Apathy and Its Response to Antipsychotic Review and Nonpharmacological Interventions in People With Dementia Living in Nursing Homes: WHELD, a Factorial Cluster Randomized Controlled Trial

Rajkumar, Anto P.; Ballard, Clive; Fossey, Jane; Corbett, Anne; Woods, Bob; Orrell, Martin; Prakash, Rohan; Moniz-Cook, Esmé; Testad, Ingelin

doi:10.1016/j.jamda.2016.04.006

Cited by 23 publications

(21 citation statements)

References 36 publications

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“…In the study by Manera et al, participants reported a preference for the virtual reality (VR) condition vs the paper condition, even if the task was more difficult. In a cluster RCT by Rajkumar et al, antipsychotic review in combination with either social interaction or exercise significantly reduced NPI‐NH apathy scores in demented patients living in nursing homes. In the pilot RCT by Sanchez et al, a positive effect was observed on neuropsychiatric symptoms and dementia severity in the MSS environment (MSSE) treatment vs the activity group.…”

Section: Resultsmentioning

confidence: 98%

“…Furthermore, Treusch et al suggested that the use of physical activation and biography‐orientated mobilization could motivate demented patients. Moreover, Brodaty and Burns propose that individually provided therapeutic activities may have the best available evidence for effectiveness in dementia. Additionally, education is necessary to assist families in understanding apathy, as apathetic patients are often characterized lazy or oppositional …”

Section: Discussionmentioning

confidence: 99%

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A systematic review of non‐pharmacological treatments for apathy in dementia

Theleritis

Siarkos

Politis

et al. 2017

Int J Geriat Psychiatry

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Section: Resultsmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

A systematic review of non‐pharmacological treatments for apathy in dementia

Theleritis

Siarkos

Politis

et al. 2017

Int J Geriat Psychiatry

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“…Fifteen of seventeen studies of tailored activity and eight of the nine studies using non-tailored activity reported a positive or partly positive outcome (481). In the Improving Well-being and Health for People with Dementia (WHELD) study, antipsychotic review combined with social activity or exercise led to a reduction in apathy as a secondary outcome (482). The ADMET (Alzheimer's Disease Methylphenidate Trial) with 60 people given 20 mg methylphenidate or placebo found no difference in the apathy evaluation scale but more people in the intervention group rated as mildly to markedly improved (483) Therefore, although there are no definitive trials on management of apathy, there is an indication that interventions that increase activity or methylphenidate may be helpful.…”

Section: Apathymentioning

confidence: 99%

Dementia prevention, intervention, and care

et al. 2017

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People with dementia are usually older, often have co-morbidities and may need help in coping with these illnesses. A third of older people now die with dementia and all professionals working in endof-life care need to make this a central part of their planning and communication. In this commission, we have detailed evidence-based approaches to dementia and its symptoms. Services should be available, scalable and give value. As there are limited resources, professionals and services need to use what works, not use what is ineffective, and be aware of the difference. Overall, there is good potential for prevention and, once someone develops dementia, for care to be high-quality, accessible, and give value to an under-served, growing population. Effective dementia prevention and care could transform the future for society and vastly improve living and dying for individuals with dementia and their families. Acting now on what we already know can make this difference happen. Key Messages 1 There are increasing numbers of people with dementia globally although incidence in some countries has decreased. 2 Be ambitious about prevention: We recommend energetically treating hypertension in middle aged and older people without dementia to reduce dementia incidence. Interventions for other risk factors, including more childhood education, exercise, maintaining social engagement, reducing smoking, and management of hearing loss, depression, diabetes and obesity; may have the potential of delaying or preventing a third of dementias. 3 Treat cognitive symptoms: To maximise cognition, people with Alzheimer's dementia or Dementia with Lewy Bodies should be offered Cholinesterase Inhibitors (ChEIs)at all stages, or memantine for severe dementia. ChEIs are not effective in Mild Cognitive Impairment. 4 Individualise dementia care: Good dementia care spans medical, social and supportive care, should be tailored to unique individual and cultural needs, preferences, priorities, and should incorporate support for the family carers 5 Care for family carers. Family carers are at high risk of depression. Effective interventions reduce the risk and treat the symptoms, include START (Strategies for Relatives) or REACH (Resources for Enhancing Alzheimer's Caregiver Health intervention) and should be made available. 6 Plan for the future. People with dementia and their families value discussions about the future and decisions about possible attorneys to make decisions. Clinicians should consider capacity to make different types of decisions at diagnosis. 7 Protect people with dementia. People with dementia and society require protection from possible risks of the condition, including self-neglect, vulnerability including to exploitation, managing money, driving or using weapons. Risk assessment and management at all stages of the disease is essential but it should be balanced against the persons' right to autonomy. 8 Manage neuropsychiatric symptoms. Management of the neuropsychiatric symptoms of dementia including agitation, low mood or psyc...

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“…Prevailing evidence does not support the use of antipsychotic medications for treating apathy in PD, but stopping long-term antipsychotic medication may lead to worsening of apathy [166].…”

Section: Managementmentioning

confidence: 99%

Assessment and Management of Neuropsychiatric Symptoms in Parkinson’s Disease

et al. 2018

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Neuropsychiatric symptoms are highly prevalent in Parkinson's disease and associated with decreased quality of life and adverse health outcomes. In this review, the assessment and management of common neuropsychiatric symptoms are discussed: depression, anxiety, psychosis, cognitive impairment, dementia and apathy. Validated assessment scales are now available for the majority of symptoms. Balancing dopaminergic therapy plays an important role in their management as increasing doses of dopaminergic agents might address depression and anxiety related to 'off' phases, non-motor fluctuations and apathy, while dose reduction might alleviate psychotic symptoms. More targeted treatment is possible through medications utilising different pathways. Although efficacy profiles of individual agents require further exploration, antidepressants as a drug class have shown utility in depression and anxiety in Parkinson's disease. Psychological therapies, especially cognitive behavioural approaches, are effective. Pimavanserin allows the treatment of psychosis in Parkinson's disease without directly affecting the dopaminergic and cholinergic system. The cholinergic system is currently the only target in Parkinson's disease dementia, and antagonists of this system, as are many psychotropic drugs, need to be used with caution. Management of apathy largely relies on non-pharmacological strategies adapted from dementia care, with antidepressants being ineffective and the role of stimulant therapy needing further evaluation.

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Apathy and Its Response to Antipsychotic Review and Nonpharmacological Interventions in People With Dementia Living in Nursing Homes: WHELD, a Factorial Cluster Randomized Controlled Trial

Abstract: Antipsychotic review can play a significant role in improving apathy in people with dementia living in nursing homes, when combined with psychosocial interventions such as social interaction and exercise. Guidance must be adapted to reflect this subtlety in care.

Cited by 23 publications

References 36 publications

A systematic review of non‐pharmacological treatments for apathy in dementia

A systematic review of non‐pharmacological treatments for apathy in dementia

Dementia prevention, intervention, and care

Assessment and Management of Neuropsychiatric Symptoms in Parkinson’s Disease

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