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Behavioral and psychological symptoms of dementia (BPSD) are common in the patients with dementia.Creative arts therapies (CAT) are one of the safe and effective non-pharmacological interventions for BPSD.This paper elaborates on the therapeutic effects of four common CAT,including art therapy,music therapy,dance therapy,and drama therapy,on BPSD.Despite the shortcomings,CAT offer a new gateway for the safe and noninvasive treatment of BPSD.
Subject(s)
Humans , Art Therapy , Music Therapy , Dementia/psychologyABSTRACT
ABSTRACT Behavioral disturbances are clinically relevant in patients with dementia, and pharmacological regimens to mitigate these symptoms have provided limited results. Proven to be effective in several psychiatric conditions, electroconvulsive therapy is a potentially beneficial strategy for treating severe agitation due to dementia. Objective: This review aimed to examine the publications on the efficacy, safety and tolerability of electroconvulsive therapy in treating patients with agitation due to dementia. Methods: We performed a systematic analysis on the electroconvulsive therapy to treat patients with dementia and coexisting severe agitation. Articles were classified according to the level of evidence based on methodological design. Patients received an acute course of electroconvulsive therapy, often followed by maintenance intervention. Results: We selected 19 studies (156 patients; 64.1% women; 51-98 years old), which met the inclusion criteria: one case-control study by chart analysis (level of evidence 2); one open-label study (level of evidence 3); three historical/retrospective chart analyses (level of evidence 4); and 14 case series/reports (level of evidence 5). No randomized, sham-controlled clinical trials (level of evidence 1) were identified, which represents the main methodological weakness. Some patients had postictal delirium, cardiovascular decompensation and cognitive changes, lasting for a short time. Conclusions: Overall, patients achieved significant improvement in agitation. However, the main finding of the present review was the absence of methodological design based on randomized and sham-controlled clinical trials. Despite methodological limitations and side effects requiring attention, electroconvulsive therapy was considered a safe and effective treatment of patients with severe agitation and related behavioral disorders due to dementia.
RESUMO Distúrbios comportamentais são clinicamente relevantes em pacientes com demência, e regimes farmacológicos para mitigar esses sintomas têm proporcionado resultados limitados. Comprovadamente eficaz em diversas condições psiquiátricas, a eletroconvulsoterapia é uma estratégia potencialmente benéfica para o tratamento de pacientes com agitação grave na demência. Objetivos: Esta revisão examina as publicações sobre eficácia, segurança e tolerabilidade da eletroconvulsoterapia no tratamento de pacientes com agitação na demência. Métodos: Realizamos uma análise sistemática da eletroconvulsoterapia no tratamento de pacientes com demência e agitação grave. Os artigos foram classificados quanto ao nível de evidência com base no delineamento metodológico. Os pacientes receberam um curso agudo de eletroconvulsoterapia, frequentemente seguido de manutenção. Resultados: Foram selecionados 19 estudos (156 pacientes; 64,1% mulheres; 51-98 anos): um estudo caso-controle desenvolvido com base na análise de prontuários (nível de evidência 2); um estudo aberto (nível de evidência 3); três estudos de análise retrospectiva de prontuários (nível de evidência 4); e 14 séries/relatos de casos (nível de evidência 5). Não foram identificados ensaios clínicos randomizados e controlados com placebo (nível de evidência 1), fator que representa a principal fragilidade metodológica. No entanto, o principal achado da presente revisão consistiu na ausência de desenho metodológico baseado em ensaios clínicos randomizados e controlados com placebo. Em geral, os efeitos colaterais foram transitórios e bem tolerados. Alguns pacientes apresentaram delirium pós-ictal, descompensação cardiovascular e alterações cognitivas por períodos breves. Conclusões: No geral, os pacientes obtiveram melhora significativa na agitação. No entanto, o principal achado da presente revisão foi a ausência de delineamento metodológico baseado em ensaios clínicos randomizados e controlados com placebo. Apesar das limitações metodológicas e dos efeitos adversos, a eletroconvulsoterapia foi considerada um tratamento seguro e eficaz em pacientes com agitação grave e com outros distúrbios comportamentais clinicamente relevantes na demência.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Violence , Mental DisordersABSTRACT
Objective:To explore the factors on malnutrition or risk of malnutrition in patients with Alzheimer′s disease (AD)-related cognitive impairment,and to further analyze the association between the severity of behavioral and psychological symptoms in dementia (BPSD) and nutritional status.Methods:The clinical data of 247 patients with AD-related cognitive impairment were collected continuously from the Chinese Imaging, Biomarkers and Lifestyle Study of Alzheimer′s Disease (CIBL) cohort between June 1, 2021 and August 31, 2022. The patients were divided into well-nourished group ( n=128) and malnourished group ( n=119) according to the scores of Mini-Nutritional Assessment scale (MNA). The sociodemographic data (sex, age, body mass index, waist-to-hip ratio, education level), the medical history of olfactory dysfunction, combination with more than two chronic diseases, and gastrointestinal diseases, presenting BPSD, and the scores of the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Neuropsychiatric Inventory (NPI), Activity of Daily Living (ADL), Caregiver Burden Inventory (CBI) and Dietary Diversity Score (DDS) were compared between the two groups. The factors with statistically significant differences in hypothesis test and univariate Logistic regression analysis were enrolled in multivariate Logistic regression analysis to further identify independent factors associated with malnutrition in patients with AD-related cognitive impairment. Furthermore, the association between NPI scores and MNA scores was analyzed by Spearman′s rank correlation test. Results:Compared with those in the well-nourished group, patients in the malnourished group had higher age [(66.70±7.01) years vs (69.14±8.87) years, t=-2.39, P=0.018], lower body mass index [(24.68±2.84) kg/m 2vs (22.69±3.63) kg/m 2, t=4.78, P<0.001], and higher proportion of presenting BPSD [22.66% (29/128) vs 76.47% (91/119), χ 2=71.49, P<0.001]; lower scores of MMSE, MoCA, and DDS [24.27±4.69 vs 18.95±8.40, t=6.09; 20.29±5.18 vs 14.55±8.12, t=6.56; 8.00 (8.00, 9.00) vs 8.00 (7.00, 8.00), Z=-4.66; all P<0.001], and higher scores of NPI, ADL and CBI [1.00 (0, 6.00) vs 10.00 (2.00, 25.00), Z=-6.50; 20.00 (20.00, 22.00) vs 27.00 (20.00, 40.00), Z=-7.08; 1.00 (0, 14.75) vs 12.00 (2.00, 35.00), Z=-5.13; all P<0.001]. There were no statistically significant differences in the sex, waist-to-hip ratio, education level, and the medical history of olfactory dysfunction, combination with more than two chronic diseases, and gastrointestinal diseases between the two groups. The multiple Logistic regression analysis demonstrated that the decreased body mass index ( OR=0.79, 95% CI 0.70-0.89, P<0.001), presenting BPSD ( OR=7.84, 95% CI 3.67-16.73, P<0.001), elevated ADL scores ( OR=1.15, 95% CI 1.06-1.24, P<0.001) and CBI scores ( OR=0.98, 95% CI 0.97-1.00, P=0.026), and decreased scores of DDS ( OR=0.66, 95% CI 0.51-0.84, P=0.001) were independently associated with malnutrition in patients with AD-related cognitive impairment. The MNA scores were significantly negatively associated with NPI scores ( r=-0.483,95% CI -0.58--0.38, P<0.001). Conclusions:The decreased body mass index, dietary diversity, and ability of daily living, and presenting BPSD and heavy burden of caregivers can independently contribute to the malnutrition in patients with AD-related cognitive impairment. The more serious the BPSD, the worse the nutritional status.
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Objectives:To analyze the potential biomarkers of behavioral and psychological symptoms of dementia (BPSD) in patients with Alzheimer′s disease (AD) continuum.Methods:A prospective cohort study was consecutively conducted on 179 patients with AD continuum (135 presented with BPSD, 44 patients without BPSD as control) from Capital Medical University, Beijing Tiantan Hospital, the Chinese imaging biomarkers and lifestyle cohort between January 1, 2021 and December 31, 2022. Gender, age, body max index, education level, diagnosis, the apolipoprotein E epsilon4 allele (APOE ε4) carrier status, the scores of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), cerebrospinal fluid (CSF) AD-related pathological biomarkers (Aβ 42, Aβ 40, Aβ 42/40, tTau, pTau181), and blood biomarkers (white blood cell count, red blood cell count, hemoglobin, platelet, total bilirubin, albumin, total cholesterol, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting glucose, erythrocyte sedimentation rate, homocysteine, vitamin B 12, folate) were compared between the two groups by using hypothesis testing and univariate logistic regression analysis. Multivariate logistic regression analysis was used to analyze the potential biomarkers associated with BPSD in patients with AD. Results:Among the 179 patients with AD continuum in the final analysis, 77 patients were men, 102 cases were women; 35 patients were identified with mild cognitive impairment (MCI) due to AD and 144 patients with AD dementia stage, the mean age was (66.54±9.75) years. Compared with those in control group, patients with BPSD had lower cerebrospinal fluid (CSF) Aβ 40 and blood hemoglobin levels [7.08 (4.42, 15.42) vs 9.62 (6.45, 12.12) pg/L, (132.70±13.37) vs (138.80±14.38) g/L] ( U=-1.856, t=2.579, P<0.05). The levels of CSF Aβ 40 ( OR=0.030, 95% CI: 0.001-0.760) and blood hemoglobin ( OR=0.051, 95% CI: 0.004-0.670) were independently negatively associated with BPSD in patients with AD continuum (both P<0.05). Conclusion:The decreased levels of CSF Aβ 40 and blood hemoglobin could be considered as potential biomarkers in detecting BPSD in patients with AD continuum.
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Objective:To explore the impact factors of behavioral and psychological symptoms of dementia (BPSD) in patients with Alzheimer′s disease (AD).Methods:The clinical data of 116 patients with AD admitted to the Outpatient Department of Cognitive Neurology of Beijing Tiantan Hospital, Capital Medical University from June 1, 2021 to March 1, 2022 were collected continuously. The patients were divided into BPSD group ( n=85) and control group ( n=31) according to the presence or absence of BPSD. The sociodemographic data (gender, age, body mass index, years of education), the medical history of hypertension, diabetes mellitus, hyperlipidemia, and the scores of the Mini-Mental State Examination (MMSE), the Activity of Daily Living (ADL), Mini-Nutritional Assessment scale (MNA) and Caregiver Burden Inventory (CBI) were compared between the two groups with hypothesis test and univariate logistic regression analysis. The statistically significant factors in hypothesis test and univariate logistic regression analysis were enrolled in multivariate logistic regression analysis to further identify the factors associated with BPSD in patients with AD. Results:There was no significant statistics differences in the gender, age, body max index, years of education and the medical history of hypertension, diabetes mellitus, hyperlipidemia between the two groups (all P>0.05). Compared with control group, patients with BPSD had lower scores of MMSE and MNA scales [(16.24±7.52) vs (20.81±5.09) points, (21.62±3.75) vs (24.87±2.89) points] (both P<0.001) and higher scores of ADL and CBI scales [29.00 (22.00, 38.50) vs 22.00 (20.00, 25.00) points, 25.00 (12.50, 41.00) vs 3.00 (0.00, 11.00) points](both P<0.001). The multiple logistic regression analysis demonstrated that the decreased MNA scores ( OR=0.762, 95% CI: 0.631-0.922; P=0.005) and elevated CBI scores ( OR=1.077, 95% CI: 1.029-1.128; P=0.002) were associated with BPSD in patients with AD. Conclusion:The malnutrition or the risk of malnutrition and greater caregiver burden can independently contribute to the onset of BPSD in patients with AD.
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OBJECTIVE: Due to limited efficacy of medications, non-pharmacological interventions (NPI) are frequently co-administered to people with moderate to severe dementia (PWMSD). This systematic review and meta-analysis investigated the effects of NPI on activities of daily living (ADL), behavioral and psychological symptoms of dementia (BPSD), and cognition and quality of life (QoL) of PWMSD. METHODS: A literature search was conducted in the following databases: Cochrane CENTRAL, EMBASE, Medline, CIHNAL, PsycINFO, KoreaMED, KMbase, and KISS. We conducted a meta-analysis on randomized controlled trials and used the generic inverse variance method with a fixed-effects model to calculate the standardized mean difference (SMD). The protocol had been registered (CRD42017058020).
Subject(s)
Activities of Daily Living , Anxiety , Cognition , Dementia , Depression , Dihydroergotamine , Methods , Music Therapy , Quality of LifeABSTRACT
Objective To observe the efficacy and safety of citalopram in the treatment of behav-ioural and psychological symptoms of dementia(BPSD)and cognitive function of Alzheimer's disease(AD) patients.Methods From April 2015 to February 2016,80 cases of moderate Alzheimer's disease(according to the clinical dementia rating scale,CDR)with symptoms of BPSD in Qingdao Mental Health Center were collected and randomly divided into treatment group and control group.Treatment group was given citalopram (10 to 30 mg/d),the control group was given the same dose of placebo,and the patients in both group were given memantine(10 mg/bid)for 12 weeks.Simple mental state examination(MMSE)was used to measure cognitive function.Neural psychiatric questionnaire(NPI)measurement was used to evaluate BPSD and the TESS was used to assess adverse effects.Results Decreased scores of MMSE between the treatment group and the control group were respectively(0.67±0.77)and(0.26±0.68)after 12 weeks of treatment.There was significant difference in decreased scores of MMSE between the two groups(t=2.49,P=0.02).The scores of NPI in agitation/attack(t=2.986,P=0.04),apathy(t=3.144,P=0.002),indifference/dysthymia (t=6.094,P=0.000)and anxiety(t=6.496,P=0.000)showed statistically significant differences between the two groups.There were no significant difference in TESS scores(P>0.05).The most frequently adverse e-vents in the study included dizziness,headache,fatigue and nausea.QTc interval prolongation were found in participants treated with 30 mg citalopram per day in the study group.Conclusion Citalopram is an effec-tive and safe drug in the treatment of BPSD and cognitive function associated with moderate AD.
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Objective To compare the cognitive functions and behavioral and psychological symptoms between Parkinson disease with dementia(PDD)and Alzheimer disease(AD). Methods Seventy-five cases with AD and 63 cases with PDD were recruited in this study. The mini mental state examination (MMSE), Montreal cognitive assessment (MoCA)and activities of daily living scale (ADL)were used to evaluate the cognitive impairment.The Chinese version of neuropsychiatric questionnaire(CNPI)was used to measure behavioral and psychological symptoms. Results ①Cognitive assessments:there were no statistically significant differences in total MMSE scores,total MoCA scores,total CNPI scores and ADL scores between AD patients and PDD patients (P>0.05).The sub-items of MoCA showed that memory loss was more severe in AD patients(2.17±0.65)than in PDD patients(2.44±0.50)(P<0.01).Visuospatial/executive dysfunction was more severe in PDD patients(3.73±0.70)than in AD patients(4.01±0.76)(P<0.05).②The items of CNPI showed that ADD patients had lower scores in the items of CNPI compared with the PDD patients (15.31±3.16 vs 19.41±3.52). The sub-items of CNPI showed that the most common mental symptoms in PDD patients were hallucination, depression, and agitation, which were 55.6%, 54%, and 52.4%, respectively Compared with the AD patients (P<0.05). On the contrary, compared with PDD patients, the most common mental symptoms were anxiety, apathy and irritability in AD patients, which were 53.3%, 52% and 49.3%, respectively (P<0.05). Conclusion Patients with AD and PDD exhibit different characteristics in cognitive functions and behavioral and psychological symptoms.Neuropsychological tests combined with clinical history can be helpful for differentiation between AD and PDD in dementia patients.
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Dementia is a neuropsychiatric disorder characterized by cognitive impairment,and behavioral and psychological symptoms.Behavioral and psychological symptoms of dementia (BPSD) are common in patients with dementia and can have a major impact on the quality of life for patients and caregivers,and accelerate their cognitive decline.Atypical antipsychotics (AAP) possess excellent efficacy and tolerability in BPSD treatment;however,compared with conventional drugs,the use of antipsychotics has been widely debated for concerns over safety in elderly patients with dementia.The US FDA has issued several specific recommendations and emphasized that treatment of BPSD with AAP is"off-label".We have searched and reviewed the literature on the treatment of BPSD with AAP published in the last 10 years,and evaluated the efficacy and safety of AAP for clinicians' reference.
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The study is designed as a systematic review on nonpharmacological interventions for patients with moderate to severe dementia. This review will be conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. The following databases will be searched: Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, KoreaMED, KMbase, and KISS. The primary outcome will include the effect of the interventions on activities of daily living and behavioral and psychological symptoms of dementia. The literature search will be conducted based on search strategies designed for each database. The reviewers will independently assess the identified studies and extract the data. The risk of bias will be assessed and a meta-analysis will be conducted in accordance with the methodology for meta-analysis described in the Cochrane handbook. This systematic review will provide clinicians and policy makers with reliable evidence for developing and implementing nonpharmacological interventions for moderate to severe patients with dementia.
Subject(s)
Humans , Activities of Daily Living , Administrative Personnel , Bias , DementiaABSTRACT
Abstract Background To better understand the trends of behavioral and psychological symptoms of dementia (BPSD) over the disease progression is important to provide psychoeducation for dementia caregivers. Objective This study examined the severity and occurrence of BPSD across the various degrees of the disease. Methods This study was a cross-sectional design. Patients (N = 276) who had dementia from July 2001 to October 2008 were surveyed and assessed for dementia stage, using the clinical dementia rating scale (CDR). BPSD was evaluated using the Neuropsychiatric Inventory (NPI). We examined the differences between the severities and occurrence of the individual's BPSD among various CDR stages with the Kruskal-Wallis test and Chi-square test. Results Delusion (p = 0.01), agitation/aggression (p = 0.033), apathy/indifference (p = 0.009), aberrant motor behavior (p < 0.001), nighttime behavior disturbances (p < 0.001), and eating abnormalities (p = 0.001) were significantly different among stages of dementia. The severity of BPSD became exacerbated over the course of the disease, and was highest in moderate (CDR = 2) or severe (CDR = 3) dementia. The occurrence of BPSD was highest when the CDR equaled 2 (97.5%). Discussion The association of global (or certain) BPSD, across different stages of dementia, is a non-linear relationship. These findings suggest the importance of taking into account clinical dementia stage for managing BPSD.
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Objective · To explore family medical intervention model of senile dementia with behavioral and psychological symptoms. Methods · Four streets of Changning District in Shanghai were randomly selected and subjects were enrolled according to the inclusion criteria, who were randomly divided into the intervention group (n=71) and control group (n=70). The intervention group received door-to-door service from psychiatric doctors, given drug treatment and psychological intervention. Subjects were evaluated by several scales, including Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), Mini-Mental State of Examination (MMSE), Activity of Daily Living Scale (ADL), Quality of Life-Alzheimer's Disease (QOL-AD), and Generic Quality of Life Inventory-74 (GQOLI-74), at baseline and by the end of 6 months and 12 months. Results · ① There was no significant difference in the total scores and all factor scores of BEHAVE-AD between the two groups before intervention (P>0.05). Repeated measures analysis of variance revealed a significant main effect of time (P0.05). Repeated measures analysis of variance revealed a significant main effect of time (P<0.001). The between-group effect was significant in the scores of MMSE and QOL-AD (P<0.001). The interactive effect of time×group was significant in the scores of MMSE, ADL, QOL-AD, and GQOLI-74 (P<0.05). ④ Inter-group comparison of MMSE, ADL, QOL-AD, and GQOLI-74 scores indicated that by the end of 6 months, scores of MMSE of the intervention group were remarkably better than those of the control group and the differences were statistically significant (P<0.05). By the end of 12 months, scores of MMSE, ADL, QOL-AD, and GQOLI-74 of the intervention group were remarkably better than those of the control group and the differences were statistically significant (P<0.05). Conclusion · The family medical intervention model of door-to-door services from psychiatrists integrating multidisciplinary team is effective to attenuate the mental and behavioral symptoms of senile dementia patients, and can improve the quality of life of patients and caregivers. The effect of persistent implementation will be more remarkable.
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Objective To compare the differences in cognitive function and behavioral and psychological symptoms between patients with Alzheimer's disease (AD) and behavioral variant frontotemporal dementia (bvFTD). Methods Thirty-six AD patients and 20 bvFTD patients at mild-to-moderate stage, who were biomarker-confirmed by positron emission tomography (PET), were assessed with a neuropsychological battery and neuropsychiatry inventory (NPI). Cognitive domains, including memory, language, information processing speed and executive function, and behavioral and psychological symptoms were assessed and compared. Results AD patients had lower scores in immediate recall, delayed recall and recognition than bvFTD patients (all P<0.05); while bvFTD patients had poorer performance in language and executive function than AD patients (all P<0.05). The NPI total score was significantly higher in patients with bvFTD compared with patients with AD (17.5±5.7 vs 9.3±3.5, P<0.05). In respect to the 12 items of NPI, the incidence of agitation and irritability was higher in AD group than in bvFTD group (72.2%vs 35.0%, 55.6%vs 20.0%, all P<0.05);while the incidence of apathy, disinhibition, euphoria, aberrant motor behavior and appetite/eating was higher in bvFTD group than in AD group (65.0%vs 33.3%, 80.0% vs 5.5%, 70.0% vs 5.6%, 40.0% vs 11.1%, 50.0% vs 5.6%, all P<0.05). Conclusion Comprehensive neuropsychological assessment and evaluation of behavioral and psychological symptoms of patients with dementia are helpful in distinguishing AD from bvFTD.
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In addition to cognitive and functional decline, various behavioral and psychological symptoms in dementia (BPSD) are manifested in the patients with Alzheimer's dementia (AD). Some of BPSD, especially psychosis, agitation, and aggression could be challenges to caregivers and clinicians. Atypical antipsychotic drugs (risperidone, olanzapine, quetiapine, and aripiprazole) are widely prescribed to manage complicated neuropsychiatric symptoms associated with AD. It is known that atypical antipsychotics (AAP) have modest and significant beneficial effects in the short term treatment of BPSD. However their safety of AAP has been concerned with potentially increased adverse events. This article reviewed the treatment outcomes and adverse effects of AAP when managing BPSD in the patients with AD. The effects of risperidone and aripiprazole are obvious on psychosis and aggression, but with small effect size. AAP could exacerbate cognitive decline, and it could increase the rate of cerebrovascular accidents and mortality rate in the patients with AD.
Subject(s)
Humans , Aggression , Alzheimer Disease , Antipsychotic Agents , Behavioral Symptoms , Caregivers , Dementia , Dihydroergotamine , Mortality , Psychotic Disorders , Risperidone , Stroke , Aripiprazole , Quetiapine FumarateABSTRACT
BACKGROUND: The evaluation of behavioral and psychological symptoms (BPS) in ALS is important because its existence may serve as a prognostic factor and suggest a shared pathology with frontotemporal dementia (FTD) in ALS. In this study, we sought to identify the prevalence of the BPS of ALS patients and evaluate its relationship with the clinical profiles and survival of ALS patients. METHODS: One hundred sixty-six patients were enrolled in a cross-sectional cohort analysis from September 2008 to February 2012. All patients had sporadic ALS without a genetic mutation and were collected clinical profiles. The t-test and chi-square test were used to assess differences in the clinical characteristics and caregiver-administered neuropsychiatric inventory (CGA-NPI) scores. The Kaplan-Meier method and Cox proportional hazard model were used for the survival analysis. RESULTS: Forty-two patients had clinically significant BPS (42/166, 25.3%). ALS patients with BPS had worse clinical dementia rating (CDR), ALS Functional Rating Scale-Revised (ALSFRS-R) score, and progression rate of disease than those without BPS. Among CGA-NPI subscales, depression, irritability, apathy, and agitation were higher prevalent than the others. There was a trend for ALS patients with BPS having short survival time than those without BPS in the Kaplan-Meier analysis (p=0.006). However, in the Cox proportional hazard model, BPS in ALS patients were not associated with poor survival. CONCLUSION: These results support the presence of an overlapping spectrum between ALS and FTD and emphasize the importance of neuropsychiatric evaluations in ALS. Although the association between BPS and prognosis are not explained clearly, these results could be used to stratify ALS patients according to neuropsychiatric symptoms and help investigators to evaluate the BPS in ALS patients.
Subject(s)
Humans , Amyotrophic Lateral Sclerosis , Apathy , Cohort Studies , Dementia , Depression , Dihydroergotamine , Frontotemporal Dementia , Kaplan-Meier Estimate , Pathology , Prevalence , Prognosis , Proportional Hazards Models , Research PersonnelABSTRACT
OBJECTIVE: We performed a cross-sectional study to examine the relationship between premorbid personality and behavioral and psychological symptoms in dementia (BPSD) in Korean patients with Alzheimer's disease (AD). METHODS: We assessed 103 patients diagnosed with AD for the presence of BPSD over the disease course by using the caregiver-rated Korean version of the Neuropsychiatric Inventory (K-NPI) and for the premorbid personality by using a retrospective version of the NEO-Five Factor Inventory questionnaire completed by informants. RESULTS: Premorbid neuroticism was significantly correlated with delusion, agitation, anxiety, disinhibition, total K-NPI score (p<0.05), and sleep disturbances (p<0.01). Lower premorbid conscientiousness was significantly correlated with symptoms of hallucinations and sleep disturbances in AD patients (p<0.05). However, premorbid neuroticism and low premorbid conscientiousness did not act as independent predictors for "psychosis, hyperactivity," or "moods, apathy, frontal" factors of BPSD. CONCLUSION: Premorbid personality was associated with the K-NPI score, but was not observed to be potential predictors of BPSD.
Subject(s)
Humans , Alzheimer Disease , Anxiety , Apathy , Cross-Sectional Studies , Delusions , Dementia , Dihydroergotamine , Hallucinations , Surveys and Questionnaires , Retrospective StudiesABSTRACT
The aim of this study was to investigate behavioral and psychological symptoms of dementia (BPSD) measured by caregiver-administered neuropsychiatric inventory (CGA-NPI) as a function of dementia severity in early onset (EOAD) versus late onset Alzheimer's disease (LOAD). A total of 113 patients with AD consisting of 49 patients with EOAD and 64 patients with LOAD were enrolled consecutively. General cognitive function and severity of dementia were assessed by the Korean version of mini-mental status examination and clinical dementia rating (CDR), respectively. In the mild stage (CDR 0.5-1), LOAD patients had a significantly higher total CGA-NPI score than EOAD patients. Subgroup analysis demonstrated that disinhibition and night-time behavior were more common and severe in the LOAD group than the EOAD group. However, in the moderate to severe stage (CDR 2-3), EOAD patients had a significantly higher total CGA-NPI score with higher subscores in hallucination, agitation/aggression, irritability/lability, aberrant motor behavior, and appetite/eating change. This study suggested that the heterogeneity of BPSD in AD might be accounted for by dementia severity as well as age at symptoms onset.
Subject(s)
Humans , Alzheimer Disease , Dementia , Hallucinations , Population CharacteristicsABSTRACT
OBJECTIVES: We aimed to identify the neuroimaging marker for prediction of the use of atypical antipsychotics (AAP) in dementia patients. METHODS: From April 2010 to March 2013, 31 patients who were diagnosed as dementia at the psychiatric department of Soonchunhyang University Hospital, completed the brain magnetic resonance imaging scan and cognitive test for dementia. Ten patients were treated with AAP for the improvement of behavioral and psychological symptoms of dementia (BPSD) and the other 21patients were not. Using T1 weighted and Fluid Attenuated Inversion Recovery (FLAIR) images of brain, areas of white matter (WM), gray matter (GM), cerebrospinal fluid (CSF) and white matter hyperintensities (WMH) have been segmented and measured. Multivariate logistic regression models were applied for assessment of association between AAP use and the GM/WM ratio, the WMH/whole brain (GM + WM + CSF) ratio. RESULTS: There was a significant association between AAP use and the GM/WM ratio (odds ratio, OR = 1.18, 95% confidence interval, CI 1.01-1.38, p = 0.037), while there was no association between AAP use and the WMH/whole brain ratio (OR = 0.82, 95% CI 0.27-2.48, p = 0.73). CONCLUSIONS: The GM/WM ratio could be a biological marker for the prediction of AAP use and BPSD in patients with dementia. It was more likely to increase as dementia progress since atrophy of WM was more prominent than that of GM over aging.
Subject(s)
Humans , Aging , Antipsychotic Agents , Atrophy , Biomarkers , Brain , Cerebrospinal Fluid , Dementia , Logistic Models , Magnetic Resonance Imaging , NeuroimagingABSTRACT
Behavioral and psychological symptoms in dementia (BPSD) are one of the common causes leading to significant impairment in quality of life for both patients and their caregivers, as well as an increased risk of institutionalization. In the treatment of BPSD, the first step is to check medical illness, and environmental status that can cause BPSD. When BPSD are associated with medical illness or environmental status, it is important to correct this condition for treatment of BPSD. However, if BPSD are very severe enough to be dangerous to patients or others and are not treatable by nonpharmacological approaches, pharmacological treatments could be considered. In pharmacological approaches, it is important to select relevant drugs according to the target symptoms, such as psychosis, depression, agitation, sleep disturbance, and so on. Due to the altered pharmacokinetics and pharmacodynamics, drug dosages for the patients with dementia should be started very low and increased slowly.
Subject(s)
Humans , Caregivers , Dementia , Depression , Dihydroergotamine , Drug Therapy , Institutionalization , Pharmacokinetics , Psychotic Disorders , Quality of Life , Resin CementsABSTRACT
BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are less well-defined aspects of Alzheimer's disease (AD). We designed this study to explore the followings: 1) the clinical profiles of BPSD 2) the clustered-groups domains of the Korean-Neuropsychiatric Inventory (K-NPI) assessment of BPSD 3) the clinical characteristics of the clustered-groups of BPSD in patients with drug-naive probable AD. METHODS: Descriptive and cluster analyses of the 12 K-NPI domains were done in 220 patients with drug-naive probable AD. After clustering these domains, characteristics of these positive symptoms clustered-group of patients were compared with the negative symptoms groups of patients. RESULTS: The mean Korean-Mini Mental Status Examination (K-MMSE), Clinical Dementia Rating (CDR) scale, and K-NPI scores were 15.0, 1.6, and 14.2, respectively. The CDR and K-MMSE scores correlated with total K-NPI scores, and depression was the most common symptom. According to cluster analysis, five major clusters were identified. Using the associated neuropsychological dysfunctions, characteristics of each group were defined. CONCLUSIONS: This study identified the clustered-domains for K-NPI, and suggested the possible anatomical substrates for these groups in drug-naive AD patients. These attempts may clarify the complex and bizarre behavioral and psychological symptoms as more neurologically relevant symptoms.