Behavioral and psychological symptoms of dementia and hypertension in nursing home residents

项目摘要/摘要 这项应用旨在调查痴呆症患者的行为和心理症状 (BPSD)疗养院(NH)阿尔茨海默病及相关患者的血压升高 痴呆症(ADRD)，从而使这一群体的高血压的管理和治疗复杂化。BPSD 在患有ADRD的NH居民中很常见，影响到至少80%的患者，并通过造成痛苦和 交感神经系统的激活，可能会增加血压和测量血压 可变性。其临床意义是，NH临床医生可以根据患者的需求做出降压处方决策 对次理想的血压测量，并可能加强对患有高血压的患者的降压治疗 ADRD具有不太可能的好处和可能的危害。本研究的目的是探索性和发展性的 没有关于这些问题和发现的大规模研究可以为未来研究的设计提供信息 研究BPSD暴露对ADRD和高血压患者预后的影响。我们的 具体目的是：1)探讨痴呆症患者的行为和心理症状之间的关系 (BPSD)、高血压和血压读数对患有ADRD的NH居民的影响，2)检查两者之间的关系 患有ADRD的NH居民的BPSD和降压药物治疗强度之间的关系，以及3) 检查NH居民抗精神病药物使用的变化与血压读数之间的关系 使用ADRD，控制BPSD。我们预计，与其他因素无关，BPSD将与 患有ADRD的NH居民的血压变异性增加和血压升高。此外，我们 预计患有ADRD和更严重的BPSD的NH居民将接受更密集的药物治疗 治疗高血压。最后，我们预计抗精神病药物的减少将与 可能影响降压药物管理的血压变化，但方向 关联可能因个人而异。为了实现这些目标，我们将利用两个长期居留队列 患有ADRD的NH居民：1)在退伍军人社区生活中心(VA NHS)服役的退伍军人队列；2) 参加联邦医疗保险的美国NHS居民。这两个队列都将提供有关BPSD、高血压和 其他诊断；认知和身体功能；药物处方；以及药物不良反应 国家代表团体。VA队列将提供有关血压的信息，并将用于 目标1、2和3。医疗保险队列将提供抗高血压和抗精神病药物的人口估计 所有美国疗养院居民的药物治疗，将在目标2和目标3中使用。我们将 生成多变量模型，使我们能够测试行为和行为之间的假设关系 痴呆症的心理症状、血压及血压管理。

PROJECT SUMMARY/ABSTRACT This application aims to investigate the possibility that behavioral and psychological symptoms in dementia (BPSD) increase blood pressure in nursing home (NH) residents with Alzheimer's Disease and related dementias (ADRD), thereby complicating the management and treatment of hypertension in this group. BPSD is common in NH residents with ADRD, affecting at least 80% of patients, and, by causing distress and sympathetic nervous system activation, may increase blood pressure and blood pressure measurement variability. The clinical implication is that NH clinicians may make antihypertensive prescribing decisions based on suboptimal blood pressure measurements, and may intensify antihypertensive treatment of patients with ADRD with unlikely benefit and possible harm. The aims of this study are exploratory and developmental in that there are no large-scale studies on these questions and findings can inform the design of future studies to examine interactions between BPSD exposures on outcomes in patients with ADRD and hypertension. Our specific aims are to: 1) Explore the associations between behavioral and psychological symptoms in dementia (BPSD), hypertension, and blood pressure readings in NH residents with ADRD, 2) Examine the association between BPSD and intensity of antihypertensive medication treatment in NH residents with ADRD, and 3) Examine the association between changes in antipsychotic use and blood pressure readings in NH residents with ADRD, controlling for BPSD. We expect that, independent of other factors, BPSD will be associated with increased variability of blood pressure and higher blood pressure in NH residents with ADRD. In addition, we expect that NH residents with ADRD and more severe BPSD will receive more intense medication treatment for high blood pressure. Finally, we expect that antipsychotic medication reduction will be associated with changes in blood pressure that may affect antihypertensive medication management, but the direction of association may differ from individual to individual. To achieve these aims we will utilize 2 cohorts of long-stay NH residents with ADRD: 1) a cohort of veterans served in VA Community Living Centers (VA NHs); and 2) Medicare-enrolled residents of U.S. NHs. Both cohorts will provide information on BPSD, hypertension, and other diagnoses; cognitive and physical function; medication prescribing; and adverse drug effects in large national representative groups. The VA cohort will provide information on blood pressure and will be used in Aims 1, 2 and 3. The Medicare cohort will provide population estimates of antihypertensive and antipsychotic medication treatment among all U.S. nursing home residents and will be used in Aims 2 and 3. We will produce multivariable models that will enable us to test hypothesized relationships between behavioral and psychological symptoms in dementia, blood pressure and blood pressure management.