P2-338 Evaluating the efficacy of a caregiver-based, behavioral intervention for reducing neuropsychiatric symptoms among patients with Alzheimer's disease and for reducing caregiver distress: a controlled trial

Background: The study aimed to compare neuropsychiatric symptoms (NPS) in people with early-onset Alzheimer’s disease (EOAD) and late-onset AD (LOAD). Methods: Fifty-six participants with LOAD and 24 participants with EOAD having mild dementia were assessed for NPS for their frequency, severity, and caregiver distress as measured by Neuropsychiatry Inventory (NPI) along with assessments of cognition and functional dependence. Results: Participants with EOAD and LOAD were not significantly different for total NPI score ( P = .057). Early-onset Alzheimer disease had greater prevalence of all the NPS except apathy. Participants with EOAD were significantly worse on anxiety ( P = .03), irritability ( P = .01), and sleep ( P < .01) subscales and their carers significantly more distressed by their irritability ( P = .002) and sleeping patterns ( P = .005). Regression analysis showed that higher NPI score was associated with longer duration of illness in EOAD and higher functional dependence in LOAD. Conclusions: The NPS severity was similar between EOAD and LOAD although EOAD had higher symptom prevalence and carer distress.

Download Full-text

Caregiver burden in atypical dementias: comparing frontotemporal dementia, Creutzfeldt–Jakob disease, and Alzheimer's disease

International Psychogeriatrics ◽

10.1017/s1041610215001647 ◽

2015 ◽

Vol 28 (2) ◽

pp. 269-273 ◽

Cited By ~ 20

Author(s):

Alice Uflacker ◽

Mary C. Edmondson ◽

Chiadi U. Onyike ◽

Brian S. Appleby

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Frontotemporal Dementia ◽

Caregiver Burden ◽

Neuropsychiatric Symptoms ◽

Published Data ◽

Caregiver Distress ◽

Severity Scores ◽

Symptom Domains ◽

Jakob Disease

ABSTRACTBackground:Caregiver burden is a significant issue in the treatment of dementia and a known contributor to institutionalization of patients with dementia. Published data have documented increased caregiver burden in behavioral variant frontotemporal dementia (bvFTD) compared to Alzheimer's disease (AD). Another atypical dementia with high-perceived caregiver burden is sporadic Creutzfeldt–Jakob disease (sCJD), but no formal studies have assessed this perception. The aim of this study was to compare caregiver burden across atypical dementia etiologies.Methods:76 adults with atypical dementia (young-onset AD [YOAD], bvFTD, language variant FTD [lvFTD], and sCJD) were administered an abbreviated version of the Zarit Burden Interview (ZBI), Neuropsychiatric Inventory (NPI-Q), and other assessment instruments during a five-year time period at Johns Hopkins Hospital (JHH). A Cox regression model examined differences between disease categories that impact mean ZBI scores.Results:Mean ZBI scores were significantly different between dementia etiologies, with bvFTD and sCJD having the highest caregiver burden (p = 0.026). Mean NPI-Q caregiver distress scores were highest in bvFTD and sCJD (p = 0.002), with sCJD and bvFTD also having the highest number of endorsed symptom domains (p = 0.012). On regression analyses, an interactive variable combining final diagnosis category and NPI-Q total severity score demonstrated statistically significant differences in mean ZBI scores for sCJD and bvFTD.Conclusions:This study demonstrates that bvFTD and sCJD have increased levels of caregiver burden, NPI-Q caregiver distress, total severity scores, and number of endorsed symptom domains. These results suggest that higher caregiver burden in bvFTD and sCJD are disease specific and possibly related to neuropsychiatric symptoms.

Download Full-text

Effects of frequent and long-term exercise on neuropsychiatric symptoms in patients with Alzheimer's disease – Secondary analyses of a randomized, controlled trial (FINALEX)

European Geriatric Medicine ◽

10.1016/j.eurger.2017.01.004 ◽

2017 ◽

Vol 8 (2) ◽

pp. 153-157 ◽

Cited By ~ 7

Author(s):

H. Öhman ◽

N.R.N. Savikko ◽

T.E. Strandberg ◽

H. Kautiainen ◽

M.M. Raivio ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Randomized Controlled Trial ◽

Controlled Trial ◽

Neuropsychiatric Symptoms ◽

Randomized Controlled ◽

Secondary Analyses

Download Full-text

Behavioral and Neuropsychiatric Outcomes in Alzheimer's Disease

CNS Spectrums ◽

10.1017/s1092852900014206 ◽

2005 ◽

Vol 10 (S18) ◽

pp. 22-25 ◽

Cited By ~ 16

Author(s):

Jeffrey L. Cummings

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cholinesterase Inhibitors ◽

Psychological Symptoms ◽

Neuropsychiatric Symptoms ◽

Caregiver Distress ◽

Aspartate Receptor ◽

Home Placement ◽

Behavioral And Psychological Symptoms

AbstractBehavioral and psychological symptoms of dementia pose significant challenges in the management of patients with Alzheimer's disease. Neuropsychiatric symptoms are associated with cognitive decline, highly impaired activities of daily living, and frontal lobe pathology. Moreover, behavioral and psychological symptoms can diminish patient quality of life, increase caregiver distress, and accelerate nursing home placement. Although these symptoms are often associated with the later stages of Alzheimer's disease, a high percentage of individuals with mild cognitive impairment or mild Alzheimer's report symptoms as well. This article provides an overview of behavioral and neuropsychiatric symptoms associated with Alzheimer's disease and discusses nonpharmacologic and pharmacologic approaches to the management of such symptoms. For patients with severe behavioral and psychological symptoms of dementia, pychotropic agents may be warranted, whereas approved therapies for Alzheimer's, including cholinesterase inhibitors and the N-methyl-D-aspartate receptor antagonist memantine, may be appropriate in less severe cases.

Download Full-text

A randomized, double-blind, placebo-controlled trial of memantine in a behaviorally enriched sample of patients with moderate-to-severe Alzheimer's disease

International Psychogeriatrics ◽

10.1017/s1041610213000239 ◽

2013 ◽

Vol 25 (6) ◽

pp. 919-927 ◽

Cited By ~ 34

Author(s):

Nathan Herrmann ◽

Serge Gauthier ◽

Neli Boneva ◽

Ole Michael Lemming

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Outcome Measures ◽

Primary Outcome ◽

Controlled Trial ◽

Neuropsychiatric Symptoms ◽

Primary Outcome Measure ◽

Community Dwelling ◽

Secondary Outcome ◽

Double Blind

ABSTRACTBackground: Agitation and aggression in Alzheimer's disease (AD) are amongst the most serious of neuropsychiatric symptoms, and contribute to poor outcomes and worse quality of life. Previous studies have suggested a benefit for memantine on agitation and aggression, but none have examined its efficacy in community-dwelling patients with significant agitation and aggression at baseline, utilizing these behaviors as a primary outcome measure.Methods: Patients with moderate-to-severe AD with Neuropsychiatric Inventory (NPI) total score ≥13 and NPI agitation/aggression score ≥1 were randomized to placebo or 20-mg memantine in a double-blind, 24-week trial. Co-primary outcome measures were behavior, measured by total NPI score, and cognition, using the Severe Impairment Battery (SIB). Secondary outcome measures included global assessment, function and other measures of behavior. This trial was registered as Clinicaltrials.gov: NCT00857649.Results: A total of 369 patients (average age = 75, average MMSE = 12) were randomized to placebo or memantine. The study was prematurely terminated due to recruitment problems. There were no statistically significant differences between memantine and placebo in mean change from baseline in NPI, SIB, or any of the secondary outcome measures. Behavior improved in both groups (total NPI change scores −3.90 ± 1.24 for memantine and −5.13 ± 1.23 for placebo). Memantine was generally well tolerated and patient retention in both treatment arms was good.Conclusions: The study failed to show the superiority of memantine in this sample of patients with moderate-to-severe AD with significant baseline agitation and aggression. Methodological limitations could have contributed to these results.

Download Full-text