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The International Psychogeriatric Association (IPA) published a provisional consensus definition of agitation in cognitive disorders in 2015. As proposed by the original work group, we summarize the use and validation of criteria in order to remove “provisional” from the definition.
This report summarizes information from the academic literature, research resources, clinical guidelines, expert surveys, and patient and family advocates on the experience of use of the IPA definition. The information was reviewed by a working group of topic experts to create a finalized definition.
We present a final definition which closely resembles the provisional definition with modifications to address special circumstances. We also summarize the development of tools for diagnosis and assessment of agitation and propose strategies for dissemination and integration into precision diagnosis and agitation interventions.
The IPA definition of agitation captures a common and important entity that is recognized by many stakeholders. Dissemination of the definition will permit broader detection and can advance research and best practices for care of patients with agitation.
To develop an agitation reduction and prevention algorithm is intended to guide implementation of the definition of agitation developed by the International Psychogeriatric Association (IPA)
Review of literature on treatment guidelines and recommended algorithms; algorithm development through reiterative integration of research information and expert opinion
IPA Agitation Workgroup
IPA panel of international experts on agitation
Integration of available information into a comprehensive algorithm
The IPA Agitation Work Group recommends the Investigate, Plan, and Act (IPA) approach to agitation reduction and prevention. A thorough investigation of the behavior is followed by planning and acting with an emphasis on shared decision-making; the success of the plan is evaluated and adjusted as needed. The process is repeated until agitation is reduced to an acceptable level and prevention of recurrence is optimized. Psychosocial interventions are part of every plan and are continued throughout the process. Pharmacologic interventions are organized into panels of choices for nocturnal/circadian agitation; mild-moderate agitation or agitation with prominent mood features; moderate-severe agitation; and severe agitation with threatened harm to the patient or others. Therapeutic alternatives are presented for each panel. The occurrence of agitation in a variety of venues—home, nursing home, emergency department, hospice—and adjustments to the therapeutic approach are presented.
The IPA definition of agitation is operationalized into an agitation management algorithm that emphasizes the integration of psychosocial and pharmacologic interventions, reiterative assessment of response to treatment, adjustment of therapeutic approaches to reflect the clinical situation, and shared decision-making.
This study describes the performance of the Multilingual Naming Test (MINT) by Chinese American older adults who are monolingual Chinese speakers. An attempt was also made to identify items that could introduce bias and warrant attention in future investigation.
The MINT was administered to 67 monolingual Chinese older adults as part of the standard dementia evaluation at the Alzheimer’s Disease Research Center (ADRC) at the Icahn School of Medicine at Mount Sinai (ISMMS), New York, USA. A diagnosis of normal cognition (n = 38), mild cognitive impairment (n = 12), and dementia (n = 17) was assigned to all participants at clinical consensus conferences using criterion sheets developed at the ADRC at ISMMS.
MINT scores were negatively correlated with age and positively correlated with education, showing sensitivity to demographic factors. One item, butterfly, showed no variations in responses across diagnostic groups. Inclusion of responses from different regions of China changed the answers from “incorrect” to “correct” on 20 items. The last five items, porthole, anvil, mortar, pestle, and axle, yielded a high nonresponse rate, with more than 70% of participants responding with “I don’t know.” Four items, funnel, witch, seesaw, and wig, were not ordered with respect to item difficulty in the Chinese language. Two items, gauge and witch, were identified as culturally biased for the monolingual group.
Our study highlights the cultural and linguistic differences that might influence the test performance. Future studies are needed to revise the MINT using more universally recognized items of similar word frequency across different cultural and linguistic groups.
We report on the design and first results from experiments looking at the formation of radiative shocks on the Shenguang-II (SG-II) laser at the Shanghai Institute of Optics and Fine Mechanics in China. Laser-heating of a two-layer CH/CH–Br foil drives a $\sim 40$ km/s shock inside a gas cell filled with argon at an initial pressure of 1 bar. The use of gas-cell targets with large (several millimetres) lateral and axial extent allows the shock to propagate freely without any wall interactions, and permits a large field of view to image single and colliding counter-propagating shocks with time-resolved, point-projection X-ray backlighting ($\sim 20$ μm source size, 4.3 keV photon energy). Single shocks were imaged up to 100 ns after the onset of the laser drive, allowing to probe the growth of spatial nonuniformities in the shock apex. These results are compared with experiments looking at counter-propagating shocks, showing a symmetric drive that leads to a collision and stagnation from $\sim 40$ ns onward. We present a preliminary comparison with numerical simulations with the radiation hydrodynamics code ARWEN, which provides expected plasma parameters for the design of future experiments in this facility.
This study aimed to determine the diagnostic utility of a Chinese test battery for evaluating cognitive loss in elderly Chinese Americans.
Data from a pilot study at the Mount Sinai Alzheimer’s Disease Research Center was examined. All participants were > 65 years old, primarily Chinese speaking, with adequate sensorimotor capacity to complete cognitive tests. A research diagnosis of normal mild cognitive impairment (MCI) or Alzheimer’s disease (AD) was assigned to each participant in consensus conference. Composite scores were created to summarize test performance on overall cognition, memory, attention executive function, and language. Multivariable logistic regression models were used to assess the sensitivity of each cognitive domain for discriminating three diagnostic categories. Adjustment was made for demographic variables (i. e., age, gender, education, primary language, and years living in the USA).
The sample included 67 normal, 37 MCI, and 12 AD participants. Performance in overall cognition, memory, and attention executive function was significantly worse in AD than in MCI, and performance in MCI was worse than in normal controls. Language performance followed a similar pattern, but differences did not achieve statistical significance among the three diagnostic groups.
This study highlights the need for cognitive assessment in elderly Chinese immigrants.
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