Reduction of caregiver burden in Alzheimer's disease by treatment with galantamine

Alzheimer's disease is a progressive condition characterized by a loss of cognition, altered behavior, and a loss of functional ability, such as bathing, dressing, toileting, and organizing finances. Family and friends provide nearly three quarters of all care for patients with Alzheimer's disease. This informal care results in significant burden to caregivers. Caregiver burden is the set of physical, psychological or emotional, social, and financial problems that family members may experience when caring for impaired older adults. Caregivers of Alzheimer's disease patients report higher rates of physical symptoms, mortality, depression, and fatigue, as well as adverse effects on employment compared with those who are not caregivers for Alzheimer's disease patients. In many cases, the same family members are responsible for both out-of-pocket expenditures and caregiving duties. For this article, a MEDLINE search using the key words "caregiver and Alzheimer's disease" and "cost and Alzheimer's disease" was performed. The purpose of this article is to review the literature on caregiver burden, the components of caregiver burden, effects of caregiving on the health of caregivers, the cost of Alzheimer's disease on the caregiver and society, and the benefits attainable with treatment.     

Video interaction guidance inviting transcendence of postpartum depressed mothers' self‐centered state and holding behavior

By sometimes evoking self‐absorbed and avoidance behaviors in new mothers, postnatal depression affects the quality of mother–infant interaction, which in turn may invoke distress and avoidance in the infant and cause even more lasting impairment in the child's development. Three depressed mothers, A, B, and C, are reported upon after having been offered counseling in accordance with the Marte Meo approach through jointly watching with the therapist video replays of themselves interacting with their newborns. Clinical vignettes are offered which indicate how empathic and positive support of a sensitive therapist can be helpful in inviting the mother's recognition of her importance to her infant and facilitating mutually gratifying interaction between mother and child. Protocol analyses of select sessions of video‐related therapy reveal that two of the mothers sometimes complete the therapist's unfinished statements in an other‐centered manner, thereby transcending their initial self‐centered state. This is most dramatic in the case of Mother A, who starts out in the first session almost incapable of speech, merely nodding or shaking her head. In addition to other indications of improved mother–infant interaction, comparison of pre‐ and postguidance windows regarding the three mothers' holding behaviors reveals a shift from an avoidance or anxious stance to closer and more secure holding.     

A laboratory model for evaluating relapse of undesirable caregiver behavior

The success of behavioral treatments like functional communication training depends on their continued implementation outside of the clinical context, where failures in caregiver treatment adherence can lead to the relapse of destructive behavior. In the present study, we developed a laboratory model for evaluating the relapse of undesirable caregiver behavior that simulates two common sources of disruption (i.e., changes in context and in treatment efficacy) believed to affect caregiver treatment adherence using simulated confederate destructive behavior. In Phase 1, the caregiver's delivery of reinforcers for destructive behavior terminated confederate destructive behavior in a home‐like context. In Phase 2, the caregiver implemented functional communication training in a clinical context in which providing reinforcers for destructive or alternative behavior terminated confederate destructive behavior. In Phase 3, the caregiver returned to the home‐like context, and caregiver behavior produced no effect on confederate destructive or alternative behavior, simulating an inconsolable child. Undesirable caregiver behavior relapsed in three of four treatment‐adherence challenges.     

Modeling caregiver adaptation over time: the longitudinal impact of behavior problems

Although cross-sectional research has established the link between care demands and various indicators of caregiver adaptation, few studies have examined the impact of care recipients' problematic behavior over time. The present analysis determines the importance of behavior problems when predicting rates of change in subjective stressors (role overload and role captivity) and depression. Using 4-wave longitudinal data (N = 137) on dementia caregivers, the authors fit individual growth curve models for care demands (i.e., behavior problems, activities of daily living dependencies, and cognitive impairment), subjective stressors, and depression. Subsequent structural equation models found that increases in behavior problems were most likely to predict increases in role overload. The findings emphasize the deleterious long-term impact of behavior problems on individuals' emotional adaptation to caregiving.     

The effect of neonatal temperament on caregiver behavior in the newborn nursery

The research was conducted to determine whether temperamental characteristics of neonates influence caregiver behavior as early as the second day of life. Visual attentiveness, activity, and irritability of 28 healthy newborns were rated during six 30-minute sessions. Derived scores represented the infant's behavior during the total observation time and during specified caretaking activities. Several categories of nurturant behaviors and types of comments directed toward each infant by nurse-caregivers were coded during independent sessions. Variations in caregiver behavior were shown by Pearson correlations to be related to independently assessed differences among neonates. Alert babies received the most nurturant and social contact; active infants received the least contact, but the most comments that reflected concern about their health; irritable infants were soothed most. The data clearly suggest that emerging infant temperament plays a role in shaping the caregiving environment by the second day of life.     

Treating destructive behavior reinforced by increased caregiver compliance with the participant's mands

Functional analyses sometimes do not identify momentary fluctuations in the function of destructive behavior (Bowman, Fisher, Thompson, & Piazza, 1997). In such cases, individuals may mand for the reinforcer that is currently most preferred and display destructive behavior if that mand goes unreinforced. In this study, we conducted a mand analysis to test whether destructive behavior functioned as a precurrent response that increased reinforcement for the participant's mands. We then evaluated a treatment that matched this function of destructive behavior by providing differential or time-based reinforcement of participant mands in accordance with multiple or chained schedules with reinforcement-schedule thinning. Decreases in destructive behavior averaged 97.4% across cases. We discuss these results relative to the importance of matching treatments for destructive behavior to operant functions for both traditional and idiosyncratic functions of destructive behavior.     

The wellness behavior interaction model

A cognitive-behavioral model for conceptualizing wellness is proposed consisting of situational/antecedent variables, person variables, and consequence variables which, taken individually or together, may serve to describe and explain wellness behavior. The model also is interactional in the sense that different categories of variables or factors within a category may impact on each other in a multidirectional fashion. A selective review of research relating to each variable is provided to demonstrate the need for such a multidimensional conceptual scheme for wellness.     

Mother-child interaction and mirror behavior

Toddlers and children, aged 6 to 38 months, with their mothers, were observed in free-play that included a hand and standing mirror. The mother-toddler interaction was assessed according to a proposed profile that described 34 categories of maternal behaviors, such as empathy, attunement, acceptance of the child as a separate individual, and capacity to provide a referencing framework. Fourteen maternal modes or styles, such as consistency, genuineness, intrusiveness, and pleasure in maternal role, also were coded. The global ratings of maternal behaviors were related to the behaviors in front of the mirrors as outlined by Amsterdam (1972). Initial observations suggest that deviant mirror behaviors parallel deficits in the mother-toddler interaction. In contrast, mirror behavior is appropriate or beyond the chronological age if the mother-toddler interaction is satisfactory. Because mirror behavior reflects a sense of self and covaries with the quality of the mother-toddler interaction, the behavior in front of the mirror may be used as a clinical diagnostic tool.     

Wearable strain sensor suit for infants to measure limb movements under interaction with caregiver

Development of motion capture technology has enabled the measurement of body movements over long periods of time in daily life. Although accelerometers have been used as primary sensors, problems arise when they are used to measure the movements of infants. Because infants and caregivers interact frequently, accelerometer data from infants may be significantly distorted by a caregiver’s movement. To overcome this problem, a strain sensor suit was developed for infants to measure flexion and extension movements of the limbs. A case study was performed to analyze the strain sensor data of an infant in relation to the accelerometer data of the infant’s and a caregiver’s body under various types of infant–caregiver interaction. The results demonstrated that the strain sensor data had low correlation with the accelerometer data of the infant and caregiver while the accelerometer data between infant and caregiver had higher correlation. This suggests that the strain sensor is suitable to detect limbs’ angular displacements mostly independent from the translational body movements exerted by a caregiver.     

Maternal sensitivity behavior and infant behavior in early interaction

Maternal sensitivity behavior and infant behavior in early interaction were investigated among 57 Finnish mother–child pairs. Their interaction was video‐recorded at home in free‐play situation when the infants were 3 months and 12 months of age, and evaluated using the Parent–Child Early Relational Assessment Scale (PCERA). Maternal sensitivity behavior was mainly related to infant's positive aspects of mood, social and play behavior, and visual contact, both at 3 months and 12 months of age. Even though maternal sensitivity behavior correlated to infant behavior at 3 months and 12 months, infant behavior at 3 months of age contributed to later maternal sensitivity behavior. ©2001 Michigan Association for Infant Mental Health.     

Face-to-face interaction behavior across early infancy

Stability and change in mother-infant interaction behavior were assessed across early infancy. At 8 versus 4 months, the infants showed more smiling, vocalizing and motor-activity, and their mothers touched and moved their infants' limbs less often. Stability was noted only for infant distress-brow and mother's touching the infant. Although very few relationships were apparent between mother and infant behavior at 4 months, several maternal behaviors at 4 months were related to infant behaviors at 8 months, and several relationships were noted between maternal and infant behavior at 8 months.     

Nonverbal behavior of vendors in customer-vendor interaction

Two research questions were posed on the homophily theory of customer-vendor interactions: (a) do vendors show any nonverbal preference for Euro-American or African-American customers?; (b) do vendors demonstrate any nonverbal preference for customers with which they share racial homophily? The results supported the homophily theory for Euro-American customers in that there were significant interaction effects by race in facial expression (F = 5.33, p < .05), amount of speaking (F = 6.76, p < .01), tone of voice (F = 7.62, p < .01), and touching (F = 4.57, p < .05). Vendor behavior varied when the customer was Euro-American, with Euro-American vendors smiling more frequently (M = 4.05) than African-American vendors (M = 3.69), speaking more frequently (M = 3.57) than African-American vendors (M = 3.09), using a more friendly tone of voice (M = 3.59, and engaging in more touching behaviors (M = 1.81) than African-American vendors (M = 1.48). There was no significant difference in the behavior of Euro-American and African-American vendors when the customer was African-American.     

Assessment of apathy in neurological patients using the Apathy Motivation Index caregiver version

Apathy is a common, disabling neuropsychiatric syndrome that occurs across many brain disorders and may be associated with diminished motivation in behavioural, cognitive, emotional and social domains. Assessment is complicated by the variability of symptoms across apathy domains and self-report from patients, which can be misleading due to their lack of insight. Independent evaluation by clinicians also has limitations though if it has to be performed with limited time. Caregiver reports are a viable alternative, but current assessments for them either do not distinguish between different apathy domains or are interview-based and take long to administer. In this study, we developed a brief caregiver questionnaire version of the recently developed Apathy Motivation Index (AMI), which is a self-report tool. We confirmed three apathy factors in this new caregiver measure (AMI-CG) that were also present in the AMI: Behavioural Activation, Emotional Sensitivity and Social Motivation. Furthermore, we validated the scores against more extensive caregiver interviews using the established Lillle apathy rating scale as well as patient self-reports of apathy, measures of depression, anhedonia, cognition, activities of daily living and caregiver burden across four different neurological conditions: Parkinson's disease, Alzheimer's disease, subjective cognitive impairment and limbic encephalitis. The AMI-CG showed good internal reliability, external validity and diagnostic accuracy. It also uncovered cases of social apathy overlooked by traditional instruments. Crucially, patients who under-rated their apathy compared to informants were more likely to have difficulties performing everyday activities and to be a greater burden to caregivers. The findings provide evidence for a multidimensional conceptualization of apathy and an instrument for efficient detection of apathy based on caregiver reports for use in clinical practice.     

Spiritual healing of disrupted childhood

This essay suggests ways in which spiritual resources--healing stories, psalms of lament and reassurance, rituals, and meditative practices--can be used to foster emotional and spiritual healing for people, such as the adult children of missionaries, who have experienced disrupted relationships with parents during childhood.     

Cognitive guidance and improvement of Alzheimer's disease patients based on human-computer interaction design

Cognitive dysfunction is a common problem in patients with Alzheimer's disease. This not only affects the comprehensive rehabilitation of motor function and activities of daily living, but also directly affects the social adaptability, and brings difficulties to the reintegration of Alzheimer's patients. Therefore, cognitive rehabilitation of Alzheimer's patients has become one of the important topics facing the medical community. Under the concept of human-computer interaction design, this study uses puzzle games as an entry point to observe the impact of puzzle games on cognitive function guidance and improvement in patients with Alzheimer's disease. Expecting to provide daily rehabilitation for patients with Alzheimer's disease. It is also hoped that it can promote the cognitive ability recovery of Alzheimer's patients, effectively delay the progress of dementia, improve the daily living ability and adaptability of patients, and improve the quality of life and life.