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P14: Behavioural and psychological symptoms of dementia

Detailed programme, abstracts and presentations

P14: Behavioural and psychological symptoms of dementia

P14.1. Burden of behavioral and psychiatric symptoms in people screened positive for dementia in primary care – results of the DelpHi-study

THYRIAN Jochen René, EICHLER Tilly, WUCHERER Diana, DREIER Adina, MICHALOWSKY Bernhard, KILIMANN Ingo, TEIPEL Stefan, HOFFMANN Wolfgang

Background: There is limited knowledge about the range and effects of neuropsychiatric symptoms shown by persons with dementia (PWD) living in the community and their related caregiver burden.

Objective: (a) "to examine neuropsychiatric symptoms in PWD in primary care in regard to frequency, severity and burden to caregiver, (b) compare PWD with and without symptoms in regard to sociodemographics, care- and disease-related variables, (c) identify variables associated with symptoms.

Methods: Assessment of the Neuropsychiatric Interview (NPI), sociodemographics and disease –related variables in a general physician-based epidemiological cohort of n=248 people screened positive for dementia above 70, living at home and their caregivers.

Results: In preliminary analyses neuropsychiatric symptoms were frequent in PWD. Prevalences of dysphoria/ depression, apathy and agitation/ aggression were each more than 30%. The severity of neuropsychiatric symptoms in people screened positive for dementia in primary care is moderate with a mean NPI score of m =11.91. (SD=16.0).. Overall, caregiver distress is low, indicated by a total distress score of m=5.94 (SD=7.2, range 0-39). Common or frequent symptoms are not necessarily the most distressing symptoms.

Conclusions: Neuropsychiatric symptoms are common in people screened positive for dementia in primary care. While frequency, severity and perceived distress might be low in the total sample, we identified the dimensions delusions, aggression, anxiety, disinhibition and depression to be perceived “severely” to “extremely” distressing in more than 30% of the caregivers affected. The association between ADL and symptoms needs further attention in care.

P14.2. Importance of behavioral symptoms on caregivers needs: The impact on community services

SETZER Manuela, SCHALLER Sandra, MARINOVA-SCHMIDT Velislava, WART Ina, LUTTENBERGER Katharina, GRAESSEL Elmar, MALER Juan Manuel, HOESL Katharina, MASSICOT Gudrun, POPP Susanne, SIEGL Carlo, ANHERT Andreas, KORNHUBER, Johannes, KOLOMINSKY-RABAS Peter

Background: Neuropsychological behavioral problems often occur in persons with dementia (PwD) and play a vital role for informal caregivers involved in their care.

Methods: Data of the Erlanger Dementia Registry (2012-2014) has been analyzed (N=91). The data was collected with standardized instruments (Charlson Index, NPI, CNA-D) during face-to-face interviews with persons with dementia and their informal caregivers at baseline (T0).

Results: 63% of the caregivers reported a tendency of perceived burden, caused by explicitly depressive symptoms of the PwD. 39% of the caregivers reported a personal affliction caused by PwD suffering from a loss of interest and mood swings. The caregivers’ perceived experiences of perceived burden, as a result of the neuropsychological behavioral problems of PwD, are also reflected in their statements concerning support for caregivers. In this context, a strong need for support could be identified in the area of emotional distress, in contrast to areas of organization or information. In the case of emotional distress, 36% of caregivers admitted being overwhelmed by the situation and 34% reported suffering from depressive symptoms. The informal caregivers asked explicitly for more psychological therapy services, as well as guided and non-guided support groups.

Conclusion: These results indicate that 1.) behavioral symptoms of dementia syndrome need to be taken into account already at the time of diagnosis, and 2.) for informal caregivers, these symptoms have a strong influence on the perception of personal distress and 3.) there exists a vocalized need for support-services for families caring for PwD. Such services are explicitly desired by caregivers in the context of coping with the caregiving situation.

P14.3. Depression, anxiety and quality of life in relatives of individuals with dementia in Malta

SCERRI Charles, MUSCAT Marthese

In Malta, most of the care for individuals with dementia is delivered at home by members of the family.  Due to the nature of dementia, in which progression leads to increased dependency, the delivery of around the clock informal care leads to caregiver physical and psychological burnout. Indeed, various studies suggest that the majority of family caregivers would develop psychological and behavioural problems including anxiety and depression which undermine their quality of life.

The main objective of this study was to comprehensively identify and determine the levels of anxiety and depression in family caregivers of individuals with dementia and how this impacts their quality of life.

The results have shown that there is a strong positive correlation between anxiety and depression and that both significantly affected the four domains of the WHO-QOL-BREF instrument. Furthermore, the most important parameter that had an effect on depression was the loss in activities of daily living experienced by the relative with dementia. The presence of depression in the relative led to a significant increase in the level of burden as measured by the Zarit Caregiver Burden Scale.

The data obtained continues to add on the need of developing services that address the psychological and behavioural needs of relatives caring for individuals with dementia.

P14.4. Sensory gardens in dementia care: An evidence-based translation into practice

PROLO Paolo, SAREDO-PARODI Antonio, SASSI Enrico

Aims and objectives: To translate into an actual project the results of a systematic review on the benefits associated with the use of sensory gardens in dementia care.

Background: Sensory gardens are increasingly used in dementia care, yet their benefits are uncertain as a pure therapeutic tool, although they might improve personal feelings and quality of life.

Design: A systematic review with descriptive analysis of selected empirical studies was conceived as a base for a novel project of sensory garden in an elder daytime health care center in Balerna, Switzerland.

Methods: We performed systematic searches on MEDLINE, ISI Web of Science, Embase. Search terms were the free-text concepts 'healing garden', 'horticultural therapy', 'restorative garden', ‘sensory garden’ and 'wander garden' which were combined with dementia and Alzheimer’s.

Results: Eighteen studies were included with included participants ranging from eight to 129 participants. Research designs were case studies (n = 3), survey (n = 2), intervention studies with pretest/post-test design (n = 11) and randomized controlled studies (n = 2). Of these studies, eight examined the benefits of sensory gardens, eight examined horticultural therapy or therapeutic horticulture and two examined the use of plants indoors. Results are mutually supportive with some contradictory findings. Nighttime sleep pattern, aggressiveness and anxiety seem to improve.

Conclusions: We designed an open but well delimited and protected space, appearing as an accessible, simple and normal garden to counterbalance aggressiveness and anxiety. The garden allows to stroll safely and to satisfy one’s wandering on an elliptical circuit surrounded by and enclosing clearly recognizable interest points, a place of therapeutic sensory stimulation though flower colors, smells, water sounds and noises in which the perceptive awareness is a priority, with primary focus on the person, not the disease.

P14.5. Community occupational therapy in dementia (COTID): preliminary reports in Italy

GARZETTA Glenda, BARBIERI Sara, BEVILACQUA Petra, BONORA Annalisa, LANZONI Alessandro, FABBO Andrea

Background. Occupational Therapy program “Community Occupational Therapy in Dementia” (COTiD), from Netherlands, has been demonstrated useful for improving motor and process skills and self-perception in occupational performance from client with dementia. improved and that they needed less help. The sense of competence of their caregivers also improved. Cost-effectivness of the intervention has shown a saving of one thousand seven hundred and fifty euros for every successful treatment.The objective of this study was explore the effects of occupational therapy for people with dementia and their caregivers. Methods. We conducted a case series trial on ten clients with mild to moderate dementia living at home and their respective caregivers. The treatment consist in ten sessions of occupational therapy at home. The main outcome measures are Canadian Occupational Performance Measure (COMP) and Sense of Competence Questionnaire (SCQ). Other outcome measures are: Mini-Mental State Examination (MMSE); Quality of life-AD Measure (QOL-AD); Neuropsychiatric Inventory (UCLA-NPI); Disability Assessment for Dementia (DAD); Zarit Burden Assessment (ZARIT); Center for Epidemiologic Studies Depression Scale (CES-D); SF-12 Health Survey (SF-12); General Health Questionnaire (GHQ-12); Geriatric Depression Scale-30 (GDS-30).Participants were evaluated at baseline and at the end of treatment. Results. Is observed an improvement in self-perception and satisfaction on the activities of daily living for people with dementia and also in behavioural problems. An improvement has also been measured in sense of competence, quality of life, mood and perception of assistance for caregivers. Conclusions. This pilot study has shown preliminary results which are positive and useful for implementation of COTiD program in Italy. It can be a starting point for a randomized controlled trial which could demonstrate the effectiveness.

 

 
 

Last Updated: Tuesday 29 September 2015

 

 
  • Acknowledgements

    The 25th AE Conference in Ljubljana received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe and Spominčica gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche
  • SCA Global Hygiene
 
 

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