American Journal of Alzheimer's Disease and Other Dementias current issue

Review of Issue: Safety, End-of-Life Issues, and Dealing With Sexually Inappropriate Behavior in Dementia Patients

Lippa, C. F. — 2008-10-03

Standardized Note Template Improves Screening of Firearm Access and Driving Among Veterans With Dementia

LoConte, N. K., Gleason, C. E., Gunter-Hunt, G., Carlsson, C. M., Siebers, M. — 2008-10-03

Little is known about screening used in clinical practice to assess driving and firearm safety among patients with dementia. A case-controlled study was performed, including 22 patients with dementia seen in a geriatric evaluation and management clinic and 22 matched patients with dementia seen in a memory assessment clinic. Data about prevalence of firearm use and driving were obtained. In geriatric evaluation and management clinic, 57.9% of patients had dementia, compared with 71.0% in memory assessment clinic, and more patients were diagnosed with Alzheimer dementia in memory assessment clinic (P = .005). In geriatric evaluation and management clinic, 65% of patients had driving screening compared with 100% in memory assessment clinic (P = .07). Four percent in geriatric evaluation and management clinic were screened for firearm access versus 100% in memory assessment clinic (P < .001). In memory assessment clinic, 31.8% had firearms access and 50% were driving. Many patients continued to drive and have access to firearms. The use of templates for the progress note was effective in increasing the screening rate.

Meaning and Practice of Palliative Care for Nursing Home Residents With Dementia at End of Life

Powers, B. A., Watson, N. M. — 2008-10-03

Objective: To describe the meaning and practice of palliative care (PC) for nursing home (NH) residents with dementia at end of life (EOL). Design: Concurrent mixed methods (quantitative retrospective chart review and qualitative field study). Setting: Three NHs with varying approaches to EOL care: in-house non-Medicare hospice, Medicare hospice by outside agency, and Medicare hospice by outside agency plus specialized staff and comfort care unit. Results: Residents' course fluctuated between curative and comfort care, with a noticeable increase in symptoms right before death. Hospice care was short. Most died of complications of dementia. Families found care decisions based on residents' uncertain disease course difficult. Conclusion: The role of PC for NH residents with dementia at EOL is complex and poorly understood. As they are in a residential setting, decisions need to be made about how residents live, as well as how they die, thus balancing quality of living/comfort with disease management.

Neuropsychiatric Impairments as Predictors of Mild Cognitive Impairment, Dementia, and Alzheimer's Disease

Stepaniuk, J., Ritchie, L. J., Tuokko, H. — 2008-10-03

In this study, the relations between cognitive status and neuropsychiatric impairments in nondemented older adults in cross section and over time is examined. Using data from the Canadian Study of Health and Aging (CSHA), a longitudinal, nation-wide study in which data were collected 3 times (ie, CSHA-1, CSHA-2, CSHA-3) at 5-year intervals, individuals were classified with (n = 240) and without (n = 386) cognitive impairment at CSHA-2. Loss of interest, changes in personality and mood, and depression were reported by a knowledgeable informant (ie, family or friends) more frequently for those with cognitive impairment than for those without cognitive impairment. After controlling for initial cognitive status, loss of interest and depression contributed significantly to the prediction of mild cognitive impairment, dementia, and Alzheimer's disease over time. These findings suggest that these neuropsychiatric impairments play significant roles throughout the course of cognitive decline and should be taken into consideration even before cognitive impairment is evident.

One-Year Follow-up Study of Elderly Group-Home Residents With Dementia

Suzuki, M., Kanamori, M., Yasuda, M., Oshiro, H. — 2008-10-03

For the present research, a 1-year follow-up study was conducted on elderly group-home residents with dementia (n = 13). This research compared the cognitive function and behavioral disorders of the elderly group-home residents with dementia with a control group (n = 13) of elderly patients with dementia in a dementia care ward. Thirteen residents of a group home were observed for 1 year, following the establishment of the group home in January 2003. The subjects in the control group were matched for the sex and dementia type of the group-home residents. The present results suggest that cognitive function among elderly group-home residents was maintained in comparison with elderly patients in a dementia ward. In addition, behavioral and psychological symptoms of dementia were not observed in either group. Furthermore, these findings suggest that behavioral disorders significantly improved in the group-home residents because of the incorporation of activities combining basic and instrumental activities of daily living.

Pharmacotherapy for Inappropriate Sexual Behaviors in Dementia: A Systematic Review of Literature

Ozkan, B., Wilkins, K., Muralee, S., Tampi, R. R. — 2008-10-03

The aim of this study is to systematically review the published literature on pharmacotherapy for inappropriate sexual behaviors in dementia. Literature search of the 5 databases (PubMed, MEDLINE, EMBASE, PsychINFO, and COCHRANE collaboration) and the analysis of the data available for the pharmacotherapeutic treatments of inappropriate sexual behaviors in dementia were carried out.There are no published randomized controlled trials of pharmacotherapy for inappropriate sexual behaviors in dementia, but available data from uncontrolled trials, case series, and individual case reports suggest efficacy for antidepressants, antipsychotics, mood stabilizers, hormonal agents, cimetidine, and pindolol for the treatment of these behaviors. Although there are no controlled data for the treatment of inappropriate sexual behaviors in dementia, available data suggest efficacy for some commonly used pharmacotherapeutic agents.

Transitioning Dementia Residents from Assisted Living to Memory Care Units: A Pilot Study

Kelsey, S. G., Laditka, S. B., Laditka, J. N. — 2008-10-03

Our study examined the process of transitioning residents of assisted living facilities (ALFs) who have Alzheimer's disease or a related disorder to memory care units (MCUs). In-depth surveys with 10 ALF administrators in South Carolina were conducted. Grounded theory identified major themes; thematic analysis organized content. Most administrators used a preadmission screening process to assess cognitive status. About half reported that they discussed the possibility of future transfer to another level of care with the family at admission. Most administrators said that their facilities had transfer policies in place; of these, only two-thirds discussed their policies with families on admission. Transfer triggers included leaving the facility without anyone's knowledge, disturbing behaviors, and increased care needs. Challenges included family resistance and greater costs of MCUs. Assisted living facilities that were part of continuing care retirement communities used more multidisciplinary transfer decision-making than free-standing ALFs. Suggested improvements stressed educating families about dementia and MCUs.

Cognitive Deficits and Reduced Insight in Primary Progressive Aphasia

Banks, S. J., Weintraub, S. — 2008-10-03

Primary progressive aphasia (PPA) is a form of dementia caused by frontotemporal lobar degeneration. Unlike aphasia due to stroke, in which the association between particular aphasia profiles and insight has been well characterized, this relationship has not been investigated in PPA. Reduced insight is seen in other neurological conditions, but tends to involve right hemisphere damage, whereas PPA is predominantly a left hemisphere disorder. The aim of the current study was to examine whether fluent aphasia with less meaningful speech output, associated with diminished insight in stroke, is also characteristic of PPA patients with reduced insight. Fourteen PPA patients were studied. Results indicated that reduced information content in speech and poor performance on a nonlanguage test, the Pyramids and Palm Trees test, predicted reduced insight. This study has implications for the anatomical network involved in insight and clinical implications in terms of selecting interventions appropriate for individual patients with PPA.

Multisensory Stimulation for Elderly With Dementia: A 24-Week Single-Blind Randomized Controlled Pilot Study

2008-10-03

Background: Dementia in the elderly is a common, debilitating condition. Residents in long-term care facilities present with a number of challenging behaviors. Pharmacological management is not always helpful. Alternative approaches are needed. Methods: Multisensory stimulation (MSS) was developed to address sensory stimulation imbalance. In this pilot 24-week single-blinded, randomized controlled study, the authors examined the effect of MSS when given for 12 weeks in either 1 or 3 sessions per week with a control group. Results: There is a trend for better outcomes as measured by daily observation scales (DOS) or Clinical Global Impression-Improvement (CGI-I) with the increase of sessions of treatment per week. This became statistically significant at weeks 8 (DOS) and 12 (CGI). This difference continued for 12 additional weeks after treatment ended. Conclusions: MSS may be a useful addition to the care of elderly patients with dementia. A larger double-blind randomized control study is required.

The Clock-Drawing Test: Time for a Change?

Chan, A., Remington, R., Paskavitz, J., Shea, T. B. — 2008-10-03

Clock-drawing tests are simple and rapid screening devices for dementia. It was observed that individuals <60 years of age showed similar performance with a digital prompt (" . . .make the clock read 12:45") or an analog prompt (" . . .quarter to 1"), whereas individuals >70 years of age showed improved performance with an analog prompt. The digital prompt has routinely been used to force participants to recode the prompt via conceptualization. Differential scoring across a range of ages has likely derived from the advent and increase of digital clocks with the younger segment of the population. This implies the need for as-yet undetermined alteration in the nature of prompts to force recoding as the current younger population ages.

The Effects of a Multimodal Intervention on Outcomes of Persons With Early-Stage Dementia

Burgener, S. C., Yang Yang, , Gilbert, R., Marsh-Yant, S. — 2008-10-03

Theories supporting the existence of a use-dependent neuroplasticity in the older brain were used to guide this pilot study. A repeated-measures randomized design was used to test the effectiveness of a multimodal (Taiji exercises, cognitive-behavioral therapies, support group) intervention on cognitive functioning, physical functioning, and behavioral outcomes in persons with dementia. The treatment group (n = 24 persons with dementia) participated in a 40-week intervention, with outcomes assessed at 20 and 40 weeks to assess optimal treatment length. Control group subjects (n = 19 persons with dementia) received attention-control educational programs. At 20 weeks, differences between groups were found for mental ability and self-esteem, with gains in balance being evident. Also, stability in depression and physical health were evident at 20 and 40 weeks for treatment group subjects. Continued improvement in outcomes was not observed at 40 weeks. However, findings support further testing of the intervention along with potential for achieving positive outcomes in early-stage dementia.

News Briefs

2008-10-03