Caffeine Consumption and Behavioral Symptoms in Nursing Home Residents: A Cross-Sectional Analysis.

OBJECTIVE: Although behavioral changes are common in nursing home residents with dementia and caffeine is known to influence behavior in healthy adults, the effects of caffeine on the behavior of persons with dementia has received little attention. In this study we assessed the relationship of caffeine and behavioral symptoms in older persons with dementia. DESIGN: A multicenter sub-cohort study embedded in the Elderly Care Physicians (ECP) training program. SETTING: Dutch nursing homes associated with the ECP training program. PARTICIPANTS: A total of 206 individuals with both diabetes and dementia resident in Dutch nursing homes. MEASUREMENTS: Trainee ECPs collected data on caffeine consumption, cognition and behavioral symptoms using the NPI-NH, MDS-DRS and AES-C. Data on factors known to influence behavior in persons with dementia (e.g. marital status, kidney function, urinary tract infection and medication) were also collected. RESULTS: Of the 206 participants, 70% showed behavioral symptoms. An increase in caffeine consumption was associated with a decrease in the presence of behavioral symptoms in the NPI-NH cluster affect and NPI-NH item agitation. Caffeine consumption groups also differed on the presence of disinhibition and depression. In addition, the severity of dementia influenced agitation, anxiety and the clusters affect and psychomotor. CONCLUSION: In a large group of older persons with dementia resident in nursing homes, a low daily consumption of caffeine was associated with greater behavioral symptoms.

Caffeine and neuropsychiatric symptoms in patients with dementia: A systematic review.

BACKGROUND: The consumption of caffeine has well known effects on the behavior and sleep of healthy adults. Behavioral symptoms and sleeping difficulties are common in patients with dementia which may be affected by caffeine consumption. This systematic review examines the association between caffeine intake and neuropsychiatric symptoms in patients with dementia. METHODS: In January 2019 an extensive search was conducted in Medline (PubMed), Embase, Emcare, Cochrane, PsychInfo, Web of Science and gray literature. Studies were included when they: i) investigated patients diagnosed with dementia, ii) reported neuropsychiatric symptoms, iii) used caffeine or coffee consumption as an intervention, and iv) reported associations between caffeine or coffee consumption and neuropsychiatric symptoms. Studies were excluded when they also included participants without a diagnosis of dementia, or presented a review or expert opinion. Two reviewers independently rated the studies and reached consensus on the appraisal. RESULTS: Of the seven studies eligible for this review, four reported on sleeping difficulties and five on behavioral symptoms. There was no consistent effect of caffeine administration on neuropsychiatric symptoms: e.g., both high caffeine consumption and eliminating caffeine were associated with less apathy, the total Neuropsychiatric Inventory (Nursing Home) decreased after both coffee therapy and after eliminating caffeine, and both caffeine consumption and eliminating caffeine improved sleep. CONCLUSION: These findings suggest that caffeine can either induce or reduce neuropsychiatric symptoms in individual patients with dementia. Therefore, in these patients, caffeine consumption requires a prudent individualized approach and further research on the effects of caffeine on individual neuropsychiatric symptoms is required.

Relation between caffeine and behavioral symptoms in elderly patients with dementia: an observational study.

OBJECTIVES: Caffeine is known to improve concentration and reduce fatigue in healthy adults, but high doses may induce anxiety and agitation. Because the effects of caffeine in elderly people with dementia are unknown, this study explores the relation between caffeine and behavioral symptoms in a group of elderly patients with dementia. DESIGN: An observational pilot study. SETTING: A dementia special care unit of a Dutch nursing home. PARTICIPANTS: A total of 29 elderly patients with dementia. MEASUREMENTS: Behavioral symptoms were measured with the NPI-NH, and sleep and caffeine consumption were measured using questionnaires. RESULTS: A significant relation was found between the total amount of caffeine consumed during the day and apathy [Kendall's tau (KT) -0.287 p=0.03], and the number of times that participants got up at night (KT 0.462; p <0.01). The amount of caffeine consumed after 6 p.m. was also significantly related to the number of times participants got up at night (KT 0.436; p <0.01). Multilevel analysis showed caffeine to be negatively correlated with aberrant motor behavior [b = -0.47 (0.22), Wald (461) = -2.12, p=0.03] and apathy [b = -0.88 (0.45), Wald (461)= -1.96, p=0.05], and showed a significant relation between caffeine consumption after 6 p.m. and the number of times participants got up at night [b=0.48 (0.22), Wald (461)= 2.20, p=0.03]. CONCLUSION: This study established an association between caffeine consumption and behavioral symptoms in elderly patients with moderately severe dementia. Therefore, adjusting caffeine consumption could be part of an interdisciplinary approach to behavioral symptoms, particularly when aberrant motor behavior, apathy or sleeping difficulties are involved. These results indicate that further research on the effects of caffeine on behavioral symptoms in dementia is warranted.