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Journal article

Agitation in the morning: symptom of depression in dementia?

Authors:
THEISON Anna-Katharina, et al
Journal article citation:
International Journal of Geriatric Psychiatry, 24(4), April 2009, pp.335-340.
Publisher:
Wiley-Blackwell

Data were collected from three independent nursing homes in an urban setting in Germany. Trained nursing home staff pre-selected 110 demented and agitated patients with a minimum age of 60 years. Three main groups were formed based on agitation peak either: in the morning, evening or none. Each is respectively: sunrisers, sundowners and constants. Agitation was assessed by the same staff twice a day for a 2-week timeframe using the CMAI (Cohen-Mansfield Agitation Inventory); MMSE (Mini-Mental State Examination) for dementia re-evaluation and staging; CSDD (Cornell Score for Depression in Dementia) for depression screening. Sixty-three (60%) of all patients were depressive but only 16 patients of them were treated with antidepressants. Forty-four patients were classified as belonging

Journal article

Towards defining restlessness in individuals with dementia

Authors:
REGIER Natalie G., GITLIN Laura N.
Journal article citation:
Aging and Mental Health, 21(5), 2017, pp.543-552.
Publisher:
Taylor and Francis

Objectives: Most individuals with dementia develop significant behavioural problems. Restlessness is a behavioural symptom frequently endorsed by caregivers as distressing, yet is variably defined and measured. Lack of conceptual and operational clarity hinders an understanding of this common behavioural type, its prevalence, and development of effective interventions. The authors advance a systematic definition and understanding of restlessness from which to enhance reporting and intervention development. Method: The literature for existing definitions and measures of restlessness, is reviewed and common elements across existing definitions are identified. Fit with relevant theoretical frameworks are assessed, and the relationship between restlessness and other behavioural symptoms in a data set of 272 community-dwelling persons with dementia are explored. Results: Twenty-five scales assessing restlessness were identified. Shared components included motor/neurological, psychiatric, and needs-based features. Exploratory analyses suggest that restlessness may co-occur primarily with argumentation, anxiety, waking the caregiver, delusions/hallucinations, and wandering. The authors propose that restlessness consists of three key attributes: diffuse motor activity or motion subject to limited control, non-productive or disorganised behavior, and subjective distress. Restlessness should be differentiated from and not confused with wandering or elopement, pharmacological side effects, a (non-dementia) mental or movement disorder, or behaviours occurring in the context of a delirium or at end-of-life. Conclusion: Restlessness appears to denote a distinct set of behaviours that have overlapping but non-equivalent features with other behavioural symptoms. The authors propose that it reflects a complex behaviour involving three key characteristics. Understanding its specific manifestations and which components are present can enhance tailoring interventions to specific contexts of this multicomponent behavioural type. (Edited publisher abstract)

Journal article

Complementary medicine for treatment of agitation and delirium in older persons: a systematic review and narrative synthesis

Authors:
LEVY Ilana, et al
Journal article citation:
International Journal of Geriatric Psychiatry, 32(5), 2017, p.492–508.
Publisher:
Wiley-Blackwell

Background: Agitation and delirium frequently occur in cognitively impaired older people. The authors conducted a systematic review with narrative synthesis of the literature aiming to assess effectiveness of complementary and alternative medicine (CAM) modalities to address these conditions. Methods: Following preliminary search, the authors included 40 original researches on CAM treatment of delirium and agitation in older persons. Then, the quality of these studies was assessed using the Downs and Black Checklist and Quality Assessment Tool for Studies with Diverse Designs, and the effect sizes were calculated. The authors subsequently conducted a narrative synthesis of the main findings, including theory development, preliminary synthesis, exploration of relationships within and between that the investigated CAM therapies may ameliorate the severity of agitation and delirium. The physiological surrogates of agitation assessed in these studies included cortisol level, chromogranin A level, and heart rate variability. Very few of the studies systematically assessed safety issues, although no major adverse effects were reported. Conclusion: Overall, the systematic review of the literature suggests that several CAM modalities are potentially beneficial in the treatment of agitation and delirium among older persons. The authors suggest that promising CAM modalities should be further explored through large-scale randomised controlled trials in different clinical settings. (Edited publisher abstract)

Journal article

Impact of caregiver readiness on outcomes of a nonpharmacological intervention to address behavioral symptoms in persons with dementia

Authors:
GITLIN Laura N., ROSE Karen
Journal article citation:
International Journal of Geriatric Psychiatry, 31(9), 2016, pp.1056-1063.
Publisher:
Wiley-Blackwell

Background: Previous research shows that nonpharmacological strategies may effectively manage behavioural symptoms (agitation, wandering) in persons with dementia and improve caregiver wellbeing. However, strategies depend upon caregivers for their implementation. This study examines the impact of caregiver readiness to use nonpharmacological strategies on treatment outcomes. Methods: Data were (Edited publisher abstract)

Journal article

Safety and utility of acute electroconvulsive therapy for agitation and aggression in dementia

Authors:
ACHARYA Deepa, et al
Journal article citation:
International Journal of Geriatric Psychiatry, 30(3), 2015, pp.265-273.
Publisher:
Wiley-Blackwell

... (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)

Journal article

Relationship between anxiety and agitation in dementia

Authors:
TWELFTREE H., QAZI A.
Journal article citation:
Aging and Mental Health, 10(4), July 2006, pp.362-367.
Publisher:
Taylor and Francis

Anxiety and agitation are common in people with dementia. Their consequences can be severe, including increased mortality rates and institutionalization. Despite the importance of these symptoms there is little literature in this area. Some studies have assumed that agitation is the outward manifestation of anxiety, while others have attempted to differentiate between them. The aim of this study was to investigate the relationship between anxiety and agitation in people with mild-to-moderate dementia. A secondary aim was to compare two measures of anxiety which have been used in people with dementia. A cross-sectional correlation design was used. Participants were 40 older adults with dementia. Agitation, anxiety, depression, and level of cognitive impairment were measured. The main finding from the study was that anxiety and agitation are associated in dementia. The degree of correlation did not support the use of agitation as a measure of anxiety. Anxiety symptoms of autonomic sensitivity were not correlated with agitation and could be used to differentiate between the two if this was required. The use of the Rating for Anxiety in Dementia (RAID) was supported as a measure of anxiety in people with dementia.

Journal article

Agitation-associated behavioral symptoms in mild cognitive impairment and Alzheimer's dementia

Authors:
VAN DER MUSSELE Stefan, et al
Journal article citation:
Aging and Mental Health, 19(3), 2015, pp.247-257.
Publisher:
Taylor and Francis

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)

Journal article

Which behavioral and psychological symptoms of dementia are the most problematic? Variability by prevalence, intensity, distress ratings, and associations with caregiver depressive symptoms

Authors:
FAUTH E. B., GIBBONS A.
Journal article citation:
International Journal of Geriatric Psychiatry, 29(3), 2014, pp.263-271.
Publisher:
Wiley-Blackwell

... average frequency, and average distress ratings. RMBPC subscales were correlated with GDS, and discriminant function analyses used NPI symptoms to discriminate between caregivers' normal (range 0–9) or elevated (10+) GDS. Results: Most prevalent NPI symptoms were Apathy, Depression, and Agitation. Most intense (frequency × severity) were Appetite, Motor behaviors, and Apathy, and most distressing were Delusions, Agitation, and Irritability. For RMBPC, Memory was most frequent but least distressing, whereas Disruptive was least frequent but most distressing. RMBPC frequency and distress subscales were significantly associated with caregiver GDS. Discriminant function analyses were statistically significant. Conclusions: Symptoms revealed as “most problematic” varied by measurement criterion. Common (Publisher abstract)

Journal article

The effect of music therapy compared with general recreational activities in reducing agitation in people with dementia: a randomised controlled trial

Authors:
VINK A.C., et al
Journal article citation:
International Journal of Geriatric Psychiatry, 28(10), 2013, pp.1031-1038.
Publisher:
Wiley-Blackwell

A randomised controlled trial compared the effects of music therapy and general day activities on agitation in older nursing home residents with dementia (n = 94) in six Dutch nursing homes. Both music therapy and general activities were offered twice weekly for 4 months. Changes in agitation were measured with a modified Cohen-Mansfield Agitation Inventory (CMAI) at four intervals on each in agitated behaviours from 1 h before to 4 h after each session. This decrease was somewhat greater in the music therapy group than in the general activities group, but this difference was statistically not significant and disappeared completely after adjustment for Global Deterioration Scale stage. Although music therapy and recreational activities lead to a short-term decrease in agitation, (Edited publisher abstract)

Journal article

A group music intervention using percussion instruments with familiar music to reduce anxiety and agitation of institutionalized older adults with dementia

Authors:
SUNG Huei-chuan, et al
Journal article citation:
International Journal of Geriatric Psychiatry, 27(6), June 2012, pp.621-627.
Publisher:
Wiley-Blackwell

The effect of a group music intervention on anxiety and agitation was examined in a group of older adults with dementia living in a Taiwanese residential care facility. A total of 60 participants (average age 81.37 years, 65.8% female) were randomly assigned to an experimental or a control group. The experimental group received a 30-minute music intervention using percussion instruments with familiar music in a group setting mid afternoon twice weekly for 6 weeks. The control group received usual care. The Rating of Anxiety in Dementia scale was used to assess anxiety, and Cohen-Mansfield Agitation Inventory was used to assess agitation at baseline, week 4 and week 6. Repeated measures analysis of covariance indicated that older adults who received a group music intervention had a significantly lower anxiety score than those in the control group while controlling for pre-test score and cognitive level. However, the reduction of agitation between the two groups was not significantly different. Anxiety and agitation are common in older adults with dementia and can produce challenges for caregivers. This group music programme may provide a cost-effective approach to reducing anxiety

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