Effectiveness of treatment in wards for patients with dementia and issues associated with this treatment: A prospective analysis

Dementia ◽  
2017 ◽  
Vol 18 (5) ◽  
pp. 1751-1763 ◽  
Author(s):  
Shogo Taniguchi ◽  
Teruyuki Matsuoka ◽  
Takeshi Hikawa ◽  
Atsushi Machihara ◽  
Keisuke Shibata ◽  
...  
Keyword(s):  
Nursing Home ◽  
Length Of Stay ◽  
Scale Score ◽  
Psychological Symptoms ◽  
Prospective Analysis ◽  
Neuropsychiatric Inventory ◽  
Clinical Dementia Rating ◽  
Severity Of Dementia ◽  
Distress Scale ◽  
Behavioral And Psychological Symptoms

In order to optimize the treatment in wards for patients with dementia, we investigated predictors of the length of stay in the ward for patients with dementia. A prospective analysis of 72 patients with dementia was conducted in two wards for patients with dementia. Severity of dementia was assessed by the Clinical Dementia Rating, basic activities of daily living were evaluated using the Physical Self-Maintenance Scale, and severity of behavioral and psychological symptoms of dementia and caregiver distress were determined with the Nursing Home version of the Neuropsychiatric Inventory. Stepwise regression analysis was used to identify predictors of the length of stay. Fewer patients were discharged to home compared to those discharged to institutions or transferred to a different hospital or ward. The mean length of stay was 92.0 days. Clinical Dementia Rating and total distress scale score on the Nursing Home version of the Neuropsychiatric Inventory were significant independent predictors of the length of stay. The total Nursing Home version of the Neuropsychiatric Inventory score and total distress scale score on the Nursing Home version of the Neuropsychiatric Inventory were significantly improved through treatment. Our results suggest that treatment in the wards for patients with dementia is effective for improvement of behavioral and psychological symptoms of dementia. However, some patients could not be discharged to their home despite improvement of behavioral and psychological symptoms of dementia, and this may be related to caregiver burden at admission.

Treatment in Nursing Home versus Hospital for Patients with Behavioral and Psychological Symptoms of Dementia

GeroPsych ◽  
2012 ◽  
Vol 25 (2) ◽  
pp. 97-102 ◽  
Author(s):  
Stein-Arne Hval ◽  
Kari Midtbø Kristiansen ◽  
Bernhard Lorentzen ◽  
Lisbeth Fagerstrøm ◽  
Lars Tanum
Keyword(s):  
Nursing Home ◽  
Pilot Study ◽  
Hospital Admission ◽  
Psychological Symptoms ◽  
Intervention Group ◽  
Treatment Intervention ◽  
Neuropsychiatric Inventory ◽  
Treatment Groups ◽  
Significant Difference ◽  
Behavioral And Psychological Symptoms

Introduction: This article is concerned with the optimal treatment of behavioral and psychological symptoms present in patients with dementia. This pilot study compares the benefits of an ambulant treatment intervention in nursing homes to hospital admission. Material and Methods: Patients referred for hospital admission were randomized to either hospital admission or ambulant treatment intervention in their nursing home. Registration of behavioral and psychological symptoms of dementia (BPSD) together with the caregiver’s distress were assessed at T1, T2, and T3 using the Neuropsychiatric Inventory (NPI). Results: Both treatment groups showed a statistically significant reduction in BPSD, and there was no significant difference between the groups in total score of NPI. NPI-reported carer distress was reduced in both groups, and this was statistically significant for the intervention group.

scholarly journals The influence of caregivers and behavioral and psychological symptoms on nursing home placement of persons with Alzheimer’s disease: A matched case–control study

2016 ◽  
Vol 4 ◽  
pp. 205031211666187 ◽  
Author(s):  
Candace N Porter ◽  
Margaret C Miller ◽  
Marcia Lane ◽  
Carol Cornman ◽  
Khaled Sarsour ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Nursing Home ◽  
Psychological Symptoms ◽  
Nursing Home Placement ◽  
Nursing Home Admission ◽  
Neuropsychiatric Inventory ◽  
Matched Case ◽  
Home Placement ◽  
Behavioral And Psychological Symptoms

Objectives: Behavioral and psychological symptoms of dementia in individuals with Alzheimer’s disease and caregiver characteristics may influence the decision to provide care at home or in a nursing home, though few studies examine this association near the actual time of nursing home placement. Using a matched case–control design, this study investigates the association between (1) total Neuropsychiatric Inventory score, (2) the Neuropsychiatric Inventory-4 (an agitation/aggression subscale), and (3) individual domains of the Neuropsychiatric Inventory and nursing home placement. Methods: Data from the South Carolina Alzheimer’s disease Registry provides an opportunity to expand the literature by looking at cases at the time of nursing home care eligibility/placement and allowing for propensity-score-matched controls. Cases (n = 352) entered a nursing home within 6 months of study initiation; controls (n = 289) remained in the community. Registry data were combined with caregiver survey data, including the Neuropsychiatric Inventory. Conditional logistic regression was applied. Results: A 10% increase in the Neuropsychiatric Inventory score implied a 30% increase in odds of nursing home admission (odds ratio: 1.30; 95% confidence interval: 1.14–1.50), having married or male caregivers predicted nursing home placement. Cases versus controls were significantly more likely to have behavioral and psychological symptoms of dementia related to agitation/aggression 1 month prior to nursing home admission. Conclusion: Interventions targeting behavioral and psychological symptoms of dementia without available effective interventions in individuals with Alzheimer’s disease and caregiver support services are necessary to prevent or delay nursing home admission.

scholarly journals The impact of lockdown during SARS-CoV-2 outbreak on behavioral and psychological symptoms of dementia

2021 ◽  
Vol 42 (3) ◽  
pp. 825-833
Author(s):  
Arianna Manini ◽  
Michela Brambilla ◽  
Laura Maggiore ◽  
Simone Pomati ◽  
Leonardo Pantoni
Keyword(s):  
Logistic Regression ◽  
Psychological Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Community Dwelling ◽  
Caregiver Distress ◽  
Neuropsychiatric Inventory ◽  
Logistic Regression Models ◽  
The Impact ◽  
Behavioral And Psychological Symptoms

Abstract Background During Covid-19 pandemic, the Italian government adopted restrictive limitations and declared a national lockdown on March 9, which lasted until May 4 and produced dramatic consequences on people’s lives. The aim of our study was to assess the impact of prolonged lockdown on behavioral and psychological symptoms of dementia (BPSD). Methods Between April 30 and June 8, 2020, we interviewed with a telephone-based questionnaire the caregivers of the community-dwelling patients with dementia who had their follow-up visit scheduled from March 9 to May 15 and canceled due to lockdown. Among the information collected, patients’ BPSDs were assessed by the Neuropsychiatric Inventory (NPI). Non-parametric tests to compare differences between NPI scores over time and logistic regression models to explore the impact of different factors on BPSD worsening were performed. Results A total of 109 visits were canceled and 94/109 caregivers completed the interview. Apathy, irritability, agitation and aggression, and depression were the most common neuropsychiatric symptoms experienced by patients both at baseline and during Covid-19 pandemic. Changes in total NPI and caregiver distress scores between baseline and during lockdown, although statistically significant, were overall modest. The logistic regression model failed to determine predictors of BPSD worsening during lockdown. Conclusion This is one of the first studies to investigate the presence of BPSD during SARS-CoV-2 outbreak and related nationwide lockdown, showing only slight, likely not clinically relevant, differences in BPSD burden, concerning mostly agitation and aggression, anxiety, apathy and indifference, and irritability.

Behavioral and Psychological Symptoms of Dementia: Physical Nonaggressive Agitation

2000 ◽  
Vol 12 (S1) ◽  
pp. 125-127 ◽  
Author(s):  
Martin Haupt
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Psychological Symptoms ◽  
Institutional Care ◽  
Nursing Home Admission ◽  
Behavioral And Psychological Symptoms

Agitated behaviors occur frequently in patients with dementia. These behaviors affect the quality of life of the dementia sufferers and their caregivers. For example, these behaviors can greatly complicate everyday management in familiar surroundings and in institutional care, and they predict premature nursing home admission.

Behavioral and Psychological Symptoms in Dementia in Nursing Home Residents: The Economic Implications

2000 ◽  
Vol 12 (S1) ◽  
pp. 51-57 ◽  
Author(s):  
Judith A. O'Brien ◽  
Lori A. Shomphe ◽  
J. Jaime Caro
Keyword(s):  
Nursing Home ◽  
Caregiver Burden ◽  
Behavioral Problems ◽  
Sleep Disturbances ◽  
Psychological Symptoms ◽  
Violent Behavior ◽  
Nursing Home Residents ◽  
Level Of Care ◽  
Economic Implications ◽  
Behavioral And Psychological Symptoms

A variety of behavioral and psychological symptoms are inherent to dementia, such as delusional thinking, hallucinations, agitation, violent behavior, verbal outbursts, wandering, sleep disturbances, and sexually inappropriate behavior (Jackson et al., 1989; Reisberg et al., 1987; Teri et al., 1992; Yeager et al., 1995). Although opinions in the literature differ concerning behavioral problems and how they relate to caregiver burden and institutionalization (Martinson et al., 1995; Mega et al., 1996; Reisberg et al., 1987), this analysis focuses on their role in increasing the level of care once the patient is placed in permanent residential care.

scholarly journals Correlation of Frontal Atrophy and CSF Tau Levels With Neuropsychiatric Symptoms in Patients With Cognitive Impairment: A Memory Clinic Experience

2021 ◽  
Vol 13 ◽  
Author(s):  
Matteo Cotta Ramusino ◽  
Giulia Perini ◽  
Gloria Vaghi ◽  
Beatrice Dal Fabbro ◽  
Marco Capelli ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Psychological Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Lewy Body Disease ◽  
Cortical Atrophy ◽  
Psychotic Symptoms ◽  
Memory Clinic ◽  
Neuropsychiatric Inventory ◽  
Clinic Experience ◽  
Behavioral And Psychological Symptoms

Background: Behavioral and psychological symptoms of dementia (BPSD) are a distressful condition. We aimed to investigate the BPSD distribution in subjects with cognitive impairment, and the potential correlations between BPSD and neurodegeneration in terms of cerebrospinal fluid (CSF) tau and brain atrophy.Methods: One-hundred patients with mild cognitive impairment (MCI) or dementia (Alzheimer’s disease, AD; Lewy-body disease, LBD; frontotemporal dementia, FTD; vascular dementia, VD) underwent a complete diagnostic workup, including 3T-MRI and/or CT and CSF. Cortical atrophy was assessed with medial temporal atrophy (MTA), posterior atrophy (PA), and global cortical atrophy-frontal lobe (GCA-F) scales. BPSD were rated using the Neuropsychiatric Inventory (NPI), and BPSD clusters were defined according to the European Alzheimer Disease Consortium.Results: Delusions, hallucinations, and psychosis cluster were differently distributed among the diagnostic groups (p < 0.05, p < 0.001, and p < 0.05), with LBD patients showing higher scores for hallucinations (vs. MCI, p < 0.001, and AD, p < 0.05) and psychosis cluster (vs. MCI, p < 0.05). In primary dementias, we found a negative correlation between NPI total score and tau levels (p = 0.08), confirmed by beta regression (p < 0.01), while a positive non-significant relationship was observed in MCI. Higher GCA-F scores were associated with delusions and apathy (p < 0.05, on both hemispheres) and hallucinations (left: p < 0.01, right: p < 0.05). GCA-F scores were positively correlated with psychosis cluster (right: p < 0.05), and agitation/aggression (left: p < 0.05). Conversely, nighttime disturbances were positively correlated with both GCA-F and MTA scores (left: p < 0.01; right: p < 0.05).Conclusion: Our results suggest that psychotic symptoms are significantly more represented in LBD patients and that CSF tau and frontal atrophy are associated with the occurrence and severity of BPSD in clinical practice. Longitudinal studies are however required to ascertain their actual predictive value.

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 Behavioral and Psychological Symptoms of Dementia (BPSD): Clinical Characterization and Genetic Correlates in an Italian Alzheimer’s Disease Cohort

2020 ◽  
Vol 10 (3) ◽  
pp. 90 ◽  
Author(s):  
Catia Scassellati ◽  
Miriam Ciani ◽  
Carlo Maj ◽  
Cristina Geroldi ◽  
Orazio Zanetti ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Genetic Variants ◽  
Genetic Factors ◽  
Psychological Symptoms ◽  
Neuropsychiatric Inventory ◽  
Combined Use ◽  
Definition Of ◽  
Genetically Determined ◽  
Behavioral And Psychological Symptoms

Background: The occurrence of Behavioral and Psychological Symptoms of Dementia (BPSD) in Alzheimer’s Disease (AD) patients hampers the clinical management and exacerbates the burden for caregivers. The definition of the clinical distribution of BPSD symptoms, and the extent to which symptoms are genetically determined, are still open to debate. Moreover, genetic factors that underline BPSD symptoms still need to be identified. Purpose. To characterize our Italian AD cohort according to specific BPSD symptoms as well as to endophenotypes. To evaluate the associations between the considered BPSD traits and COMT, MTHFR, and APOE genetic variants. Methods. AD patients (n = 362) underwent neuropsychological examination and genotyping. BPSD were assessed with the Neuropsychiatric Inventory scale. Results. APOE and MTHFR variants were significantly associated with specific single BPSD symptoms. Furthermore, “Psychosis” and “Hyperactivity” resulted in the most severe endophenotypes, with APOE and MTHFR implicated as both single risk factors and “genexgene” interactions. Conclusions. We strongly suggest the combined use of both BPSD single symptoms/endophenotypes and the “genexgene” interactions as valid strategies for expanding the knowledge about the BPSD aetiopathogenetic mechanisms.

scholarly journals Behavioural and Psychological Symptoms in Poststroke Vascular Cognitive Impairment

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Meena Gupta ◽  
Abhijit Dasgupta ◽  
Geeta Anjum Khwaja ◽  
Debashish Chowdhury ◽  
Yogesh Patidar ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Rating Scale ◽  
Psychological Symptoms ◽  
Vascular Cognitive Impairment ◽  
Neuropsychiatric Symptom ◽  
Neuropsychiatric Inventory ◽  
Clinical Dementia Rating ◽  
Behavioural And Psychological Symptoms ◽  
Relationship Of ◽  
The Relationship

Background.Behavioural and psychological symptoms of dementia (BPSD) cause significant patient and caregiver morbidity in vascular cognitive impairment (VCI).Objectives. To study and compare the occurrence and severity of BPSD between multi-infarct dementia (MID), subcortical ischaemic vascular disease (SIVD), and strategic infarct subtypes of poststroke VCI and to evaluate the relationship of these symptoms with the severity of cognitive impairment.Methods. Sixty patients with poststroke VCI were classified into MID, SIVD, and strategic infarct subtypes. BPSD were studied by the neuropsychiatric inventory (NPI). The severity of cognitive impairment was evaluated by the clinical dementia rating scale (CDR).Results. 95% of cases had at least one neuropsychiatric symptom, with depression being the commonest, irrespective of subtype or severity of VCI. Strategic infarct patients had the lowest frequency of all symptoms. SIVD showed a higher frequency and severity of apathy and higher total NPI scores, compared to MID. Apathy and appetite disturbances occurred more commonly with increasing CDR scores. The total NPI score correlated positively with the CDR score.Conclusion. Depression was the commonest neuropsychiatric symptom in VCI. The neuropsychiatric profiles of MID and SIVD were similar. The frequency and severity of apathy and the net burden of BPSD increased with increasing cognitive impairment.

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