Moving Evidence-Informed Assessment and Management of Behavioral and Psychological Symptoms of Dementia into the Real World: Training Family and Staff Caregivers in the DICE Approach

Kales, Helen C.; Kern, Vincent; Kim, H. Myra; Blazek, Mary

doi:10.1016/j.jagp.2020.08.008

Cited by 21 publications

(28 citation statements)

References 9 publications

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“…Moreover, family caregivers might be more involved in affective disturbances of care recipients, and the internalizing symptoms of dementia, such as anxiety and depression, might be over-reported by family caregivers because of their increased risks for stress, depression, and burden. Another explanation is that formal caregivers are more likely to have had some training in managing BPSD ( 34 ). Training has been found to have an impact on the way staff behave toward residents with dementia ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

“…Family caregivers’ improper management of behavior problems might result in aggravation of the symptoms ( 36 ). Delivery appropriate training to caregivers has been proposed as a key component of good dementia care ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

“…The present study found that family caregivers caring for community-dwelling older people with dementia were exposed to more frequent clinically significant and moderate-severe distressing BPSD than formal caregivers (nursing home staff). BPSD are the most treatable aspects of dementia and might be alleviated or eliminated through comprehensive interventions to target contributing factors or triggers ( 34 ). There are complex overlaps or interplay of reactive, responsive, and/or organic causes of BPSD ( 50 ).…”

Section: Discussionmentioning

confidence: 99%

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Comparing Behavioral and Psychological Symptoms of Dementia and Caregiver Distress Caused Between Older Adults With Dementia Living in the Community and in Nursing Homes

Rui

Rao

et al. 2022

Front. Psychiatry

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ObjectivesTo investigate differences in behavioral and psychological symptoms of dementia (BPSD) and caregiver distress caused between older adults with dementia living in the community and in nursing homes.DesignA comparative cross-sectional study.Setting and ParticipantsParticipants were recruited from outpatient clinics of a tertiary psychiatric hospital and dementia units of a nursing home in Guangzhou, China.MethodsNeuropsychiatric Inventory was used to assess symptoms and caregiver distress. Dementia severity was determined using the Clinical Dementia Rating.ResultsThis study included 157 community and 112 nursing home residents with dementia. Clinically significant symptoms (item score ≥ 4) were found in 88.5% of the former and 75% of the latter. Caregivers of 79.6% of the former and 26.8% of the latter reported that at least one of these caused them moderate-to-severe distress (distress score ≥ 3). Among the community patients, anxiety was the most frequent “very severe” symptom, while sleep disorders and agitation caused the most frequent “very severe” caregiver distress. After controlling for dementia severity and medication use, family caregiving remained an independent risk predictor for clinically significant symptoms and moderate-to-severe caregiver distress. The prediction of caregiver distress based on symptom scores varied across caregiver types and individual symptoms (R2 0.36–0.82). Group differences in clinically significant symptoms and moderate-to-severe caregiver distress showed at the stage of moderate-to-severe dementia.Conclusions and ImplicationsTailored management strategies to relieve family caregivers’ BPSD-induced distress are needed, especially at the stage of moderate-to-severe dementia. An effective service system should be established for supporting family caregivers to cope with BPSD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparing Behavioral and Psychological Symptoms of Dementia and Caregiver Distress Caused Between Older Adults With Dementia Living in the Community and in Nursing Homes

Rui

Rao

et al. 2022

Front. Psychiatry

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“…Primary inclusion criteria were patients with a discharge diagnosis of MCI or dementia due to AD (ICD-10th: G30) [35, 36] or idiopathic PD (ICD-10th: G20) from January 1, 2016 to December 31, 2017. Secondary inclusion criteria were the presence of neurocognitive disorder with BPSD [37-39] and white blood cells (WBCs) anomalies in AD and PD. Exclusion criteria comprised of patients under 18 years old and a diagnosis of gastrointestinal, urogenital, respiratory infection, bacteremia, viral infection, sepsis, or fever.…”

Section: Methodsmentioning

confidence: 99%

Peripheral Leukocytosis Predicts Cognitive Decline but Not Behavioral Disturbances: A Nationwide Study of Alzheimer’s and Parkinson’s Disease Patients

Unda

Antoniazzi

Altschul

et al. 2021

Dement Geriatr Cogn Disord

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Introduction: Peripheral and central nervous system inflammation have been linked to the classic symptoms of Parkinson’s disease (PD) and Alzheimer’s disease (AD). However, it remains unclear whether the analysis of routine systemic inflammatory markers could represent a useful prediction tool to identify clinical subtypes in patients with Parkinson’s and Alzheimer’s at higher risk of dementia-associated symptoms, such as behavioral and psychological symptoms of dementia (BPSD). Methods: We performed a multivariate logistic regression using the 2016 and 2017 National Inpatient Sample with International Classification of Diseases 10th edition codes to assess if pro-inflammatory white blood cells (WBCs) anomalies correlate with dementia and BPSD in patients with these disorders. Results: We found that leukocytosis was the most common WBC inflammatory marker identified in 3.9% of Alzheimer’s and 3.3% Parkinson’s patients. Leukocytosis was also found to be an independent risk factor for Parkinson’s dementia. Multivariate analysis of both cohorts showed that leukocytosis is significantly decreased in patients with BPSD compared to patients without BPSD. Conclusions: These results suggest a link between leukocytosis and the pathophysiology of cognitive dysfunction in both PD and AD. A better understanding of the role of systemic neuroinflammation on these devastating neurodegenerative disorders may facilitate the development of cost-effective blood biomarkers for patient’s early diagnosis and more accurate prognosis.

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“…4,[13][14][15][16] In previous studies, in the absence of pharmacological interventions, the development of BPSD has been associated with a more rapid cognitive decline, reduced quality of life for people with dementia and for caregivers, earlier institutionalisations, and worse living environments. [17][18][19] Several randomised controlled trials on caregiver education and the adjustment of the physical and social living environments of people with dementia have shown that improvements in the caregiver burden, living environment and other related factors may reduce the severity of BPSD. [20][21][22] China has the highest number of people with dementia in the world.…”

Section: Introductionmentioning

confidence: 99%

Behavioural and psychological symptoms of early‐onset and late‐onset Alzheimer's disease among Chinese adults: analysis of modifiable factors

et al. 2022

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Background To conduct a comprehensive comparison of behavioural and psychological symptoms of dementia (BPSD) in Chinese people with early‐onset Alzheimer's disease (EOAD) and late‐onset Alzheimer's disease (LOAD) and analyse the factors of differences. Methods A cross‐sectional survey of 93 EOAD and100 LOAD and their caregivers in China from November 2018 to May 2019. Results The total Neuropsychiatric Inventory score was significantly higher in LOAD. A higher level of agitation in EOAD was related to a lower quality of life of caregivers and the emotional expression of ignoring people with dementia. Higher euphoria scores in LOAD were associated with reduced negative coping by caregivers and reduced stability and predictability at home. Conclusion The early identification and management of specific BPSD of EOAD and LOAD by family members and health professionals may improve the quality of care and life for people with dementia and that of caregivers.

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Moving Evidence-Informed Assessment and Management of Behavioral and Psychological Symptoms of Dementia into the Real World: Training Family and Staff Caregivers in the DICE Approach

Cited by 21 publications

References 9 publications

Comparing Behavioral and Psychological Symptoms of Dementia and Caregiver Distress Caused Between Older Adults With Dementia Living in the Community and in Nursing Homes

Comparing Behavioral and Psychological Symptoms of Dementia and Caregiver Distress Caused Between Older Adults With Dementia Living in the Community and in Nursing Homes

Peripheral Leukocytosis Predicts Cognitive Decline but Not Behavioral Disturbances: A Nationwide Study of Alzheimer’s and Parkinson’s Disease Patients

Behavioural and psychological symptoms of early‐onset and late‐onset Alzheimer's disease among Chinese adults: analysis of modifiable factors

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