Christopher C. Colenda

Bright light therapy : Improved sensitivity to its effects on rest-activity rhythms in alzheimer patients by application of nonparametric methods

Sleep-wake rhythm disturbances in patients with Alzheimers disease (AD) make a strong demand on caregivers and are among the most important reasons for institutionalization. Several previous studies reported that the disturbances improve with increased environmental light, which, through the retinohypothalamic tract, activates the suprachiasmatic nucleus (SCN), the biological clock of the brain. The data of recently published positive and negative reports on the effect of bright light on actigraphically assessed rest-activity rhythms in demented elderly were reanalyzed using several statistical procedures. It was demonstrated that the light-induced improvement in coupling of the rest-activity rhythm to the environmental zeitgeber of bright light is better detected using nonparametric procedures. Cosinor, complex demodulation, and Lomb-Scargle periodogram-derived variables are much less sensitive to this effect because of the highly nonsinusoidal waveform of the rest-activity rhythm. Guidelines for analyses of actigraphic data are given to improve the sensitivity to treatment effects in future studies.

Position Statement of the American Association for Geriatric Psychiatry Regarding Principles of Care for Patients With Dementia Resulting From Alzheimer Disease

There exists currently an effective, systematic care/treatment model for patients with dementia resulting from Alzheimer disease (AD). This consists of a series of therapeutic interventions—pharmacologic and nonpharmacologic—targeted at patients with AD and their caregivers. Although these interventions do not produce a cure of the underlying disease and do not appear to stop its progression, they have been shown to produce benefits for patients and their caregivers. The aims of this care model, often referred to as “Dementia Care,” are to delay disease progression, delay functional decline, improve quality of life, support dignity, control symptoms, and provide comfort at all stages of AD. This evolving model is based on scientific evidence of beneficial outcomes, with acceptable risks, and is increasingly targeted at an improving pathophysiological understanding of the biology of AD. Although the evidence is limited, the existing evidence, coupled with clinical experience and common sense, is adequate to produce a minimal set of care principles. In this context, the American Association for Geriatric Psychiatry (AAGP) affirms that there now exists a minimal set of care principles for patients with AD and their caregivers. Consequently, the detection and treatment of AD must now be considered part of the typical care practices for any physician and other licensed clinicians who interact with patients with this disease. This document articulates these principles of care.

The incremental direct costs associated with behavioral symptoms in AD

Objective: To determine the incremental costs associated with behavioral symptoms in patients with AD. Methods: A total of 128 patients with probable AD were enrolled into this study. Cognitive function and extrapyramidal features were assessed in patients with AD. Caregivers were interviewed to determine use of health care services, receipt of unpaid care, severity of behavioral symptoms (Neuropsychiatric Inventory [NPI]), and comorbid medical conditions in patients with AD. Healthcare utilization data were multiplied by unit costs to estimate direct formal costs. Unpaid caregiving hours were multiplied by an hourly wage to estimate direct informal costs. The annual incremental direct costs of additional behavioral symptoms were estimated with multiple regression equations. Results: Annual, direct costs were significantly higher in patients with AD at or above the median score on the NPI (high NPI group), after adjusting for group differences in severity of cognitive impairment and comorbid conditions. Patients in the high NPI group had formal costs between

Geriatric Mental Health Services Research: Strategic Plan for an Aging Population: Report of the Health Services Work Group of the American Association for Geriatric Psychiatry

3,162 and

Mental Health Services for Alzheimer's Disease: Current Trends in Reimbursement and Public Policy, and the Future Under Managed Care

5,919 higher than the low NPI group and total direct costs between

Comparison of Healthcare Utilization and Direct Costs in Three Degenerative Dementias

10,670 and

Late-life depression and mental health services in primary care

16,141 higher, depending on the severity of cognitive impairments. Models for the entire sample estimated that a one-point increase in the NPI score would result in an annual increase of between

Update of Geriatric Psychiatry Practices Among American Psychiatrists: Analysis of the 1996 National Survey of Psychiatric Practice

247 and

Nicotine replacement methods on a psychiatric unit.

409 in total direct costs, depending on the value of unpaid caregiving. Conclusions: Behavioral symptoms in patients with AD significantly increase direct costs of care.

The Psychiatry Chief Resident as Information Manager.

In November 1999, a working group of the American Association for Geriatric Psychiatry (AAGP) convened to consider strategic recommendations for developing geriatric mental health services research as a scientific discipline. The resulting consensus statement summarizes the principles guiding mental health services research on late-life mental disorders, presents timely and topical priorities for investigation with the potential to benefit the lives of older adults and their families, and articulates a systematic program for expanding the supply of well-trained geriatric mental health services researchers. The agenda presented here is designed to address critical questions in provision of effective mental health care to an aging population and the health policies that govern its delivery.