Symptoms Of Agitation Research Articles

An overview of the pathophysiology of agitation in Alzheimer's dementia with a focus on neurotransmitters and circuits.

Alzheimer's dementia (AD) is a progressive, neurodegenerative disease often accompanied by neuropsychiatric symptoms that profoundly impact both patients and caregivers. Agitation is among the most prevalent and distressing of these symptoms and often requires treatment. Appropriate therapeutic interventions depend on understanding the biological basis of agitation and how it may be affected by treatment. This narrative review discusses a proposed pathophysiology of agitation in Alzheimer's dementia based on convergent evidence across research approaches. Available data indicate that agitation in Alzheimer's dementia is associated with an imbalance of activity between key prefrontal and subcortical brain regions. The monoamine neurotransmitter systems serve as key modulators of activity within these brain regions and circuits and are rendered abnormal in AD. Patients with AD who exhibited agitation symptoms during life have alterations in neurotransmitter nuclei and related systems when the brain is examined at autopsy. The authors present a model of agitation in Alzheimer's dementia in which noradrenergic hyperactivity along with serotonergic deficits and dysregulated striatal dopamine release contribute to agitated and aggressive behaviors.

The Development of an Intradisciplinary Staff Training Intervention on the Optimal Management of Behavioural and Psychological Symptoms of Dementia: A Qualitative Study

Introduction: Behavioural and psychological symptoms of dementia (BPSDs) are a group of highly prevalent symptoms in residents with a neurocognitive disorder, including agitation and depressive symptoms. Caregiving staff often mention knowledge and skills deficits regarding optimal BPSD management. While several staff training on BPSDs management exist internationally, their transferability to other clinical contexts is limited, owing to methodological challenges. Therefore, to address this implementation gap, there is a strong need for training based on high-quality research to strengthen existing evidence, and ensure feasibility and reproducibility. Methods: This qualitative study, part of a larger research project, occurred in 2022 on long-term care (LTC) centre unit and an alternate level of care (ALC) hospital unit located in the Province of Quebec, Canada. This study aimed to (1) evaluate the needs and perceptions of staff caregivers regarding BPSD management, (2) identify the training content and modalities to prioritize according to experts, (3) develop intradisciplinary training on BPSD management, and (4) pretest the preliminary version of the training. Objectives one and two were evaluated using focus groups and objective four using individual cognitive interviews. Qualitative interview data was audio-recorded with participants’ consent, transcribed verbatim, and thematically content analysed using an established method. Results: Overall, thirteen caregivers participated in objective one (8 from the LTC unit, and 6 from the ALC unit). The main staff training need identified on each site was the management of resident’s aggressive behaviours. Staff verbalized a preference for virtual training. Objective 2 involved a panel of eight experts. Experts recommended the use of an online training platform, and certain training models and indicators. Based on caregivers’ and experts’ input, five interactive online staff training capsules lasting from 20 to 25 min each and an algorithm guiding the evaluation and management of BPSDs were created. The training capsules and the algorithm were iteratively improved following cognitive interviews with 4 caregivers from the participating sites. Conclusion: An interactive virtual staff training on BPSD management was created based on staff and expert consultation. The next step in the investigation will be to evaluate the feasibility and acceptability of the training.

COVID-19 and Its Influence on Prevalence of Dementia and Agitation in Australian Residential Aged Care: A Comparative Study

Agitation is one of the most common and persistent behavioral and psychological symptoms among persons with dementia (PWD) in residential aged care facilities (RACFs). While most studies have explored the general impact of COVID-19 on the mental health and well-being of aged care residents, there has been limited research on the pandemic’s impact on agitation in dementia within RACFs. This knowledge is crucial to ensuring that RACFs are better equipped to handle future public health emergencies. Therefore, this retrospective cohort study investigates the impact of the pandemic on agitation incidents within 40 Australian RACFs. Using Python, we extracted agitation symptoms from nursing notes and compared the frequency and percentage of symptom occurrence pre-pandemic versus during-pandemic. Chi-square tests examined any significant change in the prevalence of dementia and agitation in dementia between the comparative groups and periods. Dementia prevalence dropped significantly during the second year of the pandemic, with a concurrent increase in early-onset dementia cases. Overall, agitation symptoms decreased by 20.1%, but six symptoms significantly increased: resisting (28.98%), wandering (11.78%), restlessness (3.19%), complaining (10.1%), arguing (2.36%), and outbursts (1.74%). Conversely, pacing decreased by 15.88% and speaking loudly decreased by 10.9%. Over half of the care recipients with dementia experienced agitation symptoms 2–5 times each year, increasing from 50.56% in 2019 to 58.28% in 2021. Despite the co-occurrence of symptoms such as falls, confusion, and weakness, there was no evidence to suggest that these comorbidities were specific to COVID-19; rather, they appeared to be prevalent even before the pandemic. Persons with agitation in dementia had a significantly higher death rate during the COVID-19 pandemic than otherwise.

COMPARISON BETWEEN OLANZAPINE AND HALOPERIDOL AS TREATMENT OF ACUTE AGITATION

Introduction – Antipsychotics have been used as a treatment of choice in acute agitation, with haloperidol being the most widely used from the first generation, and olanzapine from the second generation. Therefore, there is a need to understand these drugs, particularly in their efficacy and safety as a treatment of acute agitation. Methods – This review uses several works of literature between 2011 to 2021 that discuss olanzapine and haloperidol as treatments for acute agitation. Results – Atypical antipsychotic agents are equally effective when compared to typical antipsychotics in treating acute agitation Discuss – On several head-to-head comparisons, olanzapine showed superiority to haloperidol based on the onset of efficacy. Conclusion – Agitated patients interfere with the diagnostic and treatment process. First-line treatment involves verbal de-escalation for patients and if failed, a physician could use pharmacological intervention in the form of rapid tranquillization to continue the therapeutic process. When determining which drug to use, a physician must consider both efficacy and safety. Due to the heterogeneity of study results, it is difficult to conclude that a certain agent is the best treatment for acute agitation. Olanzapine and haloperidol are equally effective antipsychotic agents in treating agitated symptoms. Olanzapine has numerous advantageous properties, including a lesser risk of causing extrapyramidal side effects that in turn can aggravate agitation, but the downside of olanzapine is that it is expensive and has limited availability compared to haloperidol. On the other hand, haloperidol, as a monotherapy or combination therapy either with an antihistamine-anticholinergic or benzodiazepine is a good alternative. Therefore, determining which agent to use should consider the comprehensive state of the patient, as is almost always the case when psychotropic medications are prescribed. Keywords: olanzapine, haloperidol, agitation.

Effect of a Group-Based Personal Assistive RObot (PARO) Robot Intervention on Cognitive Function, Autonomic Nervous System Function, and Mental Well-being in Older Adults with Mild Dementia: A Randomized Controlled Trial

ObjectivesPersonal Assistive RObot (PARO) interventions have been used to treat agitation and mood symptoms of dementia effectively. However, the effects of a PARO intervention on physiological and cognitive function are unclear. To examine the effects of a group-based PARO intervention for older adults with mild dementia. DesignUsing a group-based PARO intervention randomized controlled trial with 2-arm parallel groups. Setting and ParticipantsOlder adults with mild dementia aged 65 years or older from 4 dementia day care centers were recruited. MethodsPhysiological parameters were assessed using the finger tapping test (FTT) and heart rate variability (HRV). The Mini-Mental State Examination (MMSE), Geriatric Depression Scale–Short Form (GDS-SF), University of California Los Angeles loneliness scale–version 3 (UCLA-3), and Warwick-Edinburgh Mental Well-being Scale (WEMWBS) were assessed before the intervention, end of the intervention, and 1-month after the intervention. ResultsUsing a repeated-measures generalized linear model, significant time × group interactions were found in the MMSE [F(2, 115) = 19.54, P < .001], FTT [F(2, 115) = 4.87, P = .01], HRV high-frequency [F(2, 115) = 3.57, P = .03], and high-frequency/low-frequency ratio [F(2, 115) = 0.96, P = .01], UCLA-3 [F(2, 115) = 54.7, P < .001], GDS-SF [F(2, 115) = 3.36, P = .04], and WEMWBS [F(2, 115) = 5.93, P < .001]. Furthermore, psychological parameters improved significantly and continuously even 1 month after the PARO intervention was finished. Physiological parameters significantly improved at week 6, but the effects had diminished by week 10. Conclusions and ImplicationsA PARO intervention may effectively improve the physiological and psychological responses of people with mild dementia.

Towards full recovery with lurasidone: effective doses in the treatment of agitation, affective, positive, and cognitive symptoms in schizophrenia and of dual psychosis.

The management of schizophrenia necessitates a comprehensive treatment paradigm that considers individual patient nuances and the efficacy of lurasidone in addressing schizophrenia symptoms, particularly at elevated dosages. Numerous randomized trials have affirmed the efficacy of lurasidone across various dimensions of schizophrenia, demonstrating marked enhancements in positive, negative and cognitive symptoms compared to a placebo. In addition, lurasidone exhibits potential in ameliorating agitation amongst acutely ill patients, showcasing greater efficacy at higher doses. However, despite the favourable outcomes observed with higher lurasidone doses, routine clinical practice often opts for lower doses, potentially limiting its maximal therapeutic impact. Furthermore, lurasidone also shows efficacy in reducing post-psychotic depression in dual psychosis. Moreover, practical insights into lurasidone usage encompass swift dose escalation within a 1-5-day span and recommended combination strategies with other medications such as benzodiazepines for insomnia or agitation, beta-blockers for akathisia, and antihistamines or antimuscarinic drugs for patients transitioning rapidly from antipsychotics with substantial antihistamine and/or anticholinergic effects. Finally, a series of clinical cases is presented, highlighting benefits of lurasidone in terms of cognitive function, functional recovery and other therapeutic aspects for the management of schizophrenia.

Exploring actigraphy as a digital phenotyping measure: A study on differentiating psychomotor agitation and retardation in depression.

Psychomotor activity stands out as a crucial symptom in characterizing behaviors associated with depression. This study aims to explore the potential of actigraphy as a tool for digital phenotyping in characterizing symptoms of psychomotor agitation and retardation, which are clinically challenging dimensions to capture, in patients diagnosed with major depressive episode (MDE) according to DSM-5 criteria. We compared rest-activity circadian rhythm biomarkers measured by the Motion Watch 8 actigraphy between 58 (78.4%) patients with MDE and psychomotor retardation (PMR), and 16 (21.6%) patients with MDE and psychomotor agitation (PMA), according to DSM-5 criteria. Actigraphy allowed to objectively report PMA through heightened activity over a 24-h period, while PMR manifests as reduced activity during the most active 10 h. Lower rest-activity rhythm (RAR) amplitude in PMR was accompanied by increased irregularities in intra- and inter-day rhythms. Interestingly, actigraphy emerges as an objective tool to measure the characteristics of the active and rest periods, free from the confounding effects of sleep disturbances. Indeed, no differences in sleep disturbances were identified between patients exhibiting psychomotor agitation and those displaying PMR. Digital phenotyping through actigraphy may aid in distinguishing psychomotor retardation and psychomotor agitation allowing for a more precise characterization of the depression phenotype. When integrated with clinical assessment, measurements from actigraphy could offer additional insights into activity rhythms alongside subjective assessments and hold the potential to augment existing clinical decision-making processes in psychiatry.

Relationship between plasma TNF-α levels and agitation symptoms in first episode patients with schizophrenia

BackgroundIncreasing evidence suggested that immune abnormalities involved in the pathophysiology of schizophrenia. However, the relationship between immunity and clinical features has not been clarified. The aim of this study was to measure the plasma levels of tumor necrosis factor alpha (TNF-α) and soluble TNF-α receptor 1 (sTNF-α R1) and to investigate their association with agitation in first episode patients with schizophrenia (FEPS).MethodsThe plasma TNF-α and sTNF-α R1 levels were measured using sandwich enzyme-linked immunosorbent assay (ELISA) in the FEPS with (n = 36) and without agitation (n = 49) symptoms, and healthy controls (HCs, n = 54). The psychopathology was assessed by the Positive and Negative Syndrome Scale (PANSS), and the agitation symptoms were evaluated by the PANSS excitatory component (PANSS-EC).ResultsThe plasma TNF-α levels in patients with and without agitation symptoms were significantly higher than those in HCs. The patients with agitation had significantly higher plasma TNF-α levels compared to the patients without agitation. There were no significant differences in the sTNF-α R1 levels among the three groups. Furthermore, the plasma TNF-α levels were positively correlated with the PANSS total score, Positive and General psychopathological subscores, and PANSS-EC score in the FEPS, but the relationships were not found for the plasma sTNF-α R1 levels.ConclusionsThese results suggested that TNF-α might play an important role in the onset and development of agitation symptoms of schizophrenia.

Detecting agitation and aggression in persons living with dementia: a systematic review of diagnostic accuracy

Objective40–60% of persons living with dementia (PLWD) experience agitation and/or aggression symptoms. There is a need to understand the best method to detect agitation and/or aggression in PLWD. We aimed to identify agitation and/or aggression tools that are validated against a reference standard within the context of PLWD.MethodsOur study was registered on PROSPERO (CRD42020156708). We searched MEDLINE, Embase, and PsycINFO up to April 22, 2024. There were no language or date restrictions. Studies were included if they used any tools or questionnaires for detecting either agitation or aggression compared to a reference standard among PLWD, or any studies that compared two or more agitation and/or aggression tools in the population. All screening and data extraction were done in duplicates. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Data extraction was completed in duplicates by two independent authors. We extracted demographic information, prevalence of agitation and/or aggression, and diagnostic accuracy measures. We also reported studies comparing the correlation between two or more agitation and/or aggression tools.Results6961 articles were screened across databases. Six articles reporting diagnostic accuracy measures compared to a reference standard and 30 articles reporting correlation measurements between tools were included. The agitation domain of the Spanish NPI demonstrated the highest sensitivity (100%) against the agitation subsection of the Spanish CAMDEX. Single-study evidence was found for the diagnostic accuracy of commonly used agitation scales (BEHAVE-AD, NPI and CMAI).ConclusionsThe agitation domain of the Spanish NPI, the NBRS, and the PAS demonstrated high sensitivities, and may be reasonable for clinical implementation. However, a limitation to this finding is that despite an extensive search, few studies with diagnostic accuracy measurements were identified. Ultimately, more research is needed to understand the diagnostic accuracy of agitation and/or aggression detection tools among PLWD.

Mild behavioral impairment domains are longitudinally associated with pTAU and metabolic biomarkers in dementia-free older adults.

The mechanisms linking mild behavioral impairment (MBI) and Alzheimer's disease (AD) have been insufficiently explored, with conflicting results regarding tau protein and few data on other metabolic markers. We aimed to evaluate the longitudinal association of the MBI domains and a spectrum of plasma biomarkers. Our study is a secondary analysis of data from NOLAN. The longitudinal association of the MBI domains with plasma biomarkers, including pTau181, was tested using adjusted linear mixed-effects models. The sample comprised 359 participants (60% female, mean age: 78.3, standard deviation: 0.3 years). After 1 year, the MBI domain of abnormal perception was associated with steeper increases in plasma pTau181. Abnormal perception, decreased motivation, and impulse dyscontrol were associated with homocysteine or insulin dysregulation. Apart from the association with plasma pTau181, our results suggest that MBI might also represent metabolic dysregulation, probably contributing to dementia transition among older adults with subjective cognitive decline or mild cognitive impairment. Mild behavioral impairment (MBI) psychosis was associated with steeper increases in plasma p. pTau could be a pharmacological target to treat agitation and psychosis symptoms. MBI domains were linked to metabolic dysregulation involving insulin and homocysteine.

Effects of cariprazine on reducing symptoms of irritability, hostility, and agitation in patients with manic or mixed episodes of bipolar I disorder

BackgroundHostility, irritability, and agitation are common in patients with bipolar I disorder. Post hoc analyses evaluated the effect of cariprazine on these symptoms in patients with bipolar I mania. MethodsData were pooled from three randomized, double-blind, placebo-controlled phase 3 cariprazine trials in adults with bipolar I manic/mixed episodes (NCT00488618, NCT01058096, NCT01058668); pooled cariprazine doses (3–12 mg/d) were analyzed. Patients were categorized into hostility/irritability and agitation subgroups by baseline scores: Young Mania Rating Scale (YMRS) irritability and disruptive-aggressive behavior items score ≥ 2; Positive and Negative Syndrome Scale (PANSS) hostility item ≥ 2; PANSS–Excited Component (PANSS-EC) total score ≥ 14 and score ≥ 4 on ≥ 1 individual item. Changes from baseline to week 3 in hostility/irritability- and agitation-related outcomes were evaluated. Adjustments were made for the presence of other manic symptoms, sedation, and akathisia. ResultsMost patients met subgroup inclusion criteria (YMRS hostility = 930; PANSS hostility = 841, PANSS-EC agitation = 486). In the YMRS subgroup, least squares mean differences in change from baseline were statistically significant for cariprazine versus placebo on YMRS hostility/irritability-related items (irritability [−0.93], disruptive-aggressive behavior [−0.79], combined [−1.75]; P ≤ 0.001 each), YMRS total score (−5.92, P ≤ 0.0001), and all individual YMRS items (−0.25 to −0.93, P ≤ 0.0001); differences remained significant after adjustment for other manic symptoms, sedation, and akathisia. Differences in PANSS hostility and PANSS-EC subgroups were significant for cariprazine versus placebo (P ≤ 0.001). LimitationsPost hoc analysis. ConclusionCariprazine demonstrated specific antihostility/irritability and anti-agitation effects in patients with manic/mixed episodes of bipolar I disorder and baseline hostility, irritability, or agitation.

Risperidone Induced DRESS Syndrome: A case report

IntroductionDRESS (Drug Reaction with Eoshinophilia and Systemic Symptoms) syndrome, also called DIHS (Drug-Induced Hypersensitivity Syndrome) is a rare drug-induced systemic hypersensitivity reaction that can be potentially life-threatening (Choudhary et al. J Clin Aesthet Dermatol 2013; 6 -7). Risperidone is an antipsychotic drug with significant antagonist activity at the 5-HT2 and the D2 receptors. It has been reported that risperidone may be effective in controlling agitation, delusion, hallucination, and withdrawal behavior in geriatric patients (Yunusa &amp; El Helou. Front Pharmacol 2020;11:596).Objectives The aim of this study is to demonstrate the case of developed DRESS syndrome following the use of risperidone.Methods The 81-year-old female patient was admitted to the Dermatology Clinic due to skin rash, high fever and leukocytosis following the use of risperidone. The patient was consulted to Psychiatry.Results In her history it was determined that risperidone 0.5 mg/d was started to the patient with depression due to agitative symptom. On the 4th day of treatment, targeoid lesions, starting from the back and spreading first to the trunk and then to the extremities, were observed. Further laboratory examinations revealed that the fever was measured at 39.5 C°, liver enzymes were elevated (ALT= 119 IU/ lt, AST= 124 IU /lt), and significant leukocytosis (WBC =12.000) was present along with the lesions. The patient was planned to be hospitalized to Dermatology Clinic on the 5th day and risperidone was stopped. The patient’s agitation increased and following the risperidone discontinuation thereupon the lesions tended to fade and desquamation began. After the treatment of the DRESS syndrome, aripiprazole was given to the patient for agitative symptom. The level of agitation symptoms decreased, and the patient tolerated aripiprazole well without any observed side effects.Image:ConclusionsWhen initiating medication for the elderly population to address agitation, considering such rare side effects can prevent the patient from being hospitalized due to DRESS syndrome. To the best of our knowledge, this is the first case report associated with DRESS syndrome and risperidone treatment thus, it is necessary to be very careful when starting psychotropic medication for elderly patients.Disclosure of InterestNone Declared

Thyroid psychosis: when your hormones take over your mind: a case report

IntroductionHyperthyroidism, characterized by excessive production of thyroid hormones, is a common endocrine disorder that affects various body systems. While most commonly recognized for its classic symptoms such as weight loss, tremors, and palpitations, it is important to acknowledge that hyperthyroidism can also lead to a rare but significant complication: psychosis. Psychosis in the context of hyperthyroidism refers to the presence of delusions, hallucinations, and disordered thinking, which can significantly impact an individual’s mental health and overall well-being.ObjectivesThis case report aims to describe a rare case of hyperthyroidism-related psychosis in a patient including the clinical presentation, diagnosis, and management. Additionally, we aim to increase awareness of and promote further research into this condition.MethodsWe present a comprehensive case report detailing the clinical course of a 29-year-old male patient with no previous medical or psychiatric history, who sought urgent psychiatric evaluation at the Razi Hospital La Manouba’s emergency department due to escalating symptoms of agitation and paranoia persisting for three days. The patient, identified as Mr. S.O., a Tunisian male, presented with severe agitation and paranoia necessitating the use of restraints upon admission to the psychiatric emergency department. The initial physical examination revealed no notable abnormalities, except for the presence of tachycardia, which was subsequently confirmed on an electrocardiogram, arousing suspicion of a primary psychiatric illness.ResultsWhile the standard blood workup yielded unremarkable findings, the endocrine workup revealed decreased levels of thyroid-stimulating hormone (TSH) and elevated free thyroxine (FT4). Further laboratory investigations demonstrated elevated anti-thyroid-stimulating hormone receptor antibodies, leading to the diagnosis of Graves’ disease. Collaborative consultation with an endocrinologist resulted in the initiation of a treatment regimen consisting of methimazole, propranolol, and risperidone. Notably, within three days of the initiated therapy, the patient exhibited significant improvement in terms of reduced agitation, coherent speech, and the development of self-reflection regarding the episode, ultimately leading to his discharge on the seventh day of hospitalization. This case report serves to highlight the complexity of psychiatric presentations associated with underlying endocrine disorders and underscores the importance of interdisciplinary collaboration in achieving optimal patient outcomes.ConclusionsWhile mental health factors play a significant role in the development of psychosis, it is essential to recognize that underlying medical conditions may also contribute to its onset or exacerbation.Disclosure of InterestNone Declared

The Optimization of Pharmacological and Non-pharmacological Interventions in a Case of Parkinson's Psychosis

Mr. L is a 64 y.o. male with a history of Parkinson's disease s/p bilateral DBS who initially presented to the emergency room from an assisted living facility for altered mental status and increased combativeness with staff. Patient was found to be experiencing symptoms of Parkinson's Psychosis and had uncontrol behavioral disturbance. Psychiatry was consulted for recommendations for agitation and hallucinations. Mr. L was hospitalized for over a year due to the need for higher level of care, inability to obtain guardianship, and inability to obtain subsequent placement. The patient's medication regimen was optimized with use of multiple medications including clozapine, lorazepam, and trazodone. Though medications showed some efficacy, Mr. L continued to display symptoms of agitation requiring use of restraints and emergency medication. Non-pharmacological interventions were recommended and included a combination of specific approaches to help address his needs such as techniques for medication adherence and increasing environment and social stimulation to decrease agitation and confusion. After initiating and distributing behavioral plan to patient's team, he required less medication alterations, emergency treatment orders, and ultimately the quality of life for patient and treating care team members was improved. This case underlines the efficacy of medication initiation in combination with non-pharmacological interventions in the hospital setting to improve the quality of life of patients and staff providing long term care for patients. Data on behavioral intervention and standardization of behavioral intervention is limited and typically is utilized more often in outpatient settings. However, behavioral plans for complex patients with prolonged hospital stays may allow for less agitation, thus alleviating barriers to care and limiting patient discomfort while hospitalized without complicating patient care with adverse effects. Simultaneously, decreased use of restraints, emergency medications for agitation, and staff intervention can be useful for alleviating provider team and staff burnout.

Care partner evaluation of the behaviors in the Cohen-Mansfield Agitation Inventory.

Agitation is a common symptom in patients with Alzheimer's dementia. But agitation can be a heterogeneous symptom, encompassing a diverse array of behaviors exhibited by patients. The Cohen-Mansfield Agitation Inventory (CMAI) is a 29-item scale that is used to systematically assess the frequency and severity of agitation in older adults as rated by a primary caregiver. The CMAI was originally designed for use by professional care givers in institutional care settings. Alzheimer's dementia, however, is associated with a significant burden on family members, who provide the majority of care, and other informal care partners. Our qualitative study aimed to assess the accuracy and applicability of the CMAI according to the needs and perceptions of non-professional care partners. Specifically, we wanted to determine if the behaviors included in the instrument reflect: (a) the care partner's experience with agitation in Alzheimer's dementia patients, (b) how the behaviors and their frequency are related to the perception of agitation severity, and (c) what changes in agitation behaviors are meaningful to care partners. We interviewed 30 care partners for patients with Alzheimer's dementia in the United States. The care partners confirmed all behaviors listed in the CMAI as relevant. The behaviors reflect a spectrum of severity, with aggressive behaviors considered more severe than non-aggressive behaviors and physical behaviors generally considered more severe than verbal behaviors. Any reduction or increase in the frequency of a behavior was meaningful to care partners. Generally, a change from physical to verbal behaviors and aggressive to non-aggressive was considered a meaningful improvement while a change from verbal to physical and non-aggressive to aggressive was considered a meaningful worsening. The CMAI appropriately captures relevant behaviors of agitation in Alzheimer's dementia and provides insight into the relative improvement or worsening of agitation symptoms.

Formative evaluation of an emergency department clinical decision support system for agitation symptoms: a study protocol

IntroductionThe burden of mental health-related visits to emergency departments (EDs) is growing, and agitation episodes are prevalent with such visits. Best practice guidance from experts recommends early assessment of at-risk...

Extracting Symptoms of Agitation in Dementia from Free-Text Nursing Notes Using Advanced Natural Language Processing.

Nursing staff record observations about older people under their care in free-text nursing notes. These notes contain older people's care needs, disease symptoms, frequency of symptom occurrence, nursing actions, etc. Therefore, it is vital to develop a technique to uncover important data from these notes. This study developed and evaluated a deep learning and transfer learning-based named entity recognition (NER) model for extracting symptoms of agitation in dementia from the nursing notes. We employed a Clinical BioBERT model for word embedding. Then we applied bidirectional long-short-term memory (BiLSTM) and conditional random field (CRF) models for NER on nursing notes from Australian residential aged care facilities. The proposed NER model achieves satisfactory performance in extracting symptoms of agitation in dementia with a 75% F1 score and 78% accuracy. We will further develop machine learning models to recommend the optimal nursing actions to manage agitation.

A Five-Step Workflow to Manually Annotate Unstructured Data into Training Dataset for Natural Language Processing.

Natural Language Processing (NLP) is a powerful technique for extracting valuable information from unstructured electronic health records (EHRs). However, a prerequisite for NLP is the availability of high-quality annotated datasets. To date, there is a lack of effective methods to guide the research effort of manually annotating unstructured datasets, which can hinder NLP performance. Therefore, this study develops a five-step workflow for manually annotating unstructured datasets, including (1) annotator training and familiarising with the text corpus, (2) vocabulary identification, (3) annotation schema development, (4) annotation execution, and (5) result validation. This framework was then applied to annotate agitation symptoms from the unstructured EHRs of 40 Australian residential aged care facilities. The annotated corpus achieved an accuracy rate of 96%. This suggests that our proposed annotation workflow can be used in manual data processing to develop annotated training corpus for developing NLP algorithms.

Education Needs of Canadian Physiotherapists Working with People Living with Dementia: An Online Survey

Purpose: To evaluate the education needs of Canadian physiotherapists in working with people living with dementia. Method: An online survey (English and French) was completed by physiotherapists registered to practice in Canada. Data collection included demographics, training in dementia, Confidence in Dementia Scale (CiD), Dementia Knowledge Assessment Scale (DKAS), Impact of Cognitive and Behavioural Symptoms on Physiotherapy Treatment, and strategies for cognitive and behavioural symptoms. A descriptive summary and analysis of outcomes based on education were performed. Results: One hundred thirty physiotherapists participated (age = 39.8 (10.7) years and 12.5 (11.0) years of practice). Education on dementia was reported by 55% during entry-to-practice and 65% after graduation. Training was reported as sufficient for 60.3% in mild, 49.6% in moderate, and 29.2% for severe dementia. The score on the DKAS was 60% and the CiD score was 67.4%. Therapists reported strategies to manage the behavioural symptoms of anxiety (67%) and agitation (61%), and cognitive symptoms of memory (79%) and language impairment (50%). Overall, 60.1% reported good job satisfaction in caring for PLWD. Conclusions : Confidence, knowledge, and job satisfaction was fair. Education needs included dementia knowledge and strategies for behavioural and cognitive symptoms. Targeted education needs to begin in entry-to-practice training and be available in post-professional courses.

Brexpiprazole improves symptoms of agitation in patients with Alzheimer's dementia

Patients with Alzheimer's dementia who received the atypical antipsychotic brexpiprazole for 12 weeks experienced significant improvement in symptoms of agitation relative to placebo, a Phase 3 trial found. Results of the trial led to Food and Drug Administration approval of brexpiprazole for the treatment of agitation associated with dementia due to Alzheimer's disease.