bluuebunny/crossref_metadata_2025 huggingface dataset:
Laminar Distribution of β-Amyloid Deposits in Dementia With Lewy Bodies and in Alzheimer’s Disease
Authors: Armstrong Richard A.
Published: June 2007

This study tested whether the laminar distribution of the β-amyloid (Aβ) deposits in dementia with Lewy bodies (DLB) cases with significant Alzheimer’s disease (AD) pathology (DLB/AD) was similar to “pure” AD. In DLB/AD, the maximum density of the diffuse and primitive deposits occurred either in the upper laminae or a bimodal distribution was present with density peaks in the upper and lower laminae. A bimodal distribution of the classic Aβ deposits was also observed. Compared with AD, DLB/AD cases had fewer primitive deposits relative to the diffuse and classic deposits; the primitive deposits exhibited a bimodal distribution more frequently, and the diffuse deposits occurred more often in the upper laminae. These results suggest that Aβ pathology in DLB/AD may not simply represent the presence of associated AD.
Switching Elderly Patients With Dementia From Risperidone to Quetiapine
Authors: Madhusoodanan Subramoniam , Bogunovic Olivera
Published: June 2007

The objective of this study was to collect data on outcomes obtained when switching elderly nursing home residents with dementia from risperidone to quetiapine. Medical records were reviewed to identify dementia patients switched from risperidone to quetiapine. Clinical Global Impressions (CGI) scores assigned retrospectively (at switch and weeks 4-6) assessed treatment. Data from 15 men and 52 women (mean age, 82.8 years) were evaluated. The mean daily dose of risperidone at switch was 1.42 mg. Switching was abrupt in all but 2 patients. The mean daily dose of quetiapine after the switch was 87.3 mg. After the switch, the CGI Severity of Illness score remained unchanged, but the CGI Global Improvement score was positive. Fourteen patients reported somnolence; 3 patients discontinued quetiapine. Most patients in this study were switched from risperidone to quetiapine with no worsening of clinical status.
Neuropsychological Markers of Progression From Mild Cognitive Impairment to Alzheimer’s Disease
Authors: Marcos Alberto , Gil Pedro , Barabash Ana , Rodriguez Raquel , Encinas Marta , Fernández Cristina , Cabranes José Antonio
Published: June 2007

To find early clinical markers that may predict a likely progression to Alzheimer’s disease (AD), the authors performed neuropsychological tests on 82 mild cognitive impairment (MCI) subjects. After 3 years, 38 patients developed AD while 44 retained the diagnosis of MCI. The cognitive differences between the groups were studied. Patients who developed AD showed significantly lower values than did MCI subjects in some neuropsychological scores ( P = .02-.001), with sensitivities and specificities higher than 84% and 64%, respectively, for detecting early-onset AD, with a 7.9-fold increased risk of converting to AD ( P < .001). Regarding the logistic regression model, the CAMCOG Memory and Perception cognitive screening items were the optimum independent tools to classify the patients who will progress to AD, showing a relative risk of progression of 10.5 ( P = .002), 5.5 ( P = .008), and 3.9 times ( P = .05), respectively, with a sensibility of of 92.1% and a specificity 72.7%.
Neuropsychiatric and Behavioral Symptoms in a Community Sample of Hispanics With Alzheimer's Disease
Authors: Ortiz Freddy , Fitten L. Jaime , Cummings Jeffrey L. , Hwang Sun , Fonseca Maureen
Published: June 2007

The purpose of this study was to characterize and compare neuropsychiatric symptoms in a sample of 367 community-dwelling subjects: 70 Hispanics and 230 non-Hispanic white patients with Alzheimer's disease, and 22 Hispanics and 45 non-Hispanic white healthy age-matched controls. Neuropsychiatric symptoms were common among all patients with Alzheimer's disease. In the Alzheimer's disease groups, Hispanic subjects presented to the initial assessment with more symptoms than non-Hispanic white subjects did. In comparison to the non-Hispanic white population, the proportion of Hispanics with neuropsychiatric and behavioral symptoms was higher. These findings have implications for differential sociocultural presentations of Alzheimer's disease among ethnic/racial groups.
Perceptions of Natural Health Products Among Patients Attending a Memory Clinic
Authors: Sharma Papita , Herrmann Nathan , Rochon Paula A. , Lee Monica , Croxford Ruth , Rothenburg Lana , Black Sandra E. , Lanctôt Krista L.
Published: June 2007

This study compared patient and caregiver perceptions of natural health products (NHPs) and conventional medications in a memory clinic population. A total of 620 mildly cognitively impaired patients and their care-givers participated in interviews enquiring about their perceptions of NHPs in 4 areas: (1) disclosure of NHP usage information to health care professionals, (2) safety and benefits of NHPs, (3) safety and benefits of conventional medications, and (4) physician knowledge about NHPs. Differences in responses between NHP users and nonusers and between patients and caregivers were examined. A total of 51.8% of subjects were current NHP users, with vitamin E, ginkgo biloba, and glucosamine being the most commonly used products. Multivariate analysis of variance showed that NHP use significantly influenced participant interview responses (Pillai’s trace, F[4, 613] = 3.488, P= .008), while interviewee (patient or caregiver; Pillai’s trace, F[8, 1228] = 1.499, P = .153) and gender (Pillai’s trace, F[4, 615] = 0.528, P = .715) did not. Subsequent univariate tests showed that NHP users were significantly more likely to endorse the effectiveness and safety of NHPs compared with nonusers ( F[1, 616] = 7.826, P = .005). Careful questioning during visits with health care providers and better counseling may be necessary to reduce the potential for adverse events and NHP-drug interactions.
Insight and Cognitive Impairment
Authors: Ready Rebecca E. , Ott Brian R. , Grace Janet
Published: June 2007

This study follows previous work to determine the effect of patient insight and cognitive impairment on the reliability and validity of self-reported quality of life (QOL) from patients diagnosed with Alzheimer's disease (AD) and mild cognitive impairment (MCI). AD and MCI patients (N = 68) and their caregivers participated. Patients with impaired insight provided QOL ratings that were less reliable than those provided by patients with better insight. Patient-caregiver agreement for QOL reports was used as an index of validity. Neither better insight nor lesser cognitive impairment suggested better agreement. Thus, even when patient insight is intact, patient reports are unlikely to agree with caregiver reports. Patient and caregiver reports about patient QOL may represent 2 unique, yet potentially valid, perspectives.
Development and Testing of a New Outcome Measure of Relationship Between Patients With Alzheimer's Disease and Their Partners
Authors: Reilly Margaret C. , Relkin Norman R. , Zbrozek Arthur S.
Published: June 2007

In mild Alzheimer's disease (AD), loss of relationship with the patient is a significant consequence for the partner (relative) and may be amenable to improvement with effective intervention. To evaluate relationship dynamics, the authors developed and tested content and discriminative validity of the self-administered Partner-Patient Questionnaire for Shared Activities among 100 partners of patients with mild to moderate Alzheimer's disease. Principal component analysis confirmed that interference in 17 activities derived from the literature and partner-specified activities comprised a relationship factor; internal consistency was very high. Time spent caregiving, care-giver esteem, lack of family support, and impact on partner health and activities were significant predictors of the Partner-Patient Questionnaire for Shared Activities, but the patient's cognitive and mood states were not. The Partner-Patient Questionnaire for Shared Activities warrants additional psychometric testing as a measure of Alzheimer's disease outcome.
Assessing Perceived Change in the Well-being of Family Caregivers: Psychometric Properties of the Perceived Change Index and Response Patterns
Authors: Gitlin Laura N. , Winter Laraine , Dennis Marie P. , Hauck Walter W.
Published: June 2007

The purpose of this study was to evaluate the psychometric properties of the Perceived Change Index (PCI), a 13-item scale that measures caregiver appraisals of self-improvement or decline in distinct areas of well-being, and to examine demographic differences in responses. The scale was administered to 255 care-givers participating at the Philadelphia site of the National Institute of Aging-funded Resources for Enhancing Alzheimer’s Caregiver Health initiative. Principal axis analysis with one half of the sample was used to evaluate factor structure. Evidence of convergent and divergent validity was examined using the second half of the sample. Differential response patterns by caregiver characteristics were also examined using regression analysis. Using one half of the sample, 3 underlying factors were found (affect, α = .85; somatic, α = .80; management, α = .76), accounting for 63% of the variance. The overall index was internally consistent (Cronbach’s α = .90). Using the second half of the sample, Pearson correlational analyses of the overall index and its subscales revealed that perceived improvement was significantly associated with fewer depressive symptoms, higher scores on perceived positive aspects of caregiving, and more participation in social activities. As expected, it was not associated with the care recipient’s Mini-Mental Status Examination scores or functional status. Perceived improvement scores for specific areas of well-being were associated with being African American, male, and a spouse. The PCI is a brief, easily administered, and valid self-report measure that can serve as an indicator of caregiver appraisal of well-being in research and clinical practice.
Structured Practice: A Memory Intervention for Persons With Dementia
Authors: Hochhalter Angela K. , Stevens Alan B. , Okonkwo Ozioma
Published: June 2007

This study assessed the feasibility of Structured Practice, a memory intervention format for persons with dementia that requires little or no expertise on the part of a trainer. Fourteen residents of assisted-living facilities practiced a 7-digit telephone number and engaged in guided social interaction with a trainer during several sessions. Free and cued recalls were assessed 5 minutes after each session and at least 1 day after each session. Week-long retention was also assessed for those who showed day-long retention on 2 consecutive assessments. Participants were easily engaged with the Structured Practice materials. Half successfully recalled at least part of the number after a day delay. Most recalled at least part of the number after a 5-minute delay. Structured Practice can serve as a format for teaching everyday information and guiding social interaction with persons with dementia.
Different Perception of Cognitive Impairment, Behavioral Disturbances, and Functional Disabilities Between Persons With Mild Cognitive Impairment and Mild Alzheimer’s Disease and Their Caregivers
Authors: Onor M. L. , Trevisiol M. , Negro C. , Aguglia E.
Published: June 2007

Insight in dementia is a multifaceted concept and ability, which includes the persons’ perception of their behavioral and cognitive symptoms and functional disability. This ability seems to deteriorate as dementia progresses. The aim of this study was to evaluate the level of insight in the cognitive, behavioral, and functional disorders in a group of persons with mild cognitive impairment (MCI) or mild AD (Alzheimer’s disease) and to compare their perception of their illness with that of their caregivers. The study involved a group of 121 persons with MCI and mild AD and their caregivers. The persons with MCI and mild AD were administered the tests Mini-Mental State Examination, Instrumental Activities of Daily Living, Activities of Daily Living, Neuropsychiatric Inventory, Schedule for the Assessment of Insight, Clinical Insight Rating Scale, and a short interview. Major differences were identified between how the persons with MCI or mild AD and their caregivers perceived the persons’ cognitive and behavioral disorders. The group with MCI or mild AD underestimated their deficits, which were considered serious and disabling by their caregivers.
The Psychosocial Impact of Young Onset Dementia on Spouses
Authors: Kaiser Sam , Panegyres Peter K.
Published: June 2007

Dementia in young adults is not very well studied in terms of clinical effects on the patient, and not much is known about the effects on spouses and caregivers. This study assessed the psychological impact of the diagnosis of young onset dementia on spouses. A questionnaire that used the Zarit Burden Interview and the Beck Depression Index was sent to 120 spouses of a cohort of patients with established diagnoses of young onset dementia (age of onset before 65 years), including frontotemporal lobar degeneration, Alzheimer’s disease, and primary progressive aphasia. A total of 100 usable responses were received. The mean age of respondents was 62.3 years (54% women, 46% men). A cross-sectional analysis showed that the diagnosis of young onset dementia has a significant impact on spouses, characterized by concerns of dependency, fear, and increased depression, especially in the spouses of patients with frontotemporal lobar degeneration.
Course and Causes of Suspected Dementia in Young Adults: A Longitudinal Study
Authors: Panegyres Peter K. , Frencham Kate
Published: June 2007

The authors performed a prospective, unbiased analysis of a cohort of young patients assessed consecutively with the question of dementia. The onset of patients’ cognitive symptoms was prior to the age of 65 years. A study group of 226 patients was followed for a mean duration of 4.59 ∓ 2.23 years (1 SD; range, 0.04-7.86 years). The diagnoses were established using published diagnostic criteria. A diagnosis of dementia was made in 112 patients (49.56%). Psychiatric disease was the most common diagnosis in those who did not have dementia (24.3%) followed by frontotemporal lobar degeneration (19.0%), Alzheimer’s disease (11.9%), patients with cognitive symptoms who obtained normal neuropsychometric profiles (10.6%), nonneurological disorders (eg, obstructive sleep apnea [8.4%]), neurological disorders (eg, Parkinson’s disease [4.9%]), and mild cognitive impairment (4.9%). The frequencies of frontotemporal lobar degeneration and psychiatric disease were higher than Alzheimer’s disease, unlike in older populations.
The Influence of β-Blockers on Delayed Memory Function in People With Cognitive Impairment
Authors: Gliebus Gediminas , Lippa Carol F.
Published: June 2007

Adrenergic signaling is important for the retrieval of intermediate-term contextual and spatial memories. The role of norepinephrine in retrieval requires signaling through β1-adrenergic receptors in the hippocampus. Environmental cues activate the locus ceruleus, the main adrenergic nucleus of the brain, when an environmental stimulus is memorable. This leads to norepinephrine activation in the hippocampus, which is important for retrieving memories. Although β-blockers do not impair cognition in normal subjects, this article explores the possibility that central nervous system (CNS)-active β-blockers could affect delayed memory in patients with cognitive impairment. The authors investigated the influence of β-blockers on delayed memory function in cognitively impaired patients. There was a trend for worse delayed memory retrieval in patients who were on CNS-active β-blockers. These data support the notion that common medications used in cognitively impaired elderly patients can worsen cognition and that careful selection of medications may help to maximize retrieval of newly formed memories.
Presenilin-1 C410Y Alzheimer Disease Plaques Contain Synaptic Proteins
Authors: Haleem Kamran , Lippa Carol F. , Smith Thomas W. , Kowa Hisatomo , Jianlin Wu  , Iwatsubo Takeshi
Published: June 2007

Presenilin-1 (PS-1) mutations are associated with familial Alzheimer's disease (AD). Although beta-amyloid (Aβ) plaques in brain tissue are characteristic of AD patients, space occupying “cotton-wool” plaques (CWPs) lacking dense Aβ cores have also been described in patients with mutations in exon 9 of the PS-1 gene. The composition of CWPs has not been fully described. To better elucidate the composition of these space-occupying plaques, we used immunohistochemistry with antibodies to the synaptic proteins synapsin-1 and synaptophysin, as well as antibodies to tau, Aβ-42, Aβ-40, ubiquitin, neurofilament, and glial fibrillary acidic protein. Confocal laser scanning microscopy (CLSM) was utilized to further characterize these plaques. CWPs showed increased synapsin-1 and synaptophysin immunoreactivity relative to the background gray matter. Synaptic protein-containing CWPs occurred in all affected MTL regions, including the granule cell layer of the dentate gyrus, where synaptic terminals are usually sparse. These data suggest that in C410Y PS-1 AD patients, CWPs may constitute a major component of synaptic terminal-specific proteins, and that the C410Y PS-1 mutation may influence either synaptic structure or synaptic protein expression.
Comparative Outcomes of Two Distance-Based Interventions for Male Caregivers of Family Members With Dementia
Authors: Gant Judith R. , Steffen Ann M. , Lauderdale Sean A.
Published: June 2007

Data are presented on a preliminary study investigating the efficacy of 2 distance-based psychosocial interventions (N = 32) for male family dementia caregivers. Male caregivers were randomly assigned to either a basic education intervention (ie, educational booklet and biweekly check-in telephone calls) or a video intervention (ie, set of 10 videos, an accompanying workbook, and weekly telephone coaching sessions using behavioral strategies to manage challenging caregiving situations). Results did not support the greater efficacy of the video condition in reducing psychosocial distress (eg, negative affect, upset and annoyance following behavior problems) or increasing positive affect or caregiving self-efficacy. There was, however, a statistically significant effect for postintervention improvement in both the video/coaching and the educational booklet/check-in conditions. Potential reasons for the lack of differential treatment effects are discussed, along with implications for recruitment of male dementia caregivers.
Helping families deal with Alzheimer's disease
Authors: Lambert Anne
Published: June 2007

Following a diagnosis of Alzheimer's disease, a prime role of medical professionals involves helping patients and families understand the disease and cope with its consequences. While some symptoms of Alzheimer's disease can be managed, there is no cure or treatment to halt progression of the disease. In the initial phase of the illness, patients may benefit from supportive counseling and be able to help plan their care. Families will need counseling, usually on an intermittent basis, to deal with the patient's behavior changes and their own feelings about what is happening. Information will be needed about community resources, financial and legal planning, and nursing home placement. This article reviews common conerns of patients and families affected by Alzheimer's disease. The main focus of the article is how to assist family members to become more effective caregivers while also attending to their own needs.
Nursing Home Management of Alzheimer's Disease
Authors: Koff Theodore H.
Published: June 2007

Between now and the year 2050 the number of people with Alzheimer's disease (AD) and related disorders will increase from 2 million to 8.5 million. Conservative estimates project that during this same period, nursing-home residencies of people age 65 and older will rise from 1.1 million to 5.4 million.1 Since people afflicted with Alzheimer's disease frequently require institutionalization, and since it is likely that nursing homes will continue to be an important part of the caring spectrum, how will these facilities deal with large numbers of people with dementia?

Currently, there is an absence of industrywide standards defining Alzheimer's care. Nursing homes may identify “specialty care units” even when no special competence exists. To assure AD patients and their families that services consistent with their expectations for Alzheimer's care will be provided, industrywide standards must be established.

This paper, presented in May to the American College of Health Care Administrators in San Diego, outlines guidelines for the formulation and eventual adoption of standards of care for Alzheimer's patients.
Family Oriented Interventions in Alzheimer's Care
Authors: McCann Joseph T.
Published: June 2007

Recent statistics indicate that 1.5 million persons in the United States have Alzheimer's disease (AD) and that the number may continue to rise. Scientists are searching for the causes of the disease and have recently identified genetic links within families, brain abnormalities and environmental toxins, such as aluminum, as possible causal factors. The primary method of treating patients with AD is drug therapy to delay the progressive loss of mental abilities. While there are as yet no cures for the disease, the burdens that the illness places on the family are clearly recognized, and family counseling is the major approach taken by physicians. There is very little research that has systematically looked at how effective family counseling programs have been. The existing research has not been well conducted to this point, but it has been clearly recognized that the major purposes of family counseling must be 1/ to convey accurate information about the disease and its expected course, 2) to help families solve problems in their lives that are the result of the disease, and 3) to provide emotional support to family members. This article suggests that future research on family counseling programs must clearly define what the “family” is, measure observable changes in family coping that result from family counseling, determine the extent to which family counseling may save families money in the long run, and examine the special needs of AD patients. It is hoped that these recommendations will guide researchers in their attempts at measuring the productive changes that can take place within a family with a member that has AD.
Intervivos Asset Management
Authors: Sandoe Anthony B.
Published: June 2007

Early in the course ofAlzheimer's Disease (AD}, patients begin to experience a gradually diminishing capacity to manage their personal and business affairs. It becomes increasingly apparent that assistance in these matters will be required. Accordingly, the patient's family must identify those assets and sources of income that will require management. Thereafter, they should consider the objectives of the asset and income management, the legal forms of management that may eventually be employed, and the identity of the manager-Who will have the authority to make such decisions when the patient is no longer capable?
Alzheimer's Care
Authors: Woerner Louise , Casper Karen
Published: June 2007

The characteristics of Alzheimer's disease (AD) create specialized problems of care for the Alzheimer's patient. Treatment for AD victims does not only involve medical procedures; rather, Alzheimer's disease is what Kahn termed a bio-psycho-social phenomenon. 1 Since the epidemiology of the disease is not treatable as such, the emphasis of Alzheimer's care is on management of its physical, social, and psychological manifestations. Therefore, nursing home care and home health care are not sufficient for AD victims. Alzheimer's patients need the specialized care we've called Alzheimer's care, which is directed toward meeting the specific needs of AD victims and their families.

It is generally agreed that both in stitutional and home settings are appropriate for treating certain characteristics of Alzheimer's disease, depending on the degree to which the disease has progressed, financial circumstances, and the family's ability and willingness to keep the patient at home. The choice between nursing home placement and home care is, of course, ultimately the decision of the primary caregiver or family. If caregivers are unable or unwilling to serve as the primary support for a victim-because of their financial considerations, their own infirmities, or because the responsibility for care becomes overwhelming-a family may feel that the decision to place the patient in a nursing home is the only alternative.

In our experience, we have found that specialized Alzheimer's care, delivered in a home setting, can place the responsibility for primary care with home care professionals. The environment or treatment setting is highly significant in the management of Alzheimer's disease. We have found that of the two major settings for treatment ofAD patients-the institution and the home-the home is significantly more adaptable to Alzheimer's care. The home environment is familiar and can, with planning and training, be very helpful in the care plan. Home health personnel assigned to such cases can be specifically selected, trained, and supervised to maximize their effectiveness in providing the highest quality of Alzheimer's care.

Under the assumption that many families do have a choice in treatment settings for an AD victim and that the home may be the more effective treatment setting, this article will seek to explain the adaptability of the home health option for Alzheimer's care.
The New York State Department of Health's Alzheimer's disease and other dementias registry first year experience
Authors: Henry Mary Ellen , Gerber Todd M. , Bunn Geraldine , Stacy Andrew , Tsan Linda
Published: June 2007

The New York State Departm ent of Health established the Alzheimer's Disease and Other Dementias Registry in August 1986. A legal requirement was enacted through Public Health Law that stipulated physicians and facilities must begin reporting the diagnosis or confirmation of Alzheimerls disease beginning January 1, 1987. By September 1987, over4, 000 reports had been submitted to the registry.

Analysis of the reporting experience up to September 1987 provided the basis for a revision of the case report form and procedures for reporting, that are intended to improve the validity of the data. The process of revising the confidential case report form involved both consideration of methodologic issues and reporter concerns.
Measuring cognitive and behavior changes in community dwelling Alzheimer's disease patients
Authors: Kumar Vinod , Peterson Kathleen , Kumar Nita , Fulk Linda
Published: June 2007

Dementia of the Alzheimer's type (DAT) is a disorder that is becoming more common as the population's life expectancy increases. It is essential for health care providers to monitor and help caregivers manage possible stressful symptoms associated with the progression of DAT. We evaluated 38 community dwelling DAT patients with a test battery comprised of several commonly used neuropsychological instruments to see if they could:

• detect treatable psychiatric symptoms

• predict the course of illness and

• predict the likelihood of long term institutionalization in DAT patients

Our results showed that the interviewer administered instruments were useful tools for detecting patient deficits and developing treatment strategies. However, we found the self-rating scales to be inappropriate for use with this population.
Institutional care of dementia patients: A state-wide survey of long-term care facilities and special care units
Authors: Hepburn Kenneth , Severance Janet , Gates Bruce , Christensen Margaret
Published: June 2007

A two-wave survey gathered information on dementia residents in long-term care (LTC) facilities in the State of Minnesota (76 percent response). Respondents reported that dementia patients represented more than half the total LTC population. Behavior management issues are the chief concern of respondents, but techniques for management are not well-developed. Fourteen percent of the respondents reported they had or planned special care units (SCU) for dementia patients. A sub-survey of these SCU indicated a lack of clarity and precision about diagnosis admission and discharge criteria. The need for evaluation of and standards for these SCU are discussed.
Caregiver views of help from the physician
Authors: Glasser Michael , Rubin Susan , Dickover Mary
Published: June 2007

A major issue in caregivers' management of dementia is their interaction with the patient's physician. This paper explores the expectations and attitudes of caregivers relative to the perceived roles and responsibilities of the medical profession in the diagnosis and treatment of dementia and examines level of satisfaction with aspects of medical management. Findings indicate that caregivers want support and acknowledgment of their role from the medical community, as opposed to simply assistance with behavior management.
Humor and the Alzheimer's patient: The psychological basis
Authors: Adasiak Janette P.
Published: June 2007

Persons suffering from Alzheimer's disease still have some capacity to appreciate and respond to humor. This article shows that humor can have positive behavioral conditioning effects as a by-product, and that an understanding of normal cognitive development across the life span is usefil in selecting humor that will be effective with impaired clients. The author observed various uses of humor by the staff of an adult day care center, and offers suggestions for caregivers based on these observations.
The role of psychology in the medical care of the older patient
Authors: Kandel Elizabeth , Lancey Stephen
Published: June 2007

The impact of familial attitudes toward normal and pathological aging on the health care and life satisfaction of older adults is reviewed both in the literature and by utilizing several representative case studies. The authors conclude that certain family attitudes and brief psychological intervention in the hospital setting can have a marked impact on the life satisfaction and happiness of older relatives.
Variables influencing burden in spousal and adult child primary caregivers of persons with Alzheimer's disease in the home setting
Authors: Price Holly Jane , Levy Kathy Ann
Published: June 2007

The purpose of this study was twofold: to compare caregiver burden perceived by spouses and adult children providing care to a family member with Alzheimer's disease in the home, and to determine if functional ability of the Alzheimer's victim affects burden experienced by the caregiver.

Fifty-five primary caregivers providing care at home for a family member with Alzheimer's disease were invited to participate in this study and asked to complete the Caregiver Data Sheet, Burden Interview, Physical Self-Maintenance Scale (PSMS), and the Instrumental Activities of Daily Living Scale (IADL). Thirty caregivers (55 percent) responded.

The mean burden score for all participants was 67 (SD = 15), indicative of severe burden. A t-test performed to compare burden scores of spouse and adult child caregivers showed no significant difference between the two groups (t-value = 1.93, p> .05).

The mean scores for the PSMS (1.4; SD = 1.86) and IADL (1.4; SD = 1.59) indicated that the Alzheimer's victims were very dependent. This functional deficit, however, did not correlate significantly with caregiver burden. The Pearson Product Moment Correlation Coefficient (Pearson r) was -.339 for the PSMS and Burden Interview and -.203 for the IADL and Burden Interview. Neither were found significant at the .05 level of significance.

This study contributed to nursing knowledge by describing burden experienced by a specific population of primary caregivers; those spouses and adult children providing care for a family member with Alzheimer's disease in the home. A lack of a significant correlation between functional impairment of the Alzheimer's victim and caregiver burden was found. The researcher suggested that perhaps other factors, such as family and community support, had more of an impact on caregiver burden. Future nursing research to further delineate such factors would contribute to the understanding of caregiver burden.
Alzheimer's disease and outdoor space: Issues in environmental design
Authors: Lovering Mary Jane
Published: June 2007

As special care units for individuals with Alzheimer's disease become established, there is a growing interest in creating outdoor space to complement the interior program. At present, little information exists concerning appropriate design principles for outdoor spaces. This paper discusses the design implications for outdoor environments based upon the changes in physical and mental abilities that are associated with aging and Alzheimer's disease. Methods of compensating for limited physical and mental capabilities are explored, including the provision of prosthetic supports and orientation aids to increase an individual's independence and sense of well being.
The South Carolina Alzheimer's disease patient registry: A progress report
Authors: Macera Caroline A. , Still Charles N. , Brandes Debra A. , Abramson Ruth K. , Davis Dorothy R.
Published: June 2007

In April1988, the American Health Assistance Foundation in Rockville, Maryland, provided major funding to establish a registry of persons in South Carolina who have been diagnosed with dementia, particularly Alzheimer's disease (AD). This funding was matched by the state Health and Human Services Finance Commission, and with supplemental funding from the Association of Schools of Public Health, and the Centers for Disease Control. The goals of the registry are as follows:

* To collect and report annual prevalence and incidence data;

* To assess and to project required health and human services resources;

* To study genetic transmission patterns;

* To provide a sampling frame for etiologic studies.

The first year experience of this project is described, with recommendations for future development.
The sundowning syndrome: A conceptual analysis and review
Authors: Rindlisbacher Peter , Hopkins Robert W.
Published: June 2007

The increased agitation, and confusion in late afternoon, evening or night, shown by some victims of dementing disorders, has been called “sundowning,” or “the sundowning syndrome.” This paper reviews the available literature and examines the definition of this condition, the observed symptoms, reported time of occurrence, incidence, stability or regularity, relative importance, its relationship to other processes in dementia, etiology, treatment-as well as its diagnostic implications. Patterns in the literature are discussed. It is concluded that in spite of many references to it in clinical texts, sundowning remains a poorly understood phenomenon.
Criteria for recommending options for the elderly cognitively impaired
Authors: Morrill Elizabeth G.
Published: June 2007

The plight of the cognitively impaired elderly in the United States deserves great attention as there are glaring deficits in the areas of care and treatment of dementia.

This author would like to convey a set of ideas to give the healthcare professional some clear direction on:

• What needs to be considered in evaluating the deficits and needs of the demented elderly person and family. • How can we best go about the process of making the determination about what is needed.? • What are the characteristics of the patient that serve as predictors for assignment to services- and what are the characteristics of the caregivers that serve as predictors for services?
A shortage of long-term care workers: Effects on clients with dementia
Authors: Pearlman Deborah N. , Mahoney Diane Feeney , Callahan James J.
Published: June 2007

Although advocates promote caregiving services to families in need, the formal care system is directly dependent upon the availability of workers willing to provide this type of care. If there is a worker shortage, are clients with cognitive impairment more adversely affected than other clients? This article reports the findings from a study conducted in one state during a worker shortage. A worker bias was found against servicing Alzheimer clients in their homes that was not evident in day care facilities or nursing homes with Alzheimer units. Policy is sues are raised and recommendations made concerning worker's wages and benefits, work life, job design, and the structure of the long term care industry.
Dressing independently: A closet modification model for Alzheimer's disease patients
Authors: Namazi Kevan H. , Johnson Beth DiNatale
Published: June 2007

The deteriorative nature of AD often affects the ability of patients to perform ADL's independently, resulting in reduced autonomy and decreased opportunities to make pertinent decisions. This study separates decision making into two components and describes pertinent autonomy for AD patients in a supportive environment. The project examines how the alteration of a closet modifies resident dressing behavior and measures the degree of patient independence according to the level of caregiver's intervention. Results indicate that when the selection process is separated from the motor skillfunctions, and when clothing is visually assessable in a preplanned sequential order, independence in dressing is enhanced in some AD patients.
Caregivers' observations and report of early symptoms of Alzheimer's disease
Authors: Taussig I. Maribel , Mack Wendy J.
Published: June 2007

Caregivers of patients with Alzheimer's disease (AD) and other dementing illnesses are typically asked to recall details regarding the onset and course of specific symptoms. These reports are often essential for clinical diagnosis. We report caregivers' recalls of initial symptoms in family members diagnosed with AD. In addition, we determine whether caregivers' reports of specific symptoms are associated with certain caregiver/patient characteristics. In a sample of 76 caregivers of AD patients, the most frequent initial problems cited included memory, activities of daily living, disorientation, and personality change. Personality changes were reported as a first symptom significantly more often by spouses, younger caregivers, and caregivers of higher socioeconomic status. Caregivers of AD patients with longer duration of illness and higher age at onset were also more likely to report personality changes as a first symptom. The children of AD patients were more likely than spouses to report disorientation as a first symptom; older caregivers were also more likely to report disorientation. Implications for caregiver reporting and therapeutic guidance are discussed.
Effects of a 'quiet week' intervention on behavior in an Alzheimer boarding home
Authors: Meyer Daniel L. , Dorbacker Beatrice , O'Rourke Jane , Dowling Jim , Jacques Jessie , Nicholas Mary
Published: June 2007

The objective of this study was to test whether an intervention to reduce noise in an Alzheimer boarding home lowers patient levels of agitation. Hourly behaviors were observed and recorded by nursing staff one week prior to and one week during institution of a 'quiet week' protocol. The changes included lowering voices and reducing fast movements by staff, relocating the entrance out of residents' view, and not using television or playing piano. A sample of 11 of 28 residents of the home was selected to represent three general levels of overall agitation. The number of frantic/violent' behavior observations declined from 38 to 19; overall, there was an average reduction in 'non-calm' sampled observations of 0.441 per day per resident (paired t-test, t = 2.318, 10 df p < .043). Interviews with staff indicated that stafffelt some of the 28 residents definitely benefittedfrom the reduced noise levels while theyfelt others appeared to miss the activity and noise.

Results suggest that alterations in staff behavior and facility design can influence agitation levels of Alzheimer patients, but effects are not uniform across patients. Continued research is needed to help identify effective activities and care strategies as well as the most appropriate staffing levels and optimal design features of special care units.
Objective assessment of aggression and irritability in the elderly
Authors: Sorrentino Elizabeth A.
Published: June 2007

There is a tendency to generalize or stereotype certain behaviors exhibited by the elderly. This study was conducted to determine the feasibility of using a structured, validated instrument to objectively assess aggression and irritability in nursing home residents. Results showed a majority of the residents (65 percent) scored below the cut-off point for irritability. Ninety-two percent scored below the cut-off point for aggression. The findings point to the value of using quantitative measures of aggression and irritability, particularly in communicating information. With a standardized tool such as the one used for this study, objective assessment could serve as an indicator of the severity of the problem. Implementing a system for quantifying observations may be a beginning step in allowing caregivers to focus on the residents' actions or responses to prevent generalizations or stereotypes.
Self-injurious behavior in Alzheimer's disease
Authors: Hagen Garrett , Sky Adam , Grossberg George T.
Published: June 2007

Self-injurious behaviors in psychiatric disorders are not uncommon, particularly among developmentally disabled children and psychotic patients. However; this phenomenon is rarely discussed in Alzheimer's disease. In this paper we cite a case of self-injurious behavior in a patient with probable Alzheimer's disease and speculate about psychologic, neurochemical, as well as potential environmental and psychosocial etiologies.
Feeding behaviors in mid-stage Alzheimer's disease: A review
Authors: Durnbaugh Tana , Haley Barbara , Roberts Sharon
Published: June 2007

Nutritional problems associated with dementia and Alzheimer's disease (AD) are of concern and have been documented in the literature for many years.1 Despite this emphasis, the complexity of assessing the AD client's eating or feeding behaviors as well as nutritional status has only recently been recognized in practice and in research. This literature review presents current research and study of the nutritional status, problem feeding behaviors and therapy of AD clients.
Sleep patterns of home or hospitalized Alzheimer's disease patients
Authors: Jelinski Mary , Fettig Mary
Published: June 2007

It has been documented that Alzheimer's disease patients suffer from sleep pattern changes and this interrupted sleep pattern is disruptive to the caregiver as well as the patient. There is little printed information in this area. The study will show sleep patterns in the Alzheimer patient, at home vs. in hospital, do appear to have some differences. Data was collected on 21 Alzheimer patients admitted for a two week in-hospital stay. Overall data was collected over a four week period of time. Assessment checksheets were completed by the caregiver on day seven and day two pre-hospitalization and day two and day seven posthospitalization. Nursing staff used the same checksheets on days two, seven, and 13 during hospitalization. Sleep time was tabulatedfrom this data. Significant differences were found in the mean number of hours slept at home versus in hospital. The data will support the conclusion that hospitalization for respite care does have a detrimental effect on the Alzheimer patient.
Communication between formal caregivers and individuals with Alzheimer's disease
Authors: Richter Judith M. , Bottenberg Donna , Roberto Karen A.
Published: June 2007

Dysfunctional communication, behaviorproblems, and the lack of meaningful exchanges make it difficult for the nursing assistant (NA) to establish a relationship with the nursing home resident who has Alzheimer's disease (AD). As a result, the NA may avoid communication. Long term care is inevitable for many persons with AD. Therefore, it is important to understand the impact of verbal and nonverbal communication on the caregiving relationship between the formal caregiver in the nursing home and the person with AD.

The purpose of the study was to describe communication barriers and successes identified by NAs. NAs did not understand resident behaviors such as fearfulness, agitation and wandering. They were also frustrated with the demands of family members. Results indicated that NAs did not have the necessary education orsupportto communicate effectively with the individual with AD and the family, and that training NAs to work more effectively should be a priority for nursing homes.
Trigger events that indicate the need for proxy decision-making in cognitively impaired older persons
Authors: Kjervik Diane K. , Weisensee Mary G. , Anderson Joanne B.
Published: June 2007

The purpose of this exploratory study was to ascertain the primary event or “trigger” that prompted caregivers to initiate planning for a change in monitoring or substitute decision-making needed for the older person receiving their care. Understanding the impetus to make this decision can help caregivers to anticipate needs and plan accordingly. Caregivers from the community who did not choose guardianship (N=39) and caregivers who were court-appointed guardians or conservators (N=22) were compared for their views about the trigger events, the views of their own health, number of hours in caregiving and the circumstances surrounding the decision-making experience. Three categories of trigger events were identified:

• Physical; • Emotional/cognitive; and • Situational events with the vast majority of triggers falling into the first two categories.

Guardians as a group were younger, provided fewer hours of caregiving and rated themselves healthier than the other caregivers. A variety of situational stressors were identified by respondents with time and financial concerns the primary concerns. Further research with a wider variety of caregiving dyads is recommended to examine the decision-making process involved and to further validate the categorization of trigger events.
Implicit memory in patients with Alzheimer's disease
Authors: Jelicic Marko
Published: June 2007

Patients with Alzheimer's disease (AD) exhibit impaired performance on tests of recall and recognition. Recall and recognition require conscious, or intentional, recollection of a previous experience and have been labeled explicit memory tests. Recently, researchers have studied the performance of AD patients on tests that do not require conscious recollection of previous learning so-called implicit memory tests. This paper describes the rationale for, and results of implicit-memory research in patients with this type of dementia. It appears that studies of implicit memory have produced mixed results. Implications of research into the implicit-memory abilities of AD patients will be discussed.
The Breakfast Club: A multi-modal language stimulation program for nursing home residents with Alzheimer's disease
Authors: Boczko Faerella
Published: June 2007

The dismantling of language characteristic of people with Alzheimer's disease and related disorders has a profound effect on their quality of life and on their interactions with family, staff andpeers in the nursing home environment. Recognition that the ability to articulate our experiences enqbles us to sustain connections with other people and ourselves, speech pathologists are challenged to develop innovative therapies to compensate for the ravages the disease inflicts on language and communication. This article describes a program designed to enhance residents' communication skills and interactions, creating opportunities for decision-making which in turn promote optimal use of their residual cognitive abilities.