Identifying mild cognitive impairment at baseline in the Ginkgo Evaluation of Memory (GEM) study

Objectives: To identify, characterize and compare the frequency of mild cognitive impairment (MCI) subtypes at baseline in a large, late-life cohort (n = 3063) recruited into a dementia prevention trial.

Method: A retrospective, data-algorithmic approach was used to classify participants as cognitively normal or MCI with corresponding subtype (e.g. amnestic vs. non-amnestic, single domain vs. multiple domain) based on a comprehensive battery of neuropsychological test scores, with and without Clinical Dementia Rating (CDR) global score included in the algorithm.

Results: Overall, 15.7% of cases (n = 480) were classified as MCI. Amnestic MCI was characterized as unilateral memory impairment (i.e. only verbal or only visual memory impaired) or bilateral memory impairment (i.e. both verbal and visual memory impaired). All forms of amnestic MCI were almost twice as frequent as non-amnestic MCI (10.0% vs. 5.7%). Removing the CDR = 0.5 (‘questionable dementia’) criterion resulted in a near doubling of the overall MCI frequency to 28.1%.

Conclusion: Combining CDR and cognitive test data to classify participants as MCI resulted in overall MCI and amnestic MCI frequencies consistent with other large community-based studies, most of which relied on the ‘gold standard’ of individual case review and diagnostic consensus. The present data-driven approach may prove to be an effective alternative for use in future large-scale dementia prevention trials.     

Anxiety symptoms and risk of dementia and mild cognitive impairment in the oldest old women

Objectives: Research is limited and findings conflict regarding anxiety as a predictor of future cognitive decline in the oldest old persons. We examined the relationship between levels of and changes in anxiety symptoms, and subsequent dementia and mild cognitive impairment (MCI) in the oldest old women.

Method: We conducted secondary analyses of data collected from 1425 community-dwelling women (mean age = 82.8, SD ±3.1 years) followed on average for five years. The Goldberg Anxiety Scale was used to assess anxiety symptoms at baseline, and an expert clinical panel adjudicated dementia and MCI at follow-up. Participants with probable cognitive impairment at baseline were excluded.

Results: At baseline, 190 (13%) women had moderate/severe anxiety symptoms and 403 (28%) had mild anxiety symptoms. Compared with those with no anxiety symptoms at baseline, women with mild anxiety symptoms were more likely to develop dementia at follow-up (multivariable-adjusted odds ratio = 1.66, 95% confidence interval 1.12–2.45). No significant association was observed between anxiety symptoms and MCI.

Conclusion: In the oldest old women, our findings suggest that mild anxiety symptoms may predict future risk of dementia, but not MCI. Future studies should explore potential biological mechanisms underlying associations of anxiety with cognitive impairment.     

The association between mild cognitive impairment and doing housework

Objectives: The ability to perform instrumental activities of daily living (IADL) is thought to be relatively intact for people with mild cognitive impairment (MCI). Doing housework as part of IADL is an important skill needed for older people to live independently and successfully. A limited number of studies explore the association between MCI and doing housework. The aim of this study was to assess the association between MCI and doing housework among old people.

Method: The study employed a community-based, cross-sectional design. A total of 1773 older people residents, aged 60 and over, were randomly recruited in the Suzhou area, and they underwent the Montreal cognitive assessment (MoCA) for screening MCI in 2009. Participants were required to complete a questionnaire, which was comprised of their demographic information, health status, and life style, to evaluate the associations between MCI and these factors.

Results: About 13% of the respondents were found to have MCI. People with MCI are found to be less healthy and live unhealthy lifestyles. After adjusting confounding factors, a significant association was observed between MCI and not doing housework (Odds ratio (OR) = 1.64; 95% confidence interval (CI) = 1.17–2.30).

Conclusions: MCI is associated with doing less housework. The deterioration in the ability to do housework is a potentially important indicator of evolving cognitive impairment in some old people.     

Caregiver burden in mild cognitive impairment

Objectives: We aimed to compare the rates of burden amongst caregivers of participants with mild cognitive impairment (MCI), compared to a control group. We also aimed to identify factors in both the caregiver and patient that are associated with significant levels of burden.

Method: This was a cross-sectional study. Sixty-four participants with MCI, 36 control-participants and their respective caregivers/informants were recruited to a university research clinic. The proportion of those who showed clinically significant levels of burden was determined by a Zarit Burden Interview score of >21. The associations of burden in MCI-caregivers were calculated in the following categories; participant characteristics (including depressive symptoms, cognition and informant ratings of cognitive and behavioural change); caregiver characteristics; and the caregiving context. Multivariate analyses were performed to examine the relative contribution of individual variables to burden amongst MCI-caregivers.

Results: We found that 36% of MCI-caregivers reported clinically significant levels of burden, twice that of the control informant group. Participant behavioural problems contribute most to burden, with participant depression and possibly cognition also having a significant association.

Conclusion: Caregiver burden is a considerable problem in MCI and shares some of the same characteristics as caregiver burden in dementia, namely a strong association with challenging behaviours in the patient. This has implications for further research and intervention studies.     

Patterns of everyday technology use and activity involvement in mild cognitive impairment: a five-year follow-up study

Objectives: The aims were to describe longitudinal patterns in terms of perceived ability to use everyday technology (ET) and involvement in everyday activities over five years in older adults with mild cognitive impairment (MCI), and to examine the predictive value of these patterns regarding diagnostic outcomes.

Method: Thirty older adults diagnosed with MCI at inclusion, reported their perceived ability in using ET and involvement in everyday activities on seven occasions over five years. Individual longitudinal case plots and a pattern-oriented analysis were used to compare the participants' distribution in earlier identified stable/ascending, fluctuating and descending patterns of functioning (year 0–2). Fisher's exact test was used for testing the relation between pattern and diagnostic outcomes.

Results: An initial descending pattern of functioning tended to continue; none of these participants later developed a more stable pattern. More congruent trajectories of change appeared over time. Pattern affinity years 0–2 and diagnostic outcome were significantly related (p = .05), with a dementia diagnosis being more likely for those initially displaying an early descending pattern

Conclusion: These findings point to a need for early support focusing on the use of ET for persons with MCI who early after diagnosis descend in functioning.     

Psychiatric disorders among older prisoners: a systematic review and comparison study against older people in the community

Objectives: Despite emerging evidence that older prisoners experience poor mental health, literature in this area is still limited. In the present systematic review and meta-analysis, we report on the prevalence of psychiatric disorders among older prisoners and compare our findings against community studies on older people.

Methods: We searched on Assia, PsycInfo, MedLine, Embase, Web of Science, Google and Gov.uk. We carried out bias assessments, rated studies for quality and ran a heterogeneity test. We meta-analysed prevalence rates of psychiatric disorders through an aggregate weighted mean and calculated relative risk (RR) and statistical significance against community studies. Sensitivity analyses were further performed.

Results: We reviewed nine studies and obtained the following prevalence: ‘Any psychiatric disorder’ 38.4%, depression 28.3%, schizophrenia/psychoses 5.5%, bipolar disorder 4.5%, dementia 3.3%, cognitive impairment 11.8%, personality disorder 22.9%, alcohol abuse 15.9%, anxiety disorders 14.2%, PTSD 6.2%. Older prisoners were found to have higher RR for every single psychiatric disorder against older people in the community, with the sole exception of alcohol abuse (RR = 1) and dementia (RR = .75). The prevalence rates were statistically significantly higher (p < .05) among the prisoners for ‘Any psychiatric disorder’, depression and personality disorder. Overall, the sensitivity analyses confirmed our original results.

Conclusion: Our findings point at a high prevalence of every single psychiatric disorder among older prisoners, who also experience rates of dementia and alcohol abuse comparable to those reported in the community. Our results have relevant implications for policy and practice in this area. Further research is crucial to confirm findings from this study.     

Psychosis associated behavioral and psychological signs and symptoms in mild cognitive impairment and Alzheimer's dementia

Objectives: The aim of this study is to determine the prevalence of psychosis in mild cognitive impairment (MCI, Petersen's criteria) and patients with Alzheimer's dementia, and to characterize the associated behavioral and psychological signs and symptoms of dementia (BPSD).

Method: A cross-sectional analysis of baseline data from an ongoing, prospective, longitudinal study on BPSD was performed, including 270 MCI and 402 AD patients. BPSD assessment was performed through Middelheim Frontality Score (MFS), Behave-AD, Cohen-Mansfield Agitation Inventory (CMAI) and Cornell Scale for Depression in Dementia (CSDD). Psychosis was considered to be clinically relevant when delusions and/or hallucinations occurred at least once in the last two weeks prior to the BPSD assessment.

Results: The prevalence of psychosis in AD (40%) was higher than in MCI (14%; p < 0.001). AD patients with psychosis showed more severe frontal lobe, BPSD, agitation and depressive symptoms (MFS, Behave-AD, CMAI and CSDD total scores), whereas MCI patients with psychosis only showed more severe frontal lobe and physically non-aggressive agitated behavior. In addition, only in psychotic AD patients, all BPSD and types of agitation were more severe compared to non-psychotic AD patients. Comparing MCI and AD patients, MCI patients with psychosis did not show more severe frontal lobe, behavioral and psychological (Behave-AD), depressive symptoms or agitation than AD patients without psychosis.

Conclusion: AD patients clearly display psychosis associated BPSD, whereas MCI patients only display more severe frontal lobe symptoms and physically non-aggressive agitated behavior, but also less pronounced than in AD.     

Race and cognitive decline among community-dwelling elders with mild cognitive impairment: findings from the Memory and Medical Care Study

Objective: Previous studies have reported conflicting findings on the relationship between race and cognitive decline in elders with dementia. Few studies have examined the role of race in cognitive decline in mild cognitive impairment (MCI). We investigate the relationship between race and cognitive decline in participants with MCI in a community-based, longitudinal study of cognitively impaired elders.

Method: Based on a validated method utilizing a neuropsychiatric battery, 133 subjects [mean age: 78.7 years (SD?=?6.5); female: 112 (76.7%); black: 59 (44.4%)] out of 512 participants in the Memory and Medical Care Study were diagnosed with MCI. The main outcome measure was the Telephone Interview for Cognitive Status (TICS) score over three years. Other baseline subject characteristics (demographics, health-related variables, behavioral, and psychiatric symptoms) were included in the analysis.

Results: Overall, the three-year decline in mean TICS score was significantly higher among African Americans than non-African Americans [3.31 (SD: 7.5) versus 0.96 (SD: 3.0), t-value?=?1.96, p-value?=?0.05]. General estimating equation analyses revealed that African American race was associated with a faster rate of cognitive decline in all models.

Conclusion: The rate of cognitive decline in MCI appears to be faster in African Americans than non-African Americans in the community. Diagnosis of MCI among African American elders could lead to early interventions to prevent or delay cognitive decline in the future.     

Agitation-associated behavioral symptoms in mild cognitive impairment and Alzheimer's dementia

Objectives: The aim of this study is to determine the prevalence of agitation in mild cognitive impairment (MCI, Petersen's criteria) and patients with Alzheimer's dementia (AD), and to characterize the associated behavioral symptoms.

Method: A cross-sectional analysis of baseline data from a prospective, longitudinal study on behavioral symptoms was performed, including 268 MCI and 393 AD patients. Behavioral assessment was performed through Middelheim Frontality Score (MFS), Behavioral Pathology in Alzheimer's Disease Rating Scale (Behave-AD) and Cornell Scale for Depression in Dementia (CSDD). Agitated behavior was considered to be clinically relevant when one or more items of the Cohen-Mansfield Agitation Inventory (CMAI) occurred at least once a week.

Results: The prevalence of agitation in AD (76%) was higher than in MCI (60%; p < 0.001). Patients with agitation showed more severe frontal lobe, behavioral and depressive symptoms (MFS, Behave-AD and CSDD total scores). In agitated AD patients, all behavioral symptoms and types of agitation were more severe compared to non-agitated AD patients, but in agitated MCI patients only for diurnal rhythm disturbances. This resulted in more severe Behave-AD global scores in patients with agitation as compared to patients without agitation. Comparing MCI and AD patients, MCI patients with agitation showed more severe behavioral and depressive symptoms than AD patients without agitation. The structure of agitation in AD consisted of more aggressive and physically non-aggressive behavior than in MCI.

Conclusion: Frontal lobe, behavioral and depressive symptoms are more severe in MCI and AD patients with clinically relevant agitation as compared to patients without agitation. However, this association is less pronounced in MCI.     

Patterns of functioning in older adults with mild cognitive impairment: a two-year study focusing on everyday technology use

Objectives: Early detection is vital for persons with mild cognitive impairment (MCI) who are at risk of activity and participation limitations, and crosssectional studies suggest the ability to use everyday technology (ET) to be a sensible tool. However, group level analyses fail to inform us about how functioning can vary over time for individuals. This study aimed at exploring and describing patterns of functioning over two years in a sample newly classified with MCI, with a special focus on perceived difficulty in ET use and involvement in everyday activities. In addition, cognitive functioning and conversion to dementia were studied.

Method: 37 older adults (aged ≥ 55) with MCI were assessed at inclusion, and at 6, 12, and 24 months. Longitudinal case plots for the variables under study were analyzed based on strict criteria using a person-oriented approach. Paired t-tests from baseline and 24 months were also conducted to analyze change.

Results: The 32 participants who remained in the study after two years showed three distinct patterns of functioning over time: stable/ascending (n = 10), fluctuating (n = 10), and descending (n = 12), with the highest conversion to dementia in the descending pattern (58%). The perceived ability to use ET decreased or fluctuated in 50% of the sample. However, on a group level, a significant difference between baseline and 24 months was found only regarding cognitive function.

Conclusion: As the need for support is individual and likely to alter over time, repeated evaluations of activity involvement and difficulty in ET use are suggested to target timely interventions for persons with MCI.     

An expert opinion on PANDAS/PANS: highlights and controversies

Objectives: ‘Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections’ (PANDAS) identified a unique subgroup of patients with abrupt onset of obsessive compulsive disorder (OCD) symptoms clinically related to Streptococcus infection and accompanied by neuropsychological and motor symptoms. After almost 20 years, PANDAS has not been accepted as distinct disorder and new criteria for paediatric acute-onset neuropsychiatric syndrome (PANS) have been replaced it, highlighting the fact that several agents rather than only Streptococcus might be involved.

Methods: Extensive review of the PANDAS/PANS literature was performed on PubMed.

Results: Although antibiotics have been reported to be effective for acute and prophylactic phases in several uncontrolled studies and non-steroidal anti-inflammatory drugs (NSAID) are used during exacerbations, clinical multicenter trials are still missing. Selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioural therapy (CBT) are still the first line of recommendation for acute onset OCD spectrum. Immunological therapies should be restricted to a few cases.

Conclusions: While PANDAS has found no confirmation as a distinct syndrome, and it is not presented in DSM-5, patients with acute onset OCD spectrum, neurocognitive and motor symptoms should be evaluated for inflammatory, infective, immunological and metabolic abnormalities with a comprehensive diagnostic algorithm.     

Mixed states in bipolar disorder – changes in DSM-5 and current treatment recommendations

Objective: Mixed states in affective disorders represent a particular challenge in clinical routine, characterized by a complicated course of treatment and a worse treatment response.

Methods: Clinical features of mixed states and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria are presented and critical discussed. We then performed a systematic review using the terms ‘bipolar’, ‘mixed’ and ‘randomized’ to evaluate current treatment options.

Results: For pharmacological treatment of mixed states in total, there is still insufficient data from RCTs. However, there is some evidence for efficacy in mixed states from RCTs for atypical antipsychotics, especially olanzapine, aripiprazole and asenapine as well as mood stabilizers as valproate and carbamazepine.

Conclusions: Mixed states are of a high clinical relevance and the DSM-5 criteria substantially reduced the diagnostic threshold. Besides advantages of a better characterization of patients with former DSM-IV-defined mixed episodes, disadvantages arise for example differential diagnoses with a substantial overlap in symptoms such as borderline personality disorders. Atypical antipsychotics, valproate and carbamazepine demonstrated efficacy in a limited sample of RCTs.

Limitations: The number of RCTs in the treatment of mixed states is highly limited. Furthermore, nearly all studies were funded by pharmaceutical companies which may lead to an underestimation of classical mood stabilizers such as lithium.     

Differentiating levels of cognitive functioning: a comparison of the Brief Interview for Mental Status (BIMS) and the Brief Cognitive Assessment Tool (BCAT) in a nursing home sample

Objectives: In US nursing homes, cognitive assessment has been an essential component of the federally mandated Minimum Data Set assessment system, inclusive of the Brief Interview for Mental Status (BIMS) for identifying possible cognitive impairment. We compare it with the Brief Cognitive Assessment Tool (BCAT) to determine which instrument is more sensitive in differentiating degrees of cognitive functioning in nursing home residents. We attempt to cross-validate the psychometric properties of both measures.

Method: Two hundred twenty-nine individuals residing in a Maryland skilled nursing facility were referred for neurocognitive evaluation over a 10-month period. One hundred eighty-nine of these residents met inclusion criteria by completing the BCAT and BIMS, and were aged 60 or older.

Results: The BIMS and the BCAT were confirmed to have strong internal consistency reliability and construct validity. Both cognitive tools were found to predict cognitive diagnoses generally, but only the BCAT was able to identify residents at all specific cognitive levels. The BIMS did not differentiate between residents with normal cognition and those with mild cognitive impairment, or between mild and moderate dementia. Both measures demonstrated high specificity and positive predictive values for identifying severe cognitive impairment or probable dementia. The BIMS had lower sensitivity and negative predictive values for identifying dementia compared to the BCAT. The BCAT accounted for an additional 47% of the variance in dementia diagnoses over and above BIMS scores.

Conclusion: Based on these findings, the BCAT appears to be more sensitive than the BIMS in predicting cognitive level for nursing home residents.     

Trichotillomania and its clinical relationship to depression and anxiety

Objective: Trichotillomania (TTM) is associated with high rates of co-occurring depression and anxiety disorders. What the co-occurrence of TTM, depression or anxiety disorders means clinically and cognitively, however, has garnered little research attention.

Methods: About 530 adults with TTM were examined on a variety of clinical measures including symptom severity, psychosocial measures of functioning, psychiatric comorbidity and neurocognitive testing assessing motor inhibition and cognitive flexibility. Clinical features and cognitive functioning were compared between TTM patients with current comorbid major depressive disorder (MDD), a current anxiety disorder, both MDD and an anxiety disorder, or neither.

Results: Of 530 participants, 58 (10.3%) had MDD only, 97 (18.3%) had an anxiety disorder only, 58 (10.3%) had both MDD and an anxiety disorder, and 317 (59.8%) had neither. For almost all clinical measures, those with MDD only reported worse symptoms than those with an anxiety disorder only, and the combination of MDD and an anxiety disorder reported the worst level of symptom severity.

Conclusions: These results suggest that adults with TTM and co-occurring MDD and anxiety disorders exhibit unique clinical differences. The clinical differences may also have treatment implications.     

Interaction of erythrocyte eicosapentaenoic acid and physical activity predicts reduced risk of mild cognitive impairment

Objectives: To evaluate relationships between self-reported physical activity, proportions of long-chain omega-3 polyunsaturated fatty acids (LCn3) in erythrocyte content (percentage of total fatty acids) and risk of mild cognitive impairment (MCI) in older adults.

Method: A cross-sectional study was conducted. Community-dwelling male and female (n = 84) participants over the age of 65 years with and without MCI were tested for erythrocyte proportions of the LCn3s eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Physical activity was measured using a validated questionnaire.

Results: The interaction between erythrocyte EPA, but not DHA, and increased physical activity was associated with increased odds of a non-MCI classification.

Conclusion: An interaction between physical activity and erythrocyte EPA content (percentage of fatty acids) significantly predicted MCI status in older adults. Randomised control trials are needed to examine the potential for supplementation with EPA in combination with increased physical activity to mitigate the risk of MCI in ageing adults.     

The impact of Cognitive Stimulation Therapy groups on people with dementia: views from participants, their carers and group facilitators

Objectives: Cognitive Stimulation Therapy (CST) can lead to significant improvements in cognitive function and quality of life for people with dementia. This study sought to investigate whether improvements found in clinical trials were also noted by people with dementia, their carers and group facilitators in everyday life.

Method: Qualitative interviews and focus groups were conducted with people attending CST groups, their carers and the group facilitators. Data were recorded and transcribed, before being analysed using Framework Analysis.

Results: Two main themes emerged, ‘Positive experiences of being in the group’ and ‘Changes experienced in everyday life’, along with seven sub-themes. The overall experience of attending CST was seen as being emotionally positive and most participants reported some cognitive benefits.

Conclusions: The findings lend further support to previous quantitative findings, as well as providing information about the personal experience of CST.     

Poor sleep quality is observed in mild cognitive impairment and is largely unrelated to depression and anxiety

Background: Individuals with mild cognitive impairment (MCI) commonly experience a number of sleep quality related issues. However, it remains unclear if these issues are specific to MCI or are simply attributed to the elevated levels depression and anxiety symptoms frequently observed among those with MCI. The present study sought to examine group differences between participants with MCI and matched controls on self-reported measures of sleep quality while controlling for depression and anxiety levels.

Methods: Participants with MCI (N = 48) and demographically matched controls (N = 48) were administered with self-reported measures of anxiety, depression and sleep quality. Sleep quality between both groups were first analyzed using a Multivariate Analysis of Variance, and then subsequently a Multivariate Analysis of Covariance incorporating depression and anxiety scores as covariates.

Results: The MCI group had significantly higher levels of depression and anxiety than the controls. On the sleep-related measures, the MCI group had significantly worse outcomes in sleep duration, disturbances, latency, efficiency, quality and daytime dysfunction. After controlling for depression and anxiety levels, with the exception of daytime dysfunction, all other differences remain significant, and are also associated with moderate to large effect sizes.

Conclusion: The results suggest that sleep quality issues are present in MCI and are largely independent of depression and anxiety.     

Subjective memory complaints,mood and MCI: a follow-up study

Objectives: Subjective memory complaints (SMC) are common in older people and previous research has shown an association with mood problems, such as depression and anxiety. SMC form part of the criteria for many definitions of mild cognitive impairment (MCI), but there is controversy over whether they should be included as they may be related more strongly to mood than to objective cognitive impairment. This study aims to clarify the relationship between mood and SMC in people with MCI.

Method: This paper reports an analysis of data from the Medical Research Council Cognitive Function and Ageing study. Structured interviews were conducted with community-dwelling older people to assess a range of aspects of cognitive functioning and mood. Data from two time points approximately 24 months apart were used in this analysis. At baseline, participants without dementia or severe cognitive impairment were categorised into three groups according to cognitive status. Mood was investigated by assessing symptoms of anxiety and depression which were defined using a diagnostic algorithm. Associations were tested using logistic regression and chi square analyses.

Results: A clear association was shown between SMC and mood, both cross-sectionally and over time. The relationship between our two competing definitions of MCI suggested that mood problems were more strongly related to the presence of SMC than objective cognitive impairment.

Conclusion: SMC may be a function of anxiety and depression rather than being related to objective cognitive function. This questions whether SMC should be included in definitions of MCI.     

Antipsychotic drug use and associations with neuropsychiatric symptoms in persons with impaired cognition: a cross-sectional study

Background: Neuropsychiatric symptoms (NPS) in cognitive disorders impair quality of life, increase caregiver stress, and may lead to earlier institutionalization and death. The objective of this study was to investigate the use of antipsychotics among persons with cognitive impairment in home care and residential care, and its associations with NPS and personal characteristics.

Methods: Data were collected in the South Savo Hospital District area with 105 000 inhabitants, where 66 of 68 institutions providing long-term residential care and 20 of 21 municipal home care producers joined the study. Nurses recorded the current use of drugs, the activities of daily living (ADL), prevalence of diagnosed dementia, and assessed the cognitive status and the prevalence of recent NPS based on the item list of the Neuropsychiatric Inventory (NPI).

Results: The study population was 1909 persons with cognitive impairment, and 1188 of them lived in residential care. Antipsychotics were used by 563 (29.5%) persons in the whole study population. In residential care 448 (37.7%) used antipsychotics and the corresponding figure in home care was 115 (15.9%). In the multivariate analysis, the antipsychotic use was associated with living in residential care, benzodiazepine use, and with NPS symptoms agitation/aggression (OR =1.70, 95% CI =1.16–2.48), disinhibition (OR =2.33, 95% CI =1.31–4.15), hallucinations (OR =2.77, 95% CI =1.69–4.55), and delusions (OR =1.71, 95% CI =1.01–2.91).

Conclusions: Antipsychotic use was common among persons with cognitive impairment. The results suggest that antipsychotics are commonly used to treat hyperactivity and psychotic symptoms, especially in residential care.