Behavioral symptoms are well-recognized concomitants of the progression of dementia. These symptoms include agitation, aggression, anxiety, depression, disinhibition, delusions, hallucination, and sleep disturbance. Because these symptoms are a major source of impaired quality of life for patients and their caregivers, appropriate pharmacological management of them may reduce the burden of caregivers and postpone institutionalization. Furthermore, behavioral symptoms may be more amenable to pharmacological intervention than cognitive symptoms. For that reason, detailed evaluation and appropriate treatment are the mainstay in the management of dementia patients. In this article, we reviewed symptomatology and psychopharmacology for behavioral symptoms of dementia.
Aggression ; Alzheimer Disease ; Anxiety ; Behavioral Symptoms* ; Caregivers ; Delusions ; Dementia* ; Depression ; Dihydroergotamine ; Hallucinations ; Humans ; Institutionalization ; Neurobehavioral Manifestations ; Psychopharmacology ; Quality of Life

The increasing number of patients with depression is a serious social issue in contemporary Korean society. To fully understand the pathophysiology of depression, this paper reviewed how depression affects the decision making process of humans. Various recent studies in behavioral economics, mathematics, medicine, and neurobiology have shown how humans make decisions and how emotional disturbances, such as depressive disorder, affect this process. There has been great progress in behavioral economics during this decade, and numerous experiments have been designed to evaluate decision making process in humans. In general, economic decision making is evaluated using the Iowa Gambling Task, and social decision making is assessed using the ultimatum game. Numerous research studies have analyzed the performance and reaction of patients with depression in these games. As a result of the advancement of neurophysiology, research has successfully identified the part of the brain that causes the specific results of tests being conducted on patients with depression. Meanwhile, computational neuroscientists have established decision making models based on bayesian framework. These models also match with the neuroanatomy. Although a large part remains unclear, researchers look forward to achieving a better understanding in depression by analyzing the distinct patterns of responses that patients under depression show in the experiment of behavioral economics.
Affective Symptoms ; Brain ; Decision Making* ; Depression* ; Depressive Disorder ; Economics, Behavioral ; Gambling ; Humans ; Interdisciplinary Studies ; Iowa ; Mathematics ; Neuroanatomy ; Neurobiology ; Neurophysiology

Background: Compassion fatigue is a true phenomenon experienced by overworked and exhausted nurses. Objective: This study assessed frontline nurses' compassion fatigue, stress, mental health, and turnover intention during the second year of the COVID-19 outbreak Methods: Using a cross-sectional design, an online survey was administered in the first quarter of 2021 to 259 hospital nurses in the Central Philippines using standardized scales to gather the necessary data. Results: Nurses were found to have moderate levels of compassion fatigue and turnover intention, high stress, and good mental health. Results revealed that compassion fatigue was associated with poor mental health (r = −5.05, p = 0.01), higher stress levels (r = 0.54, p = <0.001), and turnover intention (r = 0.27, p = <0.001). Conclusion Pandemic-related compassion fatigue in nurses increases their stress, worsens their mental health, and heightens their intentions to leave their jobs. Organizations should address compassion fatigue through a supportive work climate.
Compassion Fatigue ; Mental Health ; Nursing

Pharmacological interventions are critical in dementia treatment to prevent disease progression. In this review, we aim to summarize and discuss about the current developments and recommendations in the pharmacological treatment of dementia. Cholinesterase inhibitors have demonstrated efficacy for Alzheimer's disease, mixed pathology with vascular dementia and Parkinson's disease dementia. The comparison study revealed no difference between each cholinesterase inhibitors. A high incidence of side effects of cholinesterase inhibitors could lower compliance. In this case, changing to the other drug or trying a transdermal type could be the solution. Memantine, a N-methyl-D-aspartate receptor antagonist, has proven to improve function at moderate to severe dementia and for dementia with Lewy body. But there are still insufficient evidences for the combination of a cholinesterase inhibitors and memantine. Discontinuing medicine in moderate to severe dementia may lead to worsening of cognitive function. For this reason, improving patients' compliance is important and for drug selection we should consider the type of dementia, severity of cognitive impairment and side effects of each medicine. Noncognitive symptoms, behavioral and psychological symptoms of dementia (BPSD) are common and can dominate disease presentation. For depression, selective serotonin reuptake inhibitors could be effective. Atypical antipsychotics could be used for other neuropsychological symptoms such as agitation, aggression, delusions and hallucinations.
Aggression ; Alzheimer Disease ; Antipsychotic Agents ; Behavioral Symptoms ; Cholinesterase Inhibitors ; Compliance ; Delusions ; Dementia* ; Dementia, Vascular ; Depression ; Dihydroergotamine ; Disease Progression ; Hallucinations ; Incidence ; Lewy Bodies ; Memantine ; N-Methylaspartate ; Parkinson Disease ; Pathology ; Serotonin Uptake Inhibitors

Children with chronic illness are known to have an increased risk of emotional and behavioral problems. Many studies have been conducted to identify risk and resistance factors associated with differences in adjustment among these children. It is a major theoretical framework of the Wallander and Varni model that modifiable risk and resistance factors can be identified empirically. Risk factors in the original model include disease/ disability parameters, functional dependence in the activities of daily living, and psychosocial stressors. Resistance factors in the original model are delineated in three categories: intrapersonal factors such as competence, temperament; socialecological factors such as family psychological environment, social support; and stressprocessing factors such as cognitive appraisal and coping strategies. In addition, it is proposed that the factors such as age of onset, certainty of diagnosis and prognosis of illness affect adjustment. Children with chronic illness are known to have an increased risk of emotional, behavioral, academic problems. Research findings show that children with chronic illnesses are at a higher risk for developing emotional problems such as anxiety, depression, social withdrawal and low self-esteem. The parents of children with Type 1 diabetes and asthma reported emotional and behavioral problems more. Also children with chronic illness tend to more behavior problems than healthy peers. Especially, increased risk of children with neurological conditions is explained by the lower level of cognitive functioning. The association of poor school performance with type I diabetes and sickle cell anemia is proposed.
Activities of Daily Living ; Affective Symptoms ; Age of Onset ; Anemia, Sickle Cell ; Anxiety ; Asthma ; Behavioral Symptoms ; Child ; Chronic Disease ; Depression ; Humans ; Mental Competency ; Parents ; Prognosis ; R Factors ; Risk Factors ; Social Environment

PURPOSE: This study was a systematic review and meta-analysis designed to investigate the effects of stimulation-oriented interventions for behavioral problems among people with dementia. METHODS: Based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), a literature search was conducted using seven electronic databases, gray literature, and other sources. Methodological quality was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) for randomized controlled trials (RCTs). Data were analyzed using R with the 'meta' package and the Comprehensive Meta-Analysis (CMA 2.0) program. RESULTS: Sixteen studies were included for meta-analysis to investigate the effect of stimulation-oriented interventions. The quality of individual studies was rated as '++' for eight studies and '+' for the rest. The effect sizes were analyzed according to three subgroups of interventions (light, music, and others); Hedges' g=0.04 (95% CI: -0.38~0.46), -0.23 (95% CI: -0.56~0.10), -0.34 (95% CI: -0.34~0.00), respectively. To explore the possible causes of heterogeneity (I²=62.8%), meta-regression was conducted with covariates of sample size, number of sessions, and length of session (time). No moderating effects were found for sample size or number of sessions, but session time showed a significant effect (Z=1.96, 95% CI: 0.00~0.01). Finally, a funnel plot along with Egger's regression test was performed to check for publication bias, but no significant bias was detected. CONCLUSION: Based on these findings, stimulation-oriented interventions seem to have a small effect for behavioral problems among people with dementia. Further research is needed to identify optimum time of the interventions for behavioral problems among dementia pateints.
Acoustic Stimulation ; Behavioral Symptoms ; Bias (Epidemiology) ; Dementia* ; Music ; Population Characteristics ; Problem Behavior* ; Publication Bias ; Sample Size ; Sensory Art Therapies

Background: Compassion fatigue is a true phenomenon experienced by overworked and exhausted nurses. Objective: This study assessed frontline nurses' compassion fatigue, stress, mental health, and turnover intention during the second year of the COVID-19 outbreak. Methods: Using a cross-sectional design, an online survey was administered in the first quarter of 2021 to 259 hospital nurses in the Central Philippines using standardized scales to gather the necessary data. Results: Nurses were found to have moderate levels of compassion fatigue and turnover intention, high stress, and good mental health. Results revealed that compassion fatigue was associated with poor mental health (r = −5.05, p = 0.01), higher stress levels (r = 0.54, p = <0.001), and turnover intention (r = 0.27, p = <0.001). Conclusion Pandemic-related compassion fatigue in nurses increases their stress, worsens their mental health, and heightens their intentions to leave their jobs. Organizations should address compassion fatigue through a supportive work climate.
Compassion Fatigue ; mental health ; nursing ; stress

A number of brain imaging and human lesion studies suggest an involvement of the cerebellum in various cognitive functions. A 60-year-old woman developed dizziness due to cerebellar infarction. One month later, she developed cognitive decline, delusion, irritability, impulsive and violent behavior. Cognitive and behavioral symptom onset, neuroimaging findings and neuropsychological test led us to the diagnosis of cerebellar cognitive affective syndrome.
Arteries ; Behavioral Symptoms ; Cerebellum ; Delusions ; Dizziness ; Female ; Humans ; Infarction ; Middle Aged ; Neuroimaging ; Neuropsychological Tests

Depression is one of the most devastating behavioral symptoms in demented patients but there is little evidence about effective and safe pharmacotherapy. We aimed to determine the effectiveness and safety of mirtazapine in treatment of depressed patients with Alzheimer's disease (AD). The consecutive patients with AD who have significant depression were assigned to an 8-week open-label, prospective study. Patients received mirtazapine 15-45 mg/day. The changes in Hamilton Depression Rating Scale (HAM-D) scores were primary outcome measurement. The change in Clinical Global Impression-Severity scale (CGI-S) scores and tolerability-safety profile were the secondary efficacy variables. Thirty-two out of 38 (84.2%) patients completed the study. There was a significant reduction in HAM-D and CGI-S between the pre- and post-treatment with mirtazapine (p<0.01). There was no significant side effect and cognitive deterioration. The results of this open-label pilot study suggest that mirtazapine may be an effective choice for treatment of depressed patients with AD.
Alzheimer Disease ; Behavioral Symptoms ; Dementia ; Depression ; Humans ; Mianserin ; Pilot Projects ; Prospective Studies

OBJECTIVES: Coexistence of depression is one of the important behavioral symptoms in patients with dementia of Alzheimer type. The study on the relationship between depression and cognitive abilities and/or functional abilities emerges as very important one. The aim of this study was to investigate whether depression is related to the impairment of daily activities and to certain areas of cognitive function in mild to moderate dementia of Alzheimer type. METHODS: In this study, 48 patients with dementia of Alzheimer type among elderly community-residents in Kwangju, Kyunggi province, aged 65 and older, were finally included. We examined their demographics and administered Korean Version of the Mini-Mental State Examination(MMSE-K), Korean Version of the Neurobehavioral Cognitive Status Examination(Korean version of NCSE), Korean Form of Geriatric Depression Scale(KGDS), Activities of Daily Living(ADL), and Instrumental Activities of Daily Living(IADL) to the subjects. We classified the subjects into two groups, dementia with and without depression on the basis of KGDS scores. The two groups were compared using X2 test and independent ttest. RESULTS: The results show that the two groups did not differ in sex, age, education, and scores of MMSE-K. The depressed dementia group showed significantly poorer performance in bathing, one item of ADL, than the nondepressed dementia group. The depressed dementia group showed significantly more impairment in total scores of IADL and each score of three items(shopping, housework, handling finances) than the non-depressed dementia group. However, the two groups showed no significant differences in five major cognitive ability areas of Korean version of NCSE. CONCLUSION: These results suggest that depression in patients with dementia of Alzheimer type is highly related to the functional impairments, instrumental activities of daily living and part of activities of daily living, beyond the effects of cognitive impairments.
Activities of Daily Living* ; Aged ; Baths ; Behavioral Symptoms ; Dementia ; Demography ; Depression* ; Education ; Gwangju ; Gyeonggi-do ; Housekeeping ; Humans