American journal of Alzheimer's disease and other dementias

February 2010, Volume 25, No. 1

Review of Issue: Focusing on the Caregiver: Grief in Dementia Caregiving
Page 7-8.

Review: The Role of Grief in Dementia Caregiving
The literature examining issues of caregiver stress, burden, or depression has focused on the stress-process model of caregiving, which posits that there are characteristics inherent in dementia and in the course of caregiving for a person with dementia that can cause stress in the caregiver’s life. A more recent literature has emerged that argues that issues of loss and grief play a significant role in a caregiver’s ability to cope with the stressors of caregiving. This article reviews the caregiver stress and grief literatures, and proposes a conceptual model of dementia caregiving that outlines pathways of stress and grief in dementia caregiving. Issues specific to caregiver grief are proposed for future research and intervention design.
Page 9-17.

Treatment and Management of Epilepsy in the Elderly Demented Patient
Epilepsy and seizures are more frequent in the elderly population than in any other age group. The number of individuals older than 65 is constantly increasing, and dementia is a process that predominantly affects this age group. Several studies have shown that dementia is an important risk factor for developing seizures and epilepsy. Seizure semiology in the elderly demented might differ from that of younger age groups and diagnosis can be complicated further by the variety of other causes of transient changes of alertness and behavior that affects these patients. The pharmacokinetic changes of antiepileptic drugs in the elderly make this group a major therapeutic challenge. Side effects and drug interactions play a major role in the choice of antiepileptic agents. This review intends to summarize the existing data to see whether this can help guide the clinician in the treatment and management of epilepsy in the elderly patient with dementia. Nonpharmacologic therapeutic options are also briefly considered.
Page18-26.

Injuries and Unattended Home Exits in Persons With Dementia: A 12-Month Prospective Study
Persons with dementia are at particular risk for injuries and unattended home exits. The purposes of this study were to prospectively describe the characteristics and determine the hazard rates of unattended home exits and injuries. A total of 9 times over 12 months, data were collected from 53 caregivers of persons with dementia about persons with dementia unattended home exits or injuries. A total of 24% of persons with dementia had at least 1 unattended exit; 4 participants exited multiple times. Men and younger persons with dementia were significantly more likely to exit than women or older individuals. A total of 30% of persons with dementia sustained injuries in 29 separate incidents; all but 3 injuries were caused by falls, and 38% of injuries resulted in nursing home placement. The hazard rate of untoward events was high, at approximately 1 unattended exit and 1 fall per person-year. For all persons with dementia living in the community, health care plans should include specific interventions to prevent these untoward events.
Page 27-31.

Which Presidents Are Most Memorable?
Background/rationale. Episodic memory loss is a hall-mark of Alzheimer’s disease (AD), with recall of recent events becoming progressively difficult. A commonly used tool, the recollection of US presidents, was assessed in evaluating episodic versus semantic memory loss among AD patients compared with spouse controls.
Conclusions. Patients with AD preferentially recalled remote presidents, supporting retention of semantic memory in this group. There were no gender differences between groups.
Page 32-36.

The Impact of Different Dog-related Stimuli on Engagement of Persons With Dementia
Objective: To provide further empirical evaluation of the effectiveness of animal-assisted therapy in nursing home residents with dementia.
Results: Mean engagement duration was significantly lower for the small dog. Highest mean engagement duration was found for the puppy video, followed by the real dog and lowest was for the dog-coloring activity. Positive attitudes were found toward the real dogs, robotic dog, the puppy video, and the plush dog. No significant differences were found in engagement duration among our dog-related stimuli.
Conclusions: Nursing homes should consider animal-assisted therapy and dog-related stimuli, as they successfully engage residents with dementia.
Page 37-45.

Effects of Namaste Care on Residents Who Do Not Benefit From Usual Activities
Namaste Care is a program designed to offer meaningful activities to nursing home residents with advanced dementia or those who cannot be engaged in traditional activities. This 7-day-a-week program is staffed by specially trained nursing assistants who provide activities of daily living in an unhurried manner, with a ‘‘loving touch’’ approach to care. The program takes place in a room with lowered lighting, soft music playing, and the scent of lavender. Analyses of Minimum Data Set data before the program were implemented and after residents were involved in the program for at least 30 days showed a decrease in residents’ withdrawal, social interaction, delirium indicators, and trend for decreased agitation. Namaste Care helps families feel that in spite of the many losses experienced because of the disease process, something special can still help their loved one to feel comforted, cared for, and cared about in a unique loving environment.
Page 46-50.

Continuity in the Midst of Change: Behaviors of Residents Relocated from a Nursing Home Environment to Small Households
A time-sampling procedure was used to observe behaviors of 22 long-term-care residents with dementia (Mini-Mental State Exam median, 11.94; range 0-23) in public areas before and after relocation from a traditional nursing home environment to 2 small household units. Two trained observers noted the occurrence of 19 social behaviors (14 verbal, 5 nonverbal) in which the resident intentionally interacted with another person. Another 19 nonsocial behaviors (16 active, 3 passive) were also coded. Analysis by t tests of 6 groupings of behaviors showed no significant differences before and after relocation, with the exception of nonverbal social interactions. Overall, residents showed consistency in both social and nonsocial behaviors. Results are interpreted in light of personal, social, and environmental continuity despite the many changes associated with the relocation.
Page 51-57.

EEG Markers Discriminate Among Different Subgroup of Patients With Mild Cognitive Impairment
Aim of the study is to discriminate among participants with mild cognitive impairment through electroencephalography brain rhythms. A total of 79 participants with MCI were classified into 4 subgroups based on the beginning of memory complaints up to the time of first visit. All participants underwent electroencephalography recording, magnetic resonance imaging, apolipoprotein E characterization, and volumetric morphometry estimation of hippocampal region. Electroencephalography markers show 2 distinct patterns: (1) increase of theta/ delta power ratio and highest value of alpha2 band power in the group with shorter duration of disease, the greater right-left hippocampal volume difference and worst memory performance; (2) the highest value of alpha3 band power and the highest alpha3/alpha2 power ratio in the group with the lesser total hippocampal volume but preserved memory performance. Apolipoprotein E4 is linked to a major risk of early beginning of disease. Electroencephalography markers allow a mean correct percentage of correct classification up to 89%.
Page 58-73.

Designing Leisure Products for People With Dementia: Developing ‘‘the Chitchatters’’ Game
Providing leisure to people with dementia is a serious challenge, for health care professionals and designers and engineers of products used for activity sessions. This article describes the design process of ‘‘the Chitchatters,’’ a leisure game for a group of people with dementia in day care centers. The game aims to stimulate social interaction among people with dementia. Different stakeholders, such as older adults with dementia, their relatives and care professionals were involved in the design process via qualitative research methods as participant observation and the use of probes. These methods were applied to give the design team insight into the experiential world of people with dementia. This article presents how design insights from practice and literature can be translated into a real design for a leisure product for group use by older people with dementia, and shows designers how to work with, and design for, special groups.
Page 74-89.

Activities directors' quarterly volume 10 number 4

Contents
Notes from nursing:
Tips for helping older adults with dementia who suffer from hearing loss, includes common symptoms. p. 5

All functioning levels

Creating time well spent with nursing home residents
includes communication strategies, activity ideas - that can be modified for the family cargivers. eg Reminiscence, music , reading, movies, radio shows and TV shows. Plus issues with hearing problems and quick visits …p.7

Cooking groups in therapeutic recreation in the nursing home
Cooking programs have the potential to increase appetite, calm, and entice people to engage in social interactions as well as reminisce as well as relieve stress and improve physical and cognitive stimulation. includes a list of skills needed by the facilitator and special considerations such as selection criteria of the participants, and hygiene and food safety issues and cooking without a kitchen….p. 13

Featured lesson plan
2010 indoor golf club
includes lesson plan, size o f group, equipment needed and objectives; such as socialization, improved mood, decreased wandering, improved concentration, and self esteem and reduced passivity…p. 23

seasonal planner
includes winter activities, women’s history month and St. Patrick’s Day

Proven activities
Ipod music project
Participants to design personal play lists, Outcomes include: reduced boredom, improved motor skills and concentration and self esteem…p. 26


The therapeutic value of nature in dementia interventions
Integrating the natural environment into daily routines can be an easy but meaningful part of the interactions with residents. It is the primary natural source of multi sensory therapy stimulation with the person with dementia. Looks at the environment and human connections and the therapeutic response as well as the potential benefits shown in the research and a list of suggested activities which includes conversation topics such as ‘how good it is to have hot soup after a walk in the cold”…p. 41

INsite aged care - Feb/Mar 2010 Issue 58

Poster
Activities for comfort, includes Men’s reminiscing, guided visualisations, comforting food, laughter therapy and other comfort activities.

Government program still in transition: study more
New research raises questions about transition care program.
The transition care program has not achieved its goal of improving the flow of older people moving between hospitals, community and residential sectors, new research has found. The study linked, for the first time, data from all sectors including hospital and aged care places, both flexible and mainstream, across Australia at the ACAT regional geographical level. The study, led by Dr Lynne Giles of Adelaide University, and including Professor Len Gray from Queensland University, was published in the November issue of Australian Health Review. The first 594 transition care packages were...p. 4

The greyer the doctor, the better the care more
Providing medical students with exposure to healthy older people may help promote positive attitudes, research says.
Older doctors and doctors with more experience with the elderly have a more positive attitude towards older people, a new survey has found. Researchers analysed responses from 122 doctors to a survey designed to gauge attitudes towards older people, according to a report in the Internal Medicine Journal. It found that doctors who were aged over 30, female, more senior in position, had social contact with elderly people or who had experience in aged care showed a more positive attitude towards older people. The authors said the attitudes were similar to results from other various population...p.5

Food back in focus more
Dietitians call for routine screeing program for malnutrition.
Resident malnutrition is back in the news with a Queensland Health briefing paper that found malnutrition is "highly prevalent" in aged care facilities. It said malnutrition could be costing Queensland more than $13 million a year. It was blamed for extended hospital stays and causing illness and disease. Queensland Health's patient safety centre conducted a six-month investigation into malnutrition in acute and aged care in 2008, the Courier Mail reported. It found that 30 per cent of hospital patients and 50 per cent of aged care facility residents suffered from malnutrition…p. 9

The future's grey more
Intergenerational report further evidence of need for reform, peak bodies say.
Another report, another worrying prediction. Industry leaders have seized on the third Intergenerational Report (IGR3), released last week, as further evidence of the need to reform aged care. They say that combined with previous reports from the Productivity Commission and the Senate enquiry into aged care, the government will have no choice but to implement major policy changes to address immediate issues and plan for future demand. IGR3 found the number of people aged 65 to 84 will more than double by 2050, while the population of those aged 85 and over will more than quadruple. By 2050,...

We’re in the money, for now
High care and community care best performers in financial report.
There was a significant improvement in the financial performance of residential facilities, particularly those in high care, during the first quarter of the financial year, new figures show. But the authors of the financial survey said it was unlikely these results would be sustained for the remainder of 2010. However, it may be an insight into what the future holds as the cap on subsidies is removed, they said. The Stewart Brown financial survey for the three months ended 30 September 2009 found 47 per cent of high care facilities achieved an operating profit, up from 21 per cent in June... p. 5

ACAR announced, three months late more
But will ghost beds come back to haunt Justine Elliot?
The Minister for Ageing, Justine Elliot, has finally announced details of the 2010-11 Aged Care Assessment Round (ACAR), almost three months later than expected. It is thought the delay was caused by the threats of providers in all states not to apply for beds, and the possibility of an under subscribing of applications similar to the 2009-10 ACAR. The belated announcement on 22 January offered 8140 beds and 4078 community care packages. If successfully subscribed, it would enable a big pre election announcement on the government's commitment to aged care, when applications have been...

Court ruling puts professional boundaries in focus
Lawyer warns providers of the need for policy outlining parameters of professional relationship with clients.
A registered nurse in Queensland has been found guilty of professional misconduct following her relationship with an elderly man. Last November, the Supreme Court of Queensland Court of Appeal overturned the decision of a District Court regarding a Nursing Council tribunal finding a registered nurse guilty of professional misconduct. It was alleged she had gone beyond her professional duty to the deceased. Following her work with him in his home, as an employee of Blue Care, she entered the role of an unpaid carer and friend, while failing to clarify that her professional relationship had...p. 7

Management & Finance:
Much ado about nothing?
The much lauded handover of home and community care services to the Commonwealth appears to have stalled. Where did it all go wrong? And what does it mean for the reform agenda?
Many are reading it as an ominous sign for the more ambitious health reforms. The government has put the transfer of home and community care services (HACC) from states and territories to the Commonwealth - announced in August 2008 - into the too hard basket. It appeared to be a done deal at the Council of Australian Governments (COAG) meeting on 2 October 2008, (INsite, October/November 2008). The states would hand over community aged care funding responsibilities (primarily HACC) in return for accepting responsibility for disability and community-based mental services from the Commonwealth....p. 10

Aged care's angels
From the kitchen to the activities room to the facility bus, volunteers are making a difference in aged care.
Social commentators would have you believe the volunteer is a dying breed. These days, Australians aren't interested or simply don't have the time. Those same commentators might like to visit one of the many aged care facilities across Australia where volunteers are an intricate part of the social fabric. In fact, statistics from 2007, the most recent available, show that over 330,000 people gave up their free time to volunteer in the health sector, providing more than 12 million hours of service. Aged care is a particularly popular area for these good smaritans, traditionally in residential...p.12

Changing hands more
number of facilities are up for grabs with several state governments planning sell-offs. But such moves can be politically costly.
The NSW government's attempt to sell off 11 state-owned aged care facilities has stalled. The process, announced by then health minister John Della Bosca in March 2009, was meant to conclude by early 2010. It has now blown out to late 2010 - taking it closer to the state election in March 2011. Political instability, ministerial changes in the health portfolio and strong local opposition - including from local state labor MPs - forced a back down in Wallsend, in the Hunter Valley and Murrumburrah Harden. New health minister Carmel Tebbutt said on 21 December that the expressions of interest...

Size matters more
New research raises important questions about optimum
Facility size and its links to efficiency and equity of access. Bigger is not necessarily better in aged care, especially for residents with special needs. That's one of the major findings from a groundbreaking new study of all aged care homes in Queensland. Its author, quality assessor Dr Bev Richardson, analysed the results of the first two accreditation rounds. She found the state's dominant provider, Blue Care, which manages 85 homes, had lower average compliance rankings than other large and small providers. Her research raises important issues for government, policy-makers, and service...p. 18

Building & Refurbishment
From household to neighbourhood more
Aged care should be designed to encourage living in place, not ageing in place.
Creating, eating, dancing, dating, visiting, learning, socialising, working, singing, shopping, engaging - not just ageing. The challenge for providers and designers of living environments for older people is to afford opportunities for all these activities and more, not in a prescriptive, functional way, but in an inclusive and flexible manner that responds to individual need. Much has been written about models of living for the general population trying to identify the key elements necessary to establish successful communities or neighbourhoods…p.25

The cost of indifference more
With rising energy prices, and the growing public appetite for energy efficiency, how long can providers afford to waste money on inefficient buildings.
Most aged care facilities we visit are wasting up to $50,000 per year simply by running their buildings inefficiently. When asked, most of our clients say they never, or rarely, review their operations to identify areas of waste or inefficiency. The average 100 bed facility spends between $800 and $2000 per annum, per bed on electricity. That can average out to a cost of between $80,000 and $200,000 annually. Most of those facilities are generally at least 20 years old. However, in many cases they may be only two or three years old. It is amazing that many of the new facilities waste as much...p.27

Technology
We've only just begun more
With rising energy prices, and the growing public appetite for energy efficiency, how long can providers afford to waste money on inefficient buildings
Most aged care facilities we visit are wasting up to $50,000 per year simply by running their buildings inefficiently. When asked, most of our clients say they never, or rarely, review their operations to identify areas of waste or inefficiency. The average 100 bed facility spends between $800 and $2000 per annum, per bed on electricity. That can average out to a cost of between $80,000 and $200,000 annually. Most of those facilities are generally at least 20 years old. However, in many cases they may be only two or three years old. It is amazing that many of the new facilities waste as much...p.34

Lifestyle
A life worth living more
A new model for resident wellness could very well be the future of aged care.
Highercombe home in Hope Valley, Adelaide isn't your typical nursing home. ACH Group's newest facility, which opened its doors last October, is operating under an innovative new model of resident wellness. At its core is a partnership between staff and residents, with both parties sharing the responsibility of achieving improved mental health and physical outcomes. "It's a model that consciously addresses the low expectations that older people often have of their goals, skills and capacity to retain or regain a rewarding and satisfying life," …

Nutrition
Calling in the experts more
Accredited dietitians play a key role in maintaining resident health and wellbeing.
Aged care professionals must work together to help people living in residential aged care and community care lead healthier, happier lives. And in order to effectively partner with dietitians, aged care staff need a good understanding of the type of services dietitians provide, when to refer and how to find a suitable practitioner. Dietitians translate scientific nutrition information into practical advice to help people make the right decisions about what to eat. A dietitian assesses a patient's nutritional and medical history, reviews biochemistry or other relevant test results, and takes a...p.33

Alzheimer's Care Today - Vol 11 January/March 2010

Dementia Care Training in Nursing Homes and Assisted Living Settings, Part 1
p.1-3, .

DEPARTMENTS
Moving From Research to Best Practice

Research Updates: The Importance of Relationships in Nursing Homes and Residential Care/Assisted Living Settings p. 4-5,

Best Practices
The Foundations of Dementia Care: Context for a Program Evaluation Research Study
Foundations of Dementia Care is the evidence-based training curriculum developed as a key component of the Alzheimer's Association's Campaign for Quality Residential Care, a comprehensive and multifaceted initiative with the goal of enhancing the lives of residents with dementia. This article discusses the development of this national dementia care training program, including the process of formation, curriculum design, conceptual influences, and tools for delivery. It also introduces the 4-state, control-designed evaluation research study conducted by researchers at the University of North Carolina and Duke University to assess the impact of the program. p. 6-16,

Challenges and Strategies for Implementing and Evaluating Dementia Care Staff Training in Long-term Care Settings
Evidence suggests that staff training in dementia care can improve the quality of care and the quality of life for older adults in nursing home (NH) and residential care/assisted living (RC/AL) settings. Although there is a great need for staff to be trained in dementia care, the long-term care setting poses challenges for training and uptake of new practices. This article provides a review of the published literature on dementia care staff training in NHs and RC/AL settings, the challenges faced when conducting training, and how these challenges influence the evaluation of its effectiveness. The authors examined this issue by reviewing 382 articles published between 1995 and 2009, with 25 articles meeting the review's inclusion criteria of provided staff training in dementia care, being conducted in an NH or RC/AL setting, focusing on changing overall dementia care practices (instead of single issues such as wandering or incontinence), or providing a review of relevant literature. Findings suggest that staff training is challenged by low staff attendance, lack of organizational support, and financial limitations. This review highlights the need for practical strategies to better focus and conduct staff training, such as involving community members and practitioners in the content and design of training. p. 17-39, .


Research
Dementia Care Training for Long-term Care Staff: If You Provide It, Will They Come?
The number of older adults with dementia who reside in long-term care (LTC) settings is large and increasing, meaning that the need for a well-trained workforce will become increasingly important. This article examines the percentage of LTC staff in 16 facilities who attended the 6-session Foundations of Dementia Care training program and the characteristics related to higher attendance. Overall, 62% of staff attended at least 1 training session, and they attended 42% of all training sessions. There was no difference in attendance by setting (nursing home or residential care/assisted living) or staff type (supervisor or direct care staff). However, the odds of attending the training increased with staff age, and the odds were higher for staff reporting more effective leadership and who worked in facilities that were more tolerant of residents who displayed behavioral symptoms. These findings suggest strategies to increase attendance in staff training programs in LTC settings. p. 40-50, .


Implementation Fidelity of a Standardized Dementia Care Training Program Across Multiple Trainers and Settings
Few staff training programs examine implementation fidelity (the extent to which the training was provided as planned). Poor fidelity affects whether trainees receive the content that was intended and achieve the related outcomes. This study examined the extent of fidelity in the Foundations of Dementia Care training program, measuring fidelity by the use of key words, trainer additions to the script, and session duration. A total of 119 sessions of this training program were implemented in 9 nursing homes and 6 residential care/assisted living communities participating in the Collaborative Studies of Long-Term Care. Results indicate that some or all key words were delivered in more than 85% of the sessions. There was significant variability in fidelity across session and across trainer-level variables. The article concludes with strategies to maintain fidelity in training programs intended for diverse settings, including identifying core components, better adhering to the script in interactive sessions, and recognizing trainer characteristics related to fidelity. p. 51-60, .

Trainee and Trainer Reactions to a Scripted Dementia Care Training Program in Residential Care/Assisted Living Settings and Nursing Homes
Standardized, scripted training programs to educate staff members who work in long-term care (LTC) have the potential to be replicated across diverse settings because scripted material helps ensure that the program is delivered consistently and as intended by developers. While there are potential benefits to such standardization, little is known about trainee and trainer reactions to scripted training programs. This study, one of the Collaborative Studies of Long-Term Care, investigated trainee and trainer reactions to a scripted training program developed for staff members who care for residents with dementia in LTC settings. Specifically, we examined the extent to which the degree of adherence to the script (ie, implementation fidelity) was related to (1) trainee satisfaction, (2) trainee rating of trainer knowledge, (3) trainer rating of program effectiveness and relevance, and (4) the trainer's perception of trainee interest. Results indicate that higher trainee satisfaction and higher trainee rating of trainer knowledge were significantly related to the amount of implementation fidelity. Trainer additions to the script were related to their own lower ratings of session effectiveness and perceived trainee interest. However, trainers had some unfavorable reactions to reading a script. These results suggest that adhering to a standardized training program may be received positively by trainees, although trainers may need to become more comfortable with such standardization.
p. 61-70, .


DEPARTMENTS
Tips & Strategies
….In addition to helping your client evaluate Web site, there is some additional
information that you will want to share with them regarding using
Internet-based resources.
1. It is important to remember that a Web site should support but not
replace the patient/healthcare provider relationship. Always discuss
information gleaned from Internet resources with your healthcare
provider. Ask your healthcare provider for a list of reliable health
Web sites to use.
2. Be cautious about providing personal information on Web sites.
Always read the privacy statement before providing any information.
3. Compare information from a variety of Web sites to further validate
accuracy and currentness.
p. 71-72,

Alzheimer's & Dementia: The Journal of the Alzheimer's Association - January 2010 - Vol. 6, No. 1

• Full text articles are available to fee paying members of Alzheimer’s Australia NSW by emailing lis@alznsw.asn.au

Featured Articles

Efficacy of a medical food in mild Alzheimer's disease: A randomized, controlled trial
To investigate the effect of a medical food on cognitive function in people with mild Alzheimer's disease (AD).
Methods
A total of 225 drug-naïve AD patients participated in this randomized, double-blind controlled trial. Patients were randomized to active product, Souvenaid, or a control drink, taken once-daily for 12 weeks. Primary outcome measures were the delayed verbal recall task of the Wechsler Memory Scale–revised, and the 13-item modified Alzheimer's Disease Assessment Scale–cognitive subscale at week 12.
Conclusions
Supplementation with a medical food including phosphatide precursors and cofactors for 12 weeks improved memory (delayed verbal recall) in mild AD patients. This proof-of-concept study justifies further clinical trials. pages 1-10.e1


Outcome over seven years of healthy adults with and without subjective cognitive impairment
Subjective cognitive impairment (SCI) in older persons without manifest symptomatology is a common condition with a largely unclear prognosis. We hypothesized that (1) examining outcome for a sufficient period by using conversion to mild cognitive impairment (MCI) or dementia would clarify SCI prognosis, and (2) with the aforementioned procedures, the prognosis of SCI subjects would differ significantly from that of demographically matched healthy subjects, free of SCI, termed no cognitive impairment (NCI) subjects.
Conclusions
These results indicate that SCI in subjects with normal cognition is a harbinger of further decline in most subjects during a 7-year mean follow-up interval. Relevance for community populations should be investigated, and prevention studies in this at-risk population should be explored.
pages 11-24


Toward an Alzheimer's disease diagnosis via high-resolution blood gene expression
There is a significant need for reliable molecular biomarkers to aid in Alzheimer's disease (AD) clinical diagnosis.
Methods
We performed a genome-wide investigation of the human transcriptome, taking into account the discriminatory power of splice variations from the blood of 80 AD patients and 70 nondemented control (NDC) individuals.
Conclusions
This study provides proof-of-concept that whole-blood profiling can generate an AD-associated classification signature via the specific relative expression of biologically relevant RNAs. Such a signature will need to be validated with extended patient cohorts, and evaluated to learn whether it can differentiate AD from others types of dementia. pages 25-38


Disease progression meta-analysis model in Alzheimer's disease, 10 July 2009
Various authors have evaluated disease progression in Alzheimer's disease (AD), using patient data from individual clinical studies or pooled data across various trials. We conducted a systematic review of public data sources from 1990 to 2008 for all available AChE inhibitor studies, as well as clinical studies that evaluated the rate of deterioration in AD patients. Unique to this analysis, we developed a model based on literature data to describe the longitudinal response in the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-cog) (change from baseline) in mild to moderate severity AD patients. The model was used to estimate disease progression for both placebo-treated patients and acetylcholinesterase (AChE)-inhibitor treated patients, and factors that affected disease progression.
Methods
We collected 576 mean ADAS-cog changes from baseline data points of 52 trials, representing data from approximately 19,972 patients and more than 84,000 individual observations. The model described the rate of disease progression, the evident placebo effect, and the symptomatic effect of AChE-inhibitors. Baseline ADAS-cog, Mini-Mental State Examination score, age, and year of publication were tested as covariates.
Conclusions
Baseline ADAS-cog is a significant covariate affecting the rate of disease progression, and it describes or at least explains the different rates of deterioration evident in early or late stages of the disease. There was no significant impact of publication year in the model, suggesting that disease progression has not slowed in more recent trials. pages 39-53


White matter integrity and cortical metabolic associations in aging and dementia
Studies show that white matter hyperintensities, regardless of location, primarily affect frontal lobe metabolism and function. This report investigated how regional white matter integrity (measured as fractional anisotropy [FA]) relates to brain metabolism, to unravel the complex relationship between white matter changes and brain metabolism.
Objective
To elucidate the relationship between white matter integrity and gray matter metabolism using diffusion tensor imaging and fluorodeoxyglucose-positron emission tomography in a cohort of 16 subjects ranging from normal to demented (age, >55 years).
Methods
Mean FA values from white matter regions underlying the medial prefrontal, inferior-lateral prefrontal, parietal association, and posterior temporal areas and the corpus callosum were regressed with glucose metabolism (by positron emission tomography), using statistical parametric mapping (P <>100). Regional cerebral glucose metabolism was the primary outcome measure. According to our hypothesis, those hypometabolic cortical regions affected by Alzheimer's disease would correlate with a lower FA of associated tracks.
Conclusions
These regions are associated with cognitive processes affected in Alzheimer's disease and cerebrovascular disease, suggesting a link with white matter degeneration and gray matter hypometabolism. Therefore, cortical function and white matter degeneration are related in aging and dementia. pages 54-62


Subtypes of depression among patients with Alzheimer's disease and other dementias
We compared the prevalence of subtypes of depression in patients with Alzheimer's disease (AD), vascular dementia (VaD), and unspecified dementia (UD).
Methods
Using the Integrated Healthcare Information Services database, we conducted an analysis of subtypes of depression (major depressive disorder, depressive disorder not otherwise specified, dysthymic disorder; depressive psychosis, and adjustment disorder depressive) among patients with AD, VaD, and UD. Six thousand four hundred and forty patients aged 60 years or older with dementia (2947 with AD, 725 with VaD, and 2768 with UD) were identified from January 1 to December 31, 2001. Both subtypes of depression and dementia subgroups were diagnosed using criteria from the International Classification of Diseases, 9th version.
Conclusions
This study supports the view that depressive disorders are more prevalent in VaD compared with UD and AD, and provides indicators to the clinician for further evaluation of depression in dementia subgroups. pages 63-69

Perspectives

Rivastigmine for the treatment of dementia in patients with progressive supranuclear palsy: Clinical observations as a basis for power calculations and safety analysis
Cognitive decline and dementia are present in about 50% of patients with progressive supranuclear palsy (PSP). Based on the known involvement of the cholinergic system in PSP patients, and because rivastigmine, in contrast to other cholinesterase inhibitors, inhibits both acetylcholinesterase and butyrylcholinesterase, we discuss clinical observations of five patients suffering from PSP and dementia who were all treated with rivastigmine over a period of 3 to 6 months. We found a slight improvement in specific cognitive function that may justify further controlled studies. A calculation of sample size revealed that a study on the effect of rivastigmine in PSP should include about 31 patients to detect a significant effect. In subtests, meaningful results can be obtained with even lower numbers (five patients for a verbal fluency test, and 14 patients for a logical memory task). pages 70-74


Early dementia diagnosis and the risk of suicide and euthanasia
Brian Draper, Carmelle Peisah, John Snowdon, Henry Brodaty
Diagnosis of dementia is occurring earlier, and much research concerns the identification of predementia states and the hunt for biomarkers of Alzheimer's disease. Reports of suicidal behavior and requests for euthanasia in persons with dementia may be increasing.
Results
In the absence of any effective treatments for Alzheimer's disease or other types of dementia, there is already evidence that persons with mild cognitive change and early dementia are at risk of suicidal behavior, often in the context of comorbid depression. The ensuing clinical, ethical, and legal dilemmas associated with physician-assisted suicide and euthanasia in the context of dementia are a subject of intense debate. By analogy, the preclinical and early diagnoses of Huntington's disease are associated with an increased risk of suicidal behavior. Thus there is the potential for a preclinical and early diagnosis of Alzheimer's disease (through biomarkers, neuroimaging, and clinical assessment) to result in increased suicide risk and requests for physician-assisted suicide.
Conclusions
Although dementia specialists have long recognized the importance of a sensitive approach to conveying bad news to patients and families and the possibility of depressive reactions, suicidal behavior has not been regarded as a likely outcome. Such preconceptions will need to change, and protocols to monitor and manage suicide risk will need to be developed for this population. pages 75-82

Correspondence

Alzheimer's disease and infection: Do infectious agents contribute to progression of Alzheimer's disease?
pages 83-84


Commentary on the letter for Alzheimer's disease and infection: Do infectious agents contribute to progression of Alzheimer's disease?
page 85

Journal of Dementia Care - Vol.18 No 1. Jan/Feb 2010

Full text articles are available to fee paying members of Alzheimer’s Australia NSW by emailing lis@alznsw.asn.au

Transforming hospital care
sets out what needs to change in care for people with dementia on general hospital wards…p. 12

Good practice shared
objects include: Improving public and professional awareness and understand of dementia…p. 14

Improving dementia care in care homes and general hospitals
in this regular update on implementing the National dementia strategy - we describe the challenges for general hospitals and care homes.
dementia.dh.gov.uk
myhomelife.org.uk
p. 15

Cognitive rehabilitation - help to manage memory loss
looks at background research; course structure; Person centred approach; exchange strategies and follow up…p. 16

Work out at the memory gym
Report on groups for people with mild memory impairment - at the Portsmith memory gym, the emphasis is on cognitive exercises and practical tasks to pursue at home…p. 18

Creative interaction with people with advanced dementia
looks at creative communication and activities includes: tapping and patting; stroking; pressing; pulling; folding; picking at and wrapping, concealing…p. 20

Brain and person centred care
Making sense of the paradoxes of dementia
explains how an understanding of the organisation of the human brain and the fact that it is not one structure but many can help us understand some puzzling aspects of dementia p. 27

Three tires for a comprehensive regional memory service
looks at the functions of primary care component of the memory service (such as identifying people who have problems with memory..) and the functions of the district memory service (raise profile and knowledge of memory disorders including dementia…) and suggested staffing of district memory service and finally functions of the regional memory service..p.28

What have we have learned from teaching dementia studies?
and how these things will impact on the National dementia strategy…p. 29

Book reviews
Telling tales about dementia
The stories told here vividly reflect the tragedy of dementia, the gravity of loss, and instances of unsatisfactory diagnosis, treatment and care. But they contain hope and optimism too: clear indications that the quality of people's lives can be enhanced by sensitive support services, by improved understanding of the impact of dementia, by recognising the importance of valuing us all as human beings, and by embracing and sustaining the connections between us.This unique collection of personal accounts will be an engaging read for anyone affected by dementia in a personal or professional context, including relatives of people with dementia, social workers, medical practitioners and carers.

Connecting through music with people with dementia a guide for caregivers
This user-friendly book demonstrates how even simple sounds and movements can engage people with dementia, promoting relaxation and enjoyment. All that's needed to succeed is a love of music, and a desire to gain greater communication and more meaningful interaction with dementia sufferers. Even those who have lost many social and intellectual capabilities will still enjoy connecting with others through voice and rhythm, and be able to involve themselves in musical dialogue. Suitable for students or entry level professionals in music therapy, nursing, therapeutic recreation and care-related fields, Connecting Through Music with People with Dementia will also appeal to volunteers and family members caring for a person with dementia.
p. 32

End-Of-life care report
End of life care for people with dementia
Commissioners in Haringey expressed a desire to work with Marie Curie Cancer Care in undertaking a baseline review of end of life care for people with dementia, leading to recommendations to improve access to palliative care services for this patient group.
This was the first project that Marie Curie Cancer Care has undertaken to examine the specific needs of people with advanced neurodegenerative disease.
The objectives of the project were to:
Identify the major barriers for dementia patients and their carers in accessing good quality end of life care
Suggest cost effective ways of enabling improvements based on review findings p… 34

Achieving gold standard end-of-life care for people with dementia
care bones play a major role in supporting people with dementia at the end of their lives. Seeking to understand the views of staff on the care they provide - we look at focus groups and discuss the findings…p. 36

Journal of Gerontological Nursing - Vol. 35 No. 12 December 2009

Guest Editorial
Transitional Care: What Does It Mean for Nurses?
Most of you probably know something about transitional care. But what you may not know is that it is one of the most exciting emerging areas of nursing and health care in the country. Transitional care includes actions ensuring the coordination and continuity of care between settings (e.g., hospitals, nursing homes, patients’ homes, physicians’ offices). It is based on a comprehensive plan of care and involves health care practitioners who have current information about the patient’s goals, preferences, and clinical status (Coleman & Boult, 2003).


News

Public Policy
Caring for an Aging Population: Review of Policy Initiatives
Due to the aging population in the United States, there will be a need for a larger workforce that is prepared to provide care to an older adult population. The Institute of Medicine has noted challenges related to the preparation of a geriatric workforce due to lack of faculty, inconsistent curricula, and few training opportunities, and has made recommendations to increase the geriatric workforce. In this article, several policy initiatives are discussed that address the shortage of health professionals prepared to care for older adults. Initiatives by professional nursing organizations to improve the gerontological nursing workforce are also reviewed.



Clinical Concepts
Older Patients in the Emergency Department: What Are the Risks?
The emergency department (ED) can pose an increased risk for frail older adults. As the number of older adults in the general population grows, so will the number of older adults who seek care in the ED. This article examines the kinds of problems for which older adults visit the ED and the assessments that can be performed to help reduce risks. Geriatric-friendly waiting areas, comprehensive discharge planning, and alternatives to ED visits are explored.

Feature Articles
Rest-Activity Patterns in Institutionalized Korean Older Adults with Dementia: A Pilot Study
This pilot study examined rest-activity patterns and related factors in institutionalized older adults with dementia in Korea. Twelve individuals, residing in either a nursing home or an assisted living facility, participated in the study. Actigraphic measurements were collected for seven consecutive 24-hour periods to assess rest-activity patterns. The participants’ demographic characteristics, cognitive function, problematic behaviors, and light exposure were also assessed. The results indicated the participants experienced sleep disturbances, including multiple awakenings at night and excessive daytime napping. Those in the nursing home had significantly more interdaily stability and less intradaily variability, with higher relative amplitude in their rest-activity rhythms, indicating more stable and stronger rest-activity rhythms than those in the assisted living facility. These findings emphasize the importance of the institutional environment in care planning to improve sleep and rest-activity rhythm for older adults with dementia.

The U.S. Correctional System and the Older Prisoner
Although older prisoners may seem an unlikely article topic, the reality is that the likelihood of health care providers encountering a prisoner who has been released is high. In addition, men age 50 and older are the fastest growing age cohort in prisons. Older prisoners consume disproportional health care resources of correctional institutions. Long histories of no medical care, alcohol and substance abuse, and poor diet contribute to a 10- to 11.5-year addition to chronological age and contribute to the risk for chronic conditions, which are prevalent, often lead to functional impairments, and require careful and deliberate management strategies. This is, however, not that different from the “free world,” where chronic illnesses account for the greatest cost burden and disability in the United States. Consequently, health care providers need an understanding of the challenges faced by this vulnerable population, as well as issues related to the graying of American prisoners.

Helping Older Adults Find Meaning and Purpose Through Storytelling
The purpose of this article is to describe a storytelling project that was designed to help community-dwelling older adults find meaning and purpose in their lives through reminiscing about the past. The storytelling project was successful not only for the older adults who participated but also for the nursing students, who were given an opportunity to learn about interviewing and communicating with older adults. The value of life review and storytelling as a nursing intervention became evident from this project. When time is taken to listen to the valuable stories and life lessons of the older population, nurses create a better understanding of their patients while their patients recall special memories and feel proud of their lives.

The New Adult Orphan: Issues and Considerations for Health Care Professionals
The death of the last parent has a profound effect on survivors. Health care workers are often the first source of anticipatory guidance for newly orphaned adults as they cope with grief, loss, and awareness that their lives are forever changed. It is estimated that more than 80 million Americans were born between 1946 and 1964. As this Baby Boomer generation, often defined as seeing themselves as culturally special, becomes “orphaned,” they may be less aware, less prepared, and less supported than any previous group of Americans regarding this life event. For a number of adults, the loss creates many unexpected results that can destabilize life in profound ways. This article describes the unique new realities of helping adult orphans as they relate to health care providers and discusses the problems associated with prolonged and complicated grief. Implications for geriatric caregivers, mental health providers, health educators, and others are proposed.

New resources for carers

Telling tales about dementia : carers share their stories

How does it feel when someone you love develops dementia? How do you cope with the shock, the stress and the grief? Can you be sure that you and your family will receive the support you need? In "Telling Tales About Dementia", thirty carers from different backgrounds and in different circumstances share their experiences of caring for a parent, partner or friend with dementia. They speak from the heart about love and loss


Alzheimer's disease

Chapters include an introduction to dementia and Alzheimer's disease, aging; memory; depression; medications; alternative treatments; stages and prognosis of the disease; a chapter for caregivers; and much more.



Alzheimer's : what you must know to protect your brain and improve your memory. Dr Sandra Cabot's ground breaking 4-point program

Presenting detailed information on how exactly Alzheimer's affects the brain, and how other medical problems can mimic its symptoms, and providing vital techniques that can be implemented to sustain and improve memory, this comprehensive guide is essential for those who are or who know someone who is suffering from Alzheimer's disease, or want to take steps to reduce the risks.



Alzheimer's disease : the dignity within : a handbook for caregivers, family and friends

It contains information on how to take care of a person with Alzheimer's disease by mapping out each stage of the disease and showing what can be done from a caregiving standpoint at these various stages. In addition, the book discusses how important it is for caregivers to take care of themselves. It educates readers with easy-to-understand charts and sketches on what physically happens to the brain during the progression of Alzheimer's.

Australian Ageing Agenda - Jan/Feb 2010

Full text articles are available to fee paying members of Alzheimer’s Australia NSW by emailing lis@alznsw.asn.au

Confronting isolation
Looks at a study from WA…p. 8

In from the cold
Social isolation, discrimination and fear - just a few of the devastating issues faced by lesbian and gay people with dementia revealed by a recent report by Alzheimer’s Australia Dementia, lesbians and gay men p. 12

Workforce
A dynamic place to work - staff at a respite centre in WA are so happy that they come back to work as volunteers when they are not rostered on…looks at banishing boredom using the Eden philosophy (see library dvds and books) …p. 27

The cost of caring
Creating a supportive and emotionally secure workplace is important for worker’s morale but it may also help buffer them against the devastating effects of compassion fatigue…p. 32

Dementia supplement
A learning journey - developing leaders in dementia care …p. 34

Silver chain
forging innovative health links
This not-for-profit health care provider has a long history of helping those in need stay in their own homes - now is looking at integrating technology and leading -edge practice to create an inspiring community care approach…p. 37

Alzheimer Disease & Associated Disorders - October December 2009 - Volume 23 - Issue 4

• Full text articles are available to fee paying members of Alzheimer’s Australia NSW by emailing lis@alznsw.asn.au

On Cholesterol Levels and Statins in Cognitive Decline and Alzheimer Disease: Progress and Setbacks
p. 303-305

Missed and Delayed Diagnosis of Dementia in Primary Care: Prevalence and Contributing Factors
p. 306-314
Dementia is a growing public health problem for which early detection may be beneficial. Currently, the diagnosis of dementia in primary care is dependent mostly on clinical suspicion on the basis of patient symptoms or caregivers' concerns and is prone to be missed or delayed. Possible predictors and contributory factors were determined from the text of quantitative and qualitative studies of patient, caregiver, provider, and system-related barriers. Overall estimates of diagnostic sensitivity varied among studies and seemed to be in part a function of dementia severity, degree of patient impairment, dementia subtype, and frequency of patient-provider contact. Major contributory factors included problems with attitudes and patient-provider communication, educational deficits, and system resource constraints. The true prevalence of missed and delayed diagnoses of dementia is unknown but seems to be high. Until the case for dementia screening becomes more compelling, efforts to promote timely detection should focus on removing barriers to diagnosis.


Original Articles
The Relationship of Plasma A[beta] Levels to Dementia in Aging Individuals With Down Syndrome
p. 315-318
Consistent with recent reports regarding the effect of presenilin mutations on peptide generation, our finding supports the theory that the ratio of A[beta]42 to A[beta]40 rather than absolute levels of the peptides is important to the pathophysiology of Alzheimer's disease in genetically susceptible populations.

Gelsolin Levels are Increased in the Brain as a Function of Age During Normal Development in Children That are Further Increased in Down Syndrome
p. 319-322
Neuronal dysfunctions in several neurodegenerative diseases such as Down syndrome (DS) have been linked to oxidative stress. In this study, we observed that lipid peroxidation, a marker of oxidative stress, is significantly increased in the frontal cortex of brains of individuals with DS as compared with control subjects.

Increasing Hippocampal Atrophy and Cerebrovascular Damage Is Differently Associated With Functional Cortical Coupling in MCI Patients
p. 323-332
The aim of this study was to assess the changes of intrahemispheric and interhemispheric linear spectral electroencephalography (EEG) coherence associated with increasing hippocampal atrophy (HA) and white matter hyperintensities (WMHs) in patients with mild cognitive impairment (MCI). Eighty-five MCI patients underwent clinical and neuropsychologic assessment, EEG recordings, and magnetic resonance imaging.

MRI Substudy Participation in Alzheimer Disease (AD) Clinical Trials: Baseline Comparability of a Substudy Sample to Entire Study Population
p. 333-336
Objective: To determine if a self-selected group of participants who enroll in an imaging substudy of Alzheimer disease (AD) clinical trials is representative of the overall study sample.
Conclusions: The groups of individuals who agreed to participate in the imaging substudies of AD trials were remarkably comparable to the comparison groups at baseline on a wide range of demographic and clinical measures; there seems to be a minimal effect of self-selection bias. The results indicate that it may be reasonable to generalize findings in an imaging substudy to the complete the study population.


Rapidly Progressive Dementia: Causes Found in a Greek Tertiary Referral Center in Athens
p. 337-346
Dementia is generally considered as rapidly progressive [rapidly progressive dementia (RPD)], in cases with overt cognitive impairment, established within months. Data about the relative frequency of underlying diseases in cases of RPD are few and extremely variable, depending on the clinical setting. We examined the relative frequency of the underlying causes of RPD, in a university tertiary referral center, in Athens.
The most common cause of RPD was secondary dementias, accounting for 18 cases (26.5%). Alzheimer disease and frontotemporal dementia were almost equally represented, accounting for 12 (17.6%) and 11 (16.2%) cases, respectively. Vascular dementia, Creutzfeldt-Jakob disease, and various neurodegenerative diseases accounted for 9 cases each (13.2%). In a tertiary referral center, secondary dementias represented the most frequent cause of cases presenting with RPD. As a substantial number of these cases are potentially treatable, our finding reconfirms and underscores the importance of an exhaustive evaluation in any case presenting with RPD.

Frequency and Causes of Early-onset Dementia in a Tertiary Referral Center in Athens
p. 347-351
Objective: To investigate the frequency and causes of early-onset dementia (EOD) in consecutive patients in a highly specialized dementia referral center, focusing on unusual cases, particularly with early and/or rapid onset, in Athens, Greece.

Conclusions: We conclude that EOD patients are more likely to be seen in specialized settings. The underlying diseases are considerably different in EOD compared with LOD. Secondary causes are often found in patients with EOD. Patients with EOD had an unexpectedly longer time-to-diagnosis than patients with LOD. This argues for a need of better education about the clinical presentation of dementia in the young and middle aged.

Predictors of Physician Referral for Patient Recruitment to Alzheimer Disease Clinical Trials
p. 352-356
Background: Inadequate recruitment into Alzheimer disease clinical trials is an important threat to the validity and generalizability of the studies. The majority of dementia patients are first evaluated by community-based physicians; however, physician perceptions of clinical research are largely unknown.
Conclusions: Proximity to a research center and availability of diagnostic clinical tools are strong predictors of clinical trial referral. Concern over risks to patients and lack of time are strong barriers. These results suggest that dementia outreach education targeted to physicians should emphasize the importance of clinical trials with a focus on discussing research participation in a time-efficient manner and increasing awareness of risk reduction and the safety of research protocols. Providing easy access to up-to-date, user-friendly educational materials on dementia diagnosis and research via the internet are likely to improve referrals of patients to Alzheimer disease clinical trials from community physicians.

Rates of Cognitive Change in Alzheimer Disease: Observations Across a Decade of Placebo-controlled Clinical Trials With Donepezil
p. 357-364
Treatment success in Alzheimer disease (AD) trials is generally based on benefits over placebo-treated controls. Consequently, variation in rates of decline among placebo-treated patients could impact outcomes from AD trials. In the present analyses, individual patient data [baseline Mini-Mental State Examination (MMSE): 10 to 26] were pooled from randomized, placebo-controlled studies of donepezil for AD conducted during the 1990s, and grouped by initiation year-group 1: 1990 to 1994; group 2: 1996 to 1999. Changes in MMSE and Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) were compared between groups 1 and 2 for placebo, and then between donepezil and placebo. Data were available from 3403 patients in 13 trials. Group 2 (post-1995) included patients with lower baseline MMSE scores, older patients, fewer males, more comorbidity, and more concomitant medications. MMSE decline by week 24 was significantly greater among group 1 (pre-1995) placebo patients versus group 2; a similar trend was observed with the ADAS-cog. Nevertheless, donepezil-mediated treatment effects were consistent over the decade of enrollment. These analyses suggest that patients are showing slower rates of cognitive decline in more recent trials compared with older trials, although having more comorbidities. This finding may have important potential implications for future clinical trial design.

Cognitive and Neuropsychiatric Profile of the Synucleinopathies: Parkinson Disease, Dementia With Lewy Bodies, and Multiple System Atrophy
p. 365-370
Parkinson disease (PD), multiple system atrophy (MSA), and dementia with Lewy bodies (DLB) share [alpha]-synuclein immunoreactivity. These "synucleinopathies" have overlapping signs and symptoms, but less is known about similarities and differences in their cognitive and neuropsychiatric profiles. We compared the cognitive and neuropsychiatric profiles of individuals with PD, MSA, and DLB. We found that MSA subjects had cognitive difficulties that fell between the mild deficits of the PD group and the more severe deficits of the DLB group. PD, MSA, and DLB groups have similar neuropsychiatric profiles of increased depression and anxiety. Similar underlying [alpha]-synuclein pathology may contribute to these shared features.

Validity and Reliability of the Korean Version of the AD8 Informant Interview (K-AD8) in Dementia
p. 371-376
The Alzheimer disease 8 (AD8) is a brief informant-based measure that distinguishes individuals with very mild dementia and mild cognitive impairment from those with normal cognition. The aim of this study was to establish the validity, reliability, and discriminative properties of the Korean version of the AD8 (K-AD8).
In conclusion, the K-AD8 is a sensitive screening tool in detecting very early dementia, indicating that the AD8 could work very well in a variety of cultural entities.

A Brief Instrument to Assess Treatment Response in the Patient With Advanced Alzheimer Disease
p. 377-383
The availability of effective treatments for severe Alzheimer disease (AD) has accentuated the need for brief, simple tools to evaluate treatment response in busy clinical settings for patients with advanced dementia. To develop such a tool, data on 875 patients from 4 double-blind-randomized studies of donepezil in severe AD [Mini-Mental State Examination (MMSE) 0 to 12 inclusive] were pooled and analyzed to identify Severe Impairment Battery (SIB) items, which are sensitive to change over time. The items, Month, Months of Year, Write Name, Sentence, Fluency, Confrontational Naming-Spoon, Using Spoon-Photograph, and Digit Span, were sensitive to change with treatment (P<0.0001) and easy to administer. Baseline SIB-8 scores were correlated with baseline MMSE and full-scale SIB scores, and provided a good distribution of scores in patients at the lower end of the MMSE. The SIB-8 is a brief (<=3 min) assessment for patients with severe AD that is sensitive to change and able to detect treatment response.


A Battery of Tests for Assessing Cognitive Function in Older Latino Persons
p. 384-388
With the proportion of older Latinos in the United States rapidly growing, dementia is expected to be an increasing public health problem in this segment of the population. Yet relatively few cognitive test batteries have been developed for evaluating older Spanish-speaking persons. The results of a factor analysis supported grouping the tests into the same 5 functional domains identified for English speakers. Composite measures of performance in each domain were positively related to education and, with some exceptions, inversely related to age. The results suggest that this battery may be useful in epidemiologic research on cognition in older Latinos.

Self-efficacy as a Moderator of the Relationship Between Care Recipient Memory and Behavioral Problems and Caregiver Depression in Female Dementia Caregivers
p. 389-394
Purpose: The purpose of the current study was to explore the moderating effect of 3 domains of caregiver self-efficacy on the relationship between exogenous caregiving stressors (care recipient memory and behavioral problems) and depression.
Implications: Self-efficacy may be an important clinical tool for identifying the caregivers who are most vulnerable to depression. Self-efficacy for responding to disruptive behaviors may be especially helpful in identifying caregivers at the greatest risk for depression when care recipient memory and behavior problems are high.

Impact of Place of Residence on Relationship Between Quality of Life and Cognitive Decline in Dementia
p. 395-400
The aim of this descriptive study was to estimate and compare the association between cognitive decline and quality of life (QOL) for 2 groups of dementia patients differing by place of residence: home or institution. Place of residence and MMSE subgroups significantly affected global and subscale ADRQL scores. The MMSE 4 to 8, 9 to 13, and 14 to 18 subgroups had ADRQL global scores significantly better in the institution group than the at home group. In contrast, the MMSE 19 to 23 and 0 to 3 subgroups had similar ADRQL global scores in both places of residence. In conclusion, there is no direct relationship between cognitive decline and QOL, and QOL does not seem to be better at home compared with the institution.

Making Sense of Behavioral Disturbances in Persons With Dementia: Latino Family Caregiver Attributions of Neuropsychiatric Inventory Domains
p. 401-405
The purpose of this study was to describe the nature and frequency of Latino family caregiver attributions for dementia-related neuropsychiatric symptoms. Overall, Alzheimer disease was the most frequent attribution category but accounted for less than 30% of the total attributions. In conclusion, this study found that Latino caregivers were more likely to attribute neuropsychiatric symptoms to causes other than Alzheimer disease or a related dementia.

Case Report
A Case Series of Epilepsy-derived Memory Impairment Resembling Alzheimer Disease
p. 406-409
We report 4 cases of epilepsy-derived progressive memory disturbances that clinically resembled Alzheimer disease. The patients were 3 women and 1 man, aged 56 to 79 years. The greatest disturbance was in recent memory. …Moreover, investigation of this epilepsy-related condition with the combination of EEG and neurofunctional imaging might provide clues to clarify the pathophysiology of Alzheimer disease.

Brief Reports
Pure Progressive Amnesia and the APPV717G Mutation
p. 410-414
We report an isolated, slowly progressive, pure amnestic phenotype in a 59-year-old member of a family affected by autosomal dominant familial Alzheimer disease. Early-onset Alzheimer disease in this family was associated with a V717G mutation in the amyloid precursor protein gene (APP). Subjective impairment of episodic memory began in our subject at the age of 44 years and subsequent, longitudinal neuropsychologic assessment confirmed progressive, severe, global impairment of memory functions over a period of 14 years with preservation of other cognitive domains. The mean annual hippocampal atrophy rate, determined by volumetric magnetic resonance imaging was intermediate between values previously associated with cognitively normal individuals and those with sporadic Alzheimer disease.

A Case of Dementia With PRNP D178Ncis-129M and No Insomnia
p. 415-417
Objective: To describe a dementia case clinically diagnosed as Alzheimer disease with a PRNP genotype usually associated with familial fatal insomnia.
Conclusions: The mutation D178N in the PRNP gene associated with the M129 genotype is usually associated with familial fatal insomnia. However, a few cases have been reported with different clinical phenotypes. Here, we describe one of these cases and stress the importance of genetic screening of PRNP in early onset dementia cases.