RESUMEN
End-of-life (EOL) care has been a common option for patients with terminal medical conditions such as cancers. However, the utilization of EOL care in Alzheimer disease and other dementing conditions have become available relatively recently. As the end-stage dementia approaches, the clinicians and caregivers become faced with numerous clinical challenges-delirium, neuropbehavioral symptoms, the patient's inability to communicate pain and associated discomfort, food refusal, and so on. In addition to providing quality clinical care to the EOL patients, clinicians should pay special attention to their families, assuring that their loved ones will receive supportive measures to improve quality of life (QOL).
RESUMEN
Care of the dementia patient continues to be challenging. It is a terminal condition that many times goes undiagnosed leading to improper evidence-based interventions. Healthcare professionals (HCPs) should initiate goals of care conversations early with patients and their families in order to align treatment preferences. Early integration of palliative medicine is an important intervention that can lead to better manage symptoms and lessen the strain on loved ones. Additionally, early enrollment into hospice should be encouraged with loved ones to promote quality of life as defined by the patient.
Asunto(s)
Demencia , Cuidados Paliativos al Final de la Vida , Hospitales para Enfermos Terminales , Cuidado Terminal , Muerte , Demencia/terapia , Humanos , Cuidados Paliativos , Calidad de VidaRESUMEN
While end-of-life (EOL) care has been a relatively common option for patients with terminal cancer, the utilization of EOL care in Alzheimer disease and other dementias has become available more recently. By the time end-stage dementia is present, the clinicians and caregivers become faced with multiple clinical issues-their inability to provide subjective complaints of pain and discomfort, behavioral symptoms, delirium, food refusal, and so on. In addition to providing quality EOL care to the patients, clinicians need to work with their families in an open and empathic manner, assuring that their loved ones will receive supportive measures to keep them comfortable.
Asunto(s)
Enfermedad de Alzheimer/complicaciones , Familia/psicología , Calidad de la Atención de Salud/organización & administración , Cuidado Terminal/organización & administración , Agresión/psicología , Comunicación , Toma de Decisiones , Trastornos de Deglución/etiología , Delirio/etiología , Emociones , Empatía , Humanos , Manejo del Dolor/métodosAsunto(s)
Demencia Frontotemporal/diagnóstico , Demencia Frontotemporal/tratamiento farmacológico , Cuidados a Largo Plazo , Trastornos Parafílicos/diagnóstico , Trastornos Parafílicos/tratamiento farmacológico , Anciano de 80 o más Años , Demencia Frontotemporal/complicaciones , Humanos , Masculino , Trastornos Parafílicos/etiología , Conducta Sexual/efectos de los fármacosAsunto(s)
Asfixia , Conducta Compulsiva , Masoquismo , Masturbación , Conducta Autodestructiva , Anciano , Asfixia/diagnóstico , Asfixia/terapia , Conducta Compulsiva/diagnóstico , Conducta Compulsiva/terapia , Humanos , Discapacidad Intelectual/complicaciones , Discapacidad Intelectual/terapia , Cuidados a Largo Plazo , Masculino , Masoquismo/diagnóstico , Masoquismo/terapia , Trastornos Psicóticos/complicaciones , Trastornos Psicóticos/terapia , Conducta Autodestructiva/diagnóstico , Conducta Autodestructiva/terapiaRESUMEN
PURPOSE: With the increasing interest in apolipoprotein E (APOE) genetic testing to estimate the risk of developing late-onset Alzheimer disease, new educational tools are needed to help people make the best decision for themselves about whether to undergo this test. This study evaluated an online tool to assist in this decision process. METHODS: A prototype decision aid was studied in a two-part survey that collected data from participants before and after they examined the decision aid. Both surveys had multiple-choice options and opportunities for open-ended responses, yielding quantitative and qualitative information. The responses before and after use of the aid were compared for each participant. RESULTS: A total of 1,262 individuals completed both surveys. The overall effectiveness of the decision aid was shown by three measures: 94% found the decision aid very helpful or somewhat helpful; general knowledge was increased; and some people changed their minds about APOE genetic testing, with 35% shifting to a higher likelihood of undergoing the test and 20% to a lower likelihood. Suggestions for improvements were noted and incorporated into the online tool. CONCLUSION: This decision aid can provide useful educational assistance to many individuals as they consider APOE genetic testing as well as facilitate further discussions with their health-care providers.Genet Med advance online publication 03 November 2016.
Asunto(s)
Enfermedad de Alzheimer/genética , Apolipoproteínas E/genética , Técnicas de Apoyo para la Decisión , Pruebas Genéticas , Internet , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/diagnóstico , Femenino , Indicadores de Salud , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Patients may exhibit posttraumatic stress disorder symptoms prior to the onset of dementia or uncover long quiescent symptoms of the disease, adding to the challenge of treating this population.
RESUMEN
A retrospective analysis was followed on 20 case reports covering the possible correlation between the atypical antipsychotic, quetiapine, and neuroleptic malignant syndrome (NMS), determined by the study of 7 different NMS criteria guidelines. A great majority (19) of the case studies did not meet the requirements of all 7 guidelines, frequently due to unreported information. Nor was quetiapine proven to be the sole cause of the possible NMS in the two age groups investigated. Only one case was found to have no other medication or medical conditions confounding the relationship of quetiapine and NMS symptoms, and that case was in the context of a significant quetiapine overdose. The other 19 cases demonstrated the difficulty of identifying the cause of NMS when polypharmacy and other medical conditions are involved. The authors note the need for caution in deciding both the presence of NMS and the causal factors of the symptoms.
Asunto(s)
Antipsicóticos/efectos adversos , Dibenzotiazepinas/efectos adversos , Trastornos Mentales/tratamiento farmacológico , Síndrome Neuroléptico Maligno , Adulto , Factores de Edad , Antiparkinsonianos/efectos adversos , Antipsicóticos/administración & dosificación , Diagnóstico Diferencial , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Dibenzotiazepinas/administración & dosificación , Relación Dosis-Respuesta a Droga , Fiebre/inducido químicamente , Adhesión a Directriz , Humanos , Persona de Mediana Edad , Rigidez Muscular/inducido químicamente , Síndrome Neuroléptico Maligno/diagnóstico , Síndrome Neuroléptico Maligno/etiología , Síndrome Neuroléptico Maligno/fisiopatología , Guías de Práctica Clínica como Asunto , Fumarato de Quetiapina , Estudios Retrospectivos , Síndrome de la Serotonina/diagnóstico , Síndrome de la Serotonina/etiología , Síndrome de la Serotonina/fisiopatología , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Adulto JovenRESUMEN
Three wives share their experiences of caregiving for husbands with dementia. The 3 husbands, aged 51, 71, and 84, developed dementia following years of devoted military service. To present lived experiences of caregiving wives', meanings attributed to caregiving are investigated, variations in caregiving and grieving experiences are explored, and therapeutic implications are offered. Through case study approach and with issues of caregiver grief considered, we introduce life course and ambiguous loss theoretical perspectives. Emergent qualitative themes and quantitative inventory ratings indicate significant differences in caregiver grief response depend on care-recipient age. Practice implications and directions for future care recipient, age-related research are presented.
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Cuidadores/psicología , Demencia/terapia , Pesar , Veteranos , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/psicología , Enfermedad de Alzheimer/terapia , Demencia/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Esposos/psicología , Estados Unidos , Veteranos/psicología , Veteranos/estadística & datos numéricosRESUMEN
Providing quality palliative care is a daunting task profoundly impacted by diminished patient capacity at the end of life. Alzheimer disease (AD) is a disorder that erases our memories and is projected to increase dramatically for decades to come. By the time the patients with AD reach the end stage of the disease, the ability of patients to provide pertinent subjective complaints of pain and discomfort would have vanished. Historical perspectives of palliative care, exploration of the AD process, ethical issues, and crucial clinical considerations are provided to improve the understanding of disease progression and quality of care for patients with end-stage AD.
Asunto(s)
Enfermedad de Alzheimer/terapia , Cuidados Paliativos/normas , Cuidado Terminal/normas , Humanos , Manejo del Dolor/métodos , Cuidados Paliativos/ética , Cuidados Paliativos/métodos , Calidad de la Atención de Salud/ética , Cuidado Terminal/ética , Cuidado Terminal/métodosRESUMEN
Alzheimer disease not only affects the cognitive function but also impacts one's abilities to perform daily tasks. This study evaluated for correlation between the quality of life of patients with Alzheimer disease (QoL-AD) and the level of independence and to evaluate the statistical difference between patients' quality of life and proxy perception of quality of life by utilizing the Katz activities of daily living and QoL-AD on patients and QoL-AD on caregivers. There was a small positive correlation (r = .13) between the levels of physical and functional independence and the perceived QoL. Also, patient consistently had higher QoL-AD than their caregiver counterparts. These findings provide some insight into our need to acknowledge factors that may influence QoL and illustrate the importance of monitoring for executive dysfunction and the safety risk.
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Actividades Cotidianas/psicología , Enfermedad de Alzheimer/psicología , Vida Independiente/psicología , Calidad de Vida/psicología , Veteranos/psicología , Anciano , Anciano de 80 o más Años , Cuidadores/psicología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados UnidosRESUMEN
Horticulture therapy employs plants and gardening activities in therapeutic and rehabilitation activities and could be utilized to improve the quality of life of the worldwide aging population, possibly reducing costs for long-term, assisted living and dementia unit residents. Preliminary studies have reported the benefits of horticultural therapy and garden settings in reduction of pain, improvement in attention, lessening of stress, modulation of agitation, lowering of as needed medications, antipsychotics and reduction of falls. This is especially relevant for both the United States and the Republic of Korea since aging is occurring at an unprecedented rate, with Korea experiencing some of the world's greatest increases in elderly populations. In support of the role of nature as a therapeutic modality in geriatrics, most of the existing studies of garden settings have utilized views of nature or indoor plants with sparse studies employing therapeutic gardens and rehabilitation greenhouses. With few controlled clinical trials demonstrating the positive or negative effects of the use of garden settings for the rehabilitation of the aging populations, a more vigorous quantitative analysis of the benefits is long overdue. This literature review presents the data supporting future studies of the effects of natural settings for the long term care and rehabilitation of the elderly having the medical and mental health problems frequently occurring with aging.
RESUMEN
OBJECTIVE: To report the response to low-dose risperidone in individuals with combat-related post-traumatic stress disorder (PTSD) combat nightmares. DESIGN: Case series. SETTING: Veterans Affairs Medical Center Mental Health Clinic and collaborative VA-U.S. Army Fort Bragg Warrior Transition Telepsychiatry Clinic. PRACTICE DESCRIPTION: Veterans at the VA; soldiers that have severe medical and mental health problems in the Warrior Transition Telepsychiatry Clinic. MAIN OUTCOME MEASURE(S): No response: no change in frequency and/or severity of nightmares; partial response: decrease in frequency and/or severity of nightmares; full response: total cessation of recall of nightmares. RESULTS: The four individuals included one active duty soldier and three veterans, ranging from 40 to 76 years of age. All served in the infantry, each in a different combat theater. Two participants had a reduction in the frequency and severity of nightmares at risperidone 1 mg at night. One veteran with blood alcohol levels greater than 300 mg/mL had a partial response with risperidone 3 mg at night. Without active substance abuse, the four individuals had a total cessation of nightmares the first night at a risperidone dose of 2 mg at night. The total cessation of nightmares with risperidone continued despite changes in concurrent antidepressants, anxiolytics, and hypnotics. No medication side effects were reported. CONCLUSION: The use of low-dose risperidone (1-3 mg) at night can reduce the severity and frequency or stop the recall of PTSD combat nightmares in some veterans and active duty soldiers. Risperidone may be an effective medication for combat nightmares of PTSD and merits additional exploration.
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Antipsicóticos/uso terapéutico , Trastornos de Combate/tratamiento farmacológico , Risperidona/uso terapéutico , Trastornos por Estrés Postraumático/tratamiento farmacológico , Adulto , Anciano , Sueños/efectos de los fármacos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: Bupropion is a substituted phenyl-ethylamine that is extensively utilized for the treatment of major depressive disorder and for smoking cessation. It is a reuptake inhibitor of dopamine and norepinephrine, and it also has some nicotinic antagonism. There are concerns that it may increase the risk of psychosis due to its dopaminergic effects. Our objective is to review the literature and analyze the risk of bupropion precipitating a psychotic illness in the general population as well as in the populations with a history of psychotic symptoms. METHODS: A Medline database search limited to human and English-language studies was conducted using the keywords "bupropion" and "psychosis." A total of 23 articles were selected based on the relevance of the articles and their references. The data from these articles were collated. RESULTS: Collated data show that there is some evidence to suggest that bupropion may cause or worsen psychosis in selected subpopulations. Higher doses of bupropion appear more likely to be associated with the outcome severity. Preexisting psychotic symptoms, substance abuse and drug interactions also seem to increase the risk. Concurrent use of antipsychotics at adequate doses appears to be protective. CONCLUSIONS: The literature is incomplete and in some cases contradictory. In selected cases, bupropion appears to be associated with the induction of psychotic symptoms in addition to the precipitation or worsening of an existing psychotic syndrome. Further research including controlled studies is required to clarify the risk of bupropion precipitating a psychotic illness in vulnerable populations.
Asunto(s)
Antidepresivos de Segunda Generación/efectos adversos , Bupropión/efectos adversos , Psicosis Inducidas por Sustancias/etiología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
"Sundowning" in demented individuals, as distinct clinical phenomena, is still open to debate in terms of clear definition, etiology, operationalized parameters, validity of clinical construct, and interventions. In general, sundown syndrome is characterized by the emergence or increment of neuropsychiatric symptoms such as agitation, confusion, anxiety, and aggressiveness in late afternoon, in the evening, or at night. Sundowning is highly prevalent among individuals with dementia. It is thought to be associated with impaired circadian rhythmicity, environmental and social factors, and impaired cognition. Neurophysiologically, it appears to be mediated by degeneration of the suprachiasmatic nucleus of the hypothalamus and decreased production of melatonin. A variety of treatment options have been found to be helpful to ameliorate the neuropsychiatric symptoms associated with this phenomenon: bright light therapy, melatonin, acetylcholinesterase inhibitors, N-methyl-d-aspartate receptor antagonists, antipsychotics, and behavioral modifications. To decrease the morbidity from this specific condition, improve patient's well being, lessen caregiver burden, and delay institutionalization, further attention needs to be given to development of clinically operational definition of sundown syndrome and investigations on etiology, risk factors, and effective treatment options.
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Antipsicóticos/uso terapéutico , Sueños/efectos de los fármacos , Risperidona/uso terapéutico , Trastornos por Estrés Postraumático/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Antipsicóticos/administración & dosificación , Trastornos de Combate/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Risperidona/administración & dosificación , Resultado del Tratamiento , Estados Unidos , VeteranosRESUMEN
Alzheimer's disease is one of the most challenging threats to the healthcare system in society. One of the main characteristic of Alzheimer's disease (AD) pathology is formation of amyloid plaques from accumulation of amyloid beta peptide. The therapeutic agents that are currently available for AD including acetylcholinesterase inhibitors (AchEIs) and the N-methyl-D-aspartate (NMDA) antagonist are focused on improving the symptoms and do not revert the progression of the disease. This limitation coupled with the burgeoning increase in the prevalence of AD and resultant impact on healthcare economics calls for more substantial treatments for AD. According to the leading amyloid hypothesis, cleavage of amyloid precursor protein to release amyloid beta peptide is the critical event in pathogenesis of Alzheimer's disease. Recently treatment strategies have been focused on modifying the formation, clearance and accumulation of neurotoxic amyloid beta peptide. This article reviews different therapeutic approaches that have been investigated to target amyloid beta ranging from secretase modulators, antiaggregation agents to amyloid immunotherapy. Authors review the different novel drugs which are in clinical trials.
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Enfermedad de Alzheimer/metabolismo , Enfermedad de Alzheimer/terapia , Péptidos beta-Amiloides/metabolismo , Amiloide/antagonistas & inhibidores , Amiloide/metabolismo , Inhibidores Enzimáticos/uso terapéutico , Enfermedad de Alzheimer/etiología , Péptidos beta-Amiloides/efectos de los fármacos , Animales , Inhibidores Enzimáticos/farmacología , Humanos , Modelos BiológicosRESUMEN
Little has been reported about the relationship of a dementia wander garden with scheduled psychiatric medications in addition to changes in fall number and severity. The 28 participating residents of a dementia unit were divided into high (HUG) and low (LUG) wander garden user groups and assessed for the number and severity of falls. The type and dose of scheduled psychiatric medications were monitored for 12 months before and 12 months after the wander garden was opened. Results indicated that the residents experienced about a 30% decrease for the raw number of falls and fall severity scores. The HUG had a significant reduction in high-dose antipsychotics, whereas there was relatively no change in antidepressant, hypnotic, and anxiolytic use. High wander garden user group required fewer scheduled medications and experienced reduced falls and lower fall morbidity than the LUG. The most significant changes in scheduled psychiatric medications were reductions in scheduled antipsychotics and an increase in residents requiring no antipsychotics.