Anto P Rajkumar1, Clive Ballard2, Jane Fossey3, Anne Corbett4, Bob Woods5, Martin Orrell6, Rohan Prakash7, Esme Moniz-Cook8, Ingelin Testad4. 1. Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; Mental Health of Older Adults and Dementia Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK; Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark. Electronic address: Anto.Rajamani@kcl.ac.uk. 2. Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; Mental Health of Older Adults and Dementia Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK. 3. Oxford Health NHS Foundation Trust, Oxford, UK. 4. Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK. 5. North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK. 6. Institute of Mental Health, University of Nottingham, Nottingham, UK. 7. University College London, London, UK. 8. Faculty of Health and Social Sciences, University of Hull, Hull, UK.
Abstract
OBJECTIVES: Apathy is common, impactful, and difficult to manage in people with dementia. We evaluated the efficacy of nonpharmacological interventions, exercise, and social interaction, in combination with antipsychotic review, to reduce apathy in people with dementia living in nursing homes in a cluster randomized controlled trial (RCT). METHODS: Well-being and health for people with dementia (WHELD) program included a 2 × 2 × 2 factorial cluster RCT involving people with dementia living in 16 nursing homes in the United Kingdom. All homes received training in person-centered care, and were randomized to receive antipsychotic review, social interaction, and exercise, either alone or in combinations. Apathy was one of the secondary outcomes of the WHELD trial, and it was measured by the Neuropsychiatric Inventory-nursing home version at baseline and 9 months (n = 273). We used multilevel mixed effects linear regression models to assess the impact of the interventions on apathy. RESULTS: Prevalence of apathy was 44.0% (n = 120; 95% confidence interval [CI] 38.1%-49.9%) at baseline. Severity of apathy had significant positive correlations with dementia severity, neuropsychiatric symptoms, depressive symptoms, agitation, and the needs of the people with dementia (P < .001). Antipsychotic review reduced antipsychotic use, but it significantly increased apathy (β = 5.37; SE = 0.91; P < .001). However, antipsychotic review in combination with either social interaction (β = -5.84; SE = 1.15; P < .001) or exercise (β = -7.54; SE = 0.93; P < .001) significantly reduced apathy. CONCLUSIONS: Antipsychotic review can play a significant role in improving apathy in people with dementia living in nursing homes, when combined with psychosocial interventions such as social interaction and exercise. Guidance must be adapted to reflect this subtlety in care.
OBJECTIVES: Apathy is common, impactful, and difficult to manage in people with dementia. We evaluated the efficacy of nonpharmacological interventions, exercise, and social interaction, in combination with antipsychotic review, to reduce apathy in people with dementia living in nursing homes in a cluster randomized controlled trial (RCT). METHODS: Well-being and health for people with dementia (WHELD) program included a 2 × 2 × 2 factorial cluster RCT involving people with dementia living in 16 nursing homes in the United Kingdom. All homes received training in person-centered care, and were randomized to receive antipsychotic review, social interaction, and exercise, either alone or in combinations. Apathy was one of the secondary outcomes of the WHELD trial, and it was measured by the Neuropsychiatric Inventory-nursing home version at baseline and 9 months (n = 273). We used multilevel mixed effects linear regression models to assess the impact of the interventions on apathy. RESULTS: Prevalence of apathy was 44.0% (n = 120; 95% confidence interval [CI] 38.1%-49.9%) at baseline. Severity of apathy had significant positive correlations with dementia severity, neuropsychiatric symptoms, depressive symptoms, agitation, and the needs of the people with dementia (P < .001). Antipsychotic review reduced antipsychotic use, but it significantly increased apathy (β = 5.37; SE = 0.91; P < .001). However, antipsychotic review in combination with either social interaction (β = -5.84; SE = 1.15; P < .001) or exercise (β = -7.54; SE = 0.93; P < .001) significantly reduced apathy. CONCLUSIONS: Antipsychotic review can play a significant role in improving apathy in people with dementia living in nursing homes, when combined with psychosocial interventions such as social interaction and exercise. Guidance must be adapted to reflect this subtlety in care.
Authors: Christoph Mueller; Anto P Rajkumar; Yi Min Wan; Latha Velayudhan; Dominic Ffytche; Kallol Ray Chaudhuri; Dag Aarsland Journal: CNS Drugs Date: 2018-07 Impact factor: 5.749
Authors: Daniel J Hoyle; Ivan K Bindoff; Lisa M Clinnick; Gregory M Peterson; Juanita L Westbury Journal: Drugs Aging Date: 2018-02 Impact factor: 3.923
Authors: David S Miller; Philippe Robert; Larry Ereshefsky; Lawrence Adler; Daniel Bateman; Jeff Cummings; Steven T DeKosky; Corinne E Fischer; Masud Husain; Zahinoor Ismail; Judith Jaeger; Alan J Lerner; Abby Li; Constantine G Lyketsos; Valeria Manera; Jacobo Mintzer; Hans J Moebius; Moyra Mortby; Didier Meulien; Stephane Pollentier; Anton Porsteinsson; Jill Rasmussen; Paul B Rosenberg; Myuri T Ruthirakuhan; Mary Sano; Carla Zucchero Sarracini; Krista L Lanctôt Journal: Alzheimers Dement Date: 2021-05-05 Impact factor: 16.655