Neuropsychiatric Symptoms In People Research Articles

North Macedonia interprofessional dementia care (NOMAD) – personalized care plans for people with dementia and caregiver psychoeducation delivered at home by interprofessional teams

IntroductionThe increasing number of people living with dementia and its burden on families and systems particularly in low- and middle-income countries require comprehensive and efficient post-diagnostic management. This study aimed to explore the acceptability and efficacy of a multi-professional case management and psychoeducation model (North Macedonia Interprofessional Dementia Care, or NOMAD) delivered by mobile teams for people with dementia and their caregivers in North Macedonia.MethodWe conducted a two-arm randomized controlled trial comparing the intervention with treatment as usual. Participants were recruited from 12 general practitioner (GP) offices in the Skopje region. The NOMAD intervention included the delivery of a personalized care plan over four home visits to dyads of people with dementia and their caregivers by a team including a dementia nurse and a social worker, in collaboration with GPs and dementia experts, and the introduction of a caregiver manual. We assessed caregivers' depressive symptoms, burden, and quality of life and the neuropsychiatric symptoms, daily living activities, and service utilization of people with dementia at baseline and follow-up; we also assessed the acceptability of the intervention by analyzing case notes and attendance rates.ResultsOne hundred and twenty dyads were recruited and randomized to either the control (n = 60) or the intervention group (n = 60). At follow-up, caregivers in the intervention group had, on average, scores that were 2.69 lower for depressive symptoms (95% CI [−4.75, −0.62], p = 0.012), and people with dementia had, on average, 11.32 fewer neuropsychiatric symptoms (95% CI [−19.74, −2.90], p = 0.009) and used, on average, 1.81 fewer healthcare services (95% CI [−2.61, −1.00], p < 0.001) compared to the control group. The completion of the home visits was 100%, but the intervention's acceptability was underpinned by relationship building, GP competencies, and resources to support families with dementia. There were no differences in the caregivers' quality of life and burden levels or daily living activities in people with dementia. NOMAD is the first case management, non-pharmacological, and multi-professional intervention tested in North Macedonia.DiscussionThe trial showed that it is effective in reducing caregivers' depressive symptoms and neuropsychiatric symptoms in people with dementia and the burden on health and social care services, and it is acceptable for families. Implementing NOMAD in practice will require building primary care capacity and recognizing dementia as a national priority.

Posttraumatic stress disorder in people with dementia: study protocol

ABSTRACT Background: Posttraumatic stress disorder (PTSD) is considered an independent risk factor for dementia. Despite the (clinical) evidence that PTSD is associated with neuropsychiatric symptoms in people with dementia, studies on its prevalence and clinical manifestation are limited, and their quality is affected by the lack of a structured method to diagnose PTSD in this population. The primary aim of the current study is to validate the ‘TRAuma and DEmentia’ interview as a diagnostic tool for PTSD in people with dementia and to test feasibility of EMDR treatment for people with PTSD and dementia. Methods: This prospective multi-centre study is divided into two parts. In study A, 90 participants with dementia will be included to test the criterion validity, inter-rater reliability and feasibility of the ‘TRAuma and DEmentia’ interview. In study B, 29 participants with dementia and PTSD will receive eye movement desensitisation and reprocessing therapy by a trained psychologist, and 29 participants with dementia and PTSD will be placed on the waiting list control group. Conclusion: This study aims to improve the diagnostic process of PTSD and to assess the effects of eye movement desensitisation and reprocessing treatment in people with dementia living in Dutch care facilities. Trial registration: NL70479.068.20 / METC 20-063 / OSF registration: https://doi.org/10.17605/OSF.IO/AKW4F

Neuropsychiatric Symptoms Predict Faster Cognitive Decline in Dementia Collaborative Care Than Antipsychotic Use.

To compare short-term cognitive outcomes among groups with and without neuropsychiatric symptoms (NPSs) or antipsychotic prescription and to determine which disease status or treatment modality is associated with relatively faster cognitive decline. We retrospectively analyzed a prospective cohort of patients diagnosed with dementia and mild cognitive impairment. All participants were evaluated using the Cognitive Abilities Screening Instrument (CASI) during their initial clinical assessments and at the annual follow-up. The dependent variable was annual delta CASI. Multivariate linear regression analysis was used to assess the degree of association between NPS, antipsychotic use, and cognitive decline after adjusting for confounding factors. Neuropsychiatric symptoms were examined individually to determine their predictive value for cognitive decline. A total of 407 (N = 407) patients were included in the study. NPSs, rather than antipsychotic use, led to faster cognitive decline. A higher baseline NPI total score predicted a significantly faster decline in CASI scores (1-year delta CASI = -0.22, 95% CI = -0.38~ -0.05, p = 0.010). Specific items (delusions, agitation, depression, anxiety, euphoria, and apathy) in the NPS significantly increased cognitive decline. Certain neuropsychiatric symptoms, rather than antipsychotic use, lead to faster cognitive decline in a dementia collaborative care model. Checking for and providing appropriate interventions for NPS in people with dementia and their caregivers are highlighted.

USING THE ELECTRONIC MEDICAL RECORD OF NURSING HOME RESIDENTS FOR IMPROVED MEASURE OF BEHAVIORAL SYMPTOMS

Abstract Behavioral symptoms as study outcomes are measured by routinely collected data such as the Minimum Data Set (MDS), the standardized assessment of nursing home (NH) residents. However, MDS under-detects neuropsychiatric symptoms in people with dementia, and better identification in this outcome measurement is needed. This work aims to determine if the electronic medical record (EMR) NH data, the Interventions to Reduce Acute Care Transfers (eINTERACT) form, could improve the identification of agitated behaviors (behaviors). 77,936 assessments of the MDS and the EMR of 19,705 long-stay residents with dementia from 322 NHs, conducted between January 2020 and August 2022, were used. MDS behaviors were defined as any verbal or physical behaviors directed at others, resistance to care, or other behaviors (e.g., pacing). eINTERACT behaviors were defined as any general agitation or verbal or physical aggression. 96% of NHs used eINTERACT forms for at least half of their residents. On average, 14.8% (SD 35.6) of residents with a qualifying assessment in a given month had an MDS-documented behavior, and 2.4% (SD 15.2) had an eINTERACT-documented behavior. 1.4% (SD 11.7) had behaviors documented only on the eINTERACT form representing about a 10% increase in detectable behaviors in a given month over MDS alone. Results were robust to stratification by NH-level prevalence of MDS behaviors. Using the eINTERACT forms in addition to the MDS behavioral items increased in detection among long-stay residents with ADRD. There is some indication that greater use of eINTERACT is associated with greater increases in behavior identification.

Humanoid Robots administering Cognitive Stimulation Therapy to help improve cognition and reduce neuropsychiatric disorders

AbstractBackgroundDementia is a progressive disease that causes a continuous decline in cognition. People affected with dementia are also at high risk for neuropsychiatric disorders requiring frequent therapy sessions. The current healthcare worker shortages have made finding a therapist challenging, resulting in increased hospital admissions due to an increase in neuropsychiatric disorders in people affected with dementia. To address this problem humanoid robots and wearable sensors were programmed to administer Cognitive Stimulation Therapy(CST), a therapy that doesn’t require a clinician to be administered. CST is an evidence based therapy that is administered twice a week for seven weeks. The wearable sensors track and monitor the physiological data and are able to predict neuropsychiatric symptoms. The robots interact, communicate and administer the therapy while the participants are wearing the sensors along with artificial intelligence algorithms that track the physiological data to help predict any neuropsychiatric symptoms.MethodA humanoid robot, Pepper was programmed to administer Cognitive Stimulation Therapy to be deployed in nursing homes to help improve cognition and also help alleviate neuropsychiatric symptoms. The protocol involves conducting a cognitive assessment using the MMSE prior to initiation of the Cognitive Stimulation Therapy. The Cognitive Stimulation Therapy is administered twice a week for seven weeks. At the end of the fourteen sessions the MMSE is administered again to measure the cognition levels. Additionally pre and post surveys for depression, quality of life, Pittsburgh sleep index/ sleep quality and activities of daily living are conducted to monitor the neuropsychiatric symptoms. During the entire seven weeks the participants physiological data is tracked and analyzed using artificial intelligence algorithms to predict neuropsychiatric symptoms. The combination of the humanoid robots and the wearable sensors work in sync to improve cognition and reduce behavioral and psychological symptoms of dementia..ResultThe robot is successfully programmed and tested in the lab setting. The study is successfully designed.ConclusionRobots can be employed to administer cognitive stimulation therapy to help improve cognition and reduce neuropsychiatric symptoms in people affected with dementia. Robots have the potential to address healthcare worker shortages.

Humanoid Robots administering Cognitive Stimulation Therapy to help improve cognition and reduce neuropsychiatric disorders

AbstractBackgroundDementia is a progressive disease that causes a continuous decline in cognition. People affected with dementia are also at high risk for neuropsychiatric disorders requiring frequent therapy sessions. The current healthcare worker shortages have made finding a therapist challenging, resulting in increased hospital admissions due to an increase in neuropsychiatric disorders in people affected with dementia. To address this problem humanoid robots and wearable sensors were programmed to administer Cognitive Stimulation Therapy(CST), a therapy that doesn’t require a clinician to be administered. CST is an evidence based therapy that is administered twice a week for seven weeks. The wearable sensors track and monitor the physiological data and are able to predict neuropsychiatric symptoms. The robots interact, communicate and administer the therapy while the participants are wearing the sensors along with artificial intelligence algorithms that track the physiological data to help predict any neuropsychiatric symptoms.MethodA humanoid robot, Pepper was programmed to administer Cognitive Stimulation Therapy to be deployed in nursing homes to help improve cognition and also help alleviate neuropsychiatric symptoms. The protocol involves conducting a cognitive assessment using the MMSE prior to initiation of the Cognitive Stimulation Therapy. The Cognitive Stimulation Therapy is administered twice a week for seven weeks. At the end of the fourteen sessions the MMSE is administered again to measure the cognition levels. Additionally pre and post surveys for depression, quality of life, Pittsburgh sleep index/ sleep quality and activities of daily living are conducted to monitor the neuropsychiatric symptoms. During the entire seven weeks the participants physiological data is tracked and analyzed using artificial intelligence algorithms to predict neuropsychiatric symptoms. The combination of the humanoid robots and the wearable sensors work in sync to improve cognition and reduce behavioral and psychological symptoms of dementia..ResultThe robot is successfully programmed and tested in the lab setting. The study is successfully designed.ConclusionRobots can be employed to administer cognitive stimulation therapy to help improve cognition and reduce neuropsychiatric symptoms in people affected with dementia. Robots have the potential to address healthcare worker shortages.

A narrative review of music therapy for neuropsychiatric symptoms in Alzheimer’s disease and rationale for protocolized music teletherapy

IntroductionAlzheimer’s Disease (AD) constitutes a major societal problem with devastating neuropsychiatric involvement in over 90% of those diagnosed. The large spectrum of AD neuropsychiatric symptoms leads to polypharmacological prescribing that, in turn, poses a major risk for increased side effects. Non-pharmacological interventions such as music therapy (MT) are therefore recommended as first-line treatments. The amalgamation of an aging population, long lifespan, and shortage of qualified music therapists limits access to MT services for AD.ObjectiveThe purpose of this paper is to provide a rationale for a protocolized music teletherapy (MTT) intervention to increase accessibility for MT as a psychosocial intervention for neuropsychiatric symptoms in people with AD by conducting a narrative review of the existing MT and AD literature.MethodsWe conducted a narrative review of MT and MTT publications indexed in PubMed and Google Scholar wherein authors used the Neuropsychiatric Inventory. We examined the impact of MT on neuropsychiatric symptoms of AD and identified MTT as a way to increase access to clinical services.ResultsMT can have positive impacts on neuropsychiatric symptoms in AD. However, we identified an ensuing need for protocolized MT interventions, access to services, and increased awareness. MTT is an option that can address these needs.DiscussionAlthough MT can have positive effects on neuropsychiatric symptoms and can be beneficial and safe for individuals with AD, the current approach to MT practice is enormously heterogeneous with studies demonstrating variable therapist qualifications, uses of music, therapy approaches, and clinical populations. Congruently, the existing literature indicates that MT has not been standardized with protocolized interventions, making it difficult for clinicians and researchers to objectively assess the evidence, and thus, prescribe MT interventions. The lack of MT standardization, coupled with a low number of music therapists relative to people with AD, result in a lack of awareness that hinders access to MT as a psychosocial treatment for neuropsychiatric symptoms in people with AD. We therefore propose that protocolized MTT interventions are needed to increase access to better address neuropsychiatric symptoms associated with AD.

Greenness and neuropsychiatric symptoms in dementia

ObjectivesIt is acknowledged that living in a green environment may help mental well-being and this may be especially true for vulnerable people. However, the relationship between greenness and neuropsychiatric symptoms in dementia has not been explored yet. MethodsWe collected clinical, neuropsychiatric, and residential data from subjects with dementia living in the province of Modena, Northern Italy. Neuropsychiatric symptoms were measured with the Neuropsychiatry Inventory, a questionnaire administered to the caregiver who assesses the presence and severity of neuropsychiatric symptoms, including delusions, hallucinations, agitation/aggression, dysphoria/depression, anxiety, euphoria/elation, apathy/indifference, disinhibition, irritability/lability, aberrant motor behaviors, sleep disturbances, and appetite/eating changes. Normalized Difference Vegetation Index (NDVI) was used as a proxy of greenness. Regression models were constructed to study the association between greenness and neuropsychiatric features. Results155 patients with dementia were recruited. We found that greenness is variably associated with the risk of having neuropsychiatric symptoms. The risk of apathy was lower with lower levels of greenness (OR = 0.42, 95% CI 0.19–0.91 for NDVI below the median value). The risk of psychosis was higher with lower levels of greenness but with more imprecise values (OR = 1.77, 95% CI 0.84–3.73 for NDVI below the median value). ConclusionOur results suggest a possible association between greenness and neuropsychiatric symptoms in people with dementia. If replicated in larger samples, these findings will pave the road for identifying innovative greening strategies and interventions that can improve mental health in dementia.

Integrative Stress Reduction Program for Family Caregivers of Persons With Advanced Dementia: A Randomized-Controlled Trial.

Older adults with advanced dementia require significant care, leading to high stress levels in caregivers. The current study aimed to evaluate the effects of an Integrative Stress Reduction Program on Thai caregiver's outcomes of stress, sleep quality, and caregiver-assessed neuropsychiatric symptoms of persons with dementia. A single-blind randomized-controlled trial was conducted. A sample of family caregivers of people with dementia was recruited from memory clinics at outpatient community health centers in Thailand and randomly assigned to the experimental and control groups. Participants in the experimental group were enrolled in 5 intervention sessions over 4 weeks, while the control group received usual care. Outcome variables were collected at baseline, 4 weeks postintervention, and 8 weeks of follow-up. Compared with the control group, caregivers in the experimental group (n = 27) had significantly decreased stress (p < .01) and better sleep quality (p < .01), and caregivers reported that their family members with dementia (n = 27) had decreased neuropsychiatric symptoms (p < .01) after the intervention (week 4) and at the 8-week follow-up. The Integrative Stress Reduction Program improved outcomes for caregivers and decreased neuropsychiatric symptoms in people with dementia.

Neuropsychiatric symptoms in people living with dementia receiving home health services.

We sought to describe neuropsychiatric symptoms (NPS) among people living with dementia (PLWD) from diverse racial and ethnic groups receiving home health services while accounting for dementia severity, individual symptom prevalence, and neighborhood disadvantage. A prospective study using cross-sectional data from n = 192 PLWD receiving skilled home healthcare in New Jersey enrolled in the Dementia Symptom Management at Home Program trial. We prospectively measured symptom prevalence with the Neuropsychiatric Inventory Questionnaire and dementia severity using the Quick Dementia Rating System. A one-way ANOVA determined NPS prevalence by dementia severity (mild, moderate, severe). Fisher's exact tests were used to assess the association of individual symptom prevalence with race and ethnicity and cross tabs to descriptively stratify individual symptom prevalence by dementia severity among groups. A Pearson correlation was performed to determine if a correlation existed among neighborhood disadvantages measured by the Area Deprivation Index (ADI) state decile scores and NPS prevalence and severity. Participants identified as non-Hispanic White (50%), non-Hispanic Black (30%), or Hispanic (13%). NPS were prevalent in 97% of participants who experienced 5.4 ± 2.6 symptoms with increased severity (10.8 ± 6.6) and care partner distress (13.8 ± 10.8). NPS increased with dementia severity (p = 0.004) with the greatest difference seen between individuals with mild dementia (4.3 ± 2.3) versus severe dementia (5.9 ± 2.3; p = 0.002). Few differences were found in symptom prevalence by racial and ethnic sub-groups. Nighttime behaviors were higher in non-Hispanic Black (78%), compared with non-Hispanic Whites (46%) with moderate dementia, p = 0.042. State ADI scores were not correlated with the number of NPS reported, or severity. NPS were prevalent and increased with dementia severity with commonalities among racial and ethnic groups with varying levels of neighborhood disadvantage. There is a need for effective methods for improving NPS identification, assessment, and management broadly for homebound PLWD.

The Associations Between Neuropsychiatric Symptoms and Cognition in People with Dementia: A Systematic Review and Meta-Analysis.

Most people with dementia experience neuropsychiatric symptoms (NPS), including anxiety, depression or disinhibition. There is growing interest in the relationship between NPS and cognitive impairment, but data is still limited. This study aimed to investigate the specific associations between NPS and cognition in people with dementia. MEDLINE, EMBASE and PsycINFO were searched for published, peer-reviewed studies of associations between at least one NPS and one cognitive ability in people with dementia. The quality of the studies was assessed with the NIH National Heart, Lung and Blood Institute's quality assessment tools. A meta-analysis was conducted using Robumeta package for R. Ninety studies were included. We found significant associations between NPS, global cognition and cognitive domains, e.g. apathy was associated with global cognitive and memory impairment; dysphoria was associated with worse attention; delusions with executive dysfunction. Increased NPS in people with dementia are associated with worse cognitive performance. There were few studies looking at associations between some neuropsychiatric clusters and cognitive abilities, and there was little research on causal relationships. Our review was limited by the inclusion of studies that reported associations in specific formats, and most included people with a diagnosis of Alzheimer's disease (AD). However, given the large number of studies, this is unlikely to have biased results. More research is needed that includes diverse people with different dementia syndromes. Registration: PROSPERO 2020 CRD42020165565.

Prevalence of neuropsychiatric symptoms of people with dementia in long-term care units: A secondary analysis

Prevalence of neuropsychiatric symptoms of people with dementia in long-term care units: A secondary analysis Abstract: Background: In a progress of dementia, most people develop neuropsychiatric symptoms. However, there is little knowledge about the prevalence of these symptoms and their specific characteristics in long-term care. Aims: A differentiated investigation of the prevalence and characteristics of neuropsychiatric symptoms in people with dementia in a long-term care setting. Methods: The prevalence of neuropsychiatric symptoms of people with dementia in a long-term care setting was examined using a secondary analysis of cross-sectional data from the research projects LebenQD I and II and FallDem. The data were collected using the neuropsychiatric inventory - nursing home version. The analysis included data from 699 people with dementia from a total of 21 long-term care facilities in North Rhine-Westphalia. Results: The symptoms agitation/aggression (36%), depression/dysphoria (33%), apathy/indifference (33%), irritability/lability (30%) and aberrant motor behaviour show the highest prevalence. The symptoms hallucinations (9%) and euphoria/elation (6%) have the lowest prevalence. Conclusions: The high prevalence of specific neuropsychiatric symptoms and their characteristics in people with dementia illustrates the need for care-related or psychosocial interventions to counteract the reasons for the occurrence of the symptoms.

Usability of an app-based clinical decision support system to monitor psychotropic drug prescribing appropriateness in dementia

BackgroundGuidelines recommend reluctant psychotropic drug (PD) prescribing in nursing home residents with dementia and neuropsychiatric symptoms (NPS), as efficacy of PDs is limited, and side effects are common. Nevertheless, PDs are commonly prescribed to reduce NPS. A smartphone application that evaluates appropriateness of PD prescriptions and provides recommendations from the revised Dutch guideline on problem behaviour in dementia may promote guideline adherence and increase appropriate prescribing. ObjectiveThis study aimed to assess user experiences, barriers and facilitators of the Dutch ‘Psychotropic Drug Tool’ smartphone application (PDT) in the context of appropriate prescribing of PDs to nursing home residents with dementia and NPS. Methods/designThe PDT was developed according to the recommendations of the Dutch guideline for treatment of NPS in people with dementia. Feedback provided during usability testing with two end-users was applied to improve the PDT before implementation in day-to-day practice. Sixty-three prescribers were asked to use the PDT at their own convenience for four months. User expectations and experiences were assessed at baseline and after four months with the System Usability Scale and the Assessment of Barriers and Facilitators for Implementation. ResultsExpected usability (M = 72.59; SD = 11.84) was similar to experienced usability after four months (M = 69.13; SD = 16.48). Appreciation of the PDTs user-friendliness (on average 6.7 out of 10) and design (7.3) were moderately positive, in contrast to the global rating of the PDT (5.7). Perceived barriers for PDT use were time consumption and lack of integration with existing electronic systems. Perceived facilitators were ease of use and attractive lay out. For broader implementation, physicians suggested a change in direction of the PDT: start assessment of appropriateness based on the list of NPS instead of PD as primary input. ConclusionsIn this pragmatic prospective cohort study we found that the PDT was used by elderly care physicians, with mediocre user satisfaction. The PDT will be optimized based on user feedback regarding experienced usability, barriers and facilitators, after which broader implementation can be initialized.The Medical Ethics Review Board of the University Medical Center Groningen declared this is a non-WMO study (UMCG RR Number: 201800284).

Pharmacological treatment of neuropsychiatric symptoms of dementia: a network meta-analysis.

Pharmacological treatments are very common to be used for alleviating neuropsychiatric symptoms (NPS) in dementia. However, decision on drug selection is still a matter of controversy. To summarise the comparative efficacy and acceptability of currently available monotherapy drug regimens for reducing NPS in dementia. We searched PubMed, MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials between inception and 26 December 2022 without language restrictions; and reference lists scanned from selected studies and systematic reviews. Double-blind randomised controlled trials were identified from electronic databases for reporting NPS outcomes in people with dementia. Primary outcomes were efficacy and acceptability. Confidence in the evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). We included 59 trials (15,781 participants; mean age, 76.6years) and 15 different drugs in quantitative syntheses. Risperidone (standardised mean difference [SMD] -0.20, 95% credible interval [CrI] -0.40 to -0.10) and galantamine (-0.20, -0.39 to -0.02) were more effective than placebo in short-term treatment (median duration: 12weeks). Galantamine (odds ratio [OR] 1.95, 95% CrI 1.38-2.94) and rivastigmine (1.87, 1.24-2.99) were associated with more dropouts than placebo, and some active drugs. Most of the results were rated as low or very low according to CINeMA. Despite the scarcity of high-quality evidence, risperidone is probably the best pharmacological option to consider for alleviating NPS in people with dementia in short-term treatment when considering the risk-benefit profile of drugs.

The longitudinal course and determinants of apathy in UK care home residents with dementia

AbstractBackgroundApathy in dementia is a common and troubling symptom associated with worse disease outcomes but its longitudinal course is unclear We aimed to 1) describe the prevalence and persistence of clinically‐significant apathy in UK care home residents with dementia, 2) investigate the association of other neuropsychiatric symptoms in people with clinically‐significant apathy, and 3) identify sociodemographic and disease related factors associated with worse apathy trajectory.MethodProspective cohort study of residents with dementia recruited from 86 voluntary, state or private UK care homes. At baseline, and 4, 8, 12, and 16 months, care home staff rated apathy using the Neuropsychiatric Inventory (clinically‐significant apathy if score ≥4, sub‐clinical if 1‐3). Staff also rated dementia severity using the Clinical Dementia Rating scale, and provided other sociodemographic information about each participant. We examined the prevalence and persistence of apathy and, in mixed linear models, its association with time, age, sex, dementia severity, antipsychotic use, and baseline apathy and other neuropsychiatric symptoms.ResultsOf 1419 included participants (mean age 85 years (SD 8.5), 975 (68.7%) women), 30% had mild dementia, 33% moderate, and 37% severe. The point prevalence of clinically‐significant apathy was 21.4% (n = 304) and the period prevalence during 16 months follow‐up was 47.3% (n = 671). The point‐prevalence and 16‐month period prevalence of any apathy was 33.3% and 85.1% respectively. The longitudinal course is shown in the figure. Of participants who had follow‐up data, 45 (3.8%) were always clinically‐significantly apathetic, 3 (0.3%) were always sub‐clinically apathetic, and 420 (36.2%) were never apathetic until death or end of follow‐up. In adjusted models, apathy increased over time and was associated with having more severe dementia, worse baseline apathy and other neuropsychiatric symptoms.ConclusionMost people with dementia are not apathetic but it is common and frequently fluctuates in its course. It is important for clinicians to know that most people with dementia do not develop apathy and it is not an inevitable symptom and often remits. People with more severe dementia and other neuropsychiatric symptoms are more likely to have an adverse apathy course, so may be a priority group for current and future treatments.

Influence of affective states on informant impression of neuropsychiatric symptoms in people living with MCI

Objectives: Alzheimer’s disease (AD) and mild cognitive impairment (MCI) are often accompanied by neuropsychiatric symptoms (NPS; e.g. depression/apathy/irritability) causing challenges for people living with dementia/caregivers and predicting worse disease progression. Accurately assessing NPS is critical to research on AD/MCI. However, there are limitations to both self-reports and clinician evaluations; the field often relies on informants to assess NPS. Informants’ perception of NPS are influenced by disease and caregiver factors that may lead to biased assessments. We aimed to assess the relationship between participants self-reported affective states (valence/arousal) and informant-reported NPS. Methods: Data from a double-blinded intervention design (primarily testing neurostimulation’s effect on NPS) were used to examine the relationship between participant-reported affective states and informant-reported NPS over 1 month. Forty participants (24 females) with MCI and NPS (mean age = 71.7, SD = 7) were enrolled along with informants (primarily spouses/partners) who regularly interact with participants. NPS assessment occurred weekly and at pre- and post-intervention, and participant-reported affective states were assessed at 14 timepoints. Results: Generalized Estimating Equations showed that participant levels of arousal, but not valence, were significantly related to corresponding informant-reported NPS at weekly (arousal: B= −0.59, SE = 0.27, Wald’s χ2 = 4.61, p=.032; valence: B = 0.17, SE = 0.19, Wald’s χ2 = 0.80, p=.37) and pre-/post- (arousal: B= −4.00, SE = 1.58, Wald’s χ2 = 6.42, p=.011; valence: B= −3.34, SE = 1.80, Wald’s χ2 = 3.43, p=.06) assessments. Conclusion: The findings indicate that informant-reported NPS may be more strongly influenced by arousal, and informants may be less attuned to valence in people living with MCI.

Behavior and Psychological Symptoms of Dementia Preceded with Depression

BPSD (Behavioral and Psychological Symptoms of Dementia) is a disorder that is often found. Neuropsychiatric symptoms in people with dementia are highly variable and unpredictable, with an influence on emotion, perception, motor function, and thought content. Symptoms obtained in emotions can be depression, these depressive symptoms usually mask patients with dementia. We report a 76-year-old woman was diagnosed with BPSD (Behavioral and Psychological Symptoms of Dementia) since 3years ago. Symptoms that appear were high aggressiveness and suspicion of those around her. The patient feels that her belongings are stolen so that she often hides stuff even food in an improper places. Dementia patients often present with complaints such as depression, especially in female patients. Emotional disturbances or emotional changes are also found in patients with BPSD, in the above cases the patient loses his enthusiasm for life, continuous sadness, suicidal ideation. The patient received antipsychotic treatment (Haloperidol 0.75 b.i.d) twice a day.

Dolutegravir Discontinuation for Neuropsychiatric Symptoms in People Living with HIV and Their Outcomes after Treatment Change: A Pharmacogenetic Study.

Neuropsychiatric symptoms have been reported in patients receiving dolutegravir, a known inhibitor of the renal and neuronal-expressed organic anion transporter 2 (encoded by SLC22A2 gene). The effect of the genetic variant SLC22A2 808C&gt;A on dolutegravir discontinuation was assessed and analyzed by real-time PCR. We enrolled 627 participants: CA/AA carriers showed a higher prevalence of pre-existing psychiatric comorbidities and use of antidepressants. After 27.9 months, 108 participants discontinued dolutegravir, 64 for neuropsychiatric symptoms. Patients with pre-existing psychiatric comorbidities were at higher risk of dolutegravir discontinuation, while patients carrying the SLC22A2 CA/AA genotype were not. Combining the two variables, an opposite effect of SLC22A2 variants according to pre-existing psychiatric disorders was observed. Using multivariate Cox models, the combined variable pre-existing psychiatric comorbidities/SLC22A2 variants and the use of non-tenofovir alafenamide containing antiretroviral regimens were predictors of dolutegravir discontinuation for neuropsychiatric symptoms. Within 30 days, the majority of participants had a complete resolution of symptoms (61.8%), while 32.7% and 5.5% had partial or no change after dolutegravir discontinuation, respectively. Discontinuation of dolutegravir for neuropsychiatric symptoms was not uncommon and more frequent in participants with pre-existing psychiatric disorders. We described an interaction between SLC22A2 genetic variant and psychiatric comorbidities. In 38.2% of patients, a complete neuropsychiatric symptoms resolution was not observed after dolutegravir discontinuation suggesting the involvement of additional factors.

Dance-Specific Activity in People Living With Dementia: A Conceptual Framework and Systematic Review of Its Effects on Neuropsychiatric Symptoms.

Dance as a non-pharmacological therapy is commonly used in dementia care, although the evidence of its effects remains unclear. This study systematically reviewed the effects of dance interventions on neuropsychiatric symptoms (NPS) in people living with dementia. To systematically identify and evaluate dance interventions, a standardized terminology for Dance-Specific Activity (DSA) is proposed. Literature search was conducted on electronic databases until April 30th 2021. Studies were included when they quantified the effects of DSA on NPS in people with clinical diagnosis of dementia. Included studies were analyzed in detail for NPS. Study quality was assessed by PEDro scale (German version). 4 studies were included. The studies differed in study design, intervention protocols, dance styles, or measurement tools, and were generally of low study quality. Two trials showed improvements in NPS and 2 trials showed no exacerbation of NPS after DSA. The results of the 4 available trials indicate a positive tendency towards the effects of DSA, but considering the limitations of the few available studies, a clear statement about the effects of DSA is not possible yet. Based on the included trials, the following implications for clinical research and routine care can be derived: (1) DSA seems to be a practical terminology for identifying dance interventions (2) DSA seems to be a safe intervention for people living with dementia. (3) Different dance styles can be used. (4) DSA approaches should be better structured by differentiating between the domains type, content, intention, and protocol of the intervention.

Effectiveness of cognitive stimulation therapy (CST) on cognition, quality of life and neuropsychiatric symptoms for patients living with dementia: A meta-analysis

IntroductionMany scholars have explored the effect of cognitive stimulation therapy (CST) on dementia patients, however, due to different experimental designs and insufficient sample sizes, research results are inconsistent. Furthermore, there is a scarcity of high-quality quantitative results. ObjectiveTo assess the effectiveness of CST for improving cognition, quality of life (QoL) and neuropsychiatric symptoms in people with dementia (PwD). MethodsChinese and English databases were searched for randomized controlled trials (RCTs) between establishment of and April 2022, with another search done in May 2022. Finally, 10 studies on the application of CST in PwD for improving cognition, QoL, behavior, language and activities of daily living were reviewed. ResultsBased on the results of the 10 RCTs, CST significantly improved cognitive performance (MMSE: WMD = 1.98, 95% CI: 1.24–2.72, P<0.01), QoL (WMD = 3.12, 95% CI: 2.52–3.72, P<0.01), language (NLT: WMD = 2.71, 95% CI: 1.07–4.35, P<0.01) and activities of daily living (DAD: WMD = 7.27, 95% CI: 0.97–13.56, P<0.01) in PwD. However, no significant improvements in ADAS-Cog (WMD = 0.55, 95% CI: -3.04–4.14, P = 0.76), depression (SMD = -0.12,95% CI: -0.29–0.04, P = 0.15), anxiety (RAID: WMD = -1.05, 95% CI: -3.85–1.75, P = 0.46) or neuropsychiatric symptoms (NPI: WMD = 0.23, 95% CI: -2.62–3.07, P = 0.88) were found. ConclusionCST improved the cognitive ability, QoL, language and activities of daily living of PwD. However, the effect of neuropsychiatric symptoms on PwD requires further exploration.