Evidence-based studies on pharmacological and non-pharmacological interventions for dementia patients: An annotated bibliography

This annotated bibliography focuses on evidence-based studies on pharmacological and non-pharmacological interventions for dementia patients. It includes five important papers that provide valuable information on effective treatments for Alzheimer's disease and prevention of hospital-acquired adverse drug reactions in older people. The papers highlight the potential of apelin, insulin analogs, and GnRH agonist therapy for treating Alzheimer's disease. They also propose the use of screening tools to reduce rates of adverse drug reactions in older patients.

Running head:NURSING
Nursing
Name of student:
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Introduction:
This assignment mainly focuses on health of an older patient who has been recently
diagnosed with dementia. The nursing professional who would be providing care to the patient
has to ensure that she provides proper pharmacological as well as non-pharmacological
interventions aimed at bringing improvement in the quality of life of the patient. A patient
suffering from dementia can be seen to show symptoms like issues in memory, communication
and language issues, and ability to focus and pay attention, reasoning and judgment as well as
visual perception (Melnyk et al. 2014, pp 10). The patient of the case study was seen to be highly
confused in her approaches andexhibited many symptoms of dementia. Therefore, it becomes
extremely important for the nursing professionals to gather knowledge about the medications as
well as the non-pharmacological interventions that may assure proper quality and safe care
(Wilson et al. 2015, pp 20). Therefore, for this reason, it become extremely important for nursing
professionals to undertake evidence based studies by which she can collect valuable information
about the approaches she can take which will result in better outcome for the patient. Therefore,
five important papers were selected and annotated bibliography was conducted to find out
information, understand its credibility and applicability, its utilization in the nursing profession
and others (Upton et al. 2015, pp 81). This assignment will not only help the nurse gain new
knowledge but will also help to provide best quality modern evidences that will bring out best
outcomes for the patient of the case study.
Article 1
Masoumi, J., Abbasloui, M., Parvan, R., Mohammadnejad, D., Pavon-Djavid, G., Barzegari, A.
and Abdolalizadeh, J., 2018. Apelin, a promising target for Alzheimer disease prevention and
treatment. Neuropeptides.

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Masoumi et al. (2018) aimed at studying Apelin, a neuropeptide that has been explored as
a promising target for prevention and treatment of Alzheimer’s disease (AD) in the recent past.
According to the researchers, Alzheimer’s disease is known to be a progressive
neurodegenerative disorder that has significant outbreak rates. The disease condition indicates a
cognitive impairment of the individual due to pathological production of amyloid beta
neurofibrillary tangles in the brain along with inflammatory mediators and toxic free radicals.
The researchers further pointed out that there have been no treatment options available for
altering the course of the disease. Nevertheless, research has been going on continuously to come
up with new therapies at different stages. Neuropeptides are signaling molecules essential for
communication of neurons in the body. Apelin is a significant neuropeptide which is extracted
from bovine stomach. Research indicates that Apelin and its receptor APJ disseminate in the
neurons and oligodendrocytes of the central nervous system. Further, Apelin-13 acts as the
predominant neuropeptide in neuroprotection whose primary role is in the processes of memory
and learning. It further prevents neuronal damage. Previous studies were responsible for
pinpointing that Apelin has the potential to prevent production of amyloid beta and bring a
reduction in its amount. The aim of the review was to put forward the different functions of
apelin in relation to AD.
In the paper the researchers have given a thorough description of apelin. The
pathogenesis of Alzheimer’s disease and the target for apelin has been illustrated. The research
paper has been successful in highlighting that apelin can be effective in reducing the production
of amyloid beta through decrease in the activity of beta-secretase and amount of APP.
Neurodegenration can be prevented by reduction in the level of inflammatory mediators that are
integral part of pathogenesis of AD. Further, apelin holds the potential to bring an increase in the

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synaptic plasticity in the neurons that is responsible for improving memory as well as cognitive
function of patients through enhanced activity of factors like eNO, ACE2, and GLP-1
From the study it could be concluded that apelin can act as a suitable agent for treatment
of AD. Nevertheless, further investigations are required for understanding the impact of apelin
on the brain with reference to AD pathogenesis. The research paper though gave a clear idea of
the potential of apelin, did not consider discussing how apelin can be applied as a therapeutic
approach. A nursing professional would need to carry out further research to understand the
applicability of apelin in practice. There is a need of highlighting how the knowledge about
apelin can be translated into nursing practice (Hempell et al. 2016, p. 528).
Article 2
Abbatecola, A.M., Bo, M., Barbagallo, M., Incalzi, R.A., Pilotto, A., Bellelli, G., Maggi, S. and
Paolisso, G., 2015. Severe hypoglycemia is associated with antidiabetic oral treatment compared
with insulin analogs in nursing home patients with type 2 diabetes and dementia: results from the
DIMORA study. Journal of the American Medical Directors Association, 16(4), pp. e7-12.
Abbatecola et al. (2015, p. 7-8) highlighted that severe hypoglycemia has a significant relation
with cognitive decline in dementia patients having type 2 diabetes. The background of the
present study was the fact that role of antidiabetic treatments for addressing severe hypoglycemia
had not been explored in dementia patients. The present research’s focus was found to be on
exploration of the prevalence of severe hypoglycemic events, and understanding ofassociations
between anti-diabetic treatment and severe hypoglycemia in dementia patients at nursing homes.
This study had a cross-sectional observational research design encompassing 150 nursing homes
in Italy. 2258 patients were recruited for the study suffering from type 2 diabetes of which 1138

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were suffering from dementia. Data collection was done in terms of functional status,
antidiabetic treatments, glycemic control, comorbidities, and biochemical and clinical
measurements.Severe hypoglycemia was found to be more prevalent in those suffering from
dementia as compared to those without the condition. Dementia patients had more age and
demonstrated more impairment in daily activities of living, more number of comorbidities,
higher post prandial blood glucose level and lower fasting blood glucose level when compared to
those not having dementia. The study further indicated that sulphonylureas for addressing
hypoglycemia in patients. Nevertheless, long acting and rapid insulin analogs gave safer effects
in individuals. Upon carrying out adjusted logistic regression models in patients suffering from
dementia showed that rapid- and long-acting insulin analogs were associated with reduced odds
ratio (OR) (OR 0.333; 95% confidence interval [CI] 0.184e0.602; OR 0.248, 95% CI 0.070
e0.882, respectively). However, sulphonylureas and combined metformin þ sulphonylurea
indicated an increased ORs (OR 8.805, 95% CI 4.260e18.201; OR 6.639; 95% CI 3.273e14.710,
respectively) of experiencing severe hypoglycemia.
It can be concluded that insulin analogs are an effective alternative for the prevention of
severe hypoglycemia in those having dementia in a clinical setting which is controlled. Further,
sulphonylureas are to be administered with caution to patients with dementia. At this juncture it
is to be mentioned that the study had distinct drawbacks. The cross-sectional research design
acted as the main limitation of the study. The results of the study are not applicable for testing
the cause-effect relationship. There were wide implications of the research findings for nursing
practice since the use of insulin for treating hypoglycemia in dementia patients in care units
might assuage risks caused due to nursing home staff turnover. A nurse should be engaging in
further research to understand the implications of use of long-acting and rapid insulin analogs for

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addressing changes in cognitive abilities in frail and older patients of dementia. Through an
adequate knowledge of the appropriate drugs, nurses can consider patient-centered approaches
for dementia patients so that quality of life is improved (Twigg and Schwartzkopf 2017, p. 387).
Article 3
Smith, M.A., Bowen, R.L., Nguyen, R.Q., Perry, G., Atwood, C.S. and Rimm, A.A., 2018.
Putative Gonadotropin Releasing Hormone Agonist Therapy and Dementia: An Application of
Medicare Hospitalization Claims Data. Journal of Alzheimer's Disease, (Preprint), pp.1-9.
This article had mainly focused on a very new aspect for effectively treating patients with
dementia as well as Alzheimer’s diseases. Previously, it was hypothesized by the researchers that
degradation of the sex steroid hormones after menopause in women and andropause in men were
mainly associated with the development of the Alzheimer’s disease in the older patients.
However, such a claim was questioned when the conjugated equine estrogen therapy failed to
reverse the occurrence of the Alzheimer’s disorders which made the researchers think more
gravely in the situation. Smith et al. (2018, pp 7) had therefore taken patients within the age
group of 67 to 75 and consisted participants divided into control groups comprised of patients
with cholescystectomy, herniorrhaphy and transurethral prostatectomy and experimental group
comprising of patients with prostate cancer. An interesting result was obtained which showed
that reduction of sex steroid hormones were not the main factors that were resulting in
development of Alzheimer’s diseases. Sex-steroid hormone depletion results in complete
dysregulation of HPG axis which in turn lead to the increase of the gonadotropin, GnRH and
activin. The later is therefore the main cause of the occurrence of the Alzheimer’s diseases. This
was proved from the fact that when the patients with prostate cancer who were treated with

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GnRH agonist did not develop alzheimers but those of the control groups whose sex steroid
depletion had taken place and whose GnRH and Gn had also increased. Therefore, this scientific
discovery is entirely unique as hormone replacement therapy for treating Alzheimer’s is novel in
the scientific field and is provides a very interesting scope for treatment of Alzheimer’s in the
near future. Therefore, as a registered nurse, one can select the paper as an effective procedure
for treating Alzheimer’s. Until date, researchers were of the opinion that it is a disorder, which
can never be completely cured, but the progression can be controlled with effective treatment
procedures (Nead et al., 2017, pp 50).
This research had opened a new field in this treatment as it states that the GnRh agonists
can help in the prevention and cure of the Alzheimer’s disorder via the procedure of down
regulation of serum gonadotropins. Hence, as a nurse, one can really look forward to the
application of this GnRH agonist therapy as a preventative as well as diseases modifying
approach to the management of the disorders. However, this paper is published in this year only
and need further research work to support the argument that had been made in the paper
regarding not the depletion of sex steroid but the increase of the Gn and GnRH that cause the
disorder (Hagan et al. 2016, pp: 1655). Only after sufficient evidences are there to support the
paper then only a registered nurse can ensure use of such therapy.
Article 4
O'connor, M.N., O'sullivan, D., Gallagher, P.F., Eustace, J., Byrne, S. and O'mahony, D., 2016.
Prevention of Hospital‐Acquired Adverse Drug Reactions in Older People Using Screening Tool
of Older Persons' Prescriptions and Screening Tool to Alert to Right Treatment Criteria: A
Cluster Randomized Controlled Trial. Journal of the American Geriatrics Society, 64(8),
pp.1558-1566.

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Medication error is one of the most important safety and quality aspect that affect the
quality life of the patients associated with increased suffering. One of them is the adverse drug
reactions that have severe impacts on the patients. It results in unavoidable deaths to the patients
and increases their sufferings. They have to stay in hospitals for longer days and some are also
seen to take readmissions after the reactions occur after few days. In many cases, it is also seen
that it increases the medication costs of the patients, as more medications are required to make
them cured from the conditions. Therefore, this paper would be extremely helpful to the nursing
and other healthcare professionals in understanding the interventions that they can take in order
to reduce one specific type of medication error like adverse drug reactions. The authors had
proposed that two specific type of screening tools called the Screening Tool of Older Persons’
Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) would be able
to reduce the rates of adverse drug reaction. Randomized controlled trail was conducted where
old patients above 65 years hospitalized over a period of 13 months. It was a Single-blind cluster
randomized controlled trial (RCT). The secondary outcomes which were to be tested is the effect
of the such intervention screening tools on length of stay at the hospital as well as the 28 day
medication cost. An interesting result was found which would help the registered nurses to
ensure that they can also reduce chances of medication errors in their own practices with the help
of these two tools.
The researchers have shown that the use of the tools resulted in reduced number of
incidences of adverse drug interactions in the group of participants in the intervention groups
where the tools were used in comparison to the number of adverse drug events in the patients
who were of the control group who were not exposed to the tools. Moreover, the 28 day
medication cost was also seen to be less in the patients of the intervention group than that of the

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control group. However, the median length of stay in the hospital remained unchanged in both
the control and intervention groups that showed the fact that these tools may not help in reducing
stays of people at hospital. One of the most interesting features of this article is that it had clearly
mentioned three important limitations that the readers can follow to understand the credibility of
the information or to avoid when further researches on this would be conducted. However, the
paper can prove as one of the best evidence based studies that they can follow to find out
interventions when they are making medication errors like adverse drug reactions. The paper
shows the success of the tools and therefore these tools can be used by them as well as to provide
better quality and safe care to patients (Parry, Barriball and While 2015, pp 405).
Article 5
Ballard, C., Orrell, M., Sun, Y., Moniz‐Cook, E., Stafford, J., Whitaker, R., Woods, B., Corbett,
A., Banerjee, S., Testad, I. and Garrod, L., 2017. Impact of antipsychotic review and non‐
pharmacological intervention on health‐related quality of life in people with dementia living in
care homes: WHELD—a factorial cluster randomised controlled trial. International journal of
geriatric psychiatry, 32(10), pp.1094-1103.
Very few researches had been conducted earlier to the publication of this paper that
focused on the effects of different treatments on the patients suffering from dementia. The use of
antipsychotic medication to control the aggression and psychoticbehaviorsof the dementia
patients are extremely popular in the care home settings to keep the patients under control and
care for them effectively. This paper helps in understanding that although such medications are
extremely helpful for controlling the neuropsychiatric symptoms and its management, but it
cannot help in developing the quality of health of the patients suffering from dementia. The

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paper had conducted antipsychotic review, which had shown that it had poor effect on the health
related quality of life. The paper had also shown that withdrawal of the antipsychotic medication
also had very poor quality on the health-related quality of life (HRQL) which is worse than the
effect of using the antipsychotic medication on the health-related quality of life (HRQL) alone.
Therefore, the use of antipsychotic medication should not be completely withdrawn by registered
nurses working with the patients to develop health-related quality of life (HRQL) as it may also
stop helping in the control of the neuropsychiatric symptoms. However, one interesting feature is
also stated here is that person centered care and social interaction are the non-pharmacological
interventions that have resulted in positive outcomes on the health-related quality of life
(HRQL). However, exercises regimen did not yield out any different outcome on the health-
related quality of life (HRQL). Therefore, this information is extremely useful for the registered
nurses as well as the healthcare professionals, who aim to develop the health-related quality of
life (HRQL) of their patients in addition to controlling the symptoms of dementia. Therefore, the
professionals can learn from this paper is that a proper antipsychotic reviews may lead to
reduction in the number of medications to be used for the patient which might reduce the side
effects but cannot result in development of the health-related quality of life (HRQL). They
should not completely withdraw the medication as that many not only deteriorate the health-
related quality of life (HRQL) but can also result in increase of the neuropsychiatric symptoms.
Although the paper had suggested the combined use of person centered care and social
interaction along with the pharmacological interaction of the antipsychotic medication, they have
not provided evidence for the combined use. They have only proved the action of the medication
and non-pharmacological interventions separately on the health-related quality of life (HRQL)
but their combined effect is not jotted down. Here lies one of the negative impacts of the

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information of the paper. However, this information can be helpful for the registered nurses in
understanding the applicability of the information. They can also gain knowledge on whether
they could use them in their care for their patients to develop their quality life (Carbera et al.
2015, pp 135)
Conclusion:
It has been learnt that the procedure of collecting and critiquing articles from the library
must be relevant and credible and at the same time help me in enhancing my knowledge and
skills about the effective procedure of treatment. Evidence based practices will help me to ensure
better patient outcomes, increase the safety of the patient and ensured better outcomes for
patient. The more relevant and better the level of evidence, the higher the credibility of the
papers which tend to bring out the best outcomes. The more recent the paper, the higher is their
importance; preferences and values in clinical decision making that ensure safe care. This
assignment has helped me to collect huge amount of information about the different
pharmacological as well as non-pharmacological interventions that I can adapt in my practices
and therefore would develop my expertise in treatment of patients who are suffering from
dementia. Analyzing and critiquing articles helped me to find out their feasibility in their
utilization as evidences in handling the patient of the case study and thereby such approach
would also ensure me successful outcomes when treating patients with various disorders in the
future.

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References:
Abbatecola, A.M., Bo, M., Barbagallo, M., Incalzi, R.A., Pilotto, A., Bellelli, G., Maggi, S. and
Paolisso, G., 2015. Severe hypoglycemia is associated with antidiabetic oral treatment compared
with insulin analogs in nursing home patients with type 2 diabetes and dementia: results from the
DIMORA study. Journal of the American Medical Directors Association, 16(4), pp.349-e7.
Ballard, C., Orrell, M., Sun, Y., Moniz‐Cook, E., Stafford, J., Whitaker, R., Woods, B., Corbett,
A., Banerjee, S., Testad, I. and Garrod, L., 2017. Impact of antipsychotic review and non‐
pharmacological intervention on health‐related quality of life in people with dementia living in
care homes: WHELD—a factorial cluster randomised controlled trial. International journal of
geriatric psychiatry, 32(10), pp.1094-1103.
Cabrera, E., Sutcliffe, C., Verbeek, H., Saks, K., Soto-Martin, M., Meyer, G., Leino-Kilpi, H.,
Karlsson, S. and Zabalegui, A., 2015. Non-pharmacological interventions as a best practice
strategy in people with dementia living in nursing homes. A systematic review. European
Geriatric Medicine, 6(2), pp.134-150.
Hagan, K.A., Munger, K.L., Ascherio, A. and Grodstein, F., 2016. Epidemiology of major
neurodegenerative diseases in women: Contribution of the nurses’ health study. American
journal of public health, 106(9), pp.1650-1655.
Hempel, P., Heinig, B., Jerosch, C., Decius, I., Karczewski, P., Kassner, U., Kunze, R.,
Steinhagen‐Thiessen, E. and Bimmler, M., 2016. Immunoadsorption of Agonistic
Autoantibodies Against α1‐Adrenergic Receptors in Patients With Mild to Moderate Dementia.
Therapeutic Apheresis and Dialysis, 20(5), pp.523-529.

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Masoumi, J., Abbasloui, M., Parvan, R., Mohammadnejad, D., Pavon-Djavid, G., Barzegari, A.
and Abdolalizadeh, J., 2018. Apelin, a promising target for Alzheimer disease prevention and
treatment. Neuropeptides.
Melnyk, B.M., Gallagher‐Ford, L., Long, L.E. and Fineout‐Overholt, E., 2014. The
establishment of evidence‐based practice competencies for practicing registered nurses and
advanced practice nurses in real‐world clinical settings: proficiencies to improve healthcare
quality, reliability, patient outcomes, and costs. Worldviews on Evidence
‐Based Nursing, 11(1),
pp.5-15.
Nead, K. T., Gaskin, G., Chester, C., Swisher-McClure, S., Leeper, N. J., & Shah, N. H. 2017.
Association between androgen deprivation therapy and risk of dementia. JAMA oncology, 3(1),
49-55.
Nightingale, G., Hajjar, E., Swartz, K., Andrel-Sendecki, J. and Chapman, A., 2015. Evaluation
of a pharmacist-led medication assessment used to identify prevalence of and associations with
polypharmacy and potentially inappropriate medication use among ambulatory senior adults with
cancer. American Society of Clinical Oncology.
O'connor, M.N., O'sullivan, D., Gallagher, P.F., Eustace, J., Byrne, S. and O'mahony, D., 2016.
Prevention of Hospital‐Acquired Adverse Drug Reactions in Older People Using Screening Tool
of Older Persons' Prescriptions and Screening Tool to Alert to Right Treatment Criteria: A
Cluster Randomized Controlled Trial. Journal of the American Geriatrics Society, 64(8),
pp.1558-1566.

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Parry, A.M., Barriball, K.L. and While, A.E., 2015. Factors contributing to Registered Nurse
medication administration error: A narrative review. International journal of nursing
studies, 52(1), pp.403-420.
Smith, M.A., Bowen, R.L., Nguyen, R.Q., Perry, G., Atwood, C.S. and Rimm, A.A., 2018.
Putative Gonadotropin Releasing Hormone Agonist Therapy and Dementia: An Application of
Medicare Hospitalization Claims Data. Journal of Alzheimer's Disease, (Preprint), pp.1-9.
Twigg, P. and Schwartzkopf, C.E., 2017. Nursing Management of Dementia. Gerontological
Nursing Competencies for Care, p.387.
Upton, P., Scurlock-Evans, L., Williamson, K., Rouse, J., and Upton, D. 2015. The evidence-
based practice profiles of academic and clinical staff involved in pre-registration nursing
students' education: A cross sectional survey of US and UK staff. Nurse education today, 35(1),
80-85.
Wilson, M., Sleutel, M., Newcomb, P., Behan, D., Walsh, J., Wells, J. N., and Baldwin, K. M.
2015. Empowering Nurses With Evidence‐Based Practice Environments: Surveying Magnet®,
Pathway to Excellence®, and Non‐Magnet Facilities in One Healthcare System. Worldviews on
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