1/115. Using the towel bath to give tender care in dementia: a case example.Using the "towel" bath to clean the skin for such residents as Helen results in a reduction of agitation and an increase in comfort as the skin is cleansed. The "towel" bath is a very useful technique which should be incorporated into educational training programs for any care provider who will be working with persons with dementia. It is a procedure that can be adapted to the care of the most challenging resident and will help staff begin to display person-centred care for the resident who is afraid of care procedures and responds negatively as a result. The procedure itself addresses the issues of water temperature and privacy in a way that traditional basin bathing makes difficult. The "towel" bath should be included in the practice repertoire and used on a regular basis by all practitioners who work in this area of geriatric specialty.- - - - - - - - - - ranking = 1keywords = person (Clic here for more details about this article) |
2/115. frontotemporal dementia and Alzheimer's disease: differential diagnosis.This report addresses the clinical differentiation of Alzheimer's disease (AD) from frontotemporal dementia (FTD), including Pick's disease. The accuracy of a clinical diagnosis of a dementing disorder is determined in part by the prior probability (base rates) of the disorder, which predicts an overwhelming likelihood of a diagnosis of AD, because the prevalence of AD is much greater than FTD. The clinical features of the disorder also determine the accuracy of diagnosis. Recent studies have reported an improvement in the differential diagnosis of FTD, utilizing the Lund-Manchester criteria. patients with FTD typically have early noncognitive behavioral changes with relatively spared cognition, frontal atrophy and enlargement of the Sylvian fissures on CT and MRI scans, and frontal-temporal deficits on SPECT or PET scans. In contrast, AD patients have early cognitive changes with relatively preserved personality and behavior, hippocampal and medial-temporal lobe atrophy on CT or MRI scans, and parietotemporal SPECT or PET deficits.- - - - - - - - - - ranking = 0.5keywords = person (Clic here for more details about this article) |
3/115. Decision analysis and alzheimer disease: three case studies.Decision analysis may be useful to people facing alzheimer disease (AD) decisions. The use of decision analysis in three such cases is reported. The first case involved a middle-aged person worried about early-onset AD and deciding whether to seek genetic testing. The analysis let the participant reject testing and consider innovative care options. The second case involved a middle-aged person concerned about later-onset AD. The analysis for her was more complex, and led to the assignment of some limited value on genetic testing for her. The third case revolved around a caregiver's treatment decisions for a patient with severe AD. It led her to recognize the importance of factors she had not previously considered. In each of the three cases, the intensive process of decision analysis appears to have improved the subject's decision.- - - - - - - - - - ranking = 1keywords = person (Clic here for more details about this article) |
4/115. Constructing Alzheimer's: narratives of lost identities, confusion and loneliness in old age.This paper is a qualitative study based on retrospective, unstructured, qualitative interviews with Mrs. Jones and other African-American, Chinese-American, Irish-American and Latino family caregivers in the boston area. A narrative approach is used to show how family caregivers draw on their cultural and personal resources to create stories about the nature and meaning of illness and to ask how ethnic identity may influence the kinds of stories family caregivers tell. Three different story types are identified and described, each with a distinctive configuration of illness meanings and overarching theme, or storyline: a subset of African-American, Irish-American, and Chinese-American caregivers told us stories about Alzheimer's as a disease that erodes the core identity of a loved one and deteriorates their minds; a subset of Chinese caregivers narrated stories that emphasized how families managed confusion and disabilities, changes ultimately construed as an expected part of growing old; a subset of Puerto Rican and Dominican families, while using the biomedical label of Alzheimer's disease or dementia, placed the elder's illness in stories about tragic losses, loneliness, and family responsibility. To construct their stories, caregivers drew upon both biomedical explanations and other cultural meanings of behavioral and cognitive changes in old age. Their stories challenge us to move beyond the sharp contrast between ethnic minority and non-ethnic minority views of dementia-related changes, to local clinics and hospitals as sites where biomedical knowledge is interpreted, communicated, discussed, and adapted to the perspectives and lived realities of families.- - - - - - - - - - ranking = 0.51324571197771keywords = person, illness (Clic here for more details about this article) |
5/115. Alzheimer's disease due to an intronic presenilin-1 (PSEN1 intron 4) mutation: A clinicopathological study.We describe 21 affected individuals from a kindred with early-onset autosomal dominant familial Alzheimer's disease caused by an intronic presenilin-1 mutation (in intron 4). Mean age at onset of symptoms was 37.4 years [95% confidence interval (CI): 36.6-38.2 years], mean age at death was 44.7 years (95% CI: 43.1-46.3 years) and mean duration of illness was 7.3 years (95% CI: 5.9-8.7 years). myoclonus and seizures were prominent features of this pedigree. In the four cases for whom neuropsychometric data were available, verbal memory impairment preceded visual memory deficits; naming was relatively preserved until late in the disease. One of these four cases underwent serial volumetric MRI scans demonstrating in vivo brain tissue loss of 3.9% (38.9 ml, annualized rate of atrophy: 1. 7%) over 22 months of follow-up. The four individuals who had necropsies demonstrated the neuropathological hallmarks of Alzheimer's disease. Apolipoprotein E (APOE) status was assessed in five individuals: the case with the youngest age at onset at 33 years of age was found to be homozygous epsilon4/epsilon4, > 1 SD below the mean age of onset for those of known APOE genotype (36.4 /- 2.3 years, mean /- SD), and > 2 SDs below the mean age of onset for the pedigree as a whole (37.4 /- 1.7 years, mean /- SD). APOE genotype may therefore modulate age at onset in this pedigree.- - - - - - - - - - ranking = 0.0044152373259036keywords = illness (Clic here for more details about this article) |
6/115. Effects of individualized versus classical "relaxation" music on the frequency of agitation in elderly persons with Alzheimer's disease and related disorders.confusion and agitation in elderly patients are crucial problems. This study tested Gerdner's mid-range theory of individualized music intervention for agitation. An experimental repeated measures pretest-posttest crossover design compared the immediate and residual effects of individualized music to classical "relaxation" music relative to baseline on the frequency of agitated behaviors in elderly persons with Alzheimer's disease and related disorders (ADRD). Thirty-nine subjects were recruited from six long-term-care facilities in iowa. The sample consisted of 30 women and 9 men (mean age 82 years) with severe cognitive impairment. Baseline data were collected for 3 weeks. Findings from the Modified Hartsock music Preference Questionnaire guided the selection of individualized music. Group A (n = 16) received individualized music for 6 weeks followed by a 2-week "washout" period and 6 weeks of classical "relaxation" music. Group B (n = 23) received the same protocol but in reverse order. music interventions were presented for 30 minutes, two times per week. The Modified Cohen-Mansfield Agitation Inventory measured the dependent variable. A repeated measures analysis of variance with Bonferroni post hoc test showed a significant reduction in agitation during and following individualized music compared to classical music. This study expands science by testing and supporting a theoretically based intervention for agitation in persons with ADRD.- - - - - - - - - - ranking = 3keywords = person (Clic here for more details about this article) |
7/115. Confabulation in a patient with fronto-temporal dementia and a patient with Alzheimer's disease.This paper describes two patients, O.I. and B.Y., with a confabulatory syndrome. O.I. was diagnosed with probable fronto-temporal dementia, whereas B.Y. met the criteria for probable Alzheimer's disease. O.I., but not B.Y., was impaired on tests of frontal/executive functions, and performed better than B.Y. on clinical tests of memory. Both patients confabulated in episodic/autobiographical memory tasks and in personal future planning tasks. B.Y. confabulated also in a semantic memory task. It is argued that the pattern of confabulation and the cognitive profile shown by the two patients is explained better by the hypothesis proposed by Dalla Barba and co-workers (Dalla Barba et al., 1997b) than by current theories of confabulation.- - - - - - - - - - ranking = 0.5keywords = person (Clic here for more details about this article) |
8/115. haloperidol disrupts, clozapine reinstates the circadian rest-activity cycle in a patient with early-onset alzheimer disease.Measurement of the circadian rest-activity cycle in a patient with early-onset alzheimer disease for 555 days revealed marked changes in the timing and amount of nocturnal activity. After neuroleptic medication was changed to haloperidol, the rest-activity cycle became completely arrhythmic for two months, concomitant with a marked worsening of cognitive state. Circadian integrity returned together with clinical improvement when the patient was subsequently treated with clozapine. This observation suggests that the known tendency for patients with alzheimer disease to develop sleep-wake cycle disturbances may be aggravated by a classic neuroleptic; in contrast, the atypical neuroleptic clozapine may consolidate it. Similar observations in schizophrenic patients indicate that this chronobiological finding is drug- and not illness-related.- - - - - - - - - - ranking = 0.0044152373259036keywords = illness (Clic here for more details about this article) |
9/115. Novel applications of social-personality measures to the study of dementia.Despite the realization that personality change is a core feature of frontotemporal dementia (FTD), little work has been performed using personality as a diagnostic tool for this disease. Likewise, personality change in Alzheimer's disease (AD) has long been recognized, but generally has not been used for diagnostic purposes. We introduce novel social-personality measures (Big Five Inventory, Interpersonal Adjectives Scale and Interpersonal Measure of Psychopathy) in the differential diagnosis of AD and temporal subtypes of FTD, and integrate these measures with traditional behavioural and neuropsychological methods commonly used in diagnosing dementia. We present four cases: an FTD patient with predominantly left temporal degeneration, an FTD patient with predominantly right temporal degeneration and two patients with Alzheimer's disease (one with mild and the other with moderate impairment). Results show the diagnostic utility of these measures in differentiating among temporal subtypes of FTD and moderate AD. Right temporal FTD, in particular, shows profound shifts in personality and interpersonal behaviour, as well as a striking lack of insight into these shifts. In addition to diagnostic purposes, we discuss how measures of personality and interpersonal behaviour can be utilized as an important component of understanding disease susceptibility and risk, as well as offering insights into the neuroanatomical underpinnings of personality and social behaviour.- - - - - - - - - - ranking = 7.5keywords = person (Clic here for more details about this article) |
10/115. Mirrored-self misidentification: two cases of focal onset dementia.We present two patients in whom the mirror sign, the inability to recognize one's own reflected image, was a stable and persisting symptom signalling the onset of a progressive dementing illness. Extensive neuropsychological testing was conducted with both patients, with particular emphasis on face processing and the understanding of reflected space. Both patients were also investigated with structural imaging techniques (computed tomography and magnetic resonance imaging). Although the neuroimaging results were not strongly lateralizing for either patient, neuropsychological testing revealed striking right hemisphere dysfunction with relatively intact left hemisphere cognitive function in both patients. Of particular interest was the patients' dissociation on tests of face processing; one patient, FE, had significant face processing deficits while the other patient, TH, had relatively intact face processing. Further testing with TH revealed striking deficits in his ability to interpret reflected space. The results of the face processing tests are discussed in the context of current models of normal face processing, with particular emphasis on the affective component in face recognition. We propose that a combination of cognitive deficits underlie the mirror sign delusion, including perceptual, affective and reasoning impairments, and also discuss the contributions of cortical and subcortical lesions in these two patients and in delusions in general.- - - - - - - - - - ranking = 0.0044152373259036keywords = illness (Clic here for more details about this article) |
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