Dementia In Elderly Research Articles

P4‐361: Herpes zoster vaccine in the dementia population

The effectiveness of herpes zoster (HZ) vaccine has been shown in the general population and in individual with chronic diseases. However, it has not been examined in the dementia population. The elderly dementia patients can potentially benefit from the vaccine. The goal of the study is to examine the association of HZ vaccine and incidence of HZ among a group of elderly who had ever been diagnosed as dementia. This cohort study included immunocompetent adults 60 years of age and older enrolling in Kaiser Permanente Southern California who had at least one diagnosis of dementia within 1 year prior to the observation period. Vaccinated cohort included 2,616 individuals who receive the herpes zoster vaccine during 01/01/2007 through 12/31/2011. The vaccinated cohort was age and sex-matched to five unvaccinated individual. Electronic health records were used to categorize individual regarding HZ incidence, vaccination status, and other confounders. Multiple Cox regression was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) associated with HZ vaccination. Kaplan Meier method was used to estimate the cumulative incidence of HZ in the two cohorts. The number of herpes zoster cases among vaccinated and unvaccinated persons was 60 in 5,933 person-years (10.11 per 1,000; 95% CI, 7.7–13.0 per 1,000) and 328 in 26,212 person-years (12.5 per 1,000; 95% CI, 10.5–13.1 per 1,000), respectively. In adjusted analysis, vaccination was associated with a reduced risk of herpes zoster (HR=0.79; 95% CI, 0.60–1.04). The 60-month cumulative risk of HZ was 3.87% in the vaccinated cohort and 6.34% in the unvaccinated cohort. Among immunocompetent adults 60 years of age and older with dementia, receipt of HZ vaccine was associated with a lower incidence of HZ. However, the reduction in risk is not as significant as in the general population, probably due to advanced age in this study population. Nevertheless, dementia patients can potentially benefit from HZ vaccination to reduce the risk of this debilitating disease. More studies with larger size and longer observation are warranted.

Specialised design for dementia

Demographic trends point to a fast-rising demand for elderly dementia care - but ordinary elderly care environments are unsuitable for dementia, which requires specialised accommodation. This paper concerns itself with the health and behaviour benefits of the special environment and not the available care and medication. Compared with traditional elderly care, space requirements are larger, there are security and care issues, as well as light, sleep, sensory and exercise aspects. The internal environment can be used for therapeutic benefit, using movement, memory trails, behaviour cues, signage, sun light therapy, light spectrum control and landscape. Special planning can mitigate antisocial behaviour, agitation, anxiety and confusion. It can provide scope for family involvement. To date, care has made blanket unspecialised provision. There is a need for a coherent and comprehensive approach to the total environment and to view it as a tool for care. This paper records the features developed in the design of specialised dementia care buildings by the author as part of a sequence of care homes evolved and adapted with feedback.

Rectal perforation as a result of self‐administration of retrograde enema in an elderly dementia patient

Rectal perforation as a result of self‐administration of retrograde enema in an elderly dementia patient

Changes in activity patterns after the oral administration of brotizolam in institutionalized elderly patients with dementia

Little is known about the side effects of sedative-hypnotic agents in elderly dementia patients with sleep disorders. The present study describes activity pattern changes after a single dose of brotizolam in elderly patients with dementia. We conducted retrospective analysis of prospectively collected data from a case series at Asakayama Hospital (Osaka, Japan) between September 2008 and September 2009. Around-the-clock movements of dementia patients who were administered a single dose of brotizolam were recorded by the integrated circuit tag monitoring system during a 4-week baseline and 7-day peri-administration period. Diurnal and nocturnal activity levels and the onset times of the least-active and most-active phases were then measured. Seven patients (four men, three women; age range 59-85 years) were analyzed. All seven patients had disturbed activity patterns during the peri-administration period. Compared with the pre-administration period, the incidence of reversed rest-activity pattern increased significantly in the post-administration period, as measured by the distance moved per hour (P < 0.000). Patients with advanced stages of dementia had prolonged and delayed activity responses. Findings showed changes in activity levels and reversed active/resting phases after a single dose of brotizolam in elderly patients with dementia. Use of brotizolam in elderly patients with dementia, especially in advanced stages, calls for closer attention and longer observation periods.

Med Check

Med Check

Antipsychotic Use Is Not Associated with an Increased Burden of Cerebrovascular Pathology at Autopsy (S04.004)

Objective: Assess the correlations between antipsychotic medication use in elderly dementia persons with neuropathological outcomes data, including cerebrovascular disease (CVD) pathology. Background A 2006 FDA-issued black box indicated that elderly patients with dementia treated with antipsychotics are at an increased risk of death, primarily from vascular complications (myocardial infarction and stroke) and infections (pneumonia). Despite the profound impact this warning has had on the field, the cerebrovascular consequences of antipsychotic use in dementia remain poorly understood. Design/Methods: We identified all subjects with a history of dementia related psychosis treated with antipsychotic agents (DPAP; n=32) in the University of Kentucky Alzheimer9s Disease Center Brain Bank. Control subjects were placed in two cohorts matched for age, gender, apoe, education and MMSE including subjects with dementia but no psychosis or antipsychotic medication (DNPNAP group; n=32), and subjects with dementia and psychosis but no antipsychotic medication (DPNAP group; n=32). Demographic, clinical, genetic, and neuropathological features were compared between groups. Results: Comparative analysis of vascular risk factors (hypertension, hyperlipidemia, myocardial infarction, smoking, diabetes mellitus, cardiac arrhythmia, and Hachinski scores) revealed no significant between group differences. Clinical diagnoses including Alzheimer9s, Lewy-Body, frontotemporal, and vascular dementia did not differ between groups. Cause of death including myocardial infarction, stroke, and pneumonia did not differ between groups (p=0.73, χ2 test). Braak, CERAD, amyloid angiopathy, and Lewy body scores supported the diagnoses of moderate to severe dementia in the majority of cases (86%), but did not differ between groups. No statistically significant differences were found between the 3 groups for degree of atherosclerosis (p=0.25) or lacunar (p=0.34), micro- (p= 0.67), hemorrhagic (p= 0.81), or macro (p= 0.90) infarcts. Conclusions: Antipsychotic medication use is not associated with increased burden of cerebrovascular disease on neuropathological examination. Future studies investigating causal relationship between antipsychotic use and increased risk of death in dementia patients is warranted. Disclosure: Dr. Singhal has nothing to disclose. Dr. Abner has nothing to disclose. Dr. Schmitt has nothing to disclose. Dr. Nelson has nothing to disclose. Dr. Jicha has received personal compensation for activities with Pfizer Inc, Janssen Immunotherapy, and Eli Lilly & Company. Dr. Jicha has received research support from Baxter, Janssen, Pfizer Inc, Medivation, and Danone.

Dementia in Elderly Raises Hospitalization Risk

Dementia in Elderly Raises Hospitalization Risk

Dementia in Elderly Raises Hospitalization Risk

Dementia in Elderly Raises Hospitalization Risk

Impact of the Food and Drug Administration's antipsychotic black box warning on psychotropic drug prescribing in elderly patients with dementia in outpatient and office‐based settings

Most patients with dementia also suffer from behavioral and psychological symptoms of dementia, for which there is no Food and Drug Administration-approved treatment. To determine whether the Food and Drug Administration's black box warning in April 2005 has led to a decline in prescriptions of atypical antipsychotics for behavioral and psychological symptoms of dementia, as well as whether prescriptions for other psychotropic drugs, including antidepressants, anxiolytics, and antiepileptics, as substitutes, have increased. Data on outpatient visits by elderly dementia patients were obtained from two large national surveys from 2003 to 2008. Any psychotropic drug mentions were identified. Percentage utilization statistics were calculated. The percentage of visits mentioning an atypical antipsychotic decreased from 12.5% prewarning to 11.5% postwarning. Postwarning, 34.4% of patients were taking none of the study medications, as opposed to 26.1% prewarning. After the warning, there was a small decline in the use of atypical antipsychotics and no evidence of substitution of other psychotropic medications.

P-444 - The effectiveness of group music therapy to improve depression and cognition status in elderly persons with dementia

This study aimed to determine the effectiveness of group music therapy to improve the depression and cognitive function of elderly persons with dementia. This was a randomized clinical trial design with permuted block randomization. Three nursing homes in Taiwan. Of the 104 elderly persons with dementia randomly assigned to the experimental or control group, 100 completed the study: 49 in the experimental group and 51 in the control group. The experimental group received 12 sessions of group music therapy of 30 min each. The control group maintained routine activities of daily living. Groups were compared for depression and cognitive function before the intervention, at the 6th and 12th session and one month after cessation. Generalized estimating equations (GEEs) were used to estimate repeated effects of music therapy. Results indicated that: 1) depression decreased at the 12th session (P < 0.001); 2) cortisol level was not significant decreased in the experimental and control group after music therapy; and 3) cognitive function improved significantly at 6th, 12th session, and one month follow-up (P < 0.044; P < 0.001; P < 0.026). Music therapy is more appropriate for mild and moderate dementia. The music therapy had more impact on dementia elders’ function of recall than on orientation, registration, attention and calculation, language and spatial. Depression in elderly with dementia can be decreased and their cognitive function improved slightly through group music therapy. The mechanism behind the diminished cortisol levels in the effects of music therapy in dementia remains to be determined.

P-462 - Nutritional status of the hospitalized elderly dementia patients and it’s relation with calf circumference

Dementia is a neurological disease mainly characterized by clinically significant cognitive deficit which includes memory. Behavioral changes may occur and lead to an autonomy loss and a decreased capacity to perform daily professional and social activities. Disease-related undernutrition leads to an increased number of clinical complications as with a negative outcome in the physical and psychological status. Hospitalization can worsen the status. The Full Mini Nutritional Assessment (MNA) ® is the golden standard for nutritional status evaluation and it is validated for Alzheimer Disease (AD). Undernutrition in AD patients has been also related to significant weakness, depression, increased susceptibility to other illness. Evaluate the Nutritional Status of the hospitalized elderly dementia patients in the Geriatric Ward - Hospital de Magalhães Lemos and it‘s relation with calf circumference. Cross-sectional study made between February to May of 2011. Full MNA ® was applied. Furthermore, the patients were subjected to weight, height, calf circumference and mid-arm circumference measurements and the body mass index was calculated. 22 patients were evaluated of which 31.8% were male and 68.2% female.Mean age was 74.9 (8.2) years.Full MNA ® revealed that 45.5% of the elderly dementia people were at risk of malnutrition, 4.5% did not show nutritional risk and 50% was malnourished.The calf circumference equal or superior to 31 cm showed to be more representative with 54.5%, while inferior to 31 cm showed 45.5%. This study revealed the major importance of assessing the nutritional status and the need to use the calf circumference as a parameter for that evaluation.

LOSTE-Location Oriented System Technology for the Elder

The demographic evolution of most western developed countries show a progressive increase on population aged 65 and older. One of the consequences of this gradual ageing is the rise of expensive age-related disabilities. Elder dementia patients often get lost due to temporary lack of a sense of direction. This may put them at risk and cause their families much worry. Our project aims to provide mobility monitoring support for fast location and help in case of loss caused by elder temporary mental disabilities.

介護老人保健施設における認知症高齢者への胃瘻造設の意義

【背 景】 経皮内視鏡的胃瘻造設術 (percutaneous endoscopic gastrostomy ; PEG) が認知症高齢者に多数実施されている. 【目 的】 認知症高齢者へのPEG造設には賛否両論がある. 当老健の認知症高齢者へのPEG後家族アンケートを行いその有用性を報告する. 【対象と方法】 PEG29例の平均年齢は81.8歳. PEG後早期及び長期フォローアップアンケートを行った. 【結 果】 PEG後早期アンケートでは29例中27例93％はPEGにして良かった. 2例はどちらとも言えない意見でありPEG後3ヵ月で死亡した. PEGにして良かった理由は点滴せず, 食事の時苦しまず笑顔が見えコミュニケーションがとれ面会が楽しみとなった. 体重が増加した. 長期フォローアップアンケートは19例中17例死亡し2例が生存. 死亡例は長期間生きられ天寿を全うできた. PEG後再入所しリハビリで寝たきりにならず良かった. 生存2例も面会が家族の楽しみとなっている. 【結語】 老健における認知症高齢者に対するPEGは本人の延命を計りQOLの改善と家族の満足度を向上させるので積極的に行うべきと思われる.

Signs and Symptoms of Impending Death in End-of-life Elderly Dementia Sufferers: Point of View of Formal Caregivers in Rural Areas: -A Qualitative Study-.

Objective: The aim of the present study was to clarify the signs and symptoms of impending death in end-of-life senile dementia from the point of view of formal caregivers in rural areas.Patient/Materials and Methods: We used qualitative data based on retrospective analyses. The data was gathered following a workshop on end-of-life care of the elderly with dementia attended by formal caregivers that was held in Iga City, Mie Prefecture, Japan, in September 2011. There was a total of 29 workshop participants. The workshop products were created in the first session of the workshop entitled “Signs of death.” During the session, we used the brainstorming method, and participants took turns stating at least two signs, symptoms or premonitions of death. In the end, there were 93 cards in total displaying signs of impending death observed in the end stage of dementia. These 93 entries were then classified into clear categories.Results: The categories defined were breathing disorder, consciousness decline, vital power decline, reduced oral intake, feces disorder, calm and peaceful character, blood pressure decline, change in skin color, patient odor, edema, preagonal vital power, body temperature decline, bedsore/wound deterioration, body weight reduction, cyanosis, and oliguria. The most frequently cited symptoms fell in the breathing disorder category (12 cards), followed by consciousness decline (9 cards), vital power decline (9 cards), reduced oral intake (6 cards), and feces disorder (6 cards). Also frequently mentioned were symptoms falling in the calm and peaceful character, patient odor and preagonal vital power categories.Conclusion: The results show that formal caregivers in rural areas identified breathing disorder as a top indicator of impending death in end-of-life senile dementia cases. The results also highlight some other characteristic signs of impending death, such as preagonal vital power and calm and peaceful character. This research could help develop formal caregivers’ observational skills in the end-of-life care settings.

Robot Assisted Activity for Dementia Elderly in Nursing Home Using Robotic Pet

Robot Assisted Activity for Dementia Elderly in Nursing Home Using Robotic Pet

After the Black Box Warning: Predictors of Psychotropic Treatment Choices for Older Patients With Dementia

This study aimed to evaluate factors associated with the selection of pharmacological treatments often given as first-line treatments to elderly patients with neuropsychiatric symptoms associated with dementia. It also evaluated patterns of medication usage over time in the year preceding and three years after the U.S. Food and Drug Administration issued a black box warning for antipsychotic usage. A retrospective cohort consisted of 19,517 Veterans Affairs patients with diagnosed dementia and a new outpatient start with an antipsychotic agent (haloperidol, olanzapine, quetiapine, or risperidone) or valproic acid and its derivatives between May 1, 2004, and September 30, 2008. Patient and facility characteristics were examined for their association with the new starts of these medications. Trends in the rate of fills for psychotropic medications varied, with yearly increases in the use of quetiapine, haloperidol, and valproic acid and decreasing use of olanzapine and risperidone. Predictors of haloperidol use included a new start in nonpsychiatric settings, prior benzodiazepine use, and any prior-year hospitalization. Anxiety disorder and major depression were predictive of not receiving haloperidol. Parkinson's disease was predictive of quetiapine use, whereas bipolar disorder was predictive of valproic acid use. Older age was predictive of use of antipsychotics rather than valproic acid. Urban facilities were less likely to use olanzapine, and significant regional variations were seen. Important patient and facility characteristics were associated with initiating different psychotropic agents among elderly dementia patients. In addition, the rate of use and the factors predictive of use varied across the study years.

After the Black Box Warning: Predictors of Psychotropic Treatment Choices for Older Patients With Dementia

Objectives: This study aimed to evaluate factors associated with the selection of pharmacological treatments often given as first-line treatments to elderly patients with neuropsychiatric symptoms associated with dementia. It also evaluated patterns of medication usage over time in the year preceding and three years after the U.S. Food and Drug Administration issued a black box warning for antipsychotic usage. Methods: A retrospective cohort consisted of 19,517 Veterans Affairs patients with diagnosed dementia and a new outpatient start with an antipsychotic agent (haloperidol, olanzapine, quetiapine, or risperidone) or valproic acid and its derivatives between May 1, 2004, and September 30, 2008. Patient and facility characteristics were examined for their association with the new starts of these medications. Results: Trends in the rate of fills for psychotropic medications varied, with yearly increases in the use of quetiapine, haloperidol, and valproic acid and decreasing use of olanzapine and risperidone. Predictors of haloperidol use included a new start in nonpsychiatric settings, prior benzodiazepine use, and any prior-year hospitalization. Anxiety disorder and major depression were predictive of not receiving haloperidol. Parkinson's disease was predictive of quetiapine use, whereas bipolar disorder was predictive of valproic acid use. Older age was predictive of use of antipsychotics rather than valproic acid. Urban facilities were less likely to use olanzapine, and significant regional variations were seen. Conclusions: Important patient and facility characteristics were associated with initiating different psychotropic agents among elderly dementia patients. In addition, the rate of use and the factors predictive of use varied across the study years. (Psychiatric Services 62:1207–1214, 2011)

Editorial: New drugs for Alzheimer's disease in Japan

Editorial: New drugs for Alzheimer's disease in Japan

Alzheimer's pathology, mixed pathologies and the clinical expression of dementia in the old and the oldest old

Recent studies have come to conflicting conclusions as to whether the relationship of Alzheimer's disease (AD) pathology and clinical dementia is the same in the oldest old as it is for persons below the age of 90. Most of these studies have not incorporated data on mixed pathologies. We assessed clinical and neuropathologic data from 638 persons aged 65-106 at death from the Rush Memory and Aging Project and the Religious Orders Study, two longitudinal studies of aging and dementia. Persons were evaluated on average 6 months prior to death using standard criteria for dementia. Brains were evaluated for a pathologic diagnosis of AD (NIA-Reagan criteria), Lewy bodies (LB) and infarcts, and whether they had one or mixed pathologies. We investigated the relationship of single and mixed pathologies and clinical dementia prior to death in persons age 90 and over compared to persons under age 90. We used logistic regression models adjusted for sex and education to test whether age at death modified the effect of pathology on the odds of dementia. There were 225 persons age 90 and over at death (mean = 94.1, SD = 3.1) and 413 persons under age 90 (mean = 83.5, SD = 4.9). The frequency of AD pathology and infarcts was higher in the oldest old compared to younger old (AD: 71.1% vs. 52.8%, p < 0.001; infarcts: 40.7% vs. 27.5%, p < 0.001). There was no significant difference between the two age groups for Lewy bodies (21.3% vs. 16.4%, p = 0.099). Mixed pathologies were present in 42.2% of the oldest-old compared to 23.1% of the old (p < 0.001). Both AD and mixed pathologies independently increased the odds of dementia in both the old and oldest old (all p-values <0.001). There was no difference in the relationship of AD or mixed pathologies to dementia in the oldest old compared to the younger old (p>0.2 for all interactions). The frequency of mixed pathologies increase with age. AD pathology, LB and infarcts all individually and in combination increase the odds of dementia in both younger and older elders. AD pathology has the same effect on clinical dementia in the old and oldest old when accounting for other pathologies.

Caregiver Burden and Utilization of Social Welfare Services of Elderly Dementia Patients in Korean Long-term Care Insurance System

Caregiver Burden and Utilization of Social Welfare Services of Elderly Dementia Patients in Korean Long-term Care Insurance System