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Actigraphy in agitated patients with dementia

Monitoring treatment outcomes

Aktometrisches Monitoring von Behandlungsverläufen Demenzkranker

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Abstract

Especially in pharmacotherapeutic research, a variety of methods to monitor behavioural and psychological symptoms of dementia (BPSD) are currently being discussed. To date, the most frequently used of these are clinical scales, which, however, are subjective and highly dependent on personnel resources. In our study, we tested the usefulness of actigraphy as a more direct and objective way to measure day-night rhythm disturbances and agitated behaviour.

After a baseline assessment, 24 patients with probable dementia of the Alzheimer type (NINCDS-ADRDA) and agitated behaviour received either 3 mg melatonin (n=7), 2.5 mg dronabinol (n=7), or placebo (n=10) for two weeks. In addition, 10 young and 10 elderly healthy subjects were examined as a control group. Motor activity levels were assessed using an actigraph worn continuously on the wrist of the non-dominant hand. At the beginning and the end of the study, patients' Neuropsychiatric Inventory (NPI) scores were also assessed.

In the verum group, actigraphic nocturnal activity (P=0.001), NPI total score (P=0.043), and NPI agitation subscale score (P=0.032) showed significant reductions compared to baseline. The treatment-baseline ratio of nocturnal activity (P=0.021) and treatment-baseline difference of the nocturnal portion of 24 h activity (P=0.012) were reduced. Patients' baseline activity levels were similar to those seen in healthy elderly subjects. Younger healthy subjects exhibited higher motor activity even at night. There was no correlation between actigraphy and NPI.

Both actigraphic measures and the gold standard clinical scale were able to distinguish between the verum and placebo groups. However, because they did not correlate with each other, they clearly represent different aspects of BPSD, each of which reacts differently to therapy. As a result, actigraphy may well come to play an important role in monitoring treatment success in BPSD.

Zusammenfassung

Zur Dokumentation von Behandlungsverläufen bei Demenzpatienten mit nicht-kognitiver Symptomatik (behavioural and psychological symptoms of dementia, BPRS) werden verschiedene Methoden diskutiert. Derzeit werden vor allem klinische Skalen und psychometrische Tests angewandt, die subjektiv und personalaufwändig sind. Mit der vorgelegten Arbeit wollen wir zeigen, dass die Aktometrie als objektive Methode zur Aufzeichnung von agitiertem Verhalten und Tag- Nacht Rhythmusstörungen geeignet ist.

24 Patienten mit der wahrscheinlichen Diagnose einer Alzheimerdemenz (NINCDS-ADRDA) wurden eingeschlossen. Außerdem untersuchten wir 10 jüngere und 10 ältere gesunde Probanden. Nach einer interventionsfreien Beobachtungsphase erhielten die Patienten über einen Zeitraum 2 Wochen 3 mg Melatonin (n=7), 2,5 mg Dronabinol (n=7) oder Placebo (n=10). Die motorische Aktivität wurde kontinuierlich mit einem Aktometer aufgezeichnet. Zu Beginn und am Ende der Beobachtungszeit wurde außerdem das Neuropsychiatrische Inventar (NPI) erhoben.

Die nächtliche aktometrische Aktivität (P=0,001), der NPI-Gesamtscore (P=0,043) und der NPI-Teilscore für Agitation (P=0,032) waren in der Verumgruppe im Vergleich zu den Ausgangswerten signifikant erniedrigt. Das Behandlungs-Ausgangswert-Verhältnis der nächtlichen Aktivität (P=0,021) und die Behandlungs-Ausgangswert-Differenz des Anteils der Nachtaktivität an der Gesamtaktivität (P=0,012) zeigten eine deutliche Absenkung in der Verumgruppe im Vergleich zur Placebogruppe. In unbehandeltem Zustand zeigten die agitierten Patienten das gleiche Aktivitätsniveau wie die älteren Probanden. Die jüngeren Probanden hatten ein höheres nächtliches Aktivitätsniveau. Es gab keinerlei Korrelationen zwischen den aktometrischen Werten und dem NPI.

Sowohl für die aktometrischen als auch für die NPI-Daten zeigten sich Unterschiede in der Verum- und Placebogruppe. Da beide Methoden jedoch nicht miteinander korrelierten, folgern wir daraus, dass verschiedene, unabhängige Aspekte agitierten Verhaltens abgebildet wurden, die bei den Individuen unterschiedlich auf die Therapieversuche ansprachen. Damit hat die Aktometrie neben den klinischen Skalen einen wichtigen Stellenwert in der Dokumentation dieser Störungen.

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Authors and Affiliations

  1. Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Turmstraße 21, 10559, Berlin, Germany

    R. Mahlberg

  2. University of Bern, Psychiatric Services (UPD), 3060, Bern, Switzerland

    S. Walther

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  1. R. Mahlberg
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  2. S. Walther
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Correspondence to R. Mahlberg.

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Mahlberg, R., Walther, S. Actigraphy in agitated patients with dementia. Z Gerontol Geriatr 40, 178–184 (2007). https://doi.org/10.1007/s00391-007-0420-z

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  • DOI: https://doi.org/10.1007/s00391-007-0420-z

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