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Few studies have been conducted on service
provision for community dwelling dementia patients based in
primary care settings. In a randomized controlled trial (RCT)
of AD patients and their caregivers, usual care was compared
with an intervention that included a nurse practitioner who
acted as a care manager, and standardized care protocols to
manage specific problems, such as a variety of neuropsychiatric
symptoms (e.g. sleep, depression, psychosis). There was a significant
reduction in neuropsychiatric symptoms associated with the intervention
that rivalled results from many of the pure pharmacological
trials. While the intervention was expensive, the authors argue
it was probably cost-effective given the documented association
between neuropsychiatric symptoms and increased cost of dementia
care.
Effectiveness of collaborative care
for older adults with Alzheimer disease in primary care: a randomized
controlled trial
(JAMA 2006;295:2148-2157)
CHRISTOPHER M. CALLAHAN, MD,
MALAZ A. BOUSTANI, MD, MPH,
FREDERICK W. UNVERZAGT, PhD,
MARY G. AUSTROM, PhD,
ET AL,
indianapol is, in
INSIGHT AND NEUROPSYCHIATRIC
SYMPTOMS
Research on the relationship between insight
and neuropsychiatric symptoms in dementia has previously focused
on depression, anxiety and apathy. In a prospective study of
dementia patients, Aalten et al (2006) examined insight
(termed “awareness” by these authors) at baseline,
and changes in neuropsychiatric symptoms over the course of
one year. While baseline insight was negatively associated with
psychosis, apathy and total neuropsychiatric symptom burden,
at one year follow- up there was a positive association between
insight and symptoms of depression and anxiety. As expected,
the degree of insight in all patients declined significantly
over the follow-up period.
Awareness and behavioral problems
in dementia patients: a prospective study
(INT PSYCHOGERIATRICS 2006;18:3-17)
PAULINE AALTEN,
EVELIEN VAN VALEN,
MARJOLEIN E. DE VUGT,
RICHEL LOUSBERG,
ET AL,
maastricht, THE NETHERLANDS
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