Elderly Demented Patients Research Articles

Feasibility of psychological consultation with elderly demented patients

Feasibility of psychological consultation with elderly demented patients

The efficacy and tolerability of divalproex sodium in elderly demented patients with behavioral disturbances

Behavioral disturbances are commonly encountered in elderly demented patients. The records of all patients admitted to a geropsychiatric inpatient unit within a 2-year period who had a primary diagnosis of dementia and an accompanying behavioral disturbance treated with divalproex sodium were reviewed. Of the 13 patients identified, all tolerated divalproex sodium without significant side-effects. General psychiatric symptoms, overall agitation, physical aggression and non-aggressive physical agitation decreased significantly, but verbal agitation did not. Divalproex sodium is well tolerated and may be effective in ameliorating certain behavioral disturbances in elderly demented patients with agitation.

Another Alternative for Agitation and Dementia

Most elderly demented patients are women, and their dementia can be associated with agitation and aggression. The available techniques for controlling these difficult behaviors have significant limitations. Carbamazepine has been found to reduce aggression, agitation, and irritability in many clinical disorders. This multisite, …

Effectiveness and safety of posatirelin in the treatment of senile dementia: A multicenter, double-blind, placebo-controlled study

Summary A multicenter, double-blind, placebo-controlled study was carried out in elderly demented patients in order to confirm the efficacy and safety of posatirelin (L-pyro-2-aminoadipyl-L-leucyl-L-prolinamide), a synthetic peptide having neurotrophic effects and modulatory activity on the monoaminergic and cholinergic systems. The experimental design consisted of a two-week run-in placebo phase, followed by a double-blind period of three months, with posatirelin (10 mg/ml) or placebo administered once daily intramuscularly. Gottfries-Brne-Steen (GBS) rating scale was utilized as the primary efficacy variable and was measured at start, after 45 and 90 days. For safety evaluation laboratory tests, vital signs and adverse events were monitored. Data were evaluated using analysis of variance on the per protocol (PP) and intent-to-treat (ITT) samples. From a total of 213 patients (mean ± SD age: 78.8 ± 6.2 years) 107 were randomly assigned to posatirelin, and 106 to placebo; because of 3 cases of protocol violations or 38 dropouts, 172 patients were considered available for the PP analysis. Significant differences were obtained in the posatirelin group when analyzing the summary measures (sum of differences from baseline) of the GBS total score both in explanatory (PP) (p = 0.009) and in pragmatic (ITT) (p

Depression in male geropsychiatric inpatients with and without dementia: a naturalistic study

The authors compared the presentation and course of major depression in male geriatric inpatients with and without a diagnosis of dementia. Of 326 consecutive admissions to an inpatient geropsychiatry unit, 22 (7%) had a diagnosis of major depression without dementia, 35 (11%) had major depression with dementia. Both groups presented with similar types and severity of depressive symptoms, which improved substantially with treatment in both groups, as measured by Hamilton Depression Rating Scale scores. In addition, agitation, psychiatric, and side-effects symptoms decreased significantly in both groups. Our naturalistic results suggest the clinical value of intensive treatment of depressive symptoms in elderly demented patients, whether or not they meet the criteria for major depressive episode.

Two years follow-up of non demented elderly hypertensive patients with leukoaraiosis

Two years follow-up of non demented elderly hypertensive patients with leukoaraiosis

CLINICAL COMMENTS

ABSTRACT Cognitive status was measured in ten demented elderly patients who received divalproex sodium (daily dose = 600 ± 76.3 mg, serum levels = 51 ± 4 mg/L) for behavioral management. Hyperammonemia (serum levels 753 ± 61 ug/L) developed after 2-6 weeks of therapy. There were no changes in other liver function studies, nor did signs of hepatic encephalopathy occur. Although baseline cognitive status was poor, it did not deteriorate. Isolated hyperammonemia in demented elderly divalproex sodium users is not associated with further cognitive deterioration.

Anxiety disorders in non-demented and demented elderly patients: prevalence and correlates.

Anxiety disorders in non-demented and demented elderly patients: prevalence and correlates.

The management of coexisting depression in patients with dementia: potential of calcium channel antagonists.

Depression frequently coexists with dementia, although in many cases the depression is not recognized clinically. Depression represents a major additional burden in dementia, not only for the patients but also for families, caregivers, and, economically, society as a whole. However, depression in patients with dementia does respond to treatment, and appropriate therapy can significantly improve the well-being of these patients. Depression in patients with dementia is currently treated with a variety of standard antidepressive agents (tricyclic antidepressants, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors), but none is free from significant side effects. Moreover, the use of these drugs is often complicated by a number of age-related factors or effects on the cholinergic neurotransmitter system. Consequently, an antidementia treatment with concomitant antidepressive properties and an acceptable benefit/risk ratio would represent an attractive therapeutic option. The pathogenesis of depression in patients with dementia is not well understood, but may be related to increased intracellular calcium ions in the CNS, the so-called "calcium hypothesis." This hypothesis may explain why some calcium antagonists exert psychotropic effects, including putative antidepressant activity. Animal models and clinical data provide support for the use of calcium channel antagonists for the treatment of depression, with the potential for good tolerability. The latter aspect is especially important for elderly patients with dementia. Although antidepressive effects have been seen with a number of calcium channel antagonists, the dihydropyridine derivative nimodipine shows particular potential for clinical use, perhaps because nimodipine is one of the most lipophilic of these drugs and therefore achieves high concentrations in the CNS, and because of the unique biochemical properties of the dihydropyridine compounds compared with other L type calcium channel blockers. Nimodipine also increases somatostatin levels in CSF, one of the cardinal biochemical deficits in Alzheimer's disease. Data obtained incidentally from the use of nimodipine in the treatment of elderly demented patients clearly demonstrate significant antidepressant activity by the drug in this patient group. Formal clinical evaluation is therefore recommended to establish more clearly the therapeutic benefits offered by nimodipine in patients who suffer from both dementia and depression.

Behavioural Disorders in Demented Elderly Patients

Dementias are a significant cause of morbidity and mortality in developed countries. Although the key diagnostic factor that defines the dementias is a sustained loss of cognitive ability, dementias are also frequently accompanied by debilitating behavioural disturbances. These behavioural disturbances cause significant problems for the caregivers of people with dementia and are major factors precipitating institutionalisation.

131 Effects of a long-term trial of Fukuyama Yuai-Outdoor Activity Care Program (FY-OACP) on behavioral disorders, hypothalamic-Pituitary-adrenal axis and immune activity in demented elderly patients

131 Effects of a long-term trial of Fukuyama Yuai-Outdoor Activity Care Program (FY-OACP) on behavioral disorders, hypothalamic-Pituitary-adrenal axis and immune activity in demented elderly patients

The quality of long‐term care for dementia: A survey of ward environments

AbstractA survey of long‐stay wards for elderly demented patients was carried out. The quality of five aspects of ward environment was assessed, covering institutional practices, social/recreational input, reality orientation cues, ward condition and space availability. Of the 28 wards surveyed, two‐thirds achieved high quality on one aspect but only two wards had high quality on three or more aspects. In contrast, 14% of the wards obtained low‐quality scores on at least three aspects. A hospital trend was found for the variation in institutional care practices. The results have implications for staff training and for reprovision programmes.

Evaluation of Psychoactive Drug Therapy in Community-Dwelling Elderly Demented Patients

Evaluation of Psychoactive Drug Therapy in Community-Dwelling Elderly Demented Patients

Low-Dose Propranolol Reduces Aggression and Agitation Resembling That Associated with Orbitofrontal Dysfunction in Elderly Demented Patients

Low-Dose Propranolol Reduces Aggression and Agitation Resembling That Associated with Orbitofrontal Dysfunction in Elderly Demented Patients

Low-Dose Propranolol Reduces Aggression and Agitation Resembling That Associated with Orbitofrontal Dysfunction in Elderly Demented Patients

Although several reports suggest that intermediate to high doses of propranolol (80-160 and 200-600 mg/day) can effectively treat aggressive behavior in dementia, significant side effects can occur at these doses. To minimize these side effects, we treated and followed-up a series of 12 demented patients, whose caregivers sought medical help for their disruptive, aggressive behavior, with low-dose propranolol monotherapy (10-80 mg/day). Assessment measures obtained at baseline and during treatment by caregiver interview included ordinal ratings of aggression severity, the Cohen-Mansfield Agitation Inventory (CMAI), and the California Behavior Questionnaire (CBQ). The aggression ratings showed that low-dose propranolol effectively reduced aggression in eight of 12 patients (67%) within 2 weeks of treatment and remained effective for the duration of follow-up (1 to 14 months). Subscales of the CMAI showed responders to have significant reductions in physical and verbal aggression/agitation and in pacing/wandering. These results suggest that low-dose propranolol should be further studied for treating aggression or agitation in demented patients.

Hydergine revisited: A statistical analysis of studies showing efficacy in the treatment of cognitively impaired elderly

The pharmacologic treatment of dementia has received much attention in recent years. Hydergine, one of only two drugs approved by the Food and Drug Administration (FDA) for the treatment of dementia, was largely abandoned in the 1980’s due to the uncertainty of its degree of clinical efficacy. The purpose of our study was to more precisely define the effect of Hydergine on cognitive function in elderly demented patients by combining the results of multiple weighted studies using similar methodology. All data came from randomized placebo controlled trials on a total of 271 subjects. Our results show that Hydergine had a statistically significant effect on global functional status compared to placebo, with the most significant improvement demonstrated on symptoms of depression, emotional lability, and indifference to surroundings. Further studies using Hydergine in the treatment of dementia appear to be justified.

Correlates of mini-mental status examination scores among elderly demented patients: The influence of race-ethnicity

Data on 1888 patients seen at Alzheimer's Disease Diagnostic and Treatment Centers in California were used to examine possible differences in Mini-Mental State Examination (MMSE) results for different racial-ethnic groups. White patients had scores less indicative of dementia than Black and Hispanic patients using the standard 23 cutting point on the MMSE. However, there were no differences among these groups in the percentages clinically diagnosed as demented. The difference in the percentage of Whites vs Blacks and Hispanics categorized as demented by the MMSE was not accounted for by education, occupation, age, sex, or other variables tested, even though these variables were correlated with MMSE scores. Our data suggest that clinicians should consider MMSE scores for Black and Hispanic patients an underestimate of their cognitive capabilities relative to that of White patients.

An attempt to determine the impact of group living care in comparison to traditional long-term care on demented elderly patients

Group living (GL) care for demented elderly is an established model of care in Sweden. This study analyzes the outcome of care in terms of time of GL care, survival and care load for demented patients when extended home care no longer is considered sufficient. Twenty-eight patients, mean age 83 years, suffering from dementia of Alzheimer type or vascular dementia and previously institutionalized, were relocated from long-term care wards into GL units. These patients were compared to a matched sample of patients remaining in traditional institutional (TI) care. No difference in survival was observed between the two groups after three years, nor between length of stay in GL for the different diagnostic groups. However, in patients in GL, symptoms of dementia and functional decline were less prominent than in TI. This was most marked after six months when some improvements in the GL group were registered. The more positive outcome in GL patients abates with time due to the natural course of the diseases. After three years, the two patient groups showed a similar pattern of global deterioration with a tendency toward less care load in the GL group. Offering GL care as an alternative to TI might raise the quality of life in the demented elderly for a period of 2-2.5 years.

Pick and focal brain atrophy

In 1892 Arnold Pick presented the case of an elderly demented patient with severe aphasia and global brain atrophy most accentuated at the left temporal lobe. Picks main interest was the relationship between focally accentuated brain degeneration and focally accentuated neuropsychological deficits, and this was what he wanted to demonstrate. He made no effort to describe a new form of dementia. The term "Pick's disease" which was introduced 30 years later implies the existence of a nosological entity with characteristic clinical features, localisation and histology. The neuropathological causes of focally accentuated brain atrophies are varied. Neocortical pyramidal cell loss with or without spongiform changes, cortical and subcortical gliosis have commonly been described. Achromatic neuronal ballooning ("Pick's cells") and intraneuronal argentophilic inclusion bodies ("Pick's bodies"), Alzheimer type plaques and tangles and other features were found in a smaller number of cases. Several authors confirmed an association between the localisation of brain atrophy and its clinical manifestations, but no convincing relationship has been demonstrated between the clinical symptoms and the underlying histology. In several studies frontal lobe degeneration was found in 10% to 20% of the demented patients, whereas aphasia, apraxia and other pronounced deficits in the context of focally accentuated brain atrophy were described less frequently. An early clinical distinction between atypical early stages of Alzheimer's disease and other forms of slowly progressive dementing disorders is virtually impossible in these cases. Prospective studies documenting the clinical and anatomical findings are needed to examine the reliability of these surmised brain-behaviour relationships in degenerative brain diseases more reliably. A descriptive approach offers a better basis for data collection than the premature diagnosis of a poorly defined disease like "Pick's".

Criteria for institutional placement of elderly demented persons

This paper discusses guidelines for institutional placement of elderly demented patients. It recognizes that there are both emotional and rational issues involved, for family and professional caregivers alike. Criteria for institutional placement are derived from the condition of the patient as well as the circumstances of the caregiver. A number of options for placement are available in most communities, ranging from generalized assisted living facilities to dementia-specific care units in nursing homes. The paper discusses what caregivers need to do both before initiating placement as well as after placement has been implemented. It is hoped that the availability of such guidelines will diminish the stress associated with decision-making concerning institutional placement.