scholarly journals Use of Antipsychotics in Patients with Behavioral and Psychological Symptoms of Dementia: Results of a Spanish Delphi Consensus

2020 ◽  
pp. 1-10
Author(s):  
Sagrario Manzano-Palomo ◽  
Luis F. Agüera-Ortiz ◽  
Alexandre García-Caballero ◽  
José Martínez-Raga ◽  
Tomás Ojea-Ortega ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Delphi Study ◽  
Atypical Antipsychotics ◽  
Psychological Symptoms ◽  
High Rate ◽  
Delphi Consensus ◽  
Almost All ◽  
Behavioral And Psychological Symptoms ◽  
Typical Antipsychotics

<b><i>Background:</i></b> Behavioral and psychological symptoms of dementia (BPSD) are difficult to manage and associated with poor outcome. <b><i>Objectives:</i></b> The aim of this study was to reach consensus on the use of antipsychotics in patients with BPSD in Spain. <b><i>Methods:</i></b> A qualitative, multicenter, two-round Delphi study was carried out, with the participation of specialists involved in the care of dementia patients throughout Spain. They completed a 76-item questionnaire related to the identification of BPSD, treatment with antipsychotics, follow-up of patients, barriers for the use of atypical antipsychotics, and effects of antipsychotics on quality of life. <b><i>Results:</i></b> A total of 162 specialists in neurology, psychiatry, and geriatrics (61% men) with a mean (SD) age of 45.9 (10) years participated in the study. Almost all participants (96.9%) strongly agreed that atypical antipsychotics are safer and better tolerated than typical antipsychotics. There was agreement on the importance to review the indication and dose of the antipsychotic drug at least every 3 months. There was consistent high rate of agreement on the beneficial impact of atypical antipsychotics on the quality of life of patients with dementia and their caregivers. A consensus was also reached on the need of detecting BPSD in patients with dementia as it decreases the quality of life of both patients and caregivers, and the need to routinely screen for dementia in elderly patients with no previous psychiatric history in the presence of suggestive symptoms of BPSD. Finally, the participants in the study agreed that administrative barriers for the prescription of atypical antipsychotics in Spain hinder the access to this drug group and favor the prescription of typical antipsychotics. <b><i>Conclusions:</i></b> The participants in the study agreed that atypical antipsychotics should be preferred to typical antipsychotics in the management of BPSD. Wide consensus was reached about the importance of early identification of BPSD in persons with cognitive impairment, the use and management of atypical antipsychotic drugs and their favorable impact on patients and caregiver’s quality of life.

Behavioral and Psychological Symptoms of Dementia: Physical Nonaggressive Agitation

2000 ◽  
Vol 12 (S1) ◽  
pp. 125-127 ◽  
Author(s):  
Martin Haupt
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Psychological Symptoms ◽  
Institutional Care ◽  
Nursing Home Admission ◽  
Behavioral And Psychological Symptoms

Agitated behaviors occur frequently in patients with dementia. These behaviors affect the quality of life of the dementia sufferers and their caregivers. For example, these behaviors can greatly complicate everyday management in familiar surroundings and in institutional care, and they predict premature nursing home admission.

scholarly journals The Relationship Between Pain, Function, Behavioral, and Psychological Symptoms of Dementia and Quality of Life

2021 ◽  
Author(s):  
Barbara Resnick ◽  
Elizabeth Galik ◽  
Ann Kolanowski ◽  
Kimberly VanHaitsma ◽  
Marie Boltz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Psychological Symptoms ◽  
The Relationship ◽  
Behavioral And Psychological Symptoms

Novel Antipsychotics in the Treatment of Psychosis and Aggression Associated With Dementia: A Meta-Analysis of Randomized Controlled Clinical Trials

2000 ◽  
Vol 12 (S1) ◽  
pp. 271-277 ◽  
Author(s):  
Michael Davidson ◽  
Mark Weiser ◽  
Karla Soares
Keyword(s):  
Adverse Effects ◽  
Psychological Symptoms ◽  
Meta Analysis ◽  
The Elderly ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled ◽  
Small Patient ◽  
Almost All ◽  
Behavioral And Psychological Symptoms

Behavioral and psychological symptoms of dementia (BPSD) have a significant impact on patients and their families. These symptoms affect quality of life and medical and social service utilization, and determine time of institutionalization. Over the past three decades, academic-based clinical investigators have conducted trials of almost all classes of marketed psychotropics in an attempt to ameliorate these symptoms. With few exceptions, these studies suffered from serious methodologic shortcomings, such as small patient populations or too many outcome measurements (Stern et al., 1997). Despite these flaws and equivocal findings, a consensus has emerged, and antipsychotics have become the most commonly prescribed drugs for this condition (see consensus statement in this issue). Unfortunately, a meta-analysis of trials of conventional neuroleptics has revealed that this class of drugs is barely superior to placebo (see article by Lon Schneider in this issue). In addition, conventional neuroleptics cause extrapyramidal adverse effects, tardive dyskinesia, sedation, and cardiovascular instability, adverse effects to which the elderly are particularly vulnerable.

Music, Art, and Recreational Therapies in the Treatment of Behavioral and Psychological Symptoms of Dementia

2000 ◽  
Vol 12 (S1) ◽  
pp. 359-366 ◽  
Author(s):  
Linda A. Gerdner
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Psychological Symptoms ◽  
Unpublished Manuscript ◽  
Potential Value ◽  
Arts And Humanities ◽  
Comprehensive Literature Review ◽  
The Arts ◽  
Behavioral And Psychological Symptoms

Historically, the arts and humanities were seldom recognized for their capacity to advance health care and promote quality of life within the fields traditionally reserved for the “hard sciences.” There has been little vision of the powerful analytic and therapeutic applications offered by the myriad of art forms (Rugh & Buckwalter, 1989, unpublished manuscript). However, in recent years, we have seen an increased awareness of the potential value of music, art, and other recreational therapies in persons with dementia. A comprehensive literature review was conducted to identify the most current research in this area. Studies on the use of music and other recreational therapies in patients with dementia are summarized in Table 1.

TOP CITED PAPERS IN INTERNATIONAL PSYCHOGERIATRICS: 6a. QUALITY OF LIFE FOR PEOPLE WITH DEMENTIA LIVING IN RESIDENTIAL AND NURSING HOME CARE: THE IMPACT OF PERFORMANCE ON ACTIVITIES OF DAILY LIVING, BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS, LANGUAGE SKILLS, AND PSYCHOTROPIC DRUGS

2009 ◽  
Vol 21 (6) ◽  
pp. 1026-1030 ◽  
Author(s):  
C. Ballard ◽  
M. Margallo-Lana ◽  
J. T. O'Brien ◽  
I. James ◽  
R. Howard ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Psychological Symptoms ◽  
Social Withdrawal ◽  
Care Home ◽  
Well Being ◽  
Nursing Home Care ◽  
People With Dementia ◽  
The Impact ◽  
Behavioral And Psychological Symptoms

The majority of people with dementia develop behavioral and psychological symptoms of dementia (BPSD) at some point during their illness (Jeste et al., 2008). These symptoms, which are especially common among care home residents, are frequently distressing for the patients who experience them (Gilley et al., 2006; Jeste et al., 2008) and problematic for their professional and/or family caregivers. The starting point for our paper “Quality of life for people with dementia living in residential and nursing home care: the impact of performance on activities of daily living, behavioral and psychological symptoms, language skills, and psychotropic drugs” (Ballard et al., 2001) was to try and understand the impact of BPSD, function and language skills on quality of life in care home residents with dementia. Although there were frequent statements in previous work referring to the capacity of psychiatric and behavioral symptoms to reduce quality of life, we had been unable to identify any empirical evidence to support this clinical impression in a thorough literature review. The parallel validation of Dementia Care Mapping (DCM), predominantly a practice development tool, as an observational measure of well-being/quality of life (Kitwood and Bredin, 1997; Fossey et al., 2002) provided an excellent opportunity to examine this issue in a care home setting. The study focused on 209 people with dementia living in residential and nursing home care in north-east England in the U.K., who received a detailed assessment of BPSD, function and cognition. A DCM evaluation was completed for 112 of these individuals, providing a detailed observational measure of well-being, activities and social withdrawal as indices of quality of life over a six-hour daytime period. To our surprise, there was actually no association between well-being, social withdrawal or activities and BPSD. In contrast, there was a significant association between antipsychotic medication and reduced well-being, social withdrawal and activities respectively, even after controlling for the severity of behavioral disturbance. Using an arbitrary definition of “ill-being”, defined as a well-being score of less than zero, 5% of people not taking antipsychotics, 10% of people taking atypical antipsychotics and 22% of people taking typical antipsychotics were defined as having ill-being. Lower levels of functional ability were also associated with significantly lower well-being, less activities and more social withdrawal. At first this latter finding appears to be contrary to one of the central principles of DCM – namely, that the assessment should be independent of dementia severity. Although high levels of well-being and engagement are possible for people with severe dementia, this probably requires higher staff numbers and a workforce with more specialized skills in order to achieve this.

scholarly journals Animal-Assisted Intervention and Dementia: A Systematic Review

2018 ◽  
Vol 28 (1) ◽  
pp. 9-29 ◽  
Author(s):  
Michelle L. Yakimicki ◽  
Nancy E. Edwards ◽  
Elizabeth Richards ◽  
Alan M. Beck
Keyword(s):  
Quality Of Life ◽  
Psychological Symptoms ◽  
Dementia Patients ◽  
Study Designs ◽  
The Relationship ◽  
Animal Assisted Intervention ◽  
Study Setting ◽  
Positive Effect ◽  
Behavioral And Psychological Symptoms

This review discusses the relationship between animal-assisted interventions (AAI) and behavioral and psychological symptoms of dementia (BPSD). A systematic search was conducted within CINAHL, Web of Science CAB Abstracts, PubMed, Abstracts in Social Gerontology, Google Scholar, and PsycINFO for primary research articles. A total of 32 studies were included in the final review. Variation was noted in study designs and in study setting. Twenty-seven of 32 studies used dogs as the intervention. Agitation/aggression showed a significant decrease in nine of 15 studies. Eleven of 12 studies demonstrated increased social interaction with AAI. Mood had mixed results in nine studies. Quality of life was increased in three of four studies. Resident activity and nutritional intake were each increased in two studies. Animal assisted activities/interventions showed a strong positive effect on social behaviors, physical activity, and dietary intake in dementia patients and a positive effect on agitation/aggression and quality of life.

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