Alzheimer's Disease is a Disorder of Consciousness.

The diagnostic criteria for Alzheimer's disease (AD) described in DSM-5-TR, require a decline in memory and learning and in at least one other cognitive domain among six cognitive domains, and also interference with the activities of daily living (ADL) because of decline in these cognitive functions; as such, DSM-5-TR positions memory impairment as the core symptom of AD. DSM-5-TR shows the following examples of symptoms or observations regarding impairments in everyday activities in terms of learning and memory involving the six cognitive domains. Mild: Has difficulty recalling recent events, and relies increasingly on list making or calendar. Major: Repeats self in conversation, often within the same conversation. These examples of symptoms/observations demonstrate difficulties in recall, or difficulties in bringing memories into the consciousness. In the article, it is proposed that considering AD as a disorder of consciousness could promote a better understanding of the symptoms experienced by AD patients and contribute to devising methods to provide improved care to these patients.

Eating Behavior and Environments of Severe Alzheimer's Disease Patients With Loss of Language Skills.

Background: As Alzheimer's disease (AD) progresses, AD patients become more and more dependent on the environment. To prevent the patients from being distracted from eating, it is necessary to pay attention to the environment. Purpose: Five severe AD patients with loss of language skills were observed closely to identify the environments that interfered with their eating behaviors and environments that encouraged them to eat. Methods: The author, a certified care worker, recorded the behaviors of five severe AD patients while providing care for the overall aspects of their daily lives. From these records, the author extracted the situations in which the subjects exhibited self-eating behavior and situations in which they were distracted from eating, and organized the meanings of these environments for the subjects. Results: Eating behavior was interrupted: (1) when staff members started conversations nearby a subject, or when a caregiver attempted to stop a subject's behavior in order to get her to eat; (2) by physical environmental changes, such as phone ringing and reflection of artificial light on their table. Conclusion: By organizing the meanings of the environments surrounding each individual, we can identify the environments that encourage a patient to start eating and environments that interfere with a patient's eating behavior.

Caregivers' roles in preventing patients with severe Alzheimer's disease from becoming distracted during mealtimes: two case reports.

[Purpose] The purpose of this study was to identify the roles of caregivers in preventing patients with severe Alzheimer's disease with loss of language skills from becoming distracted while eating their meals. [Participants and Methods] The study was conducted on two residents of a nursing home with severe Alzheimer's disease who had lost their language skills. In this study, by comparing the scenes in which the two participants were distracted and not distracted from eating, we analyzed the factors associated with patients with severe Alzheimer's disease who had lost their language skills becoming distracted and factors that prevented them from becoming distracted from eating at mealtimes and considered the roles of caregivers. [Results] The participants became distracted from eating where they were in a lively environment. On the other hand, they were not distracted when they were made to sit and eat in quiet environments. [Conclusion] Patients with severe Alzheimer's disease who have lost their language skills cannot filter out a range of other information around them and focus on the information necessary to oneself. The role of caregivers is to serve as filters for patients with severe Alzheimer's disease who have lost their language skills and whose selective attention abilities have become impaired.

Aspects of the minds of mothers of children with developmental but no intellectual disabilities and the nature of these disabilities.

[Purpose] This study aimed to elucidate the aspects of psychosocial adjustment of mothers of children with developmental but no intellectual disabilities and to clarify the nature of these disabilities. [Participants and Methods] We conducted an unstructured group interview with three mothers of children with developmental but no intellectual disabilities. [Results] The mothers who were not aware of the disabilities, because the disability characteristics made it difficult to recognize easily the disabilities, began to feel anxious about the unforeseeable future when their children began to fail in society outside the home, such as in school. This anxiety was made worse by the teachers' lack of understanding of the developmental disabilities and reduced self-esteem of the children themselves. Becoming aware of their children's ability that they had not seen earlier, a peaceful life and expectations for the future brought about by awareness led to the psychosocial recovery of these mothers. [Conclusion] The truth about the nature of developmental disabilities in the absence of intellectual disabilities, human consciousness does not accept diversity and allows the majority to force minorities to conform.

Meaning and potential of interview data in depiction of life stories: interviews of three mothers caring for children with severe disabilities.

[Purpose] This study aimed to review the meaning and potential of interview data for life story depiction. [Participants and Methods] The participants were three mothers who appeared to have positively accepted their daily lives while raising children with severe disabilities. Semi-structured interviews of these mothers were performed. By reference to Trajectory Equifinality Model, noteworthy experiences were extracted for individual cases from the complete records of the interviews. [Results] After the narration of their life stories, the mothers reached the following points: "Strange sense of satisfaction with living with this child," "Both the child and I are happy," and "The presence of this child allowed us to save our marriage." [Conclusion] When one talks about oneself, the past is arranged in a form that explains the present, omitting or ignoring past experiences that are not related to the present. In other words, the present condition is not the point that the mothers has reached through the narration of their life stories, but the life story has been created to explain the present condition. This means that the life story will continue to change with each new context. This is the conclusion of this study with regard to the meaning and potential of interview data.

Effect of wearing fingers rings on the behavioral and psychological symptoms of dementia: An exploratory study.

OBJECTIVE: This study was conducted to examine the effects of an approach that wears finger rings on elderly females with behavioral and psychological symptoms of dementia. METHOD: The subjects were seven Japanese dementia patients living in elderly nursing homes. A single-case experimental design was adopted for the study. Each study subject was asked to put rings on her finger (from 9:00 to 19:00) for 7 days. The Neuropsychiatric Inventory, scenes of behavioral and psychological symptoms of dementia, interest in wearing rings, self-awareness, and overall profile were determined to assess the effect on the patients of wearing rings. RESULTS: The majority of nursing care providers stated, based on their assessment, that the "irritability/lability" that was noted during the baseline period disappeared during the ring-wearing intervention period in the three patients who displayed an interest in rings. In the assessment of the self-awareness ability, these three women were aware themselves of their intellect collapsing and were capable of conjecturing their own and others' minds. It was commonly seen that the nursing staff, even though they had not been asked to do so by the researchers, told the patients, "Mrs. XX, you look so beautiful" when they found a patient wearing rings. DISCUSSION/CONCLUSION: Individuals with low self-esteem are inclined to get angry and display aggression. In subjects with low self-esteem, anger and aggression readily arise when they are slighted by others. Self-esteem is low in those women who are aware of their own status of collapsing intellect. It is concluded that the words of conjuration, "you look so beautiful," which the wearing of the ring per se by the patient elicited from the caregivers heightened the self-esteem and alleviated "irritability/lability" in the study subjects.

Why do dementia patients become unable to lead a daily life with decreasing cognitive function?

In order to understand the words and deeds of dementia patients that we find very hard to explain or understand, we have paid attention to the self-awareness ability of dementia patients, the intellectual subject that integrates their own intellectual functions, and created 'a model for interpreting puzzling words and deeds of dementia patients from the viewpoint of self-awareness'. The purpose of this study is to explain the reasons why dementia patients become unable to successfully perform activities of daily living (ADL) with advancement of dementia, using our model to present viewpoints understandable to caregivers. We classified dementia inpatients of a geriatric health services facility into four stages, using the model of self-awareness ability (consisting of 'theory of mind', 'self-evaluation' and 'self-consciousness') that was constructed by combining 'theory of mind' and Lewis's developmental model of cognition and emotion. Furthermore, we observed and documented scenes from daily life, and we interpreted the reasons why patients become unable to seek assistance from others for ADL, based on the model. We came to understand why the patients could not seek assistance from others, because the patients who failed in the task of 'theory of mind' were unable to self-assess their own mind and the minds of others, and those having failed in the task of 'self-evaluation' could not evaluate their own situation.

Investigation of toilet activities in elderly patients with dementia from the viewpoint of motivation and self-awareness.

Toilet activities of the elderly patients with dementia were observed focusing on care conditions and investigated based on Hull's drive reduction theory (behavior = drive × habit × incentive) and our self-awareness model (consisting of theory of mind, self-evaluation, and self-consciousness) to evaluate the association between self-awareness and toilet activities in patients with dementia and to explain the time when and the reason why a series of toilet activities as habit once acquired become unfeasible. If theory of mind is lost, awareness of one's desire and intention becomes vague, and toilet activities begin to collapse. Furthermore, if incentive disappears, one's intention hardly arises and toilet activities further collapse. If self-evaluation is lost, time sense fades, future goals based on the present time cannot exist, and behavior loses directivity. As a result, toilet activities collapse, and with a decrease in drive toilet activities cease.

Investigation of eating actions of people with dementia from the viewpoint of self-awareness.

The key to improve the quality of life of people with dementia and caregivers is whether caregivers can understand the meanings of the puzzling words and deeds of people with dementia. Therefore, 2 of the authors observed and wrote down the puzzling words and deeds of 28 people with dementia in eating scenes, and these words and deeds were interpreted using our original model consisting of "theory of mind," "self-evaluation," and "self-consciousness." The results indicated that the bases for why caregivers perceive the words and deeds of people with dementia in eating scenes as puzzling are (1) those unable to pass the task of self-evaluation cannot evaluate their own eating situations in comparison with social standards, and the food culture collapses and (2) those unable to pass the task of self-consciousness cannot perceive through their senses.

Conditions associated with wandering in people with dementia from the viewpoint of self-awareness: five case reports.

The conditions associated with wandering in people with dementia include purposeless activity, purposeful actions, irritation, and symptoms of depression. The words and actions of 5 people admitted to long-term health care facilities who often exhibited wandering behavior were observed, and the above conditions were studied based on our self-awareness model (consisting of "theory of mind," "self-evaluation," and "self-consciousness"). One person who had not passed the theory of mind task but had passed the self-evaluation task was aware of her wandering. However, she could not understand where she wanted to go or for what purpose. Four persons who had not passed the self-evaluation tasks were not aware of their wandering and had no purpose for their wandering.