Agitation in Patients with Dementia: A Practical Guide to Diagnosis and Management

A Guide To Alzheimer’s & Dementia Behaviors
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Mixed dementia is often indicated by cardiovascular disease and dementia symptoms that get worse slowly over time. Vascular dementia affects different people in different ways and the speed of the progression varies from person to person. Some symptoms may be similar to those of other types of dementia and usually reflect increasing difficulty to perform everyday activities like eating, dressing, or shopping.

Behavioral and physical symptoms can come on dramatically or very gradually, although it appears that a prolonged period of TIAs—the mini-strokes discussed above—leads to a gradual decline in memory, whereas a bigger stroke can produce profound symptoms immediately. Regardless of the rate of appearance, vascular dementia typically progresses in a stepwise fashion, where lapses in memory and reasoning abilities are followed by periods of stability, only to give way to further decline. While there is currently no cure for vascular dementia, the earlier any brain damage is caught, the better your chance of preventing dementia , or at least slowing down the progression of the disease.

By treating the risk factors that led to vascular dementia, such as high blood pressure or diabetes, you may even be able to reverse some of the symptoms. But the most important thing is to minimize your risk of having another stroke and making the dementia worse. Your doctor may prescribe medications to lower blood pressure and prevent clots from forming, and may change or stop medications that can exacerbate symptoms of dementia, such sedatives, antihistamines, or strong painkillers. However, adopting healthier lifestyle changes is also a vital part of vascular dementia treatment.

A diagnosis of dementia is scary.

Agitation in Patients With Dementia: A Practical Guide to Diagnosis and Management

As much as possible, continue to look after your physical and emotional health, do the things you love to do, and spend time with family and friends. Find new ways to get moving.

Research suggests that even a leisurely minute walk every day may reduce the risk of vascular dementia and help slow its progression. Regular exercise can also help control your weight, relieve stress, and boost your overall health and happiness. Create a network of support.

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Seeking help and encouragement from friends, family, health care experts, and support groups can improve your outlook and your health. Eat for heart health.

Vascular Dementia -

Heart disease and stroke share many of the same risk factors, such as high LDL cholesterol bad cholesterol , low HDL cholesterol good cholesterol , and high blood pressure. Adopting a heart-healthy diet may help to improve or slow down your dementia symptoms. Make it a point to have more fun. Laughing, playing, and enjoying yourself are great ways to reduce stress and worry. Joy can energize you and inspire lifestyle changes that may prevent further strokes and compensate for memory and cognitive losses.

Learn how to relax and manage stress. Challenge your brain. Your brain remains capable of change throughout life, so you may be able to improve your ability to retain and retrieve memories.

Learning new skills, such as a foreign language or how to paint, can also help build brain capacity if done consistently. Managing the symptoms of vascular dementia means learning practical ways to manage memory loss , while staying as optimistic and realistic as possible. Follow a routine. Regular routines and consistent habits can compensate for a declining memory and help you feel more in control.

Link medication regimens with other activities, such as eating a meal, to make things easier to remember. Use memory aids. Take some pressure off your memory by using a notebook or smartphone to track to-do lists, appointments, and important names and dates. Be upfront about your condition. This way, they know what to expect and you can alleviate or prevent misunderstandings. Communicate your needs. Data analysis was performed using SPSS software, version It should be noted that the sample was mostly comprised of women and that the majority of residents had a medical condition.

For two of the 28 residents taking analgesics, the prescription was to take this medication if needed prn while the remaining residents took regularly scheduled analgesics at least once a day. This information suggests that an important proportion of the residents experienced chronic pain. Most residents were rated in the three last stages of the FAST which indicates that the cognitive functioning of most residents was highly impaired.

The mean score on the SMAF No other correlation coefficient was significant.

Pharmacologic Treatment

Post hoc power analyses were conducted for t tests with alpha level fixed at 0. Power was high for tests using OA 0. Correlation coefficients between agitation scores, discomfort and the other descriptive variables. Hierarchical multiple regression analyses were next performed to specify the relationship between discomfort and each agitation score except AB while statistically controlling for sex, severity of dementia and disability in performing ADL. For each analysis, these three last variables were introduced in a first block of the regression Step 1 , followed by the level of discomfort at the next step Step 2.

As shown, discomfort contributed significantly to the prediction of the variance of OA, NAPB and VAB, beyond the residents' other characteristics that were statistically controlled in each regression equation.

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Summary of hierarchical multiple regression analysis for variables predicting agitation, non aggressive physical behavior, and verbally agitated behavior. Sex, severity of dementia and disability were introduced in a first block of the regression Step 1 , followed by the level of discomfort at the next step Step 2. Statistics shown for each variable are those at Step 2. The purpose of this study was to document the relationship between discomfort and the various types of agitation in older adults suffering from dementia.

As hypothesized, our results show a positive and significant relationship between the degree of discomfort and the frequency of overall agitation. This confirms results obtained previously by Buffum and colleagues [ 20 ] and Young [ 22 ]. Our results further demonstrate that the relationship with discomfort varies according to the type of agitation.

Also as hypothesized, we found that the degree of discomfort is associated both positively and significantly with VAB.

Furthermore, our results show a positive and significant relationship with NAPB. No significant relationship was observed between discomfort and aggressive behavior but it should be noted that the power to detect this specific relationship was low and that the correlation coefficient obtained from our data 0. Various authors contend that discomfort acts as an internal factor which precipitates the occurrence of agitation [ 10 , 12 ]. VAB possibly acts as a means of communicating the patient's discomfort [ 8 , 35 ].

Matteau and colleagues [ 35 ] have found that patients that display VAB also present more language difficulties. Through behaviors such as complaining and screaming, patients may attempt to attract their caregivers' attention in the hope that they will provide them some relief. The relationship between discomfort and NAPB was unexpected and is less clear. It is possible that several types of disruptive behavior related to this type of agitation, such as wandering and pacing, result from the discomfort experienced by the patient. For example, a patient who feels sad and depressed because he or she is homesick may attempt to leave his residential facility to reduce this discomfort [ 8 ].

Algase and colleagues [ 12 ] have suggested that behavioral problems associated with dementia result from unmet needs which the patient expresses using his remaining abilities. Given our results, the need for comfort appears as one such need. From a practical point of view, the occurrence of agitation deserves particular attention on the part of caregivers since it may communicate discomfort. Identifying and treating the cause of this discomfort may help reduce agitation. Kovach and colleagues [ 36 ] have recently reported findings which support this assertion.

In their study, nursing home residents with dementia were treated using the Serial Trial Intervention which selects an appropriate treatment based on physical and affective needs assessments. Compared to a control group, the treated group had less discomfort and more frequently had behavioral symptoms return to baseline.

Barton and colleagues [ 37 ] have suggested a similar hierarchical approach to the management of inappropriate vocalization. For example, a mean score of 4. The scores on the CMAI in our sample also deserve some comments. Looking at other's work, we found that CMAI scores are reported for clinical samples in which participants are selected because they present agitation [ 38 , 39 ]. These scores are higher than for the participants in our study who were not selected on the basis of agitation.

For example, mean CMAI total scores vary between 65 and 78 across different samples in which participants present at least mild behavioral symptoms [ 39 ] compared to 41 in our sample. However, this mean score is similar to what we found previously in a separate but similar sample mean scores of Although there is no official cutoff for agitation on the CMAI, the range of scores min to max: 29 to 90 is quite broad and suggests that some participants presented some agitation while others did not.

Limitations to the generalization of our findings are the relatively small sample size and the fact that the data were compiled only during the day shift.

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Some authors have indicated that the different types of agitation occur at different periods of the day [ 40 , 41 ]. It is unclear whether the same factors are equally important contributors to agitation at different periods of the day and this should be investigated. Another limitation is that it is uncertain whether the FAST is valid and reliable when used by nurses.

However, it should be noted that the FAST is widely utilized by healthcare professionals of various backgrounds and requires minimal training because of its' face validity [ 42 ]. This measure of discomfort provides no specific information as to the nature and origin of this experience. Discomfort is a broad concept referring to a negative emotional or physical state.

Various conditions, including pain, distress, depression, loneliness, lack of stimulation, and lack of sleep can contribute to discomfort. Identifying which of these sources of discomfort play a role in agitation is essential for selecting appropriate treatment. Future studies, therefore, should identify the determinants of discomfort that are related to agitation in dementia patients and compare findings across different periods of the day.

Finally, we did not check reliability because of restrictions in the availability of the RNs. Moreover, this limitation does not seem to pose a threat to our conclusions since the results confirm our hypotheses and are consistent with those of other researchers. Dementia creates a paradoxical context in which patients are more vulnerable to various sources of discomfort while, at the same time, being less able to modify these by themselves or to communicate their discomfort directly to their caregivers.