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Actigraphy in agitated patients with dementia

Monitoring treatment outcomes

Aktometrisches Monitoring von Behandlungsverläufen Demenzkranker

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Abstract

Especially in pharmacotherapeutic research, a variety of methods to monitor behavioural and psychological symptoms of dementia (BPSD) are currently being discussed. To date, the most frequently used of these are clinical scales, which, however, are subjective and highly dependent on personnel resources. In our study, we tested the usefulness of actigraphy as a more direct and objective way to measure day-night rhythm disturbances and agitated behaviour.

After a baseline assessment, 24 patients with probable dementia of the Alzheimer type (NINCDS-ADRDA) and agitated behaviour received either 3 mg melatonin (n=7), 2.5 mg dronabinol (n=7), or placebo (n=10) for two weeks. In addition, 10 young and 10 elderly healthy subjects were examined as a control group. Motor activity levels were assessed using an actigraph worn continuously on the wrist of the non-dominant hand. At the beginning and the end of the study, patients' Neuropsychiatric Inventory (NPI) scores were also assessed.

In the verum group, actigraphic nocturnal activity (P=0.001), NPI total score (P=0.043), and NPI agitation subscale score (P=0.032) showed significant reductions compared to baseline. The treatment-baseline ratio of nocturnal activity (P=0.021) and treatment-baseline difference of the nocturnal portion of 24 h activity (P=0.012) were reduced. Patients' baseline activity levels were similar to those seen in healthy elderly subjects. Younger healthy subjects exhibited higher motor activity even at night. There was no correlation between actigraphy and NPI.

Both actigraphic measures and the gold standard clinical scale were able to distinguish between the verum and placebo groups. However, because they did not correlate with each other, they clearly represent different aspects of BPSD, each of which reacts differently to therapy. As a result, actigraphy may well come to play an important role in monitoring treatment success in BPSD.

Zusammenfassung

Zur Dokumentation von Behandlungsverläufen bei Demenzpatienten mit nicht-kognitiver Symptomatik (behavioural and psychological symptoms of dementia, BPRS) werden verschiedene Methoden diskutiert. Derzeit werden vor allem klinische Skalen und psychometrische Tests angewandt, die subjektiv und personalaufwändig sind. Mit der vorgelegten Arbeit wollen wir zeigen, dass die Aktometrie als objektive Methode zur Aufzeichnung von agitiertem Verhalten und Tag- Nacht Rhythmusstörungen geeignet ist.

24 Patienten mit der wahrscheinlichen Diagnose einer Alzheimerdemenz (NINCDS-ADRDA) wurden eingeschlossen. Außerdem untersuchten wir 10 jüngere und 10 ältere gesunde Probanden. Nach einer interventionsfreien Beobachtungsphase erhielten die Patienten über einen Zeitraum 2 Wochen 3 mg Melatonin (n=7), 2,5 mg Dronabinol (n=7) oder Placebo (n=10). Die motorische Aktivität wurde kontinuierlich mit einem Aktometer aufgezeichnet. Zu Beginn und am Ende der Beobachtungszeit wurde außerdem das Neuropsychiatrische Inventar (NPI) erhoben.

Die nächtliche aktometrische Aktivität (P=0,001), der NPI-Gesamtscore (P=0,043) und der NPI-Teilscore für Agitation (P=0,032) waren in der Verumgruppe im Vergleich zu den Ausgangswerten signifikant erniedrigt. Das Behandlungs-Ausgangswert-Verhältnis der nächtlichen Aktivität (P=0,021) und die Behandlungs-Ausgangswert-Differenz des Anteils der Nachtaktivität an der Gesamtaktivität (P=0,012) zeigten eine deutliche Absenkung in der Verumgruppe im Vergleich zur Placebogruppe. In unbehandeltem Zustand zeigten die agitierten Patienten das gleiche Aktivitätsniveau wie die älteren Probanden. Die jüngeren Probanden hatten ein höheres nächtliches Aktivitätsniveau. Es gab keinerlei Korrelationen zwischen den aktometrischen Werten und dem NPI.

Sowohl für die aktometrischen als auch für die NPI-Daten zeigten sich Unterschiede in der Verum- und Placebogruppe. Da beide Methoden jedoch nicht miteinander korrelierten, folgern wir daraus, dass verschiedene, unabhängige Aspekte agitierten Verhaltens abgebildet wurden, die bei den Individuen unterschiedlich auf die Therapieversuche ansprachen. Damit hat die Aktometrie neben den klinischen Skalen einen wichtigen Stellenwert in der Dokumentation dieser Störungen.

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References

  1. Ancoli-Israel S, Cole R, Alessi C, Chambers M, Moorcroft W, Pollak CP (2003) The role of actigraphy in the study of sleep and circadian rhythms. Sleep 26:342–392

    PubMed  Google Scholar 

  2. Ancoli-Israel S, Gehrman P, Martin JL, Shochat T, Marler M, Corey- Bloom J, Levi L (2003) Increased light exposure consolidates sleep and strengthens circadian rhythms in severe Alzheimer's disease patients. Behav Sleep Med 1:22–36

    Article  PubMed  Google Scholar 

  3. Black W, Almeida OP (2004) A systematic review of the association between the behavioral and psychological symptoms of dementia and burden of care. Int Psychogeriatr 16:295–315

    Article  PubMed  Google Scholar 

  4. Brane G, Gottfries CG, Winblad B (2001) The Gottfries-Brane-Steen scale: validity, reliability and application in anti-dementia drug trials. Dement Geriatr Cogn Disord 12:1–14

    Article  PubMed  CAS  Google Scholar 

  5. Cohen-Mansfield J (1996) Conceptualization of agitation: results based on the Cohen-Mansfield agitation inventory and the agitation behavior mapping instrument. Int Psychogeriatr 8 (Suppl 3):309–315

    Article  PubMed  Google Scholar 

  6. Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J (1994) The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology 44:2308–2314

    PubMed  CAS  Google Scholar 

  7. Dowling GA, Hubbard EM, Mastick J, Luxenberg JS, Burr RL, Van Someren EJ (2005) Effect of morning bright light treatment for rest-activity disruption in institutionalized patients with severe Alzheimer's disease. Int Psychogeriatr 17:221–236

    Article  PubMed  Google Scholar 

  8. Fetveit A, Bjorvatn B (2005) Brightlight treatment reduces actigraphicmeasured daytime sleep in nursing home patients with dementia: a pilot study. Am J Geriatr Psychiatry 13:420–423

    Article  PubMed  Google Scholar 

  9. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  PubMed  CAS  Google Scholar 

  10. Fontana GP, Krauchi K, Cajochen C, Someren E, Amrhein I, Pache M, Savaskan E, Wirz-Justice A (2003) Dawn-dusk simulation light therapy of disturbed circadian rest-activity cycles in demented elderly. Exp Gerontol 38:207–216

    Article  Google Scholar 

  11. Haimov I, Lavie P, Laudon M, Herer P, Vigder C, Zisapel N (1995) Melatonin replacement therapy of elderly insomniacs. Sleep 18:598–603

    PubMed  CAS  Google Scholar 

  12. Harper DG, Stopa EG, McKee AC, Satlin A, Harlan PC, Goldstein R, Volicer L (2001) Differential circadian rhythm disturbances in men with Alzheimer disease and frontotemporal degeneration. Arch Gen Psychiatry 58:353–360

    Article  PubMed  CAS  Google Scholar 

  13. Hebert R, Dubois MF, Wolfson C, Chambers L, Cohen C (2001) 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 56:M693–M699

    PubMed  CAS  Google Scholar 

  14. Klosch G, Kemp B, Penzel T, Schlogl A, Rappelsberger P, Trenker E, Gruber G, Zeitlhofer J, Saletu B, Herrmann WM, Himanen SL, Kunz D, Barbanoj MJ, Roschke J, Varri A, Dorffner G (2001) The SIESTA project polygraphic and clinical database. IEEE Eng Med Biol Mag 20:51–57

    Article  PubMed  CAS  Google Scholar 

  15. Mahlberg R, Kunz D, Sutej I, Kuhl KP, Hellweg R (2004) Melatonin treatment of day-night rhythm disturbances and sundowning in Alzheimer disease: an open-label pilot study using actigraphy. J Clin Psychopharmacol 24:456–459

    Article  PubMed  Google Scholar 

  16. Mahlberg R, Walther S, Eichmann U, Tracik F, Kunz D (2006) Effects of rivastigmine on actigraphically monitored motor activity in severe agitation related to Alzheimer's disease: a placebo-controlled pilot study. Arch Gerontol Geriatr

  17. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM (1984) Clinical diagnosis of Alzheimer's disease: report of the NINCDSADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 34:939–944

    PubMed  CAS  Google Scholar 

  18. Mirakhur A, Craig D, Hart DJ, McLlroy SP, Passmore AP (2004) Behavioural and psychological syndromes in Alzheimer's disease. Int J Geriatr Psychiatry 19:1035–1039

    Article  PubMed  CAS  Google Scholar 

  19. Mohs RC, Cohen L (1988) Alzheimer's disease assessment scale (ADAS). Psychopharmacol Bull 24:627–628

    PubMed  CAS  Google Scholar 

  20. Nagels G, Engelborghs S, Vloeberghs E, Van Dam D, Pickut BA, De Deyn PP (2006) Actigraphic measurement of agitated behaviour in dementia. Int J Geriatr Psychiatry 21:388–393

    Article  PubMed  Google Scholar 

  21. Olde Rikkert MG, Rigaud AS (2001) Melatonin in elderly patients with insomnia. A systematic review. Z Gerontol Geriatr 34:491–497

    Article  PubMed  CAS  Google Scholar 

  22. Paavilainen P, Korhonen I, Lotjonen J, Cluitmans L, Jylha M, Sarela A, Partinen M (2005) Circadian activity rhythm in demented and non-demented nursing-home residents measured by telemetric actigraphy. J Sleep Res 14:61–68

    Article  PubMed  Google Scholar 

  23. Reisberg B, Auer SR, Monteiro IM (1996) Behavioral pathology in Alzheimer's disease (BEHAVE-AD) rating scale. Int Psychogeriatr 8 (Suppl 3):301–308

    Article  PubMed  Google Scholar 

  24. Reisberg B, Borenstein J, Salob SP, Ferris SH, Franssen E, Georgotas A (1987) Behavioral symptoms in Alzheimer's disease: phenomenology and treatment. J Clin Psychiatry 48 (Suppl):9–15

    PubMed  Google Scholar 

  25. Ruths S, Straand J, Nygaard HA, Bjorvatn B, Pallesen S (2004) Effect of antipsychotic withdrawal on behavior and sleep/wake activity in nursing home residents with dementia: a randomized, placebo-controlled, double-blinded study. The Bergen District Nursing Home Study. J Am Geriatr Soc 52:1737–1743

    Article  PubMed  Google Scholar 

  26. Spiegel R, Brunner C, Ermini- Funfschilling D, Monsch A, Notter M, Puxty J, Tremmel L (1991) A new behavioral assessment scale for geriatric out- and in-patients: the NOSGER (Nurses' Observation Scale for Geriatric Patients). J Am Geriatr Soc 39:339–347

    PubMed  CAS  Google Scholar 

  27. Stanley N (2003) Actigraphy in human psychopharmacology: a review. Hum Psychopharmacol 18:39–49

    Article  PubMed  CAS  Google Scholar 

  28. Torta R, Badino E, Scalabrino A (2004) Therapeutic strategies for behavioral and psychological symptoms (BPSD) in demented patients. Arch Gerontol Geriatr 38(Suppl 1):443–454

    Article  Google Scholar 

  29. Volicer L, Harper DG, Manning BC, Goldstein R, Satlin A (2001) Sundowning and circadian rhythms in Alzheimer's disease. Am J Psychiatry 158:704–711

    Article  PubMed  CAS  Google Scholar 

  30. Volicer L, Hurley AC (2003) Management of behavioral symptoms in progressive degenerative dementias. J Gerontol A Biol Sci Med Sci 58:M837–M845

    PubMed  Google Scholar 

  31. Walther S, Mahlberg R, Eichmann U, Kunz D (2006) Delta-9-tetrahydrocannabinol for nighttime agitation in severe dementia. Psychopharmacology (Berl) 185:524–528

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Turmstraße 21, 10559, Berlin, Germany

    R. Mahlberg

  2. University of Bern, Psychiatric Services (UPD), 3060, Bern, Switzerland

    S. Walther

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  1. R. Mahlberg
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  2. S. Walther
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Correspondence to R. Mahlberg.

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Mahlberg, R., Walther, S. Actigraphy in agitated patients with dementia. Z Gerontol Geriatr 40, 178–184 (2007). https://doi.org/10.1007/s00391-007-0420-z

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  • DOI: https://doi.org/10.1007/s00391-007-0420-z

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