A Model of Consequences of Need-Driven, Dementia-Compromised Behavior

PURPOSE: To extend the original need-driven, dementia-compromised behavior (NDB) model by explaining the consequences of behavioral symptoms for the person with dementia. ORGANIZING CONSTRUCT AND METHODS: Literature is reviewed and the consequences of expressing needs through need-driven, dementia-compromised behaviors are posited. The consequences of need-driven, dementia-compromised behavior (C-NDB) theory is proposed as a framework to improve understanding of the person with dementia and the consequences of behavioral symptoms and unmet needs. FINDINGS: Instead of normative verbal communication, people with significant dementia commonly communicate need via non-normative behaviors, making it difficult for caregivers to know that the person has a need and the extent of such need. Not meeting needs of people with dementia affects the person with dementia, care factors, and contextual factors. Cascading effects occur in which not meeting the original need results in new needs and behavioral symptoms. CONCLUSIONS: This framework indicates the consequences of expressing need behaviorally rather than verbally and shows that caregiver actions might moderate the events that lead to many needs being unresolved. Suggestions are made regarding future research questions deduced from the model.     

Optimizing Care for Older Adults With Dementia-Associated Psychosis

Dementia continues to escalate as the aging population increases, and there are no medications available to reverse this disease. Dementia-associated psychosis/behavioral disturbances can be attributed to frontal lobe, vascular, Alzheimer, Parkinson, and Lewy body dementia, but patients must be assessed for other etiologies. Care for these patients can be challenging. Some studies find certain medications to be effective, but they are not without risk. Medications can lead to falls and even demonstrate paradoxical effects, causing significant distress in patients as well as their families. Nonpharmacologic interventions may prove helpful and should be used first if possible.     

Care providers’ perceptions of the importance of oral care and its performance within everyday caregiving for nursing home residents with dementia

Scand J Caring Sci; 2011; 25; 92–99
Care providers’ perceptions of the importance of oral care and its performance within everyday caregiving for nursing home residents with dementia Background: The oral caregiving in nursing homes for persons with dementia often becomes complicated due to the patients’ lack of compliance, which in turn can result in giving oral care a low priority in daily care. Furthermore, directives for responsibilities are unclear. Objective: The aim of this article was to describe care providers’ perception of and reasoning for the oral care for nursing home residents with dementia and to describe registered nurses’ reasoning in relation to their responsibility for monitoring oral care interventions within the regular caregiving routines for nursing home residents with dementia. Methods: Two sub‐studies were carried out; focus group discussions with nine care providers and interviews with four nurses. All participants were staff in nursing home units specialized in dementia. Results: The focus group discussion revealed three themes: Art of caregiving, Barriers and Treatment strategies. Themes related to the nurses’ statements about oral hygiene within caregiving were Care, Responsibility for care and Information. Conclusion: Three main findings from the study are discussed: Unclear responsibilities of different staff members related to daily oral care for the nursing home patients; a lack of guidelines and routines for oral hygiene and a lack of guidelines for sharing information between the different professional groups.     

混合性痴呆与血管性痴呆的临床特点对比分析

【目的】提高对混合痴采（MD）和血管性痴呆（VD）二者的鉴别能力。【方法】MD患者与VD患者各60例,对两组患者进行检查,分析比较其神经心理及影像学的不同表现及特点。【结果】轻度痴呆患者长谷川氏痴呆评定量表检查中,远记忆、近记忆计算力、识记评分中,MI）组显著低于VD组（P〈O．01）;轻度痴呆患者BEHAVE—AD评定量表痴呆的心理和行为症状严重程度比较中,MD组行为紊乱及情感障碍明显较VD组严重（P〈0．01）;两组患者影像学检查对比,MD组的外侧裂、脑沟较VD组明显增宽,脑叶的局灶性病灶出现率显著高于VD组,3、4级脑白质疏松出现率显著低于VD组。【结论]MD及VD病人的神经心理及影像学改变各有其特点,据此有助于两种疾病的鉴别。     

多梗死性痴呆患者痴呆程度和CT改变的相关性研究

目的探讨多梗死性痴呆(MID)患者痴呆程度和CT改变的相关性。方法对44例MID轻度痴呆、40例中度痴呆，38例重度痴呆患者脑梗死体积、部位及脑萎缩程度进行对比分析。结果MID患者脑梗死体积和痴呆程度关系密切，梗死体积越大，痴呆越重。重度痴呆患者脑萎缩较轻度、中度痴呆患者更明显。痴呆严重程度与病灶部位无对应关系。结论脑梗死体积及脑萎缩是影响MID患者痴呆程度的重要国素。     

痴呆患者症状分析与护理对策

目的探讨阿尔茨海默病性痴呆(AD)和血管性痴呆(VD)患者的不同症状特点及护理对策。方法采用简易智能量表(MMSE)筛选入组,用AD病理行为评分表(BEHAVE-AD)从知觉、思维、情感、行为等方面对AD组与VD组精神行为症状进行比较。结果发现两组在被窃妄想、抑郁、徘徊方面差异有显著性(P<0.05)。结论AD与VD患者的护理既有共同点,又有各自特点,应针对AD与VD患者的症状特点进行护理。     

Differentiation of vascular dementia and Alzheimer disease: a functional transcranial Doppler ultrasonographic study.

OBJECTIVE: In brain perfusion studies, perfusion defects have been reported mainly in the temporal and parietal regions in patients with Alzheimer disease (AD), but it is known that the occipital cortex is partially preserved from metabolic defects in patients with AD, at least in the early stage of the disease. We therefore evaluated the reactivity of the posterior cerebral arteries during visual stimulation with transcranial Doppler ultrasonography (TDU). METHODS: Fifteen patients with AD (mean age, 70 years), 12 patients with vascular dementia (VD) (mean age, 61.5 years), and 9 healthy control subjects (mean age, 58 years) were enrolled in the study. The reactivity of both posterior cerebral arteries during visual stimulation was measured with TDU. Reactivity was calculated by the differences in mean relative blood flow velocity (rBFv) between stimulation (vs) and rest (vr) divided by the resting value [rBFv = 100 x (vs - vr)/vr]. RESULTS: Significant increases of vascular reactivity were obtained during visual stimulation for each group (P < .001). There was no significant right or left side difference for vascular reactivity within the groups except in VD; therefore, values of the right and left sides were pooled for patients with AD and control subjects. Reactivity to visual stimulation was similar for the patients with AD (mean +/- SD, 38% +/- 2.2%) and control subjects (35% +/- 1.8%), but reactivity was found significantly decreased in both sides of patients with VD (25.7% +/- 2.1% for the left side and 24% +/- 2.6% for the right side) compared with the healthy control subjects and the patients with AD (P < .001). CONCLUSIONS: These results indicate that the occipital cortex is partially preserved in patients with AD and that functional TDU may be a valuable tool for differentiating VD and AD.     

Early recognition of dementia by nurses

BACKGROUND: Early recognition of dementia is a key policy objective designed to maximize the efficacy of treatment and to provide timely and appropriate support before crisis occurs. The impact of early recognition of dementia is under-researched in primary care nursing. AIM: To explore whether community mental health nurses (CMHNs), community nurses (CNs) and practice nurses (PNs) have different perspectives on early diagnosis of dementia and to consider the possible effects of any variation. METHOD: Data are drawn from questionnaires completed by CMHNs (79), CNs (153) and PNs (36) who attended workshops offered on 24 occasions in 21 settings across the United Kingdom. The workshops attracted a range of primary care practitioners and were part of a training programme on early diagnosis of dementia. RESULTS: Analysis of the data shows some differences in knowledge, experience and confidence between the three nurse groups. CMHNs were more confident in their abilities to recognize dementia and found providing support less difficult than CNs and PNs. CMHNs considered that they were best placed to co-ordinate services for people with newly recognized dementia. CNs and PNs, however, reported experience of working with people with dementia and many appeared able to respond to early signs and to identify potential sources of support. CONCLUSIONS: While CMHNs may have a key role in responding effectively to the newly identified needs of people with early dementia, other nurses working in the community are likely to encounter people with early dementia. In the context of a policy objective to identify people with dementia earlier, all community-based nurses should be able to recognize the possibility of dementia and support those undergoing referral or assessment. Their confidence in doing so should be enhanced by continued professional development. Training in dementia recognition, involvement in and membership of primary care teams supporting people with dementia should not be confined to CMHNs. Nurses who regularly encounter the general population of older people may be well placed to provide continuity of support for those who may, or may not, have cause to suspect that they or their relatives have early dementia.     

Delirium Superimposed on Dementia

Delirium and dementia are 2 different pathophysiologic processes, each manifesting signs that so overlap that they are often indistinguishable to the practicing clinician. Delirium superimposed on dementia is an underdiagnosed disease process associated with increased mortality and morbidity, longer recovery rates, higher cost, increased risk for falls, and long-term care placement. This article presents an overview of this disease with a focus on early recognition and prevention. Recommendations for treatment strategies, derived from evidence, are presented for consideration by family and adult and geriatric acute care nurse practitioners.     

severe disease complicated by osteoporosis

In this illustrative case, rheumatoid disease changed an active, self-supporting woman into a disabled, dependent and depressed person. When disease activity is continuous, early efforts to prevent severe deformity take on great urgency. It is also important to alleviate the psychosocial impact of the disease, which may well be more than even a highly motivated patient can handle alone.     

卡巴拉汀对血管性痴呆认知功能的影响

目的　探讨卡巴拉汀治疗血管性痴呆的疗效。方法　来自门诊和住院的血管性痴呆病人 4 6例 ,均符合NINDS AIREN的诊断标准。治疗组口服卡巴拉汀 (艾斯能 ) 3～ 6mg/日 ,对照组口服脑复康 0 8tid或银杏制剂 80mgtid ,为期 12周。采用简易精神状态检查表 (MMSE)、AD评估量表———认知分量表(ADAS Cog)进行疗效评价。结果　治疗组完成 18例 ,12周时与治疗前比较病人的MMSE、ADAS Cog ,均有显著性改善 (P <0 0 5 )。无严重副作用发生。对照组 2 3例 ,治疗前后比较MMSE、ADAS Cog ,无显著性改变。结论　卡巴拉汀可以改善血管性痴呆病人的认知功能 ,而且安全。     

Dementia Diagnosis Coding

Dementia is not a specific disease. Instead, dementia describes a group of symptoms affecting thinking and social abilities severe enough to interfere with daily functioning. There are many causes of dementia. Without an in-depth patient history, it may be difficult to identify a specific type of dementia. More than 1 type of dementia can be coded, if it is supported by the medical record. Remember to look at the Excludes notes and to code with proper sequences.     

血管性痴呆患者行为干预的研究

目的　探讨血管性痴呆 (VD)患者认知功能康复训练效果。方法　将 172例轻、中度VD(简易智能状态量表 (MMSE) 10～ 2 4分 )患者进行随机 12周行为干预临床研究 ,其中90例为单盲对照研究 ,82例为自身对照干预研究。结果　随机、单盲干预组较对照组MMSE、日常生活自理量表 (ADL)分数显著改善 ,P <0 .0 1;自身对照干预组研究结果显示 ,干预 4周后 ,MMSE、ADL分数已有改善 ,P <0 .0 5 ,12周后MMSE、ADL分数有显著改善 ,P<0 .0 1。结论　持续有计划地对轻、中度VD患者进行行为干预训练 ,对VD患者的认知功能和日常生活自理能力均有明显改善。此训练经济、方便 ,患者及家属容易接受和坚持。     

长谷川简易痴呆量表与老年痴呆的护理关系研究

目的　探讨长谷川简易痴呆量表与老年痴呆的护理关系。方法　于 1999年 9月对某部干休所的 89例老年病人 (病史情况 :高血压病 17例 ,高血脂症 16例 ,糖尿病 11例 ,脑梗塞 32例 ,冠心病 13例 )。用长谷川简易痴呆量表测试评分 (首次评分 ) ,根据测试评分结果和临床诊断分为老年痴呆组、可疑痴呆组、亚正常组、正常组。根据各组病人病情的不同而采取针对性家庭护理干预措施。一年内连续追踪随访 ,一年后再次用长谷川简易痴呆量表对 89例老年病人测试评分 (再次评分 )。结果　 89例老年病人首次与再次评分比较中 :痴呆组、可疑痴呆组、亚正常组、正常组都有极显著差异 (P <0 .0 1)。结论　长谷川简易痴呆量表对老年痴呆的护理有一定指导作用。