***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Despite modest efficacy , unpredictable individual utility , and a high rate of adverse effects , behavioural and psychological symptoms of dementia ( BPSD ) are common determinants for antipsychotic drug therapy in nursing home patients . AIMS To explore the impact on BPSD of stopping long-term antipsychotic treatment in nursing home patients with dementia . METHODS Fifty-five patients ( 43 women ; mean age 84.1 ) taking haloperidol , risperidone , or olanzapine for BPSD were r and omly assigned to cessation ( intervention group , n=27 ) or continued treatment with antipsychotic drugs ( reference group , n=28 ) for 4 consecutive weeks . The Neuropsychiatric Inventory ( NPI ) Question naire was used to examine changes in behavioural and psychological symptoms . RESULTS By study completion , 23 of the 27 intervention group patients were still off antipsychotics . Symptom scores ( NPI ) remained stable or even improved in 42 patients ( intervention group , 18 out of 27 ; reference group , 24 out of 28 ; p=0.18 ) . As compared to patients with stable or improved symptom scores , patients with behavioural deterioration after antipsychotic cessation used higher daily drug doses at baseline ( p=0.42 ) . CONCLUSION A large share of elderly nursing home patients on long-term treatment with antipsychotics for BPSD , do well without this treatment . St and ardized symptom evaluations and drug cessation attempts should therefore be undertaken at regular intervals OBJECTIVES To test the efficacy of an individualized social activity intervention ( ISAI ) on decreasing daytime sleep , improving nighttime sleep , and lowering the day/night sleep ratio and to determine its cost . DESIGN Pretest/posttest r and omized with an experimental and control group . SETTING Seven nursing homes . PARTICIPANTS One hundred forty-seven residents with dementia . INTERVENTION One to 2 hours of individualized social activities for 21 consecutive days . MEASUREMENTS Twenty-four-hour sleep/wake patterns using an Actigraph . RESULTS The ISAI group had significantly less daytime sleep ( P=.001 ) and a lower day/night sleep ratio ( P=.03 ) than the control group , after adjusting for baseline values . Because 40 % of the sample slept 7 or more hours at night , a secondary analysis was conducted . When only those residents with a sleep efficiency of less than 50 % ( n=50 ) were included , the ISAI group ( n=20 ) had less daytime sleep ( P=.005 ) , a lower day/night sleep ratio ( P=.02 ) , fell asleep faster ( P=.03 ) , and were awake less at night ( P=.04 ) than the control group ( n=30 ) , after adjusting for baseline values . The weekly cost of the ISAI was roughly $ 70 per participant . Initial training and supply costs were $ 1,944 . CONCLUSION The ISAI provides an alternative to medications , without side effects Objective To investigate the effects of pain treatment on sleep in nursing home ( NH ) patients with dementia and depression . Methods A multicenter , 2‐armed , double‐blinded , placebo‐controlled , r and omized clinical trial conducted between August 2014 and September 2016 . One hundred six long‐term patients from 47 NHs in Norway with dementia and depression according to the Mini‐Mental State Examination and the Cornell Scale for Depression in Dementia were included . Patients received stepwise pain treatment in which those who did not use analgesics were r and omized to receive either paracetamol ( 3 g/day ) or placebo tablets ; those who already used pain treatment were allocated to buprenorphine transdermal system ( max . 10 μg/h/7 days ) or placebo transdermal patches  . Sleep was assessed continuously for 14 days by actigraphy , 1 week of baseline measurement , and 1 week of ongoing treatment . The following sleep parameters were evaluated : total sleep time , sleep efficiency ( SE ) , sleep onset latency ( SOL ) , wake after sleep onset , early morning awakening ( EMA ) , and number of wake bouts . Results In the intervention group ( paracetamol/buprenorphine )  , SE ( 70%‐72 % ) , SOL ( 32‐24 min ) , and EMA ( 50‐40 min ) improved compared with the control group ( SE , 70%‐67 % ; SOL , 47‐60 min ; EMA , 31‐35 min ) . Treatment effects were significant ( P < .01 , P < .05 , and P < .05 , respectively ) . Conclusion Compared with placebo , pain treatment improved sleep as measured with actigraphy . This implies that sleep , pain , and depression in NH patients should be critically evaluated and that pain treatment should be considered to be a potentially beneficial treatment CONTEXT Most people with dementia develop neuropsychiatric symptoms ( NPSs ) , which are distressing for their carers . Untreated pain may increase the prevalence and severity of NPSs and thereby staff burden . OBJECTIVES We investigated the association between NPSs and the impact of individual pain treatment on distress in nursing home staff . METHODS Nursing home ( NH ) units were cluster-r and omized to an intervention group ( 33 NH units ; n = 175 ) or control group ( 27 NH units ; n = 177 ) . Patients in the intervention group received individual pain treatment for eight weeks , followed by a four-week washout period ; control groups received care as usual . Staff informants ( n = 138 ) used the  Neuropsychiatric Inventory-NH version ( including caregiver distress ) as primary outcome to assess their own distress . Other outcomes were pain ( Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale ) and cognitive functioning ( Mini-Mental State Examination ) . RESULTS Using hierarchical regression analysis , all NPS items at baseline were associated with staff distress ( P < 0.01 ) apart from euphoria ; agitation had the largest contribution ( β = 0.24 ) . Using mixed models , we found significantly lower staff distress in the intervention group compared to the control group . Moreover , we also found significantly reduced distress in the control group , and there were still effects in both groups throughout the washout period . CONCLUSION Individual pain treatment  reduced staff distress in the intervention group compared to control group especially in regard to agitation-related symptoms and apathy . Furthermore , our results indicated a multifactorial model of staff distress , in which enhanced knowledge and underst and ing of NPSs and pain in people with advanced dementia may play an important role Background : Pain is under-detected and undertreated in people with dementia . The present study investigates the prevalence of pain in people with dementia hospitalized in nursing homes that are members of National Association of Third Age Residences ( ANASTE ) Calabria , and evaluates the association among pain , mood , and behavioral and psychological symptoms of dementia ( BPSD ) . Objective : The aim of this study is to define the prevalence of pain in people with dementia in long term care facilities using scales of self-reporting and observational tools and , particularly , to study the relationship between pain and BPSD . Methods : A prospect i ve observational study was carried out on 233 patients .  Pain assessment was performed using self-reporting tools such as the Numeric Rating Scale ( NRS ) for patients with slight cognitive impairment or no cognitive impairment and observational tools such as Pain Assessment In Advanced Dementia Scale ( PAINAD ) for patients with moderate or severe cognitive impairment . Mood was evaluated through the Cornell Scale for Depression in Dementia ( CSDD ) while behavioral problems were assessed through the Cohen-Mansfield Agitation Inventory ( CMAI ) and Neuropsychiatric Inventory ( NPI ) . Results : Only 42.5 % of patients evaluated by NRS provided a reliable answer ; of these , 20.4 % reported no pain . The percentage of pain evaluated by PAINAD was 51.8 % . Analysis of data showed a statistically significant correlation between diagnosis of pain and depressive symptoms , assessed with CSDD ( p = 0.0113 ) , as well as by single items of NPI , such as anxiety ( p = 0.0362 ) and irritability ( p = 0.0034 ) , and F1 profile ( Aggression ) of CMAI ( p = 0.01 ) . Conclusion : This study confirms that self-report alone is not sufficient to assess pain in elderly people with dementia ; the observational tool is a necessary and suitable way of assessing pain in patients with cognitive impairment . If not adequately treated , chronic pain can cause depression , agitation , and aggression in patients with dementia OBJECTIVES To determine the safety and efficacy of 2 dose formulations of melatonin for the treatment of insomnia in patients with Alzheimer 's disease . DESIGN A multicenter , r and omized , placebo-controlled clinical trial of 2 dose formulations of oral melatonin coordinated by the National Institute of Aging-funded Alzheimer 's Disease Cooperative Study . Subjects with Alzheimer 's disease and nighttime sleep disturbance were r and omly assigned to 1 of 3 treatment groups : placebo , 2.5-mg slow-release melatonin , or 10-mg melatonin . SETTING Private homes and long-term care facilities . PARTICIPANTS 157 individuals were recruited by 36 Alzheimer 's disease research centers . Subjects with a diagnosis of Alzheimer 's disease were eligible if they averaged less than 7 hours of sleep per night ( as documented by wrist actigraphy ) and had 2 or more episodes per week of nighttime awakenings reported by the caregiver . MEASUREMENTS Nocturnal total sleep time , sleep efficiency , wake-time after sleep onset , and day-night sleep ratio during 2- to 3-week baseline and 2-month treatment periods . Sleep was defined by an automated algorithmic analysis of wrist actigraph data . RESULTS No statistically significant differences in objective sleep measures were seen between baseline and treatment periods for the any of the 3 groups . Nonsignificant trends for increased nocturnal total sleep time and decreased wake after sleep onset were observed in the melatonin groups relative to placebo . Trends for a greater percentage of subjects having more than a 30-minute increase in nocturnal total sleep time in the 10-mg melatonin group and for a decline in the day-night sleep ratio in the 2.5-mg sustained-release melatonin group , compared to placebo , were also seen . On subjective measures , caregiver ratings of sleep quality showed improvement in the 2.5-mg sustained-release melatonin group relative to placebo . There were no significant differences in the number or seriousness of adverse events between the placebo and melatonin groups . CONCLUSIONS Based on actigraphy as an objective measure of sleep time , melatonin is not an effective soporific agent in people with Alzheimer 's disease Epidemiologic studies have consistently shown an association of long sleep ( ≥8 hr ) with mortality and multiple morbidities . However , there has been little experimental investigation of the effects of sleep extension . The aim of this study was to examine the effects of time in bed ( TIB ) extension , on depression , anxiety , sleepiness , and systemic inflammation . Following baseline , 14 healthy sleepers ( 31.79±10.94 years ) were r and omized to one of two one-week treatments : ( 1 ) a TIB extension treatment involving a fixed sleep schedule in which TIB was increased by 3 hours/night compared with the participants ' median baseline TIB ; ( 2 ) a control treatment involving a fixed schedule in which TIB was the same as the participants ' median baseline TIB . Actigraphic recording of sleep  was assessed throughout both weeks . Self-reported depression , state anxiety , sleepiness , and sleep quality , as well as blood pressure , and inflammation were assessed at baseline and following the treatment week . Compared with baseline , TIB increased by 127.12±3.92 min and total sleep time increased by 119.88±18.52 min during TIB extension , but decreased slightly in the control treatment . Depression was elevated more following TIB extension ( effect size (ES)=-0.86 ) vs. control ( ES=-0.50 ) . Interleukin-6 levels increased by 2-fold following TIB extension ( ES=-0.65 ) , but did not change following the control treatment . Sleepiness increased after TIB extension , but decreased after the control treatment . The results revealed negative effects of TIB extension on mood and inflammation . Larger-scale studies involving more prolonged , but less profound sleep extension , are warranted BACKGROUND Person-centered care ( PCC ) is a widely recognized concept in dementia research and care . Dementia Care Mapping ( DCM ) is a method for implementing PCC . Prior studies have yielded heterogeneous results regarding the effectiveness of DCM for people with dementia ( PwD ) . We aim ed to investigate the effectiveness of DCM with regard to quality of life ( QoL ) and challenging behavior in PwD in nursing homes ( NHs ) . METHODS Leben-QD II is an 18-month , three-armed , pragmatic quasi-experimental trial . The sample of PwD was divided into three groups with three living units per group : ( A ) DCM applied since 2009 , ( B ) DCM newly introduced during the study , and ( C ) a control intervention based on a regular and st and ardized QoL rating . The primary outcome was QoL measured with the Quality of Life-Alzheimer 's Disease ( QoL-AD ) proxy , and the secondary outcomes were QoL ( measured with QUALID 
    Output:
    
Staff distress , resident agitation , and prescription of psychotropic medications  were associated with sleep disturbances .
Conclusions Clinical ly significant sleep disturbances are less common than those measured on actigraphy and are associated with residents and staff distress and the increased prescription of psychotropics .
Actigraphy appears to offer no benefit over proxy reports in this population