A consensus on defining and measuring treatment benefits in dementia

This issue of International Psychogeriatrics is 96 pages thicker than usual, because it carries not only the International Psychogeriatric Association (IPA) Consensus Statement on Defining and Measuring Treatment Benefits in Dementia, but also a series of papers that were presented at the two-day conference devoted to the development of the consensus statement, which took place in the precincts of Canterbury Cathedral on 31 October and 1 November 2006. During the conference, the delegates (whose names are listed in an appendix to the consensus statement) heard presentations on what outcomes matter to people with dementia and their caregivers, how these can be measured and what they mean, cognitive change as an outcome, biological outcome measures, quality of life, neuropsychiatric symptoms (also known as behavioral and psychological symptoms of dementia (BPSD)), global measures of change, the relevance of different outcome measures to various cultures, activities of daily living, economic outcomes and the regulator perspective. These presentations have been refined into papers and are now published within these pages. In addition to 12 formal presentations on these topics, nine discussants led the conference in exploring the issues raised by the talks, and there was active and often heated debate on almost all the issues discussed. During the afternoon of 1 November agreement was achieved on several key points, which formed the basis for a draft consensus statement prepared the next day. This statement has been refined by a process of circulation among participants, whose suggestions have been incorporated into the document that is now published in this issue.

Download Full-text

Approaches to Measuring the Impact of Music Therapy and Music Activities on People Living With Dementia

Music and Dementia ◽

10.1093/oso/9780190075934.003.0009 ◽

2019 ◽

pp. 171-196

Author(s):

Becky Dowson ◽

Orii McDermott

Keyword(s):

Music Therapy ◽

Outcome Measures ◽

Quantitative Research ◽

Psychological Symptoms ◽

Real Life ◽

Evidence Base ◽

People With Dementia ◽

The Impact ◽

Music Activities

This chapter provides an introduction to the evaluation of music activities and music therapy for people with dementia. We outline some of the main challenges and considerations involved in choosing or using outcome measures. An overview of common outcome measures used in current research, including those for behavioral and psychological symptoms, quality of life, physiological changes, cognitive function, and music-related behaviors, is provided. Two music-therapy case studies are presented as real-life examples of how to select clinically relevant measures. Clinicians have long argued that some clinically meaningful changes may not always be measurable. We propose that when insights obtained from high-quality qualitative and mixed methods studies are added to the evidence base of quantitative research, it will lead to a deeper understanding of the benefits that music can have in the lives of people living with dementia.

Download Full-text

International Psychogeriatric Association consensus statement on defining and measuring treatment benefits in dementia

International Psychogeriatrics ◽

10.1017/s1041610207005145 ◽

2007 ◽

Vol 19 (3) ◽

pp. 345-354 ◽

Cited By ~ 36

Author(s):

Cornelius Katona ◽

Gill Livingston ◽

Claudia Cooper ◽

David Ames ◽

Henry Brodaty ◽

...

Keyword(s):

Health Economic ◽

Consensus Statement ◽

Psychological Symptoms ◽

Political Process ◽

Health Utility ◽

Older Individuals ◽

Political Empowerment ◽

People With Dementia ◽

Economic Analyses ◽

Time Required

Current symptomatic treatments for dementia have only modest efficacy. Assessing meaningful benefits in this variably progressive syndrome is complex and difficult. This consensus statement was generated by an international group representing caregivers, organizations and professionals with expertise in dementia.We recommend the statement of clear, pre-defined diagnostic and severity criteria and outcome measures, which include functional and executive capacity, in treatment trials. Outcomes can include effects on people with dementia (PWD) with regard to cognition, behavioral and psychological symptoms, quality of life, global assessments, and activities of daily living, and must be tailored to the education and culture of the participants. Outcomes can also appropriately encompass effects on caregivers. New instruments may be needed, as validation of many existing measures has been in relatively homogenous populations. Treatment goals can be to prevent dementia emerging, or in those with established dementia to slow deterioration, and to postpone, stabilize or improve symptoms. Comparisons between treatment groups should be on the basis of clinically relevant measures with both risk and benefit reported for all participants regardless of whether or not they continue to receive treatment throughout the trial. Characterization of any groups that respond well to treatment has been unsuccessful to date, but may be facilitated in the future by measurement of putative biomarkers. Despite considerable recent progress and several ‘candidate’ biomarkers, none is yet satisfactory for determining diagnosis, severity, progression or prediction of response.To provide meaningful data, economic analyses should use up-to-date, country-specific data. Health economic measures should be incorporated as secondary outcomes in all Phase 3 trials since health systems are concerned with cost-effectiveness as well as clinical outcome. Health utility measures are not, however, validated satisfactorily in dementia, thus calling into question previous health economic analyses. While current drugs appear to reduce the amount of family caregiver time required by PWD, these costs fall in the main on older individuals who often exert little political leverage, rather than on society at large. Traditionally, elderly people have been marginalized in the political process. The growth in the older population across the world, and their potential for increasing political empowerment may lead to a radical re-evaluation of the economics of treatment in dementia.

Download Full-text

CHROME Criteria and Quality of Life: A Pilot Study from Maria Wolff-Albertia

Journal of Alzheimer s Disease Reports ◽

10.3233/adr-210015 ◽

2021 ◽

pp. 1-12

Author(s):

Ruben Muñiz ◽

Jorge López-Álvarez ◽

Luis Perea ◽

Sofía Rivera ◽

Liliana González ◽

...

Keyword(s):

Quality Of Life ◽

Psychological Symptoms ◽

Neuropsychiatric Symptoms ◽

Inappropriate Prescribing ◽

Substantial Reduction ◽

Psychotropic Medications ◽

Health Concern ◽

Post Intervention ◽

People With Dementia

Background: Over- and potentially inappropriate prescribing of psychotropic medications is a major public health concern among people with dementia. Objective: Describe the CHemical Restraints avOidance MEthodology (CHROME) criteria and evaluate its effects on psychotropic prescribing and quality of life (QoL). Methods: Observational, prospective, two-wave study conducted in two nursing homes. A multicomponent program to eliminate chemical restraints and attain quality prescription of psychotropic medications was implemented. CHROME’s diagnostic criteria comprise constellations of behavioral and psychological symptoms of dementia under six primary syndromic diagnoses. Since pharmacologic treatment is aimed at only one syndrome, polypharmacy is avoided. Psychotropic prescription, QoL, neuropsychiatric symptoms (NPS), and other clinical measurements were collected before and one year after the intervention. Results are presented for all residents (n = 171) and for completer subjects (n = 115). Results: Mean age (SD) of the residents was 87.8 (5.7), 78.9% were women, and 68.5% suffered advanced dementia. Psychotropic prescriptions decreased from 1.9 (1.1) to 0.9 (1.0) (p < 0.0005). Substantive reduction in prescribing frequency was observed for antidepressants (76.9% pre-intervention, 33.8% post-intervention) and for atypical neuroleptics (38.8% pre-intervention, 15.1% post-intervention). There was improvement in patient’s response to surroundings (p < 0.0005) and total NPS (p < 0.01), but small worsening occurred in social interaction (p < 0.02, completer subjects). Safety measurements remained stable. Conclusion: CHROME criteria appear to optimize psychotropic prescriptions, avoid chemical restraints, and allow external verification of quality prescriptions. Extensive use seems feasible, related to substantial reduction of prescriptions, and of benefit for people with dementia as de-prescriptions are not associated to increased NPS or QoL loss.

Download Full-text

202 - PSYCHOSOCIAL INTERVENTIONS FOR PEOPLE WITH DEMENTIA AS STRATEGIES TO MANAGE BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS [supported by European Association of Geriatric Psychiatry – EAGP]

International Psychogeriatrics ◽

10.1017/s1041610220001921 ◽

2020 ◽

Vol 32 (S1) ◽

pp. 29-31

Keyword(s):

Social Inclusion ◽

Psychological Symptoms ◽

Neuropsychiatric Symptoms ◽

Psychosocial Interventions ◽

The Arts ◽

People With Dementia ◽

Behavioural And Psychological Symptoms ◽

Old Age Psychiatry ◽

Symposium Overview ◽

Image Position

Symposium ChairsLia Fernandes (Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Portugal) [email protected] Mukherjee (Faculty of Old Age Psychiatry, The Royal College of Psychiatrists, United Kingdom) [email protected] Lia FernandesSymposium OverviewPresentation 1 Sujoy MukherjeeThe treatment of Behavioural and Psychological Symptoms of Dementia: where do we stand?Presentation 2 Ana Rita FerreiraAssessing unmet needs in nursing homes: a promising way to prevent neuropsychiatric symptomsPresentation 3 Slavisa LamounierThe Arts as a medium for improving social inclusion in dementiaPresentation 4 Lídia SousaMusic-based interventions in the acute setting for patients with dementia

Download Full-text

ACUPUNCTURE AND ACUPRESSURE FOR DEMENTIA BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS: A SCOPING REVIEW

Innovation in Aging ◽

10.1093/geroni/igz038.427 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S116-S116

Author(s):

Melissa L Harris ◽

Laura M Struble ◽

Marita Titler

Keyword(s):

Outcome Measures ◽

Scoping Review ◽

Sleep Disturbances ◽

Psychological Symptoms ◽

Treatment Options ◽

Current Evidence ◽

Inclusion Criteria ◽

Term Care ◽

People With Dementia ◽

Behavioral And Psychological Symptoms

Abstract This scoping review synthesized the literature on acupuncture and acupressure therapy for treating behavioral and psychological symptoms of dementia (BPSD). BPSD affect most people with dementia and are overwhelming for caregivers and healthcare providers. Current evidence encourages use of nonpharmacologic interventions for BPSD due to the dangers of psychotropic medications. Acupuncture and acupressure present as alternative treatment options for BPSD. Systematic reviews examined acupuncture therapy for improving cognitive function, but not acupuncture and/or acupressure for BPSD. The methodology outlined by Joanna Briggs Institute Reviewers’ Manual guided this scoping review. Databases searched were PubMed, CINAHL, Embase, PsychINFO and AgeLine. Study inclusion criteria were published in English, subjects with dementia, acupuncture or acupressure tested and outcome measures included at least one BPSD. Gray literature was excluded. 836 citations were screened by title and abstract. 57 full texts were reviewed to determine inclusion criteria and 15 studies were retained. Nine studies examined acupressure and 6 examined acupuncture. Eight studies were RCT, 11 were conducted in China and 10 were conducted in long-term care. The percent of studies with statistically significant improvements in BPSD outcomes measured were: ADL’s (75%), agitation (100%), anxiety (67%), depression (100%), mood (100%), neuropsychological disturbances (67%) and sleep disturbances (100%). The therapies were safe and participant satisfaction was high across studies. Variations in research designs, outcome measures and incomplete descriptions of acupoints limit interpretations about effectiveness of these interventions for BPSD. Additional RCTs are needed to improve generalizability and to evaluate dosage/methods of acupressure and acupuncture for BPSD.

Download Full-text

Developing a virtual reality for people with dementia in nursing homes based on their psychological needs: a feasibility study

BMC Geriatrics ◽

10.1186/s12877-021-02125-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jung-Hee Kim ◽

Seonmin Park ◽

Hyeongji Lim

Keyword(s):

Virtual Reality ◽

Nursing Homes ◽

Intervention Program ◽

Psychological Symptoms ◽

Likert Scale ◽

Psychological Needs ◽

Second Phase ◽

People With Dementia ◽

The Mean ◽

Behavioral And Psychological Symptoms

Abstract Background The purpose of this study was (1) to develop a virtual reality (VR) intervention program based on the psychological needs of patients residing in nursing facilities in South Korea to alleviate their behavioral and psychological symptoms and (2) to confirm the possibility of utilizing VR in patients with dementia. Methods In the first phase, patients with dementia residing in nursing homes and experiencing behavioral and psychological symptoms were recruited. Surveys and questionnaires were used to identify activities that alleviated the behavioral and psychological symptoms of dementia (BPSD) among the patients. These activities were classified into five types of psychological needs. In the second phase, a fully immersive, interactive, easy-to-use VR platform was developed that reflected these psychological needs. Patients with dementia experienced the VR content. The researchers assessed the level of the participants’ immersion, preference, and interaction with the VR using a 5-point Likert scale. Results In the feasibility test, 10 nursing home residents were recruited. The mean immersion score was 4.93 ± 0.16 points, the mean preference score was 4.35 ± 0.41 points, and the mean interaction score was 3.84 ± 0.43 points using a 5-point Likert scale. Higher mean scores indicated a more positive outcome. Six of the 10 participants required assistance while using the VR. The mean VR experience duration was 10.00 ± 3.46 min. Conclusions The VR-based intervention program that was developed to reduce BPSD was feasible for the participants and provided them with a high degree of satisfaction and immersion. Furthermore, this study also confirmed the convenience and safety of the program. These findings support the potential use of VR-based BPSD intervention programs to treat patients with dementia.

Download Full-text

Non-Pharmacologic Interventions for Caregivers of People With Dementia in Latin America: A Review

Innovation in Aging ◽

10.1093/geroni/igaa057.881 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 275-276

Author(s):

Jose Aravena ◽

Jean Gajardo ◽

Laura Gitlin

Keyword(s):

Quality Of Life ◽

Latin America ◽

Depressive Symptoms ◽

Latin American ◽

Randomized Clinical Trials ◽

Social Inequalities ◽

Neuropsychiatric Symptoms ◽

People With Dementia ◽

Person With Dementia

Abstract In a scenario of increasing longevity and social inequalities, Latin-America is an important contributor to the worldwide dementia burden. Caregivers’ health is fundamental to maintain the person with dementia quality of life. However, caregiving is a culturally sensible role that requires tailored solutions. The aim is to synthesize the evidence about non-pharmacologic interventions targeted to caregivers of people with dementia in Latin-American contexts. A comprehensive review of interventions in caregivers and persons with dementia in Latin-American countries was conducted using MEDLINE, Embase, PsycINFO, and Scopus with studies published until January 27th, 2020. Randomized clinical trials of non-pharmacologic interventions targeted to caregivers of people with dementia or dyads where included. Qualitative synthesis of the evidence was presented and analyzed. Overall, 9 pilot RCT were included for the final analysis (6 Brazil, 1 Colombia, 1 Mexico, 1 Perú). The biggest study recruited 69 caregivers and the smallest 13 dyads, with follow-up range of 3-6 months. 5 control groups received at least some other non-standard care type of intervention. 8 were targeted exclusively to caregivers (4 group intervention, 3 individual, and 1 combined) and 1 multicomponent intervention. Most frequent measured outcomes were caregiver’s burden, anxiety, depressive symptoms, and quality of life, and person with dementia neuropsychiatric symptoms. Individual interventions report better results in caregiver parameters such as burden and depressive symptoms and person with dementia neuropsychiatric symptoms. Group interventions presented mixed results. Nevertheless, the quality of evidence was low. There is a critical need to study interventions for caregivers in Latin-American contexts.

Download Full-text

Physical Activity and its Influencing Factors in Community-Dwelling Older Adults With Dementia: A Path Analysis

Clinical Nursing Research ◽

10.1177/10547738211033928 ◽

2021 ◽

pp. 105477382110339

Author(s):

Bei Li ◽

Xiuxiu Huang ◽

Chenchen Meng ◽

Qiaoqin Wan ◽

Yongan Sun

Keyword(s):

Physical Activity ◽

Older Adults ◽

Path Analysis ◽

Neuropsychiatric Symptoms ◽

Community Dwelling ◽

Cross Sectional ◽

People With Dementia ◽

The Status ◽

Path Analysis Approach ◽

Community Dwelling Older Adults

Dementia is prevalent in worldwide, and increases the care burden and potential costs. Physical activity (PA) has been increasingly shown to be beneficial for them. This was a cross-sectional observational study aiming to investigate the status of PA among community-dwelling older adults with dementia in Beijing or Hangzhou, China, and verify the relationships between neuropsychiatric symptoms, activities of daily living (ADL), caregivers’ fear of patients’ falling and their PA using a path analysis approach. The level of PA among 216 included people with dementia was low. PA was related to the neuropsychiatric symptoms, with ADL and caregivers’ fear of patients’ falling have mediation roles. The findings indicated that person-centered strategies related to the management of these symptoms might be helpful to improve ADL, relieve caregivers’ concerns about them falling and consequently foster positive participation in PA.

Download Full-text