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The period of hypotension following orthostatic challenge is prolonged in dementia with Lewy bodies
- Authors:
- ANDERSSON S., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(2), February 2008, pp.192-198.
- Publisher:
- Wiley
The aim was to determine whether orthostatic hypotension (OH) is more common in patients with dementia than in older people without cognitive impairment and to identify key differences in the profile of the orthostatic response and the pulse drive during orthostatic challenge between Alzheimer's disease (AD) and dementia with Lewy bodies (DLB).The orthostatic response was evaluated in 235 patients with AD, 52 patients with DLB and 62 elderly controls. The blood pressure and pulse rate were measured in supine position, immediately after standing up and after 1, 3, 5 and 10 min of standing. OH was defined as a reduction of systolic blood pressure (SBP) of at least 20 mm Hg or a reduction of diastolic blood pressure (DBP) of at least 10 mm Hg. OH occurred in 69% of the DLB patients and in 42% of the AD patients, but only in 13% of the controls. The DLB patients had a greater drop in SBP than the other study groups during orthostatic challenge and had a more prolonged period of orthostasis. The pulse drive on orthostatic challenge was similar in between groups. However, in the DLB group it was not adequate to restore the blood pressure to supine values. Patients with DLB react different to orthostatic challenge than patients with AD or controls, with important clinical implications for key disease symptoms and treatment.
Quality of life from the viewpoint of patients with dementia in Japan: nurturing through an acceptance of dementia by patients, their families and care professionals
- Authors:
- FUKUSHIMA Tetsuhito, et al
- Journal article citation:
- Health and Social Care in the Community, 13(1), January 2005, pp.30-37.
- Publisher:
- Wiley
Quality of life (QoL) of patients with dementia was investigated from the patient's viewpoint, and the role of an acceptance of dementia in maintaining important and distinctive elements of QoL was analysed by questionnaire and interview methods. Subjects were 18 patients, 21 family members and 8 staff at a day-care facility in Japan. Patients with dementia hoped to maintain an 'ordinary' way of life. Living peacefully, living together, living healthily and helping each other were considered by them to be important elements of their QoL. Living happily in the present is important, but hopes and expectations for the maintenance of human values in future are of greater importance in their estimation of QoL. Through recognising these needs, a culture and understanding of 'living with dementia' can be nurtured. A dynamic process involving mutual acceptance of dementia in relationships between patients with dementia, their families and care professionals enabled elderly people to surmount their initial troubles and recoup and activate their former humane attitudes. Positive thinking reappeared and new forms of relationships emerged. Patients, families and care professionals came to understand each other better and gained the sense of 'living together'. The process began with 'confronting' the situation and progressed to the final stage of 'acceptance': the patient with dementia was confronted with the dementia itself, the family was confronted with the elderly person as a human being, and the care professional was confronted with her or himself. At first care professionals had felt a sense of social responsibility for delivering justice, but they had gradually noticed that they were themselves relieved of the strain resulting from these attitudes. Acceptance of dementia by the care professional was important in carrying forward this dynamic process, which helps to ensure the desired QoL for the patient with dementia.
Psychotic symptoms in Patients with Dementia
- Authors:
- BALLARD Clive, OYEBODE Femi
- Journal article citation:
- International Journal of Geriatric Psychiatry, 10(9), September 1995, pp.743-752.
- Publisher:
- Wiley
Reviews the current state of knowledge pertaining to psychotic symptoms in patients with dementia, drawing on over 70 studies in this area.
In-hospital death according to dementia diagnosis in acutely ill elderly patients: the REPOSI study
- Authors:
- MARENGONI A., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(9), September 2011, pp.930-936.
- Publisher:
- Wiley
The Registro Politerapie SIMI (REPOSI) study in Italy aimed to describe the prevalence of co-occurring multiple diseases and treatments in hospitalised elderly patients, to correlate clinical characteristics of the patients with type and number of diseases and treatments, and to evaluate the main clinical outcomes. The project described in this article used information from the 38 hospitals in different regions of Italy participating in the REPOSI study during 2008. Logistic regression models were used to evaluate the association of dementia with in-hospital death in the 1,221 patients included in the analyses. 117 participants were diagnosed as being affected by dementia, and patients with dementia were more likely to be women, older, to have cerebrovascular diseases, pneumonia and a higher number of adverse clinical events during hospitalisation. The percentage of patients affected by dementia who died during hospitalisation was higher than that of patients without dementia. The researchers concluded that acutely ill elderly patients affected by dementia are more likely to die shortly after hospital admission and that having dementia and adverse clinical events during hospital stays increases the risk of death.
Mild cognitive impairment: coping with an uncertain label
- Authors:
- BANNINGH Liesbeth Joosten-Weyn, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(2), February 2008, pp.148-154.
- Publisher:
- Wiley
The recently introduced diagnostic label of Mild Cognitive Impairment (MCI) identifies patients with a cognitive decline that is more pronounced than is usual for a person's age and educational level but does not notably interfere with activities of daily living (ADL). The natural course of the syndrome is uncertain although MCI sufferers have a higher risk of developing dementia. The objective was to investigate how patients fulfilling MCI criteria experience and cope with their cognitive decline with the secondary aim to derive key themes for a prospective MCI support-group programme. Analysis of guided interviews with eight MCI patients revealed four common themes. Changes related to cognitive abilities, mobility, affect, vitality and somatic complaints. Attributions were numerous and concerned aetiologies such as personality traits and overload of information. Consequences were all negative and concerned the patients themselves such as anxiety and loss of self-confidence, others such as feelings of irritation and anger towards others or activities like abandoning leisure activities. Patients applied emotion-oriented, problem-focused and avoidant coping strategies. MCI patients encounter stress-inducing practical, social and psychological difficulties. Based on the current preliminary findings, the key themes for an MCI support-group programme should include the provision of information about the syndrome's causes, course, concomitant symptoms, attributions, social consequences, and available treatments. The impact of receiving an MCI label warrants further investigation.
Depressive disorders in caregivers of dementia patients: a systematic review
- Author:
- CUIJPERS P.
- Journal article citation:
- Aging and Mental Health, 9(4), July 2005, pp.325-330.
- Publisher:
- Taylor and Francis
Although depressive symptomatology has been well studied in caregivers of patients with dementia, depressive disorders have been examined much less. We conducted a systematic literature search in major bibliographical databases (Medline, Psychinfo, Dissertation Abstracts), and included studies examining caregivers of dementia patients that reported the prevalence of major depressive disorder, according to diagnostic criteria as assessed with a standardized psychiatric diagnostic interview. Ten studies with a total of 790 caregivers were identified (sample sizes: 22–147). In only one of the studies, a representative community sample was used. A total of 176 subjects (22.3%) had a depressive disorder (prevalence range from 0.15–0.32). In the three studies reporting differential prevalence rates for men and women somewhat smaller prevalence rates were found for men than for women. In six studies caregivers were compared to a (mostly matched) control group. The relative risks of having a depressive disorder in caregivers ranged from 2.80–38.68 (all RR's were significant). In the three prospective studies relatively high incidence rates were found (0.48). This study made it clear that prevalence and incidence of depressive disorders are increased in caregivers of dementia patients. More research is clearly needed in this population.
Quality of life in dementia patients in long term care
- Authors:
- GONZALEZ-SALVADOR Teresa, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 15(2), February 2000, pp.181-189.
- Publisher:
- Wiley
This project evaluates variables associated with the quality of life (QOL) in dementia residents in a long term care facility using a recently standardised and validated dementia-specific QOL scale (ADRQL). Results found that residents exhibited better QOL than expected. Suggests that future longitudinal studies address: reorientation, activity therapy, treatment of depression, and avoidance of benzodiazepines might improve QOL in this population. Interventions that might improve orientation and physical abilities, such as cholinomimetic therapies, psychosocial intervention or behavioural strategies, should also be studied in future research on QOL.
Conversational assessment in memory clinic encounters: interactional profiling for differentiating dementia from functional memory disorders
- Authors:
- JONES Danielle, et al
- Journal article citation:
- Aging and Mental Health, 20(5), 2016, pp.500-509.
- Publisher:
- Taylor and Francis
Objectives: In the UK dementia is under-diagnosed, there is limited access to specialist memory clinics, and many of the patients referred to such clinics are ultimately found to have functional (non-progressive) memory disorders (FMD), rather than a neurodegenerative disorder. Government initiatives on ‘timely diagnosis’ aim to improve the rate and quality of diagnosis for those with dementia. This study seeks to improve the screening and diagnostic process by analysing communication between clinicians and patients during initial specialist clinic visits. Establishing differential conversational profiles could help the timely differential diagnosis of memory complaints. Method: This study is based on video- and audio recordings of 25 initial consultations between neurologists and patients referred to a UK memory clinic. Conversation analysis was used to explore recurrent communicative practices associated with each diagnostic group. Results: Two discrete conversational profiles began to emerge, to help differentiate between patients with dementia and functional memory complaints, based on (1) whether the patient is able to answer questions about personal information; (2) whether they can display working memory in interaction; (3) whether they are able to respond to compound questions; (4) the time taken to respond to questions; and (5) the level of detail they offer when providing an account of their memory failure experiences. Conclusion: The distinctive conversational profiles observed in patients with functional memory complaints on the one hand and neurodegenerative memory conditions on the other suggest that conversational profiling can support the differential diagnosis of functional and neurodegenerative memory disorders. (Publisher abstract)
A guide to prescribing anti-dementia medication
- Author:
- KENNEDY Stuart
- Journal article citation:
- Nursing Times, 110(23), 2014, pp.16-18.
- Publisher:
- Nursing Times
This article outlines a good practice guide to prescribing anti-dementia medication developed jointly by a lead nurse for memory services and a clinical pharmacist. The guide brings together current evidence to produce a concise prescribing guideline for practitioners. (Publisher abstract)
Predictors of entering 24-h care for people with Alzheimer's disease: results from the LASER-AD study
- Authors:
- HABERMANN Stephanie;, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(11), November 2009, pp.1291-1298.
- Publisher:
- Wiley
This study, part of a longitudinal cohort study of 224 participants with Alzheimer's disease (AD), the London and South East Region (LASER) AD study, considered a comprehensive range of carer and care recipient characteristics derived from a systematic review. The researchers interviewed people with AD and their carers, and determined whether they entered 24 hour care in the subsequent 4.5 years. The results showed that the main independent predictors of shorter time to enter 24 hour care were the patient being more cognitively or functionally impaired and having a paid versus a family carer, the carer being less educated and spending fewer hours caring. Patients who are cared for by their partner stayed longest at home, followed by those cared for by other family or friends, while those whose carer was paid entered 24 hour care earliest. The key points were that people with dementia who were less impaired and had a family carer who spent more time caring for them had a lower risk of entering a care home, that in view of the fact that having a family carer who spent more time caring delayed entry to 24 hour care future research should investigate how to enable carers to provide this, and that other interventions to improve patients’ impairment may not only have benefits for their health but also allow them to remain longer at home