Disturbances In Dementia Research Articles

Indications for the Use of Atypical Antipsychotics in the Elderly

There has been an expanding role for the new generation atypical antipsychotic agents (clozapine, risperidone, olanzapine, and quetiapine) in elderly patients. Their efficacy in the treatment of psychoses associated with schizophrenia is now well established. But psychoses occur in other conditions. This paper will review the current research examining the use of the atypical agents in the treatment of psychoses in the elderly in three somewhat overlapping conditions: schizophrenia, dementia, and Parkinson's disease, as well as in the amelioration of a variety of movement disorders. In the elderly, any of the atypicals can be used to treat schizophrenia, although clozapine may be a second line agent because of its side effect profile. Risperidone may be the drug of choice for the treatment of psychoses and behavioral disturbances in dementia. Clozapine is a primary choice and quetiapine an alternative for the treatment of psychoses in Parkinson's disease; while clozapine and possibly risperidone may be preferred for the initial treatment of some movement disorders. The differential effectiveness of these agents across treatment indications may, in part, be related to their differing affinities at several neurotransmitter receptors. Examination of these relationships in large scale longitudinal studies may help in the development of effective tailored treatments for the elderly.

The use of typical and atypical neuroleptics for controlling behavioral disturbances in dementia: A retrospective study

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) is well known as an exogenous dopaminergic neurotoxin that induces Parkinson's disease-like symptoms. In addition, 1,2,3,4-tetrahydroisoquinoline (TIQ) derivatives have been investigated as endogenous MPTP mimetic compounds that structurally resemble selegiline, a commercially available drug for treating Parkinson's disease. In the present study, we examined the ability of 1,3-dimethyl-TIQ (1,3-diMeTIQ) and 1,3-dimethyl-N-propargyl-TIQ (1,3-diMe-N-proTIQ) to prevent MPTP-induced Parkinson's disease-like symptoms in mice and to prevent 1-methyl-4-phenylpyridinium ion (MPP+, an active metabolite of MPTP)-induced cytotoxicity in vitro, including its structural stereoselectivity. Repeated administration of MPTP induced bradykinesia, a symptom of behavioral abnormality; this was prevented by both 1,3-diMeTIQ and 1,3-diMe-N-proTIQ pretreatments. Pretreatment with 1,3-diMeTIQ did not prevent the MPTP-induced decrease in dopamine content in the striatum or the decrease in the number of tyrosine hydroxylase-positive cells in the substantia nigra. On the other hand, 1,3-diMe-N-proTIQ prevented these Parkinson's disease-like symptoms; in particular, the trans-isomer of this agent showed potent protective effects. However, the ability of the trans-1,3-diMe-N-proTIQ isomer to prevent MPP+-induced PC12 cell death was weaker than that of its cis-isomer. Thus, stereoisomers of 1,3-diMe-N-proTIQ exhibit different effects; cis-1,3-diMe-N-proTIQ inhibits MPP+-induced cytotoxicity while trans-1,3-diMe-N-proTIQ exhibits neuroprotective effects primarily through MPTP-related biological events in mice. These results also indicate the possibility of utilizing, at least in part, the stereoselective efficacy of 1,3-diMe-N-proTIQ against MPTP and/or MPP+-induced adverse states.

Introduction

This special issue of International Psychogeriatrics, “Behavioral and Psychological Symptoms of Dementia: A Clinical and Research Update,” contains the proceedings of a conference held in Lansdowne, Virginia, May 11–13, 1999. It is a sequel to a previous issue that was based on the first international Consensus Conference on Behavioral Disturbances of Dementia (Lansdowne, Virginia, March 31–April 2, 1996). The rationale for the second conference was the growing interest in the symptoms of dementia (e.g., physical aggression, delusions, wandering) that result in premature institutionalization, emotional suffering for patients and caregivers, increased financial costs, and excess disability.

A Comparison of Symptoms of Behavioral Disturbances in Yoruba and African American Individuals With Dementia

Comparative cross-cultural studies represent a great opportunity for delineating risk factors for the dementias by providing a much wider diversity of both environmental exposures and genetic variation than studies within industrialized countries. Similarly, studies of the behavioral disturbances of dementia that allow for identification of similarities and differences may be useful both in understanding the etiology of these disorders and in determining the best approach to management. So far, few such comparative studies exist.

Mental and behavioral disturbances in dementia: Findings from the cache county study on memory in aging

Mental and behavioral disturbances in dementia: Findings from the cache county study on memory in aging

The assessment of behavioral disturbances in dementia using a telemetric device

The assessment of behavioral disturbances in dementia using a telemetric device

Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging.

The authors report findings from a study of 5,092 community residents who constituted 90% of the elderly resident population of Cache County, Utah. The 5,092 participants, who were 65 years old or older, were screened for dementia. Based on the results of this screen, 1,002 participants (329 with dementia and 673 without dementia) underwent comprehensive neuropsychiatric examinations and were rated on the Neuropsychiatric Inventory, a widely used method for ascertainment and classification of dementia-associated mental and behavioral disturbances. Of the 329 participants with dementia, 214 (65%) had Alzheimer's disease, 62 (19%) had vascular dementia, and 53 (16%) had another DSM-IV dementia diagnosis; 201 (61%) had exhibited one or more mental or behavioral disturbances in the past month. Apathy (27%), depression (24%), and agitation/aggression (24%) were the most common in participants with dementia. These disturbances were almost four times more common in participants with dementia than in those without. Only modest differences were observed in the prevalence of mental or behavioral disturbances in different types of dementia or at different stages of illness: participants with Alzheimer's disease were more likely to have delusions and less likely to have depression. Agitation/aggression and aberrant motor behavior were more common in participants with advanced dementia. On the basis of their findings in this large community population of elderly people, the authors conclude that a wide range of dementia-associated mental and behavioral disturbances afflict the majority of individuals with dementia. Because of their frequency and their adverse effects on patients and their caregivers, these disturbances should be ascertained and treated in all cases of dementia.

The association between white matter lesions on magnetic resonance imaging and noncognitive symptoms.

A number of studies have suggested that cerebral changes, particularly deep white matter lesions (WML) visualized on magnetic resonance imaging (MRI), may be involved in the genesis of late life depression. This has been confirmed in a prospective study which also found a relationship between the presence of WML and poor 3-year outcome in elderly depressed subjects. Most studies find these lesions to predominate in frontal lobe and basal ganglia, supporting the hypothesis of "fronto-striatal" dysfunction in depression. To investigate whether WML are associated with mood disturbance in dementia, proton density and T2-weighted images were obtained in 80 subjects with dementia (dementia with Lewy bodies, n = 27; Alzheimer's disease, n = 28; vascular dementia, n = 25) and 26 age-matched normal controls. Periventricular lesions (PVL), white matter lesions (WML), and basal ganglia hyperintensities (BG) were visually rated blind to diagnosis using a semiquantitative scale. Frontal WML were associated with higher depression scores in patients with dementia, implying a common pathophysiology of depression irrespective of diagnosis. Further study of the neurobiological basis of WML is needed. This can best be achieved by serial clinical assessment combined with in vivo and in vitro MRI and neuropathological examination.

Bright light therapy for demented nursing home patients with behavioral disturbance

The objective of this study was to examine the effects of morning bright light on behavioral disturbances in dementia using a repeated measures ABA design. We hypothesized that morning bright light in demented patients reduces the agitation rating and directly observed disruptive behavior, but increases observed positive behavior. The study was done in a special care unit of a long term care facility, with 16 demented residents ages 60 to 89, 13 female and three male. Morning bright light (Day-Light Box 10000, produced by DayLight Technologies, Inc, providing 10,000 lux) was administered Monday to Friday during the treatment week. The Global Deterioration Scale rating at baseline, followed by baseline, treatment and post-treatment ratings in the Cohen-Mansfield Agitation Inventory (CMAI) and Environment-Behavior Interaction Code (EBIC) were used as measurements Compared to baseline, the mean total Cohen-Mansfield score decreased more during the phototherapy week than during the post-treatment week (p < 0.05 on one-tailed paired t-test). Regardless of phototherapy, Cohen-Mansfield scores decreased significantly in summer versus fall-spring (p < .005). Although the direct behavioral measures [EBIC] showed no statistically significant change compared to baseline, there was a pattern of greater mean increase in positive behaviors (p = .08) during phototherapy than in the post-treatment week, and a mean decrease of total disruptive behaviors most pronounced in the post-treatment week (p = .05). Bright light therapy has modest efficacy in reducing agitation, with possible concurrent improvement in positive behaviors. Disruptive behaviors may also become less frequent during phototherapy with evidence of even greater delayed optimal effect. Further research should focus on subgroups of patients demonstrating a particularly robust response, enhance power through a larger sample, provide for longer light exposure, and control for seasonal variables.

Is improvement possible in the measurement of behaviour disturbance in dementia?

Is improvement possible in the measurement of behaviour disturbance in dementia?

Is improvement possible in the measurement of behaviour disturbance in dementia?

Is improvement possible in the measurement of behaviour disturbance in dementia?

Dementia carer education and patient behaviour disturbance

To evaluate the impact of a dementia Carer Education Programme on carer quality of life (QoL), burden, and well-being. Single group before-after intervention study. The group was subdivided by perceived status post-programme for intragroup analysis. Hospital memory clinic. Convenience sample of 32 dementia carers. Eight weekly 2 h education and support sessions run by a psychogeriatric clinical team. Pre-programme and 6 months post-programme data were obtained. Measures included individually perceived QoL, burden, well-being, managing problem behaviour, appraisal of social support, knowledge of dementia, and perception of the programme. Patients were characterized in terms of cognition, behaviour disturbance and functional status. Twelve carers reported their situation post-programme as 'better', 12 as 'worse', and four as 'no change'. There were no significant baseline differences. For 'better/no change' carers the only significant change over time was increased knowledge about dementia. For 'worse' carers knowledge also increased, but there was evidence of poorer QoL, increased burden, a poorer appraisal of social support, and increased patient behaviour disturbance. Only patient behaviour disturbance significantly discriminated 'no change/better' from 'worse' carers (F = 4.08, p = 0.055). The programme increased carers' knowledge about dementia, but had no significant impact on QoL, burden, or well-being. Increased patient behaviour disturbance appeared to be a major factor when the carer's situation worsened over time. Despite high carer satisfaction the efficacy of a group-based education approach to the management of behaviour disturbance in dementia appears limited. More intensive or individually tailored interventions may be necessary alternatives.

Contribution of psychosis and depression to behavioral disturbances in geropsychiatric inpatients with dementia.

Specific behavioral disturbances in dementia may be associated with underlying disorders such as the presence of psychosis and depression. The objective of this study was to examine the association of depression and psychosis with behavioral disturbances in geropsychiatric inpatients with dementia. All admissions between October 1993 and May 1995 were reviewed to identify those patients admitted to the Houston Veterans Affairs Geropsychiatry Unit with a diagnosis of dementia; 208 patients were included in the study. Hierarchical regression models were constructed to explore the contribution of depressive and psychotic symptoms, and depression and psychosis diagnoses to Cohen-Mansfield Agitation Inventory (CMAI) scores. Both depression and psychotic symptoms were significantly and positively correlated with behavioral disturbances. Psychotic symptoms were associated with aggressive behavioral symptoms, and depressive symptoms were associated with constant requests for help, complaining, and negativism. Dementia severity accounted for significant variance in CMAI scores and was positively associated with behavioral disturbance; though disorder symptoms accounted for more behavioral disturbance variance than did depressive symptoms. Both depressive and psychotic symptoms were associated with overall behavioral disturbances in patients with dementia. Psychotic symptoms and depressive symptoms were associated with different types of behavioral disturbances. Our findings support the contention that underlying depression or psychosis may partially account for different behavioral disturbances and that not all behavioral disturbances should be globally labeled "agitation." Future studies should address symptom-specific treatment of behaviorally disturbed patients.

Guidelines for the Appropriate Use of Cholinesterase Inhibitors in Patients with Alzheimer??s Disease

The cholinesterase inhibitors are the only available scientifically proven symptomatic treatments for dementia of the Alzheimer’s type. The guidelines we present summarise the current updated knowledge on the available drugs, including tacrine, donepezil, rivastigmine, metrifonate and galantamine (galanthamine). Each of these drugs have been proven to be more effective than placebo in improving symptoms in well designed, double-blind, placebo-controlled studies. Although tacrine was the first drug approved by the US Food and Drug Administration, it needs frequent monitoring of alanine amino transferase levels. Hence, donepezil emerged as a frequently prescribed drug for dementia of the Alzheimer’s type, secondary to its ease of use and lack of significant adverse effects. More studies are needed regarding long term efficacy, head-to-head comparisons and effects upon behavioural disturbances in dementia of the Alzheimer’s type. These guidelines will provide the starting point for a wider clinical use because, although available and clinically effective, the cholinesterase inhibitors are under-prescribed by clinicians in the pharmacological treatment of Alzheimer’s disease.

Psychosis and behavioral disturbances in dementia: Effects of risperidone in 969 patients

To determine the extent to which frontal executive impairment early in the course of dementia is predictive of subsequent disturbed behavior.This was a prospective follow-up study set in the Memory Clinic, Leicester, United Kingdom. A patient cohort (N = 42) diagnosed with mild to moderate dementia was followed up between three and six years after initial assessment. Executive function at baseline was assessed using the The Cambridge Examination for Mental Disorders of the Elderly–Revised (CAMCOG-R) Executive Function score. Disturbed behavior and caregiver distress at follow-up were assessed on the Neuropsychiatric Inventory (NPI), Cohen-Mansfield Agitation Inventory (CMAI), and Dementia Apathy Interview and Rating (DAIR).After adjustment, the Executive Function score at baseline was predictive of disturbed behavior and caregiver distress (NPI, CMAI, DAIR) at follow up, with higher levels of executive impairment associated with higher levels of disturbance/distress. Baseline measures of global cognitive impairment (Mini-Mental State Exam, CAMCOG) were not predictive of subsequent disturbed behavior or caregiver distress.Executive impairments identifiable relatively early in the clinical course of dementia are predictive of disturbed behavior and associated caregiver distress at long-term follow-up, which supports the view that executive dysfunction is important in the etiology of these problems.

Risperidone in the treatment of behavioral disturbances in dementia

Risperidone in the treatment of behavioral disturbances in dementia

Special care units for dementia in nursing homes: A controlled study of effectiveness

Summary The management of behavioral disturbances in the demented patient is a debated issue both in the medical and the social fields. Aim of this study was to evaluate the effectiveness of an integrated model of care (special care units =SCU in long-term care facilities) to control behavioral disturbances in dementia and to compare it to the more traditional nursing home model. The study is multinational (Italy, France and Sweden) and is funded by the European Commission (DG V). Thirty-one cases (in SCU) and 35 controls (in traditional nursing homes = NH) were enrolled in 43 long-term facilities and assessed 7–14 days after admission and 3 months afterwards. On admission, cases and controls had similar sociodemografic status, cognition, diagnoses, somatic health, and psychotropic drug use, but the former tended to have more severe behavioral disturbances and to be less restrained (19 versus 46 %) over the first week after admission. On 3-month follow-up, behavioral disturbances had improved in cases and controls, but with a different pattern: delusions, hallucinations, and agitation improved in the former, and anxiety, euphoria/elation, and irritability/lability in the latter. Sleep disturbances improved in both groups and depression improved in cases and worsened in the controls. Psychotropic drug prescription had not significantly changed in either group. However, notwithstanding the higher frequency of physical restraint use in the controls soon after admission, on 3-month follow-up this was even greater (69 %), while it remained low (26 %) in the cases. The data suggest that special care unit care of behavioral disturbances in the demented can succesfully control symptoms without additional psychotropic drug and restraint use.

P.4.025 Risperidone in the treatment of behavioral disturbances in dementia

P.4.025 Risperidone in the treatment of behavioral disturbances in dementia

35-7 - Behavioral disturbances in dementia: An identifiable cost factor in long term care institutionalization

35-7 - Behavioral disturbances in dementia: An identifiable cost factor in long term care institutionalization

75-2 - Behavioral disturbances in dementia as a factor in institutionalization

75-2 - Behavioral disturbances in dementia as a factor in institutionalization