Expression of game-related and generic knowledge by dementia patients who retain skill at playing dominoes

Two new intergenerational interventions for Alzheimer's disease patients and families

Two new intergenerational interventions for Alzheimer's disease (AD) patients (with moderately severe to severe cognitive impairment) and families are being evaluated, with work to date described. Both interventions share the common goals of:

• Introducing a novel long-term care intervention for Alzheimer patients and their families in order to increase the quality of life for both;

• Increasing the incentive of family members, significant others, and volunteers to visit and spend time with AD patients;

• Increasing staff knowledge of the patient as person;

• Effecting a new intergenerational environment at sites providing care for AD patients; and

• Providing a new paradigm for innovative budget neutral programs, requiring no new public monies, building upon and leveraging existing resources to enhance the quality of life of older adults coping with dementing disorders.

The first intervention uses video biographies; the second involves the first game specifically designed for AD patients and their families. In pilot studies both interventions have been shown to increase patient engagement during visits approximately three-fold. Family and staff interest in both projects has been high.

Postmorbid learning of saxophone playing in a patient with frontotemporal dementia

Some patients with frontotemporal dementia (FTD) show an artistic enhancement of musical abilities. However, no patients with FTD, to date, have been reported to be able to learn how to play a musical instrument after disease onset. Herein we describe a patient (J. K.) who had never played any musical instruments premorbidly, but who learned to play the saxophone after being diagnosed with a behavioral variant of FTD. He mastered a repertoire that consisted of 10 pieces of Korean folk songs over a period of three years. Furthermore, his saxophone skills were high enough to outperform other students in his class.

The first therapeutic game specifically designed and evaluated for Alzheimer's disease

The first therapeutic game specifically developed for Alzheimer's disease was evaluated on an NIH grant. It was hypothesized that the game would have a positive influence on factors influencing quality of life (eg, mood, pleasure, interest in activities) and family comfort level in visiting. The study used a single group, within-participants, design, and 2 control conditions including a family visit as usual. The Observed Emotion Rating Scale for assessing individuals with Alzheimer's disease was administered with a questionnaire for the family to provide their own evaluation. Reduction of signs of depression/sadness using the game were statistically significant. An increase in patient pleasure was highly significant (P < .0001). Increases in patient interest, patient satisfaction, and family member satisfaction were all highly significant (P < .0001). The qualitative appeal of the game to family members was very high. The game provides a meaningful one-on-one intervention for individuals with advanced dementia.

The Cognition-Sensitive Approach to DEMENTIA Parallels With the Science of Unitary Human Beings

1. Theory can provide practical guidelines for nursing interventions and research. 2. The Science of Unitary Human Beings, a grand theory, provides input into clarifying the Cognition-Sensitive Approach, a mid-range theory. 3. Cognition in the Alzheimer's disease process can be categorized hierarchically. 4. The Cognition-Sensitive Approach provides a theoretical base for holistic nursing interventions for people with Alzheimer's disease.

A critique of research on the use of activities with persons with Alzheimer's disease: a systematic literature review

TOPIC

The topic of this paper concerns the use of therapeutic activities with persons with Alzheimer's disease (AD).

PURPOSE

The purpose is to present a critique of the research on these activities, with an emphasis on methodology. ORGANIZING CONSTRUCT AND SCOPE: Nursing literature identifies a number of purposes for activities for persons with AD. Activities should be therapeutic, enhance quality of life, arrest mental decline, and generate and maintain self-esteem. Other purposes of activities for this population are to create immediate pleasure, re-establish dignity, provide meaningful tasks, restore roles, and enable friendships. Activities may be more important to the psychological state of well-being of persons with dementia than the general physical and social environments in which they live.

SOURCES

The literature reviewed was identified with the use of computer data bases (Medline - 1991-March 2001; Cumulative Index of Nursing and Allied Health Literature (CINAHL) - 1991-March 2001; and PsychLit - 1988-March 1999). In addition, data bases of Science Citation Index and Social Science Citation Indexes as they appear in the computer base, Web of Science, were searched for 1992-2001. The time period for each search was determined by the manner in which the literature was grouped for inclusion in the particular database. Hand searches of 11 selected journals included the years 1993-2001. The search dates were selected to reflect the time period when the largest number of studies on activities and AD have appeared in the professional literature. We critique a total of 33 studies.

CONCLUSIONS

While researchers have demonstrated interest in the use of activities with persons with AD, theoretical and methodological difficulties, unclear findings and gaps exist, including a lack of emphasis on gender, ethnic, racial or cultural differences. Sampling issues involving diagnosis and staging complicate the research on individuals with AD. Case studies, single subject experimental designs, and tightly controlled quasi-experimental and experimental designs are needed to advance knowledge in this important area.

Representations of knowledge about dominoes in demented and normal elderly players

1. Dementia patients who retain musical and game-playing skills exhibit impaired performance on explicit memory tests of knowledge about their retained skill. 2. Dementia patients who retain skill at playing dominoes can answer complex questions about the play of the game almost as well as normal elderly domino players when the questions are presented with real dominoes. 3. The aim of this study was to determine if skilled dementia patients could answer questions about domino play when the stimuli were two-dimensional drawings of dominoes. 4. Seventeen dementia patients and eight normal elderly domino players were tested on two forms of the Domino Quiz: first with real dominoes, then with two-dimensional drawings; other neuropsychological tests were given at the same time. 5. Fourteen of the 17 patients and all of the controls showed no decline in answering questions about domino play when two-dimensional drawings were used. These patients showed retained symbolic processing of information about dominoes despite declines in overall mental status, generation of words from specific semantic categories, and recognition memory for domino terminology. 6. Because the 14 patients with retained domino skill performed as accurately as controls on both administrations of a letter cancellation task, the ability to process familiar symbols may be important to their game-playing skill.