International Journal of Geriatric Psychiatry, 30(3), 2015, pp.265-273.
Publisher:
Wiley
... (Grand Rapids, MI, USA), with a diagnosis of dementia who were referred for ECT to treat agitation and/or aggression, were enrolled in the study. The Cohen-Mansfield Agitation Inventory-Short Form, Neuropsychiatric Inventory–Nursing Home Version, Cornell Scale for Depression in Dementia, and the Clinical Global Impression Scale were administered at baseline, during, and after the ECT course.
Results: Regression analyses revealed a significant decrease from baseline to discharge on the Cohen-Mansfield Agitation Inventory and Neuropsychiatric Inventory. There was no statistically significant change in scores on the Cornell Scale for Depression in Dementia. The Clinical Global Impression scores on average changed from a rating of 'markedly agitated/aggressive' at baseline to 'borderline agitated/aggressive' at discharge. Treatment with ECT was well tolerated by most participants; discontinuation of ECT occurred for two participants because of recurrence of agitation and for three participants because of adverse events.
Conclusions: Electroconvulsive therapy may be a safe treatment option to reduce symptoms of agitation and aggression in patients with dementia whose behaviours are refractory
(Edited publisher abstract)
Objective: This study examined the safety and efficacy of electroconvulsive therapy (ECT) as a treatment for behavioural disturbances in dementia. It was hypothesized that ECT would result in reduced agitated and aggressive behaviours between baseline and discharge.
Methods: Twenty-three participants admitted to McLean Hospital (Belmont, MA, USA) and Pine Rest Christian Mental Health Services (Grand Rapids, MI, USA), with a diagnosis of dementia who were referred for ECT to treat agitation and/or aggression, were enrolled in the study. The Cohen-Mansfield Agitation Inventory-Short Form, Neuropsychiatric Inventory–Nursing Home Version, Cornell Scale for Depression in Dementia, and the Clinical Global Impression Scale were administered at baseline, during, and after the ECT course.
Results: Regression analyses revealed a significant decrease from baseline to discharge on the Cohen-Mansfield Agitation Inventory and Neuropsychiatric Inventory. There was no statistically significant change in scores on the Cornell Scale for Depression in Dementia. The Clinical Global Impression scores on average changed from a rating of 'markedly agitated/aggressive' at baseline to 'borderline agitated/aggressive' at discharge. Treatment with ECT was well tolerated by most participants; discontinuation of ECT occurred for two participants because of recurrence of agitation and for three participants because of adverse events.
Conclusions: Electroconvulsive therapy may be a safe treatment option to reduce symptoms of agitation and aggression in patients with dementia whose behaviours are refractory to medication management.
(Edited publisher abstract)
Objectives: The aim of this study is to determine the prevalence of agitation in mild cognitive impairment (MCI, Petersen's criteria) and patients with Alzheimer's dementia (AD), and to characterise the associated behavioural symptoms.
Method: A cross-sectional analysis of baseline data from a prospective, longitudinal study on behavioral symptoms was performed, including 268 MCI and 393 AD patients. Behavioural assessment was performed through Middelheim Frontality Score (MFS), Behavioural Pathology in Alzheimer's Disease Rating Scale (Behave-AD) and Cornell Scale for Depression in Dementia (CSDD). Agitated behaviour was considered to be clinically relevant when one or more items of the Cohen-Mansfield Agitation Inventory (CMAI) occurred at least once a week.
Results: The prevalence of agitation in AD (76%) was higher than in MCI (60%). Patients with agitation showed more severe frontal lobe, behavioural and depressive symptoms (MFS, Behave-AD and CSDD total scores). In agitated AD patients, all behavioural symptoms and types of agitation were more severe compared to non-agitated AD patients, but in agitated MCI patients only for diurnal rhythm disturbances. This resulted in more severe Behave-AD global scores in patients with agitation as compared to patients without agitation. Comparing MCI and AD patients, MCI patients with agitation showed more severe behavioral and depressive symptoms than AD patients without agitation. The structure of agitation in AD consisted of more aggressive and physically non-aggressive behavior than in MCI.
Conclusion: Frontal lobe, behavioural and depressive symptoms are more severe in MCI and AD patients with clinically relevant agitation as compared to patients without agitation. However, this association is less pronounced in MCI.
(Edited publisher abstract)
Objectives: The aim of this study is to determine the prevalence of agitation in mild cognitive impairment (MCI, Petersen's criteria) and patients with Alzheimer's dementia (AD), and to characterise the associated behavioural symptoms.
Method: A cross-sectional analysis of baseline data from a prospective, longitudinal study on behavioral symptoms was performed, including 268 MCI and 393 AD patients. Behavioural assessment was performed through Middelheim Frontality Score (MFS), Behavioural Pathology in Alzheimer's Disease Rating Scale (Behave-AD) and Cornell Scale for Depression in Dementia (CSDD). Agitated behaviour was considered to be clinically relevant when one or more items of the Cohen-Mansfield Agitation Inventory (CMAI) occurred at least once a week.
Results: The prevalence of agitation in AD (76%) was higher than in MCI (60%). Patients with agitation showed more severe frontal lobe, behavioural and depressive symptoms (MFS, Behave-AD and CSDD total scores). In agitated AD patients, all behavioural symptoms and types of agitation were more severe compared to non-agitated AD patients, but in agitated MCI patients only for diurnal rhythm disturbances. This resulted in more severe Behave-AD global scores in patients with agitation as compared to patients without agitation. Comparing MCI and AD patients, MCI patients with agitation showed more severe behavioral and depressive symptoms than AD patients without agitation. The structure of agitation in AD consisted of more aggressive and physically non-aggressive behavior than in MCI.
Conclusion: Frontal lobe, behavioural and depressive symptoms are more severe in MCI and AD patients with clinically relevant agitation as compared to patients without agitation. However, this association is less pronounced in MCI.
(Edited publisher abstract)
International Journal of Geriatric Psychiatry, 22(9), September 2007, pp.916-921.
Publisher:
Wiley
Although behavioural and psychological symptoms of dementia (BPSD) increase with increasing dementia severity, and institutionalization of an individual with dementia is often caused by behavioural symptoms, relatively few studies have explored the prevalence of BPSD in nursing homes. This study has taken place in dementia wards in four Norwegian nursing homes. To measure agitation in residents with dementia we used the Cohen-Mansfield Agitation Inventory (CMAI), consisting of 29 agitation items. Dementia stage was measured by Functional Assessment Staging (FAST). Two hundred and eleven patients (71% female) were included in the study: mean (SD) age 85.5 (8.4), FAST 4.7 (2.1), CMAI total sumscore 39.5 (12.6). Dementia was present in 167 (79%) subjects. Among those with dementia, weekly occurrence of at least one CMAI item (i.e. a score of 3 or higher) occurred in 75.4% (95% CI 68.4-81.4). Six of the items occurred at least weekly in 20% of the residents with dementia, and 11 of the items, including physical aggression, occurred in less than 5% of the residents. Agitation was associated with more severe dementia (p = 0.001), but not with age and gender. Symptoms of agitation were common, but may
Although behavioural and psychological symptoms of dementia (BPSD) increase with increasing dementia severity, and institutionalization of an individual with dementia is often caused by behavioural symptoms, relatively few studies have explored the prevalence of BPSD in nursing homes. This study has taken place in dementia wards in four Norwegian nursing homes. To measure agitation in residents with dementia we used the Cohen-Mansfield Agitation Inventory (CMAI), consisting of 29 agitation items. Dementia stage was measured by Functional Assessment Staging (FAST). Two hundred and eleven patients (71% female) were included in the study: mean (SD) age 85.5 (8.4), FAST 4.7 (2.1), CMAI total sumscore 39.5 (12.6). Dementia was present in 167 (79%) subjects. Among those with dementia, weekly occurrence of at least one CMAI item (i.e. a score of 3 or higher) occurred in 75.4% (95% CI 68.4-81.4). Six of the items occurred at least weekly in 20% of the residents with dementia, and 11 of the items, including physical aggression, occurred in less than 5% of the residents. Agitation was associated with more severe dementia (p = 0.001), but not with age and gender. Symptoms of agitation were common, but may nevertheless be lower compared to findings in other geographical areas. Further studies are warranted to test this hypothesis, and if confirmed, to explore possible causes for such differences.
Background/Aims: Neuropsychiatric symptoms (NPS) in dementia pose great challenges for residents and staff in nursing homes. The Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) has recently in a randomized controlled trial demonstrated reductions in NPS. This study explored the participating staff's experiences with the model and how it meets the challenges when dealing with the complexity of NPS. Methods: Three to six months after the end of the intervention, the research interviewed 32 of the caregivers, leaders, and physicians participating in the trial, in five focus groups. It used thematic content analysis. Results: The analysis yielded two main themes: (1) a systematic reflection method enhanced learning at work; (2) the structure of the approach helped staff to cope with NPS in residents with dementia. Conclusion: TIME shifts the way of learning for the staff from a traditional to a more innovative and reflection-based learning through a process of learning how to learn at work. The staff's experienced increased coping in their approach to complex problems. The results emphasise the importance of a structured and biopsychosocial approach to NPS in clinical practice. Future research should explore models for integrating situated learning in daily routines in nursing homes.
(Edited publisher abstract)
Background/Aims: Neuropsychiatric symptoms (NPS) in dementia pose great challenges for residents and staff in nursing homes. The Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) has recently in a randomized controlled trial demonstrated reductions in NPS. This study explored the participating staff's experiences with the model and how it meets the challenges when dealing with the complexity of NPS. Methods: Three to six months after the end of the intervention, the research interviewed 32 of the caregivers, leaders, and physicians participating in the trial, in five focus groups. It used thematic content analysis. Results: The analysis yielded two main themes: (1) a systematic reflection method enhanced learning at work; (2) the structure of the approach helped staff to cope with NPS in residents with dementia. Conclusion: TIME shifts the way of learning for the staff from a traditional to a more innovative and reflection-based learning through a process of learning how to learn at work. The staff's experienced increased coping in their approach to complex problems. The results emphasise the importance of a structured and biopsychosocial approach to NPS in clinical practice. Future research should explore models for integrating situated learning in daily routines in nursing homes.
(Edited publisher abstract)
CHOI Scott Seung W., BUDHATHOKI Chakra, GITLIN Laura N.
Journal article citation:
International Journal of Geriatric Psychiatry, 34(7), 2019, pp.966-973.
Publisher:
Wiley
Objective: The relationship of specific dementia‐related behaviours to caregiver depression and moderating factors is unclear. This study examined the role of rejection of care, aggression, and agitation to caregiver depression and if social support and mastery independently moderated associations. Methods: The method used was a cross‐sectional, secondary analysis using baseline data from two community‐based clinical trials. This study examined frequency of occurrence of presenting behaviours and their combinations in persons with dementia. Multiple logistic regression analyses examined associations between nonoverlapping behavioural clusters (agitation alone, agitation + rejection, agitation + aggression, and agitation + rejection + aggression) and caregiver depression. Multiple logistic regression with interaction terms was also used to investigate whether social support or caregiver mastery moderated the relationship between behavioural symptom clusters and caregiver depression. Results: Three of four symptom clusters (all three behaviours [adjusted odds ratio (AOR) = 2.22; 95% CI, 1.02‐4.83], agitation + rejection of care [AOR = 2.55; 95% CI, 1.06‐6.13], and agitation + aggression [AOR = 2.63; 95% CI, 1.17‐5.89]) had a positive association with caregiver depression, whereas agitation alone was not significantly associated with caregiver depression. Neither social support nor mastery significantly moderated the relationship between these three behavioural clusters and caregiver depression. Conclusion: Caregiver depression was associated with different combinations of behaviours but not with agitation
(Edited publisher abstract)
Objective: The relationship of specific dementia‐related behaviours to caregiver depression and moderating factors is unclear. This study examined the role of rejection of care, aggression, and agitation to caregiver depression and if social support and mastery independently moderated associations. Methods: The method used was a cross‐sectional, secondary analysis using baseline data from two community‐based clinical trials. This study examined frequency of occurrence of presenting behaviours and their combinations in persons with dementia. Multiple logistic regression analyses examined associations between nonoverlapping behavioural clusters (agitation alone, agitation + rejection, agitation + aggression, and agitation + rejection + aggression) and caregiver depression. Multiple logistic regression with interaction terms was also used to investigate whether social support or caregiver mastery moderated the relationship between behavioural symptom clusters and caregiver depression. Results: Three of four symptom clusters (all three behaviours [adjusted odds ratio (AOR) = 2.22; 95% CI, 1.02‐4.83], agitation + rejection of care [AOR = 2.55; 95% CI, 1.06‐6.13], and agitation + aggression [AOR = 2.63; 95% CI, 1.17‐5.89]) had a positive association with caregiver depression, whereas agitation alone was not significantly associated with caregiver depression. Neither social support nor mastery significantly moderated the relationship between these three behavioural clusters and caregiver depression. Conclusion: Caregiver depression was associated with different combinations of behaviours but not with agitation alone. These results have implications for intervention development and identifying caregivers at risk for depression. Level of social support and mastery does not appear to moderate impact on caregiver depression.
(Edited publisher abstract)
Subject terms:
dementia, outcomes, carers, aggression, depression, agitation, behaviour, service uptake;
Journal of Alzheimer’s Disease, 62(1), 2018, pp.99-113.
Publisher:
IOS Press
Place of publication:
Amsterdam
... PsycINFO, EMBASE, and AMED databases. An additional lateral search including reference lists was conducted. Two researchers screened all records for potential eligibility. Narrative synthesis was used to bring together the findings. Results:Out of the 5,544 records identified, 24 articles (18 distinct studies) met the eligibility criteria. Aggression and agitation were the most common behaviors present or for referrals to psychiatric community services. Lack of consistency in assessment of behavior, and management of agitation/aggression in dementia crises were evident. Conclusion:Interventions to reduce the likelihood of people with dementia-related behaviors reaching crisis point need to focus on both family and care home settings and incorporate aggression and agitation management. Future research should
(Edited publisher abstract)
Background:Behavioral crises in dementia are represented by a wide variety of symptoms, regularly require external intervention from professionals, and are reported as a risk factor for hospital admission. Little is known about the factors that are associated with them. Objective:To determine the factors associated with dementia-related behavioral crises. Methods:We searched MEDLINE, CINAHL, PsycINFO, EMBASE, and AMED databases. An additional lateral search including reference lists was conducted. Two researchers screened all records for potential eligibility. Narrative synthesis was used to bring together the findings. Results:Out of the 5,544 records identified, 24 articles (18 distinct studies) met the eligibility criteria. Aggression and agitation were the most common behaviors present at crises. Delusions, wandering/absconding, and hallucinations were also key behaviors contributing to crises. Behavioral crises predominantly happened in the severe stages of dementia (according to MMSE scores), in people with dementia residing in their own homes and in long-term care, and were the catalyst for admissions to psychiatric inpatient settings, specialist-care units, long-term care settings, or for referrals to psychiatric community services. Lack of consistency in assessment of behavior, and management of agitation/aggression in dementia crises were evident. Conclusion:Interventions to reduce the likelihood of people with dementia-related behaviors reaching crisis point need to focus on both family and care home settings and incorporate aggression and agitation management. Future research should focus on determining the factors that could be addressed to prevent behavioral crises and the interventions and models of care that may help to prevent crises.
(Edited publisher abstract)
... with their teams to implement STAR-VA with Veterans identified to have challenging dementia-related behaviours. The frequency and severity of target behaviours and symptoms of depression, anxiety, and agitation were evaluated at baseline and at intervention completion. Staff provided feedback regarding STAR-VA feasibility and impact.
Results: Seventy-one Veterans completed the intervention. Behaviours clustered into 6 types: care refusal or resistance, agitation, aggression, vocalisation, wandering, and other. Frequency and severity of target behaviours and symptoms of depression, anxiety, and agitation all significantly decreased, with overall effect sizes of 1 or greater. Staff rated both benefits for Veterans and program feasibility favourably.
Implications: This evaluation supports the feasibility
(Edited publisher abstract)
Purpose of the Study: Nonpharmacological, psychosocial approaches are first-line treatments for managing behavioural symptoms in dementia, but they can be challenging to implement in long-term care settings. The Veterans Health Administration implemented STAR-VA, an interdisciplinary behavioural approach for managing challenging dementia-related behaviours in its Community Living Center (CLCs, nursing home care) settings. This study describes how the programme was implemented and provides an evaluation of Veteran clinical outcomes and staff feedback on the intervention.
Design and Methods: One mental health professional and registered nurse team from 17 CLCs completed STAR-VA training, which entailed an experiential workshop followed by 6 months of expert consultation as they worked with their teams to implement STAR-VA with Veterans identified to have challenging dementia-related behaviours. The frequency and severity of target behaviours and symptoms of depression, anxiety, and agitation were evaluated at baseline and at intervention completion. Staff provided feedback regarding STAR-VA feasibility and impact.
Results: Seventy-one Veterans completed the intervention. Behaviours clustered into 6 types: care refusal or resistance, agitation, aggression, vocalisation, wandering, and other. Frequency and severity of target behaviours and symptoms of depression, anxiety, and agitation all significantly decreased, with overall effect sizes of 1 or greater. Staff rated both benefits for Veterans and program feasibility favourably.
Implications: This evaluation supports the feasibility and effectiveness of STAR-VA, an interdisciplinary, behavioural intervention for managing challenging behaviours among residents with dementia in CLCs.
(Edited publisher abstract)
International Journal of Geriatric Psychiatry, 29(4), 2014, pp.384-391.
Publisher:
Wiley
Objectives: To optimize care and interventions to improve care, and to reduce staff burden, it is important to have knowledge of the relation between individual neuropsychiatric symptoms and distress of care staff. We therefore explored the relation between frequency and severity of individual neuropsychiatric symptoms and distress of care staff. Design: This is an explorative study with a cross-sectional design.Participants and setting: Care staff was interviewed regarding 432 residents of 17 nursing homes for people with dementia. Measurements: Behavioural problems were assessed using the Nursing Home version of the Neuropsychiatric Inventory (NPI-NH) questionnaire. The distress scale of the NPI-NH was used to determine the distress of care staff. Results: Agitation/aggression had the highest mean distress score and was also the most prevalent symptom. Disinhibition and irritability/lability also had high mean distress scores, whereas euphoria/elation, hallucinations and apathy had the lowest mean distress score. The symptom severity of each symptom strongly predicted the distress score, whereas the frequency of the symptoms was a less important factor. Conclusions: Although some of these findings are in accordance with studies among informal caregivers, there are also notable differences. Apathy caused little distress among care staff. Therefore, care staff might not feel the urgency to explore the causes of this symptom. The findings of this study emphasize the importance of supporting care staff in the management of behavioural problems, especially aggression and apathy.
(Publisher abstract)
Objectives: To optimize care and interventions to improve care, and to reduce staff burden, it is important to have knowledge of the relation between individual neuropsychiatric symptoms and distress of care staff. We therefore explored the relation between frequency and severity of individual neuropsychiatric symptoms and distress of care staff. Design: This is an explorative study with a cross-sectional design.Participants and setting: Care staff was interviewed regarding 432 residents of 17 nursing homes for people with dementia. Measurements: Behavioural problems were assessed using the Nursing Home version of the Neuropsychiatric Inventory (NPI-NH) questionnaire. The distress scale of the NPI-NH was used to determine the distress of care staff. Results: Agitation/aggression had the highest mean distress score and was also the most prevalent symptom. Disinhibition and irritability/lability also had high mean distress scores, whereas euphoria/elation, hallucinations and apathy had the lowest mean distress score. The symptom severity of each symptom strongly predicted the distress score, whereas the frequency of the symptoms was a less important factor. Conclusions: Although some of these findings are in accordance with studies among informal caregivers, there are also notable differences. Apathy caused little distress among care staff. Therefore, care staff might not feel the urgency to explore the causes of this symptom. The findings of this study emphasize the importance of supporting care staff in the management of behavioural problems, especially aggression and apathy.
(Publisher abstract)
Aging and Mental Health, 17(8), 2013, pp.1059-1066.
Publisher:
Taylor and Francis
This study examines the prevalence and nature of behavioural symptoms at the time of admission to three long term care homes (LTCH) in Canada and occurrence of resident-to-resident aggressive behaviour associated with behavioural symptoms within three months following admission. The Cohen-Mansfield Agitation Inventory and Aggressive Behaviour Scale were completed at the time residents were without dementia. Residents with and without dementia exhibited similar behaviours but differed on the prevalence of these behaviours. The most frequently reported behavioural symptoms for residents in both groups were verbal agitation and non-aggressive physical behaviours. The most frequently recorded aggressive behaviour for all residents was ‘resisting care’. In the three months post admission, 79
(Edited publisher abstract)
This study examines the prevalence and nature of behavioural symptoms at the time of admission to three long term care homes (LTCH) in Canada and occurrence of resident-to-resident aggressive behaviour associated with behavioural symptoms within three months following admission. The Cohen-Mansfield Agitation Inventory and Aggressive Behaviour Scale were completed at the time residents were admitted into the LTCH. A chart review, conducted three months after admission into the LTCH, abstracted documented resident-to-resident aggression. During a 16-month period, 339 individuals admitted to the LTCHs comprised the study sample. A comparison was made between residents with and without dementia. At admission, residents with dementia had a greater number of behavioural symptoms than those without dementia. Residents with and without dementia exhibited similar behaviours but differed on the prevalence of these behaviours. The most frequently reported behavioural symptoms for residents in both groups were verbal agitation and non-aggressive physical behaviours. The most frequently recorded aggressive behaviour for all residents was ‘resisting care’. In the three months post admission, 79 (23%) residents were involved in a documented incident that involved aggressive behaviour to another resident. The study concludes that a standardized comprehensive assessment for admission to a LTCH is an important strategy that can be used to identify behavioural symptoms and plan appropriate care management.
(Edited publisher abstract)
Subject terms:
admission to care, care homes, older people, challenging behaviour, aggression, dementia, assessment, agitation;
Journal of Dementia Care, 19(5), September 2011, pp.36-39.
Publisher:
Hawker
Aromatherapy is one of the most widely used complementary therapies in NHS dementia care today. Several different essential oils have been used to treat a number of problems such as anxiety and depression. In this article, the authors describe their pilot study to assess the effects of Lemon Balm oil on people with dementia whose behaviour challenges staff. Participants included 18 patients with moderate to severe dementia and significant behavioural and psychological symptoms of dementia (BPSD). The study was carried out as a randomised, double-blind, cross-over placebo-controlled trial. The Lemon Balm oil was applied via massage. Findings revealed a reduction in BPSD compared to baseline, however, the reductions were not statistically significant. Because there was no significant difference in the treatment groups, the authors concluded that the results did not support the use of Lemon Balm oil specifically, but do suggest that nursing attention, touch and simple massage have positive therapeutic value.
Aromatherapy is one of the most widely used complementary therapies in NHS dementia care today. Several different essential oils have been used to treat a number of problems such as anxiety and depression. In this article, the authors describe their pilot study to assess the effects of Lemon Balm oil on people with dementia whose behaviour challenges staff. Participants included 18 patients with moderate to severe dementia and significant behavioural and psychological symptoms of dementia (BPSD). The study was carried out as a randomised, double-blind, cross-over placebo-controlled trial. The Lemon Balm oil was applied via massage. Findings revealed a reduction in BPSD compared to baseline, however, the reductions were not statistically significant. Because there was no significant difference in the treatment groups, the authors concluded that the results did not support the use of Lemon Balm oil specifically, but do suggest that nursing attention, touch and simple massage have positive therapeutic value.