Number Of Behavioral Symptoms Research Articles

Perceived Appreciation for Care Associates with Higher Quality Caregiving Day-to-Day

Family members are critical to dementia care and the U.S. long-term services system. Yet, little is known about how to support the quality of care provided by family members, who often receive little training. We hypothesize that on days when caregivers feel more appreciated, they report providing a higher quality of care. To test this hypothesis, we asked spousal dementia caregivers (N=21) to complete 14 daily surveys that asked about their daily caregiving experiences. Our measure for “quality of care” was based on the Exemplary Caregiving Scale, and included 3-items pertaining to provision of care (e.g., “You considered your spouse's wishes and opinions when providing assistance”). Response options included “Most of the time,” “Some of the time,” and “Never”; scores were summed (range 0 to 6). Caregivers were also asked to what extent their spouse appreciated the care provided (“Not at all,” “Some,” or “A lot”). We applied multi-level mixed models to the data, and controlled for age, gender, Hispanic ethnicity, number of behavioral symptoms of dementia each day and months since diagnosis. In adjusted models, we found that on days when caregivers believed care recipients appreciated care provided “Some” or “A lot,” they reported providing higher quality care (B=0.52, p=0.010 and B=0.79, p<0.001, respectively) compared with days when caregivers believed care recipients appreciated care provided “Not at all”. Preliminary results may inform programs to support caregivers’ ability to provide high quality care (e.g., by helping caregivers to perceive rewards) and to identify caregivers at risk of providing low-quality care.

Psychosocial functioning in adolescents: results according to Amiel-Tison neurological assessment in a group of preterm infants

ABSTRACTObjective: This prospective study investigated the relationship between Amiel-Tison neurological assessment (ATNA) in preterm children and their psychosocial functioning in adolescence.Methods: From the initial group of 45 children regularly assessed by the ATNA from term until the age of 2 years, 27 participated in the follow-up at 13 years.Results: Of the three groups categorized by neurological signs as normal, intermediate or abnormal, parents of adolescents with normal ATNA reported the lowest number of executive function problems (p = 0.019) and behavioral symptoms (p = 0.011), while the adolescents themselves reported the lowest number of behavioral symptoms (p = 0.005) and the highest quality of life (p = 0.012). The number of problems reported increased with the number of abnormal neurological signs.Conclusion: Standardized neurological assessment may be a helpful clinical tool for the identification of children at risk for later psychosocial problems who could benefit from prevention and early intervention programs.

Relationship between the number of behavioral symptoms in dementia and caregiver distress: what is the tipping point?

Analyses were performed with three datasets totaling 569 community-dwelling persons with dementia and their caregivers. Each included identical demographic, BPSD, cognitive, and caregiver well-being measures. Linear regression was performed with 16 BPSD symptoms on caregiver well-being measures and predictive values determined with receiver operating characteristic (ROC) curves and pre-defined scores for clinically significant distress. Of the 569 persons with dementia, 549 (96%) displayed at least one BPSD, mean of 5.7 (SD = 3.06) symptoms in the past month. After controlling for covariates, BPSD symptom number was significantly associated with caregiver depression and burden (p < 0.01 for both models). Findings indicate ≥ 4 BPSD has strong predictive values for depression (sensitivity 85%, specificity 44%, area under ROC curve 0.62, p < 0.01), and burden (sensitivity 84%, specificity 43%, area under ROC curve 0.67, p < 0.01). Caring for persons with four or more BPSD appears to reflect a tipping point for clinically meaningful distress. Findings have implications for clinicians working with persons with dementia and their caregivers and suggest need for continuous monitoring of BPSD and identification of at risk caregivers.

Assessment of Behavioral Disruption in Rats with Abdominal Inflammation Using Visual Cue Titration and the Five-choice Serial-reaction Time Task.

Both acute and chronic pain result in a number of behavioral symptoms in patients, including cognitive effects such as decreased attention and working memory. Intraperitoneal administration of dilute lactic acid in rodents has been used to induce abdominal inflammation and produce effects in behavioral assays of both sensory-discriminative and affective pain modalities. Intraperitoneal injection of dilute lactic acid was used to study the impact of abdominal inflammation on an operant task requiring sustained visual attention in rats (N = 7 to 15/group) that adapts dynamically to performance ability. The effects of ketoprofen and morphine on lactic acid-induced impairment were compared with those on the disruptive effects of scopolamine. Lactic acid impaired performance in a concentration-dependent manner, increasing the duration of cue presentation required to maintain optimal performance from 0.5 ± 0.2 s (mean ± SD) to 17.2 ± 11.4 s after the administration of 1.8% (v/v) (N = 13). The latency to emit correct responses and to retrieve the food reward were both increased by lactic acid. All effects of lactic acid injection were reversed by both ketoprofen and morphine in a dose-dependent manner. Scopolamine, however, produced dose-dependent, nonpain-related disruption in sustained attention that was not altered by either ketoprofen or morphine. These data demonstrate that abdominal inflammation induced by lactic acid produces robust disruption in a visual attention-based operant task and that this disruption is reversed by analgesics. Future studies will focus on pain-related circuitry and its impact on both limbic forebrain and frontal cortical mechanisms.

Caregiver's perceptions of the relationship of pain to behavioral and psychiatric symptoms in older community-residing adults with dementia.

Pain is underrecognized and undermanaged in older adults with dementia. Because dementia patients have a diminished capacity to communicate discomfort, untreated pain may be expressed in the form of behavioral and psychiatric symptoms. The goal of the present study was to examine the relationship between pain and behavioral and psychiatric symptoms of dementia in community-residing older adults from the perspective of the family caregiver. Dyads composed of 272 dementia patients, and their family caregivers were assessed to determine dementia patient's mental status; family caregiver's assessment of care recipient's pain, functional dependence, and number of behavioral symptoms; analgesic use; and demographic information. Hierarchical multiple regression analysis controlling for age, marital status, race, functional disability, and analgesic use showed that pain explained a small but significant percent of variance in the number of behavioral symptoms (3%, P<0.001). Pain had a stronger influence on the number of behavioral and psychiatric symptoms of dementia among those with severe cognitive impairment (F1,69=11.75, P<0.001) compared with those with low to moderate cognitive impairment (F1,199=4.543, P=0.034.). The findings indicate that pain is a risk factor for behavioral symptoms in individuals with dementia and suggest that pain is a more significant predictor of behavior for individuals with severe dementia, compared with those with mild/moderate stage dementia. These results reinforce the importance of proper pain assessment and its management as part of dementia care planning.

The character of behavioural symptoms on admission to three Canadian long-term care homes

Objectives: We determined the prevalence and nature of behavioural symptoms at the time of admission to a long-term care home (LTCH) and occurrence of resident-to-resident aggressive behaviour associated with behavioural symptoms within three months following admission.Method: The Cohen-Mansfield Agitation Inventory and Aggressive Behaviour Scale were completed at the time residents were admitted into the LTCH. A chart review, conducted three months after admission into the LTCH, abstracted documented resident-to-resident aggression. Three LTCHs located in Ontario, Canada participated in the study.Results: During a 16-month period, 339 individuals admitted to the LTCHs comprised the study sample. A comparison was made between residents with and without dementia. At admission, residents with dementia had a greater number of behavioural symptoms than those without dementia (mean = 3.79, SD = 3.32 versus mean = 2.56, SD = 2.24, respectively; t(200) = 1.91; p = 0.059). Residents with and without dementia exhibited similar behaviours but differed on the prevalence of these behaviours. The most frequently reported behavioural symptoms for residents in both groups were verbal agitation and non-aggressive physical behaviours. The most frequently recorded aggressive behaviour for all residents was ‘resisting care’. In the three months post admission, 79 (23%) residents were involved in a documented incident that involved aggressive behaviour to another resident.Conclusion: A standardized comprehensive assessment for admission to a LTCH is an important strategy that can be used to identify behavioural symptoms and plan appropriate care management.

Distress of Caregivers of Older Adults Receiving Home Care in European Countries: Results From the AgeD in HOme Care Study

To identify factors associated with distress of caregivers of home care patients in Europe and to assess whether caregivers response to distress varies among countries. Cross-sectional study among older adults receiving home care in 11 European countries. A total of 3,449 older adults receiving home care in Europe. Caregiver distress was assessed by asking whether caregiver was distressed, angry, depressed, or in conflict because of caring for the participant. Mean age of study participants was 82.4 years, and distress was present in 7.5% of their caregivers. In all the country sample, number of depressive symptoms (OR 1.38, 95% CI: 1.27-1.49), cognitive performance scale score (OR 1.19, 95% CI: 1.10-1.30), number of impaired Activities of Daily Living (OR 1.36, 95% CI: 1.25-1.47), and number of behavioral symptoms (OR 1.28, 95% CI: 1.04-1.58) were significantly associated with caregivers distress. These associations were consistent among caregivers in all countries. Overall, 295 caregivers (8.6%) felt that participant would be better off in another living environment, and 1,444 (41.9%) caregivers were willing to increase help. Despite an elevated rate of distress, a low proportion of caregivers in Italy (3.0%), Germany (6.1%), and France (5.5%) felt that participants would be better off in another living environment. By contrast, in countries with lower rate of distress, as Iceland and the Netherlands, this rate was more elevated (15.5% and 20.6%, respectively). Distress of caregivers is associated with patient cognitive and functional status, depressive, and behavioral symptoms, and there are national differences in the response to distress.

Boy's Death Spurs Action on Neonatal Genetic Screening

Boy's Death Spurs Action on Neonatal Genetic Screening

The Interrelations Between Psychosis, Behavioral Disturbance, and Depression in Alzheimer Disease

Behavioral changes are common in Alzheimer disease (AD), and heterogeneous in their presentation. Subtle personality changes tend to occur early; these include apathy, irritability and inability to pay attention. Later agitation, aggression and disinhibited behaviors may appear. We have utilized the Columbia University Scale for Psychopathology in Alzheimer's Disease to monitor a number of behavioral symptoms in 235 patients with early probable AD. Markov analyses were used to predict the probability of developing or retaining a given symptom at 6-month follow-up. The results show that the symptoms of psychopathology in AD fluctuate with time. Agitation was both the most frequent and persistent symptom, while paranoid delusions and hallucinations were less persistent. Most behavioral disturbances, except paranoid delusions, were associated with greater cognitive impairment. There was no association between depressive features and either cognitive or functional impairment. These results have important implications for the optimal treatment of the psychopathological symptoms of AD.