Effect of ferulic acid and Angelica archangelica extract on behavioral and psychological symptoms of dementia in frontotemporal lobar degeneration and dementia with Lewy bodies

Aim: The behavioral and psychological symptoms of dementia place a heavy burden on caregivers. Antipsychotic drugs, though used to reduce the symptoms, frequently decrease patients' activities of daily living and reduce their quality of life. Recently, it was suggested that ferulic acid is an effective treatment for behavioral and psychological symptoms. We have also reported several patients with dementia with Lewy bodies showing good responses to ferulic acid and Angelica archangelica extract (Feru‐guard). The present study investigated the efficacy of Feru‐guard in the treatment of behavioral and psychological symptoms in frontotemporal lobar degeneration and dementia with Lewy bodies. Methods: We designed a prospective, open‐label trial of daily Feru‐guard (3.0 g/day) lasting 4 weeks in 20 patients with frontotemporal lobar degeneration or dementia with Lewy bodies. Behavioral and psychological symptoms of dementia were assessed at baseline and 4 weeks after the start of treatment, using the Neuropsychiatric Inventory. The Neuropsychiatric Inventory scores were analyzed using the Wilcoxon rank sum test. Results: Treatment with Feru‐guard led to decreased scores on the Neuropsychiatric Inventory in 19 of 20 patients and significantly decreased the score overall. The treatment also led to significantly reduced subscale scores on the Neuropsychiatric Inventory (“delusions”, “hallucinations”, “agitation/aggression”, “anxiety”, “apathy/indifference”, “irritability/lability” and “aberrant behavior”). There were no adverse effects or significant changes in physical findings or laboratory data. Conclusion: Feru‐guard may be effective and valuable for treating the behavioral and psychological symptoms of dementia in frontotemporal lobar degeneration and dementia with Lewy bodies. Geriatr Gerontol Int 2011; 11: 309–314.     

“Falling between the cracks”: Experiences of Black dementia caregivers navigating U.S. health systems

In addition to numerous care responsibilities, family caregivers are expected to navigate health systems and engage in healthcare management tasks on behalf of their persons living with dementia (PLWD). These challenging tasks pose additional difficulties for Black dementia caregivers. Due to the centuries-old, disadvantaged social history of Black Americans, several unique stressors, vulnerabilities, and resources have emerged which inform and affect Black dementia caregivers' experiences and well-being. Focus groups were held with Black caregivers (N = 19) from the United States to explore the unique experiences and perspectives of this population navigating the U.S. health system on behalf of their PLWD. Five overarching themes were constructed during thematic analysis: Forced Advocacy, Poor Provider Interaction, Payor Source Dictates Care, Discrimination, and Broken Health System. Black dementia caregivers unanimously concurred that the health system that they experience in America is “broken.” Gaps in the health system can lead to people [as one caregiver passionately expressed] “falling between the cracks,” in terms of care, services, and resources needed. Caregivers agreed that class, sex, utilizing public health insurance, and being a “person of color” contribute to their difficulties navigating the health system. Caregivers perceived being dismissed by providers, forcing them to advocate for both themselves and their PLWD. Healthcare providers and researchers can utilize these findings to improve the experiences and healthcare outcomes of Black persons living with dementia and their caregivers. Additionally, these findings can lead to the development of culturally tailored caregiver education programs.     

Do spouse caregivers of persons with early- and late-onset dementia cope differently? A comparative study

ObjectivesTo explore spouse caregivers’ means of coping with the disease and compare them based on the age of onset of the disease in order to adapt support programs.MethodsInterviews were conducted with 38 spouse caregivers of persons with late-onset dementia (PLOD) and 40 spouse caregivers of persons with early onset dementia (PEOD). The first step in the analysis was qualitative, using QSR N’Vivo 10 to identify the coping strategies. The second step was quantitative, comparing the coping strategies based on the age of onset of the disease with a χ2 test.ResultsAn inventory of 26 strategies used by all caregivers was established and consolidated into two groups: acceptance strategies and avoidance strategies. The statistical results show that some strategies were used by the two groups of caregivers. However, when differences emerged, the “Planning” strategy was used by spouse caregivers of PEOD, whereas the “Re-arranging”, “Humor” and “Getting away from the entourage” strategies were used by spouse caregivers of PLOD.ConclusionIt would be interesting to develop a support program with a common framework and specific modules depending on the age of onset of the disease. Common modules would permit developing and strengthening acceptance strategies. Specific modules for caregivers of PEOD would guide them in the acquisition of more adaptability and flexibility in the assistance provided to the PWD, which can sometimes be too rigid and controlled. Specific modules for caregivers of PLOD would help them to develop the ability to request help and identify the intervention limits of the entourage.     

Pilot testing of the “First You Should Get Stronger” program among caregivers of older adults with dementia

ObjectiveIn this study, randomized controlled interventional study pattern was used to examine the effects of the “First You Should Get Stronger” program on the caregiving burden and healthy life style behavior of caregivers of dementia patients.Methods“Zarit Caregiver Burden Scale” and “Healthy Life Style Behavior Scale” were used. The study was completed with 40 caregivers in total with 20 in the intervention group and 20 in the control group. A statistically significant difference was determined between the “Zarit Caregiving Burden Scale” and “Healthy Life Style Behavior Scale” score averages of the intervention group that participated in the “First You Should Get Stronger” program in comparison with those of the control group.ResultsIt is important for the healths of caregivers to include similar programs for the caregivers of dementia patients in continuous and regular applications.DiscussionThe results highlight the importance of the “First You Should Get Stronger” program significantly decreased the caregiving burden and significantly developed the healthy lifestyle behaviors of caregivers in the intervention group. Since dementia is a difficult neurological syndrome with patients cared at home, it generally wears out the caregivers significantly. It is suggested that the nurses and healthcare professionals working with dementia patients are evaluated separately and that they carry out caregiving applications within the scope of the “First You Should Get Stronger” program.     

Caregivers' utilization of health services: results from the Medicare Alzheimer's Disease Demonstration, Illinois site

OBJECTIVES: The purpose of this study is to examine the effect of the Medicare Alzheimer's Disease Demonstration and Evaluation (MADDE) conducted in Illinois on the use of health services and Medicare expenditures by caregivers of persons with dementia. DESIGN: Prospective randomized clinical trial. SETTING: The MADDE (1989-1994), Illinois site. PARTICIPANTS: A cohort of 412 Medicare-eligible caregivers of persons with dementia. MEASUREMENTS: Medicare claims files provided data on the number of hospitalizations, hospital bed days, emergency department visits, and total Medicare Part A expenditures. RESULTS: After adjustment for baseline variables, the caregivers in the treatment group, when compared with those in the comparison group, had a lower likelihood of any hospitalization during the study period (odds ratio 0.58 (95% confidence interval (CI)=0.35-0.97), P= .037) and a reduced, but not significant, likelihood of emergency department use (odds ratio 0.66 (95% CI=0.40-1.08), P= .095). For those who were hospitalized, there were no significant differences between the treatment and comparison group caregivers in the number of hospitalizations, hospital length of stay, or Medicare payments. CONCLUSION: These results suggest that enhanced chronic illness case management directed at persons with dementia and their caregivers can reduce the need for acute hospital care.     

Finding meaning: an alternative paradigm for Alzheimer's disease family caregivers

Theoretical formulations of stress and coping, family systems, crisis intervention, and loss and grief have inadequately explained how persons might grow and find meaning through their caregiving experiences. An existential theoretical framework guided the data interpretation in a qualitative study of 94 dementia family caregivers. Results suggest that an existential framework provides an alternative paradigm for understanding the caregiving experience.     

A model intervention for elder abuse and dementia

This article describes a 2-year collaborative project in Cleveland, OH, that improved the reporting and management of potential and suspected elder abuse situations involving persons with dementia. Educational curricula for cross-training, screening tools, and referral protocols were developed and tested for staff and volunteers in adult protective services and dementia care. A handbook for caregivers of persons with dementia was produced that enables caregivers to self-identify elder abuse risk and seek appropriate interventions to prevent abuse. Project organization, implementation, and evaluation are discussed along with strategies for replication in other communities.     

Anosognosia and depression in patients with Alzheimer's dementia

Anosognosia refers to impaired awareness of patients to realize deficits related to a disorder and is a common symptom of dementia. Anosognosia has far-reaching consequences for diagnosis and treatment and is probably associated with unfavorable prognosis. This study examined the relationship between anosognosia and depression in patients with Alzheimer's dementia (AD). Assessment included interviews of patients and their caregivers. Depressive symptoms were evaluated with observer and self-rating instruments: the Geriatric Depression Scale (GDS), and the “mood” subscale of the Nurses Observation Scale for geriatric patients (NOSGER). Anosognosia was evaluated with the Anosognosia Questionnaire for Dementia (AQ-D). For the evaluation of behavioral and neuropsychological symptoms in dementia and the caregiver burden, the neuropsychiatric inventory (NPI) and the Cares of older People in Europe (COPE) Index were administered. A total of 47 patients were enrolled in the study at the department's geriatric psychiatry outpatient clinic. A considerable discrepancy was found between observer- and self-ratings of depressive symptoms. In 74.5% of the participants, caregiver ratings indicated secondary symptoms of depression as opposed to patient ratings. Thus, in AD, anosognosia may affect not only deficits in cognition and everyday functioning but also affective symptoms (“affective anosognosia”). Caregiver rating therefore is particularly important when assessing mood changes in AD patients.     

Ausbildungsmodell für M.A.S-Trainer

Background

Specific curricula for professionals working in various settings with persons with dementia have been developed and implemented into practice. In this study, the practical relevance of a teaching program for the M.A.S (Morbus Alzheimer syndrome) dementia trainer was evaluated. The curriculum was developed in 2002 within a scientific project. The goal was that care professionals and noncare professionals learn how to support and train persons with dementia and their caregivers. The task of the trainer is to support the functional and emotional resources of the person with dementia employing stage-specific training according to principles of the theory of retrogenesis. Trainers are also able to support family caregivers in their difficult day-to-day care for the person with dementia. With this training and support program, persons with dementia can train their residual capacities and develop a life perspective which enables them to cope with the long duration of Alzheimer’s disease.

Materials and methods

The curriculum for the training methodology is based in the theory of retrogenesis. The 1-year training course is held in the form of modules and includes the following topics: (1) stages of dementia and medical aspects, (2) communication with persons with dementia, (3) stage-specific retrogenic training, (4) physical training for the elderly and persons with dementia, (5) coaching family caregivers through the long disease duration, and (6) care issues for persons without education in care. M.A.S trainers were questioned after they had concluded the teaching program successfully and had the chance to apply the content of the teaching program in their practical work. A short questionnaire was sent via e-mail or a telephone interview was performed.

Results

A total of 279 trainers graduated and were certified. Of these, 140 persons (53.6% of the population) could be questioned after an average of 2.69 years after completion of the course: 93.6% of trainees were still using the principles of the teaching course successfully; of these, 56% were working in the function of a trainer full time and 44% used the principles within their work environment (mainly in the nursing home environment).

Conclusion

The study found that the majority of questioned trainers are still using the principles taught in the course successfully with persons with dementia living at home and the content was found to be relevant for practice. The content of the teaching course, applying principles of retrogenesis, which was originally designed for persons with dementia living at home, can also be successfully applied in the nursing home environment. Increasing interest has been shown by institutions employing professionals whose task it is to keep persons with dementia active and interested as well as physically functioning at their best possible level. As a consequence, persons with dementia perceive higher quality of life and exhibit fewer behavior problems which complicate care. More research is needed to accumulate evidence and to support these findings.     

Detection of maltreatment of people with dementia in Spain: usefulness of the Caregiver Abuse Screen (CASE)

The objective of our study is to validate the Caregiver Abuse Screen (CASE) as an instrument for detecting the maltreatment of people with dementia in Spain. In total, 326 informal caregivers of people with different types of dementia were interviewed in several cities in northwest Spain. The caregivers were selected from outpatient neurology clinics and associations of relatives of people with Alzheimer’s disease and other dementias. A comprehensive sociodemographic questionnaire was administered to all participants, and several standardized scales were used to assess burden, anxiety, depression, social support and resilience. The “Psychological Aggression” and “Physical Assault” dimensions of the Revised Conflicts Tactics Scale were used as risk factors of caregivers’ maltreatment for the construct validation. To establish the probability of maltreatment, a latent class analysis was carried out according to the item responses obtained from the CASE. The internal consistency (Cronbach’s alpha) of the CASE was 0.71. The construct validity was explored through factorial analysis, and we found that two dimensions of CASE—i.e., interpersonal abuse and neglect/dependency—explained 62.5% of the variability. According to the latent class probabilities, 20.4% of participants were categorized as possible abusers and 21.4% as non-abusers. The optimal maltreatment cutoff point was six points on the CASE. The validation of the CASE provides us a brief and easy instrument for detecting possible cases of maltreatment of Spanish people with dementia.     

Managing the behavioral problems of dementia in the home.

The majority of persons with dementia are cared for in the home by family and friends. The goals of treatment in this setting are to maximize the quality of life of the demented person and minimize burdens on the caregiver. Behavioral problems are common with dementia and can lead to significant caregiver burden. Behaviors that are most common or most serious to caregivers include behaviors related to memory disturbances, restlessness and agitation, catastrophic reactions, day/night disturbances, delusions, wandering, and physical violence. A general method for clinicians to manage these problems involves the identification of the behavior and its antecedent and consequent events. Stressors that may cause behavioral problems include fatigue, a change of routine, excessive demands, overwhelming stimuli, and acute illness or pain. Caregivers can be taught to identify these stressors in order to prevent or alleviate troublesome behaviors. When behavioral techniques are not successful and the behaviors are particularly dangerous or burdensome, therapy with low doses of high-potency neuroleptics has been suggested. Measures such as these to help caregivers in the management of dementia at home can be instrumental in improving the quality of life for the person with dementia.     

Identifying Preferences in Persons with Dementia: Systematic Preference Testing vs. Caregiver and Family Member Report

One problem facing professional caregivers of dementia patients involves identifying preferences in patients with impaired verbal abilities. Long-term care staff often rely on the opinions of family or trial and error to discover patient preferences despite the availability of empirical methods for assessing preferences in nonverbal populations. The purpose of this study was to examine whether caregivers and family members could accurately determine the preferences of dementia patients. Patient preferences were determined using an empirical preference assessment while caregivers and family completed a self-report measure concerning their opinions about patient preferences. Results indicated that family and staff were relatively inaccurate in determining the preferences of patients. Results may have implications for developing more effective care plans and improving quality of life for persons with dementia residing in long-term care facilities.     

Caring for Ethnic Older People Living with Dementia – Experiences of Nursing Staff

The total number of persons living with dementia is estimated to double every 20 years and ageing migrant populations are growing in several countries. There are gaps in the health and social care of people from other countries, regardless of the efforts made when someone has a dementia diagnosis; similarly, receiving care in sheltered accommodation is less common. The aim of this study was to explore and describe the nursing staff’s experiences of caring for non-Swedish speaking persons living with dementia in a Finnish speaking group home in relation to a Swedish speaking group home in Sweden. 27 qualitative semi-structured interviews were analysed using qualitative content analyses. The first main category, “communication”, concentrated on language abilities and deficiencies, non-verbal language, highlighting the consequences of not understanding and the benefits of a common language. The second main category, “culturally oriented activities”, focused on being served traditional food, celebrating holidays at the group home, the importance of traditions and the importance of familiar music as cultural elements. The Swedish speaking nursing staff could provide qualitative and equitable care, but the challenge was greater for them than for the bilingual nursing staff who spoke the same language as the residents.     

The Assessment of Treatment Integrity in a Cognitive Behavioral Telephone Intervention Study With Dementia Caregivers

Assessment of treatment integrity, such as therapists’ adherence and competence, is essential for the development and evaluation of evidence-based therapeutic interventions, but in most intervention studies proof of treatment integrity has not been considered on a regular basis. One reason is that there is a lack of appropriate assessment instruments. For dementia caregiver trials treatment adherence and competence scales do not exist. To evaluate treatment integrity in a cognitive behavioral therapy (CBT) telephone intervention with dementia caregivers, we developed a new adherence scale and adapted the Cognitive Therapy Scale (CTS) for CBT with dementia caregivers. We also analyzed whether CBT can be delivered with treatment integrity for interventions with dementia caregivers and by telephone. Eighty-six entire sessions with 45 caregivers in a randomized-controlled intervention study were judged by four independent raters. Inter-rater reliability was high for overall score on the adherence scale (intraclass correlation [ICC] = .85) and the CTS (ICC = .82). Overall adherence was moderate and competence was high. Both scales proved to be reliable; thus they can be used for assessing treatment integrity in other research fields with dementia caregivers, including measuring the impact of treatment on outcome criteria. The results also reveal that CBT can be delivered with adherence to the manual and competently to dementia caregivers and by telephone, opening up new options for future research and practice.     

Gerontopsychiatrischer Konsiliar- und Liaisondienst – Pioniere warten auf Nachahmer

The treatment and care of individuals with dementia, who are admitted to general hospitals due to somatic diseases, often leads to crisis situations which not only compromise the therapeutic benefit, but also can be followed by avoidable institutionalization in nursing homes or psychiatric hospitals. With the model project “Gerontopsychiatric Consultation-Liaison Service” in Kaufbeuren a comprehensive solution to this problem has been developed. A multiprofessional team consisting of a medical specialist, nurses specialized in psychiatry and an occupational therapist supports the health personnel by giving assistance and advice. It also provides contact persons for patients and their families. The effectiveness analysis proved that the work of this service has positive effects on both patient care and costs. Moreover a structural and process analysis provided data about the structure of patients and services as well as about the problems which arose during the setting up of the new service. Potential “imitators” can use this information in the implementation of similar services.     

Cross cultural issues in caregiving for persons with dementia: Do familism values reduce burden and distress?

While family caregiving for persons with dementia has been recognized as a major stressor for over twenty years, attention to the role of cultural values in influencing the stress and coping process of caregivers is rarely studied. This article summarizes individual studies from our lab group that include Latino caregivers, Korean and Korean American caregivers, Japanese American caregivers, and African American caregivers. The role of familism as a cultural value that was assumed to lead to greater acceptance of the caregiving role and to better mental health outcomes for caregivers was explored in each of these groups. Familism was found to vary across groups as expected based on acculturation to Western values of individualism. However, the relationship of familism to caregiving burden was not consistent across ethnic groups and was either independent of caregiving outcomes, or was positively correlated with distress. These results suggest that assumptions about cultural influences on caregiving need to be reexamined and explored in greater depth empirically. He is the principal investigator for the NIA-funded Stress, Ethnicity, and Caregiving Study (AG 16307) and executive director of the Los Angeles Caregiver Resource Center. Her research interests encompass the role of cultural values, personality, and social support in the stress and coping process of ethnic minority dementia caregivers. Her research interests are caregiver stress, health effects of stress, and race group health disparities. Her research interests include the stress and coping process of Korean American dementia caregivers, specifically the relationship between burden and family solidarity. Her research interests involve cross-national and cross-cultural comparisons of the issues related to gerontology and geriatric social work. Her research interests lie in the health effects of stress in Korean dementia caregivers.     

Cross cultural issues in caregiving for persons with dementia: Do familism values reduce burden and distress?

While family caregiving for persons with dementia has been recognized as a major stressor for over twenty years, attention to the role of cultural values in influencing the stress and coping process of caregivers is rarely studied. This article summarizes individual studies from our lab group that include Latino caregivers, Korean and Korean American caregivers, Japanese American caregivers, and African American caregivers. The role of familism as a cultural value that was assumed to lead to greater acceptance of the caregiving role and to better mental health outcomes for caregivers was explored in each of these groups. Familism was found to vary across groups as expected based on acculturation to Western values of individualism. However, the relationship of familism to caregiving burden was not consistent across ethnic groups and was either independent of caregiving outcomes, or was positively correlated with distress. These results suggest that assumptions about cultural influences on caregiving need to be reexamined and explored in greater depth empirically. He is the principal investigator for the NIA-funded Stress, Ethnicity, and Caregiving Study (AG 16307) and executive director of the Los Angeles Caregiver Resource Center. Her research interests encompass the role of cultural values, personality, and social support in the stress and coping process of ethnic minority dementia caregivers. Her research interests are caregiver stress, health effects of stress, and race group health disparities. Her research interests include the stress and coping process of Korean American dementia caregivers, specifically the relationship between burden and family solidarity. Her research interests involve cross-national and cross-cultural comparisons of the issues related to gerontology and geriatric social work. Her research interests lie in the health effects of stress in Korean dementia caregivers.