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Effect of acetaminophen on behavior, well-being, and psychotropic medication use in nursing home residents with moderate-to-severe dementia

Contact Information


John T Chibnall ,

dementia; pain; pain measurement; analge-sics; psychomotor agitation


Objectives: To evaluate the effect of regularly scheduled administration of analgesic medication on behavior, emotional well-being, and use of as-needed psychotropic medications in nursing home residents with moderate-to-severe dementia. Design: Randomized, double-blind, placebo-controlled, crossover trial. Setting: Nursing-home based. Participants: Twenty-five nursing home residents with moderate-to-severe dementia. Intervention: Participants received 4 weeks of acetaminophen (3,000 mg/d) and 4 weeks of placebo. Measurements: Behavior and emotional well-being were assessed using Dementia Care Mapping, an observational method that quantifies time spent in behaviors across 26 domains (e.g., social interaction, unattended distress) and assesses emotional state while behaviors are being observed. Agitation was measured using the Cohen-Mansfield Agitation Inventory. As-needed psychotropic medication use was aggregated from medication logs. Results: Participants spent more time in social interaction, engaged with media, talking to themselves, engaged in work-like activity, and experiencing unattended distress when they received acetaminophen than they did when they received placebo. Participants also spent less time in their rooms, less time removed from the nursing home unit, and less time performing personal care activities when they received acetaminophen. There were no effects on agitation, emotional well-being, or as-needed psychotropic medication use. Conclusion: Untreated pain inhibits activity in nursing home residents with moderate-to-severe dementia. Pain treatment in this group may facilitate engagement with the environment.


Chibnall, J. T., Tait, R. C., Harman, B., & Luebbert, R. A. (2005). Effect of acetaminophen on behavior, well-being, and psychotropic medication use in nursing home residents with moderate-to-severe dementia. Journal of the American Geriatrics Society, 53(11), 1921–1929.





Conent Area

John T Chibnall

EWB-Related Construct

(3) positive affect

Study Design

Species or Study Population

(5) RCT

Sex (%Female)


Age (Mean, SD)

85.9, 7.4

Younger Controls?


Longitudinal Data?


Sample Size



4 weeks of acetaminophen (3,000mg/d) and 4 weeks of placebo.

Ethnicity (%white)

Not Stated (US)

Inclusion Criteria

(1) moderate-to-severe dementia, consistent with a Functional Assessment Staging (FAST) stage of 5 or 6.
(2) aged 65 and older
(3) minimum time in nursing home of 3 months
(4) minimum of 2 months since dementia diagnosis.

Exclusion Criteria

(1) current prescription for routine acetaminophen or opioid analgesic that could not be changed to accommodate the study placebo phase;
(2) psychosis or other severe mental disorder;
advanced, severe, or unstable medical disease/disorder that could interfere with participation;
(3) known allergy or adverse reaction to acetaminophen;
(4) liver compromise, injury, or disease or history of alcoholism;
(5) renal compromise, injury, or disease; anemia;
(6) current treatment with warfarin or phenobarbital;
(7) other neurodegenerative disease/disorder, including Parkinson's disease;
(8) bed-ridden or comatose state;
(9) and current enrollment in another experimental protocol. Participants who were receiving routine aspirin (one dose/d) for cardiovascular prophylaxis or a routine antiinflammatory agent (e.g., ibuprofen) were allowed to continue this regimen. Use of as-needed analgesics (other than acetaminophen) was not prohibited in participants and was monitored during the study.

EWB Measures

(1) six-level measure of well-being in Dementia Care Mapping DCM

Non-EWB Behavioral

(1) participant behavior and well-being: Dementia Care Mapping (DCM)
(2) agitation: Cohen-Mansfield Agitation Inventory (CMAI)
(3) measure was the use of psychotropic medication

Physiological Measures


Brain IMaging Modality

Brain IMaging Paradigm


Brain Region/Circuit


Biological Measures


Other Neural Measures

Data Availability?


Data Avalability Details


Diagnostic Measures

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