The Latest Articles on Behavioral and Psychological Symptoms in Dementia

Our staff editors continue to share exciting, interesting, and thought-provoking reading material in the recommended articles series.

This week, we would like to share several latest articles on Behavioral and Psychological Symptoms in Dementia.

Title: Using Academic Detailing to Enhance the Knowledge, Skills, and Attitudes of Clinicians Caring for Persons With Behavioral and Psychological Symptoms of Dementia
Authors: Art Walaszek MD, Tammi Albrecht DNP, Molly Schroeder CSW, Tamara J. LeCaire MS, PhD, Stephanie Houston MBA, Miguel Recinos BA, Cynthia M. Carlsson MD, MS
Type: Research Article
Abstract:

Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent in long-term care settings. We sought to enhance the knowledge, skills, and attitudes of primary care clinicians caring for patients with BPSD through academic detailing, an evidence-based approach for persuading health care professionals to make changes in their practice. We implemented academic detailing among physicians and nurse practitioners in 2 primary care settings, one an urban center serving a largely Black community and another a rural center serving a largely White community, within primary care–integrated dementia diagnostic clinics. Each of the 11 academic detailing visits included didactic content, case discussion, and patient consultation. Outcome measures included assessments of clinicians’ knowledge, confidence, and acceptability of the intervention. Of 15 providers who participated at baseline, 13 participated in 1 or more academic detailing visits in the next 18 months, 12 completed a 6-month assessment, and 7 completed an 18-month assessment. Knowledge and attitudes about BPSD increased during the program, and there was high satisfaction with the program. Academic detailing thus is a feasible way of improving self-reported knowledge, skills, and attitudes of primary care clinicians caring for patients with BPSD. We plan to scale up the intervention to assess the impact on patient and caregiver outcomes.
Access this article: https://doi.org/10.1016/j.jamda.2023.09.005

Title: Home-based family caregiver-delivered music and reading interventions for people living with dementia (HOMESIDE trial): an international randomised controlled trial
Authors: Felicity Anne Baker, Vanessa Pac Soo, Jodie Bloska, Laura Blauth, Anna A. Bukowska, Libby Flynn, Ming Hung Hsu, Edyta Janus, Kjersti Johansson, Tone Kvamme, Nicola Lautenschlager, Hayley Miller, Jonathan Pool, Agnieszka Smrokowska-Reichmann, Karette Stensæth, Kate Teggelove, Sven Warnke, Thomas Wosch, Helen Odell-Miller, Karen Lamb, Sabine Braat, Tanara Vieira Sousa, Jeanette Tamplin
Type: Research Article
Abstract:

Background
Music interventions provided by qualified therapists within residential aged care are effective at attenuating behavioural and psychological symptoms (BPSD) of people with dementia (PwD). The impact of music interventions on dementia symptom management when provided by family caregivers is unclear.

Methods
We implemented a community-based, large, pragmatic, international, superiority, single-masked randomised controlled trial to evaluate if caregiver-delivered music was superior to usual care alone (UC) on reducing BPSD of PwD measured by the Neuropsychiatric Inventory-Questionnaire (NPI-Q). The study included an active control (reading). People with dementia (NPI-Q score ≥6) and their caregiver (dyads) from one of five countries were randomly allocated to caregiver-delivered music, reading, or UC with a 1:1:1 allocation stratified by site. Caregivers received three online protocolised music or reading training sessions delivered by therapists and were recommended to provide five 30-min reading or music activities per week (minimum twice weekly) over 90-days. The NPI-Q severity assessment of PwD was completed online by masked assessors at baseline, 90- (primary) and 180-days post-randomisation and analysed on an intention-to-treat basis using a likelihood-based longitudinal data analysis model. ACTRN12618001799246; ClinicalTrials.gov NCT03907748.

Findings
Between 27th November 2019 and 7th July 2022, we randomised 432 eligible of 805 screened dyads (music n = 143, reading n = 144, UC n = 145). There was no statistical or clinically important difference in the change from baseline BPSD between caregiver-delivered music (−0.15, 95% CI −1.41 to 1.10, p = 0.81) or reading (−1.12, 95% CI −2.38 to 0.14, p = 0.082) and UC alone at 90-days. No related adverse events occurred.

Interpretation
Our findings suggested that music interventions and reading interventions delivered by trained caregivers in community contexts do not decrease enduring BPSD symptoms.

Funding
Our funding was provided by National Health and Medical Research Council, Australia; The Research Council of Norway; Federal Ministry of Education and Research, Germany; National Centre for Research and Development, Poland; Alzheimer’s Society, UK, as part of the Joint Programme for Neurodegenerative Diseases consortia scheme.
Access this article: https://doi.org/10.1016/j.eclinm.2023.102224

Title: Informant-rated change in personality traits, psychological distress, well-being, and social connection with dementia
Authors: Angelina R. Sutin, Martina Luchetti, Yannick Stephan, Antonio Terracciano
Type: Research Article
Abstract:

Objective
Studies of retrospective personality change with dementia consistently find caregivers report large changes in personality (e.g., increases in neuroticism) of their care recipients compared to before dementia. This work seeks to replicate the established pattern of personality change, extend it to change in psychological distress, well-being, and social connection, and evaluate whether changes vary by stage of dementia.

Methods
Caregivers of people with dementia (N = 188) reported on the psychological and social health of their care recipient currently and how they were before they developed dementia. Personality was measured as five factor model traits. Psychological distress was measured as symptoms of depression and anxiety, perceived stress, and pessimism. Psychological well-being was measured as purpose in life, life satisfaction, happiness, self-efficacy, and optimism. Social connection was measured as loneliness, belonging, social support, and social strain.

Results
There were substantial increases in neuroticism (d = 1.14) and decreases in the other four personality traits (d range=–0.85 to –1.37). There were significant increases in psychological distress (e.g., d = 1.07 for depression) and substantial decreases in well-being (e.g., d=–1.18 for purpose in life) and social connection (e.g., d=–1.12 for belonging). Change was apparent across dementia stage and generally larger in more severe dementia.

Discussion
In addition to personality, there are large retrospective changes in psychological distress, well-being, and social connection with dementia. These quantitative findings complement clinical observations of the natural history of psychosocial changes in people with dementia, and can inform families, clinicians, and researchers on commonly observed changes and improve interventions to mitigate dementia burden.
Access this article: https://doi.org/10.1016/j.archger.2023.105218

Title: Antipsychotic Drug Reduction through the Implementation of a Neurologically Oriented, Interdisciplinary Psycho-Diagnostic and Antipsychotic Stewardship Program
Authors: Steven L. Posar MD, Anita Reid MSN, APRN, FNP, GNP, Daniel M. Heiser PsyD, Jose Pinon MD, Janean Kinzie MSW
Type: Research Article
Abstract:

Antipsychotic utilization in skilled nursing facilities (SNFs) is a major focus of regulatory compliance and a key theme in resident care. This created opportunities for innovations in clinical care of behavioral and psychological symptoms of dementia (BPSD). In a shared initiative with one of our SNF operators, the authors implemented a joint clinician/facility program focused on rigorous clinical diagnosis and “best practices” in clinical care, specifically aimed at assessing and reducing antipsychotic use where appropriate.
Access this article: https://doi.org/10.1016/j.jamda.2023.08.025

Title: Adjunctive transcranial direct current stimulation (tDCS) plus sodium benzoate for the treatment of early-phase Alzheimer's disease: A randomized, double-blind, placebo-controlled trial
Authors: Hsien-Yuan Lane, Shi-Heng Wang, Chieh-Hsin Lin
Type: Research Article

Abstract:

Previous studies found that an NMDA receptor (NMDAR) enhancer, sodium benzoate, improved cognitive function of patients with early-phase Alzheimer's disease (AD). Transcranial direct current stimulation (tDCS) induces NMDAR-dependent synaptic plasticity and strengthens cognitive function of AD patients. This study aimed to evaluate efficacy and safety of tDCS plus benzoate in early-phase dementia. In this 24-week randomized, double-blind, placebo-controlled trial, 97 patients with early-phase AD received 10-session tDCS during the first 2 weeks. They then took benzoate or placebo for 24 weeks. We assessed the patients using Alzheimer's disease assessment scale - cognitive subscale (ADAS-cog), Clinician's Interview-Based Impression of Change plus Caregiver Input, Mini Mental Status Examination, Alzheimer's disease Cooperative Study scale for ADL in MCI, and a battery of additional cognitive tests. Forty-seven patients received sodium benzoate, and the other 50 placebo. The two treatment groups didn't differ significantly in ADAS-cog or other measures. Addition of benzoate to tDCS didn't get extra benefit or side effect in this study. For more thoroughly studying the potential of combining tDCS with benzoate in the AD treatment, future research should use other study designs, such as longer-term benzoate treatment, adding benzoate in the middle of tDCS trial sessions, or administering benzoate then tDCS.

Access this article: https://doi.org/10.1016/j.psychres.2023.115461