Report on the Effects of Individualized Learning Therapy on Cognitive Function and Behavioral and Psychological Symptoms of Dementia in the Institutionalized Older Adults

ABSTRACTBackground:This study assessed the prevalence and factor structure of behavioral and psychological symptoms of dementia (BPSD) in a community-based sample of older adults with dementia and identified their correlates.Methods:Data collected from 399 Singapore residents with dementia aged 60 years and above, interviewed along with a family/friend during a national survey, were used for this analysis. Neuropsychiatric Inventory Questionnaire assessed older adults’ BPSD. Other data included socio-demographics, dementia severity, cognition, chronic physical conditions, disability, and caregivers’ burden. Exploratory factor analysis assessed BPSD sub-groups, factor scores of which were used to identify socio-demographic, and clinical correlates.Results:Prevalence of BPSD was 67.9% and 30% of the population had experienced three or more BPSD in the past month. Two distinct and moderately correlated symptom groups representing “psychosis and behavior dysregulation” and “mood disturbance and restlessness” were identified. As factor scores for both the groups increased with older age, poor cognition and caregiver burden, the former was also related to being never married and having no formal education.Conclusions:Study provides evidence of two distinct groups of BPSD and their important correlates. Clinicians treating BPSD should consider their age and cognitive impairment and be cognizant of their caregivers’ burden.

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Factors Associated With Behavioral and Psychological Symptoms of Dementia: Prospective Observational Study Using Actigraphy (Preprint)

10.2196/preprints.29001 ◽

2021 ◽

Author(s):

Eunhee Cho ◽

Sujin Kim ◽

Sinwoo Hwang ◽

Eunji Kwon ◽

Seok-Jae Heo ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Prospective Observational Study ◽

Psychological Symptoms ◽

Information Criterion ◽

Activity Levels ◽

Contributing Factors ◽

Factors Associated ◽

Physical Activity Levels ◽

Behavioral And Psychological Symptoms

BACKGROUND Although disclosing the predictors of different behavioral and psychological symptoms of dementia (BPSD) is the first step in developing person-centered interventions, current understanding is limited, as it considers BPSD as a homogenous construct. This fails to account for their heterogeneity and hinders development of interventions that address the underlying causes of the target BPSD subsyndromes. Moreover, understanding the influence of proximal factors—circadian rhythm–related factors (ie, sleep and activity levels) and physical and psychosocial unmet needs states—on BPSD subsyndromes is limited, due to the challenges of obtaining objective and/or continuous time-varying measures. OBJECTIVE The aim of this study was to explore factors associated with BPSD subsyndromes among community-dwelling older adults with dementia, considering sets of background and proximal factors (ie, actigraphy-measured sleep and physical activity levels and diary-based caregiver-perceived symptom triggers), guided by the need-driven dementia-compromised behavior model. METHODS A prospective observational study design was employed. Study participants included 145 older adults with dementia living at home. The mean age at baseline was 81.2 (SD 6.01) years and the sample consisted of 86 (59.3%) women. BPSD were measured with a BPSD diary kept by caregivers and were categorized into seven subsyndromes. Independent variables consisted of background characteristics and proximal factors (ie, sleep and physical activity levels measured using actigraphy and caregiver-reported contributing factors assessed using a BPSD diary). Generalized linear mixed models (GLMMs) were used to examine the factors that predicted the occurrence of BPSD subsyndromes. We compared the models based on the Akaike information criterion, the Bayesian information criterion, and likelihood ratio testing. RESULTS Compared to the GLMMs with only background factors, the addition of actigraphy and diary-based data improved model fit for every BPSD subsyndrome. The number of hours of nighttime sleep was a predictor of the next day’s sleep and nighttime behaviors (odds ratio [OR] 0.9, 95% CI 0.8-1.0; <i>P</i>=.005), and the amount of energy expenditure was a predictor for euphoria or elation (OR 0.02, 95% CI 0.0-0.5; <i>P</i>=.02). All subsyndromes, except for euphoria or elation, were significantly associated with hunger or thirst and urination or bowel movements, and all BPSD subsyndromes showed an association with environmental change. Age, marital status, premorbid personality, and taking sedatives were predictors of specific BPSD subsyndromes. CONCLUSIONS BPSD are clinically heterogeneous, and their occurrence can be predicted by different contributing factors. Our results for various BPSD suggest a critical window for timely intervention and care planning. Findings from this study will help devise symptom-targeted and individualized interventions to prevent and manage BPSD and facilitate personalized dementia care.

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Intramuscular Olanzapine in the Management of Behavioral and Psychological Symptoms in Hospitalized Older Adults: A Retrospective Descriptive Study

Journal of Aging Research ◽

10.1155/2015/570410 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Silvia Duong ◽

Kam-Tong Yeung ◽

Feng Chang

Keyword(s):

Older Adults ◽

Adverse Events ◽

Atypical Antipsychotics ◽

Psychological Symptoms ◽

Patient Discharge ◽

High Risk Population ◽

Discharge Destination ◽

Patient Demographics ◽

Hospitalized Older Adults ◽

Behavioral And Psychological Symptoms

Background. While behavioral and psychological symptoms are frequent in hospitalized older adults with dementia or delirium, data supporting the off-label use of intramuscular atypical antipsychotics remain scarce. We examined the use of short-acting intramuscular (IM) olanzapine in hospitalized older adults to manage behavioral and psychological symptoms.Methods. A retrospective observational study of inpatients 65 years or older with at least one order for olanzapine IM during admission in urban Ontario Canada was conducted. Patient demographics, prescriptions for olanzapine IM, reason for administration, perceived effectiveness, adverse events, concurrently prescribed psychotropics, comorbidities, and patient discharge destination were recorded.Results. Among 82 patients aged 65–96 years (mean ± SD 79.3 ± 7.7) 85 cases were identified. Cognitive impairment or dementia affected 63.5% and 50.6% had comorbidities. Olanzapine IM was ordered 102 times and 34 patients (41%) received at least one dose. The intended efficacy was achieved in 79.4% of 78 cases of 124 doses given (62.9%). Fourteen (41%) patients who received doses experienced adverse events, with sedation and hypotension being the most common.Conclusions. Olanzapine IM appears effective in hospitalized older adults but is associated with potential adverse events. Structured monitoring and documentation are needed to ensure safe use in this high-risk population.

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FACTORS AFFECTING BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS IN OLDER ADULTS WITH DEMENTIA

Innovation in Aging ◽

10.1093/geroni/igz038.3293 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S901-S902

Author(s):

Hwang Sinwoo ◽

Eunhee Cho

Keyword(s):

Older Adults ◽

Mixed Model ◽

Linear Mixed Model ◽

Psychological Symptoms ◽

Severe Depression ◽

Melatonin Level ◽

Aggressive Behaviors ◽

Salivary Melatonin ◽

Waking Up ◽

Behavioral And Psychological Symptoms

Abstract The purpose of this study was to identify factors predicting behavioral and psychological symptoms of dementia(BPSD) in older adults with Dementia. This is a cross-sectional study, recruiting 157 participants from neurology general hospital as study subjects. Data collection was performed from June 2018 to May 2019. BPSD were classified using a modified version of the Cohen-Mansfield agitation inventory(CMAI), which are physically non-aggressive behaviors(PNAB), physically aggressive behaviors(PGAB), verbally non-aggressive behaviors(VNAB), verbally aggressive behaviors(VAGB). The Cornell scale for depression in dementia(CSDD), korea activity of daily living scale(K-ADL), korean mini-mental state examination(K-MMSE), activity and sleep time through using actigraphy for 2weeks, salivary melatonin and cortisol level at 4 times a day done after waking up, after breakfast, before and after dinner, and medication were measured as influencing factors. The generalized linear mixed model analyses indicated that VNAB and VAGB were associated with severe depression(p<0.01, respectively), low melatonin level at the after waking up (p<0.05, respectively), and high melatonin level before dinner(p<0.05, respectively). On the PNAB and PGAB, severe depression(p<0.05, respectively) and high activity(p<0.05, respectively) showed great influences. These findings suggest that developing of intervention of BPSD must be started with detecting depression, ADL. Considering the factors of each type of symptom, tailoring an individual approach is recommended. In addition, this study identified that the activity through actigraphy and salivary melatonin measurement are useful tools to examine BPSD. It can be helpful in the objective evaluation of BPSD.

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Discontinuation of Long-Term Antipsychotic Drug Use for Behavioral and Psychological Symptoms in Older Adults Aged 65 Years and Older With Dementia

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2018.06.023 ◽

2018 ◽

Vol 19 (11) ◽

pp. 1009-1014 ◽

Cited By ~ 6

Author(s):

Ellen Van Leeuwen ◽

Mirko Petrovic ◽

Mieke L. van Driel ◽

An IM De Sutter ◽

Robert Vander Stichele ◽

...

Keyword(s):

Older Adults ◽

Drug Use ◽

Antipsychotic Drug ◽

Psychological Symptoms ◽

Behavioral And Psychological Symptoms

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Effect of Risperidone on Behavioral and Psychological Symptoms and Cognitive Function in Dementia

The Journal of Clinical Psychiatry ◽

10.4088/jcp.v62n1110 ◽

2001 ◽

Vol 62 (11) ◽

pp. 894-900 ◽

Cited By ~ 31

Author(s):

Michael K. Rainer ◽

Andreas J. Masching ◽

Michael G. Ertl ◽

Eva Kraxberger ◽

Manfred Haushofer

Keyword(s):

Cognitive Function ◽

Psychological Symptoms ◽

Behavioral And Psychological Symptoms

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Hormone Treatments for Behavioral and Psychological Symptoms of Dementia

International Psychogeriatrics ◽

10.1017/s104161020000716x ◽

2000 ◽

Vol 12 (S1) ◽

pp. 291-295 ◽

Cited By ~ 1

Author(s):

Gary W. Small

Keyword(s):

Cognitive Function ◽

Postmenopausal Women ◽

Older Persons ◽

Laboratory Tests ◽

Psychological Symptoms ◽

Endocrine Disorders ◽

Mood Symptoms ◽

Treatment Of Depression ◽

Cognitively Intact ◽

Behavioral And Psychological Symptoms

Several hormones have the potential for influencing the behavioral and psychological symptoms of dementia (BPSD). Endocrine disorders stemming from the thyroid and parathyroid glands, for example, can be identified through screening laboratory tests, and if the underlying abnormalities are treated, symptoms may improve. The hormone that has received the greatest attention, however, regarding its potential for treating both cognitive and mood symptoms in older persons is estrogen. Recent data suggest that estrogen may facilitate treatment of depression in cognitively intact postmenopausal women and may decrease the risk of Alzheimer's disease in postmenopausal women. In part because testosterone is converted to estrogen in men, recent studies suggest that treating hypogonadal men with testosterone may improve their cognitive function.

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