Emerging treatments for the behavioral and psychological symptoms of dementia

CNS Spectrums ◽  
2017 ◽  
Vol 23 (6) ◽  
pp. 361-369 ◽  
Author(s):  
Abhinav Anand ◽  
Puneet Khurana ◽  
Jasneet Chawla ◽  
Neha Sharma ◽  
Navneet Khurana
Keyword(s):  
Motor Behavior ◽  
Psychological Symptoms ◽  
Significant Development ◽  
Emerging Treatments ◽  
Mental Abilities ◽  
Cholinergic Agents ◽  
Clinically Significant ◽  
Underlying Pathophysiology ◽  
Behavioral And Psychological Symptoms ◽  
Research Avenue

Dementia is referred to a loss of memory and decline in other mental abilities at levels critical enough to hinder performance of daily activities. It can be of several types, depending on the underlying pathophysiology. The behavioral and psychological symptoms of dementia (BPSD) are various, but the most clinically significant are depression, apathy, and anxiety. Other BPSD include agitation, aberrant motor behavior, elation, hallucinations, and alterations in sleep and appetite. About 90% of sufferers of dementia are affected by BPSD during the course of the illness. These symptoms occur in demented patients irrespective of the dementia subtype. However, there has not been significant development in the areas of disease-modifying pharmacotherapeutics for dementia. Therefore, tackling BPSD has emerged as a research avenue in the recent past. Existing antidepressants, antipsychotics, and cholinergic agents have been extensively used in the treatment of BPSD, independently and in different combinations. However, these agents have not successful in completely alleviating such symptoms. Research in this field is going on globally, but it is still limited by various factors. There is a strong need to develop new entities and test them clinically. This review focuses on emerging treatments for the management of clinically significant BPSD.

scholarly journals The Holistic Impact of Using Arts-Based Intervention for Elderly With Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 567-567
Author(s):  
Rainbow Tin Hun Ho
Keyword(s):  
Motor Behavior ◽  
Psychological Symptoms ◽  
Controlled Trial ◽  
Negative Mood ◽  
Community Dwelling ◽  
Creative Arts ◽  
Dance Movement ◽  
Moderate Dementia ◽  
Practical Experiences ◽  
Behavioral And Psychological Symptoms

Abstract The use of creative arts on supporting elderly with dementia has been becoming popular due to its safe and engaging process. This non-pharmacological approach can complement with other treatment methods to support elderly with dementia on various aspects, including physical, cognitive and social functioning. In our randomized controlled trial on dance movement therapy (DMT) for 204 community dwelling elders with mild dementia, we found DMT could significantly reduce the level of depression, loneliness and negative mood (β=0.33-0.42, p<.01), and also the diurnal cortisol slope (β =0.30, p<.01); while in another trial on 73 elderly with moderate dementia, we found music and movement could help reduce the behavioral and psychological symptoms such as agitation (β = -0.41, p<.01), aberrant motor behavior (β=-1.02, p<.01), and dysphonia (β=-0.61, p<.05). The present presentation aims to share with the audience our practical experiences, the research procedures as well as the findings of the projects.

Caregiver-Reported Sleep Disturbances Are Associated With Behavioral and Psychological Symptoms in an Asian Elderly Cohort With Cognitive Impairment-No Dementia

2018 ◽  
Vol 31 (2) ◽  
pp. 70-75
Author(s):  
Xin Xu ◽  
Cheuk Ni Kan ◽  
Tien Yin Wong ◽  
Ching-Yu Cheng ◽  
M. Kamran Ikram ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Sleep Disturbances ◽  
Motor Behavior ◽  
Psychological Symptoms ◽  
Risk Of Progression ◽  
Elderly Cohort ◽  
Anxiety Depression ◽  
Behavioral And Psychological Symptoms ◽  
Asian Sample ◽  
Cognitive Impairment No Dementia

Objective: Sleep disturbances were found to be associated with more behavioral and psychological symptoms (BPS) in early patients with Alzheimer's disease (AD). However, data on preclinical stages of dementia are lacking. Hence, the present study sought to investigate the association between sleep disturbances and BPS in dementia-free elderly with varying severity of cognitive impairment in an Asian sample. Methods: Community-living elderly were recruited and administered a comprehensive cognitive battery (vascular dementia battery [VDB]) and the Neuropsychiatric Inventory to assess symptoms of sleep disturbances and BPS. Severity of cognitive impairment was diagnosed and classified as no cognitive impairment (NCI), cognitive impairment-no dementia (CIND) -mild (1-2 impaired domains on the VDB), and CIND-moderate (≥3 impaired domains on the VDB). Analysis of variance was conducted to assess the associations between the presence of sleep disturbances and BPS scores in each diagnostic group. Logistic regression was used to examine whether the coexistence of sleep disturbances and other BPS was associated with CIND-moderate, which is known to carry a higher risk of progression to AD. Results: Among 839 elderly, 79 (9.4%) reported sleep disturbances. Participants with sleep disturbances had higher total BPS burden than those without among CIND participants but not in NCIs. Furthermore, CIND-moderate participants with sleep disturbances had more delusions, hallucinations, anxiety, depression, irritability, aberrant motor behavior, and appetite change ( P < .05). The presence of both sleep disturbances and other BPS was associated with CIND-moderate (odds ratio: 2.5, 95% confidence interval: 1.1-5.5). Conclusions: Sleep disturbances are associated with higher total BPS burden and specific BPS among elderly patients with cognitive impairment, particularly those with CIND moderate, which carries higher risk of developing dementia.

scholarly journals Behavioral and psychological symptoms of dementia in different dementia disorders: A large-scale study of 12 000 individuals.

2021 ◽  
Author(s):  
Emilia Schwertner ◽  
Joana Braga Pereira ◽  
Hong Xu ◽  
Juraj Secnik ◽  
Bengt Winblad ◽  
...  
Keyword(s):  
Large Scale ◽  
Motor Behavior ◽  
Psychological Symptoms ◽  
Lewy Bodies ◽  
Time Behavior ◽  
Dementia Diagnosis ◽  
Night Time ◽  
Logistic Regression Models ◽  
National Quality ◽  
Behavioral And Psychological Symptoms

Objective: To characterize behavioral and psychological symptoms of dementia (BPSD) in different dementia diagnoses: Alzheimer's disease (AD), dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD), vascular dementia (VaD), frontotemporal dementia (FTD), mixed (Mixed) and unspecified dementia. Design: Registry-based cohort study. Setting and participants: 12,137 individuals with dementia registered in two national quality registries, the Swedish registry for cognitive/dementia disorders (SveDem) and the Swedish BPSD registry, during 2010 - 2016. Methods: BPSD was assessed with the Neuropsychiatric Inventory - Nursing Home Version (NPI-NH). Multivariate logistic regression models were used to evaluate the associations between dementia diagnoses and different BPSDs in reference to a) the AD group and b) each of the other diagnostic groups. All models were adjusted for age, gender, the severity of cognitive impairment at the time of dementia diagnosis, and time between dementia diagnosis and BPSD assessment. Results: In all individuals, the three most common symptoms were aberrant motor behaviour (35,1%), agitation (32,3%), and irritability (28,7%), while euphoria (5,9%) was the least frequent. Compared to AD, we found a lower risk of delusions (in VaD, FTD, unspecified dementia), hallucinations (in VaD and FTD), agitation (in PDD, unspecified dementia), elation/euphoria (in DLB), anxiety (in PDD, unspecified dementia), disinhibition (in PDD); irritability (in DLB, PDD, unspecified dementia), aberrant motor behavior (in Mixed, VaD, unspecified dementia) and sleep and night-time behavior changes (in unspecified dementia). Higher risks of delusions (in DLB), hallucinations (in DLB, PDD), apathy (VaD, FTD), disinhibition (in FTD) and appetite and eating abnormalities (in FTD) were found compared to AD. Conclusions and Implications: In this large contemporary cohort, BPSD was common in all types of dementia, with the most common symptoms being aberrant motor behavior, agitation, and irritability. Additionally, BPSD differed depending on the dementia type.

scholarly journals Prevalence of Behavioral and Psychological Symptoms of Dementia in Community-Dwelling Dementia Patients: A Systematic Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Chan-Young Kwon ◽  
Boram Lee
Keyword(s):  
Systematic Review ◽  
Eating Disorder ◽  
Sleep Disorders ◽  
Motor Behavior ◽  
Psychological Symptoms ◽  
Community Dwelling ◽  
Dementia Patients ◽  
Pooled Prevalence ◽  
Severity Of Dementia ◽  
Behavioral And Psychological Symptoms

Background: Identifying the characteristics of behavioral and psychological symptoms of dementia (BPSD) associated with different dementia types may be a promising strategy to effectively deal with BPSD. We aimed to synthesize the prevalence rates of BPSD characteristics in community-dwelling dementia patients.Methods: We searched Medline, EMBASE, and PsycARTICLES databases for original clinical studies published until December 2020 that enrolled at least 300 community-dwelling dementia patients. The methodological qualities of prevalence studies were assessed using the Joanna Briggs Institute's critical appraisal checklist.Results: Thirty studies were included. The prevalence of the BPSD characteristic ranged from 4 (elation and mania) to 32% (apathy) in the pooled samples. The prevalence of delusions, anxiety, apathy, irritability, elation and mania, and aberrant motor behavior in Alzheimer's disease patients was 1.72–2.88 times greater than that in vascular dementia (VD) patients, while the prevalence of disinhibition in VD patients was 1.38 times greater. The prevalence of anxiety, irritability, and agitation and aggression, delusion, hallucinations, apathy, disinhibition, and aberrant motor behavior tended to increase as the severity of dementia increased, while that of depression, eating disorder, sleep disorders, and elation and mania tended to stable. In community-dwelling patients with dementia, the pooled prevalence of apathy, depression, anxiety, irritability, agitation and aggression, sleep disorders, and eating disorder was higher than 20%, while that of disinhibition and elation and mania was lower than 10%.Conclusion: Overall, the pooled prevalence of apathy, depression, anxiety, irritability, agitation and aggression, sleep disorders, and eating disorder was generally high in patients with dementia. Also, the prevalence of some BPSD characteristics differed according to the type and the severity of dementia. The methodological quality of the included studies is not the best, and high heterogeneity may affect the certainty of the findings. However, the results of this review can deepen our understanding of the prevalence of BPSD.Systematic Review Registration:https://osf.io/dmj7k, identifier: 10.17605/OSF.IO/DMJ7K.

scholarly journals The Association between 5HT2A T102C and Behavioral and Psychological Symptoms of Dementia in Alzheimer’s Disease: A Meta-Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-14 ◽  
Author(s):  
Liang Tang ◽  
Yan Wang ◽  
Yiwei Chen ◽  
Lianghui Chen ◽  
Shui Zheng ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Serotonin Receptor ◽  
Motor Behavior ◽  
Psychological Symptoms ◽  
Meta Analysis ◽  
Receptor Gene ◽  
Cochrane Library ◽  
The Cochrane Library ◽  
Behavioral And Psychological Symptoms

The serotonin receptor gene (5-HT2A) has been reported to be a susceptible factor in behavioral and psychological symptoms of dementia (BPSD) in Alzheimer’s disease (AD). However, previous results were conflicting. We aim to investigate the association of 5-HT2A T102C with BPSD in AD using a meta-analysis. Studies were collected using PubMed, Web of Science, the Cochrane Library databases, Chinese National Knowledge Infrastructure (CNKI), and Embase. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess associations. Nine studies with 1899 AD patients with/without BPSD were included in this meta-analysis. The 102C and CC genotypes were associated with psychosis in AD (102C: p<0.00001, OR [95% CI] = 3.19 [2.12–4.79]; CC: p<0.00001, OR [95% CI] = 7.24 [3.60–14.59]). The TT genotype was significantly associated with hallucinations, aberrant motor behavior, and psychosis in AD (hallucinations: p=0.001, OR [95% CI] = 0.52 [0.36–0.77]; aberrant motor behavior: p=0.03, OR [95% CI] = 0.58 [0.35–0.95]; and psychosis: p=0.002, OR [95% CI] = 0.34 [0.17–0.67]). No association was observed between T102C alleles or genotypes and delusions, agitation/aggression, depression, and apathy (p>0.05). Thus, the 5HT2A T102C might be a susceptible factor for hallucinations, aberrant motor behavior, and psychosis in AD. The potential mechanism of this polymorphism in BPSD in AD requires further exploration.

scholarly journals A systematic review of the relationship between behavioral and psychological symptoms (BPSD) and caregiver well-being

2016 ◽  
Vol 28 (11) ◽  
pp. 1761-1774 ◽  
Author(s):  
Alexandra Feast ◽  
Esme Moniz-Cook ◽  
Charlotte Stoner ◽  
Georgina Charlesworth ◽  
Martin Orrell
Keyword(s):  
Systematic Review ◽  
Motor Behavior ◽  
Psychological Symptoms ◽  
Meta Analysis ◽  
Well Being ◽  
Future Research ◽  
The Individual ◽  
The Impact ◽  
Behavioral And Psychological Symptoms

ABSTRACTBackground:Behavioral and psychological symptoms in dementia (BPSD) are important predictors of institutionalization as well as caregiver burden and depression. Previous reviews have tended to group BPSD as one category with little focus on the role of the individual symptoms. This review investigates the role of the individual symptoms of BPSD in relation to the impact on different measures of family caregiver well-being.Methods:Systematic review and meta-analysis of papers published in English between 1980 and December 2015 reporting which BPSD affect caregiver well-being. Paper quality was appraised using the Downs and Black Checklist (1998).Results:Forty medium and high quality quantitative papers met the inclusion criteria, 16 were suitable to be included in a meta-analysis of mean distress scores. Depressive behaviors were the most distressing for caregivers followed by agitation/aggression and apathy. Euphoria was the least distressing. Correlation coefficients between mean total behavior scores and mean distress scores were pooled for four studies. Irritability, aberrant motor behavior and delusions were the most strongly correlated to distress, disinhibition was the least correlated.Conclusions:The evidence is not conclusive as to whether some BPSD impact caregiver well-being more than others. Studies which validly examined BPSD individually were limited, and the included studies used numerous measures of BPSD and numerous measures of caregiver well-being. Future research may benefit from a consistent measure of BPSD, examining BPSD individually, and by examining the causal mechanisms by which BPSD impact well-being by including caregiver variables so that interventions can be designed to target BPSD more effectively.

scholarly journals Behavioral and psychological symptoms of dementia in relation to level of cognitive impairment

2008 ◽  
Vol 20 (4) ◽  
pp. 777-789 ◽  
Author(s):  
Hugo Lövheim ◽  
Per-Olof Sandman ◽  
Stig Karlsson ◽  
Yngve Gustafson
Keyword(s):  
Cognitive Impairment ◽  
Motor Behavior ◽  
Psychological Symptoms ◽  
Cross Sectional ◽  
Middle Stage ◽  
People With Dementia ◽  
Non Linear ◽  
Seeking Behavior ◽  
Linear Correlations ◽  
Behavioral And Psychological Symptoms

ABSTRACTBackground: Many people with dementia exhibit some behavioral or psychological symptoms, e.g. aggressive or aberrant motor behavior, depression or hallucinations, at some time during the course of the disorder. The aim of the present study was to describe the probability of the occurrence of these symptoms of dementia in relation to the level of cognitive impairment.Methods: 3404 people with cognitive impairment were selected from two large cross-sectional surveys of those in geriatric care settings, conducted in 1982 and 2000 in the county of Västerbotten, Sweden. Symptoms were assessed using the Multi-Dimensional Dementia Assessment Scale (MDDAS), subsumed with a rotated factor analysis, and investigated in relation to level of cognitive impairment, measured using the Gottfries cognitive scale.Results: The passiveness factor had an almost linear correlation to the level of cognitive impairment (r2 = 0.237). Non-linear correlations, with highest prevalences in middle-stage cognitive impairment, were found for aggressive behavior (r2 = 0.057), wandering behavior (r2 = 0.065), restless behavior (r2 = 0.143), verbally disruptive/attention-seeking behavior (r2 = 0.099), regressive/inappropriate behavior (r2 = 0.058), hallucinatory symptoms (r2 = 0.021) and depressive symptoms (r2 = 0.029).Conclusion: The relations between the behavioral and psychological symptoms of dementia and level of cognitive impairment were non-linear, with higher prevalence rates in the middle stages of dementia, apart from the symptom of passiveness, which increased almost linearly with the severity of cognitive impairment.

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

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.

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