Department of Psychology, University of Kansas, Lawrence, KS, USA.
Gerontologist. 2013 Feb;53(1):102-12. doi: 10.1093/geront/gns104. Epub 2012 Aug 30.
Although declines in memory and attention are hallmark symptoms of Alzheimer's disease (AD), noncognitive symptoms are prevalent. Over 80% of individuals will experience neuropsychiatric symptoms, which complicates symptom profiles. Research indicates a community-integrated response to dementia crisis can reduce negative consequences attributed to crisis including increased caregiver burden, increased health care costs, and premature institutionalizations.
The Kansas Dementia Crisis Bridge Project is a multidisciplinary collaboration to provide direct support in critical situations to reduce psychiatric rehospitalizations. Coordinators provided counsel and dementia education to families throughout critical period of acute neuropsychiatric symptoms, facilitated professional involvement, and provided crisis prevention planning through crisis review. The Neuropsychiatric Inventory Questionnaire and Geriatric Depression Scale were used to measure the impact of neuropsychiatric symptoms and Bridge interventions on patient and caregivers.
The Bridge project significantly reduced patient anxiety, depression, resistance to care, impulsive behavior, verbal outbursts, and wandering. Caregivers reported significantly reduced anxiety, apathy, resistance to care, and less distress over patient neuropsychiatric symptoms. Caregivers also reported increased confidence in managing difficult behaviors, and the project effectively reduced or resolved neuropsychiatric crisis. The project delayed nursing home placement for community-dwelling patients.
Crisis support models like the Bridge project reduce strain on care-delivery systems by incorporating nonpharmacological interventions, assisting families with communication, and reducing family distress during symptom crises. Although much of AD research focuses on disease-modifying medical interventions, aging and care systems in the state must simultaneously move towards dependency-modifying care interventions.
尽管记忆和注意力衰退是阿尔茨海默病（AD）的标志性症状，但非认知症状也很普遍。超过 80%的人会出现神经精神症状，这使症状谱变得复杂。研究表明，对痴呆危机采取社区综合应对措施可以减少危机带来的负面影响，包括增加照顾者负担、增加医疗保健成本和提前机构化。
堪萨斯州痴呆危机桥梁项目是一个多学科合作项目，旨在为关键情况下提供直接支持，以减少精神科再住院。协调员在急性神经精神症状的关键时期为家庭提供咨询和痴呆症教育，促进专业人员的参与，并通过危机审查提供危机预防计划。使用神经精神疾病问卷和老年抑郁量表来衡量神经精神症状和桥梁干预对患者和照顾者的影响。
桥梁项目显著降低了患者的焦虑、抑郁、抗拒护理、冲动行为、言语爆发和徘徊。照顾者报告说，患者的神经精神症状引起的焦虑、冷漠、抗拒护理和痛苦明显减少。照顾者还报告说，他们在处理困难行为方面的信心有所增加，该项目有效地减少或解决了神经精神危机。该项目延迟了社区居住患者的疗养院安置。
像桥梁项目这样的危机支持模式通过整合非药物干预、协助家庭沟通以及减轻家庭在症状危机期间的痛苦，减轻了护理提供系统的压力。尽管 AD 研究的大部分重点都放在了改变疾病的医疗干预上，但该州的老龄化和护理系统也必须同时转向改变依赖的护理干预。
