Physicians’ practice and familiarity with treatment for agitation associated with dementia in Israeli nursing homes

Cohen‐Mansfield, Jiska; Juravel-Jaffe, Atarah; Cohen, Aaron M.; Rasooly, Iris; Golander, Hava

doi:10.1017/s104161021200172x

Cited by 23 publications

(23 citation statements)

References 36 publications

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“…Most specialties have some training in psychotropic use for NPS, but few receive instruction in nonpharmacological approaches and are aware of their effectiveness. 21 Even when aware of these techniques and their value, most providers lack basic training in assessing NPS and choosing or communicating strategies to individuals with dementia and caregivers. Assessing NPS and using nonpharmacological strategies can be time-prohibitive and not reimbursed.…”

Section: Abstract: Behavior; Behavioral Management; Nonpharmacologicmentioning

confidence: 99%

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Management of Neuropsychiatric Symptoms of Dementia in Clinical Settings: Recommendations from a Multidisciplinary Expert Panel

Kales

Gitlin

Lyketsos

2014

J American Geriatrics Society

482

350

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Non-cognitive neuropsychiatric symptoms (NPS) of dementia include aggression, agitation, depression, anxiety, delusions, hallucinations, apathy, and disinhibition. These affect dementia patients nearly universally across dementia stages and etiologies. NPS are associated with poor patient and caregiver outcomes including excess morbidity and mortality, increased health care utilization, and earlier nursing home placement, as well as caregiver stress, depression and reduced employment. While there is no FDA-approved pharmacotherapy for NPS, psychotropic medications are frequently used to manage these symptoms. However, in the few cases of proven pharmacologic efficacy, benefit may be off set by significant risk of adverse effects. Non-pharmacologic treatments, typically considered first-line, also show evidence for efficacy as well as a limited potential for adverse effects. However, their uptake as preferred treatments remains inadequate in real-world clinical settings. Thus, the field currently finds itself between a “rock and a hard place” in terms of management of these difficult symptoms. It was in this context that the University of Michigan Program for Positive Aging, working in collaboration with the Johns Hopkins Alzheimer’s Disease Research Center and Center for Innovative Care in Aging sponsored and convened a multidisciplinary expert panel in Detroit Michigan in Fall 2011 with three objectives, to: 1) define key elements of care for NPS in dementia; 2) construct an approach describing the sequential and iterative steps of managing NPS in real-world clinical settings that can be used as a basis for integrating non-pharmacologic and pharmacologic approaches; 3) discuss how the approach generated could be implemented in research and clinical care.

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Section: Abstract: Behavior; Behavioral Management; Nonpharmacologicmentioning

confidence: 99%

“…Unfortunately, effective non-pharmacologic strategies for NPS have not been translated into real-world clinical management and standard care [20]. Despite major concerns about safety and efficacy, psychotropics remain the primary “go-to” treatment approach, often without systematic assessment of potential underlying causes [21]. …”

Section: Introductionmentioning

confidence: 99%

Management of Neuropsychiatric Symptoms of Dementia in Clinical Settings: Recommendations from a Multidisciplinary Expert Panel

Kales

Gitlin

Lyketsos

2014

J American Geriatrics Society

482

350

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“…Current major treatments for BPSD can be divided into non-pharmacological approaches such as music therapy, touch therapies or massage, and pharmacological approaches such as cognitive enhancers, antipsychotics, mood stabilizers, and antidepressants (Gitlin et al, 2001). However, non-pharmacological approaches are rarely used because of lack of provider training, professional staff, or equipment (Cohen-Mansfield et al, 2013). Pharmacological treatments are often associated with side effects and other health risks (Preuss et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Kaixinsan, a Well-Known Chinese Herbal Prescription, for Alzheimer's Disease and Depression: A Preclinical Systematic Review

Zhang

et al. 2020

Front. Neurosci.

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Alzheimer's disease (AD), the most common cause of dementia, is highly prevalent worldwide with no modifying therapy. Behavioral and psychological symptoms of dementia (BPSD) occur in most patients with AD, and depression is one of the most common AD-related BPSD. Kaixinsan (KXS) is an ancient Chinese herbal prescription widely used to treat dementia and forgetfulness. In this systematic review, we conducted a meta-analysis to assess preclinical evidence for the effects of KXS on cognitive impairment and depression. Thirty-eight articles involving 1,050 animals were included after searching from six databases from the inception up to June 2019. The primary outcome measures were behavioral outcome. Indicators of cognitive function in AD included escape latency, time spent on the target quadrant, and the number of target platform crossings in the Morris water maze (MWM) test. Indicators of depression included number of rearing events and total distance in the open-field test, duration of immobility in the forced swim test, and sucrose consumption or sucrose preference index in the sucrose preference test. The secondary outcomes were mechanisms of KXS for treatment of AD and depression. The results showed that KXS significantly reduced escape latency (P < 0.01), increased time spent in the target quadrant (P < 0.01), and increased the number of target platform crossings (P < 0.01) in the MWM test in AD models compared with control. The possible mechanisms for KXS-mediated improvements in cognitive function were antioxidant activity, anti-inflammatory activity, antiapoptotic activity, neuroprotection, and synapse protection. In addition, the results demonstrated that KXS significantly increased the number of rearing instances (P < 0.01) in the open-field test, decreased the duration of immobility (P < 0.01) in forced swim test, and increased sucrose consumption or sucrose preference index (P < 0.01) in the sucrose preference test in depression models compared with control. The mechanisms of KXS-mediated anti-depressive effects were HPA axis regulation, antioxidant activity, anti-inflammatory activity, synapse protection, and neuroprotection. The results of this study suggested that KXS can be used to effectively treat AD and depression through multiple mechanisms, extrapolating the therapeutic potential of KXS for treating AD-related BPSD.Keywords: Kaixinsan, Alzheimer's disease, behavioral and psychological symptoms of dementia, depression, systematic review, meta-analysis Fu et al. Kaixinsan for AD and Depression

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“…The first manifestation and visual sing of suffering in advanced dementia is that of being not calm and is the first item of the Mini-Suffering State Examination (MSSE) scale developed by Aminoff 1 and described 11 years ago. 2 Physicians are familiar with medical attempts to define the behavior of patients with dementia: agitation, [3][4][5] behavioral and psychological symptoms of dementia, 6 behavioral and psychological disturbances, 7,8 psychosis, 9,10 restlessness, 11 discomfort, 12 delirium, 13 twilight, 14 resistance to care, [15][16][17] obstreperous behavior, 18 catastrophic reactions, 19 aggressiveness, 20 and other common terms that are of assistance in guiding decision making regarding treatment strategies. 21,22 The brain of a patient with advanced dementia, despite severe cognitive impairment, is still emotionally effective.…”

Section: Introductionmentioning

confidence: 99%

Not Calm and Aminoff Suffering Syndrome in Advanced Alzheimer’s Disease

Aminoff

2015

Am J Alzheimers Dis Other Demen

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We studied 183 patients with advanced dementia who had been admitted to the Geriatric-Internal Medicine Department of a general hospital, with a 1 year follow-up evaluated by Mini-Suffering State Examination (MSSE) scores on first days after admission. The not calm compared to calm patients with advanced dementia had a high suffering level (6.12 ± 2.16 versus 3.21 ± 1.71) with a statistically significant difference (P = 0.001). The not calm patients were sicker, a higher percentage had fever (P = 0.005), elevated levels of white blood cells WBC (P = 0.003) and C-reactive protein (CRP) (P = 0.020). The Kaplan-Meier function analysis showed a shorter survival of not calm versus calm advanced dementia patients, with a statistically significant difference (Log Rank [Mantel-Cox] P = 0.002). Not calm in advanced dementia patients is the first item of the MSSE and is a very important symptom of Aminoff Suffering Syndrome.

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Physicians’ practice and familiarity with treatment for agitation associated with dementia in Israeli nursing homes

Cited by 23 publications

References 36 publications

Management of Neuropsychiatric Symptoms of Dementia in Clinical Settings: Recommendations from a Multidisciplinary Expert Panel

Management of Neuropsychiatric Symptoms of Dementia in Clinical Settings: Recommendations from a Multidisciplinary Expert Panel

Kaixinsan, a Well-Known Chinese Herbal Prescription, for Alzheimer's Disease and Depression: A Preclinical Systematic Review

Not Calm and Aminoff Suffering Syndrome in Advanced Alzheimer’s Disease

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