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agitation and dementia

Stephen Macfarlane, Daniel O'Connor
Most patients with dementia have some behavioural and psychological symptoms. While aggression and agitation are easily recognised, symptoms such as apathy may be overlooked. Behavioural and psychological symptoms should be managed without drugs whenever possible. Although there is little evidence to support their use, antipsychotic drugs are often prescribed to people with dementia. Before prescribing it is important to exclude other causes of altered behaviour, such as pain or infection. Some symptoms may be artefacts of memory loss rather than psychosis...
August 2016: Australian Prescriber
Ipsit V Vahia, Rujvi Kamat, Cheng Vang, Carolina Posada, Lisa Ross, Sarah Oreck, Alok Bhatt, Colin Depp, Dilip V Jeste, Daniel D Sewell
OBJECTIVE: To investigate the feasibility, safety, and utility of tablet devices as novel nonpharmacologic tools in managing older psychiatric inpatients with agitation and dementia. METHODS: Thirty-six patients at a geriatric psychiatry inpatient unit were provided with tablets when agitated and used various apps on the tablet related to communication, games, music, web browser, and photography during their stay. Study staff documented the frequency, duration, and app usage history and rated the extent to which agitation improved after tablet use...
August 4, 2016: American Journal of Geriatric Psychiatry
Mark E Kunik, A Lynn Snow, Nancy Wilson, Amber B Amspoker, Shubhada Sansgiry, Robert O Morgan, Jun Ying, Gayle Hersch, Melinda A Stanley
OBJECTIVES: To compare the efficacy of Preventing Aggression in Veterans with Dementia (PAVeD) with that of usual care in decreasing incidence of aggression (primary outcome) and pain and improving depression, pleasant events, caregiver burden, and patient-caregiver relationship quality (secondary outcomes). DESIGN: Randomized controlled trial with assessments at baseline and 3, 6, 9, and 12 months SETTING: Houston, TX. PARTICIPANTS: A total of 203 community-dwelling veterans with pain and dementia and their caregivers...
April 27, 2016: American Journal of Geriatric Psychiatry
Xiaoniu Liang, Qihao Guo, Jianfeng Luo, Fang Li, Ding Ding, Qianhua Zhao, Zhen Hong
BACKGROUND: Caregivers of care-recipients with mild cognitive impairment (MCI) or dementia experience high caregiver burden; however, the psychiatric burden of caregivers of care-recipients with subjective cognitive decline (SCD) has not been investigated. We aimed to explore the prevalence of and risk factors for anxiety and depression symptoms among the caregivers of care-recipients with SCD and cognitive impairment. METHODS: The Hospital Anxiety and Depression Scale (HADS) was used to examine the anxiety and depression symptoms among the caregivers of 343 care-recipients (84 with SCD, 120 with MCI and 139 with dementia) treated at the Memory Clinic of Huashan Hospital in Shanghai, China from May 2012 to October 2014...
October 3, 2016: BMC Neurology
Tomoyuki Nagata, Shinichiro Nakajima, Shunichiro Shinagawa, Eric Plitman, Ariel Graff-Guerrero, Masaru Mimura, Kazuhiko Nakayama
OBJECTIVE: This study sought to determine psychosocial and clinico-demographic factors related to each symptomatic cluster (i.e., aggressiveness, psychosis, apathy/eating problems, and emotion/disinhibition) of neuropsychiatric symptoms (NPSs) in patients with Alzheimer's disease (AD) needing interventional treatment against their agitation or psychotic symptoms. These clusters were classified from 12 Neuropsychiatric Inventory (NPI) subscores in our previous study using the Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer's Disease (CATIE-AD) dataset...
October 7, 2016: International Journal of Geriatric Psychiatry
Tanya E Davison, Marita P McCabe, Michael Bird, David Mellor, Sarah MacPherson, David Hallford, Melissa Seedy, Daniel W O'Connor
The current study aimed to profile behaviors associated with dementia that pose management difficulties for staff and determine whether existing rating scales capture these reported behaviors. Staff in 17 nursing homes described the behavioral symptoms of 229 residents with predominantly moderate-severe dementia associated with management difficulties. Behaviors were categorized by an expert clinical panel and compared to items in four dementia behavior rating scales. Staff reported 59 discrete behavioral symptoms, with physically agitated, aggressive verbal, non-aggressive verbal, and aggressive physical behaviors most common, followed by resistance to care and inappropriate social and sexual behaviors...
October 5, 2016: Journal of Gerontological Nursing
Ådel Bergland, Hilde Johansen, Gerd Sylvi Sellevold
AIM: Describe professional caregivers' perceptions of factors and processes contributing to mealtime agitation and strategies for attaining and maintaining calm mealtimes. DESIGN: Qualitative and descriptive. METHODS: A convenience sample of professional caregivers working in two wards for residents with dementia was used. Data were collected during two focus-group interviews and supplemented with field notes from six reflection groups. Thematic content analysis was conducted...
November 2015: Nurs Open
Shiho Ikemata, Yumiko Momose
AIM: To evaluate the effects of progressive muscle relaxation on the behavioral and psychological symptoms of dementia, activities of daily living, and immune function of elderly patients with dementia in group homes. METHODS: The participants were ranked by their group home unit. Odd ranks were assigned to the intervention group and even ranks to the control group. The intervention group participated in progressive muscle relaxation for 15 min each day for 90 days in the group environment; the control group members continued with their normal routine...
October 3, 2016: Japan Journal of Nursing Science: JJNS
Fernanda Herrera da Costa, Paulo Adilson Herrera, Cecília Luiz Pereira-Stabile, Glaykon Alex Vitti Stabile
Delirium is an organic mental syndrome with acute onset characterized by diffuse brain dysfunction and neural activity disorganization. It is usually related to cognition and perception changes, decreased level of consciousness, and disorganization of thoughts that are unrelated to previous dementia. Occurrence is more frequent in patients with previous degenerative disease and elderly patients, especially those older than 85 years. Although the pathophysiology is not totally known, studies have shown that, among the main factors that lead to delirium, the drugs used for general anesthesia induction are the most relevant (hypnotics, anticholinergic drugs, and H2 receptor blockers), especially those used in long surgical procedures...
August 27, 2016: Journal of Oral and Maxillofacial Surgery
Barbara Resnick, Ann Kolanowski, Kimberly Van Haitsma, Marie Boltz, Elizabeth Galik, Alice Bonner, Erin Vigne, Lauren Holtzman, Paula M Mulhall
Behavioral and psychological symptoms of dementia are common in nursing home residents, and the Centers for Medicare and Medicaid Services now require that nonpharmacological interventions be used as a first-line treatment. Few staff know how to implement these interventions. The purpose of this study was to pilot test an implementation strategy, Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD), which was developed to help staff integrate behavioral interventions into routine care...
November 2016: American Journal of Alzheimer's Disease and Other Dementias
Candace N Porter, Margaret C Miller, Marcia Lane, Carol Cornman, Khaled Sarsour, Kristin Kahle-Wrobleski
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...
2016: SAGE Open Medicine
Nicolas Farina, Lucy Morrell, Sube Banerjee
OBJECTIVES: Antidepressants are commonly used in dementia. Depression is a frequent and important co-morbidity in dementia, and antidepressants are often used to treat depression and more widely. However, there are questions about their utility in depression in dementia and other behavioural and psychological symptoms of dementia. The aim of this narrative review is to summarize the evidence on whether there is therapeutic value in prescribing antidepressants to people with dementia. METHODS: A PubMed search was performed to identify randomized controlled trials that prescribed antidepressants to people with dementia, either in the treatment of behavioural and psychological symptoms of dementia (depression, anxiety, agitation/aggression, psychosis and apathy) or for secondary outcomes (quality of life, carer burden, activities of daily living, cognition, clinical severity and adverse events)...
September 5, 2016: International Journal of Geriatric Psychiatry
Rajesh R Tampi, Deena J Tampi, Silpa Balachandran, Shilpa Srinivasan
BACKGROUND: The purpose of this review is to evaluate the data on the use of antipsychotics in individuals with dementia from meta-analyses. METHODS: We performed a literature search of PubMed, MEDLINE, EMBASE, PsycINFO and Cochrane collaboration databases through 30 November, 2015 using the following keywords: 'antipsychotics', 'dementia' and 'meta-analysis'. The search was not restricted by the age of the patients or the language of the study. However, in the final analysis we only included studies involving patients that were published in English language journals or had official English translations...
September 2016: Therapeutic Advances in Chronic Disease
Rick Y C Kwan, Mason C P Leung, Claudia K Y Lai
OBJECTIVES: This study aimed to identify the acupressure effect over time, compare the efficacy in different dosages, and identify feasibility issues with saliva sample collection and acupressure implementation in agitated nursing home residents with dementia. DESIGN: Time serial design with eight dosage-combination groups. SETTING: Three residential care homes (RCHs) in Hong Kong. PARTICIPANTS: Agitated RCH residents with dementia...
August 30, 2016: Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice, and Policy
Janny Ho, Roland B Wetzels, Hans Bor, Sytse U Zuidema
BACKGROUND: Neuropsychiatric symptoms (NPS) have a high prevalence among patients with dementia, up to 80%. NPS can be grouped by type and stage of dementia. However, NPS have not previously been grouped by gender. Our objective was to investigate whether NPS cluster differently in men or women in the nursing home patients. METHODS: Factor analysis to assess the clustering of items in the Cohen-Mansfield Agitation Inventory (CMAI) and Neuropsychiatric Inventory-Nursing home version (NPI-NH) into components, for both scales and for gender...
August 30, 2016: International Psychogeriatrics
Sadanandavalli Retnaswami Chandra, Thomas Gregor Issac, Suresh Kumar Korada, Karru Venkata Ravi Teja, Mariamma Philip
INTRODUCTION: About 20-50% of relatively young onset dementia belongs to frontotemporal type. Most of these patients are diagnosed as psychiatric illness as their memory and instrumental activities of daily living remain unaltered till late and most of these patients do not qualify for dementia by the Diagnostic and Statistical Manual of Mental Disorders-IV criteria. In this study, we analyzed the behavioral symptoms in our patients with radiologically and neuropsychologically proven as probable behavioral variant of frontotemporal dementia (FTD)...
July 2016: Indian Journal of Psychological Medicine
Hiroaki Kazui, Kenji Yoshiyama, Hideki Kanemoto, Yukiko Suzuki, Shunsuke Sato, Mamoru Hashimoto, Manabu Ikeda, Hibiki Tanaka, Yutaka Hatada, Masateru Matsushita, Yoshiyuki Nishio, Etsuro Mori, Satoshi Tanimukai, Kenjiro Komori, Taku Yoshida, Hideaki Shimizu, Teruhisa Matsumoto, Takaaki Mori, Tetsuo Kashibayashi, Kazumasa Yokoyama, Tatsuo Shimomura, Yasunobu Kabeshita, Hiroyoshi Adachi, Toshihisa Tanaka
BACKGROUND/AIMS: Behavioral and psychological symptoms of dementia (BPSDs) negatively impact the prognosis of dementia patients and increase caregiver distress. The aims of this study were to clarify the differences of trajectories of 12 kinds of BPSDs by disease severity in four major dementias and to develop charts showing the frequency, severity, and associated caregiver distress (ACD) of BPSDs using the data of a Japan multicenter study (J-BIRD). METHODS: We gathered Neuropsychiatric Inventory (NPI) data of patients with Alzheimer's disease (AD; n = 1091), dementia with Lewy bodies (DLB; n = 249), vascular dementia (VaD; n = 156), and frontotemporal lobar degeneration (FTLD; n = 102) collected during a 5-year period up to July 31, 2013 in seven centers for dementia in Japan...
2016: PloS One
Anneli Stranz, Renita Sörensdotter
Using ethnographic data collected from nursing homes in England and Sweden, this article analyzes how a person-centered approach to dementia care has been interpreted in two different contexts. Based on typical elements of person-centered care identified in previous research, the analysis examines environmental changes and the way care is performed. A discourse of person-centered care is articulated at both nursing homes, which aim to create a good environment and care practice for people with dementia. Although we found similarities in how good care was understood at the two homes, we also found important differences...
August 2016: Journal of Aging Studies
Irene Aasmul, Bettina Sandgathe Husebo, Elisabeth Flo
CONTEXT: Most people with dementia develop neuropsychiatric symptoms (NPS), which are distressing for their carers. Untreated pain may increase the prevalence and severity of NPS and thereby staff burden. OBJECTIVES: We investigated the association between NPS and the impact of individual pain treatment on distress in nursing home staff. METHODS: NH-units were cluster-randomized to an intervention group (33 NH units; n=175) or control group (27 NH units; n=177)...
August 11, 2016: Journal of Pain and Symptom Management
Christine Øye, Frode F Jacobsen, Tone Elin Mekki
AIM AND OBJECTIVE: To investigate; a) what kind of restraint is used in three nursing homes in Norway, and b) how staff use restraint under what organizational conditions. BACKGROUND: Restraint use in residents living with dementia in nursing homes is controversial, and at odds with fundamental human rights. Restraint is a matter of hindering residents free movement and will by applying either interactional, physical, medical, surveillance or environmental restraint...
August 9, 2016: Journal of Clinical Nursing
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