Background/rationale: Various interventions are available to manage verbal agitation (VA), but our understanding regarding their acceptability is limited. The purpose of this study is to compare the acceptability of 3 interventions from the point of view of elderly individuals: direct interaction (DI), differential reinforcement of incompatible behaviors (DRI), and risperidone (RIS). Methods: Participants (N = 69) evaluated the acceptability of each treatment according to the description of a fictional person who demonstrated aggressive or nonaggressive VA. Results: There is an interaction between the type of intervention and the severity of VA. For nonaggressive VA, DI is the most acceptable intervention followed by DRI and RIS. For aggressive VA, DI and DRI are more acceptable than RIS, but there is not a significant difference between them. The acceptability of each intervention is not associated with the participants' characteristics. Conclusion: The results of this study highlight the acceptability of DI for managing VA.

The literature examining issues of caregiver stress, burden, or depression has focused on the stress-process model of caregiving, which posits that there are characteristics inherent in dementia and in the course of caregiving for a person with dementia that can cause stress in the caregiver’s life. A more recent literature has emerged that argues that issues of loss and grief play a significant role in a caregiver’s ability to cope with the stressors of caregiving. This article reviews the caregiver stress and grief literatures, and proposes a conceptual model of dementia caregiving that outlines pathways of stress and grief in dementia caregiving. Issues specific to caregiver grief are proposed for future research and intervention design.

Disease-specific assessments are not currently available for patients with Parkinson’s disease dementia (PDD). This study evaluated the criterion-related validity and test–retest reliability of the Alzheimer’s Disease Assessment scale cognitive subscale (ADAS-cog) in terms of sensitivity for differentiation between mild and moderate severity impairment in PDD. Six other dementia rating scales and cognitive tests were also examined. A total of 113 patients with PDD or Alzheimer disease were recruited into this 4-week, multicenter study, segregated into 2 severity groups based on Mini-Mental State Examination (MMSE) score. Mean ADAS-cog scores showed a statistically significant separation between mild and moderate severity patients in both dementias (P < .001). For the ADAS-cog, test–retest Spearman correlation coefficients were significant for each dementia type and severity. This study demonstrated the criterion-related validity and test–retest reliability for ADAS-cog in patients with PDD and strong correlations with MMSE. This supports the validity of previous results obtained with these measures in studies of patients with PDD.

Providing leisure to people with dementia is a serious challenge, for health care professionals and designers and engineers of products used for activity sessions. This article describes the design process of "the Chitchatters," a leisure game for a group of people with dementia in day care centers. The game aims to stimulate social interaction among people with dementia. Different stakeholders, such as older adults with dementia, their relatives and care professionals were involved in the design process via qualitative research methods as participant observation and the use of probes. These methods were applied to give the design team insight into the experiential world of people with dementia. This article presents how design insights from practice and literature can be translated into a real design for a leisure product for group use by older people with dementia, and shows designers how to work with, and design for, special groups.

Namaste Care is a program designed to offer meaningful activities to nursing home residents with advanced dementia or those who cannot be engaged in traditional activities. This 7-day-a-week program is staffed by specially trained nursing assistants who provide activities of daily living in an unhurried manner, with a "loving touch" approach to care. The program takes place in a room with lowered lighting, soft music playing, and the scent of lavender. Analyses of Minimum Data Set data before the program were implemented and after residents were involved in the program for at least 30 days showed a decrease in residents’ withdrawal, social interaction, delirium indicators, and trend for decreased agitation. Namaste Care helps families feel that in spite of the many losses experienced because of the disease process, something special can still help their loved one to feel comforted, cared for, and cared about in a unique loving environment.

Aim of the study is to discriminate among participants with mild cognitive impairment through electroencephalography brain rhythms. A total of 79 participants with MCI were classified into 4 subgroups based on the beginning of memory complaints up to the time of first visit. All participants underwent electroencephalography recording, magnetic resonance imaging, apolipoprotein E characterization, and volumetric morphometry estimation of hippocampal region. Electroencephalography markers show 2 distinct patterns: (1) increase of theta/delta power ratio and highest value of alpha2 band power in the group with shorter duration of disease, the greater right-left hippocampal volume difference and worst memory performance; (2) the highest value of alpha3 band power and the highest alpha3/alpha2 power ratio in the group with the lesser total hippocampal volume but preserved memory performance. Apolipoprotein E4 is linked to a major risk of early beginning of disease. Electroencephalography markers allow a mean correct percentage of correct classification up to 89%.

Objective: To provide further empirical evaluation of the effectiveness of animal-assisted therapy in nursing home residents with dementia.

Methods: Participants were 56 residents of 2 suburban Maryland nursing homes and had a diagnosis. Activities of daily living performance was assessed via the minimum data set and cognitive functioning assessed using the Mini-Mental State Examination. Engagement with dog-related stimuli was systematically assessed via the observational measurement of engagement.

Results: Mean engagement duration was significantly lower for the small dog. Highest mean engagement duration was found for the puppy video, followed by the real dog and lowest was for the dog-coloring activity. Positive attitudes were found toward the real dogs, robotic dog, the puppy video, and the plush dog. No significant differences were found in engagement duration among our dog-related stimuli.

Conclusions: Nursing homes should consider animal-assisted therapy and dog-related stimuli, as they successfully engage residents with dementia.

Cognitive impairment and seizures are common in our aging population. Anticonvulsant treatment is problematic due to sedation, cognitive slowing, and behavioral changes. Levetiracetam has favorable pharmacokinetics, good efficacy in elderly individuals, a favorable side effect profile, and lacks major drug interactions. We conducted a prospective, uncontrolled, phase 4, open label, 12-week study of levetiracetam to better profile its efficacy, safety, and impact on cognitive/behavioral status in 24 cognitively impaired, elderly individuals. In total, 69% were seizure free for the duration of the study; the remaining participants had satisfactory seizure control. Fatigue was the most common side effect (5 participants). Significant overall improvements were observed for the Folstein’s Mini-Mental State Examination and the Alzheimer’s Disease Assessment Scale–Cognitive. No significant changes were seen in behavioral or functional measures. Levetiracetam is an effective antiepileptic drug in elderly individuals with cognitive impairment. At 3 months, participants who remained on levetiracetam showed excellent cognitive tolerability.

Persons with dementia are at particular risk for injuries and unattended home exits. The purposes of this study were to prospectively describe the characteristics and determine the hazard rates of unattended home exits and injuries. A total of 9 times over 12 months, data were collected from 53 caregivers of persons with dementia about persons with dementia unattended home exits or injuries. A total of 24% of persons with dementia had at least 1 unattended exit; 4 participants exited multiple times. Men and younger persons with dementia were significantly more likely to exit than women or older individuals. A total of 30% of persons with dementia sustained injuries in 29 separate incidents; all but 3 injuries were caused by falls, and 38% of injuries resulted in nursing home placement. The hazard rate of untoward events was high, at approximately 1 unattended exit and 1 fall per person-year. For all persons with dementia living in the community, health care plans should include specific interventions to prevent these untoward events.

Background/rationale. Episodic memory loss is a hallmark of Alzheimer’s disease (AD), with recall of recent events becoming progressively difficult. A commonly used tool, the recollection of US presidents, was assessed in evaluating episodic versus semantic memory loss among AD patients compared with spouse controls.

Methods. A total of 36 patients (12 men, 24 women) with possible or probable AD were asked to "give the names of 5 US presidents" and concurrently administered the Mini-Mental State Examination (MMSE). Twenty-three spouses (12 men, 11 women) were controls. The year 1980 demarcated "remote" versus "recent" presidents.

Results. Patients were older, had lower MMSE scores (P< .001), and recalled fewer presidents than controls (P< .005), after controlling for age. Among patients, men were more educated than women (P < .05) and recalled more presidents (P < .001). No gender differences were observed in controls.

Conclusions. Patients with AD preferentially recalled remote presidents, supporting retention of semantic memory in this group. There were no gender differences between groups.