The Effect of Acupressure on Agitation and Salivary Cortisol in People with Dementia: A Pilot Study.

OBJECTIVES: This study aimed to identify the acupressure effect over time, compare the efficacy in different dosages, and identify feasibility issues with saliva sample collection and acupressure implementation in agitated nursing home residents with dementia. DESIGN: Time serial design with eight dosage-combination groups. SETTING: Three residential care homes (RCHs) in Hong Kong. PARTICIPANTS: Agitated RCH residents with dementia. INTERVENTIONS: Acupressure was performed for 9 minutes altogether on five acupoints: Fengchi (GB 20), Baihui (GV 20), Shenmen (HT 7), Niguan (PC 6), and Yingtang (EX-HN 3). Two frequencies (once and twice a day) and four durations (1, 2, 3, and 4 weeks) formed eight dosage combinations. OUTCOME MEASURES: The primary outcome was agitation, measured by the Cohen Mansfield Agitation Inventory. The secondary outcome was stress, measured by salivary cortisol. RESULTS: Twenty-four participants from three RCHs completed the study. Acupressure was successfully completed for 88% of total sessions, and 79.17% of participants completed more than 80% of expected sessions. The effect of acupressure on agitation onset was seen immediately at week 1 (p < 0.001), resurged at week 4 (p = 0.001), and was sustained until week 6 (p < 0.001). The effect on stress began immediately to a mild extent at week 1 (p = 0.011) and peaked at week 4 (p = 0.010). Acupressure was observed to show the largest effect when it was performed twice a day (p = 0.026) for 2 weeks (p = 0.005). Valid saliva samples were collected for 53.33% of participants. Hyposalivation caused this unsatisfactory yield of valid saliva samples. CONCLUSION: Acupressure can be conducted on agitated RCH residents with dementia, but low yield of saliva samples related to participants' hyposalivation is a problem. Preliminary findings suggest that acupressure is effective in reducing both agitation and stress. Its onset of effect was immediate, and the effect was sustained until 6 weeks after the intervention. The optimal dosage appears to be a course of acupressure twice a day for 2 weeks.

Mother/offspring co-administration of the traditional herbal remedy yokukansan during the nursing period influences grooming and cerebellar serotonin levels in a rat model of neurodevelopmental disorders.

Neurodevelopmental impairment in the serotonergic system may be involved in autism spectrum disorder. Yokukansan is a traditional herbal remedy for restlessness and agitation in children, and mother-infant co-administration (MICA) to both the child and the nursing mother is one of the recommended treatment approaches. Recent studies have revealed the neuropharmacological properties of Yokukansan (YKS), including its 5-HT1A (serotonin) receptor agonistic effects. We investigated the influence of YKS treatment on behavior in a novel environment and on brain monoamine metabolism during the nursing period in an animal model of neurodevelopmental disorders, prenatally BrdU (5-bromo-2'-deoxyuridine)-treated rats (BrdU-rats). YKS treatment did not influence locomotor activity in BrdU-rats but reduced grooming in open-field tests. YKS treatment without MICA disrupted the correlation between locomotor behaviors and rearing and altered levels of serotonin and its metabolite in the cerebellum. These effects were not observed in the group receiving YKS treatment with MICA. These data indicate a direct pharmacological effect of YKS on the development of grooming behavior and profound effects on cerebellar serotonin metabolism, which is thought to be influenced by nursing conditions.

Evaluation of the antipsychotic potential of Panax quinquefolium in ketamine induced experimental psychosis model in mice.

The search for novel pharmacotherapy from medicinal plants for psychiatric illnesses has progressed significantly from the past few decades and their therapeutic potential has been assessed in a variety of animal models. The aim of our study was to screen one such plant, Panax quinquefolium (PQ), with significant neuroactive properties for its antipsychotic potential. A graded dose study with PQ at 12.5-200 mg/kg, p. o. showed differential effects against the ketamine induced hyperactivity in the Digiscan animal activity monitor. Nevertheless at 100 mg/kg, p.o., PQ blocked ketamine induced memory impairment in the passive avoidance paradigm. In the chronic studies, PQ reduced the ketamine induced enhanced immobility in the forced swim test and did not show extra-pyramidal side effects in bar test and wood block test of catalepsy. These behavioural effects were compared with standard drugs haloperidol and clozapine. Further PQ reduced DA and 5-HT content after chronic treatment, but not after acute administration. In addition, PQ extract reduced acetylcholinesterase activity and nitrate levels, however increased glutamate levels in hippocampus. Overall our findings suggest that PQ possess antipsychotic like properties, which may leads to future studies with its specific constituents which may particularly be beneficial in predominant negative and cognitive symptoms of schizophrenia.

The effect of therapeutic touch on agitated behavior and cortisol in persons with Alzheimer's disease.

Agitated behavior in persons with Alzheimer's disease (AD) presents a challenge to current interventions. Recent developments in neuroendocrinology suggest that changes in the hypothalamic-pituitary-adrenal (HPA) axis alter the responses of persons with AD to stress. Given the deleterious effects of pharmacological interventions in this vulnerable population, it is essential to explore noninvasive treatments for their potential to decrease a hyperresponsiveness to stress and indirectly decrease detrimental cortisol levels. This within-subject, interrupted time-series study was conducted to test the efficacy of therapeutic touch on decreasing the frequency of agitated behavior and salivary and urine cortisol levels in persons with AD. Ten subjects who were 71 to 84 years old and resided in a special care unit were observed every 20 minutes for 10 hours a day, were monitored 24 hours a day for physical activity, and had samples for salivary and urine cortisol taken daily. The study occurred in 4 phases: 1) baseline (4 days), 2) treatment (therapeutic touch for 5 to 7 minutes 2 times a day for 3 days), 3) posttreatment (11 days), and 4) post- "wash-out" (3 days). An analysis of variance for repeated measures indicated a significant decrease in overall agitated behavior and in 2 specific behaviors, vocalization and pacing or walking, during treatment and posttreatment. A decreasing trend over time was notedfor salivary and urine cortisol. Although this study does not provide direct clinical evidence to support dysregulation in the HPA axis, it does suggest that environmental and behavioral interventions such as therapeutic touch have the potential to decrease vocalization and pacing, 2 prevalent behaviors, and may mitigate cortisol levels in persons with AD.