Psychotic Symptoms In Dementia Research Articles

Developing an Intuitive Graph Representation of Knowledge for Nonpharmacological Treatment of Psychotic Symptoms in Dementia.

Applying person-centered, nonpharmacological interventions to manage psychotic symptoms of dementia is promoted for health care professionals, particularly gerontological nurses, who are responsible for care of older adults in nursing homes. A knowledge graph is a graph consisting of a set of concepts that are linked together by their interrelationship and has been widely used as a formal representation of domain knowledge in health. However, there is lack of a knowledge graph for nonpharmacological treatment of psychotic symptoms in dementia. Therefore, we developed a comprehensive, human- and machine-understandable knowledge graph for this domain, named Dementia-Related Psychotic Symptom Nonpharmacological Treatment Ontology (DRPSNPTO). This graph was built by adopting the established NeOn methodology, a knowledge graph engineering method, to meet the quality standards for biomedical knowledge graphs. This intuitive graph representation of the domain knowledge sets a new direction for visualizing and computerizing gerontological knowledge to facilitate human comprehension and build intelligent aged care information systems. [Journal of Gerontological Nursing, 48(4), 49-55.].

Atypical antipsychotics in the treatment of psychotic symptoms in Alzheimer's disease: a systematic review.

With the advancement of Alzheimer's disease as well as other types of dementia, in addition to the cognitive decline, psychiatric symptoms have been outlined, including psychotic symptoms. The aim of the study is to review the available results on the antipsychotic treatment of Alzheimer's disease associated psychotic symptoms. The main objective of the study is to evaluate the efficacy of the treatment. The second objective is to assess the tolerability of this treatment. Double-blind, randomized, placebo-controlled trials, which took place over the course of at least 4 weeks, have been searched. Studies that compared one atypical antipsychotic to placebo, as well as more atypical antipsychotics, compared one to another, have been taken into account. In total 17 studies have been selected. The efficacy of the atypical antipsychotics has proven to be significant in most studies. Moreover, antipsychotic medication, such as risperidone, aripiprazole, olanzapine, quetiapine and pimavanserin, has been well tolerated. Atypical antipsychotics are the treatment of choice for psychotic symptoms in dementia. Despite the consistent results present in the literature up to this point, various antipsychotics remain insufficiently studied and would need more generous sample sizes for their outcomes to be substantiated.

Mapping behavior symptoms in dementia using passive radio sensing

AbstractBackgroundBehavioral and Psychotic Symptoms in dementia (BPSD) are associated with negative outcomes including increased mortality and morbidity, increased cost of care and caregiver burnout. Newer technologies are leading to a greatly enhanced ability to monitor and predict these symptoms using passive sensing and sophisticated analytics that rely on signal processing and potentially machine learning. In this study we utilized a novel passive sensing approach supported by AI to demonstrate how highly specific behavioral phenomena can be detected in real time with a need for limited in‐person supervision and monitoring.MethodsEmerald is a device developed at MIT for in‐home, non‐intrusive patient monitoring. The device transmits low‐power radio signals (100x lower power than WiFi) and monitors the reflection of these signals from people/their environment to map behavioral information. Signal data are uploaded to the cloud where customized machine learning algorithms process the data to extract gait speed, sleep patterns, spatial location, respiration Subject: We installed the device in the rooms of 13 adults with Dementia in an assisted living facility outside Boston. We measured the subjects’ behavior continuously for 3 months. Sensor data findings were compared to staff observations around specific behavior phenomena. Our goal was to demonstrate Emerald’s ability to accurately capture a range of BPSDResultsOver the course of the study, we identified a range of behavioral phenomena using the sensor, that were verified by staff and validated by standardized behavioral measures. These represent positive and negative states of activation. The sensor also captured the impact of pharmacotherapy.ConclusionThis study demonstrating the feasibility of an AI‐backed passive sensor‐based device to accurately phenotype a range of behavioral phenomena. Our initial findings demonstrate that this technology can identify movement‐based behavior symptoms in a manner comparable to the current standard for measuring behaviors.

Care for older adults with dementia: PACE day care or residential dementia care units?

BackgroundPersons with dementia (PwD) are at greater risk for various adverse health outcomes, and the best care model remains to be determined. This study aimed to compare the physical and neurocognitive performance of PwD in the Program of All-inclusive Care for the Elderly (PACE) and residential dementia care units. MethodsThis was a case-control study comparing outcomes between care recipients of PACE services (PC group) and residential dementia care (RC group). Demographic characteristics, underlying diseases, physical function, cognitive function, mood status, and behavioral and psychotic symptoms of dementia (BPSDs) were assessed every 3-6 months in both groups, while frailty status and Timed Up-and-Go Test (TUGT) performance were assessed every 6 months in the PC group only. ResultsOverall, 96 participants (PC group: 25, RC group: 71; mean age: 86.4 ± 6.8 years) were enrolled with the median follow-up period of 43.6 weeks. Lower incidence of hospital admissions was noted in the PC group (0.52 ± 1.12 vs 1.38 ± 2.49 admissions/1,000 person-days, p=0.023), even though the PC group had higher multimorbidity and more severe BPSDs. During the study period, the PC group showed a significant improvement in body mass index, less physical dependence, better cognitive performance and reduced depressive mood. In addition, the PC group showed improvement in frailty, leisure hour activities, and TUGT results. However, participants in the PC group were more likely to experience BPSD deterioration (β coeff.: 0.193, 95% CI: 0.121- 0.265). ConclusionThe PACE services significantly reduced unexpected hospital admissions of PwD, facilitated the maintenance of physical independence, and improved cognitive performance and mood status. Further randomized controlled studies are needed to determine the most appropriate care model for PwD.

Safety of atypical antipsychotics in the treatment of behavioral and psychological symptoms in dementia: a meta-analysis

Objective: To assess the safety of olanzapine, risperidone and quetiapine drugs in dementia patients with behavioral and psychological symptoms. Methods: The EMBASE, Cochrane Controlled Trials Register and the Cochrane Database of Systematic Reviews, Medline, CNKI, Wang Fang were systematically searched for eligible randomized controlled trials of olanzapine, risperidone and quetiapine drugs therapy in patients with psychotic symptoms of dementia before February 2016. Two reviewers independently assessed the quality of the trials and extracted information. All the data was analyzed with meta analysis and software of the Revman5.3 provided by Cochrane network. Results: Overall, 16 relevant RCTs with 1 727 participants were identified (olanzapine group: 672; quetiapine group: 395; risperidone group: 660). (1)Olanzapine group had higher incidence of somnolence than risperidone group (OR=1.49, 95% CI [-1.01-2.21], P=0.05), while for the dizziness, agitation, accidental injury, weight gain, abnormal gait, weakness, sleep disorders, extrapyramidal symptoms, there were no significant difference. (2) Risperidone had higher incidence of extrapyramidal symptoms than quetiapine group (OR=0.11, 95% CI [0.04-0.27], P=0.64), the incidence of somnolence was lower than quetiapine group (OR=0.03, 95% CI [1.06-3.51], P=0.03), while for accidental injury, dizziness, fatigue, insomnia, constipation, there were no significant difference. (3) Olanzapine group had higher incidence of extrapyramidal symptoms than quetiapine group (OR=11.10, 95% CI [3.35-36.75], P<0.000 1), while for somnolence, sleep disturbances, constipation, agitation, weight gain, dizziness, there was no significant difference. (4) The subgroup analysis showed that in the Chinese population, compared with the population in Europe and America, risperidone group had higher incidence of agitation, sleep disorders than olanzapine (agitation: [OR= 0.26, 95% CI [0.08-0.82]; sleep disorders: OR= 0.31, 95% CI [0.10-0.99]), olanzapine group had higher incidence of weight gain than quetiapine (OR=6.8, 95% CI [2.00-23.14]). Conclusions: Among olanzapine, risperidone and quetiapine, risperidone has lowest incidence of somnolence, quetiapine has lowest incidence of extrapyramidal symptoms. In the Chinese population, compared with the population in Europe and America, risperidone group has higher incidence of agitation, sleep disorders than olanzapine, and olanzapine group has higher incidence of weight gain than quetiapine.

Behavioral and Psychotic Symptoms of Dementia vs Delirium in Hospice: Challenges in Diagnosis and Management in the Long Term Care Setting: Part 2 (FR474)

Behavioral and Psychotic Symptoms of Dementia vs Delirium in Hospice: Challenges in Diagnosis and Management in the Long Term Care Setting: Part 2 (FR474)

Behavioral and Psychotic Symptoms of Dementia vs. Delirium in Hospice: Challenges in Diagnosis and Management in the Long-Term Care Setting: Part 1 (FR439)

•Describe characteristics distinguishing behavioral and psychological symptoms (BPSD) of dementia from terminal delirium in nursing home residents with advanced dementia at the end of life.•Review the evidence for the pharmacologic and non-pharmacologic management of BPSD and delirium.•Building on the Centers for Medicare and Medicaid (CMS) regulatory requirements for management of psychotropic medications in nursing home residents, develop a framework for successful hospice-nursing home team collaboration for management of BPSD and terminal delirium through engagement of palliative, medical, nursing facility and family caregiver engagement. A majority of patients with dementia suffer from at least one behavioral and psychological symptom (BPSD) of the disease. BPSD describes a wide spectrum of non-cognitive manifestations of dementia, including apathy, dysphoria, verbal and physical aggression, agitation, psychotic symptoms, sleep disturbances, oppositional behavior, and wandering. Symptoms are highly prevalent in the moderate to severe stages of dementia, when the patient is typically admitted to hospice. It has become apparent that antipsychotic treatment for BPSD shortens life expectancy and exposes these patients to morbidities including sedation, falls, fractures, aspiration, and movement disorders, with only slight efficacy for achieving improvement in target behaviors. Long-term care (LTC) regulations require gradual dose reductions in psychotropic medication, and precise behavioral documentation to support starting or continuing psychotropic medications. Hospice providers who understand the regulations can support the facility in both caring for the patient as well as adding to the documentation that the facility needs. However, terminal agitation is also a common finding at the end of life and it is important for hospice providers to differentiate between BPSD and terminal delirium. In this two-part session, we propose a case-based approach with audience participation to: 1) Differentiate BPSD from delirium for hospice dementia patients in order to appropriately treat BPSD and 2) Diagnose, manage and treat delirium in hospice dementia patients in the LTC setting. In part 1, we introduce a hospice case study of moderate to severe dementia in a nursing home. Hospice providers may initially mistake the agitation in BPSD for terminal delirium. We will discuss how to differentiate between BPSD and terminal delirium, and suggest non-pharmacological and pharmacological interventions for BPSD in this patient. We will review the literature to highlight our evidence-based approach, and allow the audience to participate in deciding management based on the literature.

Memantine: from the original brand to generics

Memantine is the first clinically available glutamate antagonist, with an antagonist action at the N-methyl-D-aspartate receptors in the brain, for correction of cognitive and behavioral functions in neurodegenerative disorders. Glutamate mediated excitotoxic neuronal damage has been implicated in Alzheimer's disease (AD) and other parkinsonism-related dementias and, therefore, memantine represents a novel mode of action to counteract the glutamate-mediated excitotoxicity. In moderate to severe AD, 20 mg of memantine shows a positive effect on cognition, mood, behavior and the ability to perform activities of daily living. Long-term studies show good tolerability of memantine with an acceptable side-effect profile. In recent years, there have been a proliferation of a number of companies producing generic memantine with different trade names. In Russia, the first memantine generic drug noojerone was approved in 2010 and its use has since been supported by a growing evidence base of efficacy in real-life clinical practice. Postmarketing studies show that noojerone provides long-term and effective therapy in patients with moderate and severe Alzheimer's dementia. This observation is supported by the clinically significant therapeutic effect of noojerone on cognitive and daily functioning, behavioral and psychotic symptoms of dementia and a reduction of the burden on caregivers. This generic version of memantine is affordable and, therefore, reduces financial burden on patients and improves compliance with treatment.

Retraction Note: Efficacy and safety of atypical antipsychotic drug treatment for dementia: a systematic review and meta-analysis.

A wide variety of atypical antipsychotic drugs (risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone and clozapine) are widely used in the management of neuropsychiatric symptoms, which are commonly seen in dementia, but results from randomised controlled trials (RCTs) on the efficacy and safety of these agents are conflicting. We aimed to quantify the efficacy and safety of atypical antipsychotic drugs on neuropsychiatric symptoms in dementia patients. PubMed, EMBASE, the Cochrane Controlled Trials Register and the Cochrane Database of Systematic Reviews for reports published before August 2014 were searched for eligible randomized controlled trials of atypical antipsychotic drugs therapy in patients with psychotic symptoms of dementia. Two reviewers independently assessed the quality of the trials and extracted information. Overall, 23 relevant RCTs with 5,819 participants were identified. This meta-analysis demonstrated a significant efficacy of atypical antipsychotics on psychiatric symptoms and cognitive functions compared to placebo. In the meta-analysis, the weighted mean differences (WMDs) in change scores for psychiatric symptoms were in favor of aripiprazole (−4.4, 95% confidence interval (CI) – 7.04 to −1.77) and risperidone (−1.48, 95% CI −2.35 to −0.61) compared to placebo. In cognitive effects, WMDs in change scores for the Clinical Global Impression-Change (CGI-C) were in favor of aripiprazole, risperidone, olanzapine and quetiapine which ranged from a −0.30 points mean difference (95% CI:-0.59 to −0.01) in the aripiprazole trials to −0.43 (95% CI:-0.62 to −0.25) in the risperidone group. Patients receiving atypical antipsychotics showed no difference in risk for injuries or falls (P > 0.05), significantly higher risks (P < 0.05) for somnolence, urinary tract infection, edema and abnormal gait. However, there was no significant evidence for death reported. Aripiprazole and risperidone are able to improve psychiatric symptoms and slow decline in cognition function at average 12 weeks in patients with neuropsychiatric symptoms of dementia. However, high adverse events may offset the efficacy of atypical antipsychotics in dementia.

The impact of psychotic symptoms on the persons with dementia experiencing them

To portray the emotional and behavioral reactions of persons with dementia to the delusions and hallucinations they experience, according to the reports of their family caregivers. The article also explores the relationship between those reactions and background variables. Study participants were family caregivers of 74 older persons with a diagnosis of dementia (aged ≥ 65) residing in the community recruited from adult day centers and support groups for caregivers of persons with dementia and by advertising online. Assessments included the Behavioral Pathology in Alzheimer's Disease, the Neuropsychiatric Inventory, the Etiological Assessment of Psychotic Symptoms in Dementia, Activities of Daily Living questionnaire, and the Mini-Mental State Examination. Findings concerning emotional reactions reveal that close to half of the delusions resulted in discomfort, whereas around 40% did not. We found significant differences in the discomfort associated with different types of delusions, with delusions of abandonment, danger, and infidelity associated with more discomfort than other delusions. Around half of the delusions were associated with a behavioral manifestation. The findings highlight the need to examine the emotional impact of delusions and hallucinations as part of their assessment and as a consideration in treatment decisions.

RETRACTED ARTICLE: Efficacy and safety of atypical antipsychotic drug treatment for dementia: a systematic review and meta-analysis

IntroductionA wide variety of atypical antipsychotic drugs (risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone and clozapine) are widely used in the management of neuropsychiatric symptoms, which are commonly seen in dementia, but results from randomised controlled trials (RCTs) on the efficacy and safety of these agents are conflicting. We aimed to quantify the efficacy and safety of atypical antipsychotic drugs on neuropsychiatric symptoms in dementia patients.MethodsPubMed, EMBASE, the Cochrane Controlled Trials Register and the Cochrane Database of Systematic Reviews for reports published before August 2014 were searched for eligible randomized controlled trials of atypical antipsychotic drugs therapy in patients with psychotic symptoms of dementia. Two reviewers independently assessed the quality of the trials and extracted information.ResultsOverall, 23 relevant RCTs with 5,819 participants were identified. This meta-analysis demonstrated a significant efficacy of atypical antipsychotics on psychiatric symptoms and cognitive functions compared to placebo. In the meta-analysis, the weighted mean differences (WMDs) in change scores for psychiatric symptoms were in favor of aripiprazole (−4.4, 95% confidence interval (CI) – 7.04 to −1.77) and risperidone (−1.48, 95% CI −2.35 to −0.61) compared to placebo. In cognitive effects, WMDs in change scores for the Clinical Global Impression-Change (CGI-C) were in favor of aripiprazole, risperidone, olanzapine and quetiapine which ranged from a −0.30 points mean difference (95% CI:-0.59 to −0.01) in the aripiprazole trials to −0.43 (95% CI:-0.62 to −0.25) in the risperidone group. Patients receiving atypical antipsychotics showed no difference in risk for injuries or falls (P > 0.05), significantly higher risks (P < 0.05) for somnolence, urinary tract infection, edema and abnormal gait. However, there was no significant evidence for death reported.ConclusionAripiprazole and risperidone are able to improve psychiatric symptoms and slow decline in cognition function at average 12 weeks in patients with neuropsychiatric symptoms of dementia. However, high adverse events may offset the efficacy of atypical antipsychotics in dementia.Electronic supplementary materialThe online version of this article (doi:10.1186/s13195-015-0102-9) contains supplementary material, which is available to authorized users.

Psychotic symptoms of dementia, their relationship with delirium and prognostic value

BackgroundThe prevalence and overlap of psychotic symptoms among patients with dementia compared to those with delirium superimposed to dementia have received little attention. The aim of our study was to investigate the overlapping and distinguishing capability of psychotic symptoms among patients with dementia or with delirium superimposed to dementia, and to clarify their prognostic value. MethodsWe assessed 255 residents with dementia in nursing homes and acute geriatric wards for psychotic symptoms and delirium. The residents were divided into three groups: those with delirium (Group 1; n=66), those with psychotic symptoms without delirium (Group 2; n=74), and without psychotic symptoms or delirium (Group 3; n=115). ResultsOf the participants, 30.9% suffered from delusions, 22.1% from visual hallucinations and 14.2% from auditory hallucinations. Delusions occurred more often in Group 2 than in Group 1. Of the subjects in Group 3, 6.5% suffered from misidentifications, whereas the respective figures in Groups 1 and 2 were 17.5% and 20.8%, respectively. Of those suffering from psychotic symptoms (n=109), one in three (n=35) suffered delirium, and two in three (n=74), psychotic symptoms without delirium. In the adjusted Cox proportional hazard model with Group 2 as the referent, we found no difference between the groups in mortality rates (Group 1: HR 0.98, 95% CI: 0.64–1.52 and Group 3: HR 1.49, 95% CI: 0.92–2.42). ConclusionsPsychotic symptoms cannot be used to distinguish patients with dementia from those with delirium superimposed to dementia.

Reactions and Interventions for Delusions in Nursing Home Residents with Dementia.

This is a qualitative and quantitative study examining institutional staff members' reactions to delusions experienced by nursing home residents. Participants were 38 nursing home residents aged 65 and older, diagnosed with dementia. Data were collected from 8 nursing homes in Israel between June 2007 and January 2009. Assessments included Behavioral Pathology in Alzheimer's Disease Rating Scale, Neuropsychiatric Inventory: Nursing Home version, Etiological Assessment of Psychotic Symptoms In Dementia, Activities of Daily Living, and Mini-Mental State Examination. A wide variety of interventions with dementia-related symptoms was found to be effective to varying degrees. This included general approaches for a variety of symptoms as well as symptom-specific interventions. Caregivers do not always seem to be aware that multiple approaches are available to them when dealing with dementia. The most effective approaches may be those tailored to the individual. Combining interventions may increase overall effectiveness. Caregiver's experience and the institutional culture may affect the choice of intervention used, either positively or negatively.

Use and Safety of Antipsychotics in Behavioral Disorders in Elderly People With Dementia

In recent years, the use of antipsychotics has been widely debated for reasons concerning their safety in elderly patients affected with dementia. To update the use of antipsychotics in elderly demented people, a MEDLINE search was conducted using the following terms: elderly, conventional and atypical antipsychotics, adverse events, dementia, and behavioral and psychotic symptoms in dementia (BPSD). Owing to the large amounts of studies on antipsychotics, we mostly restricted the field of research to the last 10 years. Conventional antipsychotics have been widely used for BPSD; some studies showed they have an efficacy superior to placebo only at high doses, but they are associated with several and severe adverse effects. Atypical antipsychotics showed an efficacy superior to placebo in randomized studies in BPSD treatment, with a better tolerability profile versus conventional drugs. However, in 2002, trials with risperidone and olanzapine in elderly patients affected with dementia-related psychoses suggested the possible increase in cerebrovascular adverse events. Drug regulatory agencies issued specific recommendations for underlining that treatment of BPSD with atypical antipsychotics is "off-label." Conventional antipsychotics showed the same likelihood to increase the risk of death in the elderly as atypical agents, and they should not replace the atypical agents discontinued by Food and Drug Administration warnings. Before prescribing an antipsychotic drug, the following are factors to be seriously considered: the presence of cardiovascular diseases, QTc interval on electrocardiogram, electrolytic imbalances, familiar history for torsades des pointes, concomitant treatments, and use of drugs able to lengthen QTc. Use of antipsychotics in dementia needs a careful case-by-case assessment, together with the possible drug-drug, drug-disease, and drug-food interactions.

Capgras Syndrome With Left Hemisphere Neurological Damage

Capgras Syndrome With Left Hemisphere Neurological Damage

Delusions and Hallucinations in Persons With Dementia

This study compares formal and informal caregivers' perceptions of delusions and hallucinations in older persons with dementia (PWDs). The study population consisted of 151 community-dwelling PWDs aged 65 and older, 90 formal caregivers, and 151 informal caregivers residing in Israel. Assessments included the Behavioral Pathology in Alzheimer's Disease Rating Scale, Neuropsychiatric Inventory, Etiological Assessment of Psychotic Symptoms in Dementia, Activities of Daily Living, and Mini-Mental State Examination. Informal caregivers reported higher rates and a higher level of severity of delusions and hallucinations than formal caregivers. Different caregivers showed varying degrees of emotional involvement, empathy, and efforts to find the meaning of the delusion for the person experiencing it. Family members and staff members may see different parts of the total picture. The combination of both points of view is essential in order to establish an accurate, comprehensive assessment of dementia symptoms and to enhance the understanding of the reality of the different parties.

A Comparison of the E-BEHAVE-AD, NBRS, and NPI in Quantifying Clinical Improvement in the Treatment of Agitation and Psychosis Associated With Dementia

The aim of this study is to compare the Empirical Behavioral Rating Scale (E-BEHAVE-AD), Neurobehavioral Rating Scale (NBRS), and Neuropsychiatric Interview (NPI) in detecting behavioral disturbance and psychotic symptoms in dementia and characterizing changes in response to treatment. Eighty-seven subjects in the randomized controlled trial "Continuation Pharmacotherapy for Agitation of Dementia" were included in this analysis. We compared the detection in, and changes of, both agitation and psychosis, using these three instruments. A receiver operating characteristic analysis was performed to compare the performance of the three instruments in detecting global improvement. The instruments were equally likely to detect agitation. The NBRS was most likely to detect psychosis. Although the NPI best detected improvement in agitation, the instruments were equal for detecting improvement in psychosis. In the receiver operating characteristic analysis for overall clinical improvement in response to treatment, there were no differences in the areas under the correlated curves for the three instruments, but they demonstrated different sensitivity and specificity at different cutoff points for target symptom reduction. The E-BEHAVE-AD performed best at a cut point of 30% target symptom reduction and the NBRS and NPI both performed best at 50%. The E-BEHAVE-AD, NBRS, and NPI were more similar than different in characterizing symptoms but differed in detecting response to treatment. Differences in sensitivity and specificity may lead clinicians to prefer a specific instrument, depending on their goal and the expected magnitude of response to any specific intervention.

Neural correlates of psychotic symptoms in dementia with Lewy bodies

The aim of this study was to investigate the association between psychotic symptoms in dementia with Lewy bodies and brain perfusion on single photon emission tomography. Based on factor analysis in 145 patients, psychotic symptoms were classified into five symptom domains (factor 1 to 4-related symptoms and delusions). The relationship between each symptom domain and brain perfusion was assessed in 100 patients with dementia with Lewy bodies, while accounting for the effects of age, sex, dementia severity, parkinsonism and dysphoria. Factor 1 symptoms (Capgras syndrome, phantom boarder, reduplication of person and place and misidentification of person) represented misidentifications, and were significantly related to hypoperfusion in the left hippocampus, insula, ventral striatum and bilateral inferior frontal gyri. Factor 3 symptoms (visual hallucination of person and feeling of presence) represented hallucinations of person and were related to hypoperfusion in the left ventral occipital gyrus and bilateral parietal areas. Delusions of theft and persecution were associated with relative hyperperfusion in the right rostral medial frontal cortex, left medial superior frontal gyrus and bilateral dorsolateral frontal cortices. This study revealed that different psychotic symptoms in dementia with Lewy bodies were associated with distinguishable cerebral networks. Visual hallucinations were related to dysfunction of the parietal and occipital association cortices, misidentifications were related to dysfunction of the limbic-paralimbic structures and delusions were related to dysfunction of the frontal cortices. Our findings provide important insights into the pathophysiological mechanisms underlying psychotic symptoms in dementia with Lewy bodies.

Psychiatric consultations for nursing home residents: a perspective from Turkey and the implications for comparable countries

No specialized geriatric psychiatry consultation services are available for elderly people in the institutional care system in Turkey. Our aim was to evaluate psychiatric consultations among the residents of three homes for the elderly in a country with a rapidly aging population, and to investigate possible problems regarding psychiatric consultations. The residents of three homes for the elderly, which served partially as "care and rehabilitation centers" (equivalent to nursing homes), were chosen for the study. Data on the use of psychiatric services (mainly patient consultations with a visiting psychiatrist) were collected and analyzed. The percentage of patients in the three homes for the elderly who had psychiatric consultations between 2005 and 2007 was 31.8% (172/540). The main reasons for referral were forgetfulness (61%), depressive symptoms (37.7%), agitation and disruptive behavior (29.6%), and psychotic symptoms (27.9%). Of these patients, 46.5% were diagnosed with dementia, 20.9% with depression, 20.5% with behavioral and psychotic symptoms of dementia, and 18.6 % with primary psychotic disorders such as schizophrenia. Homes for the elderly in Turkey are not adequate in terms of consultations for psychiatric problems. Integration of these institutions with hospitals and organizing routine consultation visits from the psychiatry units would enhance the mental health of the elderly. Supporting the staff, maintaining good cooperation between them, and organizing educational programs in the field of mental health of the elderly are also required.

Phenomenological Distinctions Needed in DSM-V: Delirium, Subsyndromal Delirium, and Dementias

Phenomenological Distinctions Needed in DSM-V: Delirium, Subsyndromal Delirium, and Dementias