JAMDA
Volume 7, Issue 3 , Pages 180-192 , March 2006

Difficult Behaviors in Long-term Care Patients With Dementia

  • Gwendolen T. Buhr, MD, MHSc

      Affiliations

    • Corresponding Author InformationAddress correspondence to Gwendolen T. Buhr, MD, MHSc, Department of Medicine, Division of Geriatrics, Center for the Study of Aging and Human Development, Box 3003, Duke University Medical Center, Durham, NC 27710
  • ,
  • Heidi K. White, MD, MHSc, CMD

References 

  1. Cohen CA , Gold DP , Shulman KI , Wortley JT , McDonald G , Wargon M . Factors determining the decision to institutionalize dementing individuals (A prospective study) . Gerontologist . 1993;33:714–720
  2. Hebert R , Dubois MF , Wolfson C , Chambers L , Cohen C . Factors associated with long-term institutionalization of older people with dementia (Data from the Canadian Study of Health and Aging) . J Gerontol A Biol Sci Med Sci . 2001;56:M693–M699
  3. Yaffe K , Fox P , Newcomer R , et al.   Patient and caregiver characteristics and nursing home placement in patients with dementia . JAMA . 2002;287:2090–2097
  4. Rovner BW , German PS , Broadhead J , et al.   The prevalence and management of dementia and other psychiatric disorders in nursing homes . Int Psychogeriatr . 1990;2:13–24
  5. Rovner BW , Kafonek S , Filipp L , Lucas MJ , Folstein MF . Prevalence of mental illness in a community nursing home . Am J Psychiatry . 1986;143:1446–1449
  6. Cohen-Mansfield J , Billig N . Agitated behaviors in the elderly. I. A conceptual review . J Am Geriatr Soc . 1986;34:711–721
  7. Patel V , Hope T . Aggressive behaviour in elderly people with dementia (A review) . Int J Geriatr Psychiatry . 1993;8:457–472
  8. Volicer L , Hurley A , Mahoney E . Behavioral symptoms of dementia . In:  Volicer L ,  Hurley A editor. Hospice Care for Patients With Advanced Progressive Dementia . New York, NY: Springer; 1998;p. 68–87
  9. Ryden MB , Feldt KS . Goal-directed care (Caring for aggressive nursing home residents with dementia) . J Gerontol Nurs . 1992;18:35–42
  10. Burgener SC , Barton D . Nursing care of cognitively impaired, institutionalized elderly . J Gerontol Nurs . 1991;17:37–43
  11. Snow T , Bunn M . Accepting the Challenge [DVD] (The Eastern North Carolina Chapter of the Alzheimer’s Association) . 2003;
  12. Burgio LD , Stevens A , Burgio KL , Roth DL , Paul P , Gerstle J . Teaching and maintaining behavior management skills in the nursing home . Gerontologist . 2002;42:487–496
  13. Sloane PD , Rader J , Barrick AL , et al.   Bathing persons with dementia . Gerontologist . 1995;35:672–678
  14. Sloane PD , Hoeffer B , Mitchell CM , et al.   Effect of person-centered showering and the towel bath on bathing-associated aggression, agitation, and discomfort in nursing home residents with dementia (A randomized, controlled trial) . J Am Geriatr Soc . 2004;52:1795–1804
  15. Rovner BW , Steele CD , Shmuely Y , Folstein MF . A randomized trial of dementia care in nursing homes . J Am Geriatr Soc . 1996;44:7–13
  16. Chitsey AM , Haight BK , Jones MM . Snoezelen (A multisensory environmental intervention) . J Gerontol Nurs . 2002;28:41–49
  17. Volicer L , Mahoney E , Brown E . Nonpharmacological approaches to the management of the behavioral consequences of advanced dementia . In:  Kaplan M ,  Hoffman S editor. Behaviors in Dementia (Best Practices for Successful Management) . Baltimore, MD: Health Professions Press, Inc; 1998;p. 155–176
  18. van Weert JC , van Dulmen AM , Spreeuwenberg PM , Ribbe MW , Bensing JM . Behavioral and mood effects of snoezelen integrated into 24-hour dementia care . J Am Geriatr Soc . 2005;53:24–33
  19. Beck C , Modlin T , Heithoff K , Shue V . Exercise as an intervention for behavior problems . Geriatr Nurs . 1992;13:273–275
  20. Camberg L , Woods P , Ooi WL , et al.   Evaluation of simulated presence (A personalized approach to enhance well-being in persons with Alzheimer’s disease) . J Am Geriatr Soc . 1999;47:446–452
  21. Remington R . Calming music and hand massage with agitated elderly . Nurs Res . 2002;51:317–323
  22. Goddaer J , Abraham IL . Effects of relaxing music on agitation during meals among nursing home residents with severe cognitive impairment . Arch Psychiatr Nurs . 1994;8:150–158
  23. Gerdner LA . Effects of individualized versus classical “relaxation” music on the frequency of agitation in elderly persons with Alzheimer’s disease and related disorders . Int Psychogeriatr . 2000;12:49–65
  24. Ragneskog H , Gerdner LA , Hellstrom L . Integration of lucid individuals and agitated individuals with dementia in different care units . J Clin Nurs . 2001;10:730–736
  25. Reimer MA , Slaughter S , Donaldson C , Currie G , Eliasziw M . Special care facility compared with traditional environments for dementia care (A longitudinal study of quality of life) . J Am Geriatr Soc . 2004;52:1085–1092
  26. Cohen-Mansfield J , Werner P . The effects of an enhanced environment on nursing home residents who pace . Gerontologist . 1998;38:199–208
  27. Kamel HK , Hajjar RR . Sexuality in the nursing home, part 2 (Managing abnormal behavior-legal and ethical issues) . J Am Med Dir Assoc . 2003;4:203–206
  28. Levitsky AM , Owens NJ . Pharmacologic treatment of hypersexuality and paraphilias in nursing home residents . J Am Geriatr Soc . 1999;47:231–234
  29. Wiseman SV , McAuley JW , Freidenberg GR , Freidenberg DL . Hypersexuality in patients with dementia (Possible response to cimetidine) . Neurology . 2000;54:2024
  30. Alagiakrishnan K , Sclater A , Robertson D . Role of cholinesterase inhibitor in the management of sexual aggression in an elderly demented woman . J Am Geriatr Soc . 2003;51:1326
  31. Alessi CA , Yoon EJ , Schnelle JF , Al-Samarrai NR , Cruise PA . A randomized trial of a combined physical activity and environmental intervention in nursing home residents (Do sleep and agitation improve?) . J Am Geriatr Soc . 1999;47:784–791
  32. Mahoney EK , Volicer L , Hurley AC . Management of Challenging Behaviors in Dementia . Baltimore, MD: Health Professions Press; 2000;
  33. White HK , McConnell ES , Bales CW , Kuchibhatla M . A 6-month observational study of the relationship between weight loss and behavioral symptoms in institutionalized Alzheimer’s disease subjects . J Am Med Dir Assoc . 2004;5:89–97
  34. Cowburn R , Hardy J , Roberts P . Neurotransmitter deficits in Alzheimer’s disease . In:  Davies D editors. Alzheimer’s disease (Towards an understanding of the aetiology and pathogenesis) . London, UK: John Libbey & Company Ltd; 1989;p. 9–32
  35. Lanctot KL , Herrmann N , Mazzotta P . Role of serotonin in the behavioral and psychological symptoms of dementia . J Neuropsychiatry Clin Neurosci . 2001;13:5–21
  36. Lee PE , Gill SS , Freedman M , Bronskill SE , Hillmer MP , Rochon PA . Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia (Systematic review) . BMJ . 2004;329:75–78
  37. Lonergan E, Luxenberg J, Colford J. Haloperidol for agitation in dementia. Cochrane Database Syst Rev2002:CD002852.
  38. Alexopoulos GS, Jeste DV, Chung H, Carpenter D, Ross R, Docherty JP. The expert consensus guideline series: Treatment of dementia and its behavioral disturbances. Postgraduate Medicine Special Report 2005;January:1–107.
  39. Reisberg B , Borenstein J , Salob SP , Ferris SH , Franssen E , Georgotas A . Behavioral symptoms in Alzheimer’s disease (Phenomenology and treatment) . J Clin Psychiatry . 1987;48(Suppl):9–15
  40. Katz IR , Jeste DV , Mintzer JE , Clyde C , Napolitano J , Brecher M  Risperidone Study Group . Comparison of risperidone and placebo for psychosis and behavioral disturbances associated with dementia (A randomized, double-blind trial) . J Clin Psychiatry . 1999;60:107–115
  41. Brodaty H , Ames D , Snowdon J , et al.   A randomized placebo-controlled trial of risperidone for the treatment of aggression, agitation, and psychosis of dementia . J Clin Psychiatry . 2003;64:134–143
  42. Frank L , Kleinman L , Ciesla G , Rupnow MF , Brodaty H . The effect of risperidone on nursing burden associated with caring for patients with dementia . J Am Geriatr Soc . 2004;52:1449–1455
  43. De Deyn PP , Rabheru K , Rasmussen A , et al.   A randomized trial of risperidone, placebo, and haloperidol for behavioral symptoms of dementia . Neurology . 1999;53:946–955
  44. Street JS , Clark WS , Gannon KS , et al.  The HGEU Study Group   Olanzapine treatment of psychotic and behavioral symptoms in patients with Alzheimer disease in nursing care facilities (A double-blind, randomized, placebo-controlled trial) . Arch Gen Psychiatry . 2000;57:968–976
  45. Cummings JL , Mega M , Gray K , Rosenberg-Thompson S , Carusi DA , Gornbein J . The Neuropsychiatric Inventory (Comprehensive assessment of psychopathology in dementia) . Neurology . 1994;44:2308–2314
  46. De Deyn PP , Carrasco MM , Deberdt W , et al.   Olanzapine versus placebo in the treatment of psychosis with or without associated behavioral disturbances in patients with Alzheimer’s disease . Int J Geriatr Psychiatry . 2004;19:115–126
  47. Ballard C , Margallo-Lana M , Juszczak E , et al.   Quetiapine and rivastigmine and cognitive decline in Alzheimer’s disease (Randomised double blind placebo controlled trial) . BMJ . 2005;330:874–878
  48. Katz IR . Optimizing atypical antipsychotic treatment strategies in the elderly . J Am Geriatr Soc . 2004;52(12 Suppl):S272–S277
  49. American Diabetes Association American Psychiatric Association American Association of Clinical Endocrinologists North American Association for the Study of Obesity . Consensus development conference on antipsychotic drugs and obesity and diabetes . Diabetes Care . 2004;27:596–601
  50. Risperdal (risperidone) and cerebrovascular adverse events in placebo-controlled dementia trials. Dear Healthcare Professional Letter; October 11, 2002. Available at: www.hc-sc.gc.ca/hpfb-dgpsa/tpd-dpt/risperdal1_e.pdf. Accessed January 5, 2005.
  51. Dear Healthcare Professional Letter; April 16, 2003. Available at: www.fda.gov/medwatch/SAFETY/2003/risperdal.html. Accessed January 5, 2005.
  52. Herrmann N , Mamdani M , Lanctot KL . Atypical antipsychotics and risk of cerebrovascular accidents . Am J Psychiatry . 2004;161:1113–1115
  53. EMEA public statement on the safety of olanzapine; March 9, 2004. Available at: www.emea.eu.int/pdfs/human/press/pus/085604en.pdf Accessed January 5, 2005.
  54. Atypical antipsychotic drugs and stroke: Message from Professor Gordon Duff, Chairman, Committee on Safety of Medicines; March 9, 2004. Available at: http://www.mhra.gov.uk/home/groups/pl-p/documents/drugsafetymessage/con019488.pdf. Accessed January 5, 2005.
  55. FDA public health advisory: Deaths with antipsychotics in elderly patients with behavioral disturbances; April 11, 2005. Available at: www.fda.gov/cder/drug/advisory/antipsychotics.htm. Accessed April 13, 2005.
  56. CATIE: Clinical Antipsychotic Trials of Intervention Effectiveness. A research program studying treatment effectiveness and outcomes in schizophrenia and Alzheimer’s disease. Available at: http://www.catie.unc.edu. Accessed January 12, 2005.
  57. Lanctot KL , Herrmann N , Mazzotta P , Khan LR , Ingber N . GABAergic function in Alzheimer’s disease (Evidence for dysfunction and potential as a therapeutic target for the treatment of behavioural and psychological symptoms of dementia) . Can J Psychiatry . 2004;49:439–453
  58. Bjork JM , Moeller FG , Kramer GL , et al.   Plasma GABA levels correlate with aggressiveness in relatives of patients with unipolar depressive disorder . Psychiatry Res . 2001;101:131–136
  59. Tariot PN , Erb R , Podgorski CA , et al.   Efficacy and tolerability of carbamazepine for agitation and aggression in dementia . Am J Psychiatry . 1998;155:54–61
  60. Porsteinsson AP , Tariot PN , Erb R , et al.   Placebo-controlled study of divalproex sodium for agitation in dementia . Am J Geriatr Psychiatry . 2001;9:58–66
  61. Tariot PN , Schneider L , Mintzer J , et al.   Safety and tolerability of divalproex sodium for the treatment of signs and symptoms of mania in elderly patients with dementia (Results of a double-blind, placebo-controlled trial) . Curr Ther Res Clin Exp . 2001;62:51–67
  62. Sival RC , Haffmans PM , Jansen PA , Duursma SA , Eikelenboom P . Sodium valproate in the treatment of aggressive behavior in patients with dementia—a randomized placebo controlled clinical trial . Int J Geriatr Psychiatry . 2002;17:579–585
  63. Cummings JL , Back C . The cholinergic hypothesis of neuropsychiatric symptoms in Alzheimer’s disease . Am J Geriatr Psychiatry . 1998;6(2 Suppl 1):S64–S78
  64. Birks JS, Harvey R. Donepezil for dementia due to Alzheimer’s disease. Cochrane Database Syst Rev2003:CD001190.
  65. Feldman H , Gauthier S , Hecker J , Vellas B , Subbiah P , Whalen E . A 24-week, randomized, double-blind study of donepezil in moderate to severe Alzheimer’s disease . Neurology . 2001;57:613–620
  66. Tariot PN , Cummings JL , Katz IR , et al.   A randomized, double-blind, placebo-controlled study of the efficacy and safety of donepezil in patients with Alzheimer’s disease in the nursing home setting . J Am Geriatr Soc . 2001;49:1590–1599
  67. Holmes C , Wilkinson D , Dean C , et al.   The efficacy of donepezil in the treatment of neuropsychiatric symptoms in Alzheimer disease . Neurology . 2004;63:214–219
  68. Courtney C , Farrell D , Gray R , et al.   Long-term donepezil treatment in 565 patients with Alzheimer’s disease (AD2000) (Randomised double-blind trial) . Lancet . 2004;363(9427):2105–2115
  69. Rockwood K , Mintzer J , Truyen L , Wessel T , Wilkinson D . Effects of a flexible galantamine dose in Alzheimer’s disease (A randomised, controlled trial) . J Neurol Neurosurg Psychiatry . 2001;71:589–595
  70. Tariot PN , Solomon PR , Morris JC , Kershaw P , Lilienfeld S , Ding C  The Galantamine USA-10 Study Group . A 5-month, randomized, placebo-controlled trial of galantamine in AD . Neurology . 2000;54:2269–2276
  71. Erkinjuntti T , Kurz A , Gauthier S , Bullock R , Lilienfeld S , Damaraju CV . Efficacy of galantamine in probable vascular dementia and Alzheimer’s disease combined with cerebrovascular disease (A randomised trial) . Lancet . 2002;359(9314):1283–1290
  72. Hynd MR , Scott HL , Dodd PR . Glutamate-mediated excitotoxicity and neurodegeneration in Alzheimer’s disease . Neurochem Int . 2004;45:583–595
  73. Bleich S , Romer K , Wiltfang J , Kornhuber J . Glutamate and the glutamate receptor system (A target for drug action) . Int J Geriatr Psychiatry . 2003;18(Suppl 1):S33–S40
  74. AreosaSA,SherriffF,McShaneR. Memantine for dementia. Cochrane Database Syst Rev2005:CD003154.
  75. Levy ML , Cummings JL , Kahn-Rose R . Neuropsychiatric symptoms and cholinergic therapy for Alzheimer’s disease . Gerontology . 1999;(45 Suppl 1):15–22
  76. Weiner MF , Edland SD , Luszczynska H . Prevalence and incidence of major depression in Alzheimer’s disease . Am J Psychiatry . 1994;151:1006–1009
  77. Rovner BW , Broadhead J , Spencer M , Carson K , Folstein MF . Depression and Alzheimer’s disease . Am J Psychiatry . 1989;146:350–353
  78. Menon AS , Gruber-Baldini AL , Hebel JR , et al.   Relationship between aggressive behaviors and depression among nursing home residents with dementia . Int J Geriatr Psychiatry . 2001;16:139–146
  79. Lanctot KL , Herrmann N , Eryavec G , van Reekum R , Reed K , Naranjo CA . Central serotonergic activity is related to the aggressive behaviors of Alzheimer’s disease . Neuropsychopharmacology . 2002;27:646–654
  80. Nyth AL , Gottfries CG . The clinical efficacy of citalopram in treatment of emotional disturbances in dementia disorders. A Nordic multicentre study . Br J Psychiatry . 1990;157:894–901
  81. Pollock BG , Mulsant BH , Rosen J , et al.   Comparison of citalopram, perphenazine, and placebo for the acute treatment of psychosis and behavioral disturbances in hospitalized, demented patients . Am J Psychiatry . 2002;159:460–465
  82. Levkovitz Y , Bloch Y , Kaplan D , Diskin A , Abramovitchi I . Fluvoxamine for psychosis in Alzheimer’s disease . J Nerv Ment Dis . 2001;189:126–129
  83. Lyketsos CG , DelCampo L , Steinberg M , et al.   Treating depression in Alzheimer disease: Efficacy and safety of sertraline therapy, and the benefits of depression reduction: The DIADS . Arch Gen Psychiatry . 2003;60:737–746
  84. Petracca G , Teson A , Chemerinski E , Leiguarda R , Starkstein SE . A double-blind placebo-controlled study of clomipramine in depressed patients with Alzheimer’s disease . J Neuropsychiatry Clin Neurosci . 1996;8:270–275
  85. Reifler BV , Teri L , Raskind M , et al.   Double-blind trial of imipramine in Alzheimer’s disease patients with and without depression . Am J Psychiatry . 1989;146:45–49
  86. Teri L , Reifler BV , Veith RC , et al.   Imipramine in the treatment of depressed Alzheimer’s patients (impact on cognition) . J Gerontol . 1991;46:P372–P377
  87. Teri L , Logsdon RG , Peskind E , et al.   Treatment of agitation in AD (A randomized, placebo-controlled clinical trial) . Neurology . 2000;55:1271–1278
  88. Magai C , Kennedy G , Cohen CI , Gomberg D . A controlled clinical trial of sertraline in the treatment of depression in nursing home patients with late-stage Alzheimer’s disease . Am J Geriatr Psychiatry . 2000;8:66–74
  89. Finkel SI , Mintzer JE , Dysken M , Krishnan KR , Burt T , McRae T . A randomized, placebo-controlled study of the efficacy and safety of sertraline in the treatment of the behavioral manifestations of Alzheimer’s disease in outpatients treated with donepezil . Int J Geriatr Psychiatry . 2004;19:9–18
  90. Teri L , Gallagher-Thompson D . Cognitive-behavioral interventions for treatment of depression in Alzheimer’s patients . Gerontologist . 1991;31:413–416
  91. Cheston R , Jones K , Gilliard J . Group psychotherapy and people with dementia . Aging Ment Health . 2003;7:452–461
  92. Bouman WP , Pinner G . Violent behavior associated with donepezil . Am J Psychiatry . 1998;155:1626–1627
  93. Caffarra P , Majer S , Godani M , Paolello P . Rivastagmine-induced agitation following transient recollection of autobiographical memory . Neurol Sci . 2001;22:279–280
  94. Smith DJ , Yukhnevich S . Adverse reactions to rivastigmine in three cases of dementia . Aust N Z J Psychiatry . 2001;35:694–695

 The preparation of this review was supported by funds awarded to Heidi K. White, MD, MHS from the Division of State, Community, and Public Health, Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS), under grant number 5 K01 HP00078-02 and title Geriatric Academic Career Award. The information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by the BHPR, HRSA, DHHS or the U.S. government.

PII: S1525-8610(05)00677-8

doi: 10.1016/j.jamda.2005.12.003

JAMDA
Volume 7, Issue 3 , Pages 180-192 , March 2006