Behavioral Psychological Symptoms Of Dementia Research Articles

Reduction of Behavioral Psychological Symptoms of Dementia by Multimodal Comprehensive Care for Vulnerable Geriatric Patients in an Acute Care Hospital: A Case Series.

Management of Behavioral and Psychological Symptoms of Dementia (BPSD) is a key challenge in geriatric dementia care. A multimodal comprehensive care methodology, Humanitude, with eye contact, verbal communication, and touch as its elements, was provided to three geriatric dementia patients for whom conventional nursing care failed in an acute care hospital. Each episode was evaluated by video analysis. All patients had advanced dementia with BPSD. Failure of care was identified by patient's shouting, screaming, or abrupt movements of limbs. In this case series, conventional care failed for all three patients. Each element of care communication was much shorter than in Humanitude care, which was accepted by the patients. The average of the elements performed during the care was eye contact 0.6%, verbal communication 15.7%, and touch 0.1% in conventional care and 12.5%, 54.8%, and 44.5% in Humanitude care, respectively. The duration of aggressive behavior of each patient during care was 25.0%, 25.4%, and 66.3% in conventional care and 0%, 0%, and 0.3% in Humanitude, respectively. In our case series, conventional care was provided by less eye contact, verbal communication, and touch. The multimodal comprehensive care approach, Humanitude, decreased BPSD and showed success by patients' acceptance of care.

Impact of Dementia Knowledge, Burden from Behavioral Psychological Symptoms of Dementia and Empathy in the Caring Behavior of Certified Caregivers in Nursing Homes

Purpose: The purpose of this study was to identify the impact of dementia knowledge, burden from behavioral psychological symptoms of dementia (BPSD) and empathy in the caring behavior of certified caregivers in nursing homes. Methods: The participants in this study were 203 caregivers who worked in 15 institutions. They were selected by quota sampling from 177 nursing homes in Jeollanam-do. Collected data were analyzed using descriptive statistics, t-test or ANOVA, Scheffe test, Pearson correlation coefficient, and multiple regression analysis. Results: Knowledge about dementia actually did not influence caring behavior (β=-.10, p=.197), but empathy towards elderly people (β=.23, p=.004) and the burden of BPSD (β=.16, p=.032) was found to have a positive influence on caring behaviors. Conclusion: The findings show that the factors that influence caring behaviors were empathy and the burden of BPSD and empathy was the most influential factor. Thus, there is a need to develop arbitration programs and include in the programs a caregiver curriculum directed at raising the level of empathy in caregivers. Also, continuous education to enable quick and accurate detection of BPSD and on how to handle it is crucial for caregivers in this sector.

Understanding of Antipsychotics in Elderly Patients with Dementia

Behavioral and psychological symptoms are often apparent and major issues in elderly patients with dementia, and are potentially the cause of the caregiver’s stress, thus leading these patients to nursing homes. Aging is a major risk factor for dementia, and using antipsychotics due to behavioral psychological symptoms in dementia (BPSD) present a challenge task in geriatric psychopharmacology, which is complicated not only by the effects of normal aging but by co-morbid medical illness. Elderly patients often present with subclinical syndromes or symptoms that are modified by co-morbid disease or partial treatment. Antipsychotics were and are frequently used for the treatment of BPSD. However, in recent years, the use of antipsychotics (both conventional and atypical) has been widely debated for their efficacy in treating behavioral disturbances and the possible serious adverse events in elderly patients with dementia.1-3 In the past, using conventional antipsychotics in the elderly patients with BPSD was strongly limited by their severe adverse events,4,5 whereas atypical antipsychotics were believed to have a far milder adverse effect profile than their older counterparts. However, several recent studies have raised questions about this belief.1,2 In 2002, trials with risperidone and olanzapine in elderly psychotic patients with dementia isUnderstanding of Antipsychotics in Elderly Patients with Dementia

Neuropsychological Characteristics of Wandering in Patients with Drug-naïve Alzheimer's Disease

Background: Wandering 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). Methods: Psychotropic-naive (drug-naive) 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. Results: Patients 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. Conclusions: This 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. Received: August 19, 2014 Revision received: September 2, 2014 Accepted: September 2, 2014

Discrepancy between subjective and objective assessments of wandering behaviours in dementia as measured by the Algase Wandering Scale and the Integrated Circuit tag monitoring system

Although wandering is one of the major research focuses of the behavioural psychological symptoms of dementia, assessment of wandering has mostly relied on caregiver-administered questionnaires. The purpose of this study was to compare staff-administered Algase Wandering Scale outcomes with objective temporal and spatial movement indicators obtained from the Integrated Circuit (IC) tag monitoring system. Patients with dementia were recruited from a dementia care unit in Osaka, Japan in 2007. Primary nurses administered the Algase Wandering Scale, and the temporal and spatial movements of the subjects were monitored by the IC tag. Written informed consent was obtained from each subject's proxies. Nurses' assessments of wandering were in agreement with the IC tag outcomes only during the day shift. Spatial movements assessed by the staff did not reflect those measured by the IC tag. This objective measurement of wandering showed the limitations in the assessment of spatial and temporal movement by the staff.

Brauchen Pflegeheime gerontopsychiatrische Liaisondienste? Ergebnisse einer Pilotstudie in fünf Pflegeheimen

This project evaluates whether a multidisciplinary consultation-liaison team with special geropsychiatric experience can help to reduce complex care problems in mentally ill nursing-home residents. Prospective longitudinal study of patients living in 5 nursing homes in Germany, supplemented by expert interviews with the members of the consultation-liaison team, as well as semi-structured interviews and by a questionnaire answered by the participating nursing home staff. Data show that in spite of the high burden of disease and the usually progressive course of illness a majority of residents could benefit from the interventions applied by the multidisciplinary team. Additionally, there were positive effects on the work situation of staff and a reduction of costs. Our results indicate that a geropsychiatric consultation-liaison team for nursing homes may improve service delivery especially with regard to behavioral psychological symptoms in dementia (BPSD).

Editorial: New drugs for Alzheimer's disease in Japan

Editorial: New drugs for Alzheimer's disease in Japan

Five Alzheimer's disease cases with refractory behavioural psychological symptoms of dementia treated with blonanserin

The aim of the present study was to determine the efficacy, side-effects and tolerability of blonanserin for treating refractory behavioural psychological symptoms of dementia (BPSD). The present study was a 12-week, prospective, structured clinical trial of blonanserin for the treatment of BPSD. The degree of cognitive function, activities of daily living score, and the degree of BPSD were determined using the Mini-Mental State Examination (MMSE), Disability Assessment for Dementia (DAD), Neuropsychiatric Inventory (NPI) and the Rating Scale for Aggressive Behaviour in the Elderly (RAGE). The severity of extrapyramidal symptoms was assessed using the Drug-Induced Extrapyramidal Symptoms scale (DIEEPS). Five patients were enrolled. These patients met the NINCDS-ADRDA criteria. The patients were prescribed more than two kinds of existing antipsychotic drugs and were considered refractory cases; the drugs were discontinued because they were ineffectual and side-effects appeared. Each drug was prescribed independently for at least 2 weeks. The mean changes (at baseline and at the last week, respectively) in the MMSE (12.25, 9.25), in the DAD (6.5, 6.75), in the RAGE (5.5, 5.3) and in the DIEEPS (0.5, 1.5) were minimal. The mean changes in the NPI were two or fewer points. Some side-effects (one gait abnormality and one pneumonia) were observed. The results of this preliminary study show that blonanserin does not have adequate efficacy for the treatment of refractory BPSD.

Personal home made digital video disk for patients with behavioral psychological symptoms of dementia

Personal home made digital video disk for patients with behavioral psychological symptoms of dementia

Aripiprazole for Treatment of Behavioural Psychological Symptoms of Dementia

Aripiprazole for Treatment of Behavioural Psychological Symptoms of Dementia

Biological, psychological and clinical markers of caregiver's stress in impaired elderly with dementia and age-related disease

Stress refers to the experience, produced through a person-environment transaction, that results in psychological or physiological distress. Everyday stress or hassles have a larger impact on health, in this frame caring for elderly disabled and/or demented persons have been shown to be a chronic role strain. The concept of stress and strain encompasses different levels of individual functioning (physiological, cognitive, affective, social). We studied whether 3 different distressing conditions show (i) different profiles in biological, psychological and clinical indices of stress, and (ii) different response to temporary environmental manipulation. A sample of 29 caregivers of elderly subjects temporarily institutionalized for (i) respite program, (ii) behavioral psychological symptoms of dementia (BPSD) in dementia-control and, (iii) a rehabilitation program after hip fracture, was assessed with clinical, psychological and biological measures. The BPSD appear to be the most powerful distressing factor, both at the beginning and at the end of the study. On the whole, to an improvement of patient's clinical picture, it corresponds only a partial improvement in stress indices of the caregiver. The slope of biological indices don not parallel those of psychological ones. Among psychometric indices, the pattern of recovery differentiate affective and cognitive domains. The “respite” care condition seems to be the less effective in reducing stress in the caregivers. The stress process should be considered in its different domains to allow a tailored intervention.

Antipsychotic Treatment of Behavioral and Psychological Symptoms of Dementia in Geropsychiatric Inpatients

Behavioral/psychological symptoms of dementia (BPSD) affect caregiver burden and transition from home to hospital or long-term care. The authors examined change in BPSD for dementia patients (from hospital admission to discharge) who were prescribed haloperidol (n = 289), olanzapine (n = 209), or risperidone (n = 500). Olanzapine was associated with significantly greater overall improvement in BPSD (based on the Psychogeriatric Dependency Rating Scale total score) than risperidone or haloperidol. Olanzapine was significantly superior on measures of active-, verbal-, and passive-aggression and delusions/hallucinations to risperidone or haloperidol, and, on manipulative behavior and noisiness, to risperidone. Results support the effectiveness of olanzapine in improving several BPSD in hospitalized dementia patients. Behavioral/psychological symptoms of dementia (BPSD) affect caregiver burden and transition from home to hospital or long-term care. The authors examined change in BPSD for dementia patients (from hospital admission to discharge) who were prescribed haloperidol (n = 289), olanzapine (n = 209), or risperidone (n = 500). Olanzapine was associated with significantly greater overall improvement in BPSD (based on the Psychogeriatric Dependency Rating Scale total score) than risperidone or haloperidol. Olanzapine was significantly superior on measures of active-, verbal-, and passive-aggression and delusions/hallucinations to risperidone or haloperidol, and, on manipulative behavior and noisiness, to risperidone. Results support the effectiveness of olanzapine in improving several BPSD in hospitalized dementia patients.

Antipsychotic Treatment of Behavioral and Psychological Symptoms of Dementia in Geropsychiatric Inpatients

Behavioral/psychological symptoms of dementia (BPSD) affect caregiver burden and transition from home to hospital or long-term care. The authors examined change in BPSD for dementia patients (from hospital admission to discharge) who were prescribed haloperidol (n= 289), olanzapine (n=209), or risperidone (n=500). Olanzapine was associated with significantly greater overall improvement in BPSD (based on the Psychogeriatric Dependency Rating Scale total score) than risperidone or haloperidol. Olanzapine was significantly superior on measures of active-, verbal-, and passive-aggression and delusions/hallucinations to risperidone or haloperidol, and, on manipulative behavior and noisiness, to risperidone. Results support the effectiveness of olanzapine in improving several BPSD in hospitalized dementia patients.

Psychosis and physical aggression in probable Alzheimer's disease

The purpose of this study was to determine the frequency and type of psychotic symptoms in patients with probable Alzheimer's disease and to test whether there is a relationship between specific psychotic symptoms and episodes of physical aggression. From 209 patients with possible or probable Alzheimer's disease who had been assessed in a research clinic every 6 months for up to 4.5 years, 181 subjects with probable Alzheimer's disease were selected for study. On the basis of the summary note for each visit in the patients' charts, the presence of delusions, hallucinations, misidentifications, and episodes of physical aggression was determined. Data regarding psychotic symptoms and aggression were available for 170 and 169 subjects, respectively. Delusions had been reported for 74 (43.5%) of the patients and were the most frequent psychotic symptom; persecutory delusions were the most common type. Physical aggression had been noted for 50 (29.6%) of the patients. Delusions and misidentifications frequently preceded and were significantly associated with episodes of physical aggression. The presence of delusions was a significant predictor of physical aggression but accounted for only 3.5% of the variance. This study suggests that delusions are a risk factor for physical aggression in patients with probable Alzheimer's disease who have moderate to severe cognitive impairment. As delusions accounted for only a small percentage of the variance, further research is needed to identify other variables that may be significant predictors of physical aggression in this population.