Observational data on time use and behavior problems in the nursing home.

A 3-month observational study of 24 agitated and severely cognitively impaired nursing home residents was conducted to document the typical ways in which residents spend their time and how time use relates to the manifestation of agitated behaviors. We found that these residents were involved in no activity during 63% of the observations. In addition, residents spent little time in structured activities (e.g., music therapy) or social activities (e.g., receiving visitors). Yet data analysis revealed that residents manifested a greater number of agitated behaviors when they were unoccupied and fewer agitated behaviors when involved in structured or social activities. We discuss implications for caregivers.

Agitation in elderly persons: an integrative report of findings in a nursing home.

Agitated behaviors in the nursing home pose a major problem for caregivers. Our data showed that the three syndromes of agitation--aggressive behaviors, physically nonaggressive behaviors, and verbally agitated behaviors--are differentially related to medical and psychosocial variables. Physically nonaggressive behaviors may be adaptive for a resident who presents a deteriorated stage of dementia, since these behaviors offer stimulation and exercise. Verbally agitated behaviors may be a form of help-seeking behavior for residents with physical disease and depressed affect. Aggressive behaviors are those least understood, although these behaviors correlate with advanced stages of dementia and with poor interpersonal relationships. These findings should be a basis for further studies, with the ultimate goal being improved care for agitated elderly persons.

Signs of early damage in glaucomatous monkey eyes: low spatial frequency losses in the pattern ERG and VEP.

Experimental glaucoma was created in one eye of three cynomolgus monkeys by argon laser application to the mid-trabecular meshwork. Simultaneous pattern electroretinograms (PERG) and pattern visual evoked potentials (PVEP) were measured in both control and glaucoma eyes to spatial frequencies of 0.5, 1.25, 2.5, and 3.5 cpd which were counterphase modulated at 6 Hz. The transient flash electroretinogram was also measured. While normal flash electroretinograms were recorded in all eyes both before and after the unilateral production of elevated intraocular pressure (IOP), reductions in PERG and PVEP amplitude were seen in the eyes with glaucoma as early as two weeks following a sustained increase of IOP, despite the absence of cupping of the optic nervehead judged by ophthalmoscopic examination and analysis of photograph by two observers. Optic nervehead abnormalities occurred subsequently. In glaucomatous monkey eyes, the earliest PERG and PVEP changes were most evident with lower spatial frequencies of stimulation. Our data suggest that the optimal stimulus parameters for the detection of early glaucoma are low spatial frequency patterns presented at a rapid rate of temporal modulation.

Electrophysiological evidence that early glaucoma affects foveal vision.

The pattern electroretinogram (PERG) and visual evoked potential (PVEP) were recorded simultaneously using a 1.1 cpd pattern which was counterphase modulated at 1 Hz. The responses of ocular hypertensive (OHT) eyes (with normal visual fields) and eyes with early glaucoma (with early visual field defects and/or early cupping of the optic nervehead) were compared to age-matched normal observers. All patients (26 eyes) and normal observers (14 eyes) had normal transient flash electroretinograms. Delays were seen in mean PERG latency in both OHT and early glaucoma eyes, while mean PERG amplitude was significantly reduced only in the early glaucoma eyes. The PVEP responses were 'unmeasurable' in 11/26 patient eyes because the waveforms were grossly abnormal in shape, making it impossible to identify the N- and P-components. The data were categorized in this manner: a patient response was considered abnormal if latency or amplitude exceeded normal limits (PERG or PVEP) or if the waveform was 'unmeasurable' due to its shape (PVEP only). Of the 26 patient eyes, we found that 8 eyes had normal PERG and PVEP, 11 eyes had abnormal PERG and PVEP, one eye had an abnormal PERG and a normal PVEP, and 6 eyes (3 patients) had a normal PERG and an abnormal PVEP. These data support the proposition that foveal vision (as assessed by the PVEP) may be affected by early glaucomatous damage. The relationship between the PERG and PVEP also was evaluated using a new measurement which we call the 'latency window'. Using this measurement, 15/26 patient eyes were abnormal-9 of these had 'unmeasurable' PVEPs. This measurement could be useful in classifying 'W'-shaped PVEPs as normal or abnormal.

Flash and pattern electroretinograms in normal and laser-induced glaucomatous primate eyes.

Experimental glaucoma was produced in one eye of five cynomolgus monkeys with the argon laser delivering 100-200 50-mu spots at 1200-1500 mW power and 0.5 sec to 360 degrees of the mid-trabecular meshwork. Monocular electroretinograms (ERGs) were recorded prior to and 2, 3, and 4 mo following the laser treatment. In the laser-treated (glaucoma) eyes, normal flash ERGs were observed using 1-Hz stimulation; however, pattern ERGs (PERGs) elicited using steady-state counterphase modulation of a 0.51 cpd square wave grating showed statistically significant reductions of amplitude. Only small reductions of PERG amplitude were seen with a 1.25 cpd grating. In three animals, abnormalities of the PERG occurred prior to clinically significant cupping of the optic nervehead. Moreover, reductions of PERG amplitude were progressive and associated with the magnitude of cupping of the optic nervehead and elevation of intraocular pressure. PERG amplitude did not change following acute reductions in intraocular pressure in the glaucoma eyes. Several control experiments were conducted to insure that results were not due to alterations in pupil size, refractive state, or accommodation in the glaucoma eyes. The authors believe they now have a monkey model for the electrophysiologic study of glaucoma.