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Alzheimer's Research & Therapy

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Open Access 01-12-2017 | Research

Structured physical exercise improves neuropsychiatric symptoms in acute dementia care: a hospital-based RCT

Authors: Tim Fleiner, Hannah Dauth, Marleen Gersie, Wiebren Zijlstra, Peter Haussermann

Published in: Alzheimer's Research & Therapy | Issue 1/2017

Abstract

Background

The primary objective of this trial is to investigate the effects of a short-term exercise program on neuropsychiatric signs and symptoms in acute hospital dementia care.

Methods

Within a hospital-based randomized controlled trial, the intervention group conducted a 2-week exercise program with four 20-min exercise sessions on 3 days per week. The control group conducted a social stimulation program. Effects on neuropsychiatric signs and symptoms were measured via the Alzheimer’s Disease Cooperative Study-Clinical Global Impression of Change, the Neuropsychiatric Inventory, and the Cohen-Mansfield Agitation Inventory. The antipsychotic and sedative dosage was quantified by olanzapine and diazepam equivalents.

Results

Eighty-five patients were randomized via minimization to an intervention group (IG) and a control group (CG). Seventy patients (82%) (mean age 80 years, 33 females, mean Mini Mental State Examination score 18.3 points) completed the trial. As compared to the CG (n = 35), the IG (n = 35) showed significantly reduced neuropsychiatric signs and symptoms. Especially, agitated behavior and lability improved. There were no between-group differences concerning antipsychotic and benzodiazepine medication.

Conclusions

This exercise program is easily applicable in hospital dementia care and significantly reduces neuropsychiatric signs and symptoms in patients suffering from predominantly moderate stages of dementia.

Trial registration

German Clinical Trial Register DRKS00006740. Registered 28 October 2014.

Savva GM, Zaccai J, Matthews FE, Davidson JE, McKeith I, Brayne C. Prevalence, correlates and course of behavioural and psychological symptoms of dementia in the population. Br J Psychiatry. 2009;194:212–9. doi:10.1192/bjp.bp.108.049619 .CrossRefPubMed

US Food and Drug Administration. Public Health Advisory: Deaths with Antipsychotics in Elderly Patients with Behavioral Disturbances. 2005. http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/ucm053171, Accessed 20 Nov 2016.

Department of Health. Living well with dementia: a national dementia strategy. London; 2009. https://www.gov.uk/government/publications/living-well-with-dementia-a-national-dementia-strategy.

Scherder EJA, Bogen T, Eggermont LHP, Hamers JPH, Swaab DF. The more physical inactivity, the more agitation in dementia. Int Psychogeriatr. 2010;22:1203–8.CrossRefPubMed

Volicer L, Simard J, Pupa J, Heartquist, Medrek R, Riordan ME. Effects of continuous activity programming on behavioral symptoms of dementia. J Am Med Dir Assoc. 2006;7:426–31. doi:10.1016/j.jamda.2006.02.003 .CrossRefPubMed

Aman E, Thomas DR. Supervised exercise to reduce agitation in severely cognitively impaired persons. J Am Med Dir Assoc. 2009;10:271–6.CrossRefPubMed

Thuné-Boyle ICV, Iliffe S, Cerga-Pashoja A, Lowery D, Warner J. The effect of exercise on behavioral and psychological symptoms of dementia: towards a research agenda. Int Psychogeriatr. 2012;24:1046–57. doi:10.1017/S1041610211002365 .CrossRefPubMed

Fleiner T, Leucht S, Foerstl H, Zijlstra W, Haussermann P. Effects of short-term exercise interventions on behavioral and psychological symptoms in patients with dementia: a systematic review. J Alzheimers Dis. 2017;55:1583–94. doi:10.3233/JAD-160683 .CrossRefPubMed

Edwards N, Gardiner M, Ritchie DM, Baldwin K, Sands L. Effect of exercise on negative affect in residents in special care units with moderate to severe dementia. Alzheimer Dis Assoc Disord. 2008;22:362–8. doi:10.1097/WAD.0b013e31818ecbbc .CrossRefPubMed

10.

Souto Barreto P de, Demougeot L, Pillard F, Lapeyre-Mestre M, Rolland Y. Exercise training for managing behavioral and psychological symptoms in people with dementia: a systematic review and meta-analysis. Ageing Res Rev. 2015;24:274–85. doi:10.1016/j.arr.2015.09.001.

11.

Forbes D, Forbes SC, Blake CM, Thiessen EJ, Forbes S. Exercise programs for people with dementia. Cochrane Database Syst Rev. 2015;4, CD006489. doi:10.1002/14651858.CD006489.pub4 .

12.

Matura S, Carvalho A, Alves G, Pantel J. Physical exercise for the treatment of neuropsychiatric disturbances in Alzheimer’s dementia: possible mechanisms, current evidence and future directions. CAR. 2016;13:1112–23. doi:10.2174/1567205013666160502123428 .CrossRef

13.

Fleiner T, Zijlstra W, Dauth H, Häussermann P. Evaluation of a hospital-based day-structuring exercise programme on exacerbated behavioural and psychological symptoms in dementia—the exercise carrousel: study protocol for a randomised controlled trial. Trials. 2015;16:228. doi:10.1186/s13063-015-0758-2 .CrossRefPubMedPubMedCentral

14.

World Health Organization (WHO). International Statistical Classification of Diseases and Related Health Problems 10^th Revision. 2015. http://apps.who.int/classifications/icd10/browse/2015/en#/V. Accessed 10 Jan 2015.

15.

Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113:941–8.CrossRefPubMed

16.

Hestermann U, Backenstrass M, Gekle I, Hack M, Mundt C, Oster P, Thomas C. Validation of a German version of the Confusion Assessment Method for delirium detection in a sample of acute geriatric patients with a high prevalence of dementia. Psychopathology. 2009;42:270–6. doi:10.1159/000224151 .CrossRefPubMed

17.

Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. JAGS. 1991;39:142–8.CrossRef

18.

Saghaei M. Implementation of an open-source customizable minimization program for allocation of patients to parallel groups in clinical trials. J Biomed Sci Eng. 2011;4:734–9. doi:10.4236/jbise.2011.411090 .CrossRef

19.

Schneider LS, Olin JT, Doody RS, Clark CM, Morris JC, Reisberg B, et al. Validity and reliability of the Alzheimer’s Disease Cooperative Study-Clinical Global Impression of Change. The Alzheimer’s Disease Cooperative Study. Alzheimer Dis Assoc Disord. 1997;11 Suppl 2:32.

20.

Drye LT, Ismail Z, Porsteinsson AP, Rosenberg PB, Weintraub D, Marano C, et al. Citalopram for agitation in Alzheimer’s disease: design and methods. Alzheimers Dement. 2012;8:121–30. doi:10.1016/j.jalz.2011.01.007 .CrossRefPubMedPubMedCentral

21.

Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44:2308–14.CrossRefPubMed

22.

Cohen-Mansfield J, Marx MS, Rosenthal AS. A description of agitation in a nursing home. J Gerontol. 1989;44:77–84.CrossRef

23.

Bezchlibnyk-Butler KZ, Jeffries JJ, Virani AS. Clinical handbook of psychotropic drugs. 18th ed. Ashland, OH, London: Hogrefe & Huber; Momenta [distributor]; 2009.

24.

Holzbach R, Martens MS, Kalke J, Raschke P. Zusammenhang zwischen Verschreibungsverhalten der Arzte und Medikamentenabhängigkeit ihrer Patienten. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2010;53:319–25. doi:10.1007/s00103-010-1029-8 .CrossRefPubMed

25.

Cohen J. Statistical power analysis for the behavioral sciences. New York: Psychology Press; 1988.

26.

Zuidema SU, Buursema AL, Gerritsen MG, Oosterwal KC, Smits MM, Koopmans RT, de Jonghe JF. Assessing neuropsychiatric symptoms in nursing home patients with dementia: reliability and Reliable Change Index of the Neuropsychiatric Inventory and the Cohen‐Mansfield Agitation Inventory. Int J Geriatr Psychiatry. 2011;2:127-134. doi:10.1002/gps.2499 .

27.

Netz Y, Yaretzki A, Salganik I, Jacob T, Finkeltov B, Argov E. The effect of supervised physical activity on cognitive and affective state of geriatric and psychogeriatric in-patients. Clin Gerontol. 1994;15:47–56. doi:10.1300/J018v15n01_06 .CrossRef

28.

Schneider LS, Tariot PN, Dagerman KS, Davis SM, Hsiao JK, Ismail MS, et al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer’s disease. N Engl J Med. 2006;355:1525–38. doi:10.1056/NEJMoa061240 .CrossRefPubMed

29.

American College of Sports Medicine. American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc. 2009;41:1510–30. doi:10.1249/MSS.0b013e3181a0c95c .

30.

George J, Adamson J, Woodford H. Joint geriatric and psychiatric wards: a review of the literature. Age Ageing. 2011;40:543–8. doi:10.1093/ageing/afr080 .CrossRefPubMed

31.

Stevens J, Killeen M. A randomised controlled trial testing the impact of exercise on cognitive symptoms and disability of residents with dementia. Contemp Nurse. 2006;21:32–40. doi:10.5555/conu.2006.21.1.32 .CrossRefPubMed

32.

Holliman DC, Orgassa UC, Forney JP. Developing an interactive physical activity group in a geriatric psychiatry facility. Act Adapt Aging. 2001;26:57–69. doi:10.1300/J016v26n01_04 .

33.

Grill JD, Karlawish J. Addressing the challenges to successful recruitment and retention in Alzheimer’s disease clinical trials. Alzheimers Res Ther. 2010;2:34. doi:10.1186/alzrt58 .CrossRefPubMedPubMedCentral

Title: Structured physical exercise improves neuropsychiatric symptoms in acute dementia care: a hospital-based RCT
Authors: Tim Fleiner
Hannah Dauth
Marleen Gersie
Wiebren Zijlstra
Peter Haussermann
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Alzheimer's Research & Therapy / Issue 1/2017
Electronic ISSN: 1758-9193
DOI: https://doi.org/10.1186/s13195-017-0289-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Structured physical exercise improves neuropsychiatric symptoms in acute dementia care: a hospital-based RCT

Abstract

Background

Methods

Results

Conclusions

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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