Behavioral Psychological Symptoms Of Dementia Research Articles

Neuropsychological Characteristics of Wandering in Patients with Drug‐naïve Alzheimer’s Disease

AbstractBackgroundWandering represents one of a major problem occurring in patients with Alzheimer’s disease (AD). To find the disproportionate neuropsychological deficit and behavioral psychological symptoms in dementia (BPSD) of AD patients with wandering compared to AD patients without wandering, this study examined the set of neuropsychological tests and caregiver‐administered neuropsychiatric inventory (CGA‐NPI).MethodsPsychotropic‐naïve (drug‐naïve) probable AD patients with wandering (64) and without wondering (278) were assessed with the Seoul Neuropsychological Screening Battery, which included measures of memory, intelligence, and executive functioning.ResultsPatients with wandering had lower scores in the Rey‐Osterrieth Complex Figure copy, Fist‐edge‐palm, Alternating hand movement tests compared to patients without wandering. The degree of wandering in AD patients was significantly related with CGA‐NPI subdomains of aggression, disinhibition, depression, and delusions.ConclusionsThis study showed that 1) AD patients with wandering have disproportionately cognitive deficit suggesting frontal and right parietal dysfunctions, 2) wanderings are related with specific BPSD. Considering these results, AD patients with wandering may have specific neuronal anatomic substrates related with pathology of Alzheimer.

Factors influencing professional quality of life of nurses in long-term care hospitals: A cross-sectional study

Purpose: The purpose of this study was to identify factors related to the professional quality of life of nurses in long-term care hospitals. Methods: A descriptive survey was conducted among 144 nurses with more than 3 months of work experience in five long-term care hospitals in B metropolitan city. Data were collected from April 15 to 30, 2022 and analyzed using the independent t-test, one-way ANOVA, Mann-Whitney test, Pearson’s correlation coefficients, and stepwise multiple regression. Results: The regression model explained 51% of the variance of long-term care hospital nurses' compassion satisfaction (F=35.72, <i>p</i><.001). Significant factors were dementia attitude (β=.23, <i>p</i>=.001), professional self-concept (β=.51, <i>p</i><.001), marital status (married) (β=.16, <i>p</i>=.019) and more than 10 years of clinical experience at a long-term care hospital (β=-.29, <i>p</i><.001). The regression model explained 36% of the variance of long-term care hospital nurses' compassion fatigue (F=12.93, <i>p</i><.001). Significant factors were dementia attitude (β=-.27, <i>p</i>=.001), burden on behavioral psychological symptoms of dementia (β=.38, <i>p</i><.001), women (β=.20, <i>p</i>=.005), more than 10 years of clinical experience at a long-term care hospital (β=.20, <i>p</i>=.004) and experience in education about dementia (yes) (β=-.16, <i>p</i>=.029). Conclusion: This study revealed several factors that are correlated with the professional quality of life of long-term care hospital nurses. To improve their quality of life, hospitals should help nurses have a positive attitude toward dementia, reduce the burden of behavioral psychological symptoms of dementia, and provide dementia care training.

Family caregiver competence in managing behavioral and psychological symptoms of dementia: A concept synthesis.

This study aimed to identify the attributes of "family caregiver competence in managing behavioral psychological symptoms of dementia". Six electronic databases were searched for studies published between January 1990 and June 2017 with the key words "dementia", "behavioral psychological symptoms of dementia", "caregiver", "coping (managing)", and "competence". From the final fully reviewed 26 articles, descriptions related to family caregiver's dealing with behavioral psychological symptoms of dementia were extracted first. Then, based on Walker and Avant's concept synthesis, the concept of "family caregiver competence in managing behavioral psychological symptoms of dementia" was explored. Four attributes, namely "Judging", "Empathizing", "Adjusting", and "Reflecting", comprised of ten categories were identified as constituting the concept of family caregiver competence in managing the behavioral psychological symptoms of dementia. As a meta competence, "reflecting" may play a significant role in improving family caregiver competence by interacting with the other dimensions of competence in managing symptoms. Based on the suggested conceptual model, education or training programs could be developed to improve family caregiver competence in managing behavioral psychological symptoms of dementia. To refine the attributes found in this study, field studies including observations of and interviews with family caregivers need to be conducted. Studies exploring the associations between these attributes are also of value.

Predictors of Change in Behavioral Psychological Symptoms of Dementia in Patients With Alzheimer’s Disease in Korea

Predictors of Change in Behavioral Psychological Symptoms of Dementia in Patients With Alzheimer’s Disease in Korea 의 이용 수, 등재여부, 발행기관, 저자, 초록, 목차, 참고문헌 등 논문에 관한 다양한 정보 및 관련논문 목록과 논문의 분야별 BEST, NEW 논문 목록을 확인 하실 수 있습니다.

Factors associated with eating performance in older adults with dementia in long-term care facilities: a cross-sectional study

BackgroundThe purpose of this study was to investigate factors influencing eating performance in older adults with dementia (OAWDs) in long-term care (LTC) facilities.MethodsThis cross-sectional study examined risk factors for compromised eating performance by comparing both independent and dependent older adults with dementia. The study participants were 117 OAWDs in LTC facilities in South Korea. Measurements included (a) general characteristics, (b) activities of daily living (ADL) including eating performance, (c) cognitive function, (d) physical capability, (e) grip strength, (f) Behavioral Psychological Symptoms of Dementia (BPSD), and (g) depression. Data were analyzed by the percentage, mean and standard deviation, Chi-square test, t-test, and logistic regression.ResultsThe eating independent group had more comorbidities than the dependent group (t = 2.793, p < .006); had significantly higher cognition (t = 4.108, p < .001) and physical capability (t = 5.258, p < .001); and had stronger grip strength (t = 2.887, p = .005). Comorbidities and physical capability were determinants for independent eating performance (Odds Ratio [OR] = 1.969, p = .014; OR = 1.324, p < .001).ConclusionsIt is suggested that maintaining physical capability should be encouraged to support independent eating performance by OAWDs in LTC facilities. The results of this study could serve as a basis for developing function-focused care to maintain the residual eating performance of OAWDs in Korean LTC facilities. This is a subject area that has not been fully explored.

Association between Behavioural Psychological Symptoms of Dementia and Caregiver Burden in a South Indian Rural Community

Background: Behavioural and psychological symptoms of dementia (BPSD) and caregiver burden are twomajor issues in dementia patients. This study was conducted to estimate the association of BPSD withcaregiver burden in patients with dementia living in a south Indian community.Method: In a cross-sectional study done in Thalikkulam village, Kerala, 71 elderly of minimum 60 yearsand living with a primary caregiver for minimum one year were first selected with purposive sampling andscreened with Brief Community Screening Instrument for Dementia. Then BPSD and caregiver burden weremeasured by Neuropsychiatric Inventory Questionnaire and Zarit Burden Interview respectively.Result: Statistical analysis revealed that all patients (100%) experienced at least one BPSD and apathy(76.1%), delusion (74.6%) and agitation (70.4%) were the most common BPSD reported. Majority (93%) ofcaregivers reported caregiver burden. Strong positive correlation (p&gt;0.05) was found between BPSD scoresand caregiver burden scores.Conclusion: The study found that BPSD and caregiver burden is common among community dwellingpatients with dementia and have significant association with various socio demographic variables. Thisstudy recommends that while identifying dementia in community, health professionals need to focus onmanagement of BPSD and caregiver burden which can influence the outcome of dementia.

351 - Success rate of various countermeasures against behavioral psychological symptoms of dementia based on the accumulation of real-world experience

Background and Objective:Appropriate countermeasures that can alleviate behavioral psychological symptoms of dementia (BPSD) are proposed. However, the effectiveness of these countermeasures has not been fully verified. Conversely, the caregivers of patients with dementia encounter BPSD every day and adopt some kind of measures against that particular BPSD.Methods:We collected data regarding “whether or not a certain measure against a particular BPSD alleviates the symptom (care experience)” from all over Japan using Dementia Chienowa Net, which is a website we developed in 2016. We also collected patient’s data, such as sex, primary disease, and nursing care level, which is an indicator of dementia severity in the Long-term Care Insurance System of Japan.Results:In this study we analyzed 2003 care experiences (M/F:808/1192). In terms of primary disease, there were 1113 cases (55.6%) of Alzheimer’s dementia (AD), 236 cases (11.8%) of dementia with Lewy bodies (DLB), 217 cases (10.8%) of frontotemporal lobar degeneration (FTLD), and 118 cases (5.9%) of vascular dementia (VaD). Among AD patients living at home with nursing care level 1, care experiences related to forgetfulness were the most common at 43%, denial/rejection was 14%, and restless behavior was 9%. For nursing care level 2, forgetfulness was 38%, restless behavior was 15%, and denial/rejection was 9%. For nursing care level 3, restless behavior was most common at 30%, forgetfulness was 17%, and denial/rejection was 16%. Success rates were calculated; for “forgetting to take medicine,” the success rate of “use of medicine box” was 40%. The success rate of “use of medicine calendar” was 60.8%, and the success rate of “someone handing over the medicine” was 92.3%. For “poor fire management,” the success rate of “changing to equipment that is less likely to cause hazards” was 71.4%.Conclusions:The frequency of DLB and FTLD in care experiences on Dementia Chienowa Net was more than the frequency of the diseases in Japan. The percentage of BPSD categories troubling patients’ families differed depending on the severity of the dementia. The success rate of some common countermeasures against BPSD frequently encountered in daily life was embodied numerically.

Exploring the barriers and gateways to intersubjectivity in dementia care: A meta-ethnography.

Behaviours that challenge in dementia, often described and diagnosed as behavioural psychological symptoms of dementia, are experienced by 75% of people living with dementia in care homes or hospital environments, with 43% of nurses and care providers reporting these behaviours as moderately or severely distressing to them. During behaviours that challenge moments in dementia, there is the potential for an intersubjective relationship to take place between the people living with dementia and the nurse. This review explores and synthesises literature to consider the presence of intersubjectivity in people living with dementia. If the ability to be intersubjective remains present for people living with dementia, it will consider how its presence can be nurtured to offer a positive intersubjective communication between the person living with dementia and their carer/nurse. The review used meta-ethnography methodology to develop concepts that help us to understand the implications of existing research on the presence of intersubjectivity in people living with dementia, and its relationship to those providing their care. Sixteen electronic databases (including MEDLINE/PubMed, Wiley Online Library and Sage publications) and grey literature such as Alzheimer's Society and Department of Health across journals dating from 2000-2020 were searched. Eight studies were selected and reviewed for quality and relevance for a meta-ethnographic literature synthesis of intersubjectivity in dementia. The meta-ethnography concluded that people living with dementia continue to have the capacity to be intersubjective on an emotional level. Nurses and other care providers need to acknowledge the presence of "personhood" and "personness" in people living with dementia to nurture positive intersubjective care relationships. The meta-ethnography has also been reviewed for reporting clarity against the EQUATOR checklist in the form of the eMERGe guideline (France et al., 2019).

Behavioral psychological symptoms of dementia and functional connectivity changes: a network-based study

Behavioral and psychological symptoms of dementia (BPSD) are commonly observed since the early stage of Alzheimer's disease (AD) associated with structural brain changes. It is conceivable that they may also relate to functional brain changes. This resting-state functional MRI (RS-fMRI) study investigated the alterations within functional brain networks of a cohort of AD patients at different clinical stages who presented with BPSD. One hundred one AD patients and 56 patients with amnestic mild cognitive impairment underwent a neuropsychological evaluation including the Neuropsychiatry Inventory-12 (NPI-12). All patients and 35 healthy controls (HS) underwent 3T-MRI. Factor analysis was used to extract the principal factors from NPI-12, while RS-fMRI data were processed using graph theory to investigate functional connectivity. Five factors were extracted from NPI-12. Sixty-two percent of patients showed BPSD and functional brain connectivity changes in various networks compared to those without BPSD and HS. These changes contributed to account for patients' BPSD. This work opens new perspectives in terms of nonpharmacological interventions that might be designed to modulate brain connectivity and improve patients' BPSD.

Implementation of the Evidence Integration Triangle for the Management of Behavioral Psychological Symptoms of Dementia (EIT-4-BPSD) Intervention in a Nursing Home Setting.

Behavioral Psychological Symptoms of Dementia (BPSD) are described as symptoms of apathy, agitation, inappropriate vocalization, aggression, wandering, and resistiveness to care. Not managing BPSD appropriately can cause an increase in frustration, stress, and burnout amongst staff members, and negatively impacts the health and quality of life for residents with dementia. Psychotropic medications are often administered to residents with BPSD in long-term care facilities and can lead to adverse effects such as an increase in falls, mortality, cardiovascular events, and hospitalizations. The Centers for Medicare and Medicaid Services require facilities to use non-pharmacological person-centered interventions as first line treatment for the management of BPSD.

A Systematic Review of the Literature for the Effects of Music on Dementia Patients

Introduction: There are over 100 different forms of dementia which is a broad term employed to describe symptoms effecting the brain caused by neurological and vascular diseases. It is a neurological disease that results in a decline in cognitive, social and physical disability which currently has no cure. The prevalence is expected to triple by 2050, due to the aging population trends in Canada. It has been estimated that 24.3 million people have dementia, and there are 4.6 million new cases annually, which accounts for one case every 3 seconds globally. Objectives: This systematic review examines the effects of music therapy on behavioral psychological symptoms of dementia and the quality of life. Methods: A systematic literature search was performed in Ovid Medline, CINAHL and PsycINFO from January 2000 until August 2019. A data abstraction template was employed to for data management and organization. We included all peer reviewed, English articles, RCT’s, systematic reviews, meta-analysis, abstract pool and all or some key words. Results: From 968 potentially relevant records, 55 studies were evaluated for eligibility, and 20 met the inclusion criteria. Overall the studies showed a significant impact on mitigating agitation, reducing BPSD and improving memory, cognition, QOL and decreasing anxiety and symptoms associated with depression. Conclusion: The role of musical interventions found in the literature demonstrates the benefits of music therapy on dementia patients due to its positive effects on BPSD, quality of life and other behavioral symptoms.

A Scoping Review of Dementia Symptom Management in Persons with Dementia Living in Home-based Settings.

A large proportion of our older adults live with Alzheimer's Disease and Related Dementias and the number of those diagnosed in the future is expected to increase dramatically as the population ages. Persons with dementia bring unique healthcare challenges due to the manifestation of behavioral and psychological symptoms associated with the disease. The lack of geriatric clinicians as well as a properly trained non-geriatric specialist workforce capable of addressing the symptoms persons with dementia exacerbate the challenge of providing effective care. Pharmacological interventions are contraindicated for treatment of most behavioral psychological symptoms of dementia (BPSD). The Centers for Medicare and Medicaid Services now requires that nonpharmacological interventions be used as a first-line treatment. It has not been determined what nonpharmacological intervention for BPSD are most effective and what the infrastructure would entail for such interventions for PWD living at home. The purpose of this study is to examine the literature focusing on interventions aimed towards managing persons' symptoms of dementia living in home-based settings. A scoping review examining the literature published on this topic over the last three years was conducted. One thousand twenty four articles were found, of which nine met inclusion criteria. Five articles used occupational based therapy, two used exercise therapy and one article was found utilizing aromatherapy and music therapy.

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 associations between behavioral-psychological symptoms of dementia (BPSD) and coping strategy, burden of care and personality style among low-income caregivers of patients with dementia

BackgroundThe main aim of this study was to determine the association between Behavioral and Psychological Symptoms of Dementia (BPSD) and caregiver burden, and the mediating role of coping strategy and personality style of caregivers to patients with dementia (PWD).MethodsThis cross-sectional study was conducted among 202 caregivers to PWD in home-based settings. Recruited caregivers were administered questionnaires regarding BPSD which was measured using Neuropsychiatric Inventory-Questionnaire (NPI-Q), caregiver burden using Zarit Burden Interview (ZBI), Brief COPE for coping strategies and Big-Five Inventory which measured personality traits.ResultsMajority of the caregivers were female (71.3%), aged 50 and above (55%), single (46%), married (43.6%), working full time (45%) while the rest work part time (22.3%), unemployed (7.4%) and retiree (25.2%), and majority were parents (58.9%) and spouse (18.3%). The duration of caregiving was less than a year (33.7%) while the rest are more than a year. Results demonstrated that the most frequent types of BPSD exhibited by PWD was irritability, followed by apathy and agitation. All of the types of BPSD showed to be significantly correlated to caregiver burden except for anxiety, elation and appetite. Of personality traits, only conscientiousness was found to mediate the relationship between BPSD and caregiver burden (p < .05). Self-distraction, active coping, planning and acceptance were the coping strategies that demonstrated to have mediation effect on the relationship between BPSD and caregiver burden.ConclusionPresentation of BPSD is correlated to caregiver burden which is partially mediated by coping strategies and personality styles.

Antipsychotic drug use and favourable natures of emotional functions in patients with dementia.

To characterise the effects of antipsychotics on brain functions of patients with behavioural psychological symptoms of dementia (BPSD). Studies were performed during 6 weeks of intervention with either a nonantipsychotic drug (group A, n = 38) or an antipsychotic drug (group B, n = 10). Neuropsychiatric Inventory scores were significantly decreased in both groups. Scores on the Mini-Mental State Examination did not change with intervention. By contrast, favourable natures of emotional functions, scored using the Delightful Emotional Index of 10 items, were significantly lower in the antipsychotic drug treatment group B relative to scores in the nonantipsychotic drug treatment group A. Antipsychotics reduce favourite emotions as well as BPSD, and this should be considered in prescribing medications for patients with dementia.

Variations and factors associated with psychotropic use in cognitively impaired elderly residing in long-term care facilities in East Asia: a cross-sectional study.

The aim of this cross-sectional study was to compare patterns of psychotropic prescription drug use among cognitively impaired residents in long-term care facilities in East Asia and to explore factors associated with these patterns. This study included elderly participants with cognitive impairments residing in long-term care facilities with and without dementia care units in Japan, South Korea, China, Taiwan, and Thailand. The Mini-Mental State Examination, the Clinical Dementia Rating, and the Neuropsychiatric Inventory, Nursing Home version were used to assess cognitive status, examine dementia severity, and evaluate behavioural psychological symptoms of dementia, respectively. The rate of psychotropic drug use and the relationship between the number of psychotropic drugs and clinical factors were examined. In total, 662 people were analyzed. Facilities with dementia care units had a higher rate of anti-dementia drug use than regular elderly care sites. Among the three dementia care sites, a Japanese hospital and a Korean site had a high rate of antipsychotic use and use of other types of psychotropics, whereas these drugs were used at a low rate in a Chinese nursing home. Patterns of psychotropic drug use may be partially associated with local regulations and facility type. Poly-pharmacy was identified as a common problem at all study sites. Our findings will be beneficial for health-care professionals and policymakers when developing practice guidelines and strategies to regulate overuse of psychotropics and poly-pharmacy. Prospective studies are needed to examine patterns of psychotropic prescriptions and to promote evidence-based practice.

Rehabilitation strategy for hip fracture, focused on behavioral psychological symptoms of dementia for older people with cognitive impairment: A nationwide Japan rehabilitation database.

The aim is to investigate the relationship between a positive outcome on rehabilitation after hip fracture and behavioral psychological symptoms of dementia (BPSD) transition during rehabilitation. This study is a retrospective cohort study based on the Japan Rehabilitation Database. We recruited 756 subjects 65 years of age or older from 31 hospitals in the database. All subjects were in the hospital as patients undergoing rehabilitation for hip fracture. Functional independence measure (FIM), walking ability, Mini-Mental State Examination (MMSE), and BPSD were measured both at the beginning and at the end of rehabilitation. MMSE for 23 or under was defined as the cognitive-impaired group. MMSE for 24 or over was used as the cognitively intact group. Cognitive impaired participants were divided into four groups: participants presented no BPSD both at the beginning of rehabilitation and at the end of rehabilitation (Group (-/-)), participants presented BPSD at the beginning of rehabilitation but resolved at the end of rehabilitation (Group (+/-)), participants had no BPSD at the beginning of rehabilitation but appeared at the end of rehabilitation (Group (-/+)) and participants had sign of BPSD both at the beginning of rehabilitation and at the end of rehabilitation (Group (+/+)). The endpoints were waking ability, FIM gain. As results, one hundred thirty-seven cognitive-impaired older people patients out of 471 (29.1%) suffered from BPSD at the beginning of rehabilitation. FIM gains in cognitively intact group, Group (-/-), Group (+/-), Group (-/+) and Group (+/+) were 24.8 ± 18.7, 17.5 ± 16.9, 27.3 ± 19.7, 17.8 ± 12.2 and 12.2 ± 17.2, respectively. The Group (+/-) was significantly connected to a positive outcome for rehabilitation. The present study suggested that the management of BPSD can lead to better functional recovery during rehabilitation.

ANALYSIS AND EVOLUTION OF THE PRESCRIPTION OF ANTIPSYCHOTICS IN A BELGIAN PSYCHOGERIATRIC WARD AFTER THE INTERVENTION OF A CLINICAL PHARMACOLOGIST AND AFTER TRAINING THE MEDICAL TEAM

Antipsychotics are frequently overused in the management of Behavioral & Psychological Symptoms of Dementia (BPSD), given their low risk-benefit ratio. This study aims to investigate if antipsychotic prescriptions in an acute geriatric ward can be reduced following the delivery of a non-pharmacological training program to care team members and the addition of a clinical pharmacist to the care team. This is a single-centre retrospective observational study based on the systematic review of computerized hospitalization records of patients who were admitted to the Psychogeriatric ward at André Vesale University Hospital in Belgium over two 12-month periods. We compared antipsychotic prescribing practices at baseline (2013-14) to data collected 3 years later (2016-17). In the period that intervened, we delivered training about non-pharmacological treatments to the care team and introduced a clinical pharmacist to the team, whose role was to verify all antipsychotic prescriptions. Dependent measures were the type of medication used, the daily dose prescribed and the daily dose defined (DDD). In 2013-14, there were 410 admissions and 163 received at least one dose of antispychotic. In 2016-17, there were 404 admissions and 167 patients received at least one dose. The samples were matched for gender, age, comorbidities, geriatric assessment, type of dementia and psychiatric diseases. Atypical antipsychotics were favored in both cohorts with a strong preference for quetiapine followed by risperidone. Average medication use, expressed as a function of DDD for each molecule per patient reported per 100 days of hospitalization, was 10.64 +/- 15.56 in 2013-14 compared to 7.49 +/- 9.38 in 2016-17. This corresponds to a significant decrease of 29% between our 2 cohorts (p = 0.05). This study shows that it is possible to improve antipsychotic prescription practices in a geriatric ward through the intervention of a clinical pharmacist and the delivery of non-pharmacological training to the care team. The management of the BPSD is challenging; when non-pharmacological treatments do not suffice to manage symptoms, antipsychotics may be used. With effective training and oversight, we show that they can be utilised effectively in lower doses and for shorter periods of time.

Backgrounds and/or Triggers of Hospitalized Dementia with Behavioral Psychological Symptoms

Backgrounds and/or triggers of dementia are vague except brain diseases such as cerebral stroke, brain injury, alcoholism, and schizophrenia. However, the backgrounds and/or triggers of patients who suffer from severe behavioral psychological symptoms of dementia (BPSD) and may require hospitalizations in institutions that specialize in the treatment of severe BPSD have not been specifically studied. In this work, we retrospectively investigated, through family interviews, the backgrounds and/or triggers of patients with BPSD hospitalized in Sendai Tomizawa Hospital, one of the psychiatric dementia hospitals.

Education Program of Kampo-medicine for Undergraduates in Preparation for Clinical Setting

Kampo-medicine has become popular in Japanese medical practice combined with western medicine. For example, Daikenchu-To for intestinal obstruction after surgical operation, Shakuyakukanzo-To and Goshajinki-Gan for anti-cancer agents-induced neuropathy, and Yokkan-San for behavioral psychological symptoms of dementia are alternatively used in addition to conventional treatments in Japan. However, combined use of Kampo-medicine and western medicine may cause unexpected adverse events including undesirable drug-drug interactions because Kampo-medicine was not originally developed to be used with western medicine. Although adverse effects of Kampo-medicine are rare compared with those of western medicine, severe events such as liver dysfunction and interstitial pneumonia have been reported in increasing trends. Medical staff including pharmacists, therefore, should be aware of the onset of adverse events before the patients' symptoms become severe. Several adverse effects are caused by chemical constituents such as glycyrrhizin in licorice for pseudoaldosteronism and geniposide in Gardeniae fructus for mesenteric phlebosclerosis. To understand the adverse effects of Kampo-medicine, pharmacists should learn trends in current medication as well as pharmacology and toxicology of the chemical constituents in pharmacognosy. These issues should also be addressed in educational materials for students of clinical pharmacy and pharmacy practice.