Management Of Dementia Patients Research Articles

Correlation of behavioral and psychological symptoms of dementia with patients’ sociodemographic & clinical details and caregivers’ distress

Background: Behavioral and psychological symptoms of dementia (BPSD) influence dementia care significantly. BPSD can be affected by factors related to the patient’s illness and socio-cultural background. Aim: This study aimed to find a relationship between BPSD with patients’ socio-demographic and clinical profiles and their caregivers’ distress in a tertiary care center. Materials and Methods: In this hospital-based cross-sectional study, the purposive sampling technique was used to select 100 dementia patients. A comprehensive record of socio-demographic and clinical details was made on a self-prepared semi-structured data sheet. The Neuropsychiatric Inventory Questionnaire was the principal tool to find the BPSD and related caregivers’ distress. Results: The sample comprised predominantly Hindu (91%) male patients (66%) with Alzheimer’s dementia (76%) coming from rural backgrounds (74%) and joint familial systems (96%), with a mean age of 71.77 ± 7.41 years. Patients’ main caregivers were their children/children-in-law (65%). The severity of an overall BPSD and its variable individual domains were directly related to the duration of dementia, patients’ age, their cognitive decline, and related decline in activities of living, as well as their caregivers’ distress. In comparison to Alzheimer’s disease patients, those with other dementia types had more impairment in cognitive functions and activities of daily living and they had a higher number and severity of BPSD. Conclusion: The advancing age, increased duration of dementia, and decline in cognition and related activities of daily living of the patients, as well as their caregivers’ distress, are important correlates of BPSD. The findings are essential for the better management of dementia patients.

Evaluating a Memory Clinic Using the RE-AIM Model. The Experience of the "Memory and Neuropsychiatry Clinic" in Hospital Del Salvador, Chile.

The development of healthcare services for dementia is key to improving access to care and post-diagnostic support for people living with dementia. Memory Units have emerged as a new healthcare service composed of multidisciplinary teams with the goal of improving diagnosis and/or management of dementia patients. The main objective of this study was to describe and evaluate the Reach and Effectiveness of a Memory Unit in a public hospital in Chile, using the RE-AIM model, a multi-component model that allows for the evaluation of the implementation of ongoing healthcare programs. Regarding “R” (Reach): from March 2018 up to June 2019, a total of 510 patients were referred and assessed. Most patients came from primary care (51.9%) and from outpatient services at the Hospital Salvador (39.2%), particularly from the Neurology (63.3%) and Psychiatry (16.0%) departments. We estimated that our Memory Unit assessed 5.39% of all of the dementia patients living in the area of referral. With respect to “E” (Effectiveness): 419 patients are still being followed up at the Memory Unit. Ninety-one patients (18%) were discharged. Of these, 55 (66%) were referred to primary healthcare, 28 (31%) to other outpatient services, 9 (10%) to a specialized mental healthcare center, and 9 (10%) to a daycare center. Due to the short period of time that the Memory Unit has been operating, no other RE-AIM dimensions could be evaluated at this juncture. To our knowledge, this is the first implementation study of a Memory Unit in Latin America, and the first using the RE-AIM model. Although cultural differences worldwide might play a role in the lack of international guidelines, the publication of the experience of the first year of this unit in Chile could inform new countries about this process. Ongoing challenges include continuing to collect data to complement the RE-AIM evaluation and developing a protocol that can be adopted elsewhere in Chile and Latin America. Further studies are needed to assess the benefits of a Memory Unit in comparison to regular care and to develop a model that assures continuity and coordination of care for people with dementia.

The needs of informal caregivers and barriers of primary care workers toward dementia management in primary care: a qualitative study in Beijing

BackgroundInformal caregivers of people with dementia in Beijing are increasingly called upon to provide home-based care for their patients due to the increasing number of dementia patients and the shortage of standardized institutional solutions of care for patients in China. This study aimed to clarify the needs of informal caregivers and barriers of primary care workers toward dementia management in primary care in Beijing to provide references that may help to improve the care and services provided to individuals with dementia and their family caregivers residing in urban China.MethodsA mixed-methods approach was used in this study. We performed individual in-depth interviews with 10 informal caregivers. Moreover, we carried out focus group interviews with 29 primary care workers. Content analysis was used to separately identify themes and codes. Discrepancies were discussed until final agreement was achieved.ResultsThree themes representing the core attitudes of informal caregivers and primary care workers were identified: care knowledge and skills, psychological counseling, and collaborative management. Most primary care workers believed that the management of dementia patients in primary care was necessary. However, due to the heavy work load and different medical specialties involved, these workers were unable to manage it.ConclusionsProfessional training focused on dementia for primary care workers should be strengthened. At the same time, the establishment of a community-based dementia team management model that includes specialists, community health service centers (CHSCs), and community committees should be explored.

Exploring Rural Family Physicians' Challenges in Providing Dementia Care: A Qualitative Study.

ABSTRACTCurrently, 564,000 Canadians are living with dementia. This number will continue to rise as the population ages. Family physicians play an integral role in the diagnosis and management of dementia patients. Although studies have looked at family physician perspectives on dementia care in the urban setting, much less is known about challenges in rural areas. This study aimed to explore rural family physicians' experiences in caring for patients with dementia in rural Alberta, Canada. We conducted three semi-structured focus groups with 16 family physicians to evaluate barriers and facilitators to providing care to persons with dementia in three rural communities. We developed focus group questions based on the theoretical domains framework (TDF) and analysed them using a framework approach. Physician capabilities, opportunities, and motivations appear to play important roles in caring for these patients. These research findings can be used to advance quality of care for rural dementia patients.

Doll therapy for dementia sufferers: A systematic review

Dementia affects more than 47.5 million people worldwide, and the number is expected to continue to increase as the population ages. Doll therapy is an emerging nonpharmacologic management strategy for patients with advanced dementia, especially in patients with challenging behaviours. A total of 12 published studies (mainly cohort and observational studies) were identified and discussed in this systematic review. In most instances, cognitive, behavioural and emotional symptoms were alleviated and overall wellbeing was improved with doll therapy, and dementia sufferers were found to be able to better relate with their external environment. Despite the relative paucity of empirical data and ethical concerns, we are of the opinion that doll therapy is effective for dementia care, is well-aligned with the ethos of person-centred care and should be applied in the management of dementia patients. Future research should include more robust randomized controlled trials.

Does an interdisciplinary network improve dementia care? Results from the IDemUck-study.

Background: Most persons with dementia live at home and are treated in the primary care. However, the ambulatory health care system in Germany contains a lot of “interface problems” and is not optimized for the future challenges. Innovative concepts like regional networks in dementia care exist on a project level and need to be tested for efficacy to encourage implementation. The goal of the study is the scientific evaluation of an already existing regional dementia network. Methods: Prospective randomized controlled trial of 235 community-living elderly with dementia and their family caregivers of network treatment (n=117) compared to usual care (n=118) in a predominantly rural region. The allocation to intervention or control group was based on network membership of their General Practitioner. Intervention patients received diagnostic evaluation and subsequent treatment according to network guidelines. Main outcome measures were the early contact with a neurologic or psychiatric specialist and dementia-specific medication as well as quality of life of the patients, and as secondary outcomes caregiver burden and caregiver health-related quality of life. Results: Network patients were more likely to receive antidementive drugs (50.5 % vs. 35.8 %; p=0.035) and had more often contact to a neurologist (18.6 % vs. 2.8 %; p<0.001). No group differences were found on patient’s quality of life nor overall effects or treatment by time effects. Intervention caregivers reported no significant improvements in health related quality of life measured by SF-36 and EQ-5D. Conclusion: The management of dementia patients in an interdisciplinary regional network solelyprovides measurable advantages with respect to the provision of dementia-specific medication and utilization of medical treatment i.e. referral rates to specialists. Further evaluation research is needed to identify relevant mechanismsof collaborative processes with respect to their impact on patient and caregiver related outcomes.

Mini‐Emotional State Examination for dementia patients

Emotional functions, as well as cognitive functions, are critical factors to assess in the care and management for dementia patients. In addition to the Mini-Mental State Examination (MMSE), we have developed a Mini-Emotional State Examination (MESE) for the examination of emotional functions in patients with dementia. MESE consists of a two-part questionnaire. The first probes emotional functions within the five senses (visual, auditory, tactile, smell and taste). The second explores more complex and comprehensive emotional functions including feelings of tenderness, violence, happiness and sadness, as well as emotional responses to more general human, moral and social phenomena. The questionnaire comprises 30 questions and is scaled to a 30-point healthy maximum. A total of 40 dementia patients in Sendai Tomizawa Hospital were tested with MESE. MESE point scores were roughly parallel to the scores on the MMSE, but MESE scores were widely distributed, independent of MMSE score. MESE scores in nine patients exceeded 23 points. The difference in distribution of MMSE and MESE scores show that cognitive and emotional functions are independently affected in dementia, and therefore assessment of both these functions should be cared taken into consideration in the care and management of dementia patients.

Nootropic Potential of Murraya koenigii leaves in Rats

Murraya koenigii leaves commonly known as 'curry patta' are routinely added to Indian gravy and vegetarian dishes by south Indian as a favourate condiment. The present study was undertaken to investigate the effects of Murraya koenigii leaves (MKL) on memory in rats. Elevated plus-maze and Hebb-Williams maze served as the exteroceptive behavioral models for testing memory. Diazepam-, scopolamine- and ageing-induced amnesia served as the interoceptive behavioral models. MKL fed orally to various groups of young and aged rats with diet containing 2, 4 and 8% w/w of MKL for 30 days consecutively were investigated. The MKL diets produced a significant dose-dependent improvement in memory scores of young and aged rats and significantly reduced the amnesia induced by scopolamine (0.4 mg/kg, i.p.) and diazepam (1 mg/kg, i.p.). Therefore, it would be worthwhile to specifically investigate the therapeutic potential of MKL in the management of dementia patients.

CORRESPONDENCE

Now that the National Institute for Health and Clinical Excellence (NICE) has given its guidance on management of dementia patients with anticholinesterase inhibitor drugs the world of dementia is reeling with a mixture of reactions and opinions.

Inanspruchnahmeverhalten von Demenzpatienten im Spiegel von GKV-Daten

In describing the patterns of utilization of healthcare services by dementia patients in comparison to age- and sex-matched controls the study was to provide information on special care needs of patients with dementia concerning somatic diseases. A representative sample of insured individuals from 1998 to 2002 (the “Versichertenstichprobe AOK Hessen/KV Hessen”) provided the database. Patients with dementia were defined according to the ICD-coded billing diagnoses. Regarding general practitioner visits, patients with dementia have approx. 11 additional contacts per year compared to their controls. A smaller percentage of patients with dementia present to a specialist (excluding neurologists/psychiatrists). Furthermore, the two groups differ as to the kind of specialists visited, which in turn is associated with different service and prescription patterns. The study was not able to clarify whether the differences are possibly due to the GPs’ prioritization of treatment of dementia patients. Both physicians and nurses should be sensitized to the possibility that dementia patients may not be able to explicitly mention existing diseases and impairments (such as cardiovascular and sensory disorders, pain). Moreover, physicians and other professionals involved in the management of dementia patients should be trained to pay special attention to the particular care-related problems (pressure ulcers, infections or inadequate fluid intake).

Pharmacological Treatments of Behavioral Symptoms in Dementia

Behavioral symptoms are well-recognized concomitants of the progression of dementia. These symptoms include agitation, aggression, anxiety, depression, disinhibition, delusions, hallucination, and sleep disturbance. Because these symptoms are a major source of impaired quality of life for patients and their caregivers, appropriate pharmacological management of them may reduce the burden of caregivers and postpone institutionalization. Furthermore, behavioral symptoms may be more amenable to pharmacological intervention than cognitive symptoms. For that reason, detailed evaluation and appropriate treatment are the mainstay in the management of dementia patients. In this article, we reviewed symptomatology and psychopharmacology for behavioral symptoms of dementia.

Group Management of Dementia Patients in a Day-Care Center

Our top and middle management initially received thorough training in group theory and group management techniques for organizational reasons. In daily shift meetings, nurse aides (NAs) learn some of the techniques and approaches, translating part of them to work with patients. From the moment we started to focus on the day-care center patients as a group to be managed every minute, we found that disturbances decreased significantly (based on empiric assessment by staff).

Management of dementia patients and their relatives: report from the routine practice of a family physician

In the care of patients with dementia the family physician takes the role of a supportive coordinator. His main partner is the caring significant other. The family physician has to adapt the results of 'evidence based medicine' to the situation of the patient and transform it into 'individually balanced medicine'. His respective decisions have to be realized with the patient, the family and the professional carers. On the ground of clinical examples from day to day practice problems encountered at the beginning of the disease, regarding medication, in advanced stages and around death are discussed and solutions proposed.

Management of dementia patients: the family as corner stone

In dementia care it is of utmost importance to include the patient's social environment, in particular his family. Established in 1988, the aims of the Swiss Alzheimer Association are to promote the support of patients suffering of Alzheimer's disease, or related disorders, and their carers, to raise the awareness of Alzheimer's disease by the medical, paramedical and social professions and to encourage their training. It also promotes the dissemination of information on dementia in the public. This article focuses mainly on the effects of dementia on the carers. They are essential partners in the care of dementia patients.

Community resources and the management of dementia patients

Clinical management of the Alzheimer's disease patient in his or her home requires an array of services. Such services are often available from voluntary organizations, religious groups, for profit, not-for-profit, or governmental agencies. This article reviews the structure and range of those services that contribute much help to maintain the patient outside of the institution.

Dexamethasone suppression test and response to antidepressant therapy in psychogeriatric patients.

Senile dementia patients show a high incidence of abnormal Dexamethasone Suppression Test (DST) which has been suggested to reflect the presence of atypical or subclinical depression; this study was designed to test this hypothesis. Thirty-six patients, diagnosed as suffering from dementia and/or depression on the DSM-III criteria, participated in the study. They were divided into three groups. dementia (12), depression (12) and dementia with depression (12). The results indicated that although patients with depression alone responded well to antidepressant therapy, no improvement occurred in patients with dementia. Demented patients who had clinical depression also showed a poor response. The response to treatment was unrelated to the DST status of the patients. It is concluded that abnormal DST in dementia patients is not indicative of a masked affective state, and antidepressants have no place in the management of dementia patients who have a positive DST but no overt affective symptoms.

Family Caregiver Appraisals of Patient Behavioral Disturbance in Senile Dementia

In the present study, 44 primary family caregivers of elderly patients with dementia were interviewed concerning the prevalence of 31 specific behavioral problems in the home setting, the subjective stressfulness of each problem, and caregivers' perceived self-efficacy in managing each problem. Results indicate that, although self-care deficits and disorientation are extremely common, they are of less concern to caregivers than a number of prevalent and highly stressful behavioral problems such as agitation, hallucinations, and dangerous or embarrassing behaviors. These specific behavioral problems deserve greater attention in the management of dementia patients who live in community settings.