Neuropsychiatric Symptoms and Antipsychotic Therapy in the Elderly Patients with Dementia

Psychiatry ◽  
2020 ◽  
Vol 18 (4) ◽  
pp. 6-15
Author(s):  
I. V. Kolykhalov
Keyword(s):  
Neuropsychiatric Symptoms ◽  
The Elderly ◽  
Psychotic Symptoms ◽  
Mixed Dementia ◽  
Short Term ◽  
Antipsychotic Therapy ◽  
Dementia Patients ◽  
Frequency Of Use ◽  
Number Of Patients ◽  
High Incidence

The objective of the study was to investigate syndromal-nosological specificities of neuropsychiatric symptoms (NPS) and the frequency of use of antipsychotics in patients with various types of dementias, institutionalized to geriatric units of mental hospitals.Patients and methods: a total of 106 in-patients of three psychogeriatric units were examined. The median age of patients is 75 years [69; 80].The diagnostic distribution of patients at the time of the examination was as follows: in 33 subjects (31.1%) Alzheimer’s disease (AD) was diagnosed, in 25 (23.6%) - mixed dementia (MD), in 32 (30.2%) - vascular dementia (VD) and in 16 (15.1%) patients had dementia of complex origin (DCO).Results: a high incidence (54.7%) of NPS was found in patients with dementia of various origins. The greatest number of patients with behavioral and psychotic symptoms was found in AD and MD. The proportion of dementia patients with such disorders in each of these types of dementia is about 70%, while in CGD and VD, the proportion of patients with NPS is noticeably smaller (30% and 40%, respectively). For the treatment of NPS, antipsychotics were most often prescribed, but their use caused adverse events (AEs) in 1/3 of cases. Patients with VD are most susceptible to the development of AE, and AD patients are the least susceptible.Conclusion: the study showed that NPS are one of the important components of dementia, regardless of the nosology and stage of the disease. The treatment of NPS in dementia is particularly challenging because, although the symptoms cause significant distress, there are currently no effective alternative therapies. The risk of AE can be minimized by carefully considering the indications for prescribing antipsychotics and their short-term use, regular monitoring of the patient’s condition, and educating caregivers.

Racial Differences in Neuropsychiatric Symptoms Among Dementia Patients: A Comparison of African Americans and Whites

2000 ◽  
Vol 12 (S1) ◽  
pp. 395-402 ◽  
Author(s):  
Carl I. Cohen
Keyword(s):  
African American ◽  
Nursing Home ◽  
African Americans ◽  
Racial Differences ◽  
Neuropsychiatric Symptoms ◽  
Psychotic Symptoms ◽  
Sociodemographic Variable ◽  
Behavioral Disturbances ◽  
Dementia Patients ◽  
Nursing Home Patients

Race is a critical sociodemographic variable that may serve as a marker for genetic, clinical, cultural, and socioeconomic factors. There have been several studies that found differences between African Americans and Whites in the neuropsychiatric symptoms of dementia. There have been fairly consistent findings that psychotic symptoms—hallucinations and delusions—are more prevalent among African American patients with dementia (Cohen & Carlin, 1993; Cooper et al., 1991, Deutsch et al., 1991; Fabrega et al., 1988), and that depression is higher among Whites than among African Americans (Fabrega et al., 1988; Walker et al., 1995). One study by Class and colleagues (1996) also suggested that behavioral disturbances might be higher among White than among African American nursing home patients, a majority of whom had dementia.

Neuropsychiatry services in Japan

2020 ◽  
pp. 537-544
Author(s):  
Koho Miyoshi
Keyword(s):  
Psychiatric Symptoms ◽  
Oldest Old ◽  
Neuropsychiatric Symptoms ◽  
Psychiatric Hospitals ◽  
The Elderly ◽  
Training System ◽  
Elderly Persons ◽  
Career Opportunities ◽  
Number Of Patients ◽  
Set Up

This chapter deals with the neuropsychiatric service provision, training, career opportunities, particular issues in aged society, and scientific activities for understanding the situation of neuropsychiatry in Japan. The proportion of people aged 65 years and older in Japan reached the world’s highest at 21.0% in 2006. The elderly population has since increased persistently and is estimated at 27.1% of the total population. In addition to this, the ratios of people aged 75 years and over and those aged 85 years and over are estimated at 13.2% and 4.1%, respectively. The ‘oldest old ’ group has contributed to the increasing prevalence of dementia. According to the governmental survey, the estimated number of elderly persons with dementia was 2.80 million in 2010 and 3.45 million in 2015. It is predicted to increase to 4.1 million by 2020 and 4.7 million by 2035. The number of patients with major neuropsychiatric disorders, especially Alzheimer’s disease, vascular dementia, and Parkinson’s disease, has been increasing for the last two decades, and the needs for neuropsychiatric services are also rapidly increasing. Neuropsychiatric services consist mainly of provision of clinical diagnosis, based on clinical examination, and medical treatment for neuropsychiatric symptoms, i.e. psychiatric symptoms of neurological disorders. Neuropsychiatric services should be provided by neuropsychiatry specialists. There are approximately 13,000 psychiatrists and 8000 neurologists working in psychiatric hospitals, general hospitals, medical schools, and private clinics. However, the number of neuropsychiatry specialists is quite limited. Therefore, there is urgency for the Japanese Neuropsychiatric Association (JNA) to set up an appropriate training system for clinicians in order to remediate the shortage of neuropsychiatrists.

scholarly journals SENAM OTAK MEMPENGARUHI DEMENSIA PADA LANSIA BRAIN EXERCISE AFFECTS DEMENTIA IN THE ELDERLY

2021 ◽  
Vol 16 (3) ◽  
pp. 662-667
Author(s):  
Elvipson Sinaga ◽  
Khairunnisa Batubara
Keyword(s):  
Health Center ◽  
Daily Living ◽  
Short Term Memory ◽  
The Elderly ◽  
P Value ◽  
Short Term ◽  
Term Memory ◽  
Physical Exercises ◽  
Dementia Patients ◽  
Before And After

Cognitive decline interferes with activities of daily living and social activities in the elderly. One of the physical exercises that can be applied in order to delay cognitive function is by means of brain exercise because it is believed to provide much-needed stimulation for dementia patients. This study aims to determine the effect of brain exercise on short-term memory (Dementia) in the elderly at the Sibolangit Health Center, Sibolangit District, Deli Serdang Regency. The design of this research is Quasi Experiment Design using One-group pretest posttest design. The sample in this study were 49 respondents using purposive sampling. Data analysis using Paired Sample T-Test. The results showed a P-value of 0.0001 (P-value <0.05) so it can be said that there were changes before and after carrying out brain exercise in the elderly at the Sibolangit Health Center, Sibolangit District, Deliserdang Regency. Brain exercise is one of the physical activity therapies that can improve the memory of the elderly or often also called dementia.

Remission of manic disorder in a hepatitis c virus (HCV) infected patient receiving pegylated-interferon (PEGIFN) plus ribavirin (RBV)

2011 ◽  
Vol 26 (S2) ◽  
pp. 881-881
Author(s):  
C.L. Ortiz Sánchez-Expósito ◽  
M. Machín Vazquez-Illá ◽  
L. Gallego Deike ◽  
J.J. López-Ibor
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Infected Patient ◽  
Psychotic Disorders ◽  
Neuropsychiatric Symptoms ◽  
Pegylated Interferon ◽  
Psychotic Symptoms ◽  
Hcv Rna ◽  
Antipsychotic Therapy

IntroductionPegylated-interferon (pegIFN) plus ribavirin (RBV) is for the moment the licensed therapy for chronic hepatitis C. Neuropsychiatric symptoms are frequent side effects due to the treatment with pegIFN, registered in 30 to 80% of instances, with mood rather than psychotic disorders usually observed.ObjectiveA manic profile with psychotic symptoms in a HCV infected patient receiving pegIFN-RBV is presented to discuss management strategies and outcome.MethodsA 47 year-old male patient, former IDU and alcohol abuser, without past psychiatric history, was under therapy for chronic hepatitis C (genotype 1a, HCV-RNA 6.2 log IU/mL, Child A5). After 14 weeks of pegIFN-RBV treatment the patient attends ER with insomnia, uneasiness, expansive mood, irritability, extravagant and disinhibited behaviour, and detrimental and self-referential delusion.ResultsThe patient was admitted at the Psychiatric Unit to receive amisulpride (400 mg/12h) plus lorazepam (1 mg/8h), with psychotic symptoms regressing over following days. It was agreed that psychotropic drugs would be maintained at the same doses until the end pegIFN-RBV therapy, intended for 48 weeks.ConclusionAntipsychotic therapy may be effective and allows VHC infected patients with manic symptoms related to pegIFN-RBV therapy to continue their treatment.

Antipsychotic Prescribing Practices Amongst the Elderly of St. James's Hospital (SJH), Dublin

2017 ◽  
Vol 41 (S1) ◽  
pp. S663-S663
Author(s):  
C. Power ◽  
B. McCarthy ◽  
B.A. Lawlor ◽  
E. Greene
Keyword(s):  
Best Practice ◽  
The Elderly ◽  
Medical Documentation ◽  
Psychotic Symptoms ◽  
Prescribing Practices ◽  
Next Of Kin ◽  
Pharmacological Interventions ◽  
Antipsychotic Medications ◽  
Number Of Patients ◽  
Antipsychotic Prescribing

IntroductionPsychotic symptoms arise commonly in the context of behavioural and psychological symptoms of dementia (BPSD) in the elderly. While non-pharmacological interventions are preferable to manage such symptoms, antipsychotic medications are frequently used. This is largely unlicensed and associated with significant risks, particularly in dementia (1).ObjectivesTo examine antipsychotic prescribing practices in SJH.MethodsOn 23rd February 2016 all inpatients aged over 65 who were prescribed antipsychotic medications were identified. Demographic and medical data were collected from medical and electronic notes and medication kardexes.ResultsComplete data were available for 53 of 59 identified cases. The cohort had a mean age of 80 (range 65–99) and 62% were male. Seventy-four percent (n = 39) had documented cognitive impairment or dementia. Fifty-eight percent (n = 31) were newly prescribed an antipsychotic following admission. The commonest indications for antipsychotics were: delirium (53%) and BPSD (25%). Haloperidol (56%), quetiapine (19%) and risperidone (8%) were prescribed most frequently. Non-pharmacological interventions were documented in 50% however in many cases it is not clear what these interventions were. Antipsychotic use was discussed with patients and/or next of kin in less than 25% of cases. Adverse effects were noted in 6/36 (17%) with equal incidence of falls, EPSEs and ECG changes.ConclusionPositive and negative aspects of current antipsychotic prescribing practices are highlighted. Antipsychotics were prescribed for a small number of patients for appropriate indications. However, there was poor consideration of non-pharmacological interventions and a lack of consultation with the patient/NOK. This may reflect, in part, inadequate medical documentation. A guideline needs to specifically address these areas of concern to improve safety and promote best practice.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Neuropsychiatric symptoms of the elderly with Alzheimer's disease and the family caregivers' distress

2016 ◽  
Vol 24 (0) ◽  
Author(s):  
Luana Baldin Storti ◽  
Débora Teles Quintino ◽  
Natália Michelato Silva ◽  
Luciana Kusumota ◽  
Sueli Marques
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Family Caregivers ◽  
Pearson Correlation ◽  
Neuropsychiatric Symptoms ◽  
The Elderly ◽  
Mixed Dementia ◽  
Neuropsychiatric Inventory ◽  
Cross Sectional ◽  
The Family

ABSTRACT Objective: to analyze the relationship between the distress of the family caregiver and the presence of neuropsychiatric symptoms in elderly patients with Alzheimer's disease or mixed dementia. Method: a descriptive, cross-sectional study conducted in the Geriatric and Dementias Clinic of a general tertiary hospital, with 96 elderly people with Alzheimer's disease or mixed dementia and their family caregivers. Questionnaires to characterize the elderly and caregivers, and the Neuropsychiatric Inventory were used. Descriptive statistics and Pearson correlation test were performed. Results: 68.7% of the elderly were women, average age 80.8 years, 56.2% had Alzheimer's disease and 43.7%, mixed dementia. Among caregivers, 90.6% were women, average age 56, 70.8% took care of parents and 64.6% lived with the elderly. There was a strong (r = 0.82) and significant (p <0.01) correlation between the total score on the Neuropsychiatric Inventory and the total score on the Neuropsychiatric Inventory-Distress and strong (r = 0.80) and significant (p <0 01) correlation between the total score on the Neuropsychiatric Inventory Distress and the number of neuropsychiatric symptoms, i.e., the higher the number, frequency and severity of these symptoms in the elderly, the more intense is the caregiver distress. Conclusion: the presence of neuropsychiatric symptoms in the elderly was related to increased distress in caregivers.

scholarly journals Validation of Croatian Version of Dementia Attitudes Scale (DAS)

2016 ◽  
Vol 19 (1) ◽  
pp. 5-22 ◽  
Author(s):  
Bojana Ćoso ◽  
◽  
Suzana Mavrinac ◽  
Keyword(s):  
The Elderly ◽  
Retirement Home ◽  
Negative Attitudes ◽  
Dementia Patients ◽  
People With Dementia ◽  
Adequate Care ◽  
Number Of Patients ◽  
Social Comfort ◽  
Original Scale ◽  
Specialized Institutions

Dementia significantly impairs cognitive and behavioral functioning of the person, and in recent years there has been a significant increase in the number of patients suffering from dementia. In Croatia, such patients are often placed in retirement homes, non-specialized institutions for the elderly and infirm, often without adequately educated employees. Attitudes toward dementia seem to be an important factor for adequate care of people with dementia, but there was no previous research on this topic in Croatia. The Dementia Attitudes Scale (DAS) developed by O’Connor and McFadden (2010), is a useful tool in research of attitudes toward dementia. The aim of the study was to translate the scale into the Croatian language and validate it on a Croatian sample. Participants were employees and retirement home users, other health care workers and the general population. Validation conducted on samples that were in everyday contact with dementia patients showed consistent factors (social comfort and dementia knowledge) as in the original scale, so the conclusion was that the questionnaire could be used in that population. Still, overall results that included the general sample showed different factors when compared to the original scale, since the Croatian version did not show standard factors, but rather positive and negative attitudes factors. Results could be seen as highly suggestive and emphasize the need to distinguish and separate research on attitudes toward dementia in different populations.

Prevalence of Inhibitors in a Population of 3435 Hemophilia Patients in France

1992 ◽  
Vol 67 (06) ◽  
pp. 600-602 ◽  
Author(s):  
Y Sultan ◽  
Keyword(s):  
Hemophilia A ◽  
Hemophilia B ◽  
Study Group ◽  
Cooperative Study ◽  
Population Prevalence ◽  
French Study ◽  
Number Of Patients ◽  
High Incidence ◽  
Recombinant Fviii ◽  
High Responders

SummaryA cooperative study between the 37 centers of the French Hemophilia Study Group was undertaken to establish the prevalence of inhibitor patients in the French hemophilia population. The prevalence reported in the literature varies widely from 3.6% to 17.5%. Some of the studies are dealing with a small number of patients and inhibitor patients are reported either to the total number of hemophiliacs or to the severely affected ones. The French study provided information concerning 3,435 hemophiliacs and showed a prevalence of 6.2% for the overall population. Prevalence of inhibitors was found to be 7% in the population of hemophilia A patients and 12.8% in the population of severely affected ones. The prevalence of inhibitors in the population of hemophilia B patients was 2% and 4% in the population of severely affected hemophilia B patients. The cooperative study also showed that 47.5% of inhibitors are detected before 10 years of age and that 82% of inhibitor patients are high responders. Analysis of inhibitor detection in patients under the age often showed that there was a peak in the population of 2 years old children. Although not comparable to the present study the high incidence of inhibitors with ultrapurified and recombinant FVIII reported in previously untransfused patient may be borne in mind.

Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative

2020 ◽  
pp. 1-6
Author(s):  
Paul Park ◽  
Victor Chang ◽  
Hsueh-Han Yeh ◽  
Jason M. Schwalb ◽  
David R. Nerenz ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Spinal Surgery ◽  
Readmission Rate ◽  
Rating Scale ◽  
Short Term ◽  
Readmission Rates ◽  
Opioid Prescribing ◽  
Number Of Patients ◽  
Before And After ◽  
The Impact

OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

scholarly journals Letter to the Editor: Microbiota in the Respiratory System—A Possible Explanation to Age and Sex Variability in Susceptibility to SARS-CoV-2

2021 ◽  
Vol 14 ◽  
pp. 117863612098860
Author(s):  
Vishal Shah
Keyword(s):  
Respiratory System ◽  
Elderly Population ◽  
Age Groups ◽  
The Elderly ◽  
Elderly Adult ◽  
Human Respiratory Tract ◽  
System A ◽  
Number Of Patients ◽  
Children And Young Adults ◽  
Age And Sex

The Human respiratory tract is colonized by a variety of microbes and the microbiota change as we age. In this perspective, literature support is presented for the hypothesis that the respiratory system microbiota could explain the differential age and sex breakdown amongst COVID-19 patients. The number of patients in the older and elderly adult group is higher than the other age groups. The perspective presents the possibility that certain genera of bacteria present in the respiratory system microbiota in children and young adults could be directly or through eliciting an immune response from the host, prevent full-fledged infection of SARS-CoV-2. The possibility also exists that the microbiota in older adults and the elderly population have bacteria that make it easier for the virus to cause infection. I call upon the scientific community to investigate the link between human microbiota and SARS-CoV-2 susceptibility to further understand the viral pathogenesis.

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