Behavior In Dementia Patients Research Articles

Systematic literature review with meta-analysis on essential oil interventions for agitated behavior in dementia patients

Introduction Essential oil treatment has been explored as a potential alternative medicine, as these therapies can induce calming and sedative effects by acting on the neuro-limbic system and upregulating neurotransmitter synthesis. Objectives This paper aims to assess the impact of essential oil interventions on aggressive behavior in people with dementia. Methods The literature search was carried out through six databases. The outcomes of interest were the survival risk and post-treatment score of the Cohen-Mansfield Agitation Inventory (CMAI), Neuropsychiatric Inventory (NPI), and Quality of Life (QoL). Quality appraisal was done using RoB 2.0, while meta-analysis was done using RevMan 5.4. This systematic review has been registered to the PROSPERO database (CRD42023476844). Results We analyzed 11 included studies with 1,418 patients. RoB 2.0 analysis resulted in eight low-risk-of-bias and three high-risk-of-bias studies. This study suggests that essential oil interventions lead to statistically significant improvements in survival risk with moderate heterogeneity [OR = 0.63 (95% CI: 0.41, 0.98, p = 0.04; I2 = 74%)]. This study also found a significant improvement in NPI scores following the use of essential oils [SMD = -2.97 (95% CI = -5.61, -0.32, p = 0.03; I2 = 98%)], but no statistically significant improvements were found in CMAI scores [SMD = 0.17 (95% CI = 0.37, 0.71, p = 0.53; I2 = 74%)]. The QoL assessment showed a trend favoring the control group after implementing essential oil treatments [SMD = 4.89 (95% CI = 1.51, 8.27, p = 0.005; I2 = 98%)]. Conclusions Essential oil is a potential approach in alleviating the agitated behavior of dementia patients considering its survival risk and some parameters, such as NPI, CMAI, and QoL score. However, more studies regarding essential oils on these parameters should be done, especially studies with specific main ingredients of the essential oil.

A new perspective on cognitive rehabilitation: layout design methods for wandering behavior in dementia patients

The global prevalence of dementia is on the rise, and existing medical models can no longer fulfill the pervasive need for intervention. Dementia is incurable, but the identification of Mild Cognitive Impairment (MCI) provides a window of opportunity for early intervention. The environmental therapy theory has been widely adopted, however, the implementation pathways and empirical evidence for cognitive behavioral interventions are still limited. The role of interior layout design as one of the environmental elements in guiding human behavioural patterns has been demonstrated by numerous scholars and extended to be explored in relation to perceptual and cognitive behavioural dimensions. There has been a great deal of research on Wandering Behavior In Patients With Cognitive Disorders in the medical field, but only sporadic reports in the field of design. Employing an “environment-behavior-neuroscience” research approach, this paper constructs the relationship between wandering behavior, cognitive function, and environmental factors, and explores the possibility of environmental intervention to improve cognitive functions. The study shows that: 1) The wandering patterns of dementia patients can be guided through landmarks; 2) There is a direct relationship between the depth of spatial communication and the layout, and optimizing the spatial layout can foster communication and theoretically have a restorative effect on cognitive function; 3) Centripetal layouts are more effective in behavior guidance, while multicore circulation path layouts can accommodate the wandering needs of dementia patients. As dementia is incurable, early intervention is the most effective approach, making this research highly valuable.

Detecting Abnormal Behaviors in Dementia Patients Using Lifelog Data: A Machine Learning Approach

In this paper, a proof-of-concept method for detecting abnormal behavior in dementia patients based on a single case study is proposed. This method incorporates the collection of lifelog data using affordable sensors and the development of a machine-learning-based system. Such an approach has the potential to enable the prompt detection of abnormal behavior in dementia patients within nursing homes and to send alerts to caregivers, which could potentially reduce their workload and decrease the risk of accidents and injuries. In a proof-of-concept experiment conducted on a single dementia patient in a Korean nursing home, the proposed system, specifically the multilayer perceptron model, demonstrated exceptional performance, achieving an accuracy of 0.99, a precision of 1.00, a recall of 1.00, and an F1 score of 1.00. While being cost-effective and adaptable to various nursing homes, these results should be interpreted as preliminary, being based on a limited sample. Future research is aimed at validating and improving the performance of the abnormal behavior detection system by expanding the experiments to include lifelog data from multiple nursing homes and a larger cohort of dementia patients. The potential application of this system extends beyond healthcare and medical fields, reaching into smart home environments and various other facilities. This study underscores the potential of this system to enhance patient safety, alleviate family concerns, and reduce societal costs, thereby contributing to the improvement of the quality of life for dementia patients.

Wearable bead-based triboelectric nanogenerator with dual-mode operation for monitoring abnormal behavior in dementia patients

A bead-based TENG (BB-TENG) that operates in dual-mode, contact-separation (CS) and free-standing (FS), is demonstrated as a two-in-one device. It serves both as an energy harvester and a sensor. This BB-TENG was designed to collect kinetic energy from two prevalent human movements: pressing related to the CS mode and walking linked to the FS mode. This functionality enables it to detect two typical behaviors of dementia patients while simultaneously harvesting energy: accidental falls corresponding to pressure and aimless wandering associated with walking, thereby enhancing its potential applications. The output characteristics from the BB-TENG was evaluated in terms of open-circuit voltage, short-circuit current and total transferred charge. The flexibility of the BB-TENG, which can be easily attached to a part of the body, gives it superior adaptability compared to other conventional TENGs. Furthermore, its sealed structure provides improved robustness against environmental factors such as humidity, making it suitable for outdoor use. A two-in-one module to enclose a wearable sensor and a flexible energy harvester can immediately alert the caregivers when a dementia patient wanders aimlessly and falls accidentally.

Cognition, Behavior, and Caregiver Stress in Dementia during the COVID-19 Pandemic: An Indian Perspective

Objectives: Little is known regarding the cognitive and behavioral status of patients with dementia and their caregivers in lower middle-income countries during the COVID-19 pandemic. This study aimed to understand the impact of the pandemic on persons with dementia and their caregivers in India. Methods: This was an observational study. A cohort of 66 persons with dementia and their caregivers were evaluated during the COVID-19 pandemic in 2 specialist hospitals in South India. Caregivers were interviewed at 2 distinct time points of the pandemic: during the national lockdown and 5 months after during later periods of the “cluster of cases” transmission phase. Participants were assessed via telephone utilizing validated instruments (Neuropsychiatric Inventory [NPI], Clinical Dementia Rating [CDR] Scale, and Depression, Anxiety and Stress Scale [DASS-21]) and a semi-structured questionnaire. The questionnaire documented sociodemographic information, clinical history, infection measures adopted, changes in caregiving routines, involvement in functional rehabilitation activities, and access to medical and long-term care support services. Results: The 2-phase follow-up study found a significant worsening of behavior in dementia patients, demonstrated by a difference in the NPI sub-domain scores for anxiety (mean difference [standard deviation, SD] = −0.552 [1.993], t₅₈ = −2.109, p = 0.039) and eating disturbances (mean difference [SD] = −1.121 [2.493], t₅₉ = −3.424, p = 0.001). A relatively high proportion of patients developed anxiety (cumulative incidence = 24.53%) and eating disturbances (cumulative incidence = 26.92%), without having these symptoms at baseline. There was a trend toward an increase in proportion of persons with severe dementia (19.7% vs. 39.4%) on follow-up. Caregiver distress reported was significantly associated with neuropsychiatric symptoms (r = 0.712, p < 0.001) and dementia severity (ρ = 0.365, p = 0.004). In addition, difficulties in accessing medical care persisted between the 2 assessments, and there were statistically significant differences between functional rehabilitation activities such as indoor activities (p < 0.001), outdoor activities (p = 0.013), and physical exercises (p = 0.003) between baseline and follow-up. Conclusion: Findings suggest interruption of functional rehabilitation activities and disruption in medical care services are likely to have had an adverse impact on patients with dementia and contributed toward caregiver distress.

Is There a Characteristic Autonomic Response During Outbursts of Combative Behavior in Dementia Patients?

We sought to determine whether skin conductance level could warn of outbursts of combative behavior in dementia patients by using a wristband device. Two outbursts were captured and are reported here. Although no physiologic parameter measured by the wristband gave advance warning, there is a common pattern of parasympathetic withdrawal (increased heart rate) followed approximately 30 seconds later by sympathetic activation (increased skin conductance). In the literature, a similar pattern occurs in psychogenic non-epileptic seizures. We hypothesize that similar autonomic responses reflect similarities in pathophysiology and that physical activity may partially account for the time course of skin conductance.

A Survey on Wandering Behavior Management Systems for Individuals with Dementia

Alzheimer’s and related dementia are associated with a gradual decline in cognitive abilities of an individual, impairing independent living abilities. Wandering, a purposeless disoriented locomotion tendency or behavior of dementia patients, requires constant caregiver supervision to reduce the risk of phys-ical harm to patients. Integrating technology into care ecology has the potential to alleviate stress and expense. An automatic wandering detection system integrated with an intervention mod-ule may provide warnings and assistive suggestions in times of abnormal behavior. In this study, we survey existing research on technology aided methodologies and algorithms used in detection and management of wandering behavior of individuals affected with dementia. Our study provides insights into mechanisms of collecting movement data and finding patterns that distinguish wandering from normal behavior.

Effect of Rehabilitation Training Combined with Psychological Intervention on Cognitive Function and Mental Behavior of Dementia Patients

Effect of Rehabilitation Training Combined with Psychological Intervention on Cognitive Function and Mental Behavior of Dementia Patients

Implementation of a baby doll therapy protocol for people with dementia: Innovative practice.

Dementia is exhibited by both emotional and physical states such as agitation. Chemical restraints, often used for agitated behaviors, are not always effective and produce untoward effects. Baby doll therapy is a nonpharmacologic therapy that can affect agitated behavior in dementia patients, yet a protocol for the therapy did not exist. An implementation protocol for doll therapy for those with dementia was developed and implemented with 16 residents in a dementia care center. Outcomes were measurements of the impact of the dolls on six areas of the resident's behavior and their reactions to the doll. Participants had an increase in level of happiness, activity/liveliness, interaction with staff and others, and ease of giving care. There was also a reduction in the level of anxiety. The increase in happiness was a statistically significant outcome. Baby doll therapy is an effective nonpharmacological approach for improving the well-being of patients with moderate to severe dementia.

Neuropsychiatric Symptoms in Dementia Patients With and Without a History of Traumatic Brain Injury

The authors aim to determine if a history of traumatic brain injury (TBI) assessed before dementia onset is associated with a higher risk of neuropsychiatric symptoms after dementia onset. A population-based incident series of people with dementia were assessed for TBI prior to onset of dementia and for neuropsychiatric symptoms after the onset, using the Neuropsychiatric Inventory. Participants with predementia TBI were more likely to exhibit disinhibition (12.7% versus 5.4%, OR=2.8, p=0.02), but not other neuropsychiatric symptoms. Traumatic brain injury may increase the risk of disinhibition in patients with dementia.

Safety, end-of-life issues, and dealing with sexually inappropriate behavior in dementia patients.

Safety, end-of-life issues, and dealing with sexually inappropriate behavior in dementia patients.

P4-413: The evidence-based alternative therapeutic intervention for dementia patients

Dementia is a longstanding progressive degenerative illness limited by the general pharmacotherapy. Even though several alternative therapeutic trials for Dementia patients have been attempted, systemic evidence–based clinical research is rare. Our aims were to assess the evidence–based effect of alternative therapeutic intervention such as music and art therapy, aromatherapy and reminiscent stimulation and were to investigate the validity of those as alternative therapeutic strategies of patients with dementia. We assessed 102 patients with Alzheimer's and vascular dementia. Among them, forty patients received well designed Music therapy (MT) 4 times per week for 2 months, and 35 patients received Art therapy(AT) by same strategy. Each session was performed about 40 minutes. Twelve patients received aromatherapy using 2% lavender oil twice a day for 14 days. Twenty five patients received reminiscent film stimulation. We evaluated devised short–formed clinical assessment tools included several tests related to language and memory functions, visuospatial function for music and art therapy group. We also evaluated Pittsburg agitation scale (PAS) and NPI score for aromatherapy group and cerebral blood flow for reminiscent stimulation group. In MT group, phonemic word fluency was significantly improved (p<0.005) without improvement in MMSE and semantic word fluency. In AT group, MMSE score, immediate and delayed visual recognition were significantly improved at 6 weeks after (p<0.05). In aroma therapy group, PAS and NPI score were significantly decreased at 7 days (p<0.05) but showed increasing tendency after then. In reminiscent stimulation group, the cerebral blood flow was significantly increased (p<0.05). Our results suggest that the various alternative therapeutic interventions can affect cognitive function and behavior of dementia patients in different ways by their specific characteristics. Music therapy improves phonemic fluency and executive functions, especially on frontal cognitive functions and art therapy improves visual recognition. Aromatherapy can be applicable as a transient BPSD control tool. Reminiscent stimulation can be applicable to nonpharmacologic therapy as a neuronal reactivation tool.

Aggressive behaviors among demented nursing home residents in Japan.

This study investigates the frequency of aggressive behaviors in a sample of elderly nursing home residents with dementia in Japan. Behavioral data were collected on 391 residents using the Cohen-Mansfield Agitation Inventory (CMAI). Data were also gathered on residents' age, sex, and ability to perform self-care. Another scale was used to code the degree of resistance that each resident manifested during bathing, toileting, dressing and eating. In addition, qualitative data were collected from caregivers regarding their main caregiving problems with dementia residents. Findings show that 45.4% of the sample manifested aggressive behavior during the 2-week study period. Men were significantly more likely to manifest physically aggressive behavior, but there was no gender difference for verbal aggression. Age had no relationship to aggressive behavior. Residents who were most dependent in self-care had significantly higher frequencies of aggressive behaviors. Caregivers reported that most aggressive behavior took place during personal care. The majority of caregivers identified verbal agitation rather than physical aggression as their main caregiving problem. This study represents the first time that the CMAI has been translated and used in Japan and the first time empirical data has been collected on the behavior of dementia patients in Japanese nursing homes.

Assessing patterns of agitation in Alzheimer's disease patients with the Cohen-Mansfield Agitation Inventory. The Alzheimer's Disease Cooperative Study.

As part of the effort of the NIA Alzheimer's disease cooperative study to develop improved instruments for quantifying effects in Alzheimer's disease (AD) clinical trials, patterns of agitated behaviors were evaluated with the Cohen-Mansfield Agitation Inventory (CMAI) in 241 AD patients and 64 healthy elderly controls with valid baseline assessment on the CMAI. The test-retest reliability of the CMAI over 1 month was good (r = 0.74 to 0.92). Physically and verbally nonaggressive behaviors were most often reported, whereas physically aggressive behaviors were rare. Frequency of agitated behaviors increased with dementia severity, especially for patients with a Mini-Mental Status Exam score of 0-4. Agitation tended to increase in the evening with dementia severity for the more impaired patients. Amount of agitation did increase after 12 months in all but controls and mildly demented patients. The CMAI shows promise for evaluating a unique aspect of behavior and may be useful in assessing the effects of cognitive enhancers and other types of psychotropic drugs on behavior in dementia patients.

An observational study of sexual behavior in demented male patients.

Concerns have been expressed that patients with dementia will display disinhibited, inappropriate sexual behavior. Retrospective research suggests that this is rare, but no observational research has been reported. The purpose of this study was to conduct such an observational study. Subjects were 40 patients with a dementia diagnosis who were living in institutional settings; subjects ranged in age from 60 to 98. Coders observed subjects on nine separate occasions, three in the morning, three in the afternoon, and three in the evening. Subjects were observed in multiple situations; coding included appropriate, ambiguous, and inappropriate sexual behaviors. Reliability coding was obtained for 42% of the patients on 11% of coded episodes. Behaviors could be coded with high reliability (94% to 100% across categories of behavior). On average, patients displayed 43 appropriate sexual behaviors, 1.48 ambiguous behaviors, and .83 inappropriate behaviors across the nine observation periods. This was not evenly distributed across patients, however; only 18% of patients ever displayed a sexually inappropriate behavior, and these were usually brief and minor. Inappropriate sexual behavior was observed in only 1.6% of the observed one-minute time segments. Observational research documents what had been previously suggested by retrospective reports: inappropriate sexual behavior is uncommon in dementia patients and brief and minor even when it occurs. Ambiguous behaviors, such as appearing in public incompletely dressed, which could suggest exhibitionism but more likely reflects self-care deficits, were more common. Misinterpretation of these events may be the source for some of the persistent lore regarding sexually disinhibited behavior in dementia patients.