Behavioral Symptoms Of Dementia Research Articles

Caring for Behavioral Symptoms of Dementia (CBD): A New Investigation into Cannabidiol for the Treatment of Anxiety and Agitation in Alzheimer's Dementia

Caring for Behavioral Symptoms of Dementia (CBD): A New Investigation into Cannabidiol for the Treatment of Anxiety and Agitation in Alzheimer's Dementia

Implementation of STAR-VA for behavioral symptoms of dementia in acute care: Lessons learned

As the population grows, the incidence of dementia will increase. A common occurrence in people with dementia is behavioral and psychological symptoms of dementia (BPSD). BPSD can include apathy, aggression, resistance to care, and agitation. BPSD can start or worsen during an acute hospitalization, but these units are not well-equipped to handle BPSD, often relying on pharmacological interventions to address distress behaviors. One known behavioral intervention for BPSD is STAR-VA, an interdisciplinary approach to managing these behaviors. However, this intervention has not been utilized in acute care. Our team implemented STAR-VA in acute care at a Veterans Affairs hospital in the northeastern United States. Using the VA's Quality Enhancement Research Initiative (QUERI) implementation roadmap to guide our work, we first outlined the problem, completed a needs assessment with staff, and began implementation. Results from this quality improvement project demonstrated the feasibility and efficacy of STAR-VA in an acute care setting.

Commentary on the Low Dose Gabapentin for Behavioral Symptoms in Dementia with Lewy Bodies Case Series, Brief Review of Pharmacology and A Hypothesis

Over 5 million people in the United States [1] and over 35 million people worldwide [2] suffer from dementia and its prevalence is expected to increase.

Physicians’ attitudes and confidence toward dementia care: A cross-sectional study at primary healthcare facilities in the Eastern Province, Saudi Arabia

BACKGROUND: Primary care physicians play an essential role in the health of older adults as they are frequently the first point of contact. Their positive attitude and knowledge influence the quality of care provided to patients with dementia and their caregivers. This study examined the attitudes of primary care physicians towards dementia care and their confidence in their own dementia-care skills. MATERIALS AND METHODS: This cross-sectional study was conducted among 316 primary care physicians working in Eastern Province of Saudi Arabia. Data were collected using a structured questionnaire that included questions related to demographic characteristics, Dementia Care Attitude Scale (DCAS) to assess attitudes towards dementia, and Confidence in Dementia Care Skills (CDCS) Scale to measure confidence. Data were analyzed using SPSS version 29; mean and standard deviation (SD) were computed for continuous and categorical variables were described using frequencies and percentages. Mann Whitney U test and Kruskal Wallis test were used to compare attitude and confidence scores by categorical variables. RESULTS: The mean DCAS score was 36.4 ± 5.41 out of 50. On a scale ranging from 15 to 75, the mean CDCS was 51.89 ± 10.20. A statistically significant (P < 0.05) relation was found between confidence and professional rank, knowing close relatives with dementia, and number of dementia and elderly patients treated. Overall, 78.9% of physicians lacked confidence to prescribe memory medications; 32% felt that dementia management was generally more frustrating than rewarding. CONCLUSION: Primary care physicians had a positive attitude toward caring for patients with dementia. However, they lacked confidence in their dementia care skills in several areas. The confidence in their diagnostic skills was higher than their management skills. Most challenging skills were recognizing and managing behavioral symptoms of dementia. Need to develop educational and training interventions that target healthcare providers to help improving dementia care in primary care settings.

Safe discontinuation of psychotropic drugs in older people? : New evidence and practical approach

Many older patients are permanently prescribed one or more psychotropic drugs for treatment of symptoms, such as behavioral and psychological symptoms in dementia, depressive symptoms, anxiety, and insomnia. They therefore contribute to the risk of polypharmacy. Recently, deprescribing studies have been published in order to clarify if inadequate medications can be safely discontinued. This mini-review summarizes the study results and derives practical recommendations for routine use. A literature search was carried out in PubMed for clinical studies on deprescribing in association with psychotropic substances. After removal of duplications, 12heterogeneous clinical studies were identified and reduction of psychotropic substances could be successfully achieved in 8studies. In four of these studies psychological, behavioral and functional endpoints were reported. Criteria for successful deprescribing of sedatives were in particular motivation, information and sufficient cooperation of the patients and for antipsychotic drugs in people with dementia, the sustainable establishment of nonpharmaceutical treatment strategies. Deprescribing was not attempted in cases of ahistory of severe chronic mental illness and in cases of severe behavioral symptoms in dementia. Evidence for antidepressants was not sufficient to extract practical recommendations. Safe deprescribing of antipsychotic drugs in patients with dementia is justified if non-pharmacological treatment options are sustainably implemented, and for sedative drugs in well-informed, highly motivated and cooperative patients.

Prevalence of and Factors Associated with Hypersexuality in Patients with Dementia: A Retrospective Cross-Sectional Study.

The psychological and behavioral symptoms of dementia are frequently observed in clinical practice, and those related to sexuality are particularly challenging. However, few studies have evaluated the prevalence or factors associated with hypersexuality in patients with dementia. This study aims to determine the prevalence of hypersexuality in patients with dementia, describe associated factors, and qualitatively report the most common presentations and treatments. This retrospective cross-sectional study collected data from semi-structured charts of dementia patients who were followed up at a secondary care reference center between 2015 and 2019. Results: Of 552 total patients, 52 (9.3%) were hypersexual, which was associated with male sex (P < .000; OR 2.95, 95% CI 1.73-5.01), frontotemporal dementia (P < .007), alcohol use (P < .015; OR 2.35, 95% CI 1.16-4.73) and tobacco use (P < .000; OR 2.88, 95% CI 1.61-5.13). Although our findings were similar to the literature, their significant variability reflects the limited and low quality of the available evidence and a lack of standardization regarding terminology, definitions, and diagnostic criteria for hypersexuality.

THE NEEDS OF FAMILY CAREGIVERS OF PERSONS LIVING WITH DEMENTIA CARED FOR IN PRIMARY CARE PRACTICES

Abstract Background The proportion of persons living with dementia (PLWD) in the US is projected to increase; the majority will be cared for by family caregivers and primary care providers. Purpose: At baseline for intervention studies to support primary care practices caring for persons with dementia, we assessed caregiver self-efficacy to inform our interventions. Methods We conducted a survey of 143 caregivers of persons living with dementia receiving care from 34 primary care practices in a Medicare ACO. The survey was conducted by postal mail and telephone in English and Spanish and used 9-item caregiver self-efficacy scale.4 , analyzing variation by caregiver relationship and location. Results A majority of 143 respondents were female (70%), White Non-Hispanic (80.4%) and lived with person with dementia (65.7%). Caregivers agreed that their doctors understand how memory or behavioral problems complicate health (85.3%) and least likely to agree that they had a health professional who helped them work through dementia care problems (39.2%). Only 45% agreed that they received advice on what problems to expect in the future related to Alzheimer’s or dementia. Caregivers who lived with the care recipient were significantly less likely than those who did not to report getting advice about common behavioral problems (43.6% vs. 68.6%, P = .005) and how to access community services (63.8% vs. 81.3%, P = .03). Discussion System innovations to support caregivers should tailor information to help caregivers of and PLWD to prepare for course of illness including treatment and management of behavioral symptoms of dementia.

Individualized Coordination and Empowerment for Care Partners of Persons with Dementia (ICECaP): Study rationale and protocol

The majority of care for >10 million older adults with dementia (PWD) in the United States depends on at least on 11 million unpaid care partners (CPs). CPs are at greater risk of adverse physical, psychological, and cognitive health outcomes relative to non-caregiving peers. The goal of this paper is to establish the rationale, design, and protocol for a pilot randomized control trial to test the efficacy of the CP-focused intervention, ICECaP: Individualized Coordination and Empowerment for Care Partners of Persons with Dementia. ICECaP involves the assignment of a trained dementia care coordinator to a CP. The care coordinator maintains at least monthly contact with the CP with hybrid delivery (in-person, phone, e-mail, and video calls) and provides individualized support with care coordination for the CP navigating the PWD's care in a complex healthcare system, as well as supportive counseling, psychoeducation, and skills training for the CP. This trial will compare outcomes from baseline to 12-months among CPs who receive ICECaP versus routine care (controls). Outcomes include CP depression, burden, anxiety, and quality of life; CPs' reactions to the behavioral symptoms of dementia; and use of support services for the PWD. This trial will also assess mechanisms of intervention efficacy including changes in CP dementia knowledge, caregiving preparedness, self-efficacy, and optimism. Publication of this intervention protocol will benefit other dementia care teams seeking to support CPs and PWDs.

DAILY FACTORS ASSOCIATED WITH EMOTIONAL DYSREGULATION AMONG DEMENTIA CAREGIVERS

Abstract Family dementia caregivers experience increased burden and stress that can negatively impact emotion regulation and overall well-being. Further, a lack of social connection may contribute to emotion dysregulation among dementia caregivers. The purpose of this study was to examine relationships between daily caregiving stress, social isolation, emotion regulation, and depression in a sample of community-dwelling dementia caregivers. Participants (N=30) completed a baseline survey and a series of daily diaries over a 14-day period (n=323 data points) that asked about day-to-day caregiving experiences. Data were analyzed using mixed-level modeling. Higher than average stress related to behavioral symptoms of dementia was associated with an increase in the odds of experiencing feelings of losing control over one’s emotions (OR=1.08, 95% CI [1.01, 1.15], p&amp;lt;0.05). Similarly, higher perceived social isolation on a given day was associated with an increase in the daily odds of feeling a loss of control over one’s emotions (OR=1.28, 95% CI [1.00, 1.27], p&amp;lt;0.05). Further, feeling a loss of control over one’s emotions was associated with an increase in the daily odds of depression-related symptoms (OR=3.39, 95% CI [1.43, 8.08], p&amp;lt;0.01). These findings highlight the importance of addressing the emotional well-being of family dementia caregivers, particularly in the context of stress related to behavioral symptoms of dementia and social isolation. Caregiver support programs and interventions that focus on improving emotion regulation and reducing social isolation may help promote the mental health and well-being of dementia caregivers.

DEVELOPING A CONCEPTUAL MODEL TO ASSESS ACTIVE ENGAGEMENT WITHIN A DEMENTIA CAREGIVER INTERVENTION

Abstract Active engagement is identified as an effective component of psychoeducational interventions for caregivers of persons living with dementia. There are many approaches to active engagement; however, limited assessment of this component within interventions reduces optimization and standardization. To fill this gap and increase transparency, we aimed to strengthen active engagement by developing Enhancing Active Caregiver Training (EnACT), an arts-based intervention designed to help caregivers address the behavioral symptoms of dementia. The intervention uses multi-sensory activities, including interacting with caregiver-informed vignettes, to foster engagement and process caregiving experiences. We partnered with caregivers of persons living with dementia (n=9) to iteratively refine EnACT through six focus groups. The purpose of this presentation is to report the process we took to identify how intervention participants actively engaged with EnACT. Focus group data were analyzed using process coding to identify the patterns of participant engagement with 17 intervention activities. The process codes were mapped to create a diagram of participant engagement for each activity. These diagrams were used to develop the EnACT Cycle of Engagement, a conceptual model illustrating how participants engaged with the intervention. The three-step model illustrates that: 1) antecedents (personal and intervention) contribute to 2) interaction with EnACT through participation, contribution, and application, which leads to 3) EnACT’s hypothesized proximal outcomes (capacity to adapt and appraisal of caregiving demands) and distal outcomes (perceived stress and caregiver well-being). The EnACT engagement model will be tested in the forthcoming randomized control trial assessing feasibility and acceptability.

P112: Valladolid Multicenter Study: Diagnostic agreement between physicians and liaison psychiatry units in an elderly population in 7 hospitals in Spain.

Objective:The objective of this study is to describe the diagnostic agreement between physicians and liaison psychiatry units (LPU) in 7 general hospitals of Spain for elderly patients and to analyze possible factors related to it.Methods:This is an observational., cross-sectional, multicenter study. We obtained data from a sample of 165 patients (≥65 years) admitted to 7 general hospitals in Spain referred from different departments to each liaison psychiatry unit. Data was collected for a month and a half period. Psychiatric evaluations were performed while the patients were on wards.Results:We obtained a sample of 165 patients (78 women, 88 men) with a mean age of 76,03 years old (42.10% &lt;75 years, 57,83% ≥ 75 years). Most of them were married and they lived accompanied (67,27%). Only 5,45% lived in a nursing home.In 55.15% the main reason to referral was anxiety/depression symptoms. 42,42% had no psychiatry medical background. After LPU visit a new diagnosis was done in 56.96%. Main diagnoses were adjustments disorders (26,66%), delirium (20,6%) and no psychiatric pathology (14,54%)Cohen’s kappa statistics were used to estimate the agreement between the diagnoses made by LPU and the diagnoses considered by the referring doctors. We obtained a moderate global agreement (kappa= 0,4971) between observers (0,424 for &lt;75 years, 0,557 for ≥65 years) Moderate agreement was found for alcohol or substance abuse (kappa= 0,41) and low agreement was found for affective disorders (kappa= 0,3278) and delirium/ psychological and behavioral symptoms in dementia (Kappa= 0,2341).We analyzed factors which might affect de agreement between physicians and LPU such is group of age, functional impairment, comorbidity by Charlson index and previous diagnosis of dementia.Conclusions:Further longitudinal studies might help in the future to analyze the factors related to agreement between doctors and might help to establish educational programs

Caregiver Attributions of Cause to Behavioral Symptoms of Dementia

AbstractBackgroundMost individuals with Alzheimer’s disease and related dementias (ADRD)exhibit behavioral and psychological symptoms of dementia (BPSD) which can negatively impact quality of life for both caregiver and care recipient, yet there is a lack of knowledge on mechanisms of symptom development and triggers that can exacerbate a symptom. Thus, the aim of this study is to explore family caregiver perceptions’ of why a particular BPSD occurred.MethodThis study used a micro‐longitudinal design with family caregivers (N = 69) completing 8 days of diaries four times a day. Diaries were sent randomly three times a day and once in the evening. Data for this study were derived from the three random diaries (n = 982 responses) from the open‐ended question, “why do you think the behavior occurred?” This question was a follow‐up question to the caregiver’s report of the last observed behavioral symptom. Content analysis was used to identify initial codes for thematic analysis. Focused coding was used to further refine and organize into thematic categories.ResultThe sample was 54% African American and 69% female with a mean age of 74 caring for a close family member with dementia. Final analysis of data revealed 5 themes describing the caregivers’ perceptions of the cause of the behavioral symptom. These themes included describing the cause as: 1) the care recipient experiencing a loss of autonomy, 2) behavioral symptom as a direct result of the disease, “it’s Alzheimer’s, stupid.” 3) attributing negative emotions to the care recipient, anger, fear 4) environmental factors such as too much conversation, TV show, being cold 5) physical symptoms, “knee pain, “lack of rest,” ill‐fitting dentures. Responses among many of the individual caregivers varied daily from diary to diary based on the behavior reported or they simply answered, I do not know.”.ConclusionThere are many interventions which aim to reduce caregiver stress and improve management of BPSD though they often have small effect sizes and do not sustain the effect over time. Incorporating insights from caregivers on how BPSD occur in daily life may provide for more ecologically valid interventions.

Nuestro día (our day): The daily experiences of Latino ADRD family caregivers

AbstractBackgroundThe prevalence of Alzheimer’s disease and related dementias (ADRDs) among the Latino population is 1.5 times higher than non‐Hispanic whites. Latinos develop ADRDs earlier and experience more severe symptoms than other ethnic and racial groups. Further, comorbidities, including diabetes, heart disease, and hypertension, have also been observed among Latino individuals living with ADRDs — introducing additional health issues, exacerbating ADRD‐related symptoms, and accelerating functional decline. Given these observed disparities, Latino ADRD family caregivers are uniquely susceptible to increased caregiving stress that can negatively impact their mental health over time. Previous studies have reported on stress and well‐being among Latino ADRD caregivers; however, relatively little is known about the day‐to‐day caregiving experiences and mental health of Latino caregivers. Thus, the purpose of this study was to examine daily contextual factors and variations in depression symptom experience among Latino ADRD family caregivers.MethodsA national sample of Latino family caregivers (N = 71) completed daily diary surveys over 21 days (n = 2,481). Mixed‐level modes were used to examine relationships between daily caregiving stress, stress moderators, and depression‐related symptoms.ResultsLatino ADRD caregivers were more likely to report depression (OR = 1.14, 95% CI: 1.03‐1.25, p &lt; 0.01) on a given day when behavioral symptoms of dementia were present and perceived as more bothersome than usual. A decrease in the daily odds of depression was observed on days when Latino ADRD caregivers reported receiving social support (OR = 0.69, 95% CI: 0.58‐0.82, p &lt; 0.01), engaging in social activities with friends or other family members (OR = 0.38, 95% CI: 0.25‐0.58, p &lt; 0.01), and engaging in self‐care activities (OR = 0.65, 95% CI: 0.46‐0.92, p &lt; 0.05).ConclusionThis study offers insight into the daily experiences and mental health of Latino ADRD family caregivers by identifying specific stressors and stress moderators associated with depressive symptoms experienced on a given day. The results of this study highlight modifiable factors for ecologically valid and culturally relevant interventions that mitigate the adverse effects of caregiving stress. Such interventions are critically needed as Latino caregivers are an underserved and underrepresented population in dementia care and aging research.

P137: Cost Considerations of Untreated Agitation: Direct, Indirect, and Intangible

OBJECTIVE:In the past decade, researchers and advocates have taken important steps toward understanding the full costs of Alzheimer’s disease and related dementias. However, our current approach to framing these costs does not fully consider the behavioral symptoms of dementia, notably agitation. Agitation in Alzheimer’s disease contributes to negative social and financial outcomes for people with the condition, their care partners, and health systems. When left untreated, the negative impact of these outcomes is exacerbated, yet the full scale of this impact is unknown. “Cost Considerations of Untreated Agitation” seeks to propose a framework to help in evaluating the variables that impact these costs.METHODS:We created a model that investigates each stage of Alzheimer’s disease with agitation. This model assesses direct, indirect, and intangible costs of the disease. Direct costs include professional caregiving, non-pharmacological intervention, nursing home costs, healthcare professional consultations, and hospitalizations. Indirect costs included loss of income and value of unpaid caregiving. Intangible costs include the mental health impact of agitation on individuals living with Alzheimer’s and their care partners. Additionally, we used quality-adjusted life years to measure disease burden and health outcomes. Finally, we leveraged qualitative research to overlay the experience of care partners and individuals with lived experience to bring their voice to this work.RESULTS:Results are a tentative framework and describe what additional research and input is necessary in order to create a version with which one can assess the comprehensive costs of untreated agitation in Alzheimer’s. This framework will include perspectives and feedback from individuals with lived experience, care partners, and key opinion leaders in Alzheimer’s research from across the world.CONCLUSION:Agitation has severe consequences on individuals, families, and health systems. Oftentimes one of the first symptoms of Alzheimer’s or dementia, agitation can increase the caregiving responsibilities, trigger placement into nursing homes, and cause severe emotional and physical toll on care partners. We cannot understand the full costs of dementia or AD until we account for untreated agitation vis-à-vis a multi-symptom assessment, therefore an accepted framework is necessary in order to fully consider the costs of untreated agitation.

Experiences of People Living with Dementia and their Care Partners in Participating in Outdoor Activities

AbstractBackgroundThere is increasing evidence for non‐pharmacological interventions to prevent dementia and delay disease progression. Outdoor recreational activities, such as visits to local parks, may help improve behavioural symptoms of dementia, cognition, and quality of life for both people living with dementia (PLWD) and their care partners. However, little is currently known about the experiences of PLWD and care partners about participating in outdoor activities. Understanding their experiences will help inform interventions and policies to promote participation in outdoor activities. Our objectives are to understand the experiences of PLWD and care partners in participating in outdoor activities.MethodsWe conducted semi‐structured interviews with PLWD and care partners, either alone or in dyads. Self‐reported characteristics of PLWD and care partners were recorded by online surveys. Interviews were recorded and transcribed for analysis. Interview questions included questions about the following topics: individuals relationships to outdoor activities; how these relationships may have changed over time; their current patterns of outdoor activities; perceived benefits of outdoor activities; potential risks of outdoor activities; and facilitators and barriers to participating in activities. The transcripts of interviews were coded by two independent members of the research team to identify common themes.ResultA total of 10 participants (7 care partners; 3 PLWD) have participated in interviews to date. Themes identified from interviews include: 1.) Outdoor activities help people maintain a sense of identity and connection with their lives before being diagnosed with dementia; 2.) Both a diagnosis of dementia, stage of dementia, and physical changes associated with aging impact on the types of activities people participate in; 3.) Outdoor activities are associated with psychological benefits for PLWD and care partners; 4.) There are unique considerations for PLWD and care partners that need to be considered when designing outdoor spaces or programs for PLWD.ConclusionOutdoor activities are important to PLWD and care partners and help maintain connections to individuals' identities and are perceived as important to maintaining quality of life. The design of outdoor spaces and activities programs for PLWD and care partners need to incorporate their perspectives to maximize participation and benefits associated with outdoor activities.

Examining Environmental Predictors of Behavioral Symptoms of Dementia Using Dynamic Structural Equation Modelling

AbstractBackgroundMost persons with Alzheimer’s disease and related dementias (ADRD) experience behavioral symptoms as a result of exposure to stressors in the environment. Daily diaries can capture fluctuations in behavioral symptoms in response to environmental stressors. The purpose of this multi‐time series longitudinal study was to determine whether potential protective factors, caregiver reciprocity and a shared activity were associated with the number of behavioral symptoms person with ADRD.MethodA community‐dwelling sample of 453 caregivers for persons with ADRD (age 18+) completed 21 days of once‐a‐day diary surveys. Caregiver perceived reciprocity was assessed using a question asking, “How satisfied were you with amount of affection or appreciation your relative with dementia showed towards you?” Responses were coded using a Likert scale with 1‐Not at all and 5‐Very much. Caregivers were asked whether they did a pleasant non‐care activity with their relative and about a presence of eight different behavioral symptoms in persons with ADRD. We used a two‐level dynamic structural equation model to examine the relationship between the number of different behavioral symptoms, caregiver reciprocity and a shared activity on a given day, and the following day.ResultCaregivers completed 7,783 diaries. Caregivers were mostly female (87.4%), non‐Hispanic white (51.4%) with a mean age of 53 years (SD = 14) caring for a parent/parent‐in‐law/stepparent (61.5%) with a mean age of 79 years (SD = 9). Caregiver perceived reciprocity had a significant direct effect on the number of behavioral symptoms experienced the same day and the next day. While no significant main or cross‐lagged effects were found between shared activity and behavioral symptoms, estimates suggest the impact was negligible (0.7% increase).ConclusionWe found that caregiver perceived reciprocity may reduce the number of behavioral symptoms a person with ADRD has that day and the following day. These findings support the growing body of theoretical and empirical work suggesting caregivers are an important feature of the environment and influence behavioral symptom presentation.

Behavioral or neuropsychiatric symptoms of Alzheimer's disease: from psychopathology to pharmacological management.

Neuropsychiatric or behavioral symptoms of dementia encompass a series of disorders, such as anxiety, depression, apathy, psychosis, and agitation, all commonly present in individuals living with dementia. While they are not required for the diagnosis of Alzheimer's disease (AD), they are ubiquitously present in all stages of the disease, contributing to negative clinical outcomes, including cognitive decline, functional disability, and caregiver burden. Neuropsychiatric symptoms have been conceptualized not only as risk factors but as clinical markers of decline along the AD spectrum. The concept of "mild behavioral impairment", the behavioral correlate of mild cognitive impairment, has been proposed within this framework. The first steps in the management of behavioral symptoms in AD involve defining the target and investigating potential causes and/or aggravating factors. Once these factors are addressed, non-pharmacological approaches are preferred as first-line interventions. Following the optimization of anticholinesterase treatments, specific pharmacological approaches (e.g., antidepressants, antipsychotics) can be considered weighing potential side effects.

Caregivers journey through experiences of people living with dementia and history of wandering behaviour

AbstractIntroductionWandering is one of the major behavioural symptoms of dementia. It leads to the high level of caregiver burden. Understanding the caregivers’ difficulties and management strategies will help the mental health professionals to gain knowledge on feasible care techniques in India.AimAim of this study was to explore the experience of caregivers in the management of wandering among persons with dementia.MethodologyThree case studies were selected from the family caregiver population and who reported wandering behaviour and associated distress. Interview method was used to understand the experience of caregivers.ResultsAll caregivers used supervision and locking the doors of their houses as key strategies to prevent the wandering behaviour among the persons with dementia. Other prominent strategies were seeking community support and listing out the destinations in which the person is found commonly. Keeping an identity card, planned activities of daily living, restricted movement, safety planning and division of caregiving responsibility were also applied in management of wandering by family caregivers.ConclusionEarly identification of wandering behaviour and caregiver education can prevent the frequency of wandering and the associated burden. Low‐middle‐income countries are yet to develop a comprehensive case management services for the families affected by the wandering secondary to dementia.

A Psychosocial Intervention for Carers of Individuals Diagnosed with Dementia in Social Isolation

Introduction: Growing research has shown the negative impact of social isolation on the health and psychological well-being of individuals with dementia and their carers. This study investigated the effectiveness of a psychosocial intervention for dementia carers during a lockdown period of the COVID-19 pandemic. Methods: Twenty-three family carers of individuals diagnosed with dementia living in the community were recruited and provided with an online psychoeducation toolkit that aims to improve health literacy, management of social and behavioural symptoms in dementia, carer social engagement, and coping skills. Carers were divided into “mild” or “moderate” groups based on the disease severity of the person with dementia they cared for. Outcome measures including distress and severity of neuropsychiatric symptoms, carer self-efficacy and burden, social network, and feelings of loneliness were assessed at baseline and 2 weeks later. Results: Carers in the moderate group reported higher levels of distress (p = 0.001) and severity (p < 0.001) of neuropsychiatric symptoms and greater carer burden (p = 0.003) than carers in the mild group. Following the intervention, both groups reported increased social networks (p = 0.001). In addition, carers in the moderate group reported significantly reduced distress for neuropsychiatric symptoms (p = 0.013), enhanced carer self-efficacy for controlling upsetting thoughts (p = 0.040), and decreased loneliness (p = 0.023). Conclusions: This study demonstrated that psychosocial interventions improve outcomes for carers of individuals with dementia, particularly those caring for individuals with greater disease severity. Findings from this study will inform the development of support services that meet the evolving needs of individuals with dementia and their carers in social isolation, during and in a post-pandemic context.

FDA Approves Rexulti for Agitation Associated With Dementia Due to Alzheimer’s Disease

Back to table of contents Next article Clinical & ResearchFull AccessFDA Approves Rexulti for Agitation Associated With Dementia Due to Alzheimer’s DiseaseMark MoranMark MoranSearch for more papers by this authorPublished Online:12 May 2023https://doi.org/10.1176/appi.pn.2023.07.7.17AbstractOne expert called the approval a “positive step” for the treatment of agitation associated with dementia in Alzheimer’s but cautioned against using the drug as a panacea for all behavioral symptoms of dementia.The U.S. Food and Drug Administration (FDA) this week approved the expanded use of Rexulti (brexpiprazole) for the treatment of agitation associated with dementia due to Alzheimer’s disease (AD).“Agitation associated with dementia due to Alzheimer’s disease is a common neuropsychiatric symptom that is reported in approximately half of all patients with Alzheimer’s dementia,” wrote Otsuka Pharmaceutical Co. Ltd. and Lundbeck LLC, makers of the medication, in a press release. The symptoms cover “a large group of behaviors occurring in patients with Alzheimer’s disease, such as pacing, gesturing, profanity, shouting, shoving, and hitting.”Brexpiprazole was first approved by the FDA in 2015, as an adjunctive therapy to antidepressants in adults with major depressive disorder and as a treatment for adults with schizophrenia. In 2021, the FDA expanded the use of the medication for the treatment of adolescents over the age of 13 with schizophrenia. Earlier this year, Otsuka and Lundbeck announced that the FDA would review the companies’ supplemental New Drug Application for brexpiprazole for the treatment of agitation associated with AD.In a hearing last month, the FDA’s Psychopharmacologic Drugs Advisory Committee and the Peripheral and Central Nervous System Drugs Advisory Committee voted 9-1 in favor of the approval of brexpiprazole for the new indication, noting the data presented by Otsuka and Lundbeck suggested that the benefits of the medication outweighed the risks for patients with these symptoms.A briefing document released prior to the April FDA hearing describes some of the data presented by the manufacturers, including several phase 3, 12-week, randomized, placebo-controlled studies. “Results from Studies 331-12-283 and 331-14-213 suggest that brexpiprazole exhibited a statistically significant treatment effect in the reduction of agitation over a 12-week treatment period, while also showing a similar safety profile relative to its use in adults with schizophrenia and major depressive disorder,” the document stated. “[B]rexpiprazole’s effect on mortality appears to be consistent with the known risk with other antipsychotics in elderly patients with dementia.”Rajesh Tampi, M.D., M.S., said it is important that physicians determine the cause of agitation in patients with Alzheimer’s disease before prescribing Rexulti.The approval of Rexulti “is a positive step for the treatment of agitation associated with dementia related to Alzheimer’s Disease,” said Rajesh Tampi, M.D., M.S., a professor and chair of the Department of Psychiatry at Creighton University and a past president of the American Association for Geriatric Psychiatry. “This is the first drug to be approved for agitation. The manufacturers were persistent and had solid data to support efficacy,” he told Psychiatric News.Tampi cautioned that agitation is just one of many noncognitive behavioral symptoms of dementia that patients may experience. “Brexpiprazole should absolutely not be assumed to treat all of those symptoms,” he said. “For instance, the most important behavioral symptom of dementia is apathy, and brexpiprazole should not be used to treat apathy.”He noted that only a minority of patients with dementia are treated by geriatric psychiatrists; most see their primary care physician (or other physicians who are not psychiatrists) for care. “My worry is that some will use the medication as a panacea for every behavioral symptom,” he said.According to the updated medication label, Rexulti is to be taken daily. The medication is not approved for the treatment of Alzheimer’s patients with dementia-related psychosis without agitation.“Physicians need to make a good assessment of whether the agitation is a result of dementia related to AD or due to other causes—for example, a medical condition or a psychiatric condition like bipolar disorder or schizophrenia,” Tampi said.Inappropriate use of brexpiprazole “will only raise the risk of adverse events associated with antipsychotic treatments—sedation, risk of falls, stroke and death,” he said.The most common side effects of Rexulti reported during the clinical trials by patients with agitation associated with dementia due to Alzheimer’s disease include headache, dizziness, urinary tract infection, nasopharyngitis, and sleep disturbances, according to an FDA release. “Rexulti will retain the Boxed Warning for medications in this class that elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death,” the agency noted. ■ResourcesFDA Approves First Drug to Treat Agitation Symptoms Associated with Dementia due to Alzheimer’s DiseaseFDA Briefing Document ISSUES NewArchived