Symptoms In Dementia Patients Research Articles

Financial Challenges in Music and Dance-Based Interventions for Older Adults: A Systematic Review

Older adults can benefit from the addition of music and dance-based programs to their care. Music and dance-based interventions are a diverse approach to address the unique needs of older people. However, aged care centre and older people are less willing to put in money for such programs. This paper examines the financial issues that surround the provision of music and dance-based interventions for older adults. Systematic search of literature retrieval on Scopus Elsevier, data extraction, and study selection were carried out. After conducting a systematic search on Scopus Elsevier, this paper retrieved 512 publications. Then, after a meticulous screening process and only five publications were suitable for analysis. Thematic analysis categorized into music and dance-based interventions for discussion. Developing and sustaining music and dance-based care programs for older people requires financial resources, such as investment and funding coverage. Dance-based interventions offer potential benefits for older adults; such as improving participation and motivation for rehabilitation in older adults, while music-based intervention helps ease cognitive and neuropsychiatric symptoms in dementia patients.

Multifaceted Music Therapy for Depression in Dementia: A Network Meta-Analysis of Randomized Controlled Trials.

This study aimed to assess the efficacy of various music therapy interventions in ameliorating depressive symptoms in dementia patients, utilizing a network meta-analysis approach. We rigorously selected randomized controlled trials focused on music therapy for dementia with depressive symptoms from major electronic databases. The primary outcome measured was the impact on depressive symptoms, with the secondary outcome evaluating dropout rates across different intervention groups and standard care control groups. The research protocol has been duly registered with PROSPERO (Registration ID: CRD42023393059). Our network meta-analysis incorporated 14 randomized controlled trials involving a total of 1080 participants and examined a range of interventions, including active music therapy, listening to music, rhythmic music therapy, singing, and tailored music interventions. The analysis revealed that active music therapy combined with singing emerged as the most effective intervention, demonstrating a significant improvement in depressive symptoms in dementia patients (Standardized Mean Difference [SMD] = -0.89, 95% Confidence Interval [CI]: -1.48 to -0.30). In contrast, listening to music alone showed a smaller effect (SMD = -0.26, 95% CI: -0.71 to 0.20). This study was particularly noteworthy for not showing higher dropout rates compared to standard care, indicating its feasibility and acceptability in clinical settings. The findings of our study indicate that active music therapy combined with singing is an effective approach to reducing depressive symptoms in dementia patients, potentially due to enhanced social interaction. These results offer new perspectives for dementia care, suggesting a promising direction for further research and clinical application.

Relationship between COVID-19 and Neurological Disorder

Abstract: The COVID-19 pandemic has resulted in a socially isolating way of life, and dementia patients are among those who are most affected. Lockdown procedures and the inability to monitor illnesses have led to a rapid decline in cognitive function in these individuals, with neuropsychiatric symptoms, such as agitation, delirium, and impaired motor performance being prevalent. However, the use of antipsychotics in treating these symptoms can increase the risk of death during COVID-19. Effective pain therapy can be used as an alternative to reduce or avoid the use of antipsychotics, given the consistent relationship between agitation and pain in dementia patients. The importance of properly assessing and managing pain in dementia patients is highlighted. Additionally, the article discusses how COVID-19 can affect brain health through inflammation, blood clotting, and blood vessel damage, leading to potential long-term effects on cognitive function. Healthcare professionals must be aware of the increased risk of neuropsychiatric symptoms in dementia patients during the pandemic and prioritize pain management as a viable alternative to antipsychotics. Proper care and attention are necessary to prevent cognitive decline and potential long-term effects on brain health in these vulnerable individuals.

Effect of hyperbaric oxygen on symptoms of dementia in patients with delayed encephalopathy after acute carbon monoxide poisoning.

Delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) is the most severe complication of carbon monoxide poisoning, which seriously endangers patients' quality of life. This study aims to investigate the efficacy of hyperbaric oxygen (HBO2) on improving dementia symptoms in patients with DEACMP. A retrospective analysis was performed on DEACMP patients, who visited Xiangya Hospital, Central South University from June 2014 to June 2020. Among them, patients who received conventional drug treatment combined with HBO2 treatment were included in an HBO2 group, while those who only received conventional drug treatment were included in a control group. HBO2 was administered once daily. Patients in the HBO2 group received 6 courses of treatment, with each course consisting of 10 sessions. The Hasegawa Dementia Scale (HDS) was used to diagnose dementia, and the Clinical Dementia Rating (CDR) was used to grade the severity of dementia for DEACMP. The Alzheimer's Disease Assessment Scale-Cognitive Section (ADAS-Cog), the Functional Activities Questionnaire (FAQ), the Neuropsychiatric Inventory (NPI), and the Clinician's Interview-Based Impression of Change-Plus Caregiver Input (CIBIC-Plus) were performed to assess cognitive function, ability to perform activities of daily living (ADL), behavioral and psychological symptoms, and overall function. The study further analyzed the results of objective examinations related to patients' dementia symptoms, including magnetic resonance imaging detection of white matter lesions and abnormal electroencephalogram (EEG). The changes of the above indicators before and after treatment, as well as the differences between the 2 groups after treatment were compared. There was no significant difference in the HDS score and CDR grading between the 2 groups before treatment (both P>0.05). After treatment, the score of ADAS-Cog, FAQ, NPI, and CIBIC Plus grading of the 2 groups were significantly improved, and the improvement of the above indicators in the HBO2 group was greater than that in the control group (all P<0.05). The effective rate of the HBO2 group in treating DEACMP was significantly higher than that of the control group (89.47% vs 65.87%, P<0.05). The objective examination results (white matter lesions and abnormal EEG) showed that the recovery of patients in the HBO2 group was better than that in the control group. Hyperbaric oxygen can significantly relieve the symptoms of dementia in patients with DEACMP.

Does Music Intervention Improve Anxiety in Dementia Patients? A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Music interventions (MIs) have been widely used to relieve anxiety in dementia in clinical settings. However, limited meta-analysis with randomized controlled trials (RCTs) on this topic has been conducted so far. A systematic search was conducted in four major databases (PubMed, EMBASE, Web of Science, and Cochrane Library) for data provided by RCTs from the inception to February 2023. The search strategy employed the terms "anxiety AND music AND dementia OR Alzheimer's disease". Thirteen RCTs (827 participants) were included. The results showed MI reduced anxiety significantly (SMD = -0.67, p < 0.001), especially for Alzheimer's disease (p = 0.007) and Mixed (p < 0.001)-type dementia. Moreover, significant improvements in agitation (p = 0.021) and depression (p < 0.001) in dementia were observed. Additionally, several psychological mechanisms which may be associated with MI were reviewed comprehensively. In conclusion, our findings support the efficacy of MI in alleviating anxiety symptoms in dementia patients. PROSPERO Registration (ID: CRD42021276646).

Can clozapine be used for treatment-refractory behavioral and psychological symptoms in dementia patients?

Can clozapine be used for treatment-refractory behavioral and psychological symptoms in dementia patients?

Efficacy and Safety of Woohwangchungsimwon Combined with Donepezil in Behavioral and Psychological Symptoms of Dementia in Patients with Probable Alzheimer's Disease: Study Protocol for a Randomized Controlled Trial.

Behavioral and psychological symptoms of dementia are a major factor in the burden of care and medical expenses. Conventional pharmacological treatments do not exert a distinct effect on the benefits versus the risks. The herbal medicine woohwangchungsimwon is frequently prescribed for neuropsychiatric disorders. An effect of woohwangchungsimwon on behavioral and psychological symptoms of dementia has been previously reported; however, no clinical studies have been conducted. We aim to evaluate the efficacy and safety of woohwangchungsimwon combined with donepezil for alleviating these symptoms in probable Alzheimer's disease. In this randomized, assessor-blinded, parallel-group clinical trial, 74 participants with probable Alzheimer's disease will be divided via block randomization into a woohwangchungsimwon + donepezil combination group (n = 37) or a donepezil single group (n = 37). Participants will include patients under donepezil treatment for at least a month. We will perform the study for 24 weeks. The Neuro-Psychiatric Inventory subscale scores will be the primary outcome. Secondary outcomes will include cognitive function, dementia severity, physical function, quality of life, depression, anxiety, and insomnia. For safety evaluation, we will assess adverse reactions, measure vital signs, and conduct laboratory tests. This is the first trial aiming to confirm the efficacy and safety of woohwangchungsimwon combined with donepezil for alleviating behavioral and psychological symptoms of dementia. Its findings could provide a basis for their co-administration to control these symptoms in probable Alzheimer's disease.

Alterations of neuropsychiatric symptoms in dementia patients during hospitalization in a dementia ward.

Alterations of neuropsychiatric symptoms in dementia patients during hospitalization in a dementia ward.

From neurodevelopmental to neurodegenerative disorders: Investigating symptoms of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in patients with dementia

Dementia is characterized by a progressive cognitive decline that could be caused by several disorders. Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are two prevalent neurodevelopmental disorders that might overlap with dementia symptoms. Hence, this study aimed to evaluate the ASD and ADHD symptoms in dementia patients referred to a memory clinic in Iran. We recruited 65 dementia patients and instructed them to fill out the autism quotient (AQ) and the Conners’ Adult ADHD Rating Scales (CAARS) questionnaires. Considering the cutoff points of AQ and CAARS questionnaires, 18.5% of participants were at higher risk of ASD, and 35.4% were at higher risk of ADHD. The results indicated that ADHD and ASD symptoms might be common comorbidities in patients with dementia which can increase the disease burden. Specialized ADHD and ASD screening tools in the elderly population with dementia are needed to prevent misdiagnoses due to symptom overlaps.

Investigating ADHD and ASD features in dementia patients referred to a memory clinic in Iran

AbstractBackgroundDementia is a clinical syndrome characterized by a progressive cognitive decline interfering with the function of activity of daily living in patients (1). Autism spectrum disorder (ASD) and Attention deficit hyperactivity disorder (ADHD) are two prevalent neurodevelopmental disorders affecting different brain functions manifesting mostly with impaired communication and behavior (3). These disorders initiate in childhood but usually persist into adulthood (3, 4). These disorders might overlap with dementia symptoms, as they might share common genetic and environmental backgrounds (5‐7). ASD and ADHD in dementia patients may complicate the timely diagnosis of each disorder leading to more pronounced dysfunction. Hence, this study aimed to evaluate ASD and ADHD symptoms in dementia patients referred to a memory clinic in Iran.MethodWe recruited 65 dementia patients in this study. Firstly, a cognitive neurologist diagnosed dementia’s subtypes by a precise clinical examination, cognitive assessment by applying the Montreal cognitive Assessment (MoCA). The severity of dementia was determined using the Functional Assessment Staging Tool (FAST). Consequently, we instructed the participants to fill out the autism quotient (AQ) and the Conners' Adult ADHD Rating Scales (CAARS) questionnaires for investigating their ASD and ADHD symptoms.ResultConsidering the cut‐off points of AQ and CAARS questionnaires, 18.5% of participants were diagnosed with ASD, and 35.4% were diagnosed with ADHD. Besides, we found a significant positive relationship between all subscales of CAARS and the FAST score (P &lt; 0.05). In other words, patients with more severe dementia were more likely to have increased ADHD symptoms.ConclusionThe results indicated that ADHD and ASD symptoms might be common manifestations in patients with dementia. This finding was in line with the previous research findings regarding the high co‐occurrence of ADHD and dementia (8). This comorbidity can further prohibit function and further worsen the prognosis. Given that there is scarce evidence on the association between ADHD and dementia in Iran, the findings of this study can pave the way for future research to elaborate more precisely on the etiological backgrounds of this association.

Online physical exercise and the neuropsychiatric symptoms in patients with dementia: a cross-sectional study during the COVID-19 pandemic.

The objective of this study was to compare the neuropsychiatric symptoms and QoL of older adults with neurocognitive disorders who participated in an online physical exercise program with sedentary patients during the COVID-19 pandemic. In this cross-sectional study, 25 older patients with neurocognitive disorders (control group=11; online exercise group=14) were evaluated based on Neuropsychiatric Inventory (NPI) and the Quality of Life in Alzheimer's Disease (QoL-AD) scale. There were differences between the two groups in the total NPI (U=36.50, p=0.025) and the nighttime behavior disturbances item (U=38.00, p=0.033), both with large effect sizes (ES=-1.03, 95% confidence interval [CI]:-1.83 to -0.16 and ES=-1.06, 95%CI -1.86 to -0.19, respectively). In terms of QoL-AD, a difference was identified only in the memory subitem (U=20.00, p=0.005), with a large ES (1.59, 95%CI 0.59-2.48). Older adults with neurocognitive disorders who participated in an online physical exercise program, during the COVID-19 pandemic, showed fewer neuropsychiatric total symptoms, fewer nighttime disturbances episodes, and better subjective memory, compared to their physically inactive counterparts. Randomized controlled trials should be performed to better understand the effect of physical exercise in neuropsychiatric symptoms in dementia patients during periods of social isolation.

A retrospective study of the behavioural and psychological symptoms of dementia in patients admitted to a Specialist Dementia Care Unit.

To explore the nature and severity of behavioural and psychological symptoms of dementia (BPSD) and outcomes for patients admitted to a specialist dementia care unit (SDCU) at a tertiary Australian hospital. This single-centre retrospective study categorised patients into a recognised seven-tiered model of severity of BPSD using a novel tool developed for this study. Descriptive characteristics, pharmacological management, and range and severity of BPSD were examined. There were 125 patients admitted over a two-year period reviewed, with 62% being males and a mean age of 82.4years. Those with high severity BPSD (n=61, 49%) had a longer length of stay (p=0.049), were on a greater number of psychotropic medications on admission (p<0.001) and were more likely to be trialled on a new psychotropic medication (p=0.001). At least five behaviours on admission were demonstrated in 84% of patients. Behaviours were ameliorated with reduction in tier severity at discharge (p<0.005). The mean number of psychotropic medications on admission was not significantly different to discharge (p=0.14). Sixty-seven per cent of patients living independently at admission were discharged to residential care, and 44% in residential care were discharged to a new facility. Multi-disciplinary management led to optimisation of behaviours and overall reduction in BPSD severity. This was achieved without a significant increase in the use of psychotropic medications, highlighting the importance of an individualised approach by a team skilled in the behavioural management of BPSD. The study confirms the high risk of transition to residential care for patients with BPSD.

Support and Empowerment for Older Adult Spousal Caregiving of People with Mild and Moderate Dementia: A Participatory Action Research

Background: Little attention has been given to the older adult caregivers of spouses with mild and moderate dementia in the caring dynamics process. The aim of this action research was to develop a program for providing support and empowerment to older adult caregivers of spouses with mild and moderate dementia in the community. Methods: The researchers acted as facilitators, with a view to empowering participants. We recruited participants from a day-care center and two community service stations. Data were collected with semi-structured, in-depth interviews with 19 dementia care dyads and from the notes, reflections, and feedback of collaborative researchers. Relevant themes for content analysis were extracted. Results: Three action cycles were completed over 18 months. The results revealed goals of three cycles: to connect the home situation and effective dialogue as a bridge to the researcher, to confirm the daily needs or expectations of the caregiver and the patient, and to enhance the interactions and quality of life of family members with resources and network. This process was cyclical and repetitive, and it also generated partnerships that built relationships among the interdisciplinary team, families, and researchers. At the same time, team workers formed a cooperative and coordinated family service mechanism to reflect the professional values and practice capabilities. Conclusions: The intervention program was based on the promotion of factors for the caregiver, linking to environmental protective factors, and the stabilization of mental and neurological symptoms of dementia patients, thereby enhancing the response capabilities of home caregivers while meeting the patient’s care needs in life. It is a tool that can effectively be used for support and empowerment in this population.

The effects of the COVID-19 pandemic on neuropsychiatric symptoms in dementia and carer mental health: an international multicentre study

As a global health emergency, the rapid spread of the novel coronavirus disease (COVID-19) led to the implementation of widespread restrictions (e.g., quarantine, physical/social distancing measures). However, while these restrictions reduce the viral spread of COVID-19, they may exacerbate behavioural and cognitive symptoms in dementia patients and increase pressure on caregiving. Here, we aimed to assess the impact of COVID-19 and related restrictions on both carers and people living with dementia across the world. We conducted an international survey (Australia, Germany, Spain, and the Netherlands) to assess the impact of COVID-19 on carers and people living with dementia. People with dementia experienced worsened neuropsychiatric symptoms since the outbreak of COVID-19, most commonly, depression, apathy, delusions, anxiety, irritability, and agitation. Regression analyses revealed that limited understanding of the COVID-19 situation and not living with the carer was associated with worsened neuropsychiatric symptoms. Carers also reported a decline in their own mental health, increased stress and reduced social networks as a result of COVID-19 and related restrictions. Regression analyses revealed uncertainty about the future and loneliness were associated with worsened carer mental health. Findings from this study will inform strategies for the development of support services and compassionate protocols that meet the evolving needs of those living with dementia and their carers.

Yokukansan, a traditional Japanese medicine, suppresses stress-induced sympathetic activation and central responses to stress in rats

Stress exposure activates the sympathetic nervous system. We previously reported that restraint stress and stress-related neuropeptides increases plasma catecholamine levels and that brain prostanoids medicate these responses in rats. Yokukansan (YKS), a traditional Japanese medicine, has been used for neurosis, night crying and irritability. Additionally, it has been reported that YKS is also effective against the behavioral and psychological symptoms of dementia in patients with Alzheimer&apos;s disease, stress-related anxiety-like behavior and stress-induced increase in plasma corticosterone in rodents. These previous findings raise the possibility that YKS can exert its action in the brain and has suppressive effects on stress responses. In this study, we examined effects of YKS on stress-induced sympathetic activation and stress responses in the brain using rats. Repeated administration with YKS suppressed stress-induced increase in plasma adrenaline level. YKS also suppressed stress-induced elevation of prostaglandin E2 and thromboxane B2 levels in the paraventricular hypothalamic nucleus (PVN). In addition, YKS suppressed stress-induced increases of acetylcholine, GABA and serotonin in the PVN. Our results suggest that YKS can ameliorate stress-induced sympathetic activation via inhibition of stress responses in the brain.

Magnitude and determinants of behavioral and psychological symptoms in dementia patients visiting a geriatric psychiatry clinic in a rural medical college

Background: The proportion of elderly people in the Indian population is increasing, thereby making dementia a major public health concern. The behavioral and psychological symptoms of dementia (BPSD) are deleterious to the illness course in dementia. The characteristics and sociodemographic and clinical correlates of BPSD is an understudied area. Materials and Methods: This was a retrospective cross-sectional observational descriptive study conducted in a public hospital. Hospital records of 97 dementia patients who visited the geriatric clinic in the time span of 20 months were analyzed using appropriate descriptive and inferential statistics. Results: The mean age of the patients was 69.9 ± 8.50 years, majority being males (72%). Sleep disturbance (75.3%), changes in psychomotor activity (55.7%), and irritability (45.3%) were the most common behavioral and psychological symptoms associated with dementia. Apathy was seen in 39% of patients, whereas the proportion of patients with depression and anxiety was 26% and 35%, respectively. Psychotic symptoms such as delusions and hallucinations were seen in approximately 24% and 15.5% of patients, respectively. The psychotic symptoms showed a significant association with lower levels of education, whereas apathy was negatively associated with age. Females had a higher likelihood of having psychotic symptoms as compared to males. Conclusion: In the present study, the frequency and association of neuropsychiatric symptoms with demographic variables have been described in dementia patients visiting a public hospital in rural India. Among BPSD, sleep and motor disturbances were most frequent whereas agitation/aggression was least frequent. The age, education level, and gender differences noted in the individual symptoms need to be confirmed in further studies with better design.

Impact of Plasma Donepezil Concentration on Behavioral and Psychological Symptoms of Dementia in Patients with Alzheimer’s Disease

Background/Aims: The behavioral and psychological symptoms of dementia (BPSD) detract from the quality of life of not only dementia patients but also their family members and caregivers. Donepezil is used to treat Alzheimer’s disease and is metabolized via cytochrome P450 (CYP) 2D6 and CYP3A4/5. It is controversial whether donepezil improves or exacerbates BPSD. This study investigated the relationships among BPSD, the pharmacokinetics of donepezil including its metabolite, 6-O-desmethyl donepezil, genetic polymorphisms of CYPs and P-glycoprotein, and patient backgrounds in 52 patients with Alzheimer’s disease. Methods: BPSD were assessed using the Neuropsychiatric Inventory (NPI), with scores ≥20 points defined as severe BPSD. Plasma donepezil and 6-O-desmethyl donepezil concentrations were measured using liquid chromatography–tandem mass spectrometry. Results: Although significant relationships between NPI scores and plasma donepezil concentrations were not seen, none of the 15 patients (29%) with high plasma donepezil concentrations (≥60 ng/mL) developed severe BPSD. Polymorphisms of CYP2D6, CYP3A5, and ABCB1 did not influence NPI scores. There were no significant relationships between NPI and patient background factors such as dosing regimen, concomitant use of other drugs, or laboratory test results. Two patients who underwent multiple blood samplings over 2 years showed an inverse correlation between plasma donepezil concentrations and NPI scores. Discussion/Conclusions: These results indicate that higher plasma concentrations of donepezil contribute to preventing or alleviating rather than developing or deteriorating BPSD.

Predictors of Change in Behavioral Psychological Symptoms of Dementia in Patients With Alzheimer’s Disease in Korea

Predictors of Change in Behavioral Psychological Symptoms of Dementia in Patients With Alzheimer’s Disease in Korea 의 이용 수, 등재여부, 발행기관, 저자, 초록, 목차, 참고문헌 등 논문에 관한 다양한 정보 및 관련논문 목록과 논문의 분야별 BEST, NEW 논문 목록을 확인 하실 수 있습니다.

Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries.

Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries.

English

BACKGROUND Behavioural and psychological symptoms of dementia (BPSD) are a heterogeneous group of clinical phenomena experienced during the course of dementia which are either subjectively reported by the patient or observed by the clinician. BPSD include agitation, aberrant motor behaviour, anxiety, elation, irritability, depression, apathy, disinhibition, delusions, hallucinations, and sleep or appetite changes. We wanted to determine the frequency of behavioural and psychological symptoms of dementia in patients with dementia of the Alzheimer’s type attending the Psychiatry Department in a tertiary care centre of north Kerala and to address the degree of caregiver distress. METHODS This is a hospital based cross sectional study. A consecutive sample of 72 patients of either gender of age group &gt; 55 years who were diagnosed with Alzheimer’s dementia using DSM 4 - TR criteria attending Department of Psychiatry of GMC Kannur during the period March 2019 to February 2020 were included in the study. The primary caregivers were interviewed to obtain the sociodemographic profile of the patients and BEHAVE AD scale was administered to assess the BPSD in patients with Alzheimer’s dementia. Descriptive statistical tools like frequency and percentage were used. RESULTS The most common BPSD identified were diurnal rhythm disturbances or day-night disturbances observed in 79.2 % (N = 57) of the sample. This was followed by affective disturbances, paranoid and delusional ideations, anxieties, hallucinations and aggressiveness. The least reported was activity disturbances. CONCLUSIONS The frequency of BPSD is very high in dementia of Alzheimer’s type and the most frequent BPSD reported was diurnal rhythm disturbances. BPSD would impact negatively on the health of the individual and their respective caregivers. KEYWORDS Alzheimer’s Dementia, Behavioural and Psychological Symptoms of Dementia