Pathological Correlations of Neuropsychiatric Symptoms in Institutionalized People with Dementia

2020 ◽  
Vol 78 (4) ◽  
pp. 1731-1741
Author(s):  
Ester Esteban de Antonio ◽  
Jorge López-Álvarez ◽  
Alberto Rábano ◽  
Luis Agüera-Ortiz ◽  
Antonio Sánchez-Soblechero ◽  
...  
Keyword(s):  
Neuropsychiatric Symptoms ◽  
Pathological Diagnosis ◽  
Personal Factors ◽  
Advanced Dementia ◽  
Multivariate Statistical ◽  
People With Dementia ◽  
Lewy Body Pathology ◽  
One Year ◽  
Argyrophilic Grains

Background: Comprehensive clinicopathological studies of neuropsychiatric symptoms (NPS) in dementia are lacking. Objective: To describe the pathological correlations of NPS in a sample of institutionalized people with dementia. Methods: We studied 59 people who were consecutively admitted to a nursing home and donated their brain. Correlations between pathological variables and NPS upon admission (n = 59) and at one-year follow-up assessment (n = 46) were explored and confirmed using bivariate and multivariate statistical methods. Results: Mean (SD) age at admission was 83.2 (6.4) years and mean (SD) age at demise was 85.4 (6.6); 73% of the subjects were female and 98% presented advanced dementia. The most frequent etiological diagnosis was Alzheimer’s disease (AD; 74.6% clinical diagnosis, 67.8% pathological diagnosis). The pathological diagnosis of AD was associated with aggression (β est 0.31), depression (β est 0.31), anxiety (β est 0.38), and irritability (β est 0.28). Tau stage correlated with aggressive symptoms (β est 0.32) and anxiety (βest 0.33). Coexistence of AD and Lewy body pathology was associated with depression (β est 0.32), while argyrophilic grains were associated with eating symptoms (β est 0.29). Predictive models were achieved for apathy, including cognitive performance, basal ganglia ischemic lesions, and sex as predictors (R2 0.38) and for sleep disorders, including pathological diagnosis of AD and age at demise (R2 0.18) (all p-values <0.05, unadjusted). Conclusion: AD was the main pathological substrate of NPS in our sample of very elderly people with advanced dementia. However, correlations were mild, supporting a model of focal/asymmetric rather than diffuse brain damage, along with relevance of environmental and other personal factors, in the genesis of those symptoms.

scholarly journals Cerebral Microbleeds in Advanced Dementia: Clinical and Pathological Correlates

2018 ◽  
Vol 33 (6) ◽  
pp. 362-372
Author(s):  
Inmaculada Boyano ◽  
Ana Ramos ◽  
Jorge López-Alvarez ◽  
Carolina Mendoza-Rebolledo ◽  
Emma Osa-Ruiz ◽  
...  
Keyword(s):  
Cerebral Microbleeds ◽  
Pathological Diagnosis ◽  
Advanced Dementia ◽  
Resonance Imaging ◽  
Severe Dementia ◽  
Nursing Home Patients ◽  
Magnetic Resonance Imaging Mri ◽  
Institutionalized Patients ◽  
One Year

Objective: We conducted a longitudinal study to explore the clinical and pathological correlates of cerebral microbleeds (CMBs) in institutionalized patients with dementia. Methods: Clinical and magnetic resonance imaging (MRI) data were extracted from 182 nursing home patients (mean age [standard deviation]: 81.3 [6.9], 78.0% female, and 83.4% moderate to severe dementia), which were divided according to the CMBs number and location. One-year follow-up data were obtained from 153 patients, and postmortem pathological diagnosis was available in 40 patients. Results: Cerebral microbleeds were observed in 42.9% of patients and were associated with MRI ischemic lesions ( P < .0005). In the adjusted analysis, lobar CMB predicted worsening of parkinsonism (standardized β: 0.43) and gait (standardized β: 0.24). A pathological diagnosis of Alzheimer’s disease was less frequent in the brains of patients with lobar and deep CMB (33.3% vs 85.3%; P < .05). Conclusion: Cerebral microbleeds were linked to cerebrovascular disease and predicted motor deterioration in institutionalized people with advanced dementia.

scholarly journals Incidence of and Risk Factors for Missing Events Due to Wandering in Community-dwelling Older People with Dementia and Mild Cognitive Impairment

2021 ◽  
Author(s):  
seungwon Jeong ◽  
Takao Suzuki ◽  
Kiyoko Miura ◽  
Takashi Sakurai
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Recurrence Rate ◽  
Community Dwelling ◽  
Disease Assessment ◽  
People With Dementia ◽  
One Year ◽  
The One

Abstract BackgroundThe burden of missing incidents is not only on the person with dementia, but also on their family, neighbors, and community. The extent to which dementia-related wandering and missing incidents occur in the community has not been evaluated thoroughly in the published literature. Therefore, we evaluated the incidence of and risk factors for missing events due to wandering.MethodsWe conducted a non-randomized prospective one-year follow-up cohort study based on symptom registration with missing events due to wandering as the endpoint. In the first consultation, 374 patients with dementia or mild cognitive impairment (MCI) and their caregivers who visited the National Center for Geriatrics and Gerontology in Japan were included. The incidence and recurrence rate of missing events were calculated. Participants were divided into (those with) dementia and (those with) MCI. Patients' basic and medical information was documented at baseline and after one year of follow-up. Furthermore, analysis of variance and logistic regression analysis were performed to clarify the risk factors associated with the missing event.ResultsAmong the 236 patients with dementia enrolled, 65 (27·5%) had a previous missing event at baseline, and 28 had a missing event during the one-year follow-up period (recurrence rate of 43·1%). Of the 171 who did not have a previous missing event at baseline, 23 had a missing event during the one-year follow-up period (incidence rate of 13·5%). The scores of Mini-Mental State Examination (MMSE), Dementia Behavior Disturbance Scale (DBD), and Alzheimer's Disease Assessment Scale (ADAS) were statistically significant as the risk factors for the incidence of wandering leading to a missing event (p<0·05).ConclusionsPrevention of missing event due to wandering requires focused attention on changes in the MMSE, DBD, ADAS scores, and the development of a social environment to support family caregivers.

scholarly journals One-Year Change in Locus of Control among People with Dementia

2021 ◽  
pp. 298-305
Author(s):  
Ingeborg Halse ◽  
Guro Hanevold Bjørkløf ◽  
Knut Engedal ◽  
Geir Selbæk ◽  
Maria Lage Barca
Keyword(s):  
Locus Of Control ◽  
Depressive Symptomatology ◽  
Personal Control ◽  
Total Sample ◽  
Daily Activities ◽  
Dementia Severity ◽  
People With Dementia ◽  
The Mean ◽  
One Year

<b><i>Introduction:</i></b> Knowledge of how perceptions of personal control change over time may provide valuable insights into how people cope with having dementia. The present study aimed to examine change in locus of control over a 12-month period in persons with dementia. <b><i>Method:</i></b> The study included 52 participants with dementia. Locus of control was measured with the Locus of Control of Behavior Scale (LoCB), with higher scores indicating a more external locus of control, interpreted as perceiving less personal control. A ≥5% change on the LoCB was considered clinically meaningful. We recorded sociodemographic characteristics and assessed dementia severity, cognition, ability to function independently in daily activities and physical self-maintenance, depressive symptomatology, and number of prescribed medications. Analyses were performed to examine differences between those with increases (more external) or decreases (less external) in the LoCB score after 12 months and to examine associations between baseline variables and change in the LoCB score. <b><i>Results:</i></b> The mean LoCB score for the total sample did not change after 12 months (baseline mean 29.33 vs. follow-up mean 30.33, <i>p</i> = 0.553); however, 2 subgroups emerged. Using the ≥5% cutoff revealed that the LoCB score changed for 92.3% of the sample, becoming less external (lower LoCB) for 21 participants and more external (higher LoCB) for 27 participants. At baseline, the mean LoBC score was higher in the group that became less external (33.81 vs. 24.56), <i>p</i> = 0.006, while this was reverse at follow-up (23.57 vs. 34.41), <i>p</i> = 0.001. Dementia severity and dependence in physical self-maintenance increased during the 12 months in both groups. Among those becoming more external, we also found a decline in cognition (<i>p</i> = 0.002), an increase in dependence in daily activities (<i>p</i> = 0.003), an increase in the use of prescribed medication, and a decrease in depressive symptomatology (<i>p</i> = 0.003). The baseline LoCB score was the only variable associated with 12-month change in LoCB scores (<i>p</i> = 0.001). <b><i>Conclusion:</i></b> Most participants showed a clinically meaningful change in locus of control after 12 months. Those with more signs of dementia progression reported a decrease in personal control but also a decrease in depressive symptoms. These findings are interesting for our understanding of coping but must be replicated with a larger sample.

scholarly journals Prediction of general hospital admission in people with dementia: Cohort study

2015 ◽  
Vol 206 (2) ◽  
pp. 153-159 ◽  
Author(s):  
Tom C. Russ ◽  
Mario A. Parra ◽  
Alison E. Lim ◽  
Emma Law ◽  
Peter J. Connelly ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Admission ◽  
General Hospital ◽  
Neuropsychiatric Symptoms ◽  
Neuropsychiatric Inventory ◽  
People With Dementia ◽  
Acute Hospitals ◽  
Dementia Research ◽  
And Gender

BackgroundPeople with dementia are extremely vulnerable in hospital and unscheduled admissions should be avoided if possible.AimsTo identify any predictors of general hospital admission in people with dementia in a well-characterised national prospective cohort study.MethodA cohort of 730 persons with dementia was drawn from the Scottish Dementia Research Interest Register (47.8% female; mean age 76.3 years, s.d. = 8.2, range 50–94), with a mean follow-up period of 1.2 years.ResultsIn the age- and gender-adjusted multivariable model (n = 681; 251 admitted), Neuropsychiatric Inventory score (hazard ratio per s.d. disadvantage 1.21, 95% CI 1.08–1.36) was identified as an independent predictor of admission to hospital.ConclusionsNeuropsychiatric symptoms in dementia, measured using the Neuropsychiatric Inventory, predict non-psychiatric hospital admission of people with dementia. Further studies are merited to test whether interventions to reduce such symptoms might reduce unscheduled admissions to acute hospitals.

Nutritional status of care-dependent people with dementia in shared-housing arrangements - a one-year follow-up

2015 ◽  
Vol 29 (4) ◽  
pp. 785-792 ◽  
Author(s):  
Saskia Meyer ◽  
Johannes Gräske ◽  
Andreas Worch ◽  
Karin Wolf-Ostermann
Keyword(s):  
Nutritional Status ◽  
People With Dementia ◽  
Shared Housing ◽  
One Year ◽  
Status Of Care

scholarly journals The Impact of the COVID-19 Pandemic on the Cognition of People with Dementia

2021 ◽  
Vol 18 (8) ◽  
pp. 4285
Author(s):  
Giacomo Tondo ◽  
Barbara Sarasso ◽  
Paola Serra ◽  
Fabiana Tesser ◽  
Cristoforo Comi
Keyword(s):  
Cognitive Decline ◽  
Significant Loss ◽  
Memory Clinic ◽  
Italian Government ◽  
People With Dementia ◽  
Intergroup Comparison ◽  
One Year ◽  
Diagnosis Therapy ◽  
The Impact

(1) Background: To limit the COVID-19 outbreak, the Italian government implemented social restrictions that may have had psychological and cognitive repercussions on people with dementia. We aimed to analyze cognitive decline during the pandemic year in people evaluated in a memory clinic in northern Italy, the epicenter of COVID-19 spread. (2) Methods: A single-center retrospective study was carried out, including individuals with annual follow-up evaluated in three different years (2020-GROUP, 2019-GROUP, 2018-GROUP). We performed an intergroup comparison of cognitive decline over a one-year follow-up, and an intragroup comparison in the 2020-GROUP to analyze the five-year cognitive decline trajectory, as measured by the MMSE. (3) Results: The 2020-GROUP showed a significant loss of MMSE points per year in the considered follow-up period compared with the 2019-GROUP and 2018-GROUP (p = 0.021). Demographics, clinical features, and the other analyzed variables, including rate of diagnosis, therapy, and comorbidities, did not significantly differ between groups. The five-year cognitive decline trajectory confirmed a significant worsening of cognitive decline between 2019 and 2020 (p < 0.001), while the decrease in MMSE scores was not statistically significant between previous time points. (4) Conclusions: COVID-19 pandemic measures have induced a significant worsening of cognitive decline in people with dementia, needing more careful assistance to minimize the adverse effects of social isolation in case of future lockdowns.

scholarly journals e-Learning and Web-Based Tools for Psychosocial Interventions Addressing Neuropsychiatric Symptoms of Dementia During the COVID-19 Pandemic in Tokyo, Japan: Quasi-Experimental Study (Preprint)

2021 ◽  
Author(s):  
Miharu Nakanishi ◽  
Syudo Yamasaki ◽  
Kaori Endo ◽  
Junko Niimura ◽  
Canan Ziylan ◽  
...  
Keyword(s):  
Neuropsychiatric Symptoms ◽  
Psychosocial Interventions ◽  
Control Group ◽  
Web Based ◽  
Face To Face ◽  
Training Course ◽  
People With Dementia ◽  
Quasi Experimental ◽  
E Learning

BACKGROUND Concern has been raised that the COVID-19 pandemic and consequent social distancing measures may increase neuropsychiatric symptoms in people with dementia. Thus, we developed and delivered an e-learning training course to professional caregivers on using a web-based tool for psychosocial interventions for people with dementia. OBJECTIVE The aim of our study was to evaluate the feasibility and efficacy of an e-learning course in combination with a web-based tool in addressing neuropsychiatric symptoms of dementia. METHODS A quasi-experimental design was used in Tokyo, Japan. The e-learning course was delivered three times to professional caregivers between July and December 2020. Caregivers who completed the course assessed the level of neuropsychiatric symptoms in people with dementia using the total score from the Neuropsychiatric Inventory (NPI) via a web-based tool. The primary outcome measures were the number of caregivers who implemented follow-up NPI evaluations by March 2021 and the change in NPI scores from baseline to their most recent follow-up evaluations. As a control group, information was also obtained from professional caregivers who completed a face-to-face training course using the same web-based tool between July 2019 and March 2020. RESULTS A total of 268 caregivers completed the e-learning course in 2020. Of the 268 caregivers, 56 (20.9%) underwent follow-up evaluations with 63 persons with dementia. The average NPI score was significantly reduced from baseline (mean 20.4, SD 16.2) to the most recent follow-up evaluations (mean 14.3, SD 13.4). The effect size was assumed to be medium (Cohen <i>d</i><sub>rm [repeated measures]</sub>=0.40). The control group consisted of 252 caregivers who completed a face-to-face training course. Of the 252 caregivers, 114 (45.2%) underwent follow-up evaluations. Compared to the control group, caregivers who completed the e-learning course were significantly less likely to implement follow-up evaluations (<i>χ</i><sup>2</sup><sub>1</sub>=52.0, <i>P</i>&lt;.001). The change in NPI scores did not differ according to the type of training course (baseline-adjusted difference=–0.61, <i>P</i>=.69). CONCLUSIONS The replacement of face-to-face training with e-learning may have provided professionals with an opportunity to participate in the dementia behavior analysis and support enhancement (DEMBASE) program who may not have participated in the program otherwise. Although the program showed equal efficacy in terms of the two training courses, the feasibility was suboptimal with lower implementation levels for those receiving e-learning training. Thus, further strategies should be developed to improve feasibility by providing motivational triggers for implementation and technical support for care professionals. Using online communities in the program should also be investigated.

Persistence of neuropsychiatric symptoms over six months in mild cognitive impairment in community-dwelling Korean elderly

2010 ◽  
Vol 23 (2) ◽  
pp. 214-220 ◽  
Author(s):  
Seung-Ho Ryu ◽  
Jee Hyun Ha ◽  
Doo-Heum Park ◽  
Jaehak Yu ◽  
Gill Livingston
Keyword(s):  
Quality Of Life ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Neuropsychiatric Symptoms ◽  
Community Dwelling ◽  
Persistent Symptoms ◽  
People With Dementia ◽  
Clinically Significant

ABSTRACTBackground: Several studies of patients with mild cognitive impairment (MCI) have revealed that this population, like people with dementia, have neuropsychiatric symptoms (NPS) as well as memory impairment. No study has reported on the natural history and course of NPS in MCI although this is important in terms of management. We aimed to determine the persistence of NPS over six months in participants with MCI.Method: The Neuropsychiatric Inventory (NPI) was used to rate the severity of NPS in 241 consecutive referrals with MCI from a Korean clinic at baseline and in 220 patients at 6-month follow-up. We also collected information about the cognition and quality of life of patients and their caregivers.Results: Ninety-seven (44.1%) MCI participants who completed the 6-month follow-up exhibited at least one NPS at baseline; 60 (27.3%) were clinically significant NPS. Seventy (72.1%) of those with any symptom had at least one persistent NPS at 6-month follow-up, and 44 (73.3%) of those with clinically significant symptoms had at least one significant and persistent NPS at 6-month follow-up. Those with persistent symptoms had more severe baseline symptoms. Both patients and caregivers had a poorer quality of life when the patient had at least one clinically significant symptom.Conclusions: NPS were highly persistent overall in older people with MCI. Persistence was predicted by having more severe symptoms at baseline. Clinically significant levels of NPS were associated with decreased quality of life. We conclude that clinicians should be aware that NPS symptoms in MCI usually persist.

1848: Revolix 70 Watt 2 Micron Continuous Wave Laser Vaporesection of the Prostate. Preliminary Results After a One Year Follow-Up

2007 ◽  
Vol 177 (4S) ◽  
pp. 614-614
Author(s):  
Thorsten Bach ◽  
Thomas R.W. Herrmann ◽  
Roman Ganzer ◽  
Andreas J. Gross
Keyword(s):  
Continuous Wave ◽  
Continuous Wave Laser ◽  
Preliminary Results ◽  
Wave Laser ◽  
One Year

337: Monarc™ Transobturator Sling for the Treatment of Stress Urinary Incontinence: A Prospective, Multi­Center Study with One Year Follow-Up

2006 ◽  
Vol 175 (4S) ◽  
pp. 110-110 ◽  
Author(s):  
Robert D. Moore ◽  
John Miklos ◽  
L. Dean Knoll ◽  
Mary Dupont ◽  
Mickey Karram ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Transobturator Sling ◽  
One Year
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