Relationship of severity of dementia to caregiving stressors

In studies of individual differences and longitudinal changes in stress and coping among dementia caregivers, assessing severity of patient impairment is critically important. It is proposed that with the progression of dementia, cognitive impairment may steadily increase, but other stressful behavioral symptoms peak at various stages of dementia. Cross-sectional data from 49 caregiving families and longitudinal follow-up data from 48 families suggest that instrumental self-care deficits begin early in dementia, and basic self-care deficits increase with dementia severity, but that many distressing behavioral symptoms decrease in late dementia. Assessments of dementia patient severity should be multidimensional, and increases and decreases in various dementia patient stressors over time should be considered as factors influencing caregiver coping.     

The neuropsychological assessment of dementia

It has become standard practice to base the diagnosis of dementia on the combination of neuropsychological and non-behavioral findings. The present article provides a short, clinically oriented synopsis of the targets, investigational procedures, and difficulties of the modern neuropsychological approach to the diagnosis of dementia. Over the years, neuropsychology has developed assessment tools to evaluate the cognitive and behavioral abnormalities of many dementias. Validated tests of memory, language, executive, and other cognitive functions are used to screen for dementia and identifying certain dementia profiles. Behavioral assessment procedures are available for non-cognitive neurodegenerative alterations. At present, problems arise mainly with the behavioral heterogeneity of certain dementia syndromes. Especially problematic are discrimination of age-associated or mild cognitive impairments from incipient dementia and the impact of psychiatric symptoms on cognitive functions. It is concluded that neuropsychology offers a valuable contribution to the diagnosis and differential diagnosis of dementia.     

Treatment of Diogenes Syndrome with Risperidone

Diogenes syndrome is characterized by shameless neglect of the body and personal environment, hoarding, and the rejection of any help. It occurs among patients with and without other psychiatric disorders. The initial treatment should be a behavioral program, but there is no information about the pharmacological treatment of this syndrome. We report the case of a 77-year-old woman with symptoms of Diogenes syndrome. After an unsuccessful behavioral program, treatment with risperidone initially improved the behavioral symptoms but impaired cognitive function, and was followed by marked global deterioration, fulfilling criteria for dementia.     

Do behavioral disturbances in persons with Alzheimer's disease predict caregiver depression over time?

Random effects models were used to examine the association between behavioral disturbances in persons with Alzheimer's disease (N = 90) and caregiver depressive symptoms at 2-month intervals over an 18-month period. There was substantial variability in trajectories of change in caregiver depressive symptoms over time but no systematic increase in distress despite increased severity of dementia symptoms. Total behavioral disturbances were associated with higher levels of caregiver depressive symptoms: this effect was primarily attributable to aggressive behaviors. No consistent departure from linearity was evident in the relationship between behavior and depression over time.     

Behavioral and Psychological Symptoms that Predict Cognitive Decline or Impairment in Cognitively Normal Middle-Aged or Older Adults: a Meta-Analysis

Neuropsychology Review - Epidemiological studies have revealed that behavioral and psychological (or non-cognitive) symptoms are risk factors for cognitive decline in older adults. This study aimed...     

Self-awareness and self-monitoring of cognitive and behavioral deficits in behavioral variant frontotemporal dementia, primary progressive aphasia and probable Alzheimer's disease

Lack of insight is a core diagnostic criterion for behavioral variant frontotemporal dementia (bvFTD), and is believed to be intact in the early stages of primary progressive aphasia (PPA). In other neurological conditions, symptom-specific insight has been noted, with behavioral symptoms appearing especially vulnerable to reduced insight. Different components of insight, self-awareness and self-monitoring, are also often considered separate phenomena. The current study compared insight in patients with PPA, bvFTD, and probable Alzheimer's disease (PrAD) and a group of cognitively intact control subjects. Additionally, differences in insight for the domains primarily affected by the three types of dementia, namely, Behavior, Naming, and Memory, were assessed, and self-awareness and self-monitoring were compared. A total of 55 participants were enrolled. Participants were asked to complete self-estimate scales demonstrating their perceived ability immediately prior to, and immediately following a test in each domain of interest. Results indicated that PPA and normal control groups performed very similarly on control (Weight and Eyesight) and cognitive domains, whereas bvFTD and PrAD patients were unable to accurately assess Memory. All three diagnostic groups failed to accurately assess their behavioral symptoms, suggesting that this domain is vulnerable to loss of insight across diagnoses. Naming ability, in contrast, was either accurately assessed or underestimated in all groups. Finally, there were no notable differences between self-awareness and self-monitoring, potential explanations for this are examined.     

Stress,coping, and adjustment in mothers and young adolescents in single- and two-parent families

Compared stress, coping, and psychological adjustment in single (divorced or separated) and married mothers and their young adolescent children. Single mothers reported more daily hassles related to economic, family, and personal health problems, and more symptoms of depression, anxiety, and psychoticism. Single mothers also reported using more coping strategies related to accepting responsibility and positive reappraisal. After controlling for level of family income, differences in family hassles and coping strategies remained significant. The two groups did not differ on subtypes of symptoms after controlling for income, but single mothers still reported more total psychological symptoms. No differences were found between children in these two family constellations on maternal reports of emotional/behavioral problems or on children's self-reported emotional/behavioral problems, stressful events, or coping. Implications of these findings for adjustment to life in single-parent families are discussed.     

Dementia and suicidal behavior

Behavioral and psychological symptoms of dementia, including depression, might complicate the course of the disorder additionally. Dementia is more frequent in older people and suicide rates are higher in later life than in any other age group. To explore the phenomenology of suicidal behavior in patients with dementia, we searched electronic databases and key journals for original research and review articles on suicide in demented patients using the search terms “suicide, suicidal behavior, dementia, Alzheimer disease, and old age”. Although cognitive impairment could result in a diminishing ability to think flexibly and to solve problems or to cope with conflict, in the early stage of dementia such impairments are absent or mild, and suicidal behavior might be expected, especially following diagnosis. In addition, personality changes based on declining cognitive capacity and the neurochemical imbalances described in late-life depression and in dementia may predispose patients to aggressive or impulsive acts, such as suicide attempt. The literature on suicidal behavior and dementia highlights the need for further research in this area.     

Nicht motorische Symptome bei Morbus Parkinson (Teil II)

Nonmotor symptoms in Parkinson’s disease have a high relevance for quality of life. A broad range of symptoms can be found in all stages of the disease, including gastrointestinal symptoms, bladder problems, erectile dysfunction, orthostatic hypotension, sleep disturbances, depression, dementia, psychosis, and drug-induced behavioral changes. The guidelines of the Austrian PD society and a recent review of the Movement Disorder Society provide therapy recommendations according to evidence-based data.     

Nicht motorische Symptome bei Morbus Parkinson

Nonmotor symptoms in Parkinson?s disease have a high impact on quality of life. A broad range of symptoms can be found in all stages of the disease, including gastrointestinal symptoms,bladder problems, erectile dysfunction, orthostatic hypotension, sleep disturbances, depression, dementia, psychosis, and drug-induced behavioral changes. The guidelines of the Austrian Parkinson’s Disease Society and a recent review of the Movement Disorder Society provide therapy recommendations according to evidence-based data.     

Evidence-based psychological treatments for disruptive behaviors in individuals with dementia

In this article, the authors review the literature regarding evidence-based psychological treatments (EBTs) for behavioral disturbances in older adults with dementia, as proposed by the American Psychological Association's Committee on Science and Practice of the Society for Clinical Psychology. Fifty-seven randomized clinical trials were reviewed for inclusion on the basis of titles or abstract information. Forty-three were excluded either because they did not meet EBT methodological criteria or because they involved environmental or psychoeducational nursing interventions in which the psychological component could not be separately evaluated. Fourteen studies were considered for inclusion as EBTs; of these, 8 showed significant differences between treatment and control groups. Results of this review indicate that behavioral problem-solving therapies that identify and modify antecedents and consequences of problem behaviors and increase pleasant events and individualized interventions based on progressively lowered stress threshold models that include problem solving and environmental modification meet EBT criteria. Additional randomized clinical trials are needed to evaluate the generalizability and efficacy of these and other promising psychological interventions in a variety of settings with individuals who have a range of cognitive, functional, and physical strengths and limitations.     

A multimodal behavior analytic model for evaluating the effects of medical problems on nonspecific behavioral symptoms in persons with developmental disabilities

A relationship between various medical illnesses and the frequency and severity of nonspecific behavioral symptoms such as aggression and self-injury has been described by a number of writers. None, however, provides a clinical case formulation model that articulates the specific nature of this relationship or the manner in which potential biomedical influences interact with psychological and socioenvironmental ones to determine the occurrence and strength of behavioral symptoms. A model is described in this paper that suggests possible contributions of medical illnesses or conditions to occurrence of nonspecific behavioral symptoms and provides a diagnostic basis for selecting and evaluation related interventions. © 1997 John Wiley & Sons, Ltd.     

父母控制与儿童心理适应的关系：儿童自我控制的中介作用

以555名小学四到六年级儿童为被试,采用问卷调查法考察父母控制与儿童心理适应的关系,以及儿童自我控制在两者关系间的中介作用。结果发现：（1）六年级儿童的自我控制水平显著高于四年级,且情绪症状显著多于四、五年级;男生多动−注意缺陷水平显著高于女生;（2）父母行为控制对儿童积极心理适应具有显著正向预测作用,对儿童消极心理适应具有显著负向预测作用;而父母心理控制对儿童积极心理适应具有显著负向预测作用,对儿童消极心理适应具有显著正向预测作用;（3）儿童自我控制在父母控制（行为控制和心理控制）与儿童多动−注意缺陷和亲社会行为的关系间起显著中介作用,在父母控制与儿童情绪症状关系间中介作用不显著。     

Psychosocial Functioning in Children and Adolescents with Gastrointestinal Complaints and Disorders

The current study examined the prevalence and presentation of psychosocial symptoms in pediatric patients and their parents presenting for first time appointments at a gastroenterology (GI) clinic compared to healthy controls (HC). One hundred GI patients, aged 8-17 years, and their mothers were compared to 100 age- and gender-matched HC on measures of child and parental behavioral/psychosocial functioning, depression, and anxiety. Results revealed significant correlations between mother- and child-reported internalizing behaviors and psychological symptoms. Significant group differences were observed in internalizing problems, adaptive and social skills, and leadership competency, as well as parental interpersonal sensitivity, depression, phobic anxiety, and number of psychological symptoms. GI patients are at increased risk for psychosocial and social dysfunction compared to healthy peers. Psychosocial factors should be considered when assessing patients in GI clinics. Patients might benefit from treatment plans that involve adjunctive behavioral intervention to assist patients in managing their conditions.     

Psychological effects of occupational exposure to various chemical agents

Research on the psychological effects of occupational exposure to various chemical agents began at the Institute of Occupational Health in Helsinki in the last half of the 1950′s. At first workers occupationally exposed to carbon disulfide in a rayon fiber factory were clinically examined. These workers were submitted to psychological testing because they complained of numerous subjective psychological symptoms. Since then the behavioral effects of occupational exposure to various common solvents and lead have been studied with psychological methods. The earlier projects were either clinical or epidemiologic studies, but now experimental studies with animals have also begun. In all these investigations one of the main objectives has been to develop and find methods sensitive and specific enough to detect adverse behavioral effects.     

Prolonged Exposure Therapy for a Vietnam Veteran With PTSD and Early-Stage Dementia

Although prolonged exposure therapy (PE) is considered an evidence-based treatment for PTSD, there has been little published about the use of this treatment for older adults with comorbid early-stage dementia. As the number of older adults in the United States continues to grow, so will their unique mental health needs. The present article describes the successful coordination of care and application of PE in the assessment and treatment of a Vietnam veteran with comorbid PTSD and early-stage dementia. Measures related to the patient's cognitive and psychological functioning were obtained before, during, and after treatment. PE was associated with significant declines in PTSD and depression symptoms. Moreover, the patient's cognitive functioning was made clearer in the absence of severe psychiatric symptoms. Factors contributing to the patient's positive response are discussed.     

Children's and parents' daily stressful events and psychological symptoms

Associations of children's daily stressful events and their parents' daily hassles and psychological symptoms with children's emotional/behavioral problems were examined in a sample of fourth- and fifth-grade children and their parents. Correlational analyses indicated that children's self-reports of depressive symptoms were associated with children's daily stressors and mothers' daily hassles, and children's self-reports of anxiety symptoms were associated with children's daily stressors and both mothers' and fathers' daily hassles. Mothers' and fathers' reports of their children's internalizing emotional/behavioral problems were correlated with mothers' and fathers' daily stressors and symptoms. Hierarchical multiple-regression analyses revealed that (a) children's self-reports of depressive symptoms were associated with children's daily stressors, (b) children's self-reports of anxiety symptoms were associated with their parents' daily hassles, (c) mothers' reports of their children's internalizing emotional/behavioral problems were marginally associated with parents' symptoms, and (d) fathers' reports of their children's internalizing emotional/behavioral problems were associated with parents' symptoms and children's self-reports of daily stressors.     

Das Reizdarmsyndrom

Irritable bowel syndrome is a common disorder that can be associated with significant disability and health care costs. Beyond it is the most common disease diagnosed by gastroenterologists. Diagnosis is based on typical complaints including abdominal pain, bloating, irregularities of bowel movements and defecation. The discussion of different etiopathogenetic models showed that irritable bowel syndrome is a biopsychosocial disorder in which psychosocial factors, altered motility and visceral hypersensitivity interact. When symptoms are moderate to severe and are associated with psychological distress and impaired quality of life, psychological treatments can be considered. Apart from symptomatic treatment with loperamide for diarrhoea and antidepressants for abdominal pain and comorbid psychological symptoms for example cognitive behavioral treatment, hypnotherapy, psychodynamic short-term psychotherapy and functional relaxation are being evaluated.     

Exercise Training for Persons with Alzheimer's Disease and Caregivers: A Review of Dyadic Exercise Interventions

Alzheimer's disease (AD) is the most common form of dementia and the prevalence will increase dramatically in the next decades. Although exercise has shown benefits for people with dementia due to AD as well as their caregivers, the impact of a dyadic exercise intervention including both groups as study participants remains to be determined. The authors review the current clinical evidence for dyadic exercise interventions, which are exercise regimens applied to both the person with dementia and the caregiver. A total of 4 controlled trials were reviewed. This review shows that dyadic exercise interventions are feasible and may produce a positive effect on functional independence and caregiver burden. However, there was insufficient evidence to support a benefit of dyadic exercise intervention on cognitive performance and on behavioral and neuropsychiatric symptoms in participants with dementia due to AD. A dyadic exercise intervention improves functional independence and caregiver burden. However, there is a need for well-designed randomized controlled clinical trials to confirm these benefits and to investigate several important points such as the effects of a dyadic exercise intervention on cognitive and noncognitive outcomes of AD, the optimal intensity of exercise training, and the cost effectiveness of such a program.