Advancing Research on Care Needs and Supportive Approaches for Persons With Dementia: Recommendations and Rationale

Kolanowski, Ann; Fortinsky, Richard H.; Calkins, Margaret P.; Devanand, Davangere P.; Gould, Edwin W.; Heller, Tamar; Hodgson, Nancy; Kales, Helen C.; Kaye, Jeffrey; Lyketsos, Constantine G.; Resnick, Barbara; Schicker, Melanie; Zimmerman, Sheryl

doi:10.1016/j.jamda.2018.07.005

Cited by 51 publications

(51 citation statements)

References 76 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Delirium can be burdensome for patient and caregiver owing to the subjective distress (ie, fear, anxiety, suffering) associated with the experiential, emotional, and situational aspects of delirium . ADRD also adversely impacts the health, socialization, and finances of caregivers, with elevated stress levels in nearly 60%, depression in 40%, and other burdens . Delirium and ADRD often coexist, but the effect of delirium burden on ADRD patients, and their caregivers, has not been well studied.…”

mentioning

confidence: 99%

See 1 more Smart Citation

The Caregiver Burden of Delirium in Older Adults With Alzheimer Disease and Related Disorders

Fong

Racine

Fick

et al. 2019

J American Geriatrics Society

View full text Add to dashboard Cite

Objectives: To measure the burden of delirium in older adults with or without Alzheimer disease or related disorders (ADRD) Design: Prospective, observational cohort Setting: Inpatient hospital, study participants’ homes Participants: A subset (n=267) of older medical and surgical patients and their caregivers enrolled in the Better Assessment of Illness (BASIL) study Measurements: Delirium burden was measured using the DEL-B instrument (range 0-40, higher scores indicate greater burden) in caregivers (DEL-B-C) and patients (DEL-B-P) one-month after hospitalization. Severity of cognitive impairment (Montreal Cognitive Assessment, MoCA), delirium presence (Confusion Assessment Method, CAM) and delirium severity (CAM-Severity, CAM-S) were measured during hospitalization and at one-month followup. ADRD diagnosis was determined by a clinical consensus process. Results: For patients with (n=56) and without (n=211) ADRD, both DEL-B instruments had good internal consistency. DEL-B-C scores had a median (interquartile range, IQR) among caregivers of patients with and without ADRD of 9 (5-15) and 5 (1-11), respectively (p<0.05). If the patient developed delirium, caregivers experienced greater burden (β[delirium×ADRD]=−0.29, p=.42), regardless of ADRD status. Further, caregiver burden was modestly correlated with patient MoCA scores (Spearman correlation coefficient, rho=−.18, p=.01). Patients with ADRD who developed delirium self-reported less burden than those without ADRD (β[delirium×ADRD]=−0.67, p=.044). As with caregivers, delirium burden was modestly correlated with patient MoCA score (rho=−.18, p=.005) and correlated with the CAM-S in patients without ADRD (rho=.38, p<.001) but not for patients with ADRD (rho=−.07, p=.61). Conclusions: Delirium resulted in the same degree of increased caregiver burden regardless of whether or not a patient had ADRD, signifying delirium is equally stressful to caregivers, even among those with experience caring for someone with a chronic cognitive disorder. Delirium burden is only modestly associated with degree of cognitive impairment, suggesting that other aspects of delirium contribute to burden.

show abstract

mentioning

confidence: 99%

“…7 ADRD also adversely impacts the health, socialization, and finances of caregivers, 9 with elevated stress levels in nearly 60%, depression in 40%, 10 and other burdens. 11,12 Delirium and ADRD often coexist, but the effect of delirium burden on ADRD patients, and their caregivers, has not been well studied.…”

mentioning

confidence: 99%

The Caregiver Burden of Delirium in Older Adults With Alzheimer Disease and Related Disorders

Fong

Racine

Fick

et al. 2019

J American Geriatrics Society

View full text Add to dashboard Cite

show abstract

“…Dementia is a non-curable syndrome which over time leads to a progressive decrease in memory, thinking, and the capacity to perform everyday activities [ 1 ]. There are alternative forms of dementia which include vascular dementia, dementia with Lewy bodies, and frontotemporal dementia [ 2 ], which can be provoked by neurodegenerative disorders, cerebrovascular disease, brain injury [ 3 ], and infections [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

The Microbiota–Gut–Brain Axis and Alzheimer’s Disease: Neuroinflammation Is to Blame?

et al. 2020

View full text Add to dashboard Cite

For years, it has been reported that Alzheimer’s disease (AD) is the most common cause of dementia. Various external and internal factors may contribute to the early onset of AD. This review highlights a contribution of the disturbances in the microbiota–gut–brain (MGB) axis to the development of AD. Alteration in the gut microbiota composition is determined by increase in the permeability of the gut barrier and immune cell activation, leading to impairment in the blood–brain barrier function that promotes neuroinflammation, neuronal loss, neural injury, and ultimately AD. Numerous studies have shown that the gut microbiota plays a crucial role in brain function and changes in the behavior of individuals and the formation of bacterial amyloids. Lipopolysaccharides and bacterial amyloids synthesized by the gut microbiota can trigger the immune cells residing in the brain and can activate the immune response leading to neuroinflammation. Growing experimental and clinical data indicate the prominent role of gut dysbiosis and microbiota–host interactions in AD. Modulation of the gut microbiota with antibiotics or probiotic supplementation may create new preventive and therapeutic options in AD. Accumulating evidences affirm that research on MGB involvement in AD is necessary for new treatment targets and therapies for AD.

show abstract

“…NPS are often considered as medication targets in cases where NPS are appropriately detected by clinicians [11]. This leads to high rates of (off-label) psychotropic medication prescriptions that are only modestly effective in dementia [20].…”

Section: Introductionmentioning

confidence: 99%

“…This leads to high rates of (off-label) psychotropic medication prescriptions that are only modestly effective in dementia [20]. In addition, this symptomatic treatment does not do justice to the multiple contributors causing NPS, including factors relating to the patient (e.g., personality), caregiver (e.g., communication style), and environment (e.g., safety) [11, 21, 22]. Therefore, a patient-centered care (PCC) approach is preferred that considers all these individual factors when managing NPS [1, 17, 23].…”

Section: Introductionmentioning

confidence: 99%

Early recognition and treatment of neuropsychiatric symptoms to improve quality of life in early Alzheimer’s disease: protocol of the BEAT-IT study

Eikelboom

Singleton²,

Berg

et al. 2019

Alz Res Therapy

View full text Add to dashboard Cite

Background Neuropsychiatric symptoms (NPS) are very common in patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) dementia and are associated with various disadvantageous clinical outcomes including a negative impact on quality of life, caregiver burden, and accelerated disease progression. Despite growing evidence of the efficacy of (non)pharmacological interventions to reduce these symptoms, NPS remain underrecognized and undertreated in memory clinics. The BEhavioural symptoms in Alzheimer’s disease Towards early Identification and Treatment (BEAT-IT) study is developed to (1) investigate the neurobiological etiology of NPS in AD and (2) study the effectiveness of the Describe, Investigate, Create, Evaluate (DICE) approach to structure and standardize the current care of NPS in AD. By means of the DICE method, we aim to improve the quality of life of AD patients with NPS and their caregivers who visit the memory clinic. This paper describes the protocol for the intervention study that incorporates the latter aim. Methods We aim to enroll a total of 150 community-dwelling patients with MCI or AD and their caregivers in two waves. First, we will recruit a control group who will receive care as usual. Next, the second wave of participants will undergo the DICE method. This approach consists of the following steps: (1) describe the context in which NPS occur, (2) investigate the possible causes, (3) create and implement a treatment plan, and (4) evaluate whether these interventions are effective. Primary outcomes are the quality of life of patients and their caregivers. Secondary outcomes include NPS change, caregiver burden, caregivers’ confidence managing NPS, psychotropic medication use, the experiences of patients and caregivers who underwent the DICE method, and the cost-effectiveness of the intervention. Conclusions This paper describes the protocol of an intervention study that is part of the BEAT-IT study and aims to improve current recognition and treatment of NPS in AD by structuring and standardizing the detection and treatment of NPS in AD using the DICE approach. Trial registration The trial was registered on the Netherlands Trial Registry ( NTR7459 ); registered 6 September 2018.

show abstract

Advancing Research on Care Needs and Supportive Approaches for Persons With Dementia: Recommendations and Rationale

Cited by 51 publications

References 76 publications

The Caregiver Burden of Delirium in Older Adults With Alzheimer Disease and Related Disorders

The Caregiver Burden of Delirium in Older Adults With Alzheimer Disease and Related Disorders

The Microbiota–Gut–Brain Axis and Alzheimer’s Disease: Neuroinflammation Is to Blame?

Early recognition and treatment of neuropsychiatric symptoms to improve quality of life in early Alzheimer’s disease: protocol of the BEAT-IT study

Contact Info

Product

Resources

About