title: Caring for early-onset dementia with excessive wandering of over 30 kilometres per day: a case report.
abstract: Excessive wandering in people in dementia is associated with a severe care burden. However, the quantification of excessive wandering has not been described, and its cause and treatment have not been evaluated with objective measurements to date. The purpose of this study was to evaluate pharmacological treatments and non-pharmacological interventions to reduce excessive wandering in an early-onset Alzheimer disease patient with objective indicators. Wandering was quantified using an integrated circuit monitoring system that measured the distance moved and the location of the patient. Monitoring was conducted in the dementia ward of a general hospital in 2012. Sleep quality was measured by non-wear actigraphy. The study was approved by the ethics committees of the Osaka University School of Allied Health Science, and of the study hospital. The case involved a 62-year-old woman diagnosed with early-onset Alzheimer disease and hospitalized in 2012 because of irritability and agitation; her Mini-Mental State Examination score was 5/30 and her Clinical Dementia Rating score was 3. When olanzapine (2.5 mg) was prescribed, she developed insomnia, and her wandering movements increased from 10 to 20 km/day. On some days, it exceeded 30 km/day, and she walked most of the night. She did not experience weight loss or physical exhaustion, but she sustained a minor injury in her left sole. Olanzapine was increased to 7.5 mg, but these problems persisted. Nursing staff discovered triggers for wandering and insomnia, including high sensitivity to odour and noise in the living room or her room. When the environment was changed to meet her needs, the distance moved per day decreased to <15 km and the sleep disturbances disappeared. This case demonstrated the difficulty in assessing the degree of ambulation and sleep disorder. Objective indicators are essential in evaluating the effectiveness of pharmacological and non-pharmacological interventions.
authors.affiliation: Department of Clinical Nursing, Division of Health Sciences, Graduate School of Medicine, Osaka University, Sakai, Japan.
authors.forename: Miyae
authors.initials: M
authors.lastname: Yamakawa
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Yoko
authors.initials: Y
authors.lastname: Higami
authors.forename: Kazue
authors.initials: K
authors.lastname: Shigenobu
authors.forename: Kiyoko
authors.initials: K
authors.lastname: Makimoto
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D003704:Dementia / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006272:Health Facility Environment; D006801:Humans; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011595:Psychomotor Agitation / Q000503:physiopathology / Q000523:psychology*; D012893:Sleep Wake Disorders / Q000150:complications; D012903:Smell / Q000187:drug effects / Q000502:physiology; D055816:Wandering Behavior / Q000523:psychology*
chemical_list: D014150:Antipsychotic Agents
keywords: dementia; excessive wandering; non-pharmacological intervention; pharmacotherapy; trigger