Department of Primary and Community Care (BA, CB, JCLD, RTCMK), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Knowledge Center for Specialized Care (BA), Landrijt Archipel, Eindhoven, The Netherlands; Radboudumc Alzheimer Center (BA, CB, JCLD, RTCMK), Nijmegen, The Netherlands; Send correspondence and reprint requests to Britt Appelhof, M.Sc., Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands..
Department of Primary and Community Care (BA, CB, JCLD, RTCMK), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Radboudumc Alzheimer Center (BA, CB, JCLD, RTCMK), Nijmegen, The Netherlands; Center for Specialized Care in Young-Onset Dementia (CB), Florence Mariahoeve, The Hague.
Am J Geriatr Psychiatry. 2019 Jun;27(6):581-589. doi: 10.1016/j.jagp.2018.12.032. Epub 2019 Jan 4.
The effect of an intervention on neuropsychiatric symptoms (NPS), particularly agitation and aggression, and psychotropic drug use (PDU) in institutionalized people with young-onset dementia (YOD) was evaluated.
A randomized controlled trial was conducted using a stepped wedge design. Thirteen YOD special care units were randomly assigned to three groups, which received the intervention at different time points. Four assessments took place every 6 months during a period of 18 months. Two hundred seventy-four people with YOD who resided in YOD special care units participated, of whom 131 took part in all assessments. The intervention consisted of an educational program combined with a care program, which structured the multidisciplinary process of managing NPS. The care program included the following five steps: evaluation of psychotropic drug prescription, detection, analysis, treatment, and evaluation of treatment of NPS. The Cohen-Mansfield Agitation Inventory and the Neuropsychiatric Inventory-Nursing Home version were used to assess NPS. Data on PDU were retrieved from residents' medical files. Multilevel models were used to evaluate the effect of the intervention, which accounted for clustering of measurements in clients within units.
No significant differences were found in agitation, aggression, other NPS, or PDU after crossing over to the intervention condition.
We found no evidence that the intervention for management of NPS in nursing home residents with YOD was more effective in reducing agitation, aggression, other NPS, or PDU compared with care as usual.
评估一项干预措施对神经精神症状（NPS），特别是激越和攻击行为，以及机构化早发性痴呆（YOD）患者精神药物使用（PDU）的影响。
采用逐步楔形设计进行随机对照试验。13 个 YOD 特殊护理单元被随机分为三组，在不同时间点接受干预。在 18 个月的时间内，每 6 个月进行 4 次评估。共有 274 名居住在 YOD 特殊护理单元的 YOD 患者参与，其中 131 名患者参加了所有评估。干预措施包括一个教育计划和一个护理计划，该计划构建了管理 NPS 的多学科流程。护理计划包括以下五个步骤：评估精神药物处方、发现、分析、治疗和治疗 NPS 的评估。使用 Cohen-Mansfield 激越量表和神经精神病学-养老院版评估 NPS。PDU 数据从居民的医疗档案中检索。使用多水平模型评估干预的效果，该模型考虑了单位内患者测量的聚类。
在交叉到干预条件后，激越、攻击、其他 NPS 或 PDU 没有显著差异。
与常规护理相比，我们没有发现针对养老院 YOD 患者 NPS 管理的干预措施在减少激越、攻击、其他 NPS 或 PDU 方面更有效。
