Agitation In People Research Articles

Donepezil is no more effective than placebo for agitation in people with Alzheimer’s disease

Donepezil is no more effective than placebo for agitation in people with Alzheimer’s disease

Relationship between anxiety and agitation in dementia

Anxiety and agitation are common in people with dementia. Their consequences can be severe, including increased mortality rates and institutionalization. Despite the importance of these symptoms there is little literature in this area. Some studies have assumed that agitation is the outward manifestation of anxiety, while others have attempted to differentiate between them. The aim of this study was to investigate the relationship between anxiety and agitation in people with mild-to-moderate dementia. A secondary aim was to compare two measures of anxiety which have been used in people with dementia. A cross-sectional correlation design was used. Participants were 40 older adults with dementia. Agitation, anxiety, depression, and level of cognitive impairment were measured. The main finding from the study was that anxiety and agitation are associated in dementia. The degree of correlation did not support the use of agitation as a measure of anxiety. Anxiety symptoms of autonomic sensitivity were not correlated with agitation and could be used to differentiate between the two if this was required. The use of the Rating for Anxiety in Dementia (RAID) was supported as a measure of anxiety in people with dementia.

Efficacy and Adverse Effects of Atypical Antipsychotics for Dementia: Meta-analysis of Randomized, Placebo-Controlled Trials

Atypical antipsychotic medications are widely used to treat delusions, aggression, and agitation in people with Alzheimer disease (AD) and other dementia. Several clinical trials have not shown efficacy, and there have been concerns about adverse events. The objective of this study was to assess the evidence for efficacy and adverse events of atypicals for people with dementia. MEDLINE, the Cochrane Register of Controlled Trials, meetings, presentations, and information obtained from sponsors were used in this study. Published and unpublished randomized, placebo-controlled, double-blind, parallel-group trials in patients with AD or dementia of atypical antipsychotics marketed in the United States were studied. Clinical and trials characteristics, outcomes, and adverse events were extracted. Data were checked by a second reviewer. Fifteen trials including 16 contrasts of atypical antipsychotics with placebo met selection criteria: aripiprazole (k = 3), olanzapine (k = 5), quetiapine (k = 3), and risperidone (k = 5). A total of 3,353 patients were randomized to drug and 1,757 to placebo. Standard meta-analysis methods were used to summarize outcomes. Quality of the reporting of trials varied. Efficacy on rating scales was observed by meta-analysis for aripiprazole and risperidone, but not for olanzapine. Response rates were frequently not reported. There were smaller effects for less severe dementia, outpatients, and patients selected for psychosis. Approximately one-third dropped out without overall differences between drug and placebo. Adverse events were mainly somnolence and urinary tract infection or incontinence across drugs, and extrapyramidal symptoms or abnormal gait with risperidone or olanzapine. Cognitive test scores worsened with drugs. There was no evidence for increased injury, falls, or syncope. There was a significant risk for cerebrovascular events, especially with risperidone; increased risk for death overall was reported elsewhere. Small statistical effect sizes on symptom rating scales support the evidence for the efficacy of aripiprazole and risperidone. Incomplete reporting restricts estimates of response rates and clinical significance. Dropouts and adverse events further limit effectiveness. Atypicals should be considered within the context of medical need and the efficacy and safety of alternatives. Individual patient meta-analyses are needed to better assess clinical significance and effectiveness.

Evaluating effects of aromatherapy massage on sleep in children with autism: a pilot study.

Previous studies have found beneficial effects of aromatherapy massage for agitation in people with dementia, for pain relief and for poor sleep. Children with autism often have sleep difficulties, and it was thought that aromatherapy massage might enable more rapid sleep onset, less sleep disruption and longer sleep duration. Twelve children with autism and learning difficulties (2 girls and 10 boys aged between 12 years 2 months to 15 years 7 months) in a residential school participated in a within subjects repeated measures design: 3 nights when the children were given aromatherapy massage with lavender oil were compared with 14 nights when it was not given. The children were checked every 30 min throughout the night to determine the time taken for the children to settle to sleep, the number of awakenings and the sleep duration. One boy's data were not analyzed owing to lengthy absence. Repeated measures analysis revealed no differences in any of the sleep measures between the nights when the children were given aromatherapy massage and nights when the children were not given aromatherapy massage. The results suggest that the use of aromatherapy massage with lavender oil has no beneficial effect on the sleep patterns of children with autism attending a residential school. It is possible that there are greater effects in the home environment or with longer-term interventions.

Pilot Study to Test the Effectiveness of Healing Touch on Agitation in People With Dementia

A pilot study was conducted to investigate the effects of Healing Touch (HT) on agitation in persons with dementia. Because of the restricted availability of patients, the main purpose of the study was to investigate the effectiveness of HT on dementia patients who demonstrated similar high levels of agitation as measured by the Cohen-Mansfield Agitation Inventory. Results indicated that agitation levels were significantly lowered and that HT is worthy of further study.

Risperidone For Treating Patients With Dementia: Systematic Review of Randomized, Placebo-Controlled Clinical Trials

Context and Objective: The atypical antipsychotic risperidone is widely used to treat delusions, aggression and agitation in people with Alzheimer's disease and other dementia. In view of some clinical trials of atypical antipsychotics not showing efficacy in dementia and concerns about adverse events, the evidence for efficacy and safety of risperidone were reviewed. Literature Review and Study Selection: We searched the Cochrane Register of Controlled Trials (2005) and meetings presentations for published and unpublished clinical trials of risperidone to treat dementia patients. Other sources were searched; some reviews were selected as well. Outcomes and adverse events were tabulated, described and assessed. Results: Eight placebo-controlled trials of risperidone were identified (five unpublished); three did not have results available. The five included were 8–12 weeks in duration; one trial each also compared haloperidol and olanzapine (five comparator controlled trials were also identified). Approximately 1175 subjects were randomized to risperidone and 779 to placebo. Risperidone doses generally averaged 1 mg/day (range 0.5 to 2.0 mg/day). Overall risperidone reduced symptom severity to a greater extent than placebo. There was no overall difference from placebo in all-cause dropouts. The most common adverse events associated with risperidone in the placebo-controlled trials were sedation, edema, and extrapyramidal symptoms. There was no statistically significant increased risk for death or cerebrovascular adverse events (CVAEs) with risperidone overall. Conclusions: Clinicians who use risperidone to treat elderly patients with dementia should consider its use within the context of the medical need, the potential for increased risk of antipsychotics in general for serious adverse events such as CVAEs and deaths in mainly nursing home residents in clinical trials, medical comorbidity, and the efficacy and safety of alternatives.

Quetiapine and rivastigmine and cognitive decline in Alzheimer's disease: randomised double blind placebo controlled trial

Objectives To determine the respective efficacy of quetiapine and rivastigmine for agitation in people with dementia in institutional care and to evaluate these treatments with respect to change in cognitive...

Effect of the BACE Intervention on Agitation of People With Dementia

This study tests the effectiveness of the theoretically driven BACE (i.e., Balancing Arousal Controls Excesses) intervention in decreasing agitation in residents of long-term care with moderate or severe dementia. A pretest-posttest double-blinded experimental design with random assignment was used with a sample of 78 participants. The BACE intervention controls the daily activity schedule so that there is a balance between a person's high-arousal and low-arousal states. The outcome measure was observed agitation. When time spent in arousal imbalance at pretest was controlled for, a repeated measures analysis of covariance revealed a statistically significant Group x Time interaction, F(1, 69) = 4.26, p =.043, with a partial eta(2) =.06. The average change in agitation for the treatment group was a decrease of 8.43 points (SD = 12.01) from pretest to posttest, an effect size of.7. The results of this study support the theory that balancing arousal states by using an individualized approach is effective in decreasing agitation levels of people with dementia.