Research Progressin the Application of Creative Arts Therapy to Behavioral and Psychological Symptoms of Dementia / 中国医学科学院学报

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.

Electroconvulsive therapy for treating patients with agitation and related behavioral disorders due to dementia: a systematic review / Eletroconvulsoterapia no tratamento de pacientes com agitação e outros distúrbios de comportamento devido à demência: uma revisão sistemática

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.

A Systematic Review and Meta-Analysis of Nonpharmacological Interventions for Moderate to Severe Dementia

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).

Comparative study of citalopram in treatment of behavioral and psychological symptoms of dementia and cognitive function in Alzheimer's disease patients / 中华行为医学与脑科学杂志

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.

A Systematic Review of Nonpharmacological Interventions for Moderate to Severe Dementia: A Study Protocol for a Systematic Review and Meta-Analysis

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.

Severity and prevalence of behavioral and psychological symptoms among patients of different dementia stages in Taiwan

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.

Comparison of Behavioral and Psychological Symptoms between Early and Late Onset Alzheimer's Disease According to the Progression of Dementia

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.

Association between Characteristics of Brain Magnetic Resonance Imaging and Atypical Antipsychotics Use in Dementia Patients

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.

Clinical Characteristics of Behavioral and Psychological Symptoms in Patients with Drug-naive Alzheimer's Disease

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.

Treatment of Alzheimers disease in Brazil: II. Behavioral and psychological symptoms of dementia / Tratamento da doença de Alzheimer no Brasil: II. Dos sintomas comportamentais e psicológicos da demência

This article reports the recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology for the treatment of Alzheimers disease (AD) in Brazil, with special focus on behavioral and psychological symptoms of dementia (BPSD). It constitutes a revision and broadening of the 2005 guidelines based on a consensus involving researchers (physicians and non-physicians) in the . The authors carried out a search of articles published since 2005 on the MEDLINE, LILACS and Cochrane Library databases. The search criteria were pharmacological and non-pharmacological treatment of the behavioral and psychological symptoms of AD. Studies retrieved were categorized into four classes, and evidence into four levels, based on the 2008 recommendations of the American Academy of Neurology. The recommendations on therapy are pertinent to the dementia phase of AD. Recommendations are proposed for the treatment of BPSD encompassing both pharmacological (including acetyl-cholinesterase inhibitors, memantine, neuroleptics, anti-depressives, benzodiazepines, anti-convulsants plus other drugs and substances) and non-pharmacological (including education-based interventions, physiotherapy, occupational therapy, music therapy, therapy using light, massage and art therapy) approaches. Recommendations for the treatment of cognitive disorders of AD symptoms are included in a separate article of this edition.

Esse texto apresenta as recomendações da Academia Brasileira de Neurologia, por intermédio do seu Departamento Científico de Neurologia Cognitiva e do Envelhecimento, para o tratamento da doença de Alzheimer (DA) no Brasil, enfocando os sintomas comportamentais e psicológicos da demência (SCPD). Trata-se de uma revisão ampliada das diretrizes publicadas em 2005, resultada de um consenso envolvendo pesquisadores da área, médicos e não médicos. Os autores realizaram uma busca de artigos publicados a partir de 2005 nas bases MEDLINE, LILACS e Cochrane Library. A busca foi direcionada para tratamento farmacológico e não farmacológico dos sintomas comportamentais e psicológicos da DA. Os estudos foram categorizados em quatro classes e as evidências em quatro níveis, com base nas recomendações da Academia Americana de Neurologia publicadas em 2008. As recomendações terapêuticas referem-se à fase demencial da DA. Apresentam-se recomendações para o tratamento dos SCPD, tanto farmacológico (incluindo inibidores da acetilcolinesterase, memantina, neurolépticos, antidepressivos, benzodiazepínicos, anticonvulsivantes e outros fármacos e substâncias), como não farmacológico (incluindo intervenções educacionais, fisioterapia, terapia ocupacional, musicoterapia, terapia com luz, massagem e arterapia). As recomendações para o tratamento dos transtornos cognitivos da DA são apresentadas em outro artigo desse fascículo.

Comparative analysis in psychological and behavioral symptom of patients with Alzheimer's disease in home and resthome / 中国实用护理杂志

Objective To understand the influene of inhabited environment on psychological and be-havioral symptom of dementia (BPSD) in patients with Alzbeimer's disease. Methods Nenrepsychiatric in-ventory was used to measure the occurrence of BPSD of 100 home and 100 resthome patients with Alzheimer's disease.Tbe data were analyzed with software SPSS version 13.0. Results The scores of hallucinations, anxi-ety,aberrant motor behavior and sleep disturbance in resthome patients were significant higher than those of home patients.There was significantly difference in the extent of occurrence in aberrant motor behavior, apathy/ indifference, hallucinations, sleep disturbance, anxiety,depression/dysphoria and appetite/eating disorders be-tween home and resthome patients,among which the extent of occurrence in resthome patients was higher except for body weight decreasing and appetite/eating disoniers. Conclusions The occurrence of BPSD is different according to different inhabited environment, symptoms of resthome patients are worse, so families should be ap-pealed as far as possibile to allow AD patients living at home.

Five Cases of Alzheimer's Type Dementia Showing Behavioral and Psychological Symptoms of Dementia (BPSD) Successfully Treated with Yokukansan / 日本東洋医学雑誌

We described here five patients with Alzheimer's disease (AD) who have behavioral and psychological symptoms of dementia (BPSD), and who have shown a remarkable improvement as a result of Yokukansan treatment. All five patients exhibited irritability and excitement, four of the patients suffered from aggression and insomnia, and three suffered from wanderings. All of the patients started recovering from these symptoms within 1-2 weeks from the start of the treatment, without any adverse reaction. In conclusion, our case study suggests that Yokukansan is a safe and effective treatment for AD patients with BPSD. Our study further suggests that Yokukansan is especially useful for patients who are difficult to treat with neuroleptics, such as patients with insomnia and wandering, patients exhibiting a depressive state as well as irritability and excitement, and those with physical symptoms, including gait disturbances and urinary incontinence.

Behavioral and Psychological Symptoms in Dementia(BPSD):Psychotic Symptoms

Dementia is a multi-dimensional disorder associated with cognitive symptoms, functional impairment, and behavioral and psychological symptoms such as agitation, depression and psychosis. Behavioral and psychological symptoms of dementia (BPSD) are an integral part of the disease process and present severe problems to patients, their families and caregivers, and society at large. BPSD are treatable and are more amenable to therapy than other symptoms or syndromes of dementia. Thus, the recognition and appropriate management of BPSD are important factors in improving our care of dementia patients and their caregivers. Psychotic symptoms presented as delusions, misidentifications, and hallucinations are most prevalent BPSD in Alzheimer's disease and related dementia. The author has reviewed the clinical feature, etiology, and pharmacological and non-phrmacological management of psychotic symptoms of BPSD.