Behavior and Affect in Alzheimer’s Disease

Rocking chair therapy for dementia patients: Its effect on psychosocial well-being and balance

The use of platform style rocking chairs to improve psychological well-being and balance of nursing home residents with dementia was studied. Despite significant cognitive impairment, most medically stable unrestrained residents accepted the chairs and learned to actively rock. During the six week program, residents were able to rock an average of 101 minutes per day. Using a cross-over design (n=25), there were improvements in depression/anxiety and reductions in PRN pain medication significantly related to amount of rocking. Those who liked rocking and wanted to continue it at the end of the study also demonstrated significant improvements in balance as measured by center of gravity.

Care recipient agreeableness is associated with caregiver subjective physical health status

OBJECTIVES

The emotional and physical health consequences of caring for a family member are well documented. However, although personality has been shown to affect dyadic interactions and been linked with individual outcomes for both care recipients (CRs) and caregivers (CGs), the influence of CR personality on CG health remains unexplored.

METHOD

This study investigated cross-sectional associations between CRs' five-factor personality traits and CGs' physical and emotional health in 312 dyads of older adults with disability and their informal CGs who participated in the Medicare Primary and Consumer-Directed Care Demonstration.

RESULTS

Regression models controlling for CG personality, strain, and sociodemographic characteristics and CR physical impairment and pain found that agreeableness in CRs was associated with better physical health among CGs. Facet-level analyses showed specific associations between the trust and compliance facets of CR agreeableness and CG physical health. Investigation of CR personality styles revealed that the "easygoing" (N-, A+) and "well-intentioned" (A+, C-) styles predicted better CG physical health; the "leaders" (E+, A-) style had the opposite effect. No significant associations were found between CR personality and CG mental health.

DISCUSSION

Results from this study reveal the value of considering CR personality in relation to CG health and highlight the importance of assessing dispositional qualities within the context of care provision and informal assistance.

Psychiatric symptoms in adults with Down syndrome and Alzheimer's disease

Changes in psychiatric symptoms related to specific stages of dementia were investigated in 224 adults 45 years of age or older with Down syndrome. Findings indicate that psychiatric symptoms are a prevalent feature of dementia in the population with Down syndrome and that clinical presentation is qualitatively similar to that seen in Alzheimer's disease within the general population. Psychiatric symptoms related to Alzheimer's disease vary by the type of behavior and stage of dementia, but do not seem to be influenced by sex or level of premorbid intellectual impairment. Some psychiatric symptoms may be early indicators of Alzheimer's disease and may appear prior to substantial changes in daily functioning. Improvements in understanding the progression of dementia in individuals with Down syndrome may lead to improved diagnosis and treatment.

Living with a person with Alzheimer's disease: Experiences related to everyday occupations

The aim of this study was to illuminate experiences of daily occupations among spouses living with a person with Alzheimer's disease (AD). The study contains phenomenological-hermeneutic interpretation of interviews with eight spouses. The analysis revealed the participants as being in the process of a changing occupational situation. They come to live an occupational life intertwined with their partners' needs. An ongoing process of occupational adjustment is taking place as a response to the changing situation. The spouses were occupied with consequences of their partner's disease. They were striving for occupational meaning and at the same time living with threats to meaningful occupations. It can be concluded that living with a partner with AD is a complex dealing with occupational meaning. This complexity should be considered in interventions.

Evaluation of non-pharmacological intervention on antisocial behavior in patients suffering from Alzheimer's disease in a day care center

Psychosocial treatment was studied on improving socially non integrated behavior and in containing cognitive-behavioral degeneration in patients suffering from Alzheimer's disease. The hypothesis was that patients who do not maintain social relationships decline in their psycho-social and psycho-cognitive behavior more rapidly and that intervention helps to attain the above mentioned objectives (18 patients in day care center). All subjects had to perform the Cohen-Mansfield Agitation Inventory and the Cornell Depression Scale at the beginning of the study and were tested again after 1.5 years. The results of the group of Alzheimer patients showed a significant difference in the CMAI Scale (P<0.01) and sub-scales and in the Cornell Scale (0.014). In conclusion, the usefulness of the center is fundamental in encouraging the maintenance of significant relationships and helping patients adapt to their disease.

Wandering behaviour in people with dementia

BACKGROUND

Wandering has been described as one of the most challenging behaviours to manage and yet a search of the literature in the last two decades yields only a limited number of papers that specifically studied wandering.

AIM

This paper reviews the current literature on wandering in relation to the nature of the phenomenon, attempts to classify the behaviour, the extent of the problem, the profile of those who wander, postulations about its aetiology, and intervention strategies being employed.

METHOD

Eight literature databases were searched for the last 40 years up to February 2003 using 'wandering' and 'dementia' as combined keywords. A total of 133 articles was included in the review.

FINDINGS

The prevalence of wandering behaviour was difficult to assess and no conclusions could be reached. The typical wanderer depicted in the literature was relatively young in the older population, more cognitively impaired, more likely to be a man, might have experienced sleep problems, had a more active premorbid lifestyle, and used more psychotropic medications. While studies agreed that wanderers are more cognitively impaired, their findings did not necessarily agree on other attributes. Three major approaches, namely the biomedical, psychosocial and person-environment interaction perspectives, in conceptualizing wandering behaviour can be identified from the literature. Medications, activity programmes, behavioural modification and environmental manipulation have been used as interventions but none has so far demonstrated unequivocal effectiveness.

CONCLUSION

Knowledge generated through research remains insufficient to explain fully why and when wandering occurs. Variability in how the phenomenon was defined and studied, and the small size of the samples made generalizability of findings difficult. Future research should incorporate a clearer definition of wandering; a specific targeted population with representative sample size; appropriate subject identification strategies; focussed interventions, and better control conditions.

Behavioral change in persons with dementia: relationships with mental and physical health of caregivers

The purpose of this study was to examine the effects that changes in behavioral and psychological symptoms of dementia of persons with Alzheimer's disease have on their caregivers' mental health and physical health. The research design was a prospective, longitudinal follow-up study conducted in a major medical center and in participants' homes. Longitudinal analysis linking change in behavior to caregiver outcomes was based on 64 cases. Care recipients were assessed at the time of diagnosis with the Mini-Mental State Examination (MMSE). To provide information on the care recipient's behaviors, caregivers participated in an interview with the Modified Neuropsychiatric Inventory at diagnosis and at follow-up. Caregivers also completed a battery of established instruments to measure stress appraisal, mental health, and perceptions of their physical health at follow-up. Results showed that increases in problem behaviors among persons living with dementia, along with residence status, were significant predictors of caregivers' mental health and also their physical health. However, these relationships were mediated through stress appraisal. Variables such as MMSE score of the person with dementia, number of years caregiving, relationship status, and education level were not significant predictors of caregivers' health when behavior change was in the model.

Review of outcome measurement instruments in Alzheimer's disease drug trials: psychometric properties of behavior and mood scales

This article reviews the reliability and validity of eight scales for behavior and mood problems that were identified in a comparative analysis of Alzheimer's disease (AD) drug trials. The scales are the Brief Psychiatric Rating Scale, the Alzheimer's Disease Assessment Scale-noncognitive, the Relative's Assessment of Global Symptomatology, the Consortium to Establish a Registry for Alzheimer's Disease-Behavior Rating Scale for Dementia, the Dementia Behavior Disturbance scale, the Neuropsychiatric Inventory, and two scales for depressive symptoms, the Cornell Scale for Depression in Dementia and the Dementia Mood Assessment Scale. This article also examines methodological limitations in the way the published literature has assessed the psychometric properties of these scales. The aim is to help clinicians and potential trial investigators select appropriate measurement instruments with which to assess behavior and mood problems in AD and to assist AD researchers in the evaluation of the psychometric properties of such scales.

The selective vulnerability of brainstem nuclei to Alzheimer's disease

In a study of thioflavin S-stained serial sections from the entire brainstem, we found that the inferior and superior colliculi and the autonomic, monoaminergic, cholinergic, and classical reticular nuclei were affected with varying degrees of severity and frequencies in 32 patients with Alzheimer's disease, whereas no changes were seen in the brainstems of 26 control subjects. The majority of the affected nuclei in patients with Alzheimer's disease exhibit either neurofibrillary tangles or senile plaques, and only a few display both. However, when sections were immunostained with the antibodies 10D5 and AT8 or ALZ50, both beta-amyloid and hyperphosphorylated epitopes of tau protein were found to be present in various concentrations in all the affected nuclei. Our findings suggest that each brainstem nucleus has a distinct vulnerability to Alzheimer's disease-related pathological changes. Given that each nucleus has idiosyncratic neuroanatomical connections and prevailing neurochemical characteristics, the heterogeneous collection of brainstem nuclei can be considered a suitable anatomical ground for further investigation of selective vulnerability in Alzheimer's disease. The finding of severe pathological changes in some brainstem nuclei also raises the possibility that the dysfunction of these nuclei may contribute to the cognitive defects and increased rates of morbidity and mortality in patients with Alzheimer's disease.

Narratives of care providers concerning picking behavior among institutionalized dementia sufferers

To illuminate the meaning of picking behavior in institutionalized people with dementia, the narratives of 15 care providers were interpreted using a method inspired by Ricoeur's phenomenologic hermeneutics. The care providers saw the behavior as a form of meaningful communication. The behavior was described as occurring in combination with wandering and in connection with restlessness and stress related to fatigue, difficulty communicating, and lack of occupation. The behavior also was seen as an attempt to engage in meaningful activities. Some care providers reported that the picking behavior caused them strain, whereas others reported a more positive reaction because the behavior made the ward more alive. Most care providers perceived the meaning of the picking behavior relative to the dementia sufferer's previous life and said they reacted by diverting, allowing, or understanding the picking.