Managing differences: care of the person with frontotemporal degeneration.

Caring for people with non-Alzheimer's dementias is particularly challenging for families and care providers. This is especially true for those with frontotemporal degeneration (FTD) who exhibit profound changes in personality, behavior, language, and movement. Initial symptoms are often misdiagnosed as psychiatric disorders or early-onset Alzheimer's disease, and typically do not respond to pharmacological and nonpharmacological interventions designed for people with other dementias. Using individual examples, this article illustrates common features of two subtypes of FTD: behavioral variant FTD and non-fluent primary progressive aphasia.

Assessment of patient and caregiver experiences of dementia-related symptoms: development of the Multidimensional Assessment of Neurodegenerative Symptoms questionnaire.

BACKGROUND: To provide preliminary validation data on a self- or informant-report multidimensional questionnaire of symptoms associated with neurodegenerative disorders. METHODS: Participants from 2 trials (n = 125), the Arizona APOE Cohort and the Arizona Alzheimer's Disease Center, completed the Multidimensional Assessment of Neurodegenerative Symptoms questionnaire (MANS) and other related measures. RESULTS: Measures of central tendency are provided for the sample as a whole and by cognitive status. Internal consistency of the MANS is excellent (alpha = 0.98). Factor analysis suggests 4 factors. Correlational analyses support the construct validity of the MANS with moderate to high (r = 0.54-0.87) correlations between the MANS and measures of mood, cognition and daily functioning. CONCLUSION: Results provide initial support for the MANS as a brief measure that is a reliable and valid indicator of cognitive, personality, functional and motor symptoms potentially related to neurodegenerative etiologies. Further research with the MANS is warranted.

Not your grandmother's Alzheimer's disease. New priorities for research and care.

Thus, in terms of having non-pharmacological care recognized to be as important as pharmacological interventions and biomedical research, we must begin to consider the longer term effects of those interventions. It no longer seems appropriate to simply report on care recipient comfort and mood, decreased use of psychotropic medications, weight, and satisfaction. Studying care recipients in nursing homes is no longer enough. To have our contributions to dementia care recognized, nurses now must shift our attention to larger, more global ideas. We need to focus on maintaining individuals with dementia in their homes or other appropriate settings. It is only through the use of preventive and anticipatory measures that emphasize cost containment will nurses continue to be leaders in the field of dementia. This is not your grandmother's Alzheimer's disease.

Application of the Progressively Lowered Stress Threshold Model across the continuum of care.

Over the last two decades, increasing attention has been paid to the nature of behavioral symptoms in dementia. Early notions that all behaviors were an inevitable component of cognitive impairment have all but disappeared in the face of evidence that diverse personal, social, and environmental factors regularly act as antecedents to behavioral and psychologic symptoms of dementia (BPSD). The quality of care provided to persons with dementia has been advanced through nursing care conceptual models that explain antecedents to BPSD and, in turn, offer specific interventions to promote comfort and optimal function.

History, development, and future of the progressively lowered stress threshold: a conceptual model for dementia care.

Behavioral symptoms associated with dementia are a major concern for the person who experiences them and for caregivers who supervise, support, and assist them. The knowledge and skill of formal and informal caregivers affects the quality of care they can provide and their ability to cope with the challenges of caregiving. Nurses are in an excellent position to provide training to empower caregivers with the knowledge and skills necessary to reduce and better manage behaviors. This article reviews advances in geriatric nursing theory, practice, and research based on the Progressively Lowered Stress Threshold (PLST) model that are designed to promote more adaptive and functional behavior in older adults with advancing dementia. For more than 17 years, the model has been used to train caregivers in homes, adult day programs, nursing homes, and acute care hospitals and has served as the theoretical basis for in-home and institutional studies. Care planning principles and key elements of interventions that flow from the model are set forth, and outcomes from numerous research projects using the PLST model are presented.

Apolipoprotein E and intellectual achievement.

OBJECTIVES: To determine whether apolipoprotein E (apo E) genotype influences intellectual achievement in cognitively normal individuals. DESIGN: Between 1994 and 1999 we performed apo E testing on 1,000 self-described cognitively normal residents of Maricopa County and detailed neuropsychological testing on a subset of 250. SETTING: Tertiary care academic medical center. PARTICIPANTS: Cognitively normal adults genotyped for apo E. MEASUREMENTS: Measures of intellectual background included years of education and a demographically based estimate of intellectual capacity (demographic intellectual quotient (DIQ)). Measures of intellectual achievement, which included Wechsler Adult Intelligence Scale revised (WAIS-R), information (WAISI), and vocabulary (WAISV) scores, occupational intellectual requirements (OIR), and census-derived estimates of household income, were compared between apo E genetic subgroups while adjusting for intellectual background and demographic variables. RESULTS: WAISI, WAISV, OIR, and income correlated with age, sex, education, and DIQ, but after controlling for these variables there were no clinically significant differences between apo E-e4 homozygotes and noncarriers on any measure. CONCLUSIONS: No clinically significant differences between genotypes were observed for the effects of education and DIQ on WAISI, WAISV, OIR, or income, although a larger sample size would be required to exclude smaller, clinically insignificant differences.

The clinical problem of neuropsychiatric signs and symptoms in dementia.

PURPOSE OF REVIEW: This article reviews behavioral signs and symptoms of dementia that can lead to increased mortality, excessive cognitive and functional disability, early institutionalization, and increased caregiver burnout. RECENT FINDINGS: Almost all patients with a dementia will develop significant behavioral disturbances at some point over the course of their illness. These behavioral signs and symptoms rarely fit into usual diagnostic classifications or meet full criteria for a formal major psychiatric disorder. SUMMARY: Treatment of behavioral signs and symptoms of dementia should include both pharmacologic and nonpharmacologic interventions. There are currently no treatments for these disturbances approved by the US Food and Drug Administration. Best judgment should be used in identifying dominant target symptoms and matching them to the most relevant drug class. Implementing nonpharmacologic interventions before the development of neuropsychiatric symptoms may prevent triggers related to a progressively lowered stress threshold and therefore is key in the treatment of all patients with a dementia.

The effects of a dementia nurse care manager on improving caregiver outcomes outcomes.

Iowa's Administration on Aging's Alzheimer's Disease Demonstration Grant to the States was a project to implement and evaluate a nurse care management model of service delivery for persons with dementia or care recipient and their family caregiver that was integrated with the case management system. The goal of the nursing service delivery model was to maintain persons with dementia safely in their homes, by connecting them with appropriate services and providing support to the care recipient and caregivers. Outcomes measures were evaluated over time. This article defines the role of dementia nurse care management and shares the results of the outcomes measurements. The evaluation showed that caregivers assisted by nurse care managements were more likely to show improvement in their stress levels, endurance potential, and well-being. This improvement was consistent over time.