Behavioral Disturbances In Dementia Research Articles

Comparative efficacy and safety of olanzapine and risperidone in the treatment of psychiatric and behavioral symptoms of Alzheimer's disease: Systematic review and meta-analysis.

Olanzapine and risperidone have emerged as the most widely used drugs as short-term prescription in the treatment of behavioral disturbances in dementia. The present systematic review and meta-analysis was hence performed to investigate the effectiveness and safety profile of olanzapine and risperidone in the treatment of behavioral and psychological symptoms of dementia (BPSD), aiming to provide updated suggestion for clinical physicians and caregivers. Prospective controlled clinical studies were included, of which available data was extracted. Outcomes of BEHAVE-AD scores with the variation of grades, specific behaviors variables, as well as safety signals were pooled for the analysis by odds rates and weighted mean differences, respectively. Medline, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and WanFang. Prospective, controlled clinical studies, conducted to compare the effectiveness and safety profile of olanzapine and risperidone in the treatment of BPSD. Interested data including baseline characteristics and necessary outcomes from the included studies were extracted independently by 2 investigators. BEHAVE-AD scale was adopted to assess the efficacy in the present study. All behaviors were evaluated at the time of the initiation of the treatment, as well as the completion of drugs courses. Adverse events were assessed with the criteria of Treatment Emergent Symptom Scale, or Coding Symbols for a Thesaurus of Adverse Reaction Terms dictionary. Weighted mean difference was used for the pooled analysis. A total of 2427 participants were included in the present meta-analysis. Comparative OR on response rate, and remarkable response rate between olanzapine and risperidone was 0.65 (95% CI: 0.51-0.84; P = .0008), and 0.62 (95% CI: 0.50-0.78; P < .0001), respectively. There were statistical differences observed by olanzapine on the improvement of variables including delusions (WMD, -1.83, 95% CI, -3.20, -0.47), and nighttime behavior disturbances (WMD, -1.99, 95% CI, -3.60, -0.38) when compared to risperidone. Our results suggested that olanzapine might be statistically superior to risperidone on the reduction of BPSD of Alzheimer's disease, especially in the relief of delusions and nighttime behavior disturbances. In addition, olanzapine was shown statistically lower risks of agitation, sleep disturbance, and extrapyramidal signs.

Integration of Geriatric Psychiatry and Geriatrics: Enhancing Mental Health Assessment in the Elderly

IntroductionThe ageing population presents complex clinical challenges, particularly in the realm of mental health among the elderly. The intersection of geriatric psychiatry and geriatrics plays a critical role in providing a holistic and comprehensive approach to addressing psychiatric issues in older adults. This abstract explores the integration of these two disciplines and their significance in elderly mental health care.ObjectivesThis study aims to underscore the benefits of collaboration between geriatric psychiatry and geriatrics while highlighting areas of intersection. These areas include the assessment of medical and psychiatric comorbidities, the management of neuropsychiatric disorders, and the promotion of healthy ageing, both physically and mentally.MethodsWe comprehensively reviewed the literature, encompassing research studies, case reports, clinical guidelines, and reports published in the last 10 years. The research was conducted on medical databases, including PubMed, Medline, and specialized sources in gerontology.Results Effective integration between geriatric psychiatry and geriatrics provides a more comprehensive and patient-centred approach to addressing the mental health needs of the elderly. This includes enhanced assessment and treatment of a wide range of psychiatric conditions commonly found in older adults, such as cognitive disorders (including dementia and mild cognitive impairment), mood disorders (including depression and bipolar disorder), anxiety disorders, psychotic disorders, and substance use disorders. Additionally, the collaboration ensures a better understanding of the complex interplay between physical and mental health in the ageing population. The integration approach also encompasses the management of neuropsychiatric symptoms associated with various medical conditions common in older adults, such as delirium and behavioural disturbances in dementia. This coordinated care extends to the judicious use of psychotropic medications, considering the unique pharmacokinetics and pharmacodynamics in the elderly population, with a focus on minimizing adverse effects and drug-drug interactions. Furthermore, promoting emotional well-being and preventing mental illnesses emerge as critical areas of collaboration between these disciplines. Strategies for achieving this goal include psychoeducation, lifestyle interventions, and fostering a supportive environment for the elderly.Conclusions In summary, the collaboration between geriatric psychiatry and geriatrics is crucial for addressing the complex mental health needs of the elderly, providing patient-centred care, and optimizing resources. This integrated approach is essential in ensuring the well-being of older adults, emphasizing a holistic, multidisciplinary approach to mental health issues in this population.Disclosure of InterestNone Declared

Joint effect of cognitive decline and walking ability on incidence of wandering behavior in older adults with dementia: A cohort study.

Wandering behavior is one of the most troublesome behavioral disturbances in dementia. Inconsistent associations between physical function and wandering behavior were reported, and the effect of cognitive decline may be different according to walking ability. The purposes of this study are to investigate whether high walking ability is a risk factor for wandering behavior and to investigate the interaction of walking ability and cognitive function with wandering behavior in older adults with dementia. This retrospective cohort study included 3979 elderly adults with dementia. The association of cognitive function and walking ability with incidence of wandering behavior during a 5-year follow-up period were examined using a generalized linear model, and relative excess risk due to interaction (RERI) was calculated. Severe cognitive decline and high walking ability were associated with a higher risk for wandering behavior. Additionally, some joint effects of cognitive decline and walking ability decline were higher than the sum of its individual effects (RERI [95% confidence interval], severe cognitive decline×'walk with help': 1.58 [0.35, 2.81]; severe cognitive decline×'independent': 3.09 [1.05, 5.14]). Effects of cognitive decline and walking ability on incidence of wandering behavior were observed, and the effects varied depending on their combination.

1383Interaction of cognitive decline and walking ability to influence wandering behavior: a cohort study

Abstract Background Wandering behavior is one of the most troublesome behavioral disturbances in dementia. Though cognitive decline leads to wandering behavior, its effects may vary across walking ability. The purpose of this study was to investigate the joint effect of cognitive decline and walking ability on wandering behavior. Methods This retrospective cohort study in community analyzed 3920 elderly adults with dementia. The association of cognitive function and walking ability with an incidence of wandering behavior during a 5-year follow-up period were examined using a generalized linear model, and relative excess risk due to interaction was calculated. Results Compared to ‘walk independently’, adjusted risk ratios (95% confidence intervals) for ‘walk with help’ and ‘unable to walk’ were 0.51 (0.42, 0.63) and 0.21 (0.16, 0.28), respectively (P for trend &amp;lt; 0.001). Compared to mild cognitive decline, adjusted risk ratios (95% confidence intervals) for moderate and severe cognitive decline were 1.44 (1.17, 1.77) and 1.73 (1.36, 2.18), respectively (P for trend &amp;lt; 0.001). Additionally, some joint effects of cognitive decline and walking ability decline were lower than the sum of its individual effects (relative excess risk due to interaction (95% confidence interval), moderate cognitive decline × ‘walk with help’: -0.45 (-0.98, -0.01); severe cognitive decline × ‘unable to walk’: -0.95 (-1.71, -0.37)). Conclusions Effects of cognitive decline and walking ability on incidence of wandering behavior were observed, and the effects varied depending on their combination. Key messages Our results help clinicians to predict and manage wandering behavior.

Behavioral Disturbances in Dementia and Beyond: Time for a New Conceptual Frame?

Alzheimer’s disease and vascular dementia are estimated to be the most common causes of dementia, although mixed dementia could represent the most prevalent form of dementia in older adults aged more than 80 years. Behavioral disturbances are common in the natural history of dementia. However, so far, there is a paucity of studies that investigated the causal association between behavioral psychological symptoms of dementia and dementia sub-types, due to the high heterogeneity of methodology, study design and type of clinical assessment. To understand the scant evidence on such a relevant clinical issue, it could be hypothesized that a new shifting paradigm could result in a better identification of the relationship between behavioral disturbances and dementia. This narrative review provides an update of evidence on the behavioral patterns associated with different dementia sub-types and offers a potential future perspective as common ground for the development of new translational studies in the field of behavioral disturbances in dementia and the appropriateness of psychoactive treatments.

The use of electroconvulsive therapy in dementia with behavioral disturbances

As many as 50% of demented patients are agitated at some point during their illness and up to a third may became physically aggressive toward caregivers. First-line treatment approaches for behavioral disturbances in dementia are psychosocial and not pharmacological. Pharmacological interventions are second line, but the use of most medications is off label and complicated by potentially serious side effects. There is an absence of evidence-based data as to the use of ECT to treat refractory behavioral disturbances in dementia, although a large body of case reports and case series points to its possible safety and efficacy. In the absence of clear evidence for its efficacy and indications for use, we have developed a clinical guide to inform the use of ECT in this population.

Prescription Benzodiazepine Use Among Older Adults: A Critical Review.

Despite evidence for many potential risks, use of benzodiazepines (BZDs) among older adults is common. The authors evaluated the available evidence for BZD effectiveness and tolerability for use in older adults in three psychiatric conditions for which BZDs are commonly prescribed: insomnia, anxiety disorders, and behavioral and psychological symptoms of dementia. Electronic databases, including PubMed/MEDLINE, were searched to identify articles that (1) included patients ≥50 years of age, (2) focused on patients diagnosed with insomnia, anxiety disorders, or behavioral and psychological symptoms of dementia, and (3) were either a randomized, placebo-controlled trial or a randomized trial comparing a BZD with either another psychotropic medication or psychotherapy. Thirty-one studies met the inclusion criteria. Of the three clinical indications evaluated, treatment of insomnia had the greatest available evidence for use of BZDs among older adults, with 21 of 25 trials demonstrating improved sleep outcomes with use of BZDs. Only one trial was found to meet eligibility criteria for BZD use in anxiety disorders, demonstrating benefit over placebo. Five studies for use in behavioral disturbances in dementia were included, of which only one demonstrated improvement over placebo. This systematic review suggests that BZD prescribing to older adults is significantly in excess of what the available evidence suggests is appropriate. Future trials should focus on efforts to reduce both acute and chronic BZD use among older adults while improving access to effective non-pharmacologic treatment alternatives.

Buspirone for the treatment of dementia with behavioral disturbance.

Behavioral disturbances are common but serious symptoms in patients with dementia. Currently, there are no FDA approved drugs for this purpose. There have been case reports and small case series of the use of buspirone. In this retrospective study, we review 179 patients prescribed buspirone for treatment of behavioral disturbance in dementia to better characterize the efficacy and potential side effects. All patients prescribed buspirone for behavioral disturbance due to dementia from a geropsychiatric outreach program were reviewed. Data was collected and analyzed using SPSS. One hundred-seventy-nine patients met criteria for the study with a mean age of 83.8 + 7. Alzheimer's dementia was the most common dementia (n = 61; 34.1%) followed by mixed dementia (n = 50, 27.9%) then vascular type (n = 31; 17.3%). Behavioral disturbances were mainly verbal aggression (n = 125; 69.8%), and physical aggression (n = 116; 64.8%). Using the Clinical Global Impression scale, 68.6% of patients responded to buspirone, with 41.8% being moderately to markedly improved. The mean dose of buspirone was 25.7 mg ± 12.50. Buspirone appears to be effective in treating behavioral disturbances in dementia. Future prospective and double blinded studies are needed.

Ethical Challenges in Geriatric Psychiatry.

Ethical Challenges in Geriatric Psychiatry.

Validity of the Korean Version of the Face, Legs, Activity, Cry, and Consolability Scale for Assessment of Pain in Dementia Patients.

Pain is often associated with a more rapid progression of cognitive and functional decline, and behavioral disturbance in dementia. Therefore, it is essential to accurately assesses pain for proper intervention in patients with dementia. The Face, Legs, Activity, Cry, and Consolability (FLACC) scale is an excellent behaviour scale which includes most of the domains that are recommended by the American Geriatrics Society to evaluate when assessing pain in patients with dementia. The purpose of this study was to develop the Korean version of the FLACC (K-FLACC) and to verify its reliability and validity in assessing pain of elderly patients with dementia. We developed the K-FLACC to consist of the five domains (face, legs, activity, cry, and consolability) with scores of 0, 1, and 2 for each domain and a total score ranging from 0 to 10 as in the original FLACC. Eighty-eight patients with dementia who visited Konkuk University Medical Center were evaluated. The K-FLACC revealed good validity as compared to the Numeric Rating Scale (NRS; r = 0.617, P < 0.001) and the Face Pain Scale (FPS; r = 0.350, P = 0.001). All of the five domains of the K-FLACC were related to the NRS and FPS, in which the activity domain showed the highest correlation. Test-retest reliability was excellent, as the intra-class correlation coefficient comparing the retest to test was 0.73 (95% confidence interval, 0.59–0.82). Our results show that the K-FLACC is a suitable and valuable scale to assess pain in patients with dementia in Korea.

The use of low-dose antipsychotic medication

Alois Alzheimer observed behavioural disturbances in dementia over a century ago with a description of his first patient. Behavioural disturbances are prominent characteristics of dementia and can be very distressing to the individual, their family and caregivers. These symptoms include agitation, aggression, disinhibition and sleep disturbances. Up to 90% of patients with dementia suffer from such behavioural disorders (Muller-Spahn, 2003). This high prevalence may be partly due to a complex interaction of cognitive deficits, psychological symptoms and behavioural abnormalities. In particular, it is purported that neurodegenerative processes in various brain areas, like fronto-temporal cortex and limbic regions lead to a dysfunction of key neurotransmitters like acetylcholine, serotonin and noradrenalin, leading to a cocktail of behavioural symptoms with personality traits playing a modifying role. A large number of pharmacological treatment strategies have been used to manage behavioural disturbances in people with dementia (Zaudig, 1996). These have included antipsychotics, benzodiazepines or anticonvulsants. Though these drugs may substantially reduce undesirable behaviour, they may cause adverse side effect that may impact on the patient’s ability to perform activities of daily living. Historically, antipsychotic drugs have often been used to treat these behavioural abnormalities, but the extant literature is sceptical about their longterm use for this indication (Declercq et al, 2013). Ostensibly, their long-term effectiveness is limited and there is concern about their propensity to induce adverse effects, including higher mortality with long-term use. The National Institute for Clinical Excellence (NICE) guideline on dementia cautions against the use of any antipsychotics for non-cognitive symptoms or challenging behaviour of dementia unless the person is severely distressed or there is an immediate risk of harm to themselves or others (NICE, 2015). However, other recent meta-analytic studies have challenged previous findings of the unfavourable safety profile of antipsychotics in people with dementia (Hulshof et al, 2015). Overall, current consensus favours the judicious treatment of aggression and psychosis with antipsychotics for no more than 12 weeks under carefully defined conditions (Zuidema et al, 2015). Where the treatment with antipsychotics is indicated, a distinction ought to be made between antipsychotic treatment of severe behavioural symptoms Stanley Mutsatsa Senior Lecturer, City University London, Northampton Square, London Stanley.Mutsatsa@city.ac.uk The use of lowdose antipsychotic medication

Session 309 - Statewide Clinical Outreach Program for the Elderly: A System of Care for Managing Behavioral Disturbances in Dementia

Session 309 - Statewide Clinical Outreach Program for the Elderly: A System of Care for Managing Behavioral Disturbances in Dementia

Efficacy and safety of delta-9-tetrahydrocannabinol in behavioral disturbances in dementia: A randomized controlled trial

Efficacy and safety of delta-9-tetrahydrocannabinol in behavioral disturbances in dementia: A randomized controlled trial

Pharmacological Interventions for Individuals With Behavioral Disturbances in Dementia

Pharmacological Interventions for Individuals With Behavioral Disturbances in Dementia

Non-Pharmacological Management of Behavioral Disturbance in Dementia

Non-Pharmacological Management of Behavioral Disturbance in Dementia

Safety and utility of acute electroconvulsive therapy for agitation and aggression in dementia.

Agitation and aggression are among the most frequent and disruptive behavioral complications of dementia that contribute to increased cost of care, hospitalization, caregiver burden, and risk of premature institutionalization. This current study examined the safety and efficacy of electroconvulsive therapy (ECT) as a treatment for behavioral disturbances in dementia. We hypothesized that ECT would result in reduced agitated and aggressive behaviors between baseline and discharge. Twenty-three participants admitted to McLean Hospital (Belmont, MA, USA) and Pine Rest Christian Mental Health Services (Grand Rapids, MI, USA), with a diagnosis of dementia who were referred for ECT to treat agitation and/or aggression, were enrolled in the study. We administered the Cohen-Mansfield Agitation Inventory-Short Form, Neuropsychiatric Inventory-Nursing Home Version, Cornell Scale for Depression in Dementia, and the Clinical Global Impression Scale at baseline, during, and after the ECT course. Regression analyses revealed a significant decrease from baseline to discharge on the Cohen-Mansfield Agitation Inventory (F(4,8) = 13.3; p = 0.006) and Neuropsychiatric Inventory (F(4,31) = 14.6; p < 0.001). There was no statistically significant change in scores on the Cornell Scale for Depression in Dementia. The Clinical Global Impression scores on average changed from a rating of "markedly agitated/aggressive" at baseline to "borderline agitated/aggressive" at discharge. Treatment with ECT was well tolerated by most participants; discontinuation of ECT occurred for two participants because of recurrence of agitation and for three participants because of adverse events. Electroconvulsive therapy may be a safe treatment option to reduce symptoms of agitation and aggression in patients with dementia whose behaviors are refractory to medication management.

Electroconvulsive Therapy as a Treatment for the Behavioral Disturbances of Dementia

Electroconvulsive Therapy as a Treatment for the Behavioral Disturbances of Dementia

Listening to Music and Active Music Therapy in Behavioral Disturbances in Dementia: A Crossover Study

Listening to Music and Active Music Therapy in Behavioral Disturbances in Dementia: A Crossover Study

Repetitive and stereotypic phenomena and dementia.

Behavioral disturbances of dementia, such as repetitive and stereotypic phenomena, can be distressing to caregivers and may lead to early institutionalization of the patient. The purpose of this article is to examine the phenomenon of repetitive phenomena in patients with dementia. We searched the PubMed electronic databases for original research and review articles on repetitive phenomena in patients with dementia using the search terms "repetitive behavior, stereotypic behavior, dementia, Alzheimer's disease, Frontotemporal dementia." Repetitive and stereotypic phenomena are common problems in dementia, which may reflect a disruption of coordinated function within the basal ganglia or corticostriatal structures. There are no systematic studies concerning repetitive phenomena in patients with dementia, and very little is known about the treatment. Further studies are needed to determine the specific phenomena.

The Efficacy and Safety of Newer Anticonvulsants in Patients with Dementia

Anticonvulsants are a class of medications that have received considerable interest as possible treatments in patients with behavioural disturbances in dementia. The role of these medications for such a use remains controversial. The current paper reviews the published evidence surrounding the safety and efficacy (i.e. as a behavioural and cognitive treatment) of newer anticonvulsants in patients with dementia. A MEDLINE, International Pharmaceutical Abstracts, PsycINFO and clinicaltrials.gov search through to December 2011 was conducted for anticonvulsants that have received regulatory approval since 1996. Studies reporting behavioural or cognitive outcomes in patients with dementia were included. Nine trials involving only four medications met selection criteria and were included: levetiracetam (n = 4), oxcarbazepine (n = 1), topiramate (n = 2) and zonisamide (n = 2). Levetiracetam may have a role in the treatment of behavioural symptoms in dementia but study limitations substantially hinder the strength of such a recommendation. Oxcarbazepine and topiramate, based on limited data, do not appear to be effective treatments of behavioural symptoms in dementia. A lack of trials do not allow for conclusions to be made regarding zonisamide. From a cognitive standpoint, levetiracetam was the anticonvulsant most examined in patients with dementia, it appears to have less deleterious effects than some anticonvulsants. Limited data are available on the safety of these medications in elderly patients; however, studies completed thus far have demonstrated some adverse events that are more common or problematic with the use of these drugs in this patient population (i.e. somnolence, dizziness, hyponatraemia, weight loss).