tract infections, contusions, and bone fractures, as well as for symptoms and findings of an unknown nature, and much less often for cancer or musculoskeletal diseases. CONCLUSION Two out of five elderly patients in general hospitals suffer from a cognitive disturbance. Patients with severe impairments such as dementia or delirium often need special care. Guidelines and model projects offer approaches by which the inpatient care of patients with comorbid dementia can be improved.
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Affiliation(s)
- Horst Bickel
- Working Group Psychiatric Epidemiology, Department of Psychiatry and Psychotherapy, Technical University of Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Ingrid Hendlmeier
- Faculty of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Johannes Baltasar Heßler
- Working Group Psychiatric Epidemiology, Department of Psychiatry and Psychotherapy, Technical University of Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Magdalena Nora Junge
- Working Group Psychiatric Epidemiology, Department of Psychiatry and Psychotherapy, Technical University of Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | | | - Joshua Weber
- Faculty of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Martina Schäufele
- Faculty of Social Sciences, University of Mannheim, Mannheim, Germany
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Bartley MM, Suarez L, Shafi RMA, Baruth JM, Benarroch AJM, Lapid MI. Dementia Care at End of Life: Current Approaches. Curr Psychiatry Rep 2018; 20:50. [PMID: 29936639 DOI: 10.1007/s11920-018-0915-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW Dementia is a progressive and life-limiting condition that can be described in three stages: early, middle, and late. This article reviews current literature on late-stage dementia. RECENT FINDINGS Survival times may vary across dementia subtypes. Yet, the overall trajectory is characterized by progressive decline until death. Ideally, as people with dementia approach the end of life, care should focus on comfort, dignity, and quality of life. However, barriers prevent optimal end-of-life care in the final stages of dementia. Improved and earlier advanced care planning for persons with dementia and their caregivers can help delineate goals of care and prepare for the inevitable complications of end-stage dementia. This allows for timely access to palliative and hospice care, which ultimately improves dementia end-of-life care.
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Affiliation(s)
| | - Laura Suarez
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Reem M A Shafi
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Joshua M Baruth
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Amanda J M Benarroch
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Maria I Lapid
- Center for Palliative Medicine, Mayo Clinic, Rochester, MN, USA. .,Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Diehl-Schmid J, Riedl L, Rüsing U, Hartmann J, Bertok M, Levin C, Hamann J, Arcand M, Lorenzl S, Feddersen B, Jox RJ. [Provision of palliative care for people with advanced dementia]. DER NERVENARZT 2018; 89:524-529. [PMID: 29327100 DOI: 10.1007/s00115-017-0468-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
As a result of a literature-based expert process, this review provides an overview about the principles of palliative care for people with advanced dementia that are relevant for clinical practice. In particular, the indications, impact and aims of palliative care for advanced dementia are described. Life-prolonging measures and management of symptoms at the end of life are discussed. Furthermore, the overview focuses on the legal basis of decision making.
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Affiliation(s)
- J Diehl-Schmid
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - L Riedl
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | | | - J Hartmann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - M Bertok
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - C Levin
- Institut für Allgemeinmedizin, Technische Universität München, München, Deutschland
| | - J Hamann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - M Arcand
- Department of Family Medicine, University of Sherbrooke, Quebec, Kanada
| | - S Lorenzl
- Krankenhaus Agatharied, Agatharied, Deutschland
| | - B Feddersen
- Klinik und Poliklinik für Palliativmedizin, Ludwig-Maximilians-Universität München, München, Deutschland
| | - R J Jox
- Geriatric Palliative Care, Lausanne University Hospital, Lausanne, Schweiz.,Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, München, Deutschland
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Kratz T. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:754. [PMID: 29169436 PMCID: PMC5719238 DOI: 10.3238/arztebl.2017.0754a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Torsten Kratz
- *Abteilung für Psychiatrie, Psychotherapie und Psychosomatik Funktionsbereich Gerontopsychiatrie Königin-Elisabeth-Herzberge Krankenhaus, Berlin
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Bienentreu S. Paying Attention to Electrolytes. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:753. [PMID: 29169435 PMCID: PMC5719237 DOI: 10.3238/arztebl.2017.0753b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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J. Stein W. Additional Comments. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:753. [PMID: 29169434 PMCID: PMC5719236 DOI: 10.3238/arztebl.2017.0753a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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