Characteristics and Real-Life Outcomes of Dementia and Cognitive Impairment at a Geriatric Clinic

2020 ◽  
Vol 49 (3) ◽  
pp. 312-320
Author(s):  
Kritapas Chulakadabba ◽  
Weerasak Muangpaisan ◽  
Pitiporn Siritipakorn ◽  
Titima Wongviriyawong ◽  
Patumporn Suraarunsumrit ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Psychological Symptoms ◽  
Real Life ◽  
Retrospective Chart Review ◽  
Acetylcholinesterase Inhibitors ◽  
Dementia Care ◽  
Subjective Cognitive Decline ◽  
Geriatric Syndromes ◽  
People With Dementia ◽  
Geriatric Clinic

<b><i>Background:</i></b> Various patterns of dementia care have been developed in different settings, depending on the availability of healthcare resources and facilities. The purpose of this study was to examine the epidemiology and characteristics of dementia care at a geriatric clinic, a field that has been subject to little prior evaluation. <b><i>Methods:</i></b> A retrospective chart review was undertaken of cohort patients with cognitive impairment who had received a diagnosis and were still on active follow-up at a geriatric clinic. A total of 892 patients were included. In addition, 203 geriatric patients with no cognitive impairment who attended the clinic during the study period were sampled as a control. <b><i>Results:</i></b> The main diagnoses of dementia were Alzheimer’s disease (AD) (40.1%), vascular dementia (16.9%), unspecified dementia (16.3%), mixed dementia (9.0%), AD with cerebrovascular disease (8.7%), and Parkinson’s disease dementia (6.1%). Atypical dementia was presented in 3.0% of cases. There were 178 patients with mild cognitive impairment, 20 with vascular cognitive impairment, and 18 with subjective cognitive decline. Other comorbidities were found in 97% of the subjects. Patients with cognitive impairment had a higher total number of other geriatric syndromes and higher percentages for delirium, falls, immobility, loss of appetite, and incontinence. Potentially reversible causes of dementia were found in 11.3% of the cases. Acetylcholinesterase inhibitors were administered to 61%, whereas 23.5% received an NMDA receptor antagonist. The need for a change in the antidementia medication was identified for 10.7% of the subjects; the major cause was adverse drug side effects. Nonpharmacological therapy only was administered to 52.4% of the people with dementia who had behavioral and psychological symptoms. <b><i>Conclusions:</i></b> Mixed brain pathologies, comorbidities, and the coexistence of other geriatric syndromes are common at geriatric clinics. Holistic, integrated, and continuous care are needed to improve the outcomes of patients with more complicated comorbidities.

Comparison of behavioral and psychological symptoms of dementia and psychotropic drug treatments among old people in geriatric care in 2000 and 2007

2011 ◽  
Vol 23 (10) ◽  
pp. 1616-1622 ◽  
Author(s):  
Hugo Lövheim ◽  
Yngve Gustafson ◽  
Stig Karlsson ◽  
Per-Olof Sandman
Keyword(s):  
Cognitive Impairment ◽  
Drug Use ◽  
Psychotropic Drug ◽  
Psychological Symptoms ◽  
Antidepressant Drug ◽  
Geriatric Care ◽  
Psychotic Symptoms ◽  
Aggressive Behaviors ◽  
People With Dementia ◽  
Behavioral And Psychological Symptoms

ABSTRACTBackground: Behavioral and psychological symptoms, such as verbal or physical aggression, aberrant motor behaviors, psychotic symptoms, anxiety, depressive symptoms and apathy are common among people with dementia. The aim of the present study was to compare the one-week prevalence of behavioral and psychological symptoms and psychotropic drug treatment among people with cognitive impairment living in institutional care, in two large, comparable samples from 2000 and 2007.Methods: A comparison was made between two cross-sectional samples, collected in 2000 and 2007, comprising 4054 participants with cognitive impairment living in geriatric care units in the county of Västerbotten, Sweden. The Multi-Dimensional Dementia Assessment Scale (MDDAS) was used to assess cognitive impairment and behavioral and psychological symptoms. The use of psychotropic drugs was recorded.Results: Between 2000 and 2007, 15 out of 39 behavioral or psychological symptoms had become less common and no symptoms had become more common, after controlling for demographic changes. Four out of six behaviors within the cluster of aggressive behaviors had declined in prevalence. Patients prescribed anti-dementia drugs increased from 5.1% to 18.0% and antidepressant drug use increased from 43.2% to 49.1%, while anxiolytic, hypnotic, sedative and antipsychotic drug use remained largely unchanged.Conclusion: The prevalence of many behavioral symptoms had declined from 2000 to 2007, and among these changes, the decline in aggressive behaviors probably has the greatest clinical impact.

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

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.

scholarly journals 29 Adapting Dementia and Delirium Awareness Training to a Rehabilitation Setting

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Emma O'Brien ◽  
Monica Devine ◽  
Sarah Maxwell ◽  
Catherine McDonnell ◽  
Stuart Lee
Keyword(s):  
Cognitive Impairment ◽  
Occupational Therapy ◽  
Dementia Care ◽  
Awareness Training ◽  
Likert Scales ◽  
Staff Members ◽  
Patient Profile ◽  
People With Dementia ◽  
Adult Rehabilitation ◽  
The Impact

Abstract Background The patient profile in a Dublin rehabilitation hospital has changed in recent years to include older adult rehabilitation alongside orthopaedic rehabilitation. A snapshot audit completed by the occupational therapy department on one day in 2018 demonstrated that 64% of patients had an assessment score indicative of a cognitive impairment. A subjective gap in knowledge regarding dementia care and a misunderstanding of the ability of people with dementia to engage in rehabilitation was identified. It was imperative that dementia awareness training was provided with a particular focus on modifying rehabilitation techniques to cater for these patients. Methods A dementia care committee was established with an Educational Development subgroup responsible for addressing dementia and delirium awareness training. Educational material was received from the field of occupational therapy, nursing, medicine, pharmacy and dietetics. The programme was accredited by the Nursing and Midwifery Board of Ireland. A focus group was completed pre/post formulation of the presentation with various departmental representatives. Feedback provided was used to inform and finalise the training content. Results Sessions are completed once monthly. One hundred and seven participants to date have attended. Ten-point Likert scales are completed pre and post training. Data from the Likert scales were analysed revealing on average a 24.4 % increase in knowledge of dementia, a 27.6% increase in awareness of the impact of dementia on function and a 23.3% increase in confidence in caring for a patient with dementia. Highest contingent of staff members trained were household and catering staff (19%) nursing staff (18%), and health care attendants (13%). Conclusion This essential training is ongoing with thirty per cent of staff trained to date. The objective is for all staff to complete this training for enhanced care and rehabilitation for all patients with dementia. It will also aim to review treatment for all patients with cognitive impairment so unique rehabilitation programmes can be tailored.

scholarly journals Designing Dementia Care Pathways to Transform Non Dementia-Friendly Hospitals: Scoping Review

2021 ◽  
Vol 18 (17) ◽  
pp. 9296
Author(s):  
Jorge Riquelme-Galindo ◽  
Manuel Lillo-Crespo
Keyword(s):  
Cognitive Impairment ◽  
Scoping Review ◽  
Care Pathway ◽  
Dementia Care ◽  
Stressful Situation ◽  
Care Plans ◽  
Hospital Environments ◽  
People With Dementia ◽  
Centered Care ◽  
Core Elements

People with dementia (PwD) occupy around 25% of the hospital beds. Once PwD are admitted to hospitals, their cognitive impairment is not considered in most of the cases. Thus, it causes an impact on the development of the disease becoming a stressful situation as care plans are not adapted to PwD. The aim of this study was to explore the published core elements when designing a dementia care pathway for hospital settings. A scoping review was conducted to provide an overview of the available research evidence and identify the knowledge gaps regarding the topic. This review highlights person-centered care, compassionate care and end-of-life process as some of the key elements that should integrate the framework when designing a dementia care pathway. Architectonical outdoor and indoor hospital elements have also been found to be considered when adapting the healthcare context to PwD. Findings provide information about the key points to focus on to successfully design dementia interventions in hospital environments within available resources, mostly in those contexts in which national dementia plans are in its infancy. Hospitals should transform their patients’ routes and processes considering the increasing demographic changes of people with cognitive impairment.

scholarly journals Prevalence and Predictors of Caregiver Burden in a Memory Clinic Population

2021 ◽  
pp. 1-9
Author(s):  
Rónán O’Caoimh ◽  
Mareeta Calnan ◽  
Arup Dhar ◽  
D. William Molloy
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Caregiver Burden ◽  
Neuropsychiatric Symptoms ◽  
University Hospital ◽  
Patient Specific ◽  
Subjective Cognitive Decline ◽  
Memory Clinic ◽  
People With Dementia ◽  
Clinic Population

Background: Although caregiver burden is common among carers of people with dementia, little is known about its prevalence and predictors among caregivers of patients attending memory clinics. Objective: To examine carer and patient-specific characteristics associated with caregiver burden across the cognitive spectrum in a memory clinic population. Methods: Consecutive patients referred to a university hospital geriatric memory clinic were included. Caregiver burden was scored using the Caregiver Burden Score (CBS), (modified Zarit), with scores≥15/30 suggesting burden. BPSD were measured with the dysfunctional behaviour rating instrument (DBRI). Cognition was screened using the Montreal Cognitive Assessment (MoCA) and Quick Mild Cognitive Impairment (Qmci) screen. Results: In all, 351 patients were included, median age 77 (±11) years; 65.5% were female. The prevalence of caregiver burden was 33.6% overall, increasing from 10.8% in subjective cognitive decline (SCD), to 15% in mild cognitive impairment (MCI) and 43% in dementia; CBS scores were significantly higher in dementia (p < 0.001). Caregivers with burden were significantly younger (p = 0.045) and were more likely to be adult children (p = 0.007). The CBS weakly correlated with the stage of cognitive impairment (r = 0.16) but had moderate correlation with MoCA (r = –0.54) and Qmci scores (r = –0.60). After adjustment for co-variates, DBRI scores alone independently predicted burden (odds ratio 1.23;1.11–1.35, p < 0.001). Conclusion: Caregiver burden is associated with the stage of cognitive impairment, with higher prevalence proportions in those with dementia compared with MCI and SCD. Only the severity of neuropsychiatric symptoms independently predicted caregiver burden in this population and its presence should prompt assessment for burden.

scholarly journals Subjective cognitive decline as a predictor of future cognitive decline: a systematic review

2020 ◽  
Vol 14 (3) ◽  
pp. 248-257
Author(s):  
Vladimir Anatolevich Parfenov ◽  
Vladimir Vladimirovich Zakharov ◽  
Anastasia Romanovna Kabaeva ◽  
Natalya Vasilyevna Vakhnina
Keyword(s):  
Systematic Review ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Neuropsychological Tests ◽  
Memory Impairment ◽  
Cognitive Capacity ◽  
Subjective Cognitive Decline ◽  
Level Of Functioning ◽  
People With Dementia ◽  
Prospective Longitudinal

ABSTRACT. Over 44 million people suffer from dementia around the world. Researchers estimated that there will be 48.1 million people with dementia by 2020 and 90.3 million by 2040. In addition to dementia, mild cognitive impairment (MCI) and subjective cognitive decline (SCD) relate to cognitive impairment. It has been established that MCI precedes dementia, however the significance of SCD is still unclear. Recent studies suggest that SCD could be a risk factor for objective cognitive impairment. SCD is defined as а self-estimated decline in cognitive capacity in comparison to an individual’s previous level of functioning, which cannot be determined by neuropsychological tests. Objectives: To perform a systematic review of prospective longitudinal cohort studies that assessed the risk of MCI and dementia among people with SCD. Methods: A search was carried out for all available peer-reviewed articles in English related to SCD in PubMed and PsychINFO databases from database initiation through January 2020. The keywords used for the search were ‘subjective cognitive (or memory) impairment (or decline or complaints)’. Three authors separately determined the inclusion or exclusion of all articles retrieved for full-text evaluation. Results: The chance of progression to dementia in the SCD group was 2.17 (95% confidence interval [95%CI] 1.53‒3.07; p<0.05) compared to normal aging. Furthermore, the SCD group was 2.15 times more likely to progress to MCI than the group without SCD (95%CI 1.39‒3.30; p=0.005). Conclusions: SCD might precede cognitive impairment, however, more detailed longitudinal studies should be conducted.

scholarly journals Developing a Virtual Reality for People With Dementia and Mild Cognitive Impairment Based on Their Psychological Needs: A Feasibility Study

2020 ◽  
Author(s):  
Jung-Hee Kim ◽  
Seonmin Park ◽  
Hyeongji Lim
Keyword(s):  
Virtual Reality ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Intervention Program ◽  
Psychological Symptoms ◽  
Psychological Needs ◽  
Second Phase ◽  
People With Dementia ◽  
The Mean ◽  
Behavioral And Psychological Symptoms

Abstract BackgroundPurpose of this study was to develop a virtual reality (VR) intervention program based on the psychological needs of patients with dementia and mild cognitive impairment residing in nursing facilities in Korea to relieve their behavioral and psychological symptoms, and to confirm the possibility of utilizing VR in patients with dementia and mild cognitive impairment.MethodsIn the first phase, surveys and questionnaires were used to identify activities that relieved the behavioral and psychological symptoms of dementia (BPSD) among 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. The VR content was used with patients with dementia and mild cognitive impairment. The researchers assessed the level of the participants’ immersion, preference, and interaction with the VR, using a 5-point Likert scale. ResultsIn the feasibility test, 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. Six out of 10 participants required assistance while using the VR. The mean VR experience duration was 10.00 ± 3.46 minutes.ConclusionsThe 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 provide evidence for the potential of VR to provide BPSD intervention programs for patients with dementia and mild cognitive impairment, and potentially for other geriatric conditions.

scholarly journals Drug Use before and after Initiating Treatment with Acetylcholinesterase Inhibitors

2019 ◽  
Vol 9 (1) ◽  
pp. 196-206
Author(s):  
Anne Sverdrup Efjestad ◽  
Hege Ihle-Hansen ◽  
Vidar Hjellvik ◽  
Knut Engedal ◽  
Hege Salvesen Blix
Keyword(s):  
General Population ◽  
Psychological Symptoms ◽  
Acetylcholinesterase Inhibitors ◽  
Behavioral Symptoms ◽  
Prescription Database ◽  
Opioid Use ◽  
People With Dementia ◽  
Before And After ◽  
Norwegian Prescription Database ◽  
Behavioral And Psychological Symptoms

Background/Aims: The aim was to study the prevalence of use of different drugs prescribed for behavioral and psychological symptoms of dementia in persistent users of acetylcholinesterase inhibitors (AChEIs) before and after AChEI initiation, and to compare with the use in the general population. Methods: Use of antidepressants, antipsychotics, and analgesics in the 4 years before and 2 years after AChEI initiation was studied based on data from the Norwegian Prescription Database 2004–2016. Results: The prevalence of use of antidepressants and antipsychotics the year before AChEI initiation was twice the prevalence in the age-adjusted general population and continued to rise in the first 2 years after initiation of AChEIs. The prevalence of weak analgesics and antipsychotics increased strongly in the last year before AChEI initiation. The increase in the use of antidepressants started at least 4 years before initiation of AChEIs. Opioid use was generally lower than in the general population and was not influenced by AChEI initiation. Conclusion: Increased use of antidepressants and antipsychotics was observed both before and after initiation of AChEIs and may indicate that behavioral symptoms occur in a preclinical or early phase of Alzheimer’s disease. The prescription pattern of analgesics with a low use of opioids may indicate an undertreatment of pain in people with dementia.

scholarly journals Occupational therapist-led mindfulness-based stress reduction for older adults living with subjective cognitive decline or mild cognitive impairment in primary care: a feasibility randomised control trial protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e035299
Author(s):  
Todd Tran ◽  
Catherine Donnelly ◽  
Emily Joan Nalder ◽  
Tracy Trothen ◽  
Marcia Finlayson
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Decline ◽  
Stress Reduction ◽  
Functional Performance ◽  
Psychological Symptoms ◽  
Subjective Cognitive Decline ◽  
Perceived Satisfaction

IntroductionCommunity-dwelling older adults living with subjective cognitive decline or mild cognitive impairment may experience decreased efficiency in their overall functional performance. This decreased cognitive efficiency may result in anxiety, low mood, perceived stress and decreased emotional well-being and quality-of-life. These psychological symptoms may further exacerbate cognitive decline.Exploring non-pharmacological interventions such as mindfulness within primary care is vital in enabling individuals to develop strategies to manage cognitive impairment or psychological symptoms. Mindfulness-based stress reduction (MBSR) is an 8-week programme that is beneficial in alleviating psychological symptoms; however, its impact on perceived satisfaction on overall functional performance with this population has not been evaluated. The primary objective of this study is to explore the feasibility of conducting a randomised controlled trial of an occupational therapist-led MBSR programme within primary care.MethodsConvergent mixed-methods, randomised control feasibility trial with 40 participants from an interprofessional primary care team in Toronto, Ontario. Participants are randomised into the 8-week MBSR group or wait-list control will be compared at baseline, postintervention and 4weeks follow-up. The primary aim is to determine the feasibility of the intervention with this population and setting. The secondary aim is to examine perceived satisfaction with functional performance as measured by the Canadian Occupational Performance Measure. Secondary clinical outcomes include psychological symptoms.AnalysisInvestigators will analyse the quantitative and qualitative data strands separately. Descriptive statistics, focus group and interviews will then be merged and further analysed to best understand the feasibility and preliminary clinical outcomes from the study.Ethics and disseminationThe study is approved by Women’s College Hospital (2017–0056-E), and Queen’s University, Kingston, Ontario (6026418). The study will follow Standard Protocol Items: Recommendations for Interventional Trials. The results will be published in peer-reviewed academic journals and disseminated to patient organisations and media.Trial registration numberNCT03867474; Pre-results.

Digital Technologies in Dementia Care

2022 ◽  
pp. 115-140
Author(s):  
Tiago Coelho
Keyword(s):  
Virtual Reality ◽  
Health Professionals ◽  
Psychological Symptoms ◽  
Digital Technologies ◽  
Well Being ◽  
Wearable Devices ◽  
Dementia Care ◽  
Cognitive Deterioration ◽  
People With Dementia ◽  
Behavioral And Psychological Symptoms

Dementia is characterized by significant cognitive deterioration, behavioral and psychological symptoms, and expanding disability. The well-being of people with dementia is influenced by the support provided by caregivers and health professionals. Especially in the past two decades, advancements in digital technology have helped reshape the way care and treatment are delivered. The main goal of the chapter is to describe technological solutions aimed at supporting the independence and safe participation of people with dementia in meaningful activities, as well as promoting their involvement in engaging experiences that seek to delay cognitive decline and diminish behavioral and psychological symptoms. These technologies include distributed systems, robotics, wearable devices, application software, and virtual reality.

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