Hearing Impairment in Senile Dementia of Alzhaimer's Type

Objectives To evaluate peripheral auditory dysfunction in senile dementia of Alzheimer’s disease (AD) and its relationship with cognitive dysfunction. Methods Pure tone thresholds,word recognition scores (WRS), acoustic immittance and auditory brain-stem responses (ABR) were tested to evaluate the auditory function in 43 AD patients and 50 normal subjects. The test reliability in these subjects was examined before the test results were evaluated for their correlation with the Mini Mental State Examination(MMSE) score. Results There were no statistically significant differences in peripheral auditory functions between the two ears in the tested subjects or between the two groups when the auditometric results of the right ear were compared(P > 0.05). Also, there were no statistically significant differences between the two groups when audiometric test reliability, acoustic impedance and ABR results were compared(P > 0.05). Conclutions The pure tone audiometric threshold and WRS in AD patients are similar to those in comparable non-AD senile subjects. Peripheral auditory dysfunction is not related to cognitive dysfunction.

Criteria for Determining the Need for Admission of People with Dementia to Dementia Nursing Wards of Psychiatric Hospitals in Japan

Purpose: This study aims to establish criteria to determine the need for admission of people with dementia to dementia nursing wards of psychiatric hospitals—based on the experience of nurses working in dementia nursing wards. Methods: Semi-structured interviews were conducted with nurses who had worked in dementia nursing wards of psychiatric hospitals for more than 3 years, to collect data related to the “condition at the time of admission and the process of hospitalization of dementia patients”. Data were analyzed using the content analysis approach. Focusing on “What is the condition of patients with dementia admitted to the dementia nursing ward?”, we created codes according to similarities in the meaning, and classified these into categories where they were evaluated to fully fit in. Results and Discussion: The analysis yielded 4 categories, and 44 codes. The four categories are as follows: [Appearance of a state where self-control is difficult] which expresses a state where behavioral and psychological symptoms of dementia (BPSD) have appeared, and the remaining three categories [Insufficient support provided], [Appearance of symptoms that make living difficult], and [Appearance of physical symptoms that require treatment] express the states that may trigger the appearance of BPSD. These show that the appearance of BPSD is a criterion for determining hospitalization. By providing support to prevent the states described in the 44 codes, nurses may help people with dementia avoid being hospitalized in dementia nursing wards in psychiatric hospitals.

Analysis on nursing competence and training needs of dementia caregivers in long-term care institutions

Objective:It is aimed to investigate the nursing competence and corresponding influence factors of dementia caregivers in long-term care institutions of Tianjin and identify the training needs of caregivers.Methods:In the cross-section survey of this study,246 dementia caregivers were selected from 6 long-term care institutions in Tianjin as objects of study through convenient sampling.Results:The scores for nursing competence of dementia caregivers were 140.28±7.73,at a moderate level.Study findings that nursing competence of dementia caregivers were positively associated with the work experience(β=0.115,P=0.005),educational level(β=0.333,P<0.01),pervdceived health status(β=0.108,P=0.003)and training times within 1 year(β=0.371,P<0.01).Through the analysis,it is found that the training needs of dementia caregivers are inconsistent with the current situation in terms of content,methods and teachers.There are some problems in the training,such as unreasonable time,single mode and not deepening the understanding of the elderly with dementia.Conclusion:Long term care institutions shall arrange training no less than 12 times a year and evaluate training needs regularly to improve training effect.Providing online and offline training and adding more specialized contents like case analysis,employing experts in the field of dementia to teach courses.

State of the Places of Senile Dementia in the Old Hospice of the City of Lubumbashi

The objective of this study was to describe the state of the scene of senile dementia in an intra-institutional environment in the city of Lubumbashi. We conducted a descriptive cross-sectional study, over a period of three months, from February 20 to May 20, 2016. The study population is made up of the residents of the 9 retirement institutions for senior citizens (old people’s home) which counts the city of Lubumbashi. Participation was voluntary with informed consent duly signed by the patient. The probable cases of dementia were detected through the CSI-D and the 5-word test. A predominance of Alzheimer’s was noted (76.92%) and most of them were widowed (69.23%). The mean age of the dementia population was 76.46 ± 9.87 years, while (69.23%) of the patients were out of school. In (23.08%) cases demented patients were male, with a sex ratio of 0.3. Nearly (46.15%) of the demented were drinking. It appears that (69.23%) of the dementias were hypertensive. There are associations between different risk factors and the presence of dementias. Alcohol with an OR (Odd Ratio) = 0.08 (95% CI [0.01 - 0.72], p < 0.05). In our environment, our results indicate a different situation with a much higher prevalence.

lmpact of Virtual Dementia Tbur on empathy leVel Of nursing Students:A quasi-experimental study

Objective:As a developable ability,empathy is significantly associated with patient-centered care.The authors intended to evaluate the effect of Virtual Dementia Tour(VDT)upon nursing students'empathy level and propose practical rationales for optimizing future dementia care.Methods:A total of 45 second-year undergraduate nursing students were organized to watch a theme movie entitled Still Alice and participate in an 8-min VDT.Jefferson Scale of Empathy-Health Professional Students(JSE-HPS)was employed for evaluating the empathy level of nursing students.After VDT,all nursing students participated in a structured interview.Descriptive statistics and paired t-tests were performed using SPSS 24.0.Results:Their empathy levels demonstrated significant overall improvements(106.69±9.49 vs 115.51±10.16,P<0.01).During the course of VDT,nursing students experienced varying levels of anxiety and frustration.All of them were satisfied with the program since they had gained a deeper understanding of demented patients and the program could change their attitudes toward demented elders.Conclusion:Watching a specially selected movie and participating in VDT may be an effective method for enhancing empathy and caring during nursing student education.

Clinical Observation and Mechanism Study on Treatment of Senile Dementia with Naohuandan(脑还丹)

Objective: To observe the therapeutic effect and mechanism of Naohuandan (脑还丹,NHD) in treating senile dementia (SD).Methods: Clinical study: Fifty-eight patients with SD, whose diagnosis conforms to the Diagnostic Standard of DSM-Ⅳ issued by American Association of Psychiatry, were enrolled and randomly assigned into two groups. The 30 patients in the treated group were treated with NHD, 4 capsules each time, 3 times daily. The 28 patients in the control group were treated with Piracetam, 1.6 g each time, 3 times daily. The therapeutic course for both groups was 3 months. The therapeutic efficacy was estimated and compared by comprehensive scores of memory and cognition, scores of Mini-mental State Examination (MMSE) and Activities of Daily Living (ADL). Experimental study: Rats were divided into the control group, the model group and the high-dosage and low-dosage NHD treated groups. The protective effect of NHD on the per-oxidative damage of hippocampal neurons in β-amyloid protein induced SD model was observed and the related criteria were determined. Results: Clinical study showed that both NHD and Piracetam could improve the clinical symptoms of patients, the two medicines showing insignificant difference in total effective rate. But NHD was better in elevating MMSE score and lowering ADL score in patients than Piracetam (P<0.05 and P<0.01). Experimental study showed that (1) 24 and 72 hrs after modeling, the activity of SOD and GSH were lower and the level of MDA higher in the model group than those in the control group (P<0.05 or P<0.01). Compared with the model group at the corresponding time points, in the high-dosage NHD group, SOD and GSH were higher, MDA was lower (P<0.05 or P<0.01); but in the low-dosage NHD group, SOD at the 72th hr was higher (P<0.05) and MDA at 24th and 72th hrs was lower (P<0.01). And most of the criteria in the high-dosage NHD group was improved better than that in the low-dosage NHD group. (2) The survival rates of neurons in various groups were not different significantly (P>0.05) 24 hrs after modeling, but that in the high-dosage NHD group was significantly higher than that in the model group ( P<0.01) and in the low-dosage NHD group 72 hrs after modeling(P<0.05). Conclusion: NHD is an effective Chinese herbal preparation for treatment of SD, and its mechanism is related with its inhibition on peroxidative injury and protection on neurons.

Factors Affecting Verbal Agitation in Dementia Patients Living in Nursing Homes, South Korea

The purpose of this study using secondary data analysis was to identify factors affecting verbal agitation in patients with dementia staying at nursing home. This study is a secondary analysis of an existing original quantitative data set (n = 193). A total of 166 subjects’ data were included in this current study after 27 subjects’ data were excluded from the original data because they did not appear verbal agitation. Multiple regression analyses identified hallucination (β = 0.27), total number of physiologic discomforts (β = 0.19) and pain (β = 0.17) as significant predictors of verbal agitation and these factors explained 27.8% of the variance in the model. The findings of this study showed that hallucination, total number of physiologic discomforts and pain with dementia need to be considered when intervention programs to control verbal agitation in patients with dementia were developed.

Effect of Montessori method on the cognitive and behavioral intervention of senile dementia patients:a meta-analysis

Background:To evaluate the effect of Montessori method on cognitive and behavioral function in patients with senile dementia by meta-analysis.Methods:The randomized controlled trials of the effect of Montessori method on cognitive and behavioral functions of Alzheimer’s patients in PubMed,Cochrane Library,Web of Science,Excerpt Medica Database,The Cumulative Index to Nursing&Allied Health Literature,Chinese BioMedical Literature Database,China National Knowledge Infrastructure,Weipu Information Chinese Periodical Service Platformdatabase and Wanfang database were searched by computer,and the references of relevant literatures were traced.Two researchers independently conducted literature screening,data extraction,evaluation and inclusion in the literature,using RevMan 5.4.1 software for meta-analysis.Results:A total of 11 literatures were included and 936 patients were enrolled.Meta analysis shows that compared with routine nursing,Montessori method is helpful to improve the overall cognitive function(standardized mean difference=1.53,95%confidence interval(1.32,1.73),P<0.01),activities of daily living and reduce the incidence of adverse events(relative risk=0.37,95%confidence interval(0.21,0.63),P<0.01)in patients with Alzheimer’s disease.Conclusion:Montessori method is helpful to improve the overall cognitive function,activities of daily living and reduce the incidence of adverse events in patients with senile dementia.Affected by the included study,it still needs to be confirmed by multi center and large sample randomized controlled study.

Dilemmas Faced by Nurses Regarding the Physical Restraint of Elderly Patients with Dementia in Japan

This study aimed to clarify the dilemma of nurses working in general wards who face the ethical dilemma of restraining older people with dementia in Midwestern Japan. The study used the questionnaire method with an independently prepared questionnaire. The questionnaire was designed to ensure privacy and anonymity. The privacy and anonymity of study participants was assured. Of the 340 survey questionnaires distributed, 291 (85.6%) completed surveys were eligible number (12 additional surveys were returned without answers). An explanatory factor analysis revealed four dilemma factors among 15 items investigated (KMO value 0.84). These were: factor 1: “Execution of treatment and security,” α = 0.91;factor 2: “approach in the nursing of older people with dementia,” α = 0.93;factor 3: “A cooperative relationship in nursing of older people with dementia,” α = 0.87;and factor 4: “Priorities in nursing,” α = 0.81. The cumulative contribution ratio was 79.1%. We suggest that the program would enable nurses to cope with these dilemmas.

Review of Nurses’ Knowledge of Delirium, Dementia and Depressions (3Ds): Systematic Literature Review

This paper aims at reviewing literature on nurses’ knowledge of delirium, dementia and depression (3Ds) which are rapidly increasing worldwide as the population ages, and to identify interventions that have shown effectiveness in improving nurses’ knowledge level of these diseases. Nurses’ knowledge of delirium, dementia and depression is essential to providing quality patient care. To access the literature, online databases including Medline (OVID), CINAHL (EBSCO), Nursing and Allied Health Source (ProQuest), and Health and Medicine (ProQuest), in addition to Google scholar search engine, were searched using key words “delirium”, “dementia”, “depression”, “nurse*”, “knowledge” and their alternative words. Overall, 20 articles were found to meet the criteria for inclusion in the review. The study found that nurses’ knowledge of the 3Ds was generally low, and they were not particularly able to differentiate between the three diseases. It is important that health care systems are adequately resourced to meet this growing challenge. Nurses should receive appropriate training about the 3Ds, and their knowledge be reinforced through continuing education.

Factors influencing the employed caregiver burden for patients with dementia residing in nursing homes:A cross-sectional study from China

Objective:The institutionalization of care for patients with dementia is becoming a trend.Understanding the burden on employed caregivers and exploring associated factors are of great importance in practice.Therefore,this study aimed to examine the relationship between basic attributes,caring ability,and caregiver burden in employed caregivers practicing in nursing homes.Methods:This cross-sectional study included 541 employed caregivers in 11 four-star nursing homes in Zhejiang Province from April to December 2022.Caregiver burden was assessed using the Zarit Burden Interview(ZBI).Demographic characteristics of participants,characteristics of the older patients with dementia,caring characteristics,training in dementia care,and caring abilities were collected for analysis of influencing factors.A hierarchical multiple regression analysis was conducted to explore the factors influencing the burden on employed caregivers in nursing homes.Results:The ZBI score of employed caregivers in nursing homes was 40.42±10.18,representing a moderate caregiver burden.Factors such as age(U=27.82,P<0.001),residence(U=7.89,P<0.001),educational level(H=55.81,P<0.001),self-care of older patients with dementia(H=85.21,P<0.001),daily care hours(H=73.25,P<0.001),number of older people with dementia cared for(H=14.56,P<0.012)and training in dementia care(U=-9.43,P<0.001)were significantly associated with caregiver burden.Caring ability was negatively associated with caregiver burden(r=-0.22,P<0.01).Furthermore,after controlling for demographic characteristics,the characteristics of older people with dementia,caring characteristics,training in dementia care,and caring ability explained 8.5%,5.8%,and 4.8%of the caregiver burden,respectively.Conclusion:The burden of employed caregivers on patients with dementia in nursing homes can be attributed to various factors.We recommend tailored interventions,such as dementia care training and reviewing the number and duration of hours worked to reduce the burden experienced by caregivers.

Sense of Coherence in Persons with Dementia and Their Next of Kin—A Mixed-Method Study

Indications of dementia disease include deterioration of memory, thinking, behaviour, and the ability to perform everyday activities. Any of these symptoms can lead to stress and difficulties organizing everyday life. As a way to view factors that support human health and well-being despite stressful situations, Antonovsky introduced a salutogenic model. This model proposes that sense of coherence primarily determines physical and mental health i.e. psychological well-being. Having a sense of coherence in everyday life can reduce the impact of stress on the individual in everyday life. The study’s aim of this study was to explore how participants in existing support groups scored on the Sense of Coherence Scale (SOC), and what they perceived as contributory factors to a meaningful, manageable, and comprehensible everyday life in the presence of dementia using a mixed method. Persons with dementia had the highest scores on the SOC scale and their partners the lowest. Persons with dementia expressed that being with others who understood them made their everyday life comprehensible and manageable. Their partners expressed that learning about dementia was helpful in managing and comprehending everyday situations. The adult children expressed that it was meaningful to care for their parents and they scored slightly higher than the partners on the SOC scale. Long-term ongoing support supplemented with information and social support can contribute to the sense of coherence in persons with dementia and their next of kin.

Improving the Appropriateness of Antipsychotic Prescribing for Behavioral and Psychological Symptoms of Dementia (BPSD): A Pilot Study of the Psychotropic Use Monitoring (PUM) Program

In nursing homes, antipsychotic prescribing decisions (APDs) for managing behavioral and psychological symptoms of dementia (BPSD) depend on the nursing staff’s feedback. Inappropriate APDs can result in the lack of timeliness, objectivity and important clinical information when nursing staff’s feedback on residents’ behavior and pharmacotherapy outcomes. Currently, there are no reported interventions for improving psychiatrists’ APDs through nursing staff’s monitoring and feedback processes. This one-group pre-and-post pilot study aimed to evaluate the feasibility and impact of implementing a newly-developed Psychotropic Use Monitoring (PUM) program for improving the appropriateness of APDs in a 50-bed dementia ward of a nursing home. The PUM intervention involved 16 pharmacist-trained nursing staff, who monitored and reported residents’ BPSD changes and psychotropic side effects for 24 weeks, while carrying out their routine care duties. A face-to-face interview was then administered to determine the nursing staff’s perceptions of PUM. Data of 51 residents were collected from hardcopy individual patient records to evaluate the changes in APDs and the number of resident falls before and after implementing PUM. The nursing staff reported increases in their knowledge, awareness, confidence, and actual frequency of monitoring for side effects, as well as their ability in differentiating and managing BPSD (p < 0.05). After PUM, there was a significant increase in the number of APDs due to side effect-related reasons (4 versus 16) (p < 0.031). Although not significant, the number of APDs with no documented reasons (5 versus 9) and the number of resident falls (7 versus 15) appeared to be lesser after PUM. This study demonstrated the nursing staff’s positive participation in PUM intervention, specifically in monitoring and feedback of side effects. Furthermore, a potential exists for PUM to encourage more judicious APDs, which may be useful in settings with heavy patient load, limited human resources and dependence on foreign nursing staff from differing cultural backgrounds.

STUDY OF THE EXTERNAL COUNTERPULSATION (ECP) THERAPY FOR SENILE DEMENTIA OF THE ALZHEIMER'S TYPE (SDAT)

Ten patients with SDAT received the ECP therapy.The examination of Hasegawa’s Dementia Scale(HDS),single photor emission computed tomography (SPECT) brain imaging,and some biochemical parameters in blood and CSF were selected to evaluate the effect of ECP for SDAT.

Acupuncture on Gnosia and Acetylcholinesterase in Senile Dementia Patients

Purpose To observe the effect of acupuncture on gnosia and acetylcholinesterase in patients with senile dementia.Methods Eight patients diagnosed with mild or moderate senile dementia were treated by acupuncture of Sishencong (Ex-HN 1), Shenmen (HT 7) and Taixi (Kl 3) for 1 month; gnosia was evaluated by Mini-mental state examination before and after the treatment; plasma acetylcholin esterase activity was measured by fluorier before and after the treatment.Results There was a significant difference in gnosia between pre- and post-treatment with acupuncture (P<0.01); there was no significant difference in acetyl- cholinesterase activity between pre- and post-treatment (P>0.05).Conclusion Acupuncture has a certain improving effect on gnosia in senile dementia; one month’s acupuncture treatment had little effect on plasma acetyl-cholinesterase activity. Key Words Dementia, Senile - Acupuncture therapy - Gnosia Author: Tang Yong (1974-), male, attending physician and doctor

Network pharmacology deciphering multiple mechanisms of volatiles of Wendan granule for treatment of senile dementia

OBJECTIVE To explore the mechanisms of the volatiles of Wendan granule for the treatment of senile dementia,network pharmacology method integrating absorption,distribution,metab.olism,and excretion(ADME) screening,target fishing,network constructing,pathway analyzing,and correlated diseases prediction was applied.METHODS Twelve small molecular compounds of WDG were selected as the objects from 74 volatiles with the relative abundances above 2%,and their ADME parameters were collected from Traditional Chinese Medicine Systems Pharmacology platform(TCMSP),and then the corresponding targets,genes,pathways and diseases were predicted according to the data provided by TCMSP,DrugBank,Uniport and the Database for Annotation,Visualization and Integrated Discovery(DAVID).The related pathways and correlation analysis were explored by the Kyoto Encyclo.pedia and Genomes(KEGG) database.Finally,the networks of compound-target,target-pathway and pathway-disease of WDG were constructed by Cytoscape software.RESULTS Twelve compounds interacted with 49 targets,of which top three targets were Gamma-aminobutyric acid receptor subunit alpha-1(GABRA1),Prostaglandin G/H synthase 2(PGHS-2) and Sodium-dependent noradrenaline transporter.Interestingly,these targets were highly associated with depression,insomnia and Alzheimer′s disease that mainly corresponded to mental and emotional illnesses.CONCLUSION The integrated network pharmacology method provides precise probe to illuminate the molecular mechanisms of volatiles of WDG for relieving senile dementia related syndromes,which will also facilitate the application of traditional Chinese medicine in modern medicine,as well as follow-up studies such as upgrading the quality stan.dard of clinical medicine and novel drug development.

Timeslips—Comparing Agitation and Anxiety Rating Scales to Evaluate the Benefit of Non-Pharmacologic Creative Sessions in Nursing Home Patients with Dementia

TimeslipsTM is a group storytelling program that encourages creative expression among dementia patients without the pressure to recall the past. Analysis of the literature was conducted to determine the nine most relevant agitation and anxiety scales most appropriate for use with Timeslips in nursing home patients with dementia, who experience agitation and anxiety. Qualitative assessment of the nine scales was conducted to identify six criteria to determine the most pertinent characteristics for implementation of Timeslips within this patient population: 1) validity/reliability, 2) observation period, 3) training required, 4) time to administer, 5) most appropriate administrator and 6) accessibility/cost. Utilizing these six criteria, quantitative assessment was conducted using the Analytical Hierarchical Process (AHP) to identify that the Overt Agitation Severity Scale (OASS) was optimal. IRB approvals have been attained to investigate use of the OASS with Timeslips in the nursing home setting for patients with dementia, who experience agitation and anxiety.

Functional Contentment Model: Optimizing Quality of Life for Nursing Home Residents with Dementia

The Functional Contentment Model (FCM) attains two objectives: 1) building a relationship focused plan of care for nursing home residents diagnosed with dementia;and 2) maximizing and maintaining older adults’ contentment, peace, and happiness while living in dementia care environments. There are three essential components within the FCM: 1) Person/Family Centered Care;2) Slow Medicine;and 3) Team Care Management. The principles of “Person/Family-Centered Care” are coupled with the philosophy of “Slow Medicine,” and neither can exist without the engagement of “Team Care Management.” In short, the FCM maximizes the older adult’s potential functioning in activities of daily living, cognition, gross and fine motor skills, communication, and physical well-being, while maintaining the highest possible level of contentment, peace, and happiness. This is accomplished through dynamically utilized professional modalities adapted to the changing needs of the older adult resident—pharmacologic, physical and occupational therapies, family education and involvement, dietary, spiritual, stimulating activities, as well as any individualized modality. The lead for operationalizing the Functional Contentment Model is the nursing home medical director, whose key role is assuring a team approach to care including the older adult resident, the family, and all staff (dietary, housekeeping maintenance as well as care and administrative staff). The FCM is a culture change model that has implications in practice and policy for each nursing home.

Advances in TCM Treatment of Senile Vascular Dementia

Senile vascular dementia refers to organic loss of intellectual function due to cerebral damages caused by insufficient blood supply. The following is a summaryon achievements in its etiology, pathogenic mechanism, type identification and treatment in TCM, and the compound formulas, special formulas and drugs, and thepatent drugs used successfully for its treatment. ……

Correlation of serum Hcy metabolism with pro-inflammatory factors, chemokines and oxidative stress response in patients with senile dementia

Objective: To investigate the correlation of serum Hcy metabolism with pro-inflammatory factors, chemokines and oxidative stress response in patients with senile dementia. Methods:A total of 50 patients who were diagnosed with senile dementia in our hospital between August 2012 and June 2016 were selected as the senile dementia group, and 50 elderly patients who underwent physical examination in this hospital during the same period were selected as normal control group. The differences in serum levels of Hcy, pro-inflammatory cytokines, chemokines and oxidative stress indexes were compared between the two groups, and Pearson test was adopted to assess the correlation between serum Hcy level and illness. Results: Serum Hcy level of senile dementia group was higher than that of control group;serum pro-inflammatory cytokines IL-1, IL-6, TNF-α and CRP levels were higher than those of control group;serum chemokines MCP-1, CCL2 and RANTES levels were higher than those of control group;serum oxidative stress indexes ROS, MDA and 4-HNE contents were higher than those of control group. Pearson test showed that the serum Hcy level in patients with senile dementia was positively correlated with the levels of pro-inflammatory factors, chemokines and oxidative stress indexes. Conclusions: The serum Hcy metabolism disorder in patients with senile dementia is closely related to the inflammatory response and oxidative stress response.