bluuebunny/crossref_metadata_2025 huggingface dataset:
Part six: Advanced cancer of the pancreas, prostate, stomach, and uterus
Authors: Kemp Charles
Published: May 2006

This is the last article in a six-part series on metastatic spread and natural history of the 18 most lethal tumors. The articles summarize symptom/problem anticipation, cancer metastasis, and the 18 tumors that each cause more than 6000 deaths/year in the United States. Bladder and brain cancer were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms. Parts II, III, IV, and V charted the natural histories, problems, and assessment parameters of advanced cancers of the breast, colon and rectum, esophagus, kidney, liver, and lung; and leukemia, melanoma, multiple myeloma, non-Hodgkin’s lymphoma, and cancers of the oral cavity (and pharynx) and ovary. Part VI finishes the series with discussions of cancers of the pancreas, prostate, stomach, and uterus. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncology emergencies. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as tables. Material is presented so that clinicians are able to anticipate the spread of these cancers and can thus identify problems early in their development so that the problems are more easily managed.
Expanding the role of hospice care in amyotrophic lateral sclerosis
Authors: Carter Gregory T. , Bednar-Butler Lisa M. , Abresch R. Ted , Ugalde Viviane O.
Published: May 2006

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive, ultimately fatal, motor neuron disease that poses a myriad of clinical and end-of-life problems. The needs of advanced ALS patients are well suited to the interdisciplinary, multi-modality setting of hospice, where comprehensive palliative strategies may ease suffering and allow the patient to die with dignity in the home. Unfortunately, hospice services are far underutilized in this setting. There is a great need to increase awareness of both patients and clinicians regarding the effectiveness of hospice in the care of advanced ALS patients.
Nutrition Education Among Low-Income Older Adults: A Randomized Intervention Trial in Congregate Nutrition Sites
Authors: Mitchell Roger E. , Ash Sarah L. , McClelland Jacquelyn W.
Published: May 2006

Nutritional well-being among older adults is critical for maintaining health, increasing longevity, and decreasingthe impactofchronicillness. However, few well-controlledstudies have examinednutritionalbehav ior change among low-income older adults. A prospective, controlled, randomized design examined a fivesession nutrition education module delivered to limited-resource older adults ( N = 703) in Congregate Nutrition sites by Cooperative Extensionagents. Experimentalgroupparticipantswere significantly more likely than con trol groupparticipants to increase multivitamin use, to increase calcium supplementuse, to read labels of dietary supplements, to carry a supplement and/or medication list, and to discuss such use with their health care profes sional. The study addresses weaknesses in the literature by using a theoretically derived education component, implementing the intervention within a setting regularly used by low-income older adults, employing random ized assignment to intervention and control conditions, and using hierarchical linear modeling to deal with “nested” data.
A Systematic Review of Readability and Comprehension Instruments Used for Print and Web-Based Cancer Information
Authors: Friedman Daniela B. , Hoffman-Goetz Laurie
Published: May 2006

Adequate functional literacy skills positively influence individuals' ability to take control of their health. Print and Web-basedcancer informationis oftenwritten at difficult readinglevels. This systematic review evaluates readability instruments (FRE, F-K, Fog, SMOG, Fry) used to assess print and Web-based cancer information and word recognition and comprehension tests (Cloze, REALM, TOFHLA, WRAT) that measure people's health literacy. Articles on readability and comprehension instruments explicitly used for cancer information were assembled by searching MEDLINE and Psyc INFO from 1993 to 2003. In all, 23 studies were included; 16 on readability, 6 on comprehension, and 1 on readability and comprehension. Of the readability investigations, 14 focused on print materials, and 2 assessed Internet information. Comprehension and word recognition measures were not applied to Web-based information. None of the formulas were designed to determine the effects ofvisuals ordesignfactorsthat couldinfluencereadabilityandcomprehensionofcancereducationinformation.
Results of a 3-Year Study of Two Methods of Delivery of Life Skills Training
Authors: Vicary Judith R. , Smith Edward A. , Swisher John D. , Hopkins Abigail M. , Elek Elvira , Bechtel Lori J. , Henry Kimberly L.
Published: May 2006

Model programs and standards for substance abuse prevention have been identified by a number of federal agencies. The study reported here assessed two methods of delivery of one such program, Life Skills Training (LST), implemented in nine rural disadvantaged school districts. The results indicate that neither standard LST nor an infused LST delivery method was found effective for the entire sample, although some encouraging results were foundforthe females in the study. This study, conductedbyresearchersindependentof the LST program, is useful for school decision makers in determining what programs are most effective with which groups. It includedall studentswith parentalpermission,controllingforprioruse levels, unlike some previous LST studies. The results of the program, as implemented by regular classroom teachers, reflect many issues relevant to recruitment, training, implementation, adaptation, and institutionalization of prevention programming.
Validity of a Sun Safety Diary Using UV Monitors in Middle School Children
Authors: Yaroch Amy L. , Reynolds Kim D. , Buller David B. , Maloy Julie A. , Geno Cristy R.
Published: May 2006

This article describes a validity study conducted among middle school students comparing self-reported sun safetybehaviorsfroma diarywith readingsfromultraviolet(UV)monitorswornondifferentbodysites. The UV monitors are stickers with panels that turn increasingly darker shades of blue in the presence of increasing amounts of UV light. Three schools participated ( N = 527). Statistically significant associations were found between self-reported behaviors and the UV monitor measurements, with Kendall's tau b's ranging from 0.400 to 0.823. Multiple regression was performed and indicator variables created separately for arm ( R = .12) and leg ( R = .49) coverage by protective clothing. The effect of time spent outdoors on the UV monitor measure was attenuated when the students reported having the corresponding body site covered with clothing. Self-reported shade was not a significant predictor of UV monitor change. Overall, the results provide evidence of validity of students' self-reports of time outdoors and protective clothing use.
Determinants of the Use of Four Categories of Complementary and Alternative Medicine
Authors: Hendrickson Darren , Zollinger Brett , McCleary Roseanna
Published: May 2006

The purpose of this research is to assess the social and health determinants of the use of four separate and distinct categories of complementary and alternative medical therapies: biologically based, mind-body, manipulative, and whole CAM medical systems. The behavioral model of health services use, which holds that health service use is a function of predisposing, enabling, and need characteristics, is used as the theoretical framework for linking specific determinants with the four categories of CAM use. Data are taken from a statewide interview survey of Kansas adults ( N = 2,166) conducted in 2001. Results from multivariate analyses demonstrate that there is variation in the determinants of the use of different categories of CAM therapies. Overall, the results indicate that future research on the determinants of CAM must delineate between various CAM therapies to gain an accurate portrayal of the factors contributing to CAM use.
Impact of a Medical School Elective in Cultivating Compassion Through Touch Therapies
Authors: Kemper Kathi J. , Larrimore Deborah , Dozier Jean , Woods Charles
Published: May 2006

This study assessed the impact of an elective for second-year students on cultivating compassion through complementary and alternative medicine practices including therapeutic touch and healing touch. Course participants completed demographic questions, precourse and postcourse questions about confidence and practice in compassion, and the Maslach Burnout Inventory. Those who completed the elective reported significant improvements in confidence, practice, and sense of personal achievement. For example, for the statement, “I am confident in being calm, peaceful and focused (centered) before and during patient encounters,” scores improved from 1.7 to 8.0 on a 10-point scale ( p < .01). Optimism about future practice improved from 5.5 before to 7.9 after the course ( p < .05). Scores significantly improved for confidence and practice of compassion and optimism about future practice. Such electives may improve desired skills and help reduce burnout. Additional research is needed to determine the impact of such electives on quality of care.
Use of Complementary and Alternative Medicine by Older Adults: An Exploratory Study
Authors: Montalto Catherine P. , Bhargava Vibha , Hong Gong Soog
Published: May 2006

Determinants of complementary and alternative medicine (CAM) use and characteristics of users are examined using a sample of 848 adults aged 50 and older from the 2000 Health and Retirement Survey. Logistic regression is used to identify the factors associated with the likelihood of using CAM. Nearly 70% of the respondents use at least one CAM modality, with 44% reporting use of curative CAM and 58% reporting use of preventive/curative CAM. Whites, relative to Blacks, were more likely to use curative and less likely to use preventive/curative CAM. Widowed older adults were more likely to use preventive/curative CAM. Number of limitations in activities of daily living was positively associated with use of both types of CAM. Recommendations are made for improving research on alternative health care utilization, for educating CAM users, and for qualitative studies to gain further insight into factors affecting the use of specific CAM modalities.
Restoring dressing independence in persons with Alzheimer's disease: A pilot study
Authors: Engelman Kimberly K. , Mathews R. Mark , Altus Deborah E.
Published: May 2006

Purpose: Well meaning nursing facility staff may compromise the independence of older adults with dementia by performing activities of daily living for residents. We assessed the impact of teaching certified nursing assistants (CNAs) to use a graduated prompting procedure to increase dressing independence of persons with dementia.

Design and methods: This study was conducted in a seven-bed dementia care unit. Three residents and two CNAs participated in the study. We used a repeatedmeasures experimental design to evaluate the effect of a training workshop for CNAs on a strategy for increasing resident engagement in self-care activities.

Results: During a series of baseline observations, we found that CNAs typically dressed residents with minimal resident involvement. Results showed that, following the training workshop for CNAs, resident independence in dressing increased and range of motion improved.

Implications: CNAs can provide restorative care that increases dressing independence and range of motion of older adults with dementia.
Alzheimer's disease and other dementias: A review
Authors: Rogan Shannon , Lippa Carol F.
Published: May 2006

Dementia and its associated diseases are important causes of disability and morbidity in developed countries, especially in the aged population. As the babyboomers arrive at retirement and individuals over 100 are one of the fastest growing segments of our nation's population, we may realize the substantial cost these diseases bring to society. Dementia is characterized by a significant loss of cognitive function and should be clinically distinguished from an acute delirium or decreased arousal. Its manifestations cause anguish to millions of caregivers and family members, who are pressed to cope with their loved one's unfortunate decline in multiple cognitive domains, functioning, and behavior. Early detection and management may prevent overuse of costly medical resources and allow patients and family members time to prepare for future medical, financial, and emotional challenges. Diagnostic clues to the etiology of the patient's dementia can be found in a medical workup in which the neurologic history and examination (including mental status examination) are essential and neuroimaging is indicated.

Herein, the concept of central nervous system (CNS) degenerative diseases as disorders of specific proteins is introduced. This review is intended to summarize clinical, biological, and genetic features of the common subtypes of dementia, and bring light to potential benefits of early and accurate diagnoses to optimize treatment. Details of the various diseases remain only partially uncovered, raising extensive prospects for future research and therapy for patients with dementia.
Slowly progressive aphasia with striatal involvement
Authors: Nagaratnam Nages , Cheuk Gary , Nagaratnam Kujan
Published: May 2006

We have described four patients with slowly progressive aphasia with striatal involvement occurring at different stages in the course of the illness. There were two males and two females, and their ages ranged from 68 to 76 (mean: 72) years. The extrapyramidal signs included tremors, bradykinesia, rigidity, and focal dystonia, and one had weakness resembling stroke. There is a heterogeniety among patients with slowly progressive aphasia and the clinical features correspond to the functional anatomy of the areas involved rather than to the pathology.
Use of a false recognition paradigm in an Alzheimer's disease clinical trial: A pilot study
Authors: Budson Andrew E. , Michalska Kalina J. , Rentz Dorene M. , Joubert Claire C. , Daffner Kirk R. , Schacter Daniel L. , Sperling Reisa A.
Published: May 2006

We report the first use of a false recognition memory test in a clinical trial of patients with Alzheimer's disease (AD). Tests of false recognition allow measurement of two components of memory: the specific details of a prior encounter with a particular item (item-specific recollection) and the general meaning, idea, or gist conveyed by a collection of items (gist memory). We used a false recognition paradigm with categorized pictures to study the effects of an experimental medication in patients with AD. Because medications to treat AD may preferentially improve gist memory or item-specific recollection, use of this type of paradigm may improve sensitivity for detection of drug effects more than standard memory tests.
Emotional response to social dencing and walks in persons with dementia
Authors: Palo-Bengtsson Liisa , Ekman Sirkka-Liisa
Published: May 2006

The emotional response to social dancing and walks in persons with dementia was studied to better understand the feasibility, popularity, and meaning of these activities from the perspective of the patient. Social dance events and walks were videotaped and analyzed using Husserl's philosophy as a basis for the analysis. Six persons with dementia participated in the study. The results are described in terms of four interrelated themes: 1) the engaged body; 2) the caregivers' understanding, encouragement, and response to patients during the activity; 3) mutual tenderness and communion; and 4) environmental conditions. Results were then synthesized into a general assessment of the emotional states observed and reported in relation to the activities.
Greek validation of the Seven-Minute Screening Battery for Alzheimer's disease in the elderly
Authors: Tsolaki Magda , Iakovidou Vasso , Papadopoulou Efi , Aminta Marianna , Nakopoulou Evagelia , Pantazi Theoharis , Kazis Aristides
Published: May 2006

The increasing prevalence of Alzheimer's disease (AD) suggests that there is an increasing need for accurate and easily administered screening instruments. The Seven-Minute Screen is a neurocognitive screening battery consisting of four brief tests (enhanced cued recall, temporal orientation, verbal fluency, and clock drawing). We studied 55 outpatients with probable AD, 40 healthy volunteers of comparable age, sex, and education and 31 elderly patients with other neuropsychological disorders. The aim of our study was to determine the validity and reliability of this test. Differences on individual tests were evaluated using the Student t test. (Recall: 6.4 ± 5.02/15.38 ± 0.95; Orientation: 48.76 ± 42.74/0.2 ± 0.52; Verbal: 8.2 ± 4.94/18.05 ± 4.63; Clock drawing: 2.07 ± 2.56/6.03 ± 11.25 for AD patients and control subjects, respectively). Mean scores for patients with AD and control subjects on all four individual tests were significantly different (for each, p < 0.001). The mean time to complete the test for healthy control subjects was nine minutes and 18 seconds, for neuropsychological disorders nine minutes and six seconds, and for AD patients 13 minutes and 32 seconds (p < 0,001). Logistic regression analysis was used to determine the degree to which the battery discriminated between control subjects and patients with AD (sensitivity 92.73 percent and specificity 97.50 percent). We then separated the patients with MMSE > 20 and the same model of regression analysis was used. Sensitivity was 81.25 percent and specificity was 96.55 percent using 0.7 as the cutoff probability, and 93.75 and 96.55 percent, respectively, using 0.5 as the cutoff probability. Neither age nor education and gender had an effect on the results. The Seven-Minute Screen appears highly sensitive to AD patients and may be useful in helping to make initial distinctions between patients with early dementia and normal elderly.
The underdetection of pain of dental etiology in persons with dementia
Authors: Cohen-Mansfield Jiska , Lipson Steven
Published: May 2006

Background. The detection of dental pain in persons suffering from dementia has not yet been investigated.

Subjects and methods. Twenty-one nursing home residents with a mean age of 88 participated in this study. Nine rotating volunteer dentists came to the nursing home to conduct dental evaluations. Two outside geriatricians performed a second assessment, and additional information concerning dental status was obtained from the minimum data set (MDS).

Results. Over 60 percent of assessed participants were considered to have a pain-causing condition. Less than half of these were rated by the geriatricians as having dentalrelated pain. Only one participant was rated to have dental or mouth pain on the MDS. Only one of the 18 persons with either a full or partial evaluation had no dental problems.

Conclusions. Dental problems are underdetected and undertreated in the nursing home. Better training for nondentists in detection of such problems and better reimbursement for dental care are needed to improve care of residents.
Discourse-derived perspectives: Differentiating among spouses' experiences of caregiving
Authors: Hepburn Kenneth , Lewis Marsha L. , Narayan Suzanne , Tornatore Jane B. , Bremer Karin Lindstrom , Sherman Carey Wexler
Published: May 2006

A method of constant comparative analysis was used to code open-ended interviews with 132 spouse caregivers regarding their experiences in caregiving. Results of this analysis yielded 69 qualitative code categories. We used these categories to compare the caregivers on several groupings that the literature has identified as providing meaningful ways to differentiate among caregivers. We used the qualitative responses to compare the caregivers by caregiver gender, care-recipient dementia severity, and duration of caregiving. Results partly confirmed previous findings that wife caregivers are more distressed than husbands, but the results also indicated these caregivers were more similar than dissimilar. The other analyses likewise indicated greater similarities than dissimilarities in the caregiving experience. We next continued the analysis and, using the coding categories as a springboard, identified four distinct patterns for construction of the meaning of the caregiving experience in the caregivers’ discourse. These discourse-derived framing categories, applicable in about three-quarters of the caregivers, offered other ways to distinguish among caregivers. Further analysis of these robust groupings showed important differences among the groups. These framing categories suggest ways to differentiate among caregivers, based on their perception of their role in the caregiving situation, ways that might point the way to intervention strategies for each of the groupings.
Evidence and mechanisms of retrogenesis in Alzheimer's and other dementias: Management and treatment import
Authors: Reisberg Barry , Franssen Emile H. , Souren Liduïn E.M. , Auer Stefanie R. , Akram Imran , Kenowsky Sunnie
Published: May 2006

Retrogenesis is the process by which degenerative mechanisms reverse the order of acquisition in normal development. Alzheimer's disease (AD) and related conditions in the senium have long been noted to resemble “a return to childhood.” Previously, we noted that the functional stages of AD precisely and remarkably recapitulated the acquisition of the same functional landmarks in normal human development. Subsequent work indicated that this developmental recapitulation also applied to the cognitive and related symptoms in AD. Remarkably, further investigations revealed that the same neurologic “infantile” reflexes, which mark the emergence from infancy in normal development, are equally robust indicators of corresponding stages in AD. Neuropathologic and biomolecular mechanisms for these retrogenic processes are now evident. For example, the pattern of myelin loss in AD appears to mirror the pattern of myelin acquisition in normal development. Also, recent findings indicate that mitogenic factors become reactivated in AD, and, consequently, the most actively “growing” brain regions are the most vulnerable. Because of this robust retrogenic process, the stages of AD can be translated into corresponding developmental ages (DAs). These DAs can account for the overall management and care needs of AD patients. A science of AD management can be formulated on the basis of the DA of the Alzheimer's patient, taking into consideration differences of AD from normal development as well as homologies.
The effects of music therapy on engagement in family caregiver and care receiver couples with dementia
Authors: Clair Alicia Ann
Published: May 2006

The purpose of this study was to examine the effects of caregiver-implemented music applications on engagement with their care receivers. Eight couples participated individually in a series of sessions, where a music therapist trained and cued the caregivers to implement a music application of choice. Changes in engagement frequency over a series of five sessions was highly statistically significant. The authors conclude that music therapy applications are effective in increasing mutual engagement in caregiving and care receiving couples with dementia, and that caregivers can effectively facilitate the engagement using music. Furthermore, once the engagement is established, it carries over into visitation without music.
Addressing psychological trauma in dementia sufferers
Authors: Flannery Raymond B.
Published: May 2006

Research has demonstrated that dementia sufferers may be victims of recent physical assault by family caregivers and other patients and staff in long-term care facilities. Some dementia sufferers have also been victims of violence at other points in their lives from events such as combat, physical and sexual abuse, natural and manmade disasters, and the like. These violent events may result in psychological trauma and the psychological aftermath of these violent incidents may last until death, if it is not treated.

The purpose of this paper is to outline some intervention strategies regarding restraints for dementia sufferers who have a history of violence and for whom little or no treatment has been provided. This paper is not intended to train trauma counseling specialists but to present common intervention strategies that may be fielded by long-term care staff to relieve unnecessary suffering.
Communicating with dementia patients on hospice
Authors: Thompson Patricia M.
Published: May 2006

There are distinct differences in caring for the “ typical” hospice patient as opposed to the hospice patient who has Alzheimer's disease. The entire long-term care team, from volunteers to physicians, can benefit from hospice training in this area. This article addresses this topic in terms of what to be aware of in the disease process, understanding and responding to the caregiver's experience and needs, and, of course, patient care. Particular communication techniques are presented to facilitate interactions with the dementia patient at each of the stages of his or her disease.
Therapeutic recreation interventions for need-driven dementia-compromised
Authors: Fitzsimmons Suzanne , Buettner Linda L.
Published: May 2006

This study describes a clinical trial of at-home recreational therapy for community dwelling older adults with dementia and disturbing behaviors. After two weeks of daily, individualized recreational therapy interventions (TRIs), results indicated a significant decrease in levels of both passivity and agitation. Biograph data collection was useful in identifying the physiological changes that occurred with each intervention technique. Specific information is included on the time of day each behavior occurred and the most effective interventions, as well as implications for service delivery.
To test or not to test: Interest in genetic testing for Alzheimer's disease among middle-aged adults
Authors: Cutler Stephen J. , Hodgson Lynne G.
Published: May 2006

Based on a hypothetical scenario positing 100 percent accuracy in test results, we examined interest in genetic testing for Alzheimer's disease (AD) among adult children, 40-60 years of age, who have a living parent with a diagnosis of probable AD (N = 108), and a matched comparison group of persons with no parental history of AD (N = 150). For both groups, planning for the future was the most important reason cited for being tested; lack of good treatment options and concerns about losing health insurance were the most important reasons for not being tested. Hierarchical regression was used to examine the effects of sociodemographic characteristics, subjective perceptions of memory functioning, concerns about having and developing AD, and mastery on interest in being tested. Personal concerns about developing AD and mastery emerged as significant predictors and subsample membership approached significance, although the full model explained just 18 percent of the variance. Because persons in the comparison group were more likely to report an interest in being tested, educational efforts about genetic testing should not be restricted only to family members of persons with a diagnosis of AD.
Domestic violence and elderly dementia sufferers
Authors: Flannery Raymond B.
Published: May 2006

Domestic violence is a serious national public health issue, and elderly dementia sufferers are not exempt from this form of aggression. This manuscript discusses the general nature of domestic violence, reviews the empirical findings of domestic violence in dementia sufferers, and outlines some of the warning signs and intervention strategies that could be considered for remediation in the presence of such abuse.
The Caregiver Vigilance Scale: Application and validation in the Resources for Enhancing Alzheimer's Caregiver Health (REACH) project
Authors: Mahoney Diane Feeney , Jones Richard N. , Coon David W. , Mendelsohn Aaron B. , Gitlin Laura N. , Ory Marcia
Published: May 2006

This article reports on the measurement properties of Caregiver Vigilance, a four-item caregiver self-report of perceived oversight demand for Alzheimer's disease and related disorders family caregiving. The self-report uses data from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) project, a multisite National Institutes of Health (NIH) sponsored study of over 1,200 family caregivers. Results indicate that the items were clearly understood by the racially/ethnically diverse respondents; and, when responses were transformed into a summary scale and analyzed, unidimensionality was evident and internal consistency reliability favorably demonstrated. We suggest using the Caregiver Vigilance Scale in conjunction with traditional burden measures to systematically include the caregiving time associated with protectively watching over care recipients and the daily duration of this responsibility. We also highlight the practical utility of selected items for potential use in the caregiver assessment process.
The characteristics of dementia caregiving onset
Authors: Gaugler Joseph E. , Wackerbarth Sarah B. , Mendiondo Marta , Schmitt Frederick A. , Smith Charles D.
Published: May 2006

This study examined the characteristics of entry into the caregiving role for family and friends of older adults suffering from dementia. Using data from a large community survey of informal caregivers of patients who visited the University of Kentucky's Alzheimer's Disease Research Center (n = 1055), respondents were classified into one of four onset sequences: recognition-diagnosis, care provision, recognition-care, and diagnosis dependent. A multinomial logistic regression identified several characteristics (i.e., caregiver income, time since onset, care recipient gender, care recipient living status, and primary caregiver identification) that were significantly associated with various caregiving onset patterns. The findings describe the complexity of the entry process and its potential association with health-related transitions in the caregiving career.
Predictors of successful relationships in a peer support program for Alzheimer's caregivers
Authors: Sabir Myra , Pillemer Karl , Suitor Jill , Patterson Michael
Published: May 2006

This study explores the role of similarity in the success of peer support relationships in an intervention program for dementia caregivers. Hypothesized predictors of successful matches included structural similarity between partners (e.g., in age, education), appraisal similarity (e.g., in satisfaction with support for caregiving), and psychological similarity (e.g., in psychological wellbeing). Contrary to expectations, no relationship between these types of similarity and the success of the match were found, but effects were found for dissimilar pairs on several characteristics. The findings suggest: 1) that what really makes a difference for successful peer support is sharing the stressful but also rewarding experience of caregiving; and 2) that program planners do not need to develop extensive matching criteria.
Neuropsychological stydy of familial Alzheimer's disease caused by mutation E280A in the presenilin 1 gene
Authors: Lasprilla Juan Carlos Arango , Iglesias Jaime , Lopera Francisco
Published: May 2006

In Antioquia, Colombia, investigators have recently discovered the largest family with the E280A mutation in the presenilin 1 gene that causes one type of familial Alzheimer's disease (FAD). The current study compares two groups within this family: those diagnosed with Alzheimer's disease (AD) in its early stage (nine subjects) and relatives (carriers) who did not show any signs of dementia (nine subjects). A battery of the following neuropsychological tests was administered to subjects in both groups: the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), a Phonological Verbal Fluency test, the Visual “A” Cancellation Test, memory of three phrases, the Rey-Osterrieth Complex Figure, and the Trail Making Test Part A. Statistical analyses of the average test scores of each group showed that the AD group scored significantly (p < 0.01 or p < 0.05) lower on 29 of the 43 neuropsychological variables measured (67 percent). Therefore, this specific battery was useful in discriminating subjects with AD from their healthy relatives who are carriers of the disease. The AD group as a whole presented slight dementia with predominant deficits in memory, language, praxis, and attention. This profile is similar to those reported in subjects with sporadic AD in its early stage and confirms the findings found in other neuropsychological studies of subjects with FAD linked to mutations in chromosome 14.
Restraint procedures and dementia sufferers with psychological trauma
Authors: Flannery Raymond B.
Published: May 2006

Restraint is an extreme response to an emergency situation in which there is imminent harm to self or others. Although some restrained patients become calm, others may become even more behaviorally disorganized. In some of these latter cases, the restrained patients may be victims of violence for whom the restraint procedure acts as a symbolic reminder of the past victimization. Elderly dementia sufferers may also be among these victims of violence. This paper provides a brief review of psychological trauma, research findings on psychological trauma in the elderly, and an approach to modifying restraint procedures that may be needed for dementia sufferers with a past history of victimization to minimize the disquiet associated with the needed restraint.
The effect of a multisensory exercise program on engagement, behavior, and selected physiological indexes in persons with dementia
Authors: Heyn Patricia
Published: May 2006

A multisensory exercise approach that evokes the stimulation and use of various senses, such as combining physical and cognitive stimuli, can assist in the management of persons with Alzheimer's disease (AD). The objective of this study was to evaluate the outcomes of a multisensory exercise program on cognitive function (engagement), behavior (mood), and physiological indices (blood pressure, resting heart rate, and weight) in 13 nursing home residents diagnosed with moderate to severe AD. A one-group pretest/post-test, quasi-experimental design was used. The program combined a variety of sensory stimulations, integrating storytelling and imaging strategies. Results showed an improvement in resting heart rate, overall mood, and in engagement of physical activity. The findings suggest that a multisensory exercise approach can be beneficial for individuals with AD.
Olanzapine as a treatment of neuropsychiatric disorders of Alzheimer's disease and other dementias: A 24-month follow-up of 68 patients
Authors: Moretti Rita , Torre Paola , Antonello Rodolfo M. , Cazzato Giuseppe , Griggio Stefania , Bava Antonio
Published: May 2006

Although the core feature of all types of dementia is progressive cognitive disruption, most demented patients also express noncognitive behavioral problems. These noncognitive problems lead to potentially devastating disabilities, and are often a major cause of stress, anxiety and concern for caregivers. Psychotropic drugs are frequently used to control these symptoms, but they have the potential for significant side effects, such as sedation, disinhibition, depression, falls, incontinence, parkinsonisms and akathisias. For 24 months, we monitored 68 outpatients suffering from Alzheimer's disease, vascular dementia, frontal lobe dementia, Parkinson dementia complex, and Lewy body disease. Our purpose was to identify the role and efficacy of olanzapine and the side effects which emerged during the treatment of behavioral alteration resulting from five etiological causes. This paper will discuss the results of this study, and will provide an overview of the existing literature.
Health Promotion for the Mind, Body, and Spirit: A college course for older adults with dementia
Authors: Fitzsimmons Suzanne , Buettner Linda L.
Published: May 2006

This article describes a pilot study of an experimental college course for individuals with newly diagnosed dementia, with a focus on teaching methods for promoting and maintaining optimal health. Community involvement included recruitment by the local Alzheimer's Association chapter and an off-campus site at a local assisted living center with easy access for the students. Course topics covered over the 10-week period, included modules on: physical and cognitive fitness, nutrition, recreation, communication, understanding the disease process, depression, coping, relationships, and driving issues. Stress, depression, selfefficacy, and self-esteem were evaluated both prior to and after the 10-week course. Providing education early in the course of the disease, empowers the older adult student and provides an element of personal control and dignity. The course also attempts to prevent future problems by teaching new habits and lifestyles early in the disease process. Attempts to change habits and behavior later in the course of the disease often fail due to the difficulty of learning new behaviors.

How do you feel when you are given a diagnosis by your physician for a disease that has no treatment to stop its progression? What do you do? Many people search for information on the Internet, ask friends, healthcare providers or others with the same diagnosis for advice, read articles, and attend workshops and conferences. When the diagnosis is Alzheimer's disease (AD) or another type of dementia, what does that person do? Where do they get information—especially since most services and education are aimed at the caregiver?
Forgetting: A memoir about culture, language, and religion
Authors: Hodder Ruth
Published: May 2006

I share the following memoir in the hope that it will help light the path of other multi-cultural, multi-lingual families who have to face the difficult task of caring for a loved one with Alzheimer's disease.
Measuring and enhancing self-efficacy among professional caregivers of individuals with dementia
Authors: Mackenzie Corey S. , Peragine Gina
Published: May 2006

Nurses who provide care for individuals with Alzheimer's disease and other dementias are at risk of burnout. Self-efficacy is a psychological construct with the potential to help reduce or prevent the impact of caregiver stress. Evidence supporting a link between higher levels of self-efficacy and lower levels of stress is emerging among lay caregivers. However, concurrent research for professional caregivers lags behind, partly due to a lack of appropriate self-efficacy measures for this population. We developed an intervention to enhance self-efficacy and an inventory to measure its improvements among long-term care nurses. Training resulted in lasting improvements in knowledge and selfefficacy regarding the management of challenging team, resident, and family situations. Short-term reductions in caregiver burnout were also evident. Suggestions for maintaining improvements in caregiver burnout over longer periods are offered.
Rivastigmine in subcortical vascular dementia: A randomized, controlled, open 12-month study in 208 patients
Authors: Moretti Rita , Torre Paola , Antonello Rodolfo M. , Cazzato Giuseppe , Bava Antonio
Published: May 2006

Subcortical vascular dementia (VaD) is characterized by executive dysfunction and behavioral problems, reflecting deterioration of the frontal lobe. This study aimed to determine whether rivastigmine, a dual inhibitor of acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE), has any effects on the typical symptoms of subcortical VaD. Patients receiving rivastigmine showed a slight improvement in executive functions and in behavior. Side effects in both groups were tolerable and there were no study withdrawals. Moreover, there are no drug interactions with other therapies previously and concomitantly assumed. Improvements in domains that characterize subcortical VaD were observed, indicating that rivastigmine may have provided targeted treatment in areas of the brain that are particularly affected in this patient population.
Teaching staff to respond effectively to cognitively impaired residents who display self-protective behaviors
Authors: Schindel-Martin Lori , Morden Pat , Cetinski Gertrude , Lasky Naomi , McDowell Cathy , Roberts Jacqueline
Published: May 2006

A randomized controlled trial (RCT) was implementedto evaluate the effectiveness of a 71/2 hour educational program designed to provide staff with the knowledge, skill, and confidence to manage physical self-protective behaviors of cognitively impaired long-term care residents. This RCT using a pretest/post-test design was conducted using consenting staff members (n = 40) who were randomly allocated to either a control or experimental group. The main outcome measure was a skills lab that evaluated participants’ responses to simulated patients. Both groups participated in the skills lab prior to training, and six weeks after the experimental group completed the program. Pre-and post-training and skills lab observational field notes were subjected to thematic content analysis. Twenty-eight staff members completed both pre-and post-training assessment measurements. Descriptive statistics and paired t-test analyses yielded statistically significant differences in change scores for performance indicators in three simulation scenarios. Analysis of the qualitative data support the finding that, once trained, staff felt better prepared to manage selfprotective behaviors. The results suggest that an initiative to educate staff will enhance knowledge, improve performance, and provide the confidence necessary for staff to respond positively to overt physical behaviors in cognitively impaired elders.
Caregiver attribution and resentment in dementia care
Authors: Martin-Cook Kristin , Remakel-Davis Barbara , Svetlik Doris , Hynan Linda S. , Weiner Myron F.
Published: May 2006

The caregivers of 37 patients with a dementing illness completed rating scales regarding the frequency and severity of their care recipient's general behavioral disturbance and manipulative behaviors, as well as their own resentment and depression. Caregivers were randomized to a four-week psychoeducational group intervention or control group to investigate the effect of dementia caregiving education on the caregiving experience. Findings indicated that, while care recipient behavioral disturbance was correlated with caregiver resentment and depression, the primary relationship was between behaviors perceived by the caregiver as manipulative or willful and caregiver resentment and depression. We found no significant differences in caregiver attribution, resentment, or depression between the caregivers who participated in the group session and those in the control group. The study supports the existence of resentment among dementia caregivers, and an important relationship between caregiving outcomes and attributions made by caregivers regarding their care recipients' actions. These results are discussed in relation to existing research on caregiver distress and intervention.
Effects on memory of verbal labeling for hand movements in persons with Alzheimer's disease
Authors: Miyahara Motohide
Published: May 2006

This study examined 1) whether patients diagnosed with dementia of the Alzheimer type spontaneously form verbal labels to remember nonmeaningful sequences of hand movements, 2) whether an instruction for a verbal labeling (VL) strategy could enhance memory performance, and 3) whether a relationship exists between the memory span for hand movements and a score on the Mini-Mental State Examination (MMSE). Of 18 Alzheimer's patients, 16 did not use the VL strategy spontaneously. However, if instructed, 12 of these 16 were able to use the technique. Of these 12, four were able to retain the strategy. There was a significant correlation only between the movement memory span and the MMSE. Meta-memory of VL seems independent of visuospatial memory and cognitive status.
Confused and disturbed behaviour in the elderly following silent frontal lobe infarction
Authors: Nagaratnam Nages , Bou-Haidar Pascal , Leung Harry
Published: May 2006

It is unclear whether silent frontal lobe infarction is truly asymptomatic; frontal behavioral syndromes following strokes have rarely been reported. We studied 12 elderly patients with silent frontal lobe infarction who were exhibiting confused and disturbed behavior. Ten were male and two female; their ages ranged from 68 to 79 (mean 78). Three groups of symptom clusters emerged: changes in mood and emotional behavior, cognitive deterioration with minor psychiatric symptoms, and a confusional state. When related to the CT scan location, three regions were identified: predominantly orbitofrontal, deep white matter and caudate, and border-zones, respectively. These findings were related to what is known about the neuroanatomic location of the lesions and the role of the frontal subcortical circuitry in relation to behavior. The different manifestations could be explained by damage to the frontal lobe or interruption of the complex frontal subcortical circuits.
Effects of animal-assisted therapy on agitated behaviors and social interactions of older adults with dementia
Authors: Richeson Nancy E.
Published: May 2006

The effects of a therapeutic recreation intervention using animal-assisted therapy (AAT) on the agitated behaviors and social interactions of older adults with dementia were examined using the Cohen-Mansfield Agitation Inventory and the Animal-Assisted Therapy Flow Sheet. In a pilot study, 15 nursing home residents with dementia participated in a daily AAT intervention for three weeks. Results showed statistically significant decreases in agitated behaviors and a statistically significant increase in social interaction pretest to post-test.
Memantine: An antiglutamatergic option for dementia
Authors: Molinuevo Jose L. , Garcia-Gil Vicente , Villar Amparo
Published: May 2006

Alzheimer i disease (AD) is the most common form of dementia in occidental countries. Currently approved treatments for AD provide mainly symptomatic benefits without clear evidence of neuroprotection. N-methyl-D-aspartate (NADA) receptor antagonists have therapeutic potential in several central nervous system disorders, including neuroprotective treatment in chronic neurodegenerative diseases, and symptomatic treatment in other neurologic diseases. Memantine, an NMDA antagonist, has been recently approvedfor the treatment of advanced AD. Due to its mechanism of action, memantine is considered a neuroprotective drug, whose utility has been demonstrated in preclinical studies. In addition, memantine is a useful symptomatic treatmentfor AD and vascular dementia. This paper reviews both aspects of memantine as well as some basic mechanisms mediating cognition and glutamatergic neurodegeneration.
Percutaneous endoscopic gastrostomy in cognitively impaired older adults: A geropsychiatric perspective
Authors: Detweiler Mark B. , Kim Kye Y. , Bass Jill
Published: May 2006

The increasing use ofpercutaneous endoscopic gastrostomy (PEG) in cognitively compromised elderly presents complex treatment-related and ethical questions. Approximately half of all dementia patients will be unable to feed themselves within eightyears of their diagnosis. Moreover, 85 percent of dementia patients have demonstrated refusal to eat. Geropsychiatry is often employed to evaluate these cognitively impaired patients either prior to or following PEG tube placement. This manuscript presents three cases to illustrate the most commonly encountered general dementia presentations. the ability to communicate with decisional capacity, the ability to communicate without decisional capacity, and severe verbal aphasia without decisional capacity. The study discusses ethical issues and treatment strategies for preand post-PEG tube placement consultations, including environmental interventions, in order to improve quality of life for this population.