Severe Stages Of Dementia Research Articles

61 The Impact of Cognitive Reserve on Executive Function in Dementia

Objective:Cognitive reserve (CR) refers to how flexibly and efficiently the individual makes use of available brain resources. Early-life education, midlife social and occupational activities, and later-life cognitive and social interactions are associated with greater CR. Years of education, premorbid intellectual (IQ) functioning, linguistic ability, and occupational complexity are often used as proxies of CR. CR theory seeks to explain discrepancies between the extent of disease pathology and clinical presentation amongst individuals with dementia. In the presence of Alzheimer’s Disease (AD) pathology, higher CR is associated with slower declines in executive functioning (EF). The current study examined the correlation between CR and EF performance across various stages of dementia severity as measured by the total score on the Clinical Dementia Rating Scale (CDRS).Participants and Methods:The study cohort consisted of 269 individuals who had completed measures of EF and the CDRS from phase 1 of the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Individuals who scored less than 2 on the CDRS were included in the MCI group (n=197), while individuals that scored 2 or higher on the CDRS were included in the dementia group (n=73). A simple linear regression was utilized to compare the MCI group to dementia group across CR and EF performance.Results:There was significant correlation between CR and EF performance in the MCI group as quantified on total CDRS score (F (200) = .353, p = .0, p < .05). CR was not observed to be predictive of EF in the dementia group (F (200) = .031, p = .666, p > .05).Conclusions:Findings are consistent with prior research suggesting CR is protective during early stages of dementia, but not in the later disease stages. As prior research has shown the expression of dementia is based on a complex interaction between genetic and lifestyle factors that are unique to each person, future research exploring the potentially protective role of CR amongst pre-symptomatic adults with a genetic predisposition for developing dementia may expand our understanding of the potential role of CR on dementia prevention and progression.

Prescribing pattern of anti-psychotic medications in patients with dementia in Oman: a retrospective observational study

BackgroundAggression, agitation, psychosis, and sleep disturbances are common behavioral symptoms of people with dementia and they can be distressing for both individuals and their carers. Due to their potential side effects, antipsychotic medications are recommended only for severe behavioral and psychological symptoms of dementia (BPSD). This study explores the prevalence, patterns, and associated factors with antipsychotic drug use among patients with dementia attending geriatric psychiatry services at Sultan Qaboos University Hospital (SQUH). Using a retrospective cross-sectional design, this study examines antipsychotic use among elderly patients aged 60 years or older with dementia who attended geriatric psychiatry services from January 2020 to December 2021. The following information was solicited: socio-demographic factors, type and severity of dementia, presence of co-morbid medical or mental illness, the psychotropic medications prescribed, the anti-psychotic medication use, duration of use, and the indication of use were solicited as well. A multivariate logistic regression analysis was conducted.ResultsThe total prevalence of anti-psychotic use among elderly patients with dementia was 56.6%, and among them, 59% were prescribed anti-psychotics for more than 2 years. Being female, having non-Alzheimer’s dementia, experiencing severe stages of dementia, and having other medical or mental co-morbid conditions were independent predictors of antipsychotic drug use (odds ratio [OR] =1.85, confidence interval [CI] =1.04–3.30; OR=2.77, C.I. 1.52–5.04; OR=4.47, C.I. 2.18–9.18; and OR=2.54, C.I. 1.11–5.78, respectively).ConclusionsAntipsychotic medication use is prevalent among elderly patients with dementia in Oman. The results from this study will help the policymakers and psychiatrists in Oman to plan for the use of non-pharmacological strategies as the first line of management for BPSD.

CO72 Predicting Sojourn Times by Dementia Stages: Evidence From 76,747 Patients in the Swedish National Registry for Cognitive Disorders (SVEDEM)

The prevalence of Alzheimer’s disease is rapidly increasing, with an expected growth to 152.8 million cases globally in 2050. A common concern for patients and caregivers is how much time remains until progression to severe stages of dementia. Moreover, predicting time by disease stage can be beneficial for clinical decision making and policy decisions around the value and use of disease-modifying therapies (DMT). We aim to determine the sojourn time by stages of disease severity and care setting.

Validation and extension of the quick dementia rating system (QDRS)

Informant report dementia severity staging measures, such as the Quick Dementia Rating System (QDRS) offer clinicians useful diagnostic and staging information. These measures also potentially avoid many of the pitfalls inherent in mental status examinations (e.g., cultural bias, educational bias, floor and ceiling effects). We derive cut points for the QDRS and comprehensively examine their classification accuracy in a large, diagnostically heterogeneous, rural, memory disorder clinic sample. Our findings suggest the QDRS may be helpful when used in the context of a comprehensive diagnostic and staging evaluation. When used in isolation, the QDRS is insufficiently accurate for diagnosis and staging of dementia.

Pisa syndrome in dementia with Lewy bodies: A Chinese multicenter study

BackgroundPisa syndrome (PS) is rarely reported in Dementia with Lewy bodies (DLB). The aim of this article is to investigate the prevalence rate of PS and the correlation with clinical features evaluated in patients with DLB. MethodsA total of 209 DLB patients were consecutively recruited and underwent standardized clinical evaluation in our multicenter study. The associations between PS and clinical factors were evaluated. ResultsThe prevalence rate of PS in patients with DLB was 15.3%, which was higher in the moderate and severe stages than mild cognitive impairment and mild stages (81.2% vs. 18.8%). Patients with PS had a longer duration of disease (P = 0.020) and parkinsonism (P = 0.003), higher scores of NPI (P = 0.028), ADL (P = 0.002) and UPDRS part III (P < 0.001), lower scores of clock drawing test (P = 0.009), visuospatial/executive abilities (P = 0.018), attention (P = 0.020), language and praxis (P = 0.020), registration (P = 0.012), greater H&Y stage (P < 0.001), and higher proportion of cholinesterase inhibitors used (P = 0.044) than those without PS. Longer disease duration (OR = 1.166, P = 0.023), presence of parkinsonism (OR = 7.971, P = 0.007), moderate and severe dementia (OR = 3.215, P = 0.021) were associated with the presence of PS. Patients had a longer duration of PS (P = 0.014) and lower mean age of onset (P = 0.040) in the group with severe lateral trunk flexion. ConclusionThe development of PS may be associated with longer disease duration, the presence of parkinsonism and severe stages of dementia in DLB. Cholinesterase inhibitors may have a correlation with PS. The severity of lateral flexion is related to the duration of PS and mean age of onset.

Source recognition discriminability impairment in Huntington’s versus Alzheimer’s disease: Evidence from the CVLT-3

Research suggests that individuals with Huntington’s disease (HD) perform better than individuals with Alzheimer’s disease (AD) on the California Verbal Learning Test (CVLT) Yes/No Recognition trial. However, those with HD have been shown to have deficits comparable to those with AD on the Source Recognition Discriminability (RD) index (which assesses the ability to distinguish between List A targets and List B distractors), suggesting that HD may involve selective impairment in aspects of yes/no recognition that rely on source memory. However, whether individuals with HD and AD show comparable deficits on Source RD across stages of dementia severity has not been adequately investigated. We examined performance on the CVLT-3 List A vs. List B RD index in individuals with HD or AD and mild or moderate dementia. Among individuals with mild dementia, scores were higher in the HD versus AD group, whereas among individuals with moderate dementia, scores were comparable between the HD and AD groups; this corresponded to differential performance across dementia stages among individuals with HD, but not AD. The present findings suggest that, relative to AD, HD may be associated with disproportionate decline in aspects of yes/no recognition that rely on source memory.

The development of independence of people living with dementia while performing an artistic painting activity

This study explored the practice and spacing-of-practice effects in people living with dementia during an artistic painting activity. The video recordings of 23 participants were systematically observed during their first and fourth session of the activity. Improvements in independence, engagement, and well/ill-being expressions were analyzed from the first to the fourth session. Moreover, it was analyzed whether a group who had practiced three times a week (n = 12) improved more than a group who had practiced once a week (n = 13). Participants became more independent as they practiced, but the spacing of the sessions did not show any significant effect. Participants with severe dementia showed greater independence improvements than participants with mild to moderate dementia, although they required significantly more assistance throughout the entire study. The positive rates in active engagement and well/ill-being expressions suggest that artistic painting activities promote the motivation and well-being of participants, including those in the severe stage of dementia.

Heterogeneity in Reports of Dementia Disease Duration and Severity: A Review of the Literature.

Background:The burden of dementia is changing due to population aging and changes in incidence and risk factor profiles. Reliable projections of future disease burden require accurate estimates of disease duration across different stages of dementia severity.Objective:To provide an overview of current evidence on severity stage and disease duration in patients with dementia.Methods:We reviewed the literature on duration of mild cognitive impairment (MCI), dementia, and various dementia severity stages. Data on study setting, country, sample size, severity stages, dementia type, and definition of disease duration was collected. Weighted averages and Q-statistics were calculated within severity stages and duration definitions.Results:Of 732 screened articles, 15 reported the duration of one or more severity stages and only half of those reported severity stage onset to conversion to the following stage. In those studies, MCI, very mild dementia, and mild dementia stages lasted 3-4 years and moderate and severe dementia stages lasted 1-2 years. Information on the disease duration was reported in 93 (13%) of screened articles and varied from 1 to 17 years. Reporting of dementia severity stage and disease duration in the literature was highly heterogeneous, which was accounted for only in part by dementia type, study setting, or continent of data collection.Conclusion:The duration of dementia disease stages shortens with advancing stage. However, reliable modelling of future dementia burden and informing of intervention strategies will require more consistently reported duration estimates from studies that follow individuals longitudinally throughout their entire disease course.

The Use of a Novel Neurologic Music Therapy Program to Improve Cognition and Emotional Affect in Individuals with Mild to Severe Dementia: A Research Protocol

Introduction: Dementia is a prevalent neurodegenerative disorder that interferes with independent and daily functioning. In addition to cognitive decline, individuals with dementia experience behavioural and psychological symptoms of dementia (BPSD), which involves neuropsychiatric disturbances such as agitation. Studies have suggested music therapy to be an effective part of treatment of individuals with dementia as a method to increase both cognitive function and quality of life (QoL). Therefore, this study aims to construct and test a novel neurologic music therapy (NMT) program to optimize the improvement of cognition and emotional affect in those with mild to severe stages of dementia. Methods: This research will be designed as a randomized-controlled crossover study, where two groups of participants will be examined: those with mild to moderate dementia and those with severe dementia. The first eight weeks will consist of a no-treatment control period, and the last eight weeks consist of the treatment period, where both participant groups will undergo cognitive and QoL testing at various times. Results: By comparing the eight-week control period to the eight-week intervention, the results of the study may indicate that NMT benefits individuals with dementia, particularly within the mild to moderate group. Following the intervention, improved cognition, emotional affect, and reduced levels of BPSD in individuals with mild to moderate dementia are anticipated. Participants with severe dementia are expected to have slight improvements within BPSD and emotional affect, and little to no improvement in cognition. Discussion: Few studies have used NMT as an intervention to treat dementia, with no study utilizing a combination of the three NMT techniques proposed in this study. Furthermore, there has been limited literature focusing on individuals with severe dementia. This proposed study will thus allow for further research on this population. Conclusion: The proposed NMT program aims to reduce BPSD, and improve emotional affect and cognition within individuals with mild to severe dementia. Future studies may be conducted to examine whether introducing the proposed NMT program may act as a preventative measure of dementia-related cognitive decline.

Characterization of the initial complaint and care pathways prior to diagnosis in very young sporadic Alzheimer\u2019s disease

BackgroundVery-early-onset Alzheimer’s disease (young-AD) differentiates from late-onset AD (old-AD) by a predominant involvement of the parietal neocortex leading to atypical presentations. The diagnosis of AD is often not the first to be mentioned in such young patients.MethodsWe retrospectively reviewed the initial complaint and care pathways of 66 sporadic young-AD (age < 62) and 30 old-AD patients (age > 65) and compared their neuropsychological profiles at the time of diagnosis (based on clinical-biological criteria) with 44 amyloid-negative controls.ResultsThe initial complaint of young-AD was non-cognitive and mimicked a burnout in 32% of cases. Their main cognitive complaints were memory (38% vs 87% in old-AD) and language (17% vs 13%) impairment. The referral to a psychiatrist prior to AD diagnosis was more frequent in young-AD than in old-AD (26% vs 0%). At the time of diagnosis, young-AD were at a more severe stage of dementia than old-AD (24% vs 10% with CDR ≥ 1) but had less anosognosia.ConclusionsBetter identifying the initial signs of very-early-onset AD is crucial to improve the early diagnosis and develop new treatments.

Sensor‐based activity and state recognition in dementia patients in stationary care as basis for situation‐aware assistive devices

AbstractBackgroundWearable sensors to monitor activity are easily available nowadays. Intelligent assistive technologies bear potential to offer innovative solutions that increase safety and facilitate independent activities in persons with dementia (PwD). It is important to incorporate knowledge about user‘s current state (e.g. cognitive and physical abilities) and situation to generate suitable interventions and provide meaningful assistance for PwD.MethodWithin the “SAMi”‐project, we set up an (ongoing) field study with PwD living in a nursing home. Participants wear smartwatches to measure activity (accelerometry) and enable indoor positioning via Bluetooth. In parallel, subjects' behavior is annotated in real time by trained observers using an elaborated scheme that contains activity, posture and place of the person, as well as disorientation, falls or request for help. The annotation scheme and possible intervention domains were derived from interviews with different groups of stakeholders. With the field study, we aim to identify in real time if a patient is at need of support and to select the most promising intervention in a given situation. Therefore, we plan to train algorithms on the synchronized sensor‐data and examine the accuracy of situation‐classification.ResultTo date, we included nine PwD in the age of 76‐96 years in moderate to severe stages of dementia (MMSE 5‐18). We gained &gt;183 hours of observational data, accompanied by sensor data. We observed 134 events of disorientation, 95 events of caregiver support but only 3 requests for help. Ca. 79% of the annotated time patients wore the smartwatch. The majority of patients accepted the device (despite advanced cognitive decline). Setting up the technical infrastructure for the indoor positioning was challenging, for example due to restricted access to power points.ConclusionAnalysis of data from wearable and ambient sensors bears potential to build a situation‐aware assistive device and is feasible to acquire in the setting of dementia patients living in nursing homes. A large number of situations where need for help became obvious was matched only by very few instances of active help seeking by the patients. This emphasizes the necessity for automated sensor‐based recognition of such situations.

Use of Patient-Reported Symptoms from an Online Symptom Tracking Tool for Dementia Severity Staging: Development and Validation of a Machine Learning Approach.

BackgroundSymptomGuide Dementia (DGI Clinical Inc) is a publicly available online symptom tracking tool to support caregivers of persons living with dementia. The value of such data are enhanced when the specific dementia stage is identified.ObjectiveWe aimed to develop a supervised machine learning algorithm to classify dementia stages based on tracked symptoms.MethodsWe employed clinical data from 717 people from 3 sources: (1) a memory clinic; (2) long-term care; and (3) an open-label trial of donepezil in vascular and mixed dementia (VASPECT). Symptoms were captured with SymptomGuide Dementia. A clinician classified participants into 4 groups using either the Functional Assessment Staging Test or the Global Deterioration Scale as mild cognitive impairment, mild dementia, moderate dementia, or severe dementia. Individualized symptom profiles from the pooled data were used to train machine learning models to predict dementia severity. Models trained with 6 different machine learning algorithms were compared using nested cross-validation to identify the best performing model. Model performance was assessed using measures of balanced accuracy, precision, recall, Cohen κ, area under the receiver operating characteristic curve (AUROC), and area under the precision-recall curve (AUPRC). The best performing algorithm was used to train a model optimized for balanced accuracy.ResultsThe study population was mostly female (424/717, 59.1%), older adults (mean 77.3 years, SD 10.6, range 40-100) with mild to moderate dementia (332/717, 46.3%). Age, duration of symptoms, 37 unique dementia symptoms, and 10 symptom-derived variables were used to distinguish dementia stages. A model trained with a support vector machine learning algorithm using a one-versus-rest approach showed the best performance. The correct dementia stage was identified with 83% balanced accuracy (Cohen κ=0.81, AUPRC 0.91, AUROC 0.96). The best performance was seen when classifying severe dementia (AUROC 0.99).ConclusionsA supervised machine learning algorithm exhibited excellent performance in identifying dementia stages based on dementia symptoms reported in an online environment. This novel dementia staging algorithm can be used to describe dementia stage based on user-reported symptoms. This type of symptom recording offers real-world data that reflect important symptoms in people with dementia.

Staging of Dementia Severity With the Hong Kong Version of the Montreal Cognitive Assessment (HK-MoCA)'s.

The Hong Kong version of Montreal Cognitive Assessment (HK-MoCA) has been used to screen for dementia, but it has not been validated to delineate the stages of Alzheimer disease (AD). This study aimed to determine the cut-off score ranges for mild, moderate, and severe AD. The HK-MoCA score was matched against the Clinical Dementia Rating on 155 patients with AD. Investigators performing the HK-MoCA and Clinical Dementia Rating were blinded to each other. Receiver-operating characteristic analysis was used to determine the cut-off scores between different stages of AD (mild, moderate, and severe stage). A secondary analysis with adjustments for age and education received were also performed. The cut-off score in HK-MoCA was ≤4 for those with severe AD (sensitivity 84.4%, specificity 91.9%, area under curve=0.92, P<0.001) and 5 to 9 for those with moderate AD (sensitivity 86.3%, specificity of 93.3%, area under curve=0.953, P<0.001). With adjustments for age and education, the cut-off score for moderate AD was adjusted to 5 to 8, whereas the cut-off score for severe AD remained unchanged. The severity of AD could be delineated using the HK-MoCA for the Cantonese-speaking population in Hong Kong, and the effect of education on the cut-off score needs further investigation.

CHARACTERIZING FREQUENCY-SELECTIVE NETWORK VULNERABILITY FOR ALZHEIMER'S DISEASE BY IDENTIFYING CRITICAL HARMONIC PATTERNS.

Alzheimer's disease (AD) is a multi-factor neurodegenerative disease that selectively affects certain regions of the brain while other areas remain unaffected. The underlying mechanisms of this selectivity, however, are still largely elusive. To address this challenge, we propose a novel longitudinal network analysis method employing sparse logistic regression to identify frequency-specific oscillation patterns which contribute to the selective network vulnerability for patients at risk of advancing to the more severe stage of dementia. We fit and apply our statistical method to more than 100 longitudinal brain networks, and validate it on synthetic data. A set of critical connectome pathways are identified that exhibit strong association to the progression of AD.

Importance of quality of life in people with dementia treated with enteral nutrition: the role of the nurse

Nutritional problems are common in dementia and can lead to enteral nutrition, a nutritional treatment option in severe stages of dementia. However, the benefits of enteral nutrition in people with dementia are still weak. The decision to use artificial nutrition in these patients is often emotional and complex and the attitudes of health personnel (physicians and nurses) in this sense they are very different. The objective of this review is to show the role of enteral nutrition on quality of life in patients affected by dementia and the possible implications for practice and research, with a special focus on nurse role. We made a literature search in PubMed and Scopus, searching for studies dealing with enteral nutrition and quality of life in dementia. We were able to find only a few observational studies related to enteral nutrition and quality of life, with a lack in the scientific literature regarding the management of nutritional problems in dementia, particularly taking in account quality of life. Furthermore, by orienting the research on a possible role of nurses, there were limited studies on properly nursing aspects. From this work emerges the need for further research in this context for which the training and education of health personnel result of fundamental importance, with a view to improving the quality of life of the patients with dementia and their family.

C-36 Montreal Cognitive Assessment for Dementia Severity Rating in a Diagnostically Heterogeneous Clinical Cohort

Abstract Objective The Mini Mental State Exam (MMSE) has enjoyed widespread use as a dementia severity staging instrument (Perneczky et al., 2006). More recently, the Montreal Cognitive Assessment (MoCA; Nasreddine, 2005) has been advanced as a potentially superior measure with enhanced sensitivity to Mild Cognitive Impairment (MCI). To the authors’ knowledge, there are no published guidelines for staging dementia severity with the MoCA. The aim of this study was to evaluate the utility of the MoCA for dementia severity staging. Method Participants (N = 162) were drawn from a diagnostically heterogeneous retrospective sample of referrals to a multidisciplinary memory clinic. Participants were categorized as MCI, mild dementia, or moderate dementia using the Quick Dementia Rating System (QDRS) sum of boxes score. Receiver operating characteristics of the MoCA were calculated using MATLAB and optimal cutpoints were determined using Youden’s Index. Results The MoCA demonstrated some utility in differentiating MCI from all severity dementia as defined by the QDRS, with an optimal cutpoint of 17 (AUC = .75). Cut points of 17 and 14 best separated MCI from mild dementia (AUC = .72) and mild from moderate dementia (AUC = .66), respectively. These cutpoints were associated with modest sensitivity (.50 - .53) and reasonable specificity (.76 - .87). Average diagnostic accuracy was 69.5%. Conclusions This study suggests that the MoCA has some utility for dementia severity staging. Future work should replicate these findings in other clinical cohorts. The use of the QDRS (an informant report measure) as the severity criterion is a significant limitation of the present study.

The Symptoms Targeted for Monitoring in a Web-Based Tracking Tool by Caregivers of People With Dementia and Agitation: Cross-Sectional Study

BackgroundIn people with dementia, neuropsychiatric symptoms (NPSs), especially agitation, are associated with worse quality of life and caregiver burden. As NPSs may vary with illness severity, knowledge of how people with dementia and their caregivers describe and rate the importance of agitation symptoms can improve the understanding of the clinical meaningfulness of the manifestations of agitation. The internet provides new opportunities to better understand patient experiences, as patients and caregivers increasingly look to Web-based platforms as a means of managing symptoms.ObjectiveThe aim of this study was to examine Web-based reports from a dementia symptom website to better understand the symptoms of agitation and explore how they are being targeted for monitoring by caregivers of people with dementia.MethodsThe Dementia Guide website hosts a Web-based database used by caregivers (97%) and people with dementia (3%).From its 61 dementia symptoms, users can select relevant symptoms that they deem important to monitor or track the effects of treatment. We employed a staging algorithm to determine if individuals had mild cognitive impairment (MCI) or mild, moderate, or severe dementia. Agitation was defined using terms consistent with the International Psychogeriatrics Association’s provisional consensus definition. We compared the proportion of people with NPSs and agitation across stages of dementia severity and studied how many agitation-defining descriptors were selected, and how often they occurred, by stage.ResultsAs of March 2017, 4121 people had used the tracking tool, of whom 2577 provided sufficient data to allow disease severity staging. NPSs were tracked by 2127/2577 (82.54%) and agitation by 1898/2577 (73.65%). The proportion in whom agitation was tracked increased with increasing cognitive impairment: 68.5% (491/717) in people with MCI, and 72.50% (754/1040), 73.3% (378/516), and 90.5% (275/304) in mild, moderate, and severe dementia, respectively (χ23=54.9; P<.001). The number of NPS and agitation descriptors selected also increased with severity (median number of NPSs=1, 2, 2, and 3 for MCI, mild, moderate, and severe dementia, respectively, Kruskal-Wallis H Test H3=250.47; P<.001; median number of agitation descriptors=1, 2, 3, and 4, H3=146.11; P<.001).ConclusionsNPSs and agitation are common targets for tracking over the course of dementia and appear more frequently with increasing disease severity. These common and distressing symptoms represent clinically meaningful targets in treating people with dementia.

Salivary Redox Biomarkers in Different Stages of Dementia Severity.

This study is the first to evaluate oxidative stress biomarkers in saliva/blood of patients with varying degrees of dementia progression. The study included 50 healthy controls and 50 dementia patients divided into two groups: those with mild and moderate dementia (MMSE 11–23) and patients suffering from severe dementia (MMSE 0–10). Cognitive functions of the subjects were assessed using the Mini Mental State Examination (MMSE). Enzymatic and non-enzymatic antioxidants, oxidative damage products and protein glycoxidative modifications were determined in non-stimulated (NWS) and stimulated (SWS) saliva as well as erythrocyte/plasma samples. Generally, in dementia patients, we observed the depletion of antioxidant defences leading to oxidative and glycoxidative damage in NWS, SWS and blood samples. Both salivary and blood oxidative stress increased with the severity of the disease, and correlated with a decrease of cognitive functions. Interestingly, in dementia patients, reduced glutathione (GSH) in NWS correlated not only with the severity of dementia, but also with GSH concentration in the plasma. In receiver operating characteristic (ROC) analysis, we have demonstrated that salivary GSH clearly distinguishes patients with severe dementia from those suffering from mild or moderate dementia (area under the curve (AUC) = 1). Therefore, salivary GSH can be used as a non-invasive biomarker of cognitive impairment.

Characterizing the symptom of misplacing objects in people with dementia: findings from an online tracking tool.

Misplacing objects is often reported as a clinically important symptom in dementia. Here we explored misplacing objects in relation to dementia type and stage in an online sample of individuals with dementia and their caregivers. Participants were recruited from www.dementiaguide.com, a web-based tracker for common dementia symptoms. Users provided information about symptoms that they selected as important for monitoring. We analysed cross-sectional data from respondents who tracked at least three symptoms, which allowed for staging dementia severity. Of 2,775 users with three-plus symptoms, 787 (28%) identified misplacing objects for symptom tracking. Misplacing objects was monitored by users across all stages of dementia, but was more prevalent in mild and severe dementia. Three common clinical subtypes of misplacing were investigated: lost & found (forgetting the location of items), hidden away (hiding items so others would not find them), and odd places (putting items in usual spots). Of the 787, 96% targeted lost & found, the most frequent type. Odd places (targeted in 56%) significantly increased with dementia severity (p < 0.001). Misplacing objects was most strongly associated with the symptoms of interaction with strangers (OR 4.60, 95% CI: 3.20-6.62), reading (3.68: 2.86-4.73), shopping (3.55: 2.73-4.61) and travel/vacationing (3.31: 2.54-4.31). Misplacing objects was most often selected for tracking in mild and severe stages of dementia. As disease advances, misplacing more often reflects odd placement of objects rather than their simple loss. Misplacing objects may be a clinically important therapeutic target for improving patients' quality of life and lessening caregiver burden.

What Do We Know About Behavioral Crises in Dementia? A Systematic Review

Behavioral crises in dementia are represented by a wide variety of symptoms, regularly require external intervention from professionals, and are reported as a risk factor for hospital admission. Little is known about the factors that are associated with them. To determine the factors associated with dementia-related behavioral crises. We searched MEDLINE, CINAHL, PsycINFO, EMBASE, and AMED databases. An additional lateral search including reference lists was conducted. Two researchers screened all records for potential eligibility. Narrative synthesis was used to bring together the findings. Out of the 5,544 records identified, 24 articles (18 distinct studies) met the eligibility criteria. Aggression and agitation were the most common behaviors present at crises. Delusions, wandering/absconding, and hallucinations were also key behaviors contributing to crises. Behavioral crises predominantly happened in the severe stages of dementia (according to MMSE scores), in people with dementia residing in their own homes and in long-term care, and were the catalyst for admissions to psychiatric inpatient settings, specialist-care units, long-term care settings, or for referrals to psychiatric community services. Lack of consistency in assessment of behavior, and management of agitation/aggression in dementia crises were evident. Interventions to reduce the likelihood of people with dementia-related behaviors reaching crisis point need to focus on both family and care home settings and incorporate aggression and agitation management. Future research should focus on determining the factors that could be addressed to prevent behavioral crises and the interventions and models of care that may help to prevent crises.