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

项目总结/摘要 本申请旨在调查痴呆症患者的行为和心理症状 （BPSD）增加老年痴呆症及相关疾病的疗养院（NH）居民的血压 痴呆（ADRD），从而使该组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，影响至少80%的患者，并且通过引起痛苦和 交感神经系统激活，可使血压升高和血压测量 可变性临床意义是，NH临床医生可能会根据 次优血压测量，并可能加强抗高血压治疗的患者 ADRD，不太可能获益，可能造成伤害。本研究的目的是探索和发展， 没有关于这些问题的大规模研究，研究结果可以为未来研究的设计提供信息， 检查BPSD暴露对ADRD和高血压患者结局的相互作用。我们 具体目标是：1）探索痴呆症的行为和心理症状之间的联系 （BPSD），高血压和血压读数在NH居民与ADRD，2）检查协会 NH居民ADRD患者BPSD与抗高血压药物治疗强度之间的关系，以及3） 检查NH居民中抗精神病药物使用变化与血压读数之间的关联 用ADRD控制BPSD我们预计，独立于其他因素，BPSD将与 在患有ADRD的NH居民中，血压变异性增加和血压升高。另外我们 预计患有ADRD和更严重BPSD的NH居民将接受更强烈的药物治疗 治疗高血压最后，我们预计抗精神病药物的减少将与 血压的变化可能会影响降压药物的管理，但方向 联想可能因人而异。为了实现这些目标，我们将利用2个长期逗留的队列 患有ADRD的NH居民：1）在VA社区生活中心（VA NHs）服务的退伍军人队列;以及2） 美国NHS的医保登记居民。两个队列将提供BPSD、高血压和 其他诊断;认知和身体功能;药物处方;以及大部分药物不良反应 国家代表团。VA队列将提供血压信息，并将用于 目标1、2和3。医疗保险队列将提供抗高血压药和抗精神病药的人群估计值 在所有美国疗养院居民中进行药物治疗，并将用于目标2和3。我们将 产生多变量模型，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、血压和血压管理。

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.