Mobile application for monitoring behavioral and psychological symptoms of dementia in patients with moderate to severe dementia.

AIM: Behavioral and psychological symptoms of dementia (BPSD) are common in patients with moderate-severe dementia and have negative impacts on both patients and caregivers. There is a lack of a tool for caregivers to monitor patients' BPSD by themselves. This study aimed to develop and validate a mobile application for caregivers to use in monitoring BPSD. METHODS: A total of 104 pairs of patients with moderate-severe dementia and their caregivers completed the study. The Neuropsychiatric Inventory (NPI) was modified and digitally transformed to a caregiver-rating mobile application to quantify nine domains of BPSD for their frequency and impact on the emotion of the caregivers. Data collected from the application were compared with the paper-and-pencil NPI for prevalence, concurrent validity (Spearman's rho) and internal consistency (Cronbach's alpha). RESULTS: The application was able to detect 93% of BPSD compared with the NPI. Concurrent validity was good-very good when compared with the Frequency × Severity score (ρ = 0.77, P < 0.001) and the burden score (ρ = 0.85, P < 0.001) from the NPI. Levels of internal consistency were acceptable for both frequency (α = 0.73) and impact (α = 0.79) scores. 80% of the caregivers reported that the application was "very likely to be helpful in caregiving". CONCLUSIONS: The mobile application for monitoring BPSD in patients with moderate-severe dementia had an excellent sensitivity, and good-very good validity and consistency. The caregivers had a positive perception of the application as an aid in caregiving. Geriatr Gerontol Int 2021; 21: 472-477.

Clinical correlates of resilience factors in geriatric depression.

ABSTRACTBackground:Traditional perspectives conceptualize resilience as a trait and depression as resulting from resilience deficiency. However, research indicates that resilience varies substantially even among adults who are clinically depressed, as well as across the lifespan of an individual. Few studies have investigated resilience in depression, and even fewer have examined resilience in depressed older adults. METHODS: Three hundred thirty-seven adults ≥60 years with major depressive disorder completed the Connor-Davidson Resilience Scale (CD-RISC) and measures of mental health, quality of life (QOL), and medical comorbidity. Exploratory factor analysis was used to explore the factor structure of the CD-RISC. Correlations and general linear models were used to examine associations between resilience and other variables. RESULTS: The rotated component matrix indicated a four-factor model. Sorting of items by highest factor loading revealed constructs associated with (1) grit, (2) active coping self-efficacy, (3) accommodative coping self-efficacy, and (4) spirituality. Resilience was significantly correlated with increased age, lower cognitive functioning, greater cerebrovascular risk, and greater medical comorbidity. Resilience was negatively associated with mental health symptoms (depression, apathy, and anxiety) and positively associated with QOL. The final optimal model identified less depression, less apathy, greater medical comorbidity, higher QOL, and minority (non-White) race as factors that significantly explained variability in resilience. CONCLUSIONS: Resilience was significantly associated with a range of mental health constructs in a sample of older adults with depression. Future clinical trials and dismantling studies may help determine whether interventions targeting grit, active coping, accommodative coping, and spirituality can increase resilience and help prevent and treat depression in older adults.

Mind-Body Therapies for Late-Life Mental and Cognitive Health.

PURPOSE OF REVIEW: A growing body of research supports the use of mind-body therapies (MBTs) as minimally invasive and effective approaches for the management of late-life mood and cognitive disorders. RECENT FINDINGS: Recent randomized controlled trials and meta-analyses indicate that MBTs are effective for enhancing well-being, mood, sleep, and cognition in older adults. Evidence suggests that mindful movement (e.g., yoga, tai chi, walking meditation) may even outperform conventional physical exercise with regard to effects on quality of life, mood, and cognitive functioning. Practitioners may recommend MBTs as holistic, effective approaches for the management of common late-life mood and cognitive disorders. Continued research on MBTs will inform the development of even more effective/targeted interventions and contribute to greater acceptance and integration of these therapies into geriatric medicine and psychiatry.

A randomized controlled trial of Kundalini yoga in mild cognitive impairment.

BACKGROUND: Global population aging will result in increasing rates of cognitive decline and dementia. Thus, effective, low-cost, and low side-effect interventions for the treatment and prevention of cognitive decline are urgently needed. Our study is the first to investigate the effects of Kundalini yoga (KY) training on mild cognitive impairment (MCI). METHODS: Older participants (≥55 years of age) with MCI were randomized to either a 12-week KY intervention or memory enhancement training (MET; gold-standard, active control). Cognitive (i.e. memory and executive functioning) and mood (i.e. depression, apathy, and resilience) assessments were administered at baseline, 12 weeks and 24 weeks. RESULTS: At baseline, 81 participants had no significant baseline group differences in clinical or demographic characteristics. At 12 weeks and 24 weeks, both KY and MET groups showed significant improvement in memory; however, only KY showed significant improvement in executive functioning. Only the KY group showed significant improvement in depressive symptoms and resilience at week 12. CONCLUSION: KY group showed short- and long-term improvements in executive functioning as compared to MET, and broader effects on depressed mood and resilience. This observation should be confirmed in future clinical trials of yoga intervention for treatment and prevention of cognitive decline (NCT01983930).

Neurochemical and Neuroanatomical Plasticity Following Memory Training and Yoga Interventions in Older Adults with Mild Cognitive Impairment.

Behavioral interventions are becoming increasingly popular approaches to ameliorate age-related cognitive decline, but their underlying neurobiological mechanisms and clinical efficiency have not been fully elucidated. The present study explored brain plasticity associated with two behavioral interventions, memory enhancement training (MET) and a mind-body practice (yogic meditation), in healthy seniors with mild cognitive impairment (MCI) using structural magnetic resonance imaging (s-MRI) and proton magnetic resonance spectroscopy (1H-MRS). Senior participants (age ≥55 years) with MCI were randomized to the MET or yogic meditation interventions. For both interventions, participants completed either MET training or Kundalini Yoga (KY) for 60-min sessions over 12 weeks, with 12-min daily homework assignments. Gray matter volume and metabolite concentrations in the dorsal anterior cingulate cortex (dACC) and bilateral hippocampus were measured by structural MRI and 1H-MRS at baseline and after 12 weeks of training. Metabolites measured included glutamate-glutamine (Glx), choline-containing compounds (Cho, including glycerophosphocholine and phosphocholine), gamma-aminobutyric acid (GABA), and N-acetyl aspartate and N-acetylaspartyl-glutamate (NAA-NAAG). In total, 11 participants completed MET and 14 completed yogic meditation for this study. Structural MRI analysis showed an interaction between time and group in dACC, indicating a trend towards increased gray matter volume after the MET intervention. 1H-MRS analysis showed an interaction between time and group in choline-containing compounds in bilateral hippocampus, induced by significant decreases after the MET intervention. Though preliminary, our results suggest that memory training induces structural and neurochemical plasticity in seniors with MCI. Further research is needed to determine whether mind-body interventions like yoga yield similar neuroplastic changes.

Rate of Serum Valproate Concentration Monitoring in Patients with Bipolar Disorder Type I at Srinagarind Hospital Outpatient Clinic.

Objective: Determine in the out-patient setting the rate and the purpose of serum valproate concentration monitoring during treatment with valproate, either single valproate or valproate in combination with other psychotropics in patients with bipolar disorder type I (BD-I), to determine the rate of recording valproate associated adverse effects, the rate of the follow-up and the length (days) that the patients were in the condition of full remission/recovery and symptomatic. Material and Method: The present study was a retrospective descriptive study done between January 1, 2007 and December 31, 2008. The data were from the medical records of DSM-IV-TR BD-I out-patients at Srinagarind Hospital, Khon Kaen who were treated either by single valproate or valproate in combination with other drugs for at least six weeks long. The studied variable included the annual rate and the reason that psychiatrist requested serum valproate concentration (SVC) monitoring per patient, the annual rate that psychiatrist recorded the valproate associated adverse effects, the annual rate that the patient returned to have a follow-up visit, and the length (days) that the patient was in full remission/recovery and symptomatic. Results: During the study period, of the 199 patients with BD-I, only 57 patients (28.6%) that were treated with valproate had complete records. The SVC monitoring occurred 17 times from 13 patients (22.8%). The mean SVC was 76.4 microgram/ml (SD = 31.8). The mean value +SD and range of SVC during the remission/recovery period were 75.1+17.5 µg/ml and 43.5-96.8 µg/ml, which was not significantly different from the symptomatic period, which was 77.1+39.9 µg/ml and 0.7 to 124.9 µg/ml. However, the oral dosage of valproate during the remission/recovery period (944.7+275.4 mg/day, median 1,000 mg/day) was significantly higher than during the symptomatic period (699.0+592.5 mg/day, 1,000 mg/day) (t = 2.7, df = 104 and p = 0.009). Of all the SVC monitoring, 58.8% occurred during the symptomatic period and most of the monitoring was due to the emergence of adverse effects. The causes for requesting the SVC determination were the emergence of adverse effects (29.4%), no reason specified (29.4%), and to monitor the clinical response (11.8%). The rate of valproate associated adverse effects recording was 1.1 times/person/year, which was 18.6% of the average rate of follow-up visits (6.6 times/person/year). The most frequent adverse effect was sedation. The treatment of BD-I by valproate or in combination with other psychotropics resulted in the remission/recovery period lasting 470.2 days (SD 256.8, median 517.0) while the symptomatic period lasted 176.1 days (SD 157.5, median 139.5). Conclusion: During treatment of BD-I, the rate of serum valproate concentration monitoring was very few. However, when determination was requested, the SVC was within the therapeutic range. In addition, rate of recording of valproate associated adverse effects was very low and the most frequent adverse effect was mild. The reason for monitoring the clinical response was rarely found. Valproate seems to be easily administered. The dosage can be adjusted using only clinical response and adverse effects. Therefore, valproate was effective and safe in treatment of BD-I.

Epidemiology of assault-related hospitalizations in Thailand in the fiscal year 2010: comparison between with and without psychiatric disorder.

BACKGROUND: Assault is a leading cause of injury and death; however little is known regarding the psychiatric epidemiology of assault-related hospitalizations (ARH) in Thailand. OBJECTIVE: To analyze the epidemiological data of ARH in Thailand for the fiscal year 2010 and to compare the epidemiology of ARH between with and without psychiatric disorder MATERIAL AND METHOD: The data analyzed were from the annual reports for the fiscal year 2010 (October 1, 2009-September 30, 2010), on every kind of hospitalization reimbursed by the Universal Health Coverage System, the Social Welfare System, and the Civil Servant Medical Benefits Scheme, altogether provided medical coverage for more than 96% of the Thai population. The information on ARH (X85-Y09: ICD-10 version for 2010) and comorbid psychiatric disorder(s) (F00-F99) were extracted. Number of in-patient hospitalizations by sex, age, geographical region, month, hospital charges, length of hospital stay (LOS) and mortality rate (MR) were analyzed. Frequencies (percentages) of ARH and subgroups were reported. RESULTS: The national ARH care cost was 0.98% of the overall national in-patient care expenses (88,964 million Baht). The rate of ARH was 0.72 of every 100 hospitalizations or 7.74 incidents/100,000 general population. Assaults leading to hospitalizations frequently occurred among males (80.86%); in 25-39 year-olds (35.60%), 40-59 year-olds (22.85%); by sharp object (29.44%), blunt object (24.40%) and bodily force (23.71%); in the Central (39.48%) and Northeast region (31.16%). There was a tri-modal monthly peak distribution: April (11.12%), December (9.45%) and October (8.90%). A minority i.e. 0.4% (male to female ratio of 4.22:1) of ARH had a concomitant psychiatric disorder(s): the most frequent being 'mental and behavioral disorders due to psychoactive substance use' (66.54%) followed by 'schizophrenia, schizotypal and delusional disorders' (14.230%). The MR of ARH with and without concomitant psychiatric disorder was 1.03% and 0.30%, respectively. The LOS of overall ARH was 5.15 +/- 12.41 days, min-max was 1-568 days and the mode was 1 day. The LOS of ARH with/without psychiatric disorder was 5.2 +/- 12.4 vs. 3.7 +/- 7.5 days. The expenses paid for ARH with/without psychiatric disorder was 75,811,383.40 Baht vs. 791,214,659.90 Baht. CONCLUSION: Assault accounted for 0.72 hospitalization of every 100 hospitalizations and 7.74 times/100,000 population. A fraction (0.04%) of ARH had concomitant psychiatric disorder(s): most frequently psychoactive substance use disorders followed by schizophrenia and related psychosis.

Epidemiology of mental and behavioral disorders among the elderly: based on data of hospitalized patients in Thailand 2010.

BACKGROUND: To date, only small, selected groups of elderly hospitalized with mental and behavioral disorders (EHMBD) have been studied. Since no national epidemiological studies have been published, the recent advent of universal healthcare in Thailand makes doing such a study timely for improving the medical curricula and service provision. OBJECTIVE: To analyze the epidemiology of the EHMBD in the year 2010 of Thailand. MATERIAL AND METHOD: The data analyzed were gathered from Medical Expense Reimbursement forms submitted for the fiscal year 2010. The particular focus of this research was on elderly inpatient aged 60 years and over with ICD-10 (for 2010) diagnosis: F00-F99 Mental and Behavioral Disorders. The authors extracted and analyzed the number of in-patient department (IPD) admissions, psychiatric diagnoses, length of hospital stays, hospital charges and mortality rate. Data were analyzed using SPSS 17 for Windows. RESULTS: In 2010, EHMBD accounted for 11,418 admissions which was 1.56 admission per 1000 elderly people or 13.9% of overall admission (19 years and over). Of the 11,418 admission, 44 died (0.39%). The mean in-patient charges/admission in Thai Baht (SD) for the EHMBD with any F00-F99 diagnosis was 12,896 (51,659). The average range of stay was 8.3 +/- 22.2 days. The leading diagnosed clusters of behavioral and mental disorders were organic mental disorders (F00-F09: 23.8%), neurotic, stress-related and somatoform disorders (F40-F48: 21.1%); and mental and behavioral disorders due to use of alcohol (F10: 20.3%). Alcohol use disorders among the elderly resulted in four times more men being hospitalized than women. Regarding the F30-F39 cluster mood (affective) disorders, the prevalence of depressive episodes increased with age and bipolar affective disorder decreased with age. CONCLUSION: The prevalence of hospitalization among the elderly with mental and behavioral disorders was about one-eighth that of all admission of adult from 19 years old. Death was an uncommon result. The most common psychiatric diagnoses were organic mental disorders, neurotic, stress-related and somatoform disorders and mental and behavioral disorders due to use of alcohol.