Management of problematic behavioral symptoms associated with dementia: a cognitive developmental approach.

The purpose of this 3-year study was to test the efficacy of using a theoretical model based on Piaget's cognitive developmental stages for consistent behavioral and environmental interventions for persons at all stages of Alzheimer's disease and related disorders (ADRD) in nursing home and special care units. The specific aims were to reduce problematic behavioral symptoms and the number, amount and frequency of use of psychotropic medications. After 18 months, problem behaviors and some types of psychotropic medications significantly decreased in the treatment group but not in the control group. Results of the study indicate that using behavioral and environmental interventions based on Piaget levels of cognitive development may be an effective method of managing problematic behavioral symptoms and decreasing the use of psychotropic medications in institutionalized ADRD patients.

The relationship between premorbid life-style and wandering behaviors in institutionalized people with dementia.

Forty-nine ambulatory residents participated in a study conducted to determine the relationship between premorbid life-style, work, and ways of handling stress, and wandering in dementia units. The sample consisted of 23 males and 26 females with a mean age of 79. Family members responded to open-ended questionnaires that asked about premorbid leisure activities, hobbies, exercise, stress management, type of employment and social interactions. Activities were ranked according to energy expended on the Metabolic Cost of Activities (MET) Scale. No activity equaled Inactive (0); 1.5-2 METS equaled Mildly Active (1), 2-3 METS equaled Moderately Active (2), and 3-4 METS equaled Very Active (3). Subjects were observed three times for one-hour intervals on each of three shifts (day, evening, night) at randomly selected times to assess wandering behavior. Behavior was logged every five minutes. The subjects' most frequent conditions were awake (21%), alone (20%), and in their own rooms (17%). Twenty-four (50%) of the subjects were observed pacing, and 16 (33%) were agitated/restless at some point in time. Statistical analyses showed no significant correlations between premorbid life-style variable rankings and the amount of time spent standing, walking and pacing. The findings suggest that wandering behavior is not influenced by premorbid life-styles.

The relationship between Piaget and cognitive levels in persons with Alzheimer's disease and related disorders.

Clinical observations and research studies have documented that people with Alzheimer's disease and related disorders (ADRD) appear to regress developmentally during the course of the disease. The purpose of this study was to prospectively determine the association between changes in Piaget levels of cognitive development and cognitive decline in nursing home residents in various stages of ADRD. Fifty-seven people were tested three times at yearly intervals, using the Folstein Mini-Mental State Exam to determine cognitive levels and a set of 14 Piaget tasks to determine cognitive developmental levels: 1) Formal Operations; 2) Concrete Operations; 3) Preoperational; and 4) Sensorimotor. Mean MMSE scores declined from 12.7 to 9.4, and there was a downward trend in Piaget levels over the study period. ANOVA showed significant differences (p < 0.0005, Years 1, 2, 3) in MMSE scores among all Piaget levels, and Spearman rho analysis showed significant correlations between Piaget levels and MMSE for each year (p < 0.0005, Years 1, 2, 3). The results suggest that there is a concurrent decline in cognitive developmental levels and cognition in people in various stages of Alzheimer's disease and related disorders.

Cognitive developmental approach to dementia.

Systematic observations of people suffering from dementia of the Alzheimer's type (DAT) reveal they regress in behavior and become childlike. These observations have been used to structure clinical research and therapeutic interventions for dementia patients. However, no concise framework explains successful caregiving. Models for care exist but they lack an adequate framework for the long-term care of a person with DAT. This state of the science review describes what is known about cognitive functioning in people with DAT. It examines studies based on cognitive functioning. It also then relates this information to an emerging theory tentatively identified as a "cognitive developmental approach" which may be useful for understanding people with dementia and for predicting caregiver requirements.

Problems of nursing home residents: nurse and resident perceptions.

The nurse's consideration of the nursing home resident's perspective of his or her problems conveys respect for the resident as an individual and as a valued source of information concerning his or her own needs. Such consideration facilitates mutual setting of goals for patient achievement. The purpose of this study was to determine the similarities and differences between the nurse's perception of the nursing home resident's problems and the resident's perception of his or her problems. Thirty-one residents and their nurses completed questionnaires to identify perceived needs for assistance with daily activities and to assess the presence and degree of specified common problems. Out of 45 items, significant differences between nurse and resident ratings were found for the following 7 items: assistance needed for bathing and grooming, appetite problems, loss of bladder control, difficulty breathing at rest, decreased sense of smell, and loss of usefulness. Implications for nursing practice and nursing staff education are discussed.