A Review of Behavioral Treatments for Persons with Dementia

Abstract The term "dementia" is used to describe the widespread decline in cognitive abilities that results from an organic process such as Alzheimer's disease, stroke, or Huntington's disease. Regardless of the cause, dementia is characterized by a decline in various intellectual abilities that is sufficient to interfere with normal daily functioning (Hutton, 1991). Dementia is also characterized by changes in behavioral functioning that can be very challenging for caregivers and patients alike. The purpose of this paper will be to briefly review the most common causes of dementia and common symptoms of dementia. Next, the paper will describe behavioral excesses and deficits that are most often associated with dementia and a review of empirically-supported interventions will be provided. Finally, the effectiveness of behavioral interventions as it related to public policy issues will be discussed. Keywords: Dementia, Alzheimer's disease, stroke, Huntington's disease, empirically-supported interventions, public policy Causes of Dementia and Prevalence Alzheimer's disease. Alzheimer's disease (AD) is the most common cause of degenerative dementia, accounting for up to 65% of all cases of dementia (Hendrie, 1997). It is estimated that approximately 4.5 million Americans suffer from AD currently, with projections of about 13 million by the year 2050 if no cure is found (Hebert, Scherr, Bienias, Bennet, & Evans, 2003). AD is characterized by gradual and continual declines in intellectual functioning, although the rate of decline varies greatly across individuals. As the disease progresses, cognitive and behavioral functioning deteriorate to the point where the individual becomes increasingly dependent on others to complete most tasks of daily living such as money management, driving, cooking, bathing, dressing and/or toileting. The median survival from initial diagnosis is 4.2 years for men and 5.7 years for women (Larson et al., 2004). Other causes of dementia. Several other conditions also can cause dementia. For example, dementia can be caused by a series of small strokes that destroy specific areas of the brain (i.e., vascular dementia). Other conditions that can cause dementia include Parkinson's disease, Pick's disease, Huntington's disease, AIDS, brain tumors, exposure to toxins such as carbon monoxide, viral infections of the brain such as meningitis or encephalitis, a history of trauma to the brain, normal pressure hydrocephalus (abnormal flow of spinal fluid) and Multiple Sclerosis (Hutton, 1991). Prevalence. If one considers all causes of dementia, approximately 6-10% of individuals over the age of 65 suffer from dementia (Hendrie, 1997). For most causes of dementia, onset is rare before age 65 (onset is earlier for those causes that primarily affect the frontal lobes first). For those ages 65-70, prevalence estimates are approximately 1-2%, while for those ages 85 and older, most prevalence estimates are between 25% and 30% (Albert & Drachman, 2000; Hendrie, 1997). These figures are particularly alarming given that the population of those 85 and older is estimated to increase by about 1.7 million by the year 2010 and will account for about 2.3% of the total population (Albert & Drachman, 2000). Behavioral Problems There are numerous behavior problems that can occur in persons with dementia, with the severity of these problems varying widely across individuals. Common behavior problems include physical and verbal aggression; disruptive vocalizations such as repetitive statements or screaming; disrobing or other sexually inappropriate behaviors such as masturbating in public areas; wandering and exit seeking; paranoia; incontinence; and eating difficulties such as food refusal. Increasing socialization among residents and increasing independence are also common targets for behavioral interventions, particularly in long-term care settings. …