1/65. The development of a dementia process within the family context: the case of Alice.Qualitative analysis was used to analyse a diary written over a period of two years by the sister of a dementia patient. The analysis is directed at the question of how a patient and a social network respond to each other during the dementia process. The diary highlights features in the development of the dementia process which receive scant attention in empirical studies: changes in the interaction process between patient and social network; a patient's residual capacities; a caregiver's perceived rewards of caregiving. We designated three phases in the interaction process: the phase of recognition, the stable phase and the phase of destabilization. This diary illustrates how a stable phase in the interaction between patient and primary caregiver can be established. The caregiver derived rewards by noticing and using the patient's residual capacities and by a feeling of being useful. In this case caregiving is not unidirectional. The quality of future support programmes may be enhanced by combining programmes aimed to influence patient's behaviour and to support caregivers.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/65. Treatment of vocally disruptive behaviour of multifactorial aetiology.OBJECTIVE: To describe the treatment of vocally disruptive behaviour (VDB) of multifactorial aetiology. METHOD: Three case reports were used to illustrate the treatment of multifactorial VDB. RESULTS: A biopsychosocial assessment is required to identify the different aetiologies involved and the way they interact. Acute medical and psychiatric factors may demand that interventions are introduced simultaneously rather than in succession. CONCLUSION: Successful interventions require the combination of biopsychosocial strategies tailored to the individual case with realistic goals that include the acceptance of a residual level of VDB as a reasonable outcome.- - - - - - - - - - ranking = 5keywords = behaviour (Clic here for more details about this article) |
3/65. A case of coprophagia presenting with sialadenitis.PRESENTATION: a 94-year-old woman with dementia was admitted to an acute geriatric ward with increasing confusion and falls. On two occasions she developed submandibular masses. Faeces were aspirated from her mouth and a diagnosis made of recurrent submandibular sialadenitis secondary to coprophagia. OUTCOME: the submandibular mass settled with antibiotics and oral care. coprophagia was not observed on the ward, but faecal smearing was noted. With regular toileting, this behaviour ceased and sialadenitis did not recur.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
4/65. Olanzapine in dementia with lewy bodies: a clinical study.OBJECTIVES: Dementia with lewy bodies (DLB) is now a well-recognized form of dementia in which psychosis and behavioural disturbance are common. Treatment with conventional neuroleptics is often very poorly tolerated. Olanzapine, a newly introduced atypical neuroleptic which binds to multiple receptor types with relatively low affinity for D2 receptors, may be a useful treatment option in DLB. MAIN OUTCOME MEASURES: The Behavioural pathology in Alzheimer's Disease Rating Scale, The Neuropsychiatric Inventory, Unified Parkinson's Disease Rating Scale and The Webster Disability Scale. DESIGN: We present the results of eight DLB patients with associated psychotic and behavioural difficulties. All patients were given olanzapine 2.5-7.5 mg. Their psychotic phenomena and behavioural and extrapyramidal symptoms were monitored at 2-weekly intervals. RESULTS: Three out of the eight patients could not tolerate olanzapine even at the lowest available dose. Two patients had clear improvement in psychotic and behavioural symptoms. Three patients were able to tolerate olanzapine but gained only minimal benefit. CONCLUSIONS: Olanzapine at the doses used conferred little advantage over conventional neuroleptics and should only be given with great caution to patients with DLB. The utility of smaller doses deserves further evaluation.- - - - - - - - - - ranking = 4keywords = behaviour (Clic here for more details about this article) |
5/65. Dementia. Part 4: risk management.Negative assumptions that people with dementia are at risk from a variety of dangers often influence the care they receive. Such attitudes are usually based on misunderstandings about the meaning behind observed behaviours. Good risk management practice involves assessing how risk can be managed in ways that enhance autonomy and wellbeing.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
6/65. Fronto-temporal dementia and motor neuron disease: a neuropsychological study.The neuropsychological follow-up study of a 58-year-old man suffering from Motor Neuron Disease (ALS/MND) and Fronto-Temporal Dementia (FTD) is reported. Neuromuscular signs first appeared at the age of 51 and slowly progressed to late bulbar involvement; behavioural symptoms of the frontal type first appeared around age 53; lastly, several neuropsychological symptoms suggestive of worsening temporal involvement supervened at age 57. Our patient died at 59 of respiratory failure with the classic clinical and neuroradiological picture of FTD. A short discussion addresses the controversial issue of the coupling of ALS/MND with Dementia and its possible interpretation as the expression of a chance association of relatively common diseases, versus that of a single multifaceted disease. The role of a detailed neuropsychological assessment is highlighted, within the context of increasingly specific diagnostic criteria for FTD.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
7/65. Selective impairment of verb processing associated with pathological changes in Brodmann areas 44 and 45 in the motor neurone disease-dementia-aphasia syndrome.We report six patients with clinically diagnosed and electrophysiologically confirmed motor neurone disease (MND), in whom communication problems were an early and dominant feature. All patients developed a progressive non-fluent aphasia culminating in some cases in complete mutism. In five cases, formal testing revealed deficits in syntactic comprehension. comprehension and production of verbs were consistently more affected those that of nouns and this effect remained stable upon subsequent testing, despite overall deterioration. The classical signs of MND, including wasting, fasciculations and severe bulbar symptoms, occurred over the following 6-12 months. The behavioural symptoms ranged from mild anosognosia to personality change implicating frontal-lobe dementia. In three cases, post-mortem examination has confirmed the clinical diagnosis of MND-dementia. In addition to the typical involvement of motor and premotor cortex, particularly pronounced pathological changes were observed in the Brodmann areas 44 (Broca's area) and 45. The finding of a selective impairment of verb/action processing in association with the dementia/aphasia syndrome of MND suggests that the neural substrate underlying verb representation is strongly connected to anterior cortical motor systems.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
8/65. Functional analysis of challenging behaviour in dementia: the role of superstition.BACKGROUND: Intervention for challenging behaviour of residents living in care homes is a neglected area of research. Pharmacological methods of management are widespread, although support for their efficacy is, on the whole, poor. AIMS: There is little research on non-pharmacological methods of management and the present study aimed to add to the small literature in this area, by examining the meaning of behaviour for a given resident, within a functional analytic experimental framework. methods: The study involved a systematic manipulation of specific trigger situations to evaluate their influence on challenging behaviour, using a single case experimental design. RESULTS: Five residents with agitated and aggressive behaviour were successfully managed. The difficulties in engaging staff in the use of non-pharmacological, rather than pharmacological, methods and the scope for future randomised trials using psychological and environmental interventions to manage challenging behaviour, are discussed.- - - - - - - - - - ranking = 9keywords = behaviour (Clic here for more details about this article) |
9/65. Severe anterograde amnesia with extensive hippocampal degeneration in a case of rapidly progressive frontotemporal dementia.frontotemporal dementia (FTD) is usually characterized as a spectrum of relatively slowly progressive disorders with largely focal frontal or temporal presentations. The development of clinical and research criteria for discriminating FTD from Alzheimer's disease has relied, in part, on the relative preservation of episodic memory in FTD. We present a patient with FTD who, in addition to the more typical behavioural and language deficits, had a profound anterograde amnesia at the time of diagnosis. neuroimaging confirmed atrophy of frontal and temporal lobes bilaterally, most marked in the anterior left temporal region. At post-mortem, non-Alzheimer pathology resulting in devastating cell loss was revealed in the hippocampi, as well as in the frontal and temporal cortex, thus providing neuroanatomical corroboration of the episodic memory deficit. Progression of the disease was extraordinarily rapid, with just 2 years between reported onset and time of death. This case demonstrates that the pattern of FTD may include severe anterograde amnesia as a prominent and early consequence of the disease.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
10/65. Dissociation of social cognition and executive function in frontal variant frontotemporal dementia.In this paper, we adopt a neurodevelopmental stance to examining frontal variant frontotemporal dementia (fv-FTD) by using experimental procedures from the literature on the growth of social behaviour in children to examine the deficits in social reasoning which may underpin behavioural disturbance in fv-FTD. We present the case of a 47-year-old man with a diagnosis of fv-FTD and severe antisocial behaviour. Tests of general neuropsychology and of executive function were performed. In addition, the patient, JM, was assessed on tasks which test theory of mind. theory of mind develops in distinct stages through childhood and is a core ability to represent the thoughts and feelings of others, independent of the level of intellectual ability. The results indicate relatively intact general neuropsychological and executive function, but extremely poor performance on tasks of theory of mind. This indicates a dissociation of social cognition and executive function suggesting that in psychiatric presentations of fv-FTD there may be a fundamental deficit in theory of mind independent of the level of executive function. The implications of this finding for diagnostic procedures and possible behavioural management are discussed.- - - - - - - - - - ranking = 4keywords = behaviour (Clic here for more details about this article) |
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