Clinical Study on the Treatment of Senile Alzheimer’s Dementia with Sodium Oligomannate Combined with Memantine Hydrochloride

Objective:To analyze the clinical effects of sodium oligomannate combined with memantine hydrochloride in the treatment of senile Alzheimer’s dementia.Methods:Sixty-eight cases of Alzheimer’s dementia treated at the Second People’s Hospital of Fujian University of Traditional Chinese Medicine from March 2020 to March 2022 were selected as the study subjects.The patients were divided into two groups based on different treatment methods:the control group(treated with memantine hydrochloride,34 cases)and the treatment group(treated with sodium oligomannate+memantine hydrochloride,34 cases).Cognitive function,activities of daily living,neurotransmitters,serum intestinal flora metabolic markers,inflammatory factors,neurotrophic factors,and adverse reactions were compared between the two groups.Results:The treatment group showed better cognitive function,quality of life scores,and levels of relevant metabolic markers in the body compared to the control group,with statistically significant differences(P<0.05).The incidence of adverse reactions between the two groups(treatment group:2%;control group:4%)was not statistically significant(χ^(2)=0.731,P=0.393).Conclusion:Sodium oligomannate combined with memantine hydrochloride has better efficacy than the control group for treating senile Alzheimer’s dementia.It significantly improves and restores cognitive function and daily living abilities,benefits neurotransmitter secretion and internal regulation,upregulates the expression of neurotrophic factors,and has fewer adverse reactions,making it a treatment worthy of further clinical promotion and application.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Effects of balance exercise training on chronic nerve injury, GLP-1 and inflammatory mediator secretion in patients with senile dementia

Objective: To study the effects of balance exercise training on chronic nerve injury, GLP-1 and inflammatory mediator secretion in patients with senile dementia. Methods: Patients with senile dementia who were treated in the Fourth People's Hospital of Ya'an between February 2015 and January 2018 were chosen as the research subjects and randomly divided into two groups, the experimental group received balance exercise training and the control group received routine intervention. The levels of chronic nerve injury indexes, GLP-1 and inflammatory cytokines in serum as well as the expression of inflammatory signaling molecules in peripheral blood were determined before and after intervention. Results:Compared with those of same group before intervention, serum Hcy, Aβ1-42, Tau, IL-1β, IL-18, TNF-α and IFN-γ levels as well as peripheral blood NLRP3, Caspase-1 and DOCK2 expression intensity of both groups were decreasing whereas serum SOD, PON1 and GLP-1 levels as well as peripheral blood PKA and CREB expression intensity were increasing after intervention, and serum Hcy, Aβ1-42, Tau, IL-1β, IL-18, TNF-α and IFN-γ levels as well as peripheral blood NLRP3, Caspase-1 and DOCK2 expression intensity of experimental group after intervention were lower than those of control group whereas serum SOD, PON1 and GLP-1 levels as well as peripheral blood PKA and CREB expression intensity were higher than those of control group. Conclusion: Balance exercise training can reduce the chronic nerve injury and regulate the secretion of GLP-1 and inflammatory mediators in patients with senile dementia.

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.

Characteristics of Patients with Decreased Cognitive Function Undergoing Treatment for Acute Exacerbation of Chronic Heart Failure—Basic Survey for Standardization of Nursing to Prevent Discontinuation of Treatment

The purpose of this study is to clarify the characteristics of patients with decreased cognitive function undergoing treatment for acute exacerbation phase of chronic heart failure as a basic survey with a view to the standardization of nursing to prevent discontinuation of treatment of patients with declining cognitive function in the acute exacerbation phase of chronic heart failure. As the first stage of the research, using the interview guide created based on the background of discontinuation of treatment and symptomatic monitoring from 33 target literature sources, seven certified chronic heart failure nurses and 15 certified dementia nurses were given semi-structured interviews. Data obtained from the interviews was analyzed by qualitative induction. As a result, we obtained opinions/views on 8 situations namely, “cognitive function at hospitalization”, “characteristics at hospitalization, “characteristics when receiving examinations, procedures or treatment”, “characteristics of course of treatment”, “characteristics related to difficulties in grasping the symptoms of chronic heart failure and indices of deterioration”, “characteristics when using diuretics”, “characteristics concerning compliance with dietary restrictions” and “support required for discharge from hospital” concerning patients with declining cognitive function. In the future, it is necessary to prepare nursing protocols incorporating these contents for standardization of nursing.

Development of Nursing Protocol for Preventing Interruptions during Clinical Examinations and Treatments in the Early Days of Hospitalization for Acute Exacerbation of Chronic Heart Failure in Patients with Impaired Cognitive Function

The purpose of this study is to prepare a nursing protocol for preventing interruptions during clinical examinations and treatments performed in the early days of hospitalization for acute exacerbation of chronic heart failure in patients with impaired cognitive function. For the first stage of the research, we prepared a draft of the nursing protocol based on a basic survey. For the second stage, semi-structured interviews were conducted with 5 nurses specialized in chronic heart failure and 11 nurses in dementia care to ensure content validity of the draft protocol. For the third stage, we examined the possibility of clinical application of the revised version of the protocol draft prepared in the second stage of the study. For assessment items, significant points of nursing care, and specific nursing care practice in this revised version, 73 subjects (84.9%) considered effective for patients, in terms of prevention of interruptions during clinical examinations and treatments in the early days of hospitalization. All items and contents were considered useful by more than 60% of the nurses. Considering that the nurses working in the clinical setting reported 84.9% of usefulness, we concluded that this nursing protocol remained valid at a certain level. We consider that this nursing protocol will be useful especially for newly graduated/employed nurses as a procedure manual which can reduce their anxiety or stress caused by lack of knowledge or experiences.

Development of Nursing Protocol for Preventing Discontinuation of Treatments by Methods Other than Physical Restraint during Acute Exacerbation of Chronic Heart Failure in Patients with Impaired Cognitive Function

The purpose of this study is to prepare a nursing protocol for preventing discontinuation of treatments using a method other than physical restraint during acute exacerbation of chronic heart failure in patients with impaired cognitive function. For the first stage of the study, we prepared a draft of the nursing protocol based on a basic survey. For the second stage, semi-structured interviews were conducted with 5 nurses specialized in chronic heart failure and 10 nurses in dementia case to ensure content validity of the draft protocol. For the third stage, we examined the possibility of clinical application of the revised version of the protocol draft prepared in the second stage of the study. For assessment items, significant points of nursing care, and specific nursing care practice in this revised version, 154 subjects (93.9%) considered effective for patients, in terms of prevention of treatment discontinuation using a method other than physical restraint. All items and contents were considered useful by more than 60% of the nurses. Considering that the nurses working in the clinical setting reported 93.9% of usefulness, we concluded that this nursing protocol remained valid at a certain level. We also received a comment from the certified nurses that we should include the basic contents for newly graduated nurses. We consider that this nursing protocol will be also useful for newly graduated nurses to acquire knowledge. It helped to standardize nursing care in order to predict potential risks for patients with impaired cognitive function.

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.

Treatment Effects of Acupuncture and Calligraphy Training on Cognitive Abilities in Senile Demented Patients

Purpose:This study compared the relative effectiveness of Chinese calligraphy handwriting(CCH)and acupuncture in the treatment of patients with senile dementia.Materials and Methods:A randomized controlled trial(RCT)with 17 mild-to-moderate dementia patients with an average age of 77.29 years were randomly assigned with 9 to the calligraphy handwriting group and 8 to the acupuncture treatment group for a month of consecutive treatment.The participants'cognitive abilities,as well as symptoms of senile dementia,were measured by the Chinese version of the Mini-mental State Examination(CMMSE)and the Chinese Medicine Quantitative Diagnostic Survey for Senile Dementia Symptoms,respectively,before and after the treatment.Results:The calligraphy group showed a significant increase in calculation and memory as well as a decline in the symptoms of senile dementia.Patients in the acupuncture group experienced a significant growth in total CMMSE scores and the subscales in orientation to time and place,behavioral operations,as well as reduced clinical symptoms.However,no significant changes were found in their memory and calculation abilities.Conclusion:Both CCH and acupuncture treatments were found significantly effective for,respectively,enhancing the patients'cognitive abilities and reducing their clinical symptoms.Further,calligraphy handwriting also improved the level of their attention and concentration,physical relaxation,and emotional stability.