Decrease In Agitation Research Articles

SMART MUSIC INTERVENTION: PROTOCOL DEVELOPMENT OF A WEARABLE DEVICE FOR COLLECTION OF PHYSIOLOGICAL DATA

Abstract This study tested a protocol of collecting physiological data through sensors on a wearable device in response to favorite music from late adolescence/early adulthood. The benefits of personalized music for individuals living with dementia have been demonstrated in various studies, showing decreases in agitation, anxiety, depression, and other behavioral and psychological symptoms of dementia and improvement in mood, memory, and well-being. Most studies have relied on observational data, standardized clinical scales, and self- or caregiver-reported perceptions of the effects of personalized music. Passively-collected physiological data may minimize researcher bias during data interpretation. We tested the protocol on 15 participants, triangulating the physiological, observational, and self-reported effects of personalized music on stress. Physiological measures were captured by a wearable wristband Empatica E4 and included heart rate, electrodermal activity, and temperature. Self-reported measures included the Perceived Stress Scale, level of stress on a 0-10 scale, and reactions to each song (happy, energized, calm, relaxed, nostalgic, sad, excited). Prior to music listening, we induced stress through three iterations of the Trier Mental Challenge Test, which involves three minutes of math exercises. Participants reported their level of stress after the Trier Test and after each song. Researchers observed participant reactions during each song. Preliminary analysis shows that nine minutes of a stress-inducing activity was enough to capture stress reactions and demonstrated a feasible protocol for collecting physiological, observational, and self-report data. These results inform the development of a novel protocol that responds to a person’s stress levels through a personalized music listening intervention.

Animal-assisted intervention and agitation in patients with dementia: evaluation in a special care unit by the Cohen-Mansfield Agitation Inventory.

Animal-assisted interventions (AAI) show promising results, but they suffer from a lack of studies and contradictory results. Our study deals with dog intervention and agitation in older patients with dementia. An epidemiological quasi-experimental study was carried out in patients living in a special care unit (SCU) in an Ehpad in the French Haut-Rhin region. Agitation was assessed using the Cohen-Mansfield Agitation Inventory at three consecutive periods one month after the introduction, discontinuation and resumption of a dog mediation. 26 patients were included in the study (76.92% female); mean age was 85.35 years and the mean score on MMSE was 6.85. Stopping AAI leads to an 11.9% relative increase in agitation (P = 0.03) whereas reintroduction of AAI leads to a 29.9% relative decrease in agitation (P < 0.0001). AAI presents an interesting and efficient therapy for agitation in older patients with dementia. However, further studies are needed to standardise their implementation (rhythm, duration and type of interaction) in order to ensure an optimal care.

CONTRIBUIÇÕES DO CUIDAR EM HUMANITUDE DURANTE A PANDEMIA EM UMA INSTITUIÇÃO PARA IDOSOS EM PORTUGAL

ABSTRACT Objective: to identify the contributions of the Humanitude Care Methodology in the comprehensive care provided to the elderly in a long-term care institution during the COVID-19 pandemic. Method: a qualitative, exploratory and descriptive research study. Data collection took place through individual online interviews in September and October 2020 with eight caregivers of elderly people from a long-term care institution for aged people in Portugal. Thematic categorization was adopted for analysis and treatment of the information. Results: the contributions of the Humanitude Care Methodology contemplated operationalization of the humanization of care, that is, approach, consolidation, professionalization of the relationship, and intentionality in the interaction. It also contemplated the organizational system with changes in care and opening to the outside and, finally, contributions to aged people such as acceptance of the care provided, decrease in agitation, promotion of autonomy and self-care, respect, satisfaction and promotion of verticality. Conclusion: the strategies related to the Humanitude Care Methodology facilitate the care practices during the COVID-19 pandemic period. Although organizational and operational matters of the care provided were altered, it was possible to maintain comprehensive care for aged people, due to the fact that the principles of Humanitude were already integrated in the institution's care practices.

The Effects of Personalized Music Listening on Older Adults with Dementia: A Literature Review

Introduction: Dementia affects millions of people globally and can impact the emotional and cognitive well-being of these individuals. Interventions such as music therapy, including the use of personalized music, are increasingly being used to help reduce the severity of symptoms and enhance patient care. Research has shown that music is strongly associated with long-term memory, and the use of familiar songs may trigger emotional arousal and past memories in individuals with dementia. However, the effectiveness of listening to personalized music on alleviating dementia symptoms is unclear. The aim of this review was to examine the effects of listening to personalized music on emotional arousal and mood in individuals with dementia. Methods: Two databases, Embase and PubMed, were searched for articles exploring personalized or preferred music listening in older adults with dementia and were screened by two co-authors. Results: A total of 9 studies were included in the review. Five of the included studies found positive impacts on mood, such as increased happiness. Two studies demonstrated decreases in agitation, and two studies demonstrated decreases in anxiety. Discussion: This review found an overall positive impact of listening to personalized music on emotion and behavioural and psychological symptoms in dementia (BPSD). The improved emotional arousal and mood shown in this review may lead to enhanced motivation during cognitive tasks, ultimately improving overall performance. Conclusion: Although listening to personalized music was found to strengthen emotional affect and mood, there are inconsistencies in the parameters used during musical interventions. Thus, it is evident that further research is required to determine the optimal guidelines for implementing personalized music listening interventions.

Deuterated dextromethorphan/quinidine for agitation in Alzheimer's disease.

Deuterated dextromethorphan/quinidine for agitation in Alzheimer's disease.

Animal-assisted intervention and agitation in patients with dementia: evaluation in a special care unit by the Cohen-Mansfield Agitation Inventory

Animal-assisted interventions (AAI) show promising results but they suffer from a lack studies and contradictory results. Our study deals with dog intervention and agitation in older patients with dementia. An epidemiological quasi-experimental study was carried out in patients living in a Special Care Unit (SCU) of an Ehpad in the French Region of Haut-Rhin. Agitation was assessed by the Cohen-Mansfield Agitation Inventory at three consecutive periods of one month after the instauration, discontinuation and resumption of a dog mediation. 26 patients were included in the study (76,92% female); mean age was 85,35 years and the mean score on MMSE was 6,85. Stopping AAI leads to a 11,9% relative increase in agitation (p =0,03) whereas reintroduction of AAI leads to a 29,9% relative decrease in agitation (p <0.0001). Animal-assisted interventions present an interesting and efficient therapy for agitation in older patients with dementia. However, further studies need to standardize their practices (rhythm, duration and type of interaction) to ensure an optimal care.

Prolong psychosis preceding cognitive and motor symptoms; an unusual presentation in Huntington's disease

ObjectiveTo describe an unusual clinical presentation of Huntington's disease.Case reportA 39-years-old married female, a homemaker, presented to the psychiatry clinic with her husband, with over a nine-year history of decreased sleep, suspiciousness, self-talking, agitation, anger outbursts, aggression, and social isolation. The patient was diagnosed with schizophrenia. Previously, she received various antipsychotics and Electroconvulsive therapy (ECT). The patient showed a partial response to treatment. Over the last 2-3 years, the patient had a progressive decline and later required supervision in her Activities of Daily Living (ADLs). She developed slurred speech limited to 1-2 worded answers, gait disturbance, falls, involuntary movements of the trunk and distal extremities, bowel and bladder incontinence, and severe weight loss. The patient's mother and older brother had a history of death in their early 40s due to an unknown cause.At presentation, the patient was restless, irritable, self-talking incoherently, neither made nor maintained eye contact and tried hitting and biting upon approaching closely. She did not respond to any queries or followed commands. The patient showed poor personal hygiene. On examination, the patient was hemodynamically stable, had a loss of muscle bulk, broad-based gait, and choreiform movements of the trunk and distal extremities. We admitted the patient to the psychiatry ward and also consulted the neurology team. Her blood investigations showed ASMA antibodies positive, MRI brain was suggestive of Huntington's disease (HD), and her genetic test for Huntington gene confirmed the diagnosis of HD. We started the patient on Fluoxetine, Clonazepam, and Olanzapine. The patient showed a decrease in agitation, and her self-talking stopped.DiscussionHD is a rare genetic disease that has well-characterized symptoms. However, as seen in our patient, these symptoms can evolve and progress unusually in the early and middle stages. Psychosis in HD patients is rare but known. Psychosis is rare in HD and usually presents after a clear clinical picture of HD is apparent. Our case discussed psychotic symptoms in the pre-choreic stage of HD which adds to the existing evidence on challenging presentations and management of HD. Further research can help increase confidence in these outcomes and treatment guidelines.ConclusionOur case highlights an unusual clinical presentation of HD, which can be challenging and lead to diagnostic delays. We recommend a thorough approach to history and revision of diagnosis in case of atypical presentations.

Abstract WP436: Sensory Distraction to Help Decrease Agitation in Stroke Patients

Background: Dysphagia is a common complication after stroke. To ensure adequate nutritional intake, nasogastric (NG) or other feeding tubes may be inserted. Post-stroke agitation and aggression can occur in 15 to 35% of stroke survivors as early as 4 days after stroke. At Rush University Medical Center (RUMC), it is common for the Stroke Unit patients to have feeding tubes and any other tubes necessary for treatment. It is a growing concern that agitated stroke patients self-remove feeding and other tubes requiring reinsertion and/or limb restraints. Although historically sensory modulation has not been heavily utilized in stroke patients, sensory based treatment objects in psychiatric inpatient units have been reported to reduce the use of restraints. Purpose: The purpose of this quality improvement project was to decrease agitation in stroke patients using sensory distraction objects (SDO). The goal of this project was to decrease the use of limb restraints and prevent patient self-removal and staff reinsertions of feeding and other tubes during this study period. Method: This project targeted stroke patients in the RUMC 12 West Tower Unit who were agitated, restless, impulsive, or anxious. Each patient was given a SDO, such as a plastic ring toy, glitter ball, activity belt, or a silk handkerchief attached to their gown. A decision tree was used to assign a SDO based on the patient’s cognitive and motor function. The Agitation Behavior Scale (ABS) was used to measure agitation in stroke patients; the scale was used pre- and post-implementation. Post-implementation assessment was done within one hour after the SDO is given. The use of limb restraints and patient self-removal of feeding and other tubes was observed. Conclusion: The project included 15 participants. Eleven out of 15 patients showed a decrease in agitation with a distraction object using the ABS. Only 20% of participants pulled out their feeding or other tube and two patients required restraints during the study period. In conclusion, this project did showcase a decrease in agitation for stroke patients using a SDO and decreased the use of limb restraints. The SDO prevented patient self-removal and staff reinsertion of feeding and other tubes.

Effects of Two Music Therapy Methods on Agitation and Anxiety among Patients Weaning off Mechanical Ventilation: A Pilot Study

Purpose The feasibility and differential effects of two music therapy methods (interventions with preferred music vs. classical relaxation music) were done to examine the effects on agitation and anxiety in patients weaning off mechanical ventilation. Methods This pilot study was conducted using a crossover design. Six patients listened to preferred music choices and classical relaxation music. Anxiety scores were measured using the Richmond Agitation Sedation Scale (RASS), State-Trait Anxiety Inventory (STAI), and visual analog scale (VAS). Results Patients showed a significant decrease in agitation and anxiety after both the preferred and classical relaxation music interventions. The difference in the effects of preferred music and that of classical relaxation music was not significant. As for feasibility, patients exhibited a change in agitated behaviors after the music interventions by not trying to take off medical devices and quietly listening to the music, and by smiling and moving lips along with the lyrics while listening. Conclusion Music interventions which centered on either patients’ preferences or classical relaxation music to enhance relaxation, helped reduce agitation and anxiety during the mechanical ventilation weaning process. Key words: Music, Agitation, Anxiety, Ventilation

Older and Newer Strategies for the Pharmacological Management of Agitation in Patients with Bipolar Disorder or Schizophrenia.

The management of acute agitation in patients with bipolar disorder or schizophrenia is a multifaceted and dynamic task, which presents unique and complex challenges to healthcare providers. To ascertain and describe which medications are best to use in patients with agitation, affected by bipolar disorder or schizophrenia. Selective review of current literature and guidelines referred to the treatment of agitation in individuals affected with bipolar disorder or schizophrenia Results: When possible, the pharmacologic management of agitation should be preceded by a in-depth evaluation of the possible causes of the agitation. The use for of first and second-generation antipsychotic medications, of benzodiazepines and of the newer inhaled antipsychotic loxapine, is reviewed and commented. The mainstay of medication treatment of acute agitation should be based on a thotough assessment cause. If agitation is due to delirium or to another physial condition, an attempt to address the underlying causes should be always considered. When agitation is primarily due to schizophrenia or bipolar disorder, antipsychotics and/or benzodiazepines are usually the mainstay of treatment. Newer inhaled formulation of loxapine has shown ability to rapidly reduce the agitation in mild to moderate patients with schizophrenia or bipolar disorder, with a decrease in agitation that was evident since the first assessment, 10 minutes after the first dose.

Pilot Testing of the EIT-4-BPSD Intervention.

Behavioral and psychological symptoms of dementia are common in nursing home residents, and the Centers for Medicare and Medicaid Services now require that nonpharmacological interventions be used as a first-line treatment. Few staff know how to implement these interventions. The purpose of this study was to pilot test an implementation strategy, Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD), which was developed to help staff integrate behavioral interventions into routine care. The EIT-4-BPSD was implemented in 2 nursing homes, and 21 residents were recruited. A research nurse facilitator worked with facility champions and a stakeholder team to implement the 4 steps of EIT-4-BPSD. There was evidence of reach to all staff; effectiveness with improvement in residents' quality of life and a decrease in agitation; adoption based on the environment, policy, and care plan changes; and implementation and plans for maintenance beyond the 6-month intervention period.

The Effects of a Single Session of Music Therapy on the Agitated Behaviors of Patients Receiving Hospice Care.

Research suggests that agitation is a common symptom for hospice patients, but while studies have examined the outcomes of music therapy on the agitated behaviors of patients in other settings, none have addressed this symptom in patients with terminal illnesses. The study objective was to determine whether a single session of music therapy provided by a board certified music therapist and using the entrainment principle would decrease agitation in hospice patients. This pilot study was a single-blind, pretest/posttest design. Music therapists used the principle of entrainment with live music during the treatment session. Subjects included in the study were 77 patients at a large hospice in south Florida with documented agitation. Agitation was measured using the Overt Agitation Severity Scale (OASS) for 5 minutes prior to and 5 minutes following a 20 minute music therapy intervention. Results from 73 participants were analyzed with a mean difference of -5.77 points from pretest to posttest. Results indicating a decrease in agitation were statistically significant (p < 0.001) for the entire sample. Age, gender, location, and diagnosis were found to have no significant effects on the results. Results indicate that a single session of music therapy using the entrainment principle may be an effective treatment for hospice patients experiencing agitation.

Effect of aripiprazole lauroxil on agitation and hostility in patients with schizophrenia.

This study aimed to evaluate the effects of aripiprazole lauroxil on hostility and aggressive behavior in patients with schizophrenia. Patients aged 18-70 years with a diagnosis of schizophrenia and currently experiencing an acute exacerbation or relapse were randomized to intramuscular (IM) aripiprazole lauroxil 441 mg (n=207), 882 mg (n=208), or placebo (n=207) for 12 weeks. In post-hoc analyses, hostility and aggression were assessed by the Positive and Negative Syndrome Scale (PANSS) Hostility item (P7) and a specific antihostility effect was assessed by adjusting for positive symptoms of schizophrenia, somnolence, and akathisia. The PANSS excited component score [P4 (Excitement), P7 (Hostility), G4 (Tension), G8 (Uncooperativeness), and G14 (Poor impulse control)], and the Personal and Social Performance scale disturbing and aggressive behavior domain were also assessed. Of the 147 patients who received aripiprazole lauroxil 882 mg and with a baseline PANSS Hostility item P7 more than 1, there was a significant (P<0.05) improvement versus placebo on the PANSS Hostility item P7 score by mixed-model repeated-measures at the end of the study, which remained significant when PANSS-positive symptoms and somnolence or akathisia were included as additional covariates. The proportion with PANSS Hostility item P7 more than 1 at endpoint was significantly (P<0.05) lower with aripiprazole lauroxil versus placebo (53.6, 46.1, and 66.3% for 441, 882 mg, and placebo). A significant (P<0.05) improvement was found with aripiprazole lauroxil versus placebo for change from baseline in the PANSS excited component score. The proportion of patients with aggressive behavior on the Personal and Social Performance scale was significantly (P<0.05) lower for aripiprazole lauroxil: 30.0% for 441 mg versus 44.1% for placebo (P=0.006) and 22.2% for 881 mg (P<0.001 versus placebo). Treatment with aripiprazole lauroxil resulted in decreases in agitation and hostility in patients with schizophrenia and this antihostility effect appears to be independent of a general antipsychotic effect.

Randomized single-blinded clinical trial on effects of nursery songs for infants and young children’s anxiety before and during head computed tomography

ObjectiveThe objective of this clinical trial was to determine if an intervention of listening to nursery songs with integrated heartbeat sounds resulted in changes in anxiety levels in infants and children younger than 4 years in an emergent setting. MethodsThis is a randomized single-blinded controlled trial. The study included 62 children younger than 4 years who were deemed by the emergency physician to need a computed tomographic (CT) scan. The experimental group (Exp) (n = 30) listened to recorded children’s songs with integrated heartbeat sounds (Baby Go To Sleep compact disc) before and during the head CT. The controls (Con) (n = 32) had no music. Two scales to measure agitation were completed by a trained research associate: (1) a 10-cm visual analog scale (VAS) and (2) the Modified Ramsay Sedation Scale (MRSS). The research associate wore headphones blocking out all music. The research associate recorded agitation levels preintervention and postintervention on the 2 scales, whether there was successful completion of the head CT without pharmacologic intervention, and the frequency of medication use. Mann-Whitney U, t test, and logistic regression were used for analysis, and P < .05 was considered significant. ResultsThere were no differences between groups in the age, sex, initial vital signs, diagnostic category, ethnicity, insurance status, rate of completion of head CT, rate of medication use, hospital admissions, or initial VAS or MRSS score. There was improvement on the VAS score in 53% of the Exp group subjects and 25% of the Con group subjects. The VAS score in the Exp group improved by 1.6 cm, whereas the Con group worsened by 0.8 cm after the intervention (difference = 2.4 cm, P = .03). There were no significant changes in MRSS scores. Accounting for age, sex, and admission status, the adjusted odds of having an improved sedation score were 3.2 (1.0-9.7) in the Exp group. ConclusionMeasured on a VAS, there was a significant decrease in agitation in children undergoing a head CT when children’s songs with integrated heartbeat sounds were played before and during the procedure.

Role of citalopram in the treatment of agitation in Alzheimer's disease.

Neuropsychiatric symptoms (NPS) are common among individuals with Alzheimer's disease (AD), associated with excess morbidity and mortality, greater healthcare use, earlier institutionalization, and caregiver burden. Agitation presents as emotional distress, excessive psychomotor activity, aggressive behaviors, disruptive irritability and dishibition. There is an unmet need to find pharmacologic treatment for agitation in patients with AD that can be safely and effectively used as a concurrent treatment alongside psychosocial interventions. A recent, multicenter, randomized, placebo-controlled trial explored the efficacy of a 30-mg daily dose of citalopram for agitation in patients with AD and showed a significant decrease in agitation for citalopram compared with placebo. Both QTc prolongation and cognitive worsening, as measured by the Mini Mental State Examination, were observed in the citalopram group and present a concern to clinicians. Citalopram at a 20-mg daily dose should be considered as a possible first-line treatment in addition to psychosocial intervention.

Blockage of coalescence of water droplets in asphaltenes solutions: A jamming perspective

Stirred tanks experiments were conducted to investigate water droplets size in asphaltenes solutions. After emulsification, droplets were kept suspended by a gentle agitation. Pictures were periodically captured by means of an in situ microscope. For low asphaltenes content, droplets were found not be stable upon completion of emulsification but to grow in size upon the decrease in agitation. This coalescence process was fast yet limited: droplets quickly reached an equilibrium size. Equilibrium size was found to be independent from emulsification conditions. On the other hand, varying emulsion composition yielded to a much larger variation of equilibrium size than expected from the impact of interfacial tension on break-up. Equilibrium droplet size proved proportional to the ratio of the mass of emulsified water to the mass of molecular asphaltenes present in the organic phase. Such a dependency is reminiscent of limited coalescence within Pickering emulsions. Upon coalescence, the total interfacial area of an emulsion decreases. For irreversibly adsorbed particles, surface coverage increases up to a critical value (close to 2D maximum packing) blocking further coalescence. In the present case, irreversible adsorption of asphaltenes was favored by the large aliphatic content of the organic phase. The estimated critical mass coverage for asphaltenes (3.2–3.5mg/m2) is close to results of direct titration found in the literature. On the other hand for high asphaltenes content (i.e. high enough to crowd water surface during emulsification), droplets do not coalesce after reduction of agitation confirming again the limited coalescence principle. Finally, the critical mass coverage was converted into a critical molecular coverage from the estimate of the molar mass of asphaltenes. This critical molecular coverage corresponds to 80–85% of a recent estimate of the surface excess coverage for asphaltenes of the same origin. Those observations tend to disqualify interfacial cross-linking as the cause for emulsion stabilization by asphaltenes. This stabilization could be due to steric jamming in dense monolayers, like for nanoparticles or proteins. Such a scenario is compatible with most of the phenomenological observations previously ascribed to slow cross-linking.

The effect of music therapy compared with general recreational activities in reducing agitation in people with dementia: a randomised controlled trial

This study aimed to compare the effects of music therapy with general recreational day activities in reducing agitation in people with dementia, residing in nursing home facilities. In a randomised controlled design, residents with dementia (n = 94) were allocated to either music therapy or recreational activities. Both music therapy and general activities were offered twice weekly for 4 months. Changes in agitation were measured with a modified Cohen-Mansfield Agitation Inventory (CMAI) at four intervals on each intervention day. A mixed model analysis was used to evaluate the effectiveness of music therapy, compared with general activities, on CMAI scores at 4 h after the intervention, controlled for CMAI scores at 1 h before the session and session number. Data were analysed for 77 residents (43 randomised to music therapy and 34 to general activities). In both groups, the intervention resulted in a decrease in agitated behaviours from 1 h before to 4 h after each session. This decrease was somewhat greater in the music therapy group than in the general activities group, but this difference was statistically not significant (F = 2.885, p = 0.090) and disappeared completely after adjustment for Global Deterioration Scale stage (F = 1.500; p = 0.222). Both music therapy and recreational activities lead to a short-term decrease in agitation, but there was no additional beneficial effect of music therapy over general activities. More research is required to provide insight in the effects of music therapy in reducing agitation in demented older people.

The Use of Chemical Restraints Reduces Agitation in Patients Transported by Emergency Medical Services

BackgroundAgitated patients are the primary source of injury to patients and providers during ambulance transport. ObjectiveOur primary hypothesis was that the addition of a chemical restraint agent (midazolam) to a restraint protocol would reduce agitation to a greater extent than a restraint protocol with physical restraint alone. MethodsThe local emergency medical services restraint protocol (RP) was implemented on October 1, 2006. It included a form for data collection about each restrained patient. On April 1, 2007, chemical restraint (CR) using midazolam in addition to physical restraints was made available through the RP, and paramedics were educated in its use. Transported patients were divided into pre-CR and post-CR. The post-CR group was split into those who received and those who did not receive midazolam. Agitation was measured on a validated agitation behavior scale with a parametric (Rasch) adjustment. ResultsThere were 96 patients in the pre-CR group and 522 patients in the post-CR group. Forty-three percent of the pre-CR group and 49% of the post-CR group had a decrease in agitation during transport (NS). Of the 522 in the post-CR group, 110 were physically restrained and given midazolam (21%) and 412 were physically restrained without midazolam (79%). There was a significantly greater decrease in agitation scores (−17 ± 21 vs. −7 ± 17) in the subjects receiving midazolam compared to those who did not. ConclusionIf available, CR is used in about 20% of restrained patients. When CR is used, there is a decrease in the subject’s agitation.

Changes in Nursing Burden Following Memantine for Agitation and Aggression in Long-Term Care Residents with Moderate to Severe Alzheimerʼs Disease

Agitation and aggression are common neuropsychiatric symptoms of Alzheimer's disease (AD) with a negative impact on caregivers. The aim of the study was to determine whether changes in agitation and aggression would follow memantine treatment and, if so, be associated with changes in nursing burden in institutionalized patients with moderate to severe AD. This was a 3-month open-label trial of memantine. The setting was two long-term care facilities. Thirty-one institutionalized patients with moderate to severe AD and significant behavioural and psychiatric symptoms were included in the study. Memantine was titrated to a target dose of 10 mg twice daily. Effectiveness was assessed by the change in the Neuropsychiatric Inventory-Nursing Home (NPI-NH) agitation/aggression subscale and Clinical Global Impression of Change (CGI-C) scale using the intent-to-treat population. To establish caregiver impact, the effect on nursing burden was measured by the Modified Nursing Care Assessment Scale (primary outcome). As a secondary analysis, the caregiver distress subscale of the NPI-NH was examined, as well as changes in as required (pro re nata [prn]) psychotropic medication use. Twenty-four patients completed the study. A significant decrease in agitation and aggression (F-test with 3 and 90 degrees of freedom [F(3,90)] = 3.721, p = 0.014) was demonstrated following memantine, with 48% of patients improving (either much improved or minimally improved) on the CGI-C scale. In addition, nursing burden (t-test with 30 degrees of freedom [t(30)] = 3.02, p = 0.005), caregiver distress (F(3,90) = 4.125, p = 0.009) and the use of prn psychotropics decreased following memantine treatment (Z = -1.99, p = 0.046). Fourteen patients experienced at least one adverse event during memantine treatment. The most common adverse event associated with treatment was somnolence (n = 5). The results of this study suggest that the decreased agitated and aggressive behaviour in institutionalized patients with moderate to severe AD following treatment with memantine was accompanied by improvements in nursing burden and decreased psychotropic use. These findings should be confirmed in a larger, controlled trial.

Nonpharmacological Management of Agitation in Hospitalized Patients

This article reports on the use of Simple Pleasures interventions to minimize agitation in hospitalized patients with late-stage dementia. The pilot project was not able to demonstrate statistical significance; however, the positive response to the education and provision of interventions has led to a hospital-wide dissemination of the interventions in the form of an activity box. No adverse effects of the interventions were found, and some patients experienced a significant decrease in agitation and use of sedative medications after exposure to the interventions. Hospital lengths of stay were shorter than expected and may also have been influenced by the intervention.