Awareness of memory task impairment versus everyday memory difficulties in dementia

The study investigated different types of awareness of memory dysfunction in dementia, specifically judgements concerning memory task performance or appraisal of everyday memory functioning and also exploring the neuropsychological correlates of such awareness. This was investigated in 76 people with dementia, comprising 46 patients with Alzheimer's disease (AD) and 30 patients with vascular dementia (VaD). The Memory Awareness Rating Scale (Clare et al., 2002, Neuropsychol Rehabil, 12, 341–362) was used, which includes an Objective‐Judgement Discrepancy (OJD) technique involving comparison of subjective evaluation of performance on specific memory tasks with actual performance, and a Subjective Rating Discrepancy (SRD) technique, which compares self versus informant judgement of everyday memory function. The AD and VaD groups showed lower awareness than a normal control group for both types of measures, the AD group showing less awareness than the VaD group on the OJD measure. Regression analyses supported associations for both groups between memory impairment and the OJD measure and between naming impairment and the SRD measure. The findings are discussed in terms of neurocognitive theories accounting for loss of awareness in dementia.     

Strategic value-directed learning and memory in Alzheimer's disease and behavioural-variant frontotemporal dementia

In healthy adults, the ability to prioritize learning of highly valued information is supported by executive functions and enhances subsequent memory retrieval for this information. In Alzheimer's disease (AD) and behavioural-variant frontotemporal dementia (bvFTD), marked deficits are evident in learning and memory, presenting in the context of executive dysfunction. It is unclear whether these patients show a typical memory bias for higher valued stimuli. We administered a value-directed word-list learning task to AD (n = 10) and bvFTD (n = 21) patients and age-matched healthy controls (n = 22). Each word was assigned a low, medium or high point value, and participants were instructed to maximize the number of points earned across three learning trials. Participants’ memory for the words was assessed on a delayed recall trial, followed by a recognition test for the words and corresponding point values. Relative to controls, both patient groups showed poorer overall learning, delayed recall and recognition. Despite these impairments, patients with AD preferentially recalled high-value words on learning trials and showed significant value-directed enhancement of recognition memory for the words and points. Conversely, bvFTD patients did not prioritize recall of high-value words during learning trials, and this reduced selectivity was related to inhibitory dysfunction. Nonetheless, bvFTD patients showed value-directed enhancement of recognition memory for the point values, suggesting a mismatch between memory of high-value information and the ability to apply this in a motivationally salient context. Our findings demonstrate that value-directed enhancement of memory may persist to some degree in patients with dementia, despite pronounced deficits in learning and memory.     

Preference for leisure items over edible items in individuals with dementia: A replication

We replicated previous research in which adults with dementia tended to show a preference for leisure items over edible items when presented in the same array. Additionally, we conducted engagement analyses with the highest, middle, and lowest preference leisure items to determine whether relative preference corresponded to engagement in the natural environment. The most highly preferred stimulus for 6 out of 7 participants was a leisure item, and for each of those six the top 3 preferred stimuli were leisure stimuli. For 4 participants, the most preferred stimulus also produced the longest duration of engagement. We discuss the issues we encountered when conducting preference assessments with adults with intact vocal verbal repertoires, and suggest potential explanations for the displacement of edibles by leisure stimuli in older adults with dementia.     

Differential impacts of age of acquisition on letter and semantic fluency in Alzheimer's disease patients and healthy older adults

The degree to which the typical age of acquisition (AoA) of words and word frequency have separable influences on verbal production tasks has been strongly debated. To examine the overlap between these factors in verbal fluency tasks, the performance of Alzheimer's disease (AD) patients (N?=?34) and normal elderly controls (N?=?36) was compared on semantic (e.g., vegetables) and letter (e.g., words that begin with F) fluency tasks. These comparisons revealed that words generated for the semantic fluency task had an earlier AoA while words generated for the letter fluency task had a higher word frequency. Differences in AoA between AD patients and controls were larger for semantic than letter fluency. These results suggest that AoA has an effect on verbal production that is independent of word frequency and that AoA has a semantic locus.     

Excess disability and malignant social psychology: A case study of Alzheimer's disease

An in-depth case study was undertaken to assess the effects of what Kitwood has termed ‘malignant social psychology’ on the observed behaviour of an Alzheimer's disease sufferer. Interviews were conducted with the spouse and observations were made in an adult day-care centre, where staff members were also interviewed. Abilities that the spouse reported to be absent at home were readily observed at the day-care centre, lending support to Brody's idea of excess disability, i.e. disability not due to disease alone. Furthermore, forms of malignant social psychology existed in the home environment but did not exist in the day-care centre. Excess disability and its absence coincided with the presence and absence of aspects of malignant social psychology. The sufferer's behaviour was found to be affected not only by the extant neuropathology, but also by social relationships.     

ASSESSMENT OF PREFERENCE FOR EDIBLE AND LEISURE ITEMS IN INDIVIDUALS WITH DEMENTIA

We conducted 2 studies on reinforcer preference in patients with dementia. Results of preference assessments yielded differential selections by 14 participants. Unlike prior studies with individuals with intellectual disabilities, all participants showed a noticeable preference for leisure items over edible items. Results of a subsequent analysis with 3 participants showed reinforcement effects when highly preferred items were delivered as consequences.     

The Home-Based Occupational Therapy Intervention in the Alzheimer's Disease Multiple Intervention Trial (ADMIT)

There is no way to prevent functional declines related to Alzheimer's Disease (AD). The use of occupational therapy (OT) has been shown to be successful in managing some aspects of AD. We added home-based OT to evidence-based best practice for AD with the aim of delaying functional decline in people with AD. OT was delivered in the home to a caregiver dyad including the person with AD and her/his caregiver. This article describes the OT intervention for the AD Multiple Intervention Trial, a parallel randomized controlled trial. We include baseline data on the 180 caregiver dyads.     

The aim of psychoanalysis

The changing aims of psychoanalysis are discussed with reference to Money-Kyrle's paper on the subject. The theory of dammed-up libido, the theory of moral conflict and the theory of misrepresentations and perversion of reality which he described, all imply different aims. It is argued that, in addition, the theory of projective identification leads to a radical change in the aim of treatment which can now be formulated in terms of helping the patient regain lost parts of the self.     

Performance on a measure of category fluency in cognitively impaired elderly

ABSTRACT

Measures of verbal fluency are widely used in the assessment of cognitive functioning of the elderly. However, limited research has evaluated patterns (across specific timed intervals) of performance on tasks of language fluency in different forms of dementia. The current study investigated semantic fluency in 488 elderly individuals (249 with Alzheimer's dementia, 97 Vascular dementia, 97 Mild Cognitive Impairment and 45 cognitively intact) across 15-second intervals in an animal naming task using retrospective chart review. Normal controls produced significantly more exemplars and AD patients produced fewer animal names than the other groups. After the first 15- second time interval, the demented groups produced significantly fewer exemplars than the non-demented. At the end of 30 seconds it was possible to differentiate normal aging from MCI who no longer differed from the VaD group. Overall, it appears that the greatest and most clinically meaningful differences between the diagnostic groups were detected in the first three 15-second intervals. The present findings support the use of time intervals and total scores on tasks of verbal fluency in clinical settings and for research purposes.     

A randomized clinical trial of Behavioral Activation (BA) therapy for improving psychological and physical health in dementia caregivers: Results of the Pleasant Events Program (PEP)

Dementia caregiving is associated with elevations in depressive symptoms and increased risk for cardiovascular diseases (CVD). This study evaluated the efficacy of the Pleasant Events Program (PEP), a 6-week Behavioral Activation intervention designed to reduce CVD risk and depressive symptoms in caregivers. One hundred dementia family caregivers were randomized to either the 6-week PEP intervention (N = 49) or a time-equivalent Information-Support (IS) control condition (N = 51). Assessments were completed pre- and post-intervention and at 1-year follow-up. Biological assessments included CVD risk markers Interleukin-6 (IL-6) and D-dimer. Psychosocial outcomes included depressive symptoms, positive affect, and negative affect. Participants receiving the PEP intervention had significantly greater reductions in IL-6 (p = .040), depressive symptoms (p = .039), and negative affect (p = .021) from pre- to post-treatment. For IL-6, clinically significant improvement was observed in 20.0% of PEP participants and 6.5% of IS participants. For depressive symptoms, clinically significant improvement was found for 32.7% of PEP vs 11.8% of IS participants. Group differences in change from baseline to 1-year follow-up were non-significant for all outcomes. The PEP program decreased depression and improved a measure of physiological health in older dementia caregivers. Future research should examine the efficacy of PEP for improving other CVD biomarkers and seek to sustain the intervention's effects.     

MULTICOMPONENT INTERVENTION FOR AGITATED BEHAVIOR IN A PERSON WITH ALZHEIMER'S DISEASE

We evaluated a multicomponent intervention for agitated behavior in a man with probable Alzheimer's disease. Hypotheses about variables controlling his agitated behavior guided intervention design. Based on staff interviews, direct observations, and brief experimental probes, intervention components were chosen to increase rate of reinforcement and decrease aversive aspects of his job. Intervention reduced agitated behavior without disrupting his work rate.     

Personality and sexuality in older adults

Objective: This study explored cross-time associations between personality and multiple components of sexual functioning and behaviour in a large cohort of older adults (n = 5745).

Design: Participants (M_age = 65.57 ± 8.28 years) completed questionnaires in 2010 and 2012.

Main outcome measures: Outcomes explored included sexual attitudes, sexual activity, sexual satisfaction, lifetime sexual partners, sexual orientation and sexual dysfunction.

Results: We found that higher levels of openness and lower levels of agreeableness were related to more liberal attitudes toward sex, a greater number of sexual partners, a higher sex drive, more frequent sexual activity, lower levels of sexual dysfunction and (for women) a greater tendency towards homosexuality. Higher levels of conscientiousness were also related to more conservative attitudes towards sex, lower levels of sexual dysfunction and a greater tendency towards heterosexuality. For sexually active older adults, higher levels of extraversion and lower levels of neuroticism were related to greater sexual satisfaction. Higher levels of extraversion and lower levels of conscientiousness were also related to a greater number of sexual partners in men but not women.

Conclusion: These findings provide evidence that personality is an important correlate of sexual functioning and behaviour in older adults.