What affects pleasure in persons with advanced stage dementia?

We examined the impact of environmental, person, and stimulus characteristics on pleasure in persons with dementia. Study participants were 193 residents of 7 Maryland nursing homes who were presented with 25 stimuli from these categories: live human social stimuli, live pet social stimuli, simulated social stimuli, inanimate social stimuli, a reading stimulus, manipulative stimuli, a music stimulus, task and work-related stimuli, and two different self-identity stimuli. Systematic observations of pleasure in the natural environment were conducted using Lawton's Modified Behavior Stream. Analysis showed that pleasure is related to stimulus category, personal attributes and environmental conditions. In the multivariate analyses, all types of social stimuli (live and simulated, human and nonhuman), self-identity stimuli, and music were related to significantly higher levels of pleasure than the control condition. Females and persons with higher ADL and communication functional status exhibited more pleasure. Pleasure was most likely to occur in environments with moderate noise levels. These results demonstrate that these nursing home residents are indeed capable of showing pleasure. Caregivers of nursing home residents with dementia should incorporate social, self-identity, and music stimuli into their residents' care plans so that eliciting pleasure from each resident becomes the norm rather than a random occurrence.     

Do people with dementia find lies and deception in dementia care acceptable?

Objectives: Research suggests that the use of lies and deception are prevalent in dementia care settings. This issue has been explored from the view point of carers and professionals, and the acceptability and ethicality of deception in dementia care remains an area of heated debate. This article explored the issue of lies and deception in dementia care from the unique perspective of the people being lied to: People with Dementia.

Method: This study used a qualitative methodology, specifically, Grounded Theory (GT). The study used a two-phased design. Phase one involved a series of one-to-one interviews with People with Dementia. During phase two, the participants were re-interviewed in order to develop the emerging theory.

Results: Lies were considered to be acceptable if told in People with Dementia's best interest. This best interest decision was complex, and influenced by factors such as the person with dementia's awareness of the lie, and the carer's motivation for lying. A model depicting these factors is discussed.

Conclusion: This study enables the perspective of People with Dementia to be considered, therefore providing a more complete understanding of the use of deceptive practices in dementia care settings. This study suggests that the use of lies and deception in dementia care warrants further investigation.     

Community-dwelling persons with dementia: What do they need? What do they demand? What do they do? A systematic review on the subjective experiences of persons with dementia

Objectives: Including the perspectives of persons with dementia (PwD) is essential in order to organize care structures for them. With this systematic review, we set out to screen the existing scientific evidence on self-expressions of community-dwelling individuals with dementia in order to provide a research base for developing an intervention for persons in early stages of the disease. The leading research questions for this review are: What needs do PwD living at home express? What are their subjective demands? What do they do to cope with their situation?

Methods: We performed a systematic literature review of review publications on subjective experiences of PwD. The publications were analysed using MAXQDA 10 to perform a thematic analysis.

Results: We identified 41 relevant reviews, of which 6 met our inclusion criteria. PwD experience the whole range of human emotions. Their needs and demands do not differ significantly from those of other groups of patients with chronic conditions. Coming to terms with the disease and maintaining normality appeared to be major themes. With regard to expectations from the side of professional health care, the need for accompanying, continuous support and counselling appeared to be central. Furthermore, disclosure of diagnosis represents a critical stage for PwD, but our findings indicated that they prefer to be included in this process.

Conclusions: PwD are well able to express their needs. They should be included in research since they can provide valuable findings. Furthermore, those findings should be implemented in applied dementia care.     

Do high functioning persons with autism present superior spatial abilities?

This series of experiments was aimed at assessing spatial abilities in high functioning individuals with autism (HFA), using a human-size labyrinth. In the context of recent findings that the performance of individuals with HFA was superior to typically developing individuals in several non-social cognitive operations, it was expected that the HFA group would outperform a typically developing comparison group matched on full-scale IQ. Results showed that individuals with autism performed all spatial tasks at a level at least equivalent to the typically developing comparison group. No differences between groups were found in route and survey tasks. Superior performance for individuals with HFA was found in tasks involving maps, in the form of superior accuracy in graphic cued recall of a path, and shorter learning times in a map learning task. We propose that a superior ability to detect [Human Perception and Performance 27 (3) (2001) 719], match [Journal of Child Psychology and Psychiatry 34 (1993) 1351] and reproduce [Journal of Child Psychology and Psychiatry 40 (5) (1999) 743] simple visual elements yields superior performance in tasks relying on the detection and graphic reproduction of the visual elements composing a map. Enhanced discrimination, detection, and memory for visually simple patterns in autism may account for the superior performance of persons with autism on visuo-spatial tasks that heavily involve pattern recognition, either in the form of recognizing and memorizing landmarks or in detecting the similarity between map and landscape features. At a neuro-anatomical level, these findings suggest an intact dorso-lateral pathway, and enhanced performance in non social tasks relying on the infero-temporal pathway.     

Do occupational therapy interventions improve quality of life in persons with dementia? A meta‐analysis with implications for future directions

Occupational therapy (OT) interventions have shown positive effects on physical functioning in persons with dementia (PwD). However, their effect on quality of life (QoL) has been inconsistent in individual clinical trials. The present review appraises current evidence for the use of OT interventions in improving QoL of PwD. Records in the Cochrane Database, MEDLINE, EMBASE, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature were searched for relevant citations, and PubMed was searched for in‐process articles. Additional searches of the reference lists of retrieved articles were undertaken. Ten studies involving 1002 PwD met the criteria for syntheses. OT intervention produced small non‐significant improvements in overall QoL. The evidence from the present review does not support the specific use of OT interventions for the improvement of QoL in PwD under pragmatic clinical conditions at this time. They may be best used as part of a comprehensive range of interventions for PwD. Recommendations are made for future design of OT interventions focusing on the improvement of QoL, which is central to the well‐being of PwD.     

Can we help persons with dementia find their way in a new environment?

The objective of this study was to conduct a randomized controlled trial to examine the effects of a way-finding intervention on residents' ability to find their way in a new environment. The effect of the intervention on the residents' spatial orientation and agitation were also examined. The study was conducted on four nursing home units in a geriatric center and the final sample consisted of 32 residents with Alzheimer's disease (17 in the treatment group and 15 in the control group). The intervention consisted of the use of a location map and a behavioral training technique, which was provided to residents over the course of a month. Repeated measures analysis of variance and McNemar tests were used to compare the groups in regard to changes in the outcomes over time. Results indicated that the residents' in the treatment group demonstrated an increased ability to find their way to the dining room one week after the intervention. The intervention effect was not sustained three months later.     

Developing the Person–Environment Apathy Rating for persons with dementia

Objectives: To develop the Person–Environment Apathy Rating (PEAR) scale that measures environmental stimulation and apathy in persons with dementia and to evaluate its psychometrics.

Method: The PEAR scale consists of the PEAR-Environment subscale and PEAR-Apathy subscales. The items were developed via literature review, field testing, expert review, and pilot testing. The construct validity and reliability were examined through video observation. The parent study enrolled 185 institutionalized residents with dementia. For this study, 96 videos were selected from 24 participants. The PEAR-Environment subscale was validated using the Ambiance Scale and the Crowding Index. The PEAR-Apathy subscale was validated using the Neuropsychiatric Inventory (NPI)-Apathy, Passivity in Dementia Scale (PDS), and NPI-Depression.

Results: The PEAR-Environment subscale and PEAR-Apathy subscales each consists of six items rated on a 1–4 scale. For validity, the Crowding Index slightly, yet significantly, correlated with the PEAR-Environment subscale total score and three of the individual scores. Ambiance Scale scores, both engaging and soothing, did not correlate with the PEAR-Environment subscale. The PEAR-Apathy highly correlated with the PDS and NPI-Apathy and moderately correlated with the NPI-Depression, suggesting good convergent validity and moderate discriminant validity. For reliability, both environment and apathy subscales demonstrated excellent internal consistency. Although facial expression and eye contact showed moderate inter-rater reliability, all other items showed good to excellent inter-rater and intra-rater reliability.

Conclusion: This study has successfully developed the PEAR scale and established its psychometrics based on the compatible scales available. The PEAR scale is the first scale that concurrently assesses apathy and environmental stimulation, and is recommended for use in persons with dementia.     

Do testosterone levels relate to aggression in elderly men with dementia?

The aim of this study was to determine if testosterone and estrogen levels correlate with aggression in older men with dementia. Plasma total and free testosterone and estrogen levels and scores for behavioral disturbances, in particular aggression, were measured in 50 elderly males who had a diagnosis of dementia. Aggression was analyzed separately from agitation. Pearson correlations were calculated to determine the association between testosterone and estrogen and aggression. Linear regression analyses determined the influence of hormone levels on aggression, controlling for age, medical burden, and dementia severity. Free testosterone levels showed significant positive correlations with measures of aggression. Estrogen levels showed significant negative correlations with measures of aggression.     

Helping caregivers of persons with dementia: which interventions work and how large are their effects?

BACKGROUND: In recent years, many different forms of interventions for caregivers of people with dementia have been developed. However, their results have been, in part, inconclusive. METHODS: Meta-analysis was used to integrate the results of 127 intervention studies with dementia caregivers published or presented between 1982 and 2005. RESULTS: Interventions had, on average, significant but small effects on burden, depression, subjective well-being, ability/knowledge and symptoms of care recipient. Only multicomponent interventions reduced the risk for institutionalization. Psychoeducational interventions that require active participation of caregivers had the broadest effects. Effects of cognitive-behavioral therapy, support, counseling, daycare, training of care recipient, and multicomponent interventions were domain specific. The effect sizes varied by study characteristics, such as caregiver gender and year of publication. CONCLUSIONS: Because most interventions have domain-specific outcomes, clinicians must tailor interventions according to the specific needs of the individual caregivers. Although more recent interventions showed stronger effects, there is room for further improvements in interventions.     

Does striatal pathology distinguish Parkinson disease with dementia and dementia with Lewy bodies?

The morphological differentiation of Parkinson disease with dementia (PDD) and dementia with Lewy bodies (DLB) is a matter of discussion. The objective of this study was to investigate the regional distribution of beta-amyloid (Abeta) plaques, alpha-synuclein (AS), and pathology in both disorders. The basal ganglia from 17 age-matched patients of PDD and DLB each were immunohistochemically examined with variable degrees of associated Alzheimer pathology using antibodies to Abeta, AS, and tau. DLB brains showed a significantly higher burden of (diffuse) amyloid plaques in the putamen and caudate nucleus and slightly more severe tau pathology than PDD brains despite similar neuritic Braak stages. Phases of Abeta development in DLB brains often, but inconsistently, correlated with both neuritic Braak stages and severity of striatal Abeta load, while these correlations were almost never seen in PDD cases with Alzheimer lesions. They also revealed a higher burden of AS-lesions (both Lewy neurites and Lewy bodies) than PDD cases that commonly had a paucity of all three types of lesion. The globus pallidus was virtually spared in both phenotypes. Differences in AS and Abeta pathologies and much less of tau lesions in the striatum support a morphologic distinction between PDD and DLB, which may be of pathophysiologic importance, but the causes of these differences are unclear.     

Are Parkinson's disease with dementia and dementia with Lewy bodies the same entity?

The diagnosis of Parkinson's disease with dementia (PDD) or dementia with Lewy bodies (DLB) is based on an arbitary distinction between the time of onset of motor and cognitive symptoms. These syndromes share many neurobiological similarities, but there are also differences. Deposition of beta-amyloid protein is more marked and more closely related to cognitive impairment in DLB than PDD, possibly contributing to dementia at onset. The relatively more severe executive impairment in DLB than PDD may relate to the loss of frontohippocampal projections in DLB. Visual hallucinations and delusions associate with more abundant Lewy body pathology in temporal cortex in DLB. The differential involvement of pathology in the striatum may account for the differences in parkinsonism. Longitudinal studies with neuropathological and neurochemical evaluations will be essential to enable more robust comparisons and determine pathological substrates contributing to the differences in cognitive, motor, and psychiatric symptoms.     

Do family caregivers perceive more difficulty when they look after patients with early onset dementia compared to those with late onset dementia?

OBJECTIVE: To compare family caregiving situations for patients with early onset dementia (EOD) and late onset dementia (LOD), and to identify the specific problems experienced by relatives caring for EOD patients. METHODS: The participants were chosen from 92 consecutive caregiver-patient dyads, comprising co-residing family caregivers and outpatients who fulfilled the diagnostic criteria for dementia. The patients were assessed according to cognitive function, neuropsychiatric disturbances and the severity of dementia. The caregivers completed a self-administered questionnaire that included items on their sociodemographic status and caregiving situation. Caregiver burden was assessed by the Japanese version of the Zarit Burden Interview. RESULTS: In total, 68 dyads were eligible for the analysis, 14 of which included patients with EOD and 54 of which included patients with LOD. There were no significant differences between the two groups in terms of patient clinical features, duration of caregiving, number of hours during which caregivers were relieved per day or number of hours of caregiving per day. No significant associations were detected between the type of dementia and caregiver characteristics (such as health status) or caregiver burden, even after adjusting for confounding variables. However, the caregivers of EOD patients had greater perceived difficulties due to patient behavioural disturbances than did the caregivers of LOD patients. CONCLUSIONS: Our findings demonstrated that additional resources, such as care services, should be provided for sufferers of EOD, in order to allow family caregivers to cope with difficulties associated with patient behavioural problems.     

Can persons with schizophrenia appreciate visual art?

The way schizophrenia patients perceive the world is largely mysterious. Understanding and appreciating the visual world begins with the perception of basic visual features, which is altered in this mental disorder. Yet, the roles basic visual features play in functional activities such as appreciation of art are unclear. This study examined the effects of visual feature manipulation on beauty perception of art in schizophrenia patients (n=29) and in normal controls (n=30). Three pieces of art--The Starry Night (Van Gogh), Mona Lisa (Da Vinci) and a natural landscape photograph (anonymous)--were manipulated in terms of their coloration (removal of color), spatial frequency content (low or high-frequency pass) and visual noise level (with added noise). Subjects judged the beauty of the original and visual-feature-manipulated artworks by rating each piece individually (1 to 7) and by ranking all pieces from most to least beautiful. For the three original art pieces, averaged ratings and rankings were similar in patients and controls. However, when the visual features of the original pieces were manipulated, changes in the beauty ratings were significantly smaller in patients. The reduced sensitivity to visual feature manipulations suggests that the modulation of basic visual signals, often used for vivid and dynamic expressions in art, may be under-appreciated in schizophrenia.     

The singer or the singing: who sings individually to persons with dementia and what are the effects?

'Live' singing to persons with dementia (PWDs) may be an underused but highly accessible resource for their caregivers, regardless of qualifications. A systematic literature review sought to illuminate who sings to PWDs, and with what objectives and effects, to address the question of whether it is the singer or the singing which is effective. The literature revealed that music therapists seek to address cognitive, behavioral, physiological, and social factors through one-to-one singing, whereas other caregivers are more broadly concerned with quality of life, often through facilitating activities of daily living. All included studies concurred that individual singing to PWDs can be effective in a variety of ways, depending on contexts and goals. PWD's perceptions of situations may influence the effectiveness of singing interventions. Music therapists are urged to empower professional caregivers to sing sensitively to PWDs during caregiving activities.