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• W1990657623 abstract "Patients with frontotemporal dementia (FTD), a relatively rare neurodegenerative dementia,1Yokota O. Sasaki K. Fujisawa Y. et al.Frequency of early- and late-onset dementias in a Japanese memory disorders clinic.Eur J Neurol. 2005; 12: 782-790Crossref PubMed Scopus (60) Google Scholar present with various behavioral and psychological symptoms, including disinhibition, stereotypy, aggression, impulsivity, indifference, and aphasia. Therefore, FTD care is very difficult and distressing for caregivers. Several recent trials showed that the efficacy of atypical antipsychotic drugs and selective serotonin reuptake inhibitors reduced the behavioral and psychological symptoms in dementia (BPSD). However, the beneficial effects of psychotropic drugs on quality of life (QOL) in long-term use have not been fully verified.2Ballard C.G. Margallo-Lana M.L. The relationship between antipsychotic treatment and quality of life for patients with dementia living in residential and nursing home care facilities.J Clinical Psychiatry. 2004; 65: 23-28PubMed Google Scholar Nonpharmacological interventions include the effects of the physical environment, social environment including interaction between staff and patients, and care philosophy in the facility. It is generally accepted that appropriate design of the care environment, especially incorporating homelike features, ameliorates the BPSD, and preserves qualities of dignity and privacy in institutionalized individuals. However, there are few studies investigating the effects of nonpharmacological interventions on FTD patients. To evaluate the influence of group-home care on cognitive function, BPSD, QOL, and the use of psychotropic drugs in FTD, we assessed 8 patients clinically diagnosed as having FTD according to the international consensus criteria for frontotemporal dementia3Neary D. Snowden J.S. Gustafson L. et al.Frontotemporal lobar degeneration A consensus on clinical diagnostic criteria.Neurology. 1998; 51: 1546-1554Crossref PubMed Scopus (4527) Google Scholar (the mean age at onset, 61.5 ± 8.1 years; the mean disease duration, 6.4 ± 4.0 years) before and after relocation from a traditional ward in a psychiatric hospital to a group home. Before relocation, all subjects had spent more than 1 year in the traditional ward. Before their introduction to the group home specializing in treatment of patients with FTD, the clinical stages of the Clinical Dementia Rating were stage 2 in 3 patients and stage 3 in 5 patients. Remarkable behavioral stereotypy, disinhibition, aggression, and agitation were found in 5 patients, and moderate behavioral disturbances as well as apathy in 3 patients. In the ward, 60 patients, including all subjects in this study, occupied 22 rooms, and all subjects were resident in rooms for 2 or more patients. The total area of the traditional ward was 1515 m2, and that of the group home was 324 m2. The area per patient, which was calculated using all areas in a unit to which residents had continuous access, increased from 25.3 m2 in the traditional ward to 36.0 m2 in the group home. The staff/patient ratio was changed from 0.47 in the traditional ward to 0.90 in the group home. In the philosophy of care, the traditional ward tended to give priority to medical and physical safety rather than a patient’s freedom and addressing the patients’ needs. In the ward, there was little personal furniture, few clothes and other personal belongings, and the personal space was limited to the area around the bed of each patient. Patients had set times for various daily activities, such as baths and occupational therapy, and were encouraged to join diverse special activities different from daily living activities. On the other hand, the staff of the group home gave first priority to creating a homelike and noninstitutional physical and social environment and helping residents to maintain their usual lifestyle, and patients’ freedom, hominess reflecting patients’ previous lifestyles, and patients’ needs and privacy were regarded as important. Cognitive functions were evaluated with the Hasegawa Dementia Scale-Revised version (HDS-R; range: 0–30 points, cut off 19/20), scores of which correlate with that of the Mini-Mental State Examination.4Katoh S. Simogaki H. Onodera A. et al.Development of the revised version of Hasegawa’s dementia scale (HDS-R).Jp J Geriatr Psychiatr. 1991; 2: 1339-1347Google Scholar, 5Folstein M.F. Folstein S.E. McHugh P.R. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198Abstract Full Text PDF PubMed Scopus (73266) Google Scholar BPSD and QOL were evaluated every 2 months for 6 months using the Cohen-Mansfield Agitation Inventory (CMAI),6Finkel S.I. Lyons J.S. Anderson R.L. Reliability and validity of the Cohen-Mansfield Agitation Inventory in institutionalized elderly.Int J Geriatr Psychiatry. 1992; 7: 487-490Crossref Scopus (101) Google Scholar the Neuropsychiatric Inventory (NPI),7Cummings J.L. Mega M. Gray K. et al.The Neuropsychiatric Inventory Comprehensive assessment of psychopathology in dementia.Neurology. 1994; 44: 2308-2314Crossref PubMed Google Scholar and the Health-Related Quality of Life Questionnaire for Dementia (QOL-D).8Terada S. Ishizu H. Fujisawa Y. et al.Development and evaluation of a health-related quality of life questionnaire for the elderly with dementia in Japan.Int J Geriatr Psychiatry. 2002; 17: 851-858Crossref PubMed Scopus (64) Google Scholar The use of psychotropic drugs was also evaluated every 2 months. The Friedman test and Wilcoxon signed-rank test were used for the statistical analysis of the CMAI, NPI, QOL-D, the number of psychotropic drugs used, and the chlorpromazine-equivalent dose of antipsychotics. The scores of the HDS-R at 0 and 6 months were compared using the Wilcoxon signed-rank test. A significance level of .05 was used for all statistical tests. No subject dropped out during the observation period. At the end of the 6-month study period, cognitive function was not significantly changed compared with the baseline. In contrast, the mean NPI total score (28.9 to 16.0, z = −2.366, P = .018) and mean CMAI total score (60.4 to 52.0, z = −2.524, P = .012) were significantly improved compared with the baseline. Three of 6 subscale scores of the QOL-D, including positive affect (12.9 to 19.3, z = −2.383, P = .017), restlessness (11.4 to 8.8, z = −2.207, P = .027), and attachment to others (7.4 to 9.6, z = −2.207, P = .027), were also significantly improved at 6 months. The number of psychotropic drugs (mean of 1.1 at the baseline) and the chlorpromazine-equivalent mean dose of antipsychotics (mean of 73.1 mg/day at the baseline) decreased gradually, and they were finally withdrawn. These preliminary results suggest the beneficial effects of a homelike physical and social environment on BPSD, QOL, and psychotropic drug use in patients with FTD. We consider that a study period of 6 months may be too short to explain the improvement by disease progression alone. The remarkable affective disturbances in patients with FTD led us to speculate that they have difficulty feeling frustration or distress about their surrounding circumstances. The present findings, however, suggest that FTD patients can be affected by their physical and social environment, and their behavior and QOL may be improved, at least in part, by using their remaining emotional and cognitive functions. Therefore, we believe that homelike physical and social environmental features should be valued more to optimize a combination of pharmacological and nonpharmacological interventions in diverse care settings for FTD patients besides group-home care. Although further controlled studies with larger size samples are needed to confirm our conclusion, we consider that the present findings have significant implications for the management strategies for behavioral disturbances of FTD. We thank Dr K. Tsuchiya (Department of Laboratory Medicine and Pathology, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan) for insightful review of the manuscript and comments, Ms H. Nakano and Ms M. Yamasaki for help in collecting clinical information, Mr A. Sasaki for help with the production of the manuscript, and all the staff members of the group home. This work was supported in part by a research grant from the Zikei Institute of Psychiatry." @default.
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• W1990657623 title "Effects of Group-Home Care on Behavioral Symptoms, Quality of Life, and Psychotropic Drug Use in Patients With Frontotemporal Dementia" @default.
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