Agitation in long-term care patients with Korsakoff’s syndrome and Alcohol-related Dementia
Description
Patients with Korsakoff’s syndrome and alcohol-related dementia frequently display agitated behavior, which negatively affects care quality and increases caregiver burden. This study aimed to systematically assess the types and frequency of agitation, identify associated factors, and compare both patient groups. A cross-sectional study was conducted in a specialist long-term care facility. Fifty-eight patients were included: 30 with Korsakoff’s syndrome and 28 with alcohol-related dementia. Agitation was assessed using the Cohen-Mansfield Agitation Inventory (CMAI). Potential associated factors included gender, psychotropic medication use, and duration of admission.
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In the Netherlands, people with severe cognitive deficits due to Korsakoff’s syndrome or alcohol-related dementia are often admitted to specialized long-term care facilities to receive appropriate support in their daily functioning. A national Centre of Expertise for Korsakoff, ‘Slingedael’ in Rotterdam, participated in this study. A total of 58 patients participated in this study. Thirty of these patients were diagnosed with Korsakoff’s syndrome and 28 with alcohol-related dementia. Extensive neuropsychological evaluation was carried out at the time of admission. All patients fulfilled the criteria for ‘alcohol-induced major neurocognitive disorder’ and had been abstinent for at least six months prior to their diagnosis. Each patient group resided on a specific unit designated for their care. Patients with Korsakoff’s syndrome met the following criteria: (1) a primary diagnosis of Korsakoff’s syndrome; (2) absence of a boarder pattern of cognitive decline and concomitant brain events (e.g., stroke, traumatic brain injury); (3) preserved intellectual abilities; (4) did not meet the criteria for alcohol dementia. Patients with alcohol-related dementia met the following criteria: (1) a clinical diagnosis of dementia at least 60 days after the last exposure to alcohol; (2) a significant alcohol use defined by a minimum average of 35 standard drinks per week for men and 28 for women; (3) sustained for over a period of five years; (4) the period of significant alcohol use must occur within three years of the initial onset of dementia. Exclusion criteria for both groups were: acute psychiatric conditions (for example psychosis, major depression); illiteracy; and physical conditions interfering with the testing procedure as indicated by medical charts. Baseline demographics were obtained from medical charts and consisted of age, duration of admission, education level, amount of drinking, Montreal Cognitive Assessment (MoCa) or Mini-Mental State Examination (MMSE) score, gender, and use of antidepressants, typical antipsychotics, atypical antipsychotics, benzodiazepines, and benzodiazepines as needed. Educational level was assessed using the Verhage coding list. Participants completed a cognitive screening test using either the MoCA or the MMSE. MoCA scores were converted to MMSE equivalents following the procedure described by Van Steenoven et al. (2014).We used the Dutch version of the 29-item Cohen-Mansfield Agitation Inventory (CMAI) to systematically assess agitation. We presume that the CMAI scale prevail in patients with Korsakoff’s syndrome and alcohol-related dementia in long-term care because they show symptoms of both dementia and psychiatric disorders. Primary caregivers rated the frequency of agitated behavior, over the past two weeks. The rating scale is as follows: Never; Less than once a week but still occurring; Once or twice a week; Several times a week; Once or twice a day; Several times a day; Several times an hour
Institutions
- Utrecht UniversityUtrecht, Utrecht