scholarly journals Inattention tests for delirium

2017 ◽  
Vol 29 (9) ◽  
pp. 1579-1580
Author(s):  
Paul Regal
Keyword(s):  
Cognitive Impairment ◽  
Gold Standard ◽  
Psychological Symptoms ◽  
Digit Span ◽  
Semantic Knowledge ◽  
List Type ◽  
Term Care ◽  
Dsm 5 ◽  
Diagnosis Of Dementia ◽  
High Level

Voyer and colleagues (2016) report an interesting and important comparison of ten attention/concentration tests for DSM-5 delirium. I have a number of questions and comments as follows: (1)What training did the research assistants have? DSM-5 diagnosis is generally regarded as a decision by medical specialists. When the person has prior dementia, identifying delirium is a high-level medical skill. Behavioral and psychological symptoms of dementia can closely mimic delirium unless the examiner focuses on behavioral triggers and the speed of cognitive decline.(2)The requirement of taking medications twice a day may have eliminated some delirium patients with impaired swallowing or refusal to take medications.(3)Lumping dementia, confusion, and disorientation into one label “cognitive impairment” is problematic and reduces the usefulness of Table 3.(4)The authors used prior diagnosis of dementia as a gold standard when in fact many people with that label have mild cognitive impairment.(5)The ten “concentration” subtests in the Hierarchic Dementia Scale (HDS) (Cole and Dastoor, 1987) are not purely indices of concentration. Serial seven subtraction is impaired in low education with normal concentration. Months of the year backwards is often ranked as both an attention and executive function test and it requires semantic knowledge. Digit span forward is a rapid attention test missing from the HDS which has been of great value in my delirium research.(6)As expected DSM-5 delirium was more common among medical inpatients than long-term care residents (14.9% vs. 4.0%, Table 1).(7)The Central Coast Australia Delirium Intervention Study (Regal, 2015) supported the gold standard to prove delirium was the speed and amplitude of both onset and recovery. In CADIS, the mean recovery of five-digit span forward was two days, six-DSF 5.6 days and Delirium Index 8.0 days.

“Music First”

GeroPsych ◽  
2018 ◽  
Vol 31 (1) ◽  
pp. 17-30 ◽  
Author(s):  
Dane L. Shiltz ◽  
Tara T. Lineweaver ◽  
Tim Brimmer ◽  
Alex C. Cairns ◽  
Danielle S. Halcomb ◽  
...  
Keyword(s):  
Usual Care ◽  
Psychological Symptoms ◽  
Care Facility ◽  
Care Group ◽  
Music Listening ◽  
Term Care ◽  
Antipsychotic Medications ◽  
Risk Of Death ◽  
Extended Care ◽  
Individualized Music

Abstract. Existing research has primarily evaluated music therapy (MT) as a means of reducing the negative affect, behavioral, and/or cognitive symptoms of dementia. Music listening (ML), on the other hand, offers a less-explored, potentially equivalent alternative to MT and may further reduce exposure to potentially harmful psychotropic medications traditionally used to manage negative behavioral and psychological symptoms of dementia (BPSD). This 5-month prospective, naturalistic, interprofessional, single-center extended care facility study compared usual care (45 residents) and usual care combined with at least thrice weekly personalized ML sessions (47 residents) to determine the influence of ML. Agitation decreased for all participants (p < .001), and the ML residents receiving antipsychotic medications at baseline experienced agitation levels similar to both the usual care group and the ML patients who were not prescribed antipsychotics (p < .05 for medication × ML interaction). No significant changes in psychotropic medication exposure occurred. This experimental study supports ML as an adjunct to pharmacological approaches to treating agitation in older adults with dementia living in long-term care facilities. It also highlights the need for additional research focused on how individualized music programs affect doses and frequencies of antipsychotic medications and their associated risk of death and cerebrovascular events in this population.

scholarly journals 404 - Effect of Psychoeducation Modul on the Administration of Psychotropic Drugs for Patients with Behavioral and Psychological Symptoms of Dementia at the RS Dr. H. Marzoeki Mahdi Bogor on Caregivers

2020 ◽  
Vol 32 (S1) ◽  
pp. 120-120
Keyword(s):  
Psychotropic Drugs ◽  
Cognitive Abilities ◽  
Health Workers ◽  
Psychological Symptoms ◽  
Clinical Syndrome ◽  
List Type ◽  
Study Program ◽  
Dementia Patients ◽  
Patients Experience ◽  
Behavioral And Psychological Symptoms

Name : Yuniar Pukuk KesumaStudy program : Psychiatry, Specialist II Geriatric PsychiatryCounsellor : Dr.dr. Martina Wiwie S. Nasrun, Sp.KJ(K)Background:Dementia is a clinical syndrome characterized by a decline in cognitive abilities and memory deficits globally. About 90% of patients experience behavioral and psychological symptoms. The use of psychotropic drugs is influenced by the patient symptoms, burden of the caregiver, and the habit of health workers.Objective:To determine the effect of psychoeducation modules to caregivers to increase knowledge, decrease of psychotropic drugs, reduce symptoms and burden of caregivers.Methods:There are 2 steps of studies. The first was a qualitative study to create psychoeducation module and the second was to conduct a pre-experimental study (one group pretest-posttest study). Psychoeducation is given in 2 consecutive weeks.Results:Fourty caregivers of dementia patients aged 41.3 (± 9.72) years. The psychoeducation modules is associated with decreasing symptoms and the use of psychotropic drugs, increasing knowledge and decreasing the burden of caregivers. At the end, 23% of patients were able to stop using psychotropic drugs and 62% of patients reduced their dose and/or the amount of psychotropic drugs.Conclusion:The psychoeducation modules to caregivers is associated with a decrease of patient symptoms and the use of psychotropic drugs. Psychoeducation also increases the knowledge of the caregiver and decreases the burden of the caregiver so that this psychoeducation module can be an additional therapy for patients with dementia.

Effects of Folic Acid Combined with DHA Supplementation on Cognitive Function and Amyloid-β-Related Biomarkers in Older Adults with Mild Cognitive Impairment by a Randomized, Double Blind, Placebo-Controlled Trial

2021 ◽  
pp. 1-13
Author(s):  
Dong Bai ◽  
Junting Fan ◽  
Mengyue Li ◽  
Cuixia Dong ◽  
Yiming Gao ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Folic Acid ◽  
Mild Cognitive Impairment ◽  
Cognitive Function ◽  
Digit Span ◽  
Controlled Trial ◽  
Amyloid Β ◽  
Amyloid Β Peptide ◽  
Double Blind ◽  
Full Scale Intelligence Quotient

Background: The neuroprotective benefits of combined folic acid and docosahexaenoic acid (DHA) on cognitive function in mild cognitive impairment (MCI) patients are suggested but unconfirmed. Objective: To explore the effects of 6-month folic acid + DHA on cognitive function in patients with MCI. Methods: Our randomized controlled trial (trial number ChiCTR-IOR-16008351) was conducted in Tianjin, China. We divided 160 MCI patients aged >  60 years into four regimen groups randomly: folic acid (0.8 mg/day) + DHA (800 mg/day), folic acid (0.8 mg/day), DHA (800 mg/day), and placebo, for 6 months. Cognitive function and blood amyloid-β peptide (Aβ) biomarker levels were measured at baseline and 6 months. Cognitive function was also measured at 12 months. Results: A total of 138 patients completed this trial. Folic acid improved the full-scale intelligence quotient (FSIQ), arithmetic, and picture complement scores; DHA improved the FSIQ, information, arithmetic, and digit span scores; folic acid + DHA improved the arithmetic (difference 1.67, 95% CI 1.02 to 2.31) and digital span (1.33, 0.24 to 2.43) scores compared to placebo. At 12 months, all scores declined in the intervention groups. Folic acid and folic acid + DHA increased blood folate (folic acid + DHA: 7.70, 3.81 to 11.59) and S-adenosylmethionine (23.93, 1.86 to 46.00) levels and reduced homocysteine levels (–6.51, –10.57 to –2.45) compared to placebo. DHA lower the Aβ40 levels (–40.57, –79.79 to –1.35) compared to placebo (p <  0.05), and folic acid + DHA reduced the Aβ42 (–95.59, –150.76 to –40.43) and Aβ40 levels (–45.75, –84.67 to –6.84) more than DHA (p <  0.05). Conclusion: Folic acid and DHA improve cognitive function and reduce blood Aβ production in MCI patients. Combination therapy may be more beneficial in reducing blood Aβ-related biomarkers.

scholarly journals Feasibility Study of a Digital Screen-Based Calming Device for Managing BPSD During Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 755-755
Author(s):  
Gloria Gutman ◽  
Avantika Vashisht ◽  
Taranjot Kaur ◽  
Ryan Churchill ◽  
Amir Moztarzadeh ◽  
...  
Keyword(s):  
Usual Care ◽  
Psychological Symptoms ◽  
Care Home ◽  
Routine Care ◽  
Care Staff ◽  
Successful Implementation ◽  
Term Care ◽  
Item Checklist ◽  
And Control

Abstract MindfulGarden (MG) is a digital device resembling a flat screen TV, with touchless sensors that react to voice and motion. In this study 13 long-term care home residents aged 74-100 exhibiting Behavioural and Psychological Symptoms of Dementia (BPSD) were randomized to treatment and control groups. On days 1-3 the treatment group received usual care plus exposure to MG during morning and evening care - events well documented to be problematic for residents and care staff; controls received usual care only. On day 4 both groups were exposed to MG with verbal cueing. A 26-item checklist was used to record frequency and types of disruptive BPSD exhibited; care duration was recorded in minutes. There was a trend toward reduction of BPSD and duration of care during morning care. Findings suggest that verbal cueing may be important for successful implementation of MG in calming residents with dementia during routine care.

scholarly journals 412 - An Affect Education Model for Caregivers: Managing Behavioural and Psychological Symptoms of Dementia

2020 ◽  
Vol 32 (S1) ◽  
pp. 128-128
Author(s):  
Ken Schwartz ◽  
Robert Madan ◽  
Rosalind Sham ◽  
Sandra Gardner
Keyword(s):  
Focus Groups ◽  
Psychological Symptoms ◽  
Care Delivery ◽  
Care Providers ◽  
Term Care ◽  
Self Reflection ◽  
Personal Support ◽  
Behavioural And Psychological Symptoms ◽  
Education Model ◽  
The Impact

Introduction:Providing care for people with behavioural and psychological symptoms of dementia is stressful as these individuals are commonly labelled as aggressive or resistant to care. Few studies have evaluated the impact of providing support to professional caregivers working in long-term care. Our mixed methods pilot study evaluated the impact of the innovative Affect Education Model among health care providers from two Toronto nursing homes.Methods:The two-person centred Affect Educational Model through the use of seven questions that encourage self-reflection teaches that problematic behaviours are co-constructed between individuals with BPSD and caregivers. Study procedures included recruiting nursing staff and personal support workers and teaching them the model in five weekly 30-minute group sessions. Qualitative measures in the form of focus groups were obtained. Quantitative measures were obtained through the use of five questionnaires.Results:Qualitative findings from focus groups identified four themes: facilitators and barriers perceived in current care delivery, the impact of the model experience on staff care delivery, reflections on being taught the model, and future model implementation. Quantitative results were also collected and discussed.Conclusions:The use of both pharmacologic and nonpharmacologic treatment of individuals with BPSD may be greatly enhanced by an interpersonal two-person Affect Education Model that emphasizes the importance of calming down and self-reflection. Future directions include expanding the model to family caregivers through the use of multimedia resources.

scholarly journals Gesture commands for controlling high-level UAV behavior

2021 ◽  
Vol 3 (6) ◽  
Author(s):  
John Akagi ◽  
T. Devon Morris ◽  
Brady Moon ◽  
Xingguang Chen ◽  
Cameron K. Peterson
Keyword(s):  
Search Algorithm ◽  
Dynamic Environment ◽  
List Type ◽  
Hardware In The Loop ◽  
Monte Carlo Tree Search ◽  
Natural Interface ◽  
Constrained Environments ◽  
Novel Variant ◽  
High Level ◽  
Tree Search Algorithm

Abstract Directing groups of unmanned air vehicles (UAVs) is a task that typically requires the full attention of several operators. This can be prohibitive in situations where an operator must pay attention to their surroundings. In this paper we present a gesture device that assists operators in commanding UAVs in focus-constrained environments. The operator influences the UAVs’ behavior by using intuitive hand gesture movements. Gestures are captured using an accelerometer and gyroscope and then classified using a logistic regression model. Ten gestures were chosen to provide behaviors for a group of fixed-wing UAVs. These behaviors specified various searching, following, and tracking patterns that could be used in a dynamic environment. A novel variant of the Monte Carlo Tree Search algorithm was developed to autonomously plan the paths of the cooperating UAVs. These autonomy algorithms were executed when their corresponding gesture was recognized by the gesture device. The gesture device was trained to classify the ten gestures and accurately identified them 95% of the time. Each of the behaviors associated with the gestures was tested in hardware-in-the-loop simulations and the ability to dynamically switch between them was demonstrated. The results show that the system can be used as a natural interface to assist an operator in directing a fleet of UAVs. Article highlights A gesture device was created that enables operators to command a group of UAVs in focus-constrained environments. Each gesture triggers high-level commands that direct a UAV group to execute complex behaviors. Software simulations and hardware-in-the-loop testing shows the device is effective in directing UAV groups.

scholarly journals The future of social care funding: who pays?

2016 ◽  
Vol 22 (1) ◽  
pp. 10-44 ◽  
Author(s):  
T. Kenny ◽  
J. Barnfield ◽  
L. Daly ◽  
A. Dunn ◽  
D. Passey ◽  
...  
Keyword(s):  
Phase 1 ◽  
List Type ◽  
Political Debate ◽  
Term Care ◽  
Means Testing ◽  
Financial Products ◽  
Funding System ◽  
The Government ◽  
The Uk ◽  
Care Costs

AbstractWith the UK population ageing, deciding upon a satisfactory and sustainable system for the funding of people’s long-term care (LTC) needs has long been a topic of political debate. Phase 1 of the Care Act 2014 (“the Act”) brought in some of the reforms recommended by the Dilnot Commission in 2011. However, the Government announced during 2015 that Phase 2 of “the Act” such as the introduction of a £72,000 cap on Local Authority care costs and a change in the means testing thresholds1 would be deferred until 2020. In addition to this delay, the “freedom and choice” agenda for pensions has come into force. It is therefore timely that the potential market responses to help people pay for their care within the new pensions environment should be considered. In this paper, we analyse whether the proposed reforms meet the policy intention of protecting people from catastrophic care costs, whilst facilitating individual understanding of their potential care funding requirements. In particular, we review a number of financial products and ascertain the extent to which such products might help individuals to fund the LTC costs for which they would be responsible for meeting. We also produce case studies to demonstrate the complexities of the care funding system. Finally, we review the potential impact on incentives for individuals to save for care costs under the proposed new means testing thresholds and compare these with the current thresholds. We conclude that:∙Although it is still too early to understand exactly how individuals will respond to the pensions freedom and choice agenda, there are a number of financial products that might complement the new flexibilities and help people make provision for care costs.∙The new care funding system is complex making it difficult for people to understand their potential care costs.∙The current means testing system causes a disincentive to save. The new means testing thresholds provide a greater level of reward for savers than the existing thresholds and therefore may increase the level of saving for care; however, the new thresholds could still act as a barrier since disincentives still exist.

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