Neuropsychiatric symptoms (behavioral and psychological symptoms of dementia) and the development of dementia treatments

2007 ◽  
Vol 19 (3) ◽  
pp. 409-420 ◽  
Author(s):  
Constantine G. Lyketsos
Keyword(s):  
Psychological Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Caregiver Distress ◽  
Meaningful Change ◽  
Treatment Target ◽  
Clinical Measures ◽  
Behavioral And Psychological Symptoms

Neuropsychiatric symptoms (NPS) are central features of dementia and an important treatment target. They should be assessed in future studies of emerging dementia therapies, using appropriate measures matched to the purpose of each study. Several significant issues remain regarding (1) the classification of these symptoms into syndromes, and (2) the development of better clinical measures for their quantification. In particular, effort should be directed at assessing their evolution over shorter time periods, and at using more objective methods in their measurement, such as actigraphy. These issues can be solved with nosologic study and other advances that could be brought about quickly, if appropriate time and effort are allocated. Empirical characterization of clinically meaningful change in NPS – by examining their relationship with dementia care burden, disability, quality of life, caregiver distress, and resource utilization – would be an important advance.

Behavioral and Neuropsychiatric Outcomes in Alzheimer's Disease

CNS Spectrums ◽  
2005 ◽  
Vol 10 (S18) ◽  
pp. 22-25 ◽  
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.

scholarly journals The impact of lockdown during SARS-CoV-2 outbreak on behavioral and psychological symptoms of dementia

2021 ◽  
Vol 42 (3) ◽  
pp. 825-833
Author(s):  
Arianna Manini ◽  
Michela Brambilla ◽  
Laura Maggiore ◽  
Simone Pomati ◽  
Leonardo Pantoni
Keyword(s):  
Logistic Regression ◽  
Psychological Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Community Dwelling ◽  
Caregiver Distress ◽  
Neuropsychiatric Inventory ◽  
Logistic Regression Models ◽  
The Impact ◽  
Behavioral And Psychological Symptoms

Abstract Background During Covid-19 pandemic, the Italian government adopted restrictive limitations and declared a national lockdown on March 9, which lasted until May 4 and produced dramatic consequences on people’s lives. The aim of our study was to assess the impact of prolonged lockdown on behavioral and psychological symptoms of dementia (BPSD). Methods Between April 30 and June 8, 2020, we interviewed with a telephone-based questionnaire the caregivers of the community-dwelling patients with dementia who had their follow-up visit scheduled from March 9 to May 15 and canceled due to lockdown. Among the information collected, patients’ BPSDs were assessed by the Neuropsychiatric Inventory (NPI). Non-parametric tests to compare differences between NPI scores over time and logistic regression models to explore the impact of different factors on BPSD worsening were performed. Results A total of 109 visits were canceled and 94/109 caregivers completed the interview. Apathy, irritability, agitation and aggression, and depression were the most common neuropsychiatric symptoms experienced by patients both at baseline and during Covid-19 pandemic. Changes in total NPI and caregiver distress scores between baseline and during lockdown, although statistically significant, were overall modest. The logistic regression model failed to determine predictors of BPSD worsening during lockdown. Conclusion This is one of the first studies to investigate the presence of BPSD during SARS-CoV-2 outbreak and related nationwide lockdown, showing only slight, likely not clinically relevant, differences in BPSD burden, concerning mostly agitation and aggression, anxiety, apathy and indifference, and irritability.

scholarly journals Neuropharmacology of the Neuropsychiatric Symptoms of Dementia and Role of Pain: Essential Oil of Bergamot as a Novel Therapeutic Approach

2019 ◽  
Vol 20 (13) ◽  
pp. 3327 ◽  
Author(s):  
Damiana Scuteri ◽  
Laura Rombolà ◽  
Luigi Antonio Morrone ◽  
Giacinto Bagetta ◽  
Shinobu Sakurada ◽  
...  
Keyword(s):  
Essential Oil ◽  
Psychological Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Term Treatment ◽  
Long Term Treatment ◽  
Anxiety Depression ◽  
Cognitive Disturbance

Aging of the population makes of dementia a challenge for health systems worldwide. The cognitive disturbance is a serious but not the only issue in dementia; behavioral and psychological syndromes known as neuropsychiatric symptoms of dementia remarkably reduce the quality of life. The cluster of symptoms includes anxiety, depression, wandering, delusions, hallucinations, misidentifications, agitation and aggression. The pathophysiology of these symptoms implicates all the neurotransmitter systems, with a pivotal role for the glutamatergic neurotransmission. Imbalanced glutamatergic and GABAergic neurotransmissions, over-activation of the extrasynaptic N-methyl-D-aspartate (NMDA) receptors and alterations of the latter have been linked to the development of neuropsychiatric symptoms experienced by almost the entire demented population. Drugs with efficacy and safety for prevention or long term treatment of these disorders are not available yet. Aromatherapy provides the best evidence for positive outcomes in the control of agitation, the most resistant symptom. Demented patients often cannot verbalize pain, resulting in unrelieved symptoms and contributing to agitation. Bergamot essential oil provides extensive preclinical evidence of analgesic properties. Incidentally, the essential oil of bergamot induces anxyolitic-like effects devoid of sedation, typical of benzodiazepines, with a noteworthy advantage for demented patients. These data, together with the reported safety profile, form the rational basis for bergamot as a neurotherapeutic to be trialed for the control of behavioral and psychological symptoms of dementia.

scholarly journals Caregiver distress associated with behavioral and psychological symptoms in mild Alzheimer's disease

2010 ◽  
Vol 4 (3) ◽  
pp. 238-244 ◽  
Author(s):  
Ari Pedro Balieiro Jr. ◽  
Emmanuelle Silva Tavares Sobreira ◽  
Marina Ceres Silva Pena ◽  
José Humberto Silva-Filho ◽  
Francisco de Assis Carvalho do Vale
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Psychological Symptoms ◽  
Time Behavior ◽  
Caregiver Distress ◽  
Night Time ◽  
The Mean ◽  
The Individual ◽  
The Relationship ◽  
Behavioral And Psychological Symptoms

Abstract The aim of this study was to analyze the relationship between Caregiver Distress and Behavioral and Psychological Symptoms in Dementias (BPSD) in mild Alzheimer's disease. Methods: Fifty patients and caregivers were interviewed using the Neuropsychiatric Inventory (NPI). Results: 96.0% of the patients had at least one BPSD. The mean NPI total score was 19.6 (SD=18.05; range=0-78) whereas the mean Caregiver Distress Index (CDI) total score was 11.5 (SD=10.41; range=0-40). For the individual symptoms, the weighted mean CDI was 2.8 (SD=1.58). All symptom CDI means were higher than 2.0 except for euphoria/elation (m=1.8; SD=1.49). There were correlations between CDI and derived measures (Frequency, Severity, FxS, and Amplitude) for all symptoms, except Disinhibition and Night-time behavior. Correlations ranged between 0.443 and 0.894, with significance at p<0.05. Conclusions: All the derived measures, including amplitude, were useful in at least some cases. The data suggests that CDI cannot be inferred from symptom presence or profile. Symptoms should be systematically investigated.

Behavioral and Psychological Symptoms of Dementia: Physical Nonaggressive Agitation

2000 ◽  
Vol 12 (S1) ◽  
pp. 125-127 ◽  
Author(s):  
Martin Haupt
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Psychological Symptoms ◽  
Institutional Care ◽  
Nursing Home Admission ◽  
Behavioral And Psychological Symptoms

Agitated behaviors occur frequently in patients with dementia. These behaviors affect the quality of life of the dementia sufferers and their caregivers. For example, these behaviors can greatly complicate everyday management in familiar surroundings and in institutional care, and they predict premature nursing home admission.

The impact of neuropsychiatric symptoms of dementia on distress in family and professional caregivers in Singapore

2005 ◽  
Vol 17 (2) ◽  
pp. 253-263 ◽  
Author(s):  
Lay Ling Tan ◽  
Hwee Bee Wong ◽  
Harry Allen
Keyword(s):  
Psychological Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Caregiver Distress ◽  
Behavioral Disturbances ◽  
Outpatient Group ◽  
Professional Caregiver ◽  
Diagnosis Of Dementia ◽  
Inpatient Group ◽  
Distress Scale ◽  
The Impact

Background: Behavioral and psychological symptoms of dementia (BPSD) are a source of distress and burden for caregivers. This study attempts to determine the neuropsychiatric symptoms, demographic characteristics, and referral patterns of outpatients with dementia compared with patients admitted to the acute psychogeriatric wards of Woodbridge Hospital. We also assessed the impact of neuropsychiatric symptoms on distress in family and professional caregivers.Method: Eighty-five consecutive patients with a first-time diagnosis of dementia were recruited. They were assessed using the Neuropsychiatric Inventory Caregiver Distress Scale (NPI-D). The professional caregiver distress questions were rephrased to assess the “occupational disruptiveness” of behaviors in the nursing home version (NPI-NH).Results: Neuropsychiatric symptoms were common and were positively correlated with caregiver distress. Family caregivers were significantly more distressed than professional caregivers over the delusion, agitation, depression and aberrant motor domains, although the severity of the behavioral disturbances reported was not higher in the sample. The median NPI scores for the agitation and disinhibition domains were significantly higher in the inpatient group, contrasting with a higher score for the depression domain among the outpatient group.Conclusions: This study highlights the prevalence of neuropsychiatric symptoms in dementia and illustrates the strong correlation between the severity of behavioral disturbances and caregiver distress.

scholarly journals Reliability and Validity Testing of the Quantified Quality of Interaction Scale (QuIS)

2021 ◽  
pp. JNM-D-19-00101
Author(s):  
Barbara Resnick ◽  
Elizabeth Galik ◽  
Anju Paudel ◽  
Rachel McPherson ◽  
Kimberly Van Haitsma ◽  
...  
Keyword(s):  
Rasch Analysis ◽  
Psychological Symptoms ◽  
Reliability And Validity ◽  
Validity Testing ◽  
Item Fit ◽  
Resistiveness To Care ◽  
Behavioral And Psychological Symptoms ◽  
Item Reliability ◽  
Evidence Integration

Background and PurposeThe purpose of this study was to test the reliability and validity of the Quality of Interaction Survey (QuIS) using a quantification scoring approach.MethodsBaseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) study was used.ResultsA total of 553 residents participated. There was evidence of inter-rater reliability with Kappa scores of .86 to 1.00 and internal consistency based on the Rasch analysis (item reliability of .98). There was some support for validity based on item fit and hypothesis testing as resistiveness to care was significantly associated with total QuIS scores.ConclusionThis study supports the use of the quantified QuIS to evaluate the quality of interactions over time and to test interventions to improve interactions.

scholarly journals Correlation of Frontal Atrophy and CSF Tau Levels With Neuropsychiatric Symptoms in Patients With Cognitive Impairment: A Memory Clinic Experience

2021 ◽  
Vol 13 ◽  
Author(s):  
Matteo Cotta Ramusino ◽  
Giulia Perini ◽  
Gloria Vaghi ◽  
Beatrice Dal Fabbro ◽  
Marco Capelli ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Psychological Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Lewy Body Disease ◽  
Cortical Atrophy ◽  
Psychotic Symptoms ◽  
Memory Clinic ◽  
Neuropsychiatric Inventory ◽  
Clinic Experience ◽  
Behavioral And Psychological Symptoms

Background: Behavioral and psychological symptoms of dementia (BPSD) are a distressful condition. We aimed to investigate the BPSD distribution in subjects with cognitive impairment, and the potential correlations between BPSD and neurodegeneration in terms of cerebrospinal fluid (CSF) tau and brain atrophy.Methods: One-hundred patients with mild cognitive impairment (MCI) or dementia (Alzheimer’s disease, AD; Lewy-body disease, LBD; frontotemporal dementia, FTD; vascular dementia, VD) underwent a complete diagnostic workup, including 3T-MRI and/or CT and CSF. Cortical atrophy was assessed with medial temporal atrophy (MTA), posterior atrophy (PA), and global cortical atrophy-frontal lobe (GCA-F) scales. BPSD were rated using the Neuropsychiatric Inventory (NPI), and BPSD clusters were defined according to the European Alzheimer Disease Consortium.Results: Delusions, hallucinations, and psychosis cluster were differently distributed among the diagnostic groups (p &lt; 0.05, p &lt; 0.001, and p &lt; 0.05), with LBD patients showing higher scores for hallucinations (vs. MCI, p &lt; 0.001, and AD, p &lt; 0.05) and psychosis cluster (vs. MCI, p &lt; 0.05). In primary dementias, we found a negative correlation between NPI total score and tau levels (p = 0.08), confirmed by beta regression (p &lt; 0.01), while a positive non-significant relationship was observed in MCI. Higher GCA-F scores were associated with delusions and apathy (p &lt; 0.05, on both hemispheres) and hallucinations (left: p &lt; 0.01, right: p &lt; 0.05). GCA-F scores were positively correlated with psychosis cluster (right: p &lt; 0.05), and agitation/aggression (left: p &lt; 0.05). Conversely, nighttime disturbances were positively correlated with both GCA-F and MTA scores (left: p &lt; 0.01; right: p &lt; 0.05).Conclusion: Our results suggest that psychotic symptoms are significantly more represented in LBD patients and that CSF tau and frontal atrophy are associated with the occurrence and severity of BPSD in clinical practice. Longitudinal studies are however required to ascertain their actual predictive value.

Agitation, Aggressive Behavior, and Catastrophic Reactions

2000 ◽  
Vol 12 (S1) ◽  
pp. 119-123 ◽  
Author(s):  
Ira R. Katz
Keyword(s):  
Environmental Factors ◽  
Aggressive Behavior ◽  
Psychological Symptoms ◽  
Behavioral And Psychological Symptoms ◽  
Key Parameter ◽  
Frequency Intensity

Current methods for characterizing the behavioral and psychological symptoms of dementia (BPSD) consider the quality of the symptoms together with their frequency, intensity, and, in some instruments, their impact on the caregiver or the environment. Although there have been significant advances in our understanding of these symptoms and their treatment, a key parameter, environmental contingency, has been largely ignored in characterizing symptoms, planning treatments, and evaluating responses. In this brief review, I consider the feasibility and usefulness of subtyping aggressive and agitated symptoms in patients with dementia according to whether these behaviors occur spontaneously or in response to environmental factors.

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