Treatment for agitation in dementia patients: A behavior management approach.

This article presents a standardized, social-learning-based, behavioral approach to the treatment of agitation in patients with dementia. It describes a multisite, randomized, controlled clinical trial designed to evaluate this approach and illustrates the use of this approach in 4 cases from 3 different sites. 41 patients with a diagnosis of probable or possible Alzheimer's disease (AD) participated. Treatment consisted of 8 weekly and 3 biweekly sessions for a total of 11 sessions over 16 weeks. Throughout treatment, therapists helped caregivers identify and modify "target" behaviors; behaviors associated with agitation that were distressing to the caregiver and/or patient. Videotapes provided didactic information and practical examples of problem-solving, and supplemental take-home reading materials were provided. Results from the case studies of a 71-yr-old man and 3 women, aged 55, 71, and 79 yrs, indicate that the structured behavioral approach appears successful in helping caregivers modify the agitated behaviors of patients with AD. These cases also illustrate the diversity of problems and the creativity needed by therapists, even with a structured approach, and the importance of a committed, involved caregiver. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interventions for decreasing agitation in persons with dementia

The specific activity of the microsomal delta 12-desaturase system, which transforms oleic acid into linoleic acid, was about 16 pmol/min/mg protein. However, most of the total activity was nonsedimentable even after a 200000 x g centrifugation for 100 min. The study of various physicochemical parameters showed that this enzymatic complex, functioning optimally between pH 7 and 8, had low thermal stability. Ca2+ which may cause an aggregation of the microsomes, and Hg2+ completely inhibited the activity, whereas Mg2+, Mn2+, and Zn2+ were activators. The delta 12-desaturase system was relatively specific toward oleic acid, though isomers of this fatty acid also had an action, either as substrates or as competitive inhibitors, on the activity of the system. The study of the effect of the exogenous oleoyl-CoA and elaidoyl-CoA on the specific activity of the delta 12-desaturase system showed a preference toward oleoyl-CoA.     

Effect of carbamazepine on agitation in Alzheimer's inpatients refractory to neuroleptics

BACKGROUND: Agitation in Alzheimer's disease remains a principal problem in the clinical management of elderly patients. Neuroleptic medication appears to have modest efficacy in controlling behavioral symptoms in dementia patients. Carbamazepine has been reported to decrease agitation associated with various psychiatric disorders and to reduce neuroleptic side effects. METHOD: In an open prospective study, the effects of carbamazepine on agitation, hostility, and uncooperativeness were investigated in 15 severely demented Alzheimer's inpatients who had failed to respond to prior treatment with neuroleptics. Depending on clinical efficacy and tolerability of carbamazepine treatment, concomitant medication with haloperidol was initiated. Severity of psychopathologic symptoms was assessed by the Brief Psychiatric Rating Scale during the study period of 4 weeks. RESULTS: In 2 subjects, carbamazepine treatment was discontinued because of leukopenia and allergic reactions. A significant improvement in factor scores activation and hostility was observed after 4 weeks. Ten patients received concomitant medication with haloperidol. CONCLUSION: Carbamazepine may be effective in treating agitation in severely demented Alzheimer's inpatients refractory to neuroleptic medication alone. The combination of carbamazepine and haloperidol seems to be promising in clinical management of elderly Alzheimer's patients.     

Dementia, agitation, and care in the nursing home

OBJECTIVE: To examine the behavioral and functional problems of the cognitively impaired. DESIGN: A survey of a cohort of residents from six nursing homes. PARTICIPANTS: Subjects were randomly selected based on a minimum age of 70 years and a Resource Utilization Group (RUG) classification of the Physical or Behavioral type. Of those eligible, 44% (n = 366) agreed to participate. The participants and non-participants had similar demographics except for a higher incidence of mental illness in the non-participant group, which did not have a significant impact on agitation. SETTING: Six nursing homes in New York City, three voluntary non-profit and three proprietary. MEASUREMENT: The study used chart review, assessment of residents' cognitive and functional abilities, nursing assistants' ratings of residents' functional abilities, behavioral problems, and the amount of effort required in care, and time-motion observations of staff-resident interactions. RESULTS: Residents' level of cognitive impairment had a significant impact on problem behaviors during ADL tasks, along with supervision required in patient care (P < 0.05). These results were validated by time-motion analysis. Regression analysis revealed that for non-demented subjects, the best indicator of care needs was health status, while for demented residents the best indicator was cognitive status (P < 0.0001). CONCLUSIONS: The care needs of residents with dementia are better estimated by a mental status test for cognitive impairment then by ADL assessment alone. Greater agitation is associated with increasing cognitive impairment. Further, agitation and behavioral problems associated with care result in a need for increased staff supervision.     

Effects of agitation on size distribution of particulate matter in large-volume parenterals

The particle-size distributions of six types of large-volume parenterals subjected to different degrees of agitation were determined using an automatic particle counter. Data acquired from each solution, which had been maintained in a stored condition, subjected to agitation by inverting 20 times, and then mechanically shaken for 30 min, produced a linear relationship between log N greater than D and log D. Both the slope (K) and the number of particles per milliliter exceeding 1 micrometer in diameter (N greater than 1) exhibited a dependence on the degree of agitation. Their combined effect indicates that agitation by 20 hand inversions removed particulate matter from the surface of the container, which increased the total number of particles in solution (greater than 1 micrometer) but did not significantly alter the relative size distribution. Agitation for 30 min, however, disintegrated agglomerates and produced a particle-size distribution with a greatly increased number of particles whose diameters were less than 1 micrometer and a corresponding decrease in the number of particles exceeding 1 micrometer in diameter. The particle-size distribution of a parenteral solution determined by this in situ instrumental method was, therefore, dependent upon the degree of agitation to which the parenteral was subjected prior to examination.     

Differential diagnosis in dementia

The results of an autopsy of a 78-year-old female patient with an occluded of the right internal carotid artery after a traffic accident are reported. She presented with consciousness disturbance, right conjugate deviation, left hemiparesis and left pathological reflex. Evidence of right skull and clavicular fractures seemed to suggest that severe hyperextension of her neck associated with contralateral lateral flexion had stretched her carotid artery. Although she was treated with antiplatelet therapy, her cerebral swelling due to right global infarction progressed and she died due to bilateral cerebral herniation three days after injury. The autopsy disclosed right dissecting carotid artery occlusion and subadventitial dissection was revealed histologically. When a hematoma dissect the media and adventitia of the carotid artery wall, the outer wall weakens and may dilate without narrowing the lumen of the carotid artery. In this case, the vessel occlusion was considered to be due to a primary intramural hematoma which developed and subsequently ruptured through the intima into the vessel lumen. Early diagnosis and treatment are necessary for improving the prognosis of this disease entity. A patient with poor colateral flow, such as in this case, will show a rapid progression of cerebral infarction. It is best to consider surgical treatment in this case if the other traumatic lesions are able to tolerate surgery.     

Eating behaviors of nursing home residents who display agitation

To determine if cognitive level and agitation affect eating behavior, 33 females and four males in a 210-bed nursing home were studied. The researcher inconspicuously observed the evening meal for subjects on three occasions. Nearly 80% of the subjects showed a high frequency of agitation and 84% exhibited cognitive impairment. More than one-half were independent in feeding, with caregivers neither touching nor encouraging subjects during more than half of the 110 meals observed. No significant relationships were demonstrated between level of agitation and eating behavior or between cognitive level and eating behavior.     

The role of gas plumes in agitation and mass transfer in metallurgical systems

A general three-dimensional model is developed for the multi-phase flow resulting from the agitation and mixing of metallurgical systems with gas plumes. This model consists of transport equations for the variables of each phase which are then coupled through interaction parameters. The model is applied to three different systems namely, gas-stirred ladles, emulsification of slag-metal systems and mixing in shallow metal baths with multiple gas jets.     

Costs of dementia and dementia care: a review

Costs of dementia care constitute a great part of the total costs of care for elderly. Because the prevalence of dementia is linked to increasing age, and the number of the oldest old is rising, the costs of dementia care will increase considerably in the forthcoming decades. In this review, research describing costs of dementia care has been analysed and classified. The available database in this field is small, though expanding, and the methodological problems are obvious. Differences between countries, and between different periods of time, are difficult to analyse due to different methods of financing and organizing care. The main result of the present study is that the costs of dementia care differ considerably in the literature. One important reason for this variability is that the number of included cost categories vary, leading to a wide range of costs. Unpaid informal care forms a major part of the total costs, but the theory of costing informal care is complicated.     

金源矿业公司充填系统搅拌桶改造实践

针对金源矿业公司充填系统在应用过程中出现的井下充填料浆离析、分层,充填体强度低等问题,认为充填系统搅拌桶设计不尽合理是其主要原因。通过搅拌桶叶轮设计及搅拌总成计算,对充填系统原搅拌桶进行了改造,并取得了较好的应用效果。     

Reversible dementia

A 65 year old woman, referred for differential diagnosis of dementia, presented with cognitive and mnestic deficits. Typical signs and symptoms of hypothyroidism led to the diagnosis of severe autoimmune thyroiditis. After six months of treatment with thyroid hormone, dementia, myopathy and ataxia had disappeared. The neurologic and neuropsychologic manifestations of hypothyroidism are discussed. In dementia the diagnosis of secondary and reversible forms is of great importance with regard to prognosis and treatment. Hypothyroidism is known to be a common and treatable cause of pseudodementia. Early diagnosis and adequate treatment are important to prevent further permanent deterioration of cerebral function.     

AIDS-related dementia

Dementia is a common process in which there is gradual decrease in mental function due to disease of either cortical or subcortical structures. The numerous causes of dementia can be divided into those in which dementia is the primary manifestation, as in Alzheimer's disease, or secondary to chronic disease, neoplasms, endocrine and metabolic disorders and chronic infections. The dementia in AIDS is usually part of the syndrome of acquired immunodeficiency and may be its first manifestation.     

Subcortical dementia

Scanning tunneling microscopy was used to investigate the structure of the two-dimensional adsorbate formed by molecular self-assembly of the purine base, adenine, on the surfaces of the naturally occurring mineral molybdenite and the synthetic crystal highly oriented pyrolytic graphite. Although formed from adenine, which is achiral, the observed adsorbate surface structures were enantiomorphic on molybdenite. This phenomenon suggests a mechanism for the introduction of a localized chiral symmetry break by the spontaneous crystallization of these prebiotically available molecules on inorganic surfaces and may have some role in the origin of biomolecular optical asymmetry. The possibility that purine-pyrimidine arrays assembled on naturally occurring mineral surfaces might act as possible templates for biomolecular assembly is discussed.