A Method for Measuring Person-Centered Interventions: Detecting and Characterizing Complex Behavioral Symptoms of Persons With Dementia

The past several years have witnessed an upsurge in the focus on person-centered care for several populations, and especially for vulnerable elders with dementia who reside in nursing homes. The limited ability to accurately detect and quantify complex behavioral symptoms of dementia (BSD) patterns has hampered the development and refinement of tailored interventions. This study's purpose was to characterize complex patterns of BSD and examine the association among different BSD patterns and cortisol profiles. Two groups of nursing home residents were analyzed (N?=?28, N?=?27) using THEME?. Behavioral and cortisol data were collected for four consecutive days. Random effects model was used to characterize BSD trajectories over time. There was a significant difference in BSD between the two groups from late afternoon to early evening. The groups differed significantly in age, comorbidities, antianxiety medication, and the number and complexity of patterns of vocalization and restlessness. THEME? analysis, a first step in developing and timing person-centered interventions, was able to identify BSD patterns that drove the overall time of day pattern.     

Exploring Spared Capacity in Persons With Dementia: What WiiTM Can Learn

This study was designed to probe the capacity of persons with dementia to learn motor tasks. The activity selected was the Nintendo Wii^TM bowling game. The experimenters followed three case studies throughout a 9-week training session, with a 5–6 month follow-up retention test. The participants had a dementia diagnosis, with disease duration ranging from 2 to 5 years. All participants demonstrated improvement in bowling scores and memory for procedural components of game participation that persisted up to 6 months. These results support spared motor learning capacity in dementia, supporting a need for further investigation of activity enhanced therapy.     

Frequency and Correlates of Caregiver‐Reported Sleep Disturbances in a Sample of Persons with Early Dementia

OBJECTIVES: To identify sleep disturbances in participants with subtypes of dementia and explore clinical correlates. DESIGN: Cross‐sectional. SETTING: Outpatient clinics in western Norway and the Mayo Clinic Study of Aging, Olmsted County, Minnesota. PARTICIPANTS: One hundred fifty‐one community‐dwelling western Norway residents referred for geriatric medicine, geriatric psychiatry or neurology evaluation and 420 participants without dementia from the Mayo Clinic Study of Aging. MEASUREMENTS: Dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. The Mayo Sleep Questionnaire, an interview to detect sleep disturbances, was administered to diagnose probable rapid eye movement (REM) sleep behavior disorder, probable periodic leg movements during sleep, probable restless legs syndrome, probable sleepwalking, probable sleep‐related leg cramps, probable obstructive sleep apnea, and excessive daytime sleepiness. Insomnia was assessed using the Neuropsychiatric Inventory, an interview to detect neuropsychiatric symptoms in dementia. RESULTS: Seventy‐one percent of the participants with dementia and 55.7% of control participants had sleep disturbances (P=.001). Most frequently reported in the mild dementia participants were insomnia (29.9%), probable sleep‐related leg cramps (24.1%), excessive daytime sleepiness (22.6%), probable restless legs syndrome (20.7%), and probable REM sleep behavior disorder (18.5%). There were more sleep‐related problems reported in participants with Lewy body dementias (LBD) (dementia with Lewy bodies and Parkinson's disease dementia) than in those with Alzheimer's disease (P=.008). Having any sleep disorder correlated with depression (P=.03) and anxiety (P=.02). CONCLUSION: Sleep problems are common in dementia, particularly in subjects with LBD, and are associated with psychiatric symptoms. Further research is needed to understand these associations and identify treatment strategies.     

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.     

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.     

The Impact of Disclosure of Unfitness to Drive in Persons with Newly Diagnosed Dementia: Patient and Caregiver Perspectives

Health professionals caring for those with dementia must frequently address fitness to drive, which is often the most difficult and emotional task in dementia care. This qualitative study explores the perspectives of patients with dementia who were told to cease driving and their caregivers. Most patients agreed with or resigned themselves to the geriatric team's recommendations regarding the need for driving cessation. Of those who did not, reactions included shock, anger, and denial. Almost all caregivers agreed with the recommendations to cease driving. Caregiver suggestions included: addressing the driving concern earlier, more detail about the tests, focusing on physical problems, providing a letter of explanation, and discussing alternative transportation. The study findings were used to develop a practical list of recommendations on how to address cessation to drive in patients with dementia.