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Objectives: Among participants with Alzheimer's disease (AD) we estimated the minimal clinically important difference (MCID) in apathy symptom severity on three scales. Design: Retrospective anchor- and distribution-based analyses of change in apathy symptom scores. Setting: Apathy in Dementia Methylphenidate Trial (ADMET) and ADMET 2 randomized controlled trials conducted at three and ten clinics specialized in dementia care in United States and Canada, respectively. Participants: Two hundred and sixty participants (60 ADMET, 200 ADMET 2) with clinically significant apathy in Alzheimer's disease. Measurements: The Clinical Global Impression of Change in Apathy scale was used as the anchor measure and the MCID on the Neuropsychiatric Inventory – Apathy (NPI-A), Dementia Apathy Interview and Rating (DAIR), and Apathy Evaluation Scale-Informant (AES-I) were estimated with linear mixed models across all study visits. The estimated thresholds were evaluated with performance metrics. Results: Among the MCID was a decrease of four points (95% CI: −4.0 to −4.8) on the NPI-A, 0.56 points (95% CI: −0.47 to −0.65) on the DAIR, and three points on the AES-I (95% CI: −0.9 to −5.4). Distribution-based analyses were largely consistent with the anchor-based analyses. The MCID across the three measures showed ∼60% accuracy. Sensitivity analyses found that MMSE scores and apathy severity at baseline influenced the estimated MCID. Conclusions: MCIDs for apathy on three scales will help evaluate treatment efficacy at the individual level. However, the modest correspondence between MCID and clinical impression of change suggests the need to consider other scales. [ABSTRACT FROM AUTHOR]

Background and objectives: This study aimed to confirm the effectiveness of the virtual passport for dementia care. Research design and methods: The virtual passport is an application (app) tool connecting healthcare professionals, dementia care sites, and people living with dementia (PLWD) and their family caregivers. This tool assists case managers in hospitals by providing individualized care plans and health education to PLWD and their caregivers. The dementia quality indicator achievement rates, care needs investigation and fulfillment, severity of behavioral and psychological symptoms of dementia (BPSD), and changes in caregiver burden and depression are measured at the initial interview and 6 and 12 months after the intervention. Results: We enrolled 57 and 54 patients and their caregivers in the virtual passport and routine care groups, respectively. Compared to the control group, six quality indicators in the passport group showed significantly higher achievement at 6 months after using the virtual passport. Case managers addressed more care needs at 6 months (1.37 vs 0, p < 0.001) and 12 months (1.32 vs 0, p < 0.001). Improvement in severity of neuropsychiatric symptoms (neuropsychiatric inventory (NPI) irritability/lability difference: -0.58 vs 0.22, p = 0.044; NPI agitation/aggression difference =-0.78 vs 0.00, p = 0.042) were also observed. No obvious influence was found in caregiver burden and depression after using the virtual passport. Discussion and implications: The virtual passport is an effective information technology tool in improving the quality of dementia care, assisting case management in identifying more care needs, and reducing the severity of BPSD. [ABSTRACT FROM AUTHOR]

Background and objectives: This study aimed to confirm the effectiveness of the virtual passport for dementia care. Research design and Methods: The virtual passport is an application (app) tool connecting healthcare professionals, dementia care sites, and people living with dementia (PLWD) and their family caregivers. This tool assists case managers in hospitals by providing individualized care plans and health education to PLWD and their caregivers. The dementia quality indicator achievement rates, care needs investigation and fulfillment, severity of behavioral and psychological symptoms of dementia (BPSD), and changes in caregiver burden and depression are measured at the initial interview and 6 and 12 months after the intervention. Results: We enrolled 57 and 54 patients and their caregivers in the virtual passport and routine care groups, respectively. Compared to the control group, six quality indicators in the passport group showed significantly higher achievement at 6 months after using the virtual passport. Casemanagers addressedmore care needs at 6months (1.37 vs 0, p < 0.001) and 12months (1.32 vs 0, p < 0.001). Improvement in severity of neuropsychiatric symptoms (neuropsychiatric inventory (NPI) irritability/lability difference: -0.58 vs 0.22, p = 0.044; NPI agitation/aggression difference =-0.78 vs 0.00, p = 0.042) were also observed. No obvious influence was found in caregiver burden and depression after using the virtual passport. Discussion and implications: The virtual passport is an effective information technology tool in improving the quality of dementia care, assisting case management in identifying more care needs, and reducing the severity of BPSD. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the beneficial outcomes of giving cannabidiol (CBD) 3% over a six-month period in the BPSD, the management of which is a crucial issue for everyday clinical praxis and to compare the progress in BPSD of patients who receive Cannabidiol 3% with those who follow usual medical treatment (UMT) in everyday clinical praxis. Methods: A total of 20 PwD with severe BPSD were recruited from the database of Alzheimer Hellas with NPI score >30. Ten of them were assigned to UMT, while ten were assigned to a six-month treatment with CBD drops. The follow-up assessment was performed with NPI, both clinically and by structured telephone interview. Results: The follow-up assessment with NPI showed significant improvement of the BPSD in all our patients who received CBD, and no or limited improvement in the second group, regardless of the underlying neuropathology of dementia. Conclusions: We suggest that CBD may be a more effective and safe choice for managing BPSD than the typical intervention. Future large randomized clinical trials are needed to re-assure these findings. Clinical Implications: Healthcare professionals should consider incorporating CBD 3% into their practices to reduce BPSD in PwD. Regular assessments are necessary to ensure long-term effectiveness. [ABSTRACT FROM AUTHOR]

Background/Objectives: As the elderly population grows, the prevalence of dementia is rising, with 70–95% of patients in hospital settings exhibiting problematic behaviors such as aggression. These behaviors significantly contribute to increased nursing workloads, affecting nurses' well-being and patient care quality. This study aims to review workload-related issues among nurses caring for dementia patients, highlighting the need for targeted interventions to mitigate stress and improve care quality. Methods: A scoping review was conducted using the five-stage framework of Arksey and O'Malley. The literature search covered studies published between 2013 and 2023, focusing on quantitative research about nurses' workload-related stress when managing patients with dementia and problematic behaviors. Databases such as PubMed and PsycINFO were searched, and 13 studies were selected based on predefined inclusion and exclusion criteria. Results: The review revealed that problematic behaviors, particularly aggression, significantly increase nurses' stress and workload. This stress has negative consequences on nurses' physical and mental health, often leading to burnout, decreased job satisfaction, and a decline in care quality. Inadequate staffing and support systems exacerbate these issues. Conclusions: Targeted education, sufficient staffing, and support are essential to reduce the workload and stress experienced by nurses caring for dementia patients. Implementing these strategies can enhance the quality of care provided and improve the well-being of healthcare professionals. [ABSTRACT FROM AUTHOR]

Objectives Caring for a spouse with Alzheimer's disease (AD) can elicit considerable distress but there are also positive moments. A growing body of work has examined caregivers' ambivalence in the care relationship and linked it to negative caregiver outcomes such as depression, but dyadic assessments of both parties' perspectives are missing. We examined ambivalence in both people with AD and their spousal caregivers, seeking to identify the correlates and well-being outcomes of such ambivalence in this unique context. Methods Participants included 72 couples managing early-stage AD. People with AD and spousal caregivers independently self-reported positive and negative relationship qualities (used to indirectly calculate their ambivalence) and life satisfaction. Caregivers reported both partners' demographic characteristics and their spouses' behavioral and psychological symptoms of dementia (BPSD), focusing on memory-related behaviors and psychological symptoms. Results Path analyses revealed that the number and frequency of psychological symptoms in people with AD were positively associated with their own and caregivers' ambivalence. Caregivers' distress ratings of memory-related behaviors and psychological symptoms were positively associated with their ambivalence. Greater ambivalence was associated with lower life satisfaction in both spouses. BPSD directly affected both spouses' life satisfaction but there were also indirect effects via ambivalence. Discussion This study utilizes a dyadic approach to assess ambivalence in dementia care. Findings reveal the conflicting emotions that couples experience as they cope with early-stage AD, identify sources of such ambivalence, and shed light on the development of dyadic interventions that can promote positive outcomes in both partners. [ABSTRACT FROM AUTHOR]

Abstract Background Quantifying the informal caregiver burden is important for understanding the risk factors associated with caregiver overload and for evaluating the effectiveness of services provided in Long-term Care (LTC). Objective This study aimed to develop and validate a Caregiver Strain Index (CSI)-based score for quantifying the informal caregiver burden, while the original dataset did not fully cover evaluation items commonly included in international assessments. Subsequently, we utilized the CSI-based score to pinpoint key caregiver burden risk factors, examine the initial timing of LTC services adoption, and assess the impact of LTC services on reducing caregiver burden. Methods The study analyzed over 28,000 LTC cases in Southern Taiwan from August 2019 to December 2022. Through multiple regression analysis, we identified significant risk factors associated with caregiver burden and examined changes in this burden after utilizing various services. Survival analysis was employed to explore the relationship between adopting the first LTC services and varying levels of caregiver burden. Results We identified 126 significant risk factors for caregiver burden. The most critical factors included caregiving for other disabled family members or children under the age of three (β = 0.74, p

Background: Quantifying the informal caregiver burden is important for understanding the risk factors associated with caregiver overload and for evaluating the effectiveness of services provided in Long-term Care (LTC). Objective: This study aimed to develop and validate a Caregiver Strain Index (CSI)-based score for quantifying the informal caregiver burden, while the original dataset did not fully cover evaluation items commonly included in international assessments. Subsequently, we utilized the CSI-based score to pinpoint key caregiver burden risk factors, examine the initial timing of LTC services adoption, and assess the impact of LTC services on reducing caregiver burden. Methods: The study analyzed over 28,000 LTC cases in Southern Taiwan from August 2019 to December 2022. Through multiple regression analysis, we identified significant risk factors associated with caregiver burden and examined changes in this burden after utilizing various services. Survival analysis was employed to explore the relationship between adopting the first LTC services and varying levels of caregiver burden. Results: We identified 126 significant risk factors for caregiver burden. The most critical factors included caregiving for other disabled family members or children under the age of three (β = 0.74, p < 0.001), the employment status of the caregiver (β = 0.30–0.53, p < 0.001), the frailty of the care recipient (β = 0.28–0.31, p < 0.001), and the behavioral symptoms of dementia in care recipients (β = 0.28–2.60, p < 0.05). Generally, caregivers facing higher burdens sought LTC services earlier, and providing home care services alleviated the caregiver's burden. Conclusion: This comprehensive study suggests policy refinements to recognize high-risk caregivers better early and provide timely support to improve the overall well-being of both informal caregivers and care recipients. Highlights: This study introduced an effective approach for quantifying the burden on informal caregivers, despite the limitations posed by the original dataset's incomplete coverage of evaluation items typically found in international assessments. Through analysis of over 28,000 cases, critical risk factors were pinpointed, such as caring for other disabled family members or young children, caregivers' employment status, care recipients' frailty, and behavioral symptoms of dementia, emphasizing the need for targeted caregiver support. Survival analysis revealed that caregivers experiencing higher burdens tend to seek Long-term Care (LTC) services—such as accompaniment on outings, companion services, and home respite services—earlier, which underscores the critical role of these services in supporting caregivers. Providing home care services alleviates caregiver burden, suggesting policy refinements to enhance the well-being of informal caregivers and care recipients through timely and practical support. [ABSTRACT FROM AUTHOR]

Objectives: Among people with dementia, poor nutritional status has been associated with worse cognitive and functional decline, but few studies have examined its association with neuropsychiatric symptoms (NPS). We examined this topic in a population-based sample of persons with dementia. Design: Longitudinal, observational cohort study. Setting: Community. Participants: Two hundred ninety-two persons with dementia (71.9% Alzheimer's disease, 56.2% women) were followed up to 6 years. Measurements: We used a modified Mini-Nutritional Assessment (mMNA) and the Neuropsychiatric Inventory (NPI) to evaluate nutritional status and NPS, respectively. Individual linear mixed effects models examined the associations between time-varying mMNA total score or clinical categories (malnourishment, risk for malnourishment, or well-nourished) and NPI total score (excluding appetite domain) or NPI individual domain or cluster (e.g. psychosis) scores. Covariates tested were dementia onset age, type, and duration, medical comorbidities, sex, apolipoprotein E (APOE) genotype, and education. Results: Compared to the well-nourished, those at risk for malnourishment and those malnourished had higher total NPI scores [ b (95% CI) = 1.76 (0.04, 3.48) or 3.20 (0.62, 5.78), respectively], controlling for significant covariates. Higher mMNA total score (better nutritional status) was associated with lower total NPI [ b (95% CI) = −0.58 (−0.86, −0.29)] and lower domain scores for psychosis [ b (95% CI) = −0.08 (−0.16,.004)], depression [ b (95% CI = −0.11 (−0.16, −0.05], and apathy [ b (95% CI = −0.19 (−0.28, −0.11)]. Conclusions: Worse nutritional status is associated with more severe NPS. Dietary or behavioral interventions to prevent malnutrition may be beneficial for persons with dementia. [ABSTRACT FROM AUTHOR]

Objective: Behavioral and psychological symptoms of dementia (BPSD) are a group of noncognitive symptoms that occur commonly among individuals with dementia. These symptoms worsen the morbidity and mortality among individuals with dementia and significantly increase the cost of caring for these individuals. Transcranial magnetic stimulation (TMS) has been shown to have some benefits in the treatment of BPSD. This review provides an updated summary of the effect of TMS on BPSD. Methods: We conducted a systematic review of PubMed, Cochrane, and Ovid databases on the use of TMS to treat BPSD. Results: We found 11 randomized controlled studies that evaluated the use of TMS among individuals with BPSD. Three of these studies examined the effect of TMS on apathy, two of which showed significant benefit. Seven studies showed that TMS significantly improves BPSD: six using repetitive transcranial magnetic stimulation (rTMS) and one using transcranial direct current stimulation (tDCS). Four studies, two evaluating tDCS, one evaluating rTMS, and one evaluating intermittent theta-burst stimulation (iTBS) showed a nonsignificant impact of TMS on BPSD. Adverse events were predominantly mild and transitory in all studies. Conclusion: Available data from this review indicate that rTMS is beneficial for individuals with BPSD, especially among individuals with apathy, and is well tolerated. However, more data are needed to prove the efficacy of tDCS and iTBS. Additionally, more randomized controlled trials with longer treatment follow-up and standardized use of BPSD assessments are needed to determine the best dose, duration, and modality for effective treatment of BPSD. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to explore the association between adherence of collaborative care model and short-term deterioration of BPSD after controlling patient and caregiver factors. Methods This retrospective case–control study enrolled 276 participants who were newly diagnosed with dementia and BPSD. A dementia collaborative care team interviewed patients and caregivers to form a care plan and provided individualized education or social resource referrals. A multivariate logistic regression model with backward selection was used to test factors associated with BPSD deterioration, defined as worse neuropsychiatric inventory (NPI) scores 1 year after joining the care model. Results Male sex (odds ratio [OR] = 0.45; 95% confidence interval [CI] = 0.25–0.84) and higher clinical dementia rating scale sum of boxes scores (CDR-SOB) (OR = 0.90; 95% CI = 0.83–0.98) were protective factors, whereas spouse caregivers and withdrawals from the care model (OR = 3.42; 95% CI = 1.28–9.15) were risk factors for BPSD deterioration. Conclusions Our study showed that both patient and caregiver factors were associated with deterioration of BPSD. The case manager-centered dementia collaborative care model is beneficial for the management of BPSD. Healthcare systems may consider implementing a case management model in clinical dementia care practice.

The current study aimed to develop a scale assessing knowledge about behavioral and psychological symptoms of dementia (KS-BPSD) among Chinese formal caregivers and to investigate its psychometric properties and factorial structure. The scale was generated with a systematic development process, and 229 formal caregivers working at nursing homes were recruited to construct and assess the psychometric properties of the scale. The preliminary scale was reviewed by an expert panel and items were selected based on item discrimination, difficulty, and item-total correlation. The final KS-BPSD version consisted of 12 items, loaded into three factors (i.e., Disease Characteristics, Care and Risks, and Treatment Needs) following principal component analysis (PCA). The KS-BPSD showed good test-retest reliability, internal consistency, as well as construct and concurrent validity. The 12-item KS-BPSD was found to have high reliability and preliminary validity in assessing the level of knowledge about patient's BPSD among formal Chinese caregivers in nursing homes. KS-BPSD is a reliable tool to address the knowledge discrepancies and support needs among dementia caregivers, helping to develop and evaluate educational programs in the management of patient's BPSD. [ABSTRACT FROM AUTHOR]

The Neuropsychiatric Inventory Questionnaire (NPI-Q) is a collateral-rated measure of behavioral and psychological symptoms commonly found in dementia (BPSD). Several factor structures have been published, but they have not been systematically compared. Furthermore, the possibility of hierarchical models or presence of measurement invariance around cognitive stage or dementia syndrome has not been previously evaluated. This study addressed these gaps with confirmatory factor analyses using a multicenter sample (n = 41,801; Mage = 71.4; 57% women; 79% White, 13% Black, 8% Hispanic; Meducation = 15.1) that was divided into exploratory, derivation, and holdover subsets for cross-validation. We found that a four-factor model had the best fit, with adequate reliability estimates, adequate τ-equivalence, and the least amount of measurement variance. Strict invariance across stage and syndrome was not supported, although there was adequate support for weaker restrictions (e.g., equal forms). Furthermore, all bifactor models had a significant increase in fit. In sum, the present study provides practical guidance on using NPI-Q factor-derived subscales and theoretical elaboration of BPSD's hierarchical and syndrome-variant structure. Public Significance Statement: This study compared models for behavioral and psychological symptoms of dementia (BPSD) and found four factors to be recommendable. It provided practical information (i.e., reliability, summability) and assessed hierarchical extensions to discover that joint consideration of broad and narrow contributors best explains BPSD. It also determined that the model variability in literature is, at least partly, due to differences in the dementia stage and type among individuals studied. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore the association between adherence of collaborative care model and short-term deterioration of BPSD after controlling patient and caregiver factors. Methods: This retrospective case–control study enrolled 276 participants who were newly diagnosed with dementia and BPSD. A dementia collaborative care team interviewed patients and caregivers to form a care plan and provided individualized education or social resource referrals. A multivariate logistic regression model with backward selection was used to test factors associated with BPSD deterioration, defined as worse neuropsychiatric inventory (NPI) scores 1 year after joining the care model. Results: Male sex (odds ratio [OR] = 0.45; 95% confidence interval [CI] = 0.25–0.84) and higher clinical dementia rating scale sum of boxes scores (CDR-SOB) (OR = 0.90; 95% CI = 0.83–0.98) were protective factors, whereas spouse caregivers and withdrawals from the care model (OR = 3.42; 95% CI = 1.28–9.15) were risk factors for BPSD deterioration. Conclusions: Our study showed that both patient and caregiver factors were associated with deterioration of BPSD. The case manager-centered dementia collaborative care model is beneficial for the management of BPSD. Healthcare systems may consider implementing a case management model in clinical dementia care practice. [ABSTRACT FROM AUTHOR]

To investigate electronic care notes to better understand reporting and management of neuropsychiatric symptoms (NPS) by residential aged care (RAC) staff. We examined semi-structured care notes from electronic healthcare notes of 77 residents (67% female; aged 67–101; 79% with formal dementia diagnosis) across three RAC facilities. As part of standard clinical practice, staff documented the NPS presentation and subsequent management amongst residents. Using a mixed-method approach, we analyzed the type of NPS reported and explored care staff responses to NPS using inductive thematic analysis. 465 electronic care notes were recorded during the 18-month period. Agitation-related behaviors were most frequently reported across residents (48.1%), while psychosis (15.6%), affective symptoms (14.3%), and apathy (1.3%) were less often reported. Only 27.5% of the notes contained information on potential causes underlying NPS. When faced with NPS, care staff responded by either providing emotional support, meeting resident's needs, removing identified triggers, or distracting. Results suggest that RAC staff primarily detected and responded to those NPS they perceived as distressing. Findings highlight a potential under-recognition of specific NPS types, and lack of routine examination of NPS causes or systematic assessment and management of NPS. These observations are needed to inform the development and implementation of non-pharmacological interventions and care programs targeting NPS in RAC. Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2032597. [ABSTRACT FROM AUTHOR]

Behavioral and psychological symptoms of dementia (BPSD) occur frequently among people with dementia and are known precipitants for placement in care facilities. Despite the social, financial, and psychological impact on dementia care, education and discussions on BPSD have not been routinely included in advance care planning (ACP). As a result, families can face great challenges in making complex medical decisions when their loved ones are admitted to the geriatric psychiatric inpatient unit with refractory BPSD. We present the case of an 83-year-old gentleman with BPSD to illustrate universal struggles in dementia care experienced by many families, which could have been alleviated by education and discussions around BPSD earlier in the patient's dementia course. A literature search did not yield any articles that mention discussions of BPSD in ACP. The lack of literature referencing BPSD in ACP supports our clinical experiences with the case and highlights the need for improvement in current dementia care. We propose a guideline for providers to facilitate conversations around BPSD as an integral part of ACP, including discussions of four key points related to the progressive nature of dementia, the commonality of BPSD, the lack of FDA-approved treatment for BPSD, and the difficulty in balancing agitation and sedation to allow safe placement. We firmly believe it is important to start discussion on BPSD as part of ACP as early as possible. Early education and discussion will help to facilitate meaningful care decisions as patients and families navigate the challenges associated with this progressive disease. [ABSTRACT FROM AUTHOR]

Introduction: Dementia patients often experience behavioral and psychological symptoms (BPSD), which severely affect their quality of life and activities of daily living. Non-pharmacological interventions are effective in treating BPSD, according to multiple clinical trials and systematic reviews. However, the optimal non-pharmacological treatment remains controversial. Therefore, the study aims to evaluate and compare multiple non-pharmacological methods for treating BPSD in order to identify the optimal non-pharmacological intervention. Objective: This study aims to perform a systematic review and network metaanalysis of evidence on non-pharmacological interventions in the treatment of BPSD, which may potentially guide future research and clinical decisions. Methods: In order to select potentially relevant randomized controlled trials (RCTs), 10 academic databases and 3 clinical trial registries will be systematically searched from inception until the 1 October 2022. Two researchers will independently extract information from eligible articles. The primary outcome is the severity of BPSD. Herein, Pairwise and Bayesian network meta-analyses will be conducted utilizing STATA 15.0 and ADDIS 1.16.8. Evidence quality will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results: Results from this study will be published in peer-reviewed journals or conference reports. Discussion: In this study, we aim to comparatively assess the efficacy of various non-pharmacological treatments for BPSD. Findings from this review will help clinicians to make evidence-based treatment decisions. [ABSTRACT FROM AUTHOR]

Objective: To explore care aide perceptions of caring for residents who aides perceived had past psychological trauma.Methods: Through cognitive interviews, we developed a definition of trauma for four survey questions about caring for residents with psychological trauma. We added these questions to our routine care aide survey in 91 care homes in Western Canada (September 2019 to February 2020). We asked if care aides perceived that they were caring for residents with trauma, how often, types of trauma experienced, and what indication led them to perceive a resident had experienced trauma. We analyzed data using content analysis (open-ended questions) and regression analyses (closed-ended questions).Results: Three thousand seven hundred and sixty five care aides responded (70% response rate) to the survey, and 53% perceived caring for one or more residents with a history of psychological trauma in the previous 2 weeks. Within six categories of traumatic events, abuse (35%) and war exposure (26%) were most common. Most common indications of trauma reported by care aides (five categories) were reliving the experience or having intrusive symptoms (28%) and avoidant behaviors (24%). Care aides were more likely to report caring for a resident who they perceived had experienced past psychological trauma if they were younger, spoke English as their first language, self-reported experiencing more aggression from residents, or who worked in not-for-profit homes.Conclusions: This preliminary study supports the need for further study of care aides' perceptions and experiences of caring for residents with past trauma, and the effects of caring for these residents on quality of work life. [ABSTRACT FROM AUTHOR]

The first-line management of behavioral and psychological symptoms of dementia (BPSD) is based on nonpharmacologic interventions such as the provision of guidance and medical support to caregivers. However, accessibility to specialized care and medical resources is often scarce. The ongoing COVID-19 pandemic has compromised the delivery of outpatient care (notably in order to minimize the risk of disease transmission), thus making it essential to provide other means of accessing care for these patient populations. The use of telemedicine (TM) may be a means of increasing access to specialist care for patients with disabilities and poor access to health services, such as those with BPSD. The aim of this study is to provide a review of the literature on the use of TM for treatment and follow-up of patients with BPSD and their caregivers. We searched the PUBMED, EMBASE and CINAHL for articles published between January 1st, 2000, and December 31st, 2020, on the applicability of TM support for people with BPSD and their caregivers. We included open-label studies, qualitative studies, and randomized controlled trials . We did not include studies on the use of TM during the COVID-19 pandemic. A total of 22 publications were included and reviewed. TM was found to 1) be acceptable and feasible for both patients and caregivers, 2) decrease the frequency and intensity of BPSD, and 3) improve the caregiver's perceived wellbeing and mental health. Videoconferencing was effective for patient-centered interventions in nursing homes. Telephone-based interventions were more relevant when they were targeted at caregivers. The published studies are lacking in scope and high-quality studies are now needed to confirm these findings and assess TM's cost-effectiveness and ability to improve the management of patients with BPSD. In view of the ongoing COVID-19 pandemic, remote solutions for assessing and monitoring individuals with BPSD are urgently needed - particularly those living in rural areas and so-called "medical deserts." [ABSTRACT FROM AUTHOR]

Purpose of Review: To provide a comprehensive overview on the evaluation and management of behavioral and psychological symptoms of dementia (BPSD) using evidence from literature. Recent Findings: Evidence indicates efficacy for some non-pharmacological techniques including education of caregivers and cognitive stimulation therapy and pharmacological agents like antidepressant and antipsychotics for the management of BPSD. The use of antipsychotics has generated controversy due to the recognition of their serious adverse effect profile including the risk of cerebrovascular adverse events and death. Summary: BPSD is associated with worsening of cognition and function among individuals with dementia, greater caregiver burden, more frequent institutionalization, overall poorer quality of life, and greater cost of caring for these individuals. Future management strategies for BPSD should include the use of technology for the provision of non-pharmacological interventions and the judicious use of cannabinoids and interventional procedures like ECT for the management of refractory symptoms. [ABSTRACT FROM AUTHOR]

Objectives: This study investigates the stability of neuropsychiatric symptoms (NPS) assessed biweekly using the Neuropsychiatric Inventory (NPI) in a memory clinic population during a 6 week period.Methods: Twenty-three spousal caregivers (mean [SD] age = 69.7 [8.8], 82.6% female) of 23 patients (43.5% had dementia) completed all assessments. The NPI was assessed four times during 6 weeks. We examined whether NPI domains were present during all four assessments, studied within-person variation for each NPI domain, and calculated Spearman's correlations between subsequent time-points. Furthermore, we associated repeated NPI assessments with repeated measures of caregiver burden to examine the clinical impact of changes in NPI scores over time.Results: The course of NPS was highly irregular according to the NPI, with only 35.8% of the NPI domains that were present at baseline persisted during all 6 weeks. We observed large within-person variation in the presence of individual NPI domains (61.3%, range 37.5%-83.9%) and inconsistent correlations between NPI assessments (e.g., range rs  = 0.20-0.57 for agitation, range rs  = 0.29-0.59 for anxiety). Higher NPI total scores were related to higher caregiver burden (rs  = 0.60, p < 0.001), but changes in NPI total scores were unrelated to changes in caregiver burden (rs  = 0.16, p = 0.20).Conclusions: We observed strong fluctuations in NPI scores within very short time windows raising the question whether this represents erratic symptoms and/or scores. Further studies are needed to investigate the origins of these fluctuations. [ABSTRACT FROM AUTHOR]

Background and Objectives Dementia awareness initiatives aim to promote helping behaviors toward people living with dementia. We applied the bystander intervention process model in the context of the general public's helping behaviors toward people living with dementia, and we sought to identify the mechanisms underlying the association between dementia knowledge and helping behaviors. Research Design and Methods In a survey featuring vignettes for the general public in Japan (N = 904), we presented four situations in which people could exhibit helping behaviors toward a person with dementia. Guttman scale analysis was used to test this sequential ordering of the bystander intervention process model: (a) interpreting the need to help, (b) perceiving personal responsibility, and (c) intention to provide help. Mediation analysis was used to examine whether the effects of knowledge on helping behaviors were mediated by attitude toward people living with dementia and the bystander intervention process. Results The results support the two-step model in which interpreting the situation as one where assistance is required is a prerequisite of helping behavior. Dementia knowledge had a significant total effect on intention to provide help (β = 0.136, p <.001). Interpretation (indirect effect: β = 0.092, p <.001), as well as attitude (indirect effect: β = 0.044, p <.001), was found to completely mediate the effect of dementia knowledge on intention to provide help. Discussion and Implications Dementia awareness initiatives designed to promote helping behaviors should focus on knowledge transfer, improving the general public's attitudes toward people living with dementia, and their ability to interpret when such people need assistance. [ABSTRACT FROM AUTHOR]

PurposeResponsive behavior, often referred to as behavioral and psychological symptoms of dementia (BPSD), is among the most critical disorders in dementia whereby nursing personnel in hospitals are increasingly confronted with such symptoms. The purpose was to reduce the level of BPSD in an acute hospital environment through a stepwise procedure followed by the initiation of a needs-oriented treatment.MethodsAn open, prospective, interventional study with before-after comparisons was used to implement “Serial Trial Intervention” (STI) in three hospital wards (internal medicine, surgery, geriatric) after its adaption for hospital setting which was supplemented with a detailed pain assessment. Participants were 65 years and older. Potential causes of BPSD were clarified in a stepwise procedure and, if possible, eliminated. The primary outcome was the reduction in BPSD measured by the Neuropsychiatric Inventory (NPI-Q-12) while secondary outcomes were through the use of non-pharmacological and pharmacological interventions.ResultsNo significant reduction in NPI-Q-12 could be found. However, significantly more mobilizations and changes of position were carried out. Higher antipsychotic use was seen in the after-groups presumably due to the higher rates of delirium and cognitive impairment. Furthermore, the data showed no increase in analgesic use.ConclusionNo significant reduction in NPI-Q-12 was observed in the before-after study. The use of antipsychotics even increased most probably due to a higher incidence of deliriousness in the after-group. However, STI seemed to improve attention to underlying causes of BPSD as well as pain. Proof that STI leads to NPI-Q-12 reduction in hospitals is still pending.

Objectives: Social isolation among older adults with cognitive impairment is understudied. The purpose of this study is to examine the relationship between social isolation and anxiety in people with cognitive impairment in the United States.Methods/design: Secondary data analyses were conducted using the National Social Life, Health, and Aging Project (NSHAP) Wave 2 (2010-2011) dataset which includes a nationally representative sample of American older adults living at home. A total of 1343 people who had probable cognitive impairment measured by a Montreal Cognitive Assessment (MoCA) score of 22 or less were selected. Anxiety was measured using the anxiety measure of Hospital Anxiety and Depression Scale (HADS-A) and social isolation was measured using Perceived Social Isolation Scale. A weighted multivariable linear regression analysis and weighted F tests were used to examine the relationship between social isolation and anxiety.Results: We observed that greater social isolation was related to increased anxiety in people with cognitive impairment (coefficients = 0.7242, t = 2.51, p = 0.015), adjusting for severity of cognitive impairment, race, pain, depression, activities of daily living, and instrumental activities of daily living. Weighted F tests showed that persons with clinically significant anxiety (HADS-A ≥ 8) had higher levels of loneliness, including feeling a lack of companionship, feeling left out, and greater social isolation.Conclusions: The results of our study suggest that people with cognitive impairment can feel social isolation and it may contribute to their anxiety. Health care professionals, family, and friends of people with cognitive impairment should pay greater attention to social isolation of their loved ones. [ABSTRACT FROM AUTHOR]

Chieh-Hsin Lin,1– 3 Hui-Ting Yang,4 Ping-Kun Chen,5,6 Shi-Heng Wang,7 Hsien-Yuan Lane2,8,9 1Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan; 3School of Medicine, Chang Gung University, Taoyuan, Taiwan; 4School of Food Safety, Taipei Medical University, Taipei, Taiwan; 5School of Medicine, China Medical University, Taichung, Taiwan; 6Department of Neurology, China Medical University Hospital, Taichung, Taiwan; 7Department of Occupational Safety and Health, China Medical University, Taichung, Taiwan; 8Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan; 9Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, TaiwanCorrespondence: Hsien-Yuan LaneDepartment of Psychiatry, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung 404, TaiwanEmail hylane@gmail.comObjective: Behavioral and psychological symptoms of dementia (BPSD) are associated with poorer prognosis of dementia. A 24-week study demonstrated that sodium benzoate, a D-amino acid oxidase (DAAO) inhibitor, surpassed placebo in improving cognitive function in early-phase Alzheimer’s disease; however, benzoate did not excel placebo in another 6-week study on BPSD. The current study examined whether the precision medicine approach was able to identify specific individuals with BPSD who could benefit from benzoate treatment.Methods: In the randomized, double-blind, placebo-controlled, 6-week trial, 97 patients with BPSD were allocated to receive 250– 1500 mg/day of sodium benzoate or placebo. Cognitive function was measured by the Alzheimer’s disease assessment scale-cognitive subscale (ADAS-cog) and behavioral and psychological symptoms were mainly measured by Behavioral Pathology in Alzheimer’s Disease Rating Scale (BEHAVE-AD). DAAO level, amino acids (L-serine, D-serine, L-alanine, and D-alanine, glycine), and two antioxidants (catalase, superoxide dismutase) were assayed in peripheral blood.Results: After benzoate treatment, DAAO inhibition was correlated with ADAS-cog decrease (p = 0.034), while baseline DAAO level was correlated with baseline BEHAVE-AD score. Multiple linear regression analyses showed that cognitive improvement after benzoate treatment was correlated with DAAO decrease, female gender, younger age, BMI, baseline BPSD severity, and antipsychotic use.Conclusion: The finding suggests that sodium benzoate may have potential to benefit cognitive function in a fraction of BPSD patients after 6 weeks of treatment. Of note, the precision medicine approach may be helpful for identifying individuals who could respond to benzoate. More studies are warranted to confirm the preliminary findings.Trial Registration: The trial was registered online (https://clinicaltrials.gov/ct2/show/NCT02103673).Keywords: behavioral and psychological symptoms of dementia, BPSD, N-methyl-D-aspartate, D-amino acids oxidase, DAAO, inhibitor, sodium benzoate, precision medicine

Background: Behavioral and psychological symptoms of dementia (BPSD) have a large impact on the quality of life of patients with Alzheimer's disease (AD). Few studies have compared BPSD between early-onset (EOAD) and late-onset (LOAD) patients, finding conflicting results.Objective: The aims of this study were to: 1) characterize the presence, overall prevalence, and time of occurrence of BPSD in EOAD versus LOAD; 2) estimate the prevalence over time and severity of each BPSD in EOAD versus LOAD in three stages: pre-T0 (before the onset of the disease), T0 (from onset to 5 years), and T1 (from 5 years onwards); 3) track the manifestation of BPSD sub-syndromes (i.e., hyperactivity, psychosis, affective, and apathy) in EOAD versus LOAD at T0 and T1.Methods: The sample includes 1,538 LOAD and 387 EOAD diagnosed from 1996 to 2018. Comprehensive assessment batteries, including the Neuropsychiatric Inventory (NPI), were administered at the first medical assessment and at different follow-up period.Results: The overall prevalence for the most of BPSD was significantly higher in EOAD compared to LOAD whereas most BPSD appeared significantly later in EOAD patients. Between the two groups, from pre-T0 to T1 we recorded a different pattern of BPSD prevalence over time as well as for BPSD sub-syndromes at T0 and T1. Results on severity of BPSD did not show significant differences.Conclusion: EOAD and LOAD represent two different forms of a single entity not only from a neuropathological, cognitive, and functional level but also from a psychiatric point of view. [ABSTRACT FROM AUTHOR]

Background/Objective: Behavioral and psychological symptoms of dementia (BPSD) have been reported to affect caregiver burden in patients with dementia with Lewy bodies (DLB). However, the factor structure of BPSD and the factors that affect caregiver burden in DLB remain unknown. This study sought to classify BPSD and to reveal what type of BPSD affects caregiver burden in patients with DLB.Methods: We collected data on neuropsychiatric inventory-plus (NPI-plus), Zarit Burden Interview (ZBI), Mini-Mental State Examination (MMSE), Lawton's Instrumental Activities of Daily Living and Physical Self-Maintenance Scale (IADL/PSMS), age, and sex of 102 patients with probable DLB. An exploratory factor analysis of 13 items of the NPI-plus was carried out to classify BPSD. Multivariate regression analyses were conducted to extract the clinical variables related to caregiver burden, including factors resulting from the aforementioned factor analysis.Results: The mean age and MMSE score were 78.6 (5.6) and 20.2 (5.2), respectively. Factor analysis revealed four factors of “psychosis,” “affection,” “wakefulness,” and “hyperactivity.” “Psychosis” and “affection” factors as well as MMSE, IADL, and PSMS were significantly associated with ZBI. Multivariate regression analyses revealed that the total score of ZBI was associated with “psychosis,” “affection,” and IADL, that the personal strain score of ZBI was associated with “affection” and IADL, and that the role strain score of ZBI was associated with “wakefulness” and IADL.Conclusions: BPSD in DLB consists of three factors common to Alzheimer's disease and a specific “wakefulness” factor. In addition to IADL, each BPSD factor would affect caregiver burden in different ways in DLB.

Background/Objective: Behavioral and psychological symptoms of dementia (BPSD) have been reported to affect caregiver burden in patients with dementia with Lewy bodies (DLB). However, the factor structure of BPSD and the factors that affect caregiver burden in DLB remain unknown. This study sought to classify BPSD and to reveal what type of BPSD affects caregiver burden in patients with DLB. Methods: We collected data on neuropsychiatric inventory-plus (NPI-plus), Zarit Burden Interview (ZBI), Mini-Mental State Examination (MMSE), Lawton's Instrumental Activities of Daily Living and Physical Self-Maintenance Scale (IADL/PSMS), age, and sex of 102 patients with probable DLB. An exploratory factor analysis of 13 items of the NPI-plus was carried out to classify BPSD. Multivariate regression analyses were conducted to extract the clinical variables related to caregiver burden, including factors resulting from the aforementioned factor analysis. Results: The mean age and MMSE score were 78.6 (5.6) and 20.2 (5.2), respectively. Factor analysis revealed four factors of "psychosis," "affection," "wakefulness," and "hyperactivity." "Psychosis" and "affection" factors as well as MMSE, IADL, and PSMS were significantly associated with ZBI. Multivariate regression analyses revealed that the total score of ZBI was associated with "psychosis," "affection," and IADL, that the personal strain score of ZBI was associated with "affection" and IADL, and that the role strain score of ZBI was associated with "wakefulness" and IADL. Conclusions: BPSD in DLB consists of three factors common to Alzheimer's disease and a specific "wakefulness" factor. In addition to IADL, each BPSD factor would affect caregiver burden in different ways in DLB. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Behavioral and psychological symptoms of dementia (BPSD) influence older persons' quality of life (QoL). Non-pharmacological interventions such as individualized music (iM) is promising to mitigate BPSD. PURPOSE: To assess the impact of iM activity on affect, BPSD, QoL and antipsychotics administration of older persons with dementia living in residential care facilities and to understand residents, families and staff experiences in the use of iM activity. METHODS: We conducted a pilot study in one residential care facility in British Columbia, Canada and implemented a predetermined intervention of iM activities for older persons diagnosed with mild to moderate dementia. We collected data at baseline and follow-up via observations, surveys, and interviews. RESULTS: We observed an increase of emotions/ affect during and immediately after the iM intervention. Most participants improved QoL dimensions, while use of medications was mainly unchanged. Participants expressed lasting effects of music on residents' QoL and reduction of BPSD after the iM intervention; they suggested sustainability and continuous use of music activities. CONCLUSION: Individualized music activities may reduce BPSD and positively affect emotions, behavior and well-being of institutionalized older persons with dementia. Awareness of music effects can support continuous use and longer sessions of iM activities for sustainability of results. [ABSTRACT FROM AUTHOR]

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Objective·To evaluate the efficacy of transcranial magnetic stimulation (TMS) on cognitive function and behavioral and psychological of dementia (BPSD) in Alzheimer′s disease (AD) patients. Methods·Nine databases including China National Knowledge Infrastructure (CNKI), WanFang, VIP, Chinese Biomedical Literature Database (CBM), PubMed, Embase, the Cochrane Library and Chinese and American Clinical Trial Center were searched before November 2, 2019. English was searched with the topics of "Alzheimer′s disease" "transcranial magnetic stimulation" and "randomize controlled trial", and free words were retrieved. Chinese was searched with the topics of"阿尔茨海默病""经颅磁刺激""随机对照试验". According to the pre-established inclusion and exclusion criteria, the literatures were screened. RevMan 5.3 software was used. The standardized mean difference (SMD) was used as the effect value, and 95% confidence interval (CI) was used for interval estimation. Gradeprofile 3.2.2 software was used to evaluate the quality of evidence. Results·A total of 23 articles were included. In improving cognitive function, the evaluation results of AD Assessment Scale-Cognitive suggest that SMD of high frequency TMS group was -0.64 (95%CI -0.89 ‒ -0.40, P=0.000), SMD of low frequency TMS group was -0.58 (95%CI -1.12 ‒ -0.05, P=0.030). The Grade of evidence quality was very lower and lower respectively. When using Mini-Mental State Examination to evaluate cognitive function, it was divided into three subgroups according to TMS frequency (high or low, value) and treatment times. The results showed that SMD in high frequency TMS group was 1.30 (95% CI 0.76‒1.85, P = 0.000), but no significant difference was found in low frequency group. The Grade of evidence quality were both very lower. In 5 Hz group, SMD was 3.99 (95%CI 0.81~7.16, P=0.010) and the Grade evidence quality grade was very low. In the group of treatment times >40 and ≤60, SMD was 3.28 (95%CI 1.67‒4.90, P=0.000) and the Grade evidence quality grade was very low. In the aspect of improving BPSD, the Neuropsychiatric Inventory was used to evaluate, and the result was no statistically significant. The Grade evidence quality grade was very low. Behavioral Pathology in Alzheimer′s Disease Scale showed that SMD of high frequency group was -0.83 (95%CI -1.06‒ - 0.60, P=0.000), and there was no significance in low frequency group. The Grade evidence quality grade were low and very low respectively. Conclusion·TMS could improve the cognitive function of patients with AD, and high frequency was better than low frequency. The quality of evidence was lower. Whether the BPSD of AD patients were effective needs further research. In the future, more high-quality clinical multicenter randomized controlled trails should be included to study the efficacy and safety of TMS in the treatment of AD, so as to provide guidance for clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: Nursing home residents with dementia are sensitive to detrimental auditory environments. This paper presents the first literature review of empirical research investigating (1) the (perceived) intensity and sources of sounds in nursing homes, and (2) the influence of sounds on health of residents with dementia and staff.Design: A systematic review was conducted in PubMed, Web of Science and Scopus. Study quality was assessed with the Mixed Methods Appraisal Tool. We used a narrative approach to present the results.Results: We included 35 studies. Nine studies investigated sound intensity and reported high noise intensity with an average of 55-68 dB(A) (during daytime). In four studies about sound sources, human voices and electronic devices were the most dominant sources. Five cross-sectional studies focused on music interventions and reported positives effects on agitated behaviors. Four randomized controlled trials tested noise reduction as part of an intervention. In two studies, high-intensity sounds were associated with decreased nighttime sleep and increased agitation. The third study found an association between music and less agitation compared to other stimuli. The fourth study did not find an effect of noise on agitation. Two studies reported that a noisy environment had negative effects on staff.Conclusions: The need for appropriate auditory environments that are responsive to residents' cognitive abilities and functioning is not yet recognized widely. Future research needs to place greater emphasis on intervention-based and longitudinal study design. [ABSTRACT FROM AUTHOR]

IntroductionThe present pilot study examined to what extent the COVID-19 lockdown affected the behavioral and psychological symptoms of dementia (BPSD) in people with dementia and worsened their family caregivers’ distress. The associations between changes in the BPSD of relatives with dementia (RwD) and in their caregivers’ distress, and sense of social and emotional loneliness, and resilience were also investigated.Materials and MethodsThirty-five caregivers of RwD attending formal healthcare services before the COVID-19 lockdown volunteered for the study, and were interviewed by phone during the lockdown. Caregivers completed the NeuroPsychiatric Inventory (NPI) to assess their care recipients’ BPSD and their own distress, and two questionnaires assessing their social and emotional loneliness, and their resilience.ResultsNo clear changes emerged in either the BPSD of the RwD or the caregivers’ distress during lockdown compared with before the pandemic. Caregivers reporting more frequent and severe BPSD in their RwD before the lockdown scored higher on emotional loneliness. Those reporting more frequent and severe BPSD under lockdown, especially men and those taking care of RwD with more advanced dementia, scored higher on both social and emotional loneliness. A significant negative correlation also emerged between caregivers’ resilience and changes in their level of distress due to the lockdown, with female caregivers reporting greater resilience.DiscussionOur findings offer preliminary insight on the effects of loneliness and resilience, and on the influence of individual characteristics on the experience and consequences of informal caregiving for RwD in times of restrictions imposed by a pandemic.

Introduction: The present pilot study examined to what extent the COVID-19 lockdown affected the behavioral and psychological symptoms of dementia (BPSD) in people with dementia and worsened their family caregivers' distress. The associations between changes in the BPSD of relatives with dementia (RwD) and in their caregivers' distress, and sense of social and emotional loneliness, and resilience were also investigated. Materials and Methods: Thirty-five caregivers of RwD attending formal healthcare services before the COVID-19 lockdown volunteered for the study, and were interviewed by phone during the lockdown. Caregivers completed the NeuroPsychiatric Inventory (NPI) to assess their care recipients' BPSD and their own distress, and two questionnaires assessing their social and emotional loneliness, and their resilience. Results: No clear changes emerged in either the BPSD of the RwD or the caregivers' distress during lockdown compared with before the pandemic. Caregivers reporting more frequent and severe BPSD in their RwD before the lockdown scored higher on emotional loneliness. Those reporting more frequent and severe BPSD under lockdown, especially men and those taking care of RwD with more advanced dementia, scored higher on both social and emotional loneliness. A significant negative correlation also emerged between caregivers' resilience and changes in their level of distress due to the lockdown, with female caregivers reporting greater resilience. Discussion: Our findings offer preliminary insight on the effects of loneliness and resilience, and on the influence of individual characteristics on the experience and consequences of informal caregiving for RwD in times of restrictions imposed by a pandemic. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of medication reviews using collegial mentoring and systematic clinical evaluation on psychotropic prescriptions, behavioral and psychological symptoms of dementia (BPSD), and activities of daily living (ADL).Design: Four-month multicenter, multicomponent, cluster-randomized, single-blinded controlled trial.Setting: Thirty-three Norwegian nursing homes including 67 nursing home wards (clusters).Participants: A total of 723 enrolled patients, of which 428 participated in the study; 217 were randomized to the intervention and 211 to care as usual (control).Intervention: The COSMOS intervention consisted of Communication, Systematic pain management, Medication reviews, Organization of activities, and Safety. During medication review, the nursing home physician evaluated treatment with colleagues systematically using the results from validated clinical assessments.Measurements: Mean changes from baseline to month 4 in the number of prescribed psychotropic drugs (antipsychotics, anxiolytics, hypnotics or sedatives, antidepressants, and antidementia drugs); Neuropsychiatric Inventory Nursing Home Version (NPI-NH) and Cornell Scale of Depression in Dementia (CSDD); Lawton and Brody's Physical Self Maintenance Scale (PSMS).Results: Compared to control, the mean change in prescribed psychotropic drugs was reduced both in total and regular number, while mean changes in NPI-NH and CSDD scores did not differ between the groups. Mean change in PSMS showed improvement in the intervention group, and deterioration in the control group.Conclusion: Medication reviews using collegial mentoring and systematic clinical evaluation led to safe deprescribing, as the reductions in psychotropic drug use did not negatively affect BPSD, while ADL improved. [ABSTRACT FROM AUTHOR]

• A number of modifiable factors were identified to be related to anxiety in PWD. • Socio-ecological model was used to classify associated factors. • Factors were found at the individual level, caregiver level, and environment level. The purpose of this integrative review was to examine factors related to the presence of anxiety in person with dementia (PWD) and to identify potentially modifiable factors among them. An integrative review was conducted using PsycINFO, CINAHL, AgeLine, PubMed, Embase, Web of Science, and Scopus. Among 1856 studies identified, 27 studies were included. A number of modifiable factors associated with anxiety were identified. Individual level factors included pain, physical health, physical functioning, fatigue, sleep disturbance, disclosure of diagnosis, embarrassment about memory problems, separation from caregivers, views about oneself and others, social rejection, social isolation, and interactions with others. Caregiver factors associated with anxiety in PWD included caregiver stress, caregiver's negative reactions towards the behavioral problems of PWD, and competence about caregiving. The results of this review can be used to identify potential targets for interventions to reduce for anxiety in persons with dementia. [ABSTRACT FROM AUTHOR]

We investigated the cognitive function, behavioral and psychological symptoms of dementia (BPSD), and activities of daily living (ADLs) of elderly individuals admitted in care facilities. Moreover, the factors affecting the care burden experienced by facility staffs were examined. Method: 24 care facilities for elderly individuals participated in the study. The Revised Hasegawa Dementia Scale (HDS-R), Japanese version of the Neuropsychiatric Inventory (NPI), and Crichton Geriatric Behavioral Rating Scale (CGBRS) were used to evaluate cognitive function, BPSD, and ADL, respectively. The short Japanese version of the Zarit Burden Interview was used to assess the care burden. A multiple regression analysis was conducted with data obtained from 464 elderly individuals who fulfilled all the scales. Results: The care burden was correlated to the scores of HDS-R, but not with those of dysphoria/depression and disinhibition of NPI, restlessness of CGBRS, and subjective mood of CGBRS (R2 = 0.309, p < 0.005). Conclusion: Dysphoria/depression, disinhibition, restlessness, and subjective mood, but not cognitive decline, have an effect on the care burden experienced by facility staffs who manage elderly individuals. These results indicated that the appropriate diagnosis and treatment of BPSD are important in reducing the burden of facility staffs. [ABSTRACT FROM AUTHOR]

• Tg mouse models of AD show social withdrawal and depressive-like behaviours with age. • Tg mouse models of AD show early sleep-wake disturbances and increased aggression. • Tg mouse models of AD show mixed results concerning generalized apathy or anxiety. • Tg mouse models of AD are an important tool to study biological mechanisms of BPSD. Transgenic mouse models have been used extensively to model the cognitive impairments arising from Alzheimer's disease (AD)-related pathology. However, less is known about the relationship between AD-related pathology and the behavioural and psychological symptoms of dementia (BPSD) commonly presented by patients. This review discusses the BPSD-like behaviours recapitulated by several mouse models of AD-related pathology, including the APP/PS1, Tg2576, 3xTg-AD, 5xFAD, and APP23 models. Current evidence suggests that social withdrawal and depressive-like behaviours increase with progressive neuropathology, and increased aggression and sleep-wake disturbances are present even at early stages; however, there is no clear evidence to support increased anxiety-like behaviours, agitation (hyperactivity), or general apathy. Overall, transgenic mouse models of AD-related pathology recapitulate some of the BPSD-like behaviours associated with AD, but these behaviours vary by model. This reflects the patient population, where AD patients typically exhibit one or more BPSD, but rarely all symptoms at once. As a result, we suggest that transgenic mouse models are an important tool to investigate the pathology underlying BPSD in human AD patients. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to provide an overview of the recent research on android robotic media with a focus on its effects on older adults and to present a discussion on the implications of the experimental results. Social isolation of older adults is a leading issue in healthcare. Patients with dementia experience symptoms, such as agitation, which can result in increasing care burden. Android robotic media have been shown to provide a feeling of safety and communication support to older adults. In previous case studies, an increase in prosocial behaviors was observed in participants with dementia; however, the media effects needed to be measured by assessment scales. The current results indicate the effects of robotic media on dementia symptoms, especially the decrease in patients' anxiety. As demonstrated in another experiment, anxiety reduction can also be expected in healthy older adults; however, certain conditions may be required for both healthy older adults and those with dementia. Key factors for the media effect, namely, dementia type, user's personality, and personalized dialogue are taken into consideration for the further development of robotic systems. Additionally, we further discuss the significance of long-term data collection, especially from the early life stages because teleoperation or autonomous systems are expected to utilize information that can affect the effect of robotic media. [ABSTRACT FROM AUTHOR]

A pangenome is composed of all the genetic variability of a group of individuals, and its application to the study of neurodegenerative diseases may provide valuable insights into the underlying aspects of genetic heterogenetiy for these complex ailments, including gene expression, epigenetics, and translation mechanisms. Furthermore, a reference pangenome allows for the identification of previously undetected structural commonalities and differences among individuals, which may help in the diagnosis of a disease, support the prediction of what will happen over time (prognosis) and aid in developing novel treatments in the perspective of personalized medicine. Therefore, in the present review, the application of the pangenome concept to the study of neurodegenerative diseases will be discussed and analyzed for its potential to enable an improvement in diagnosis and prognosis for these illnesses, leading to the development of tailored treatments for individual patients from the knowledge of the genomic composition of a whole population. • Pangenomics can detect undisclosed aspects of genetic variability in neurodegeneration. • The complexity of neurodegenerative diseases can be more easily disentangled with population-based information. • Personalized medicine can leverage knowledge from pan-omic methods to inform tailored treatments. • Identification of novel variability among subjects may improve diagnosis, prognosis, and care in neurodegeneration. [ABSTRACT FROM AUTHOR]