American Journal of Alzheimer's Disease & Other Dementias®

In the present study, the hypothesis was tested that peripheral tactile nerve stimulation by massage would improve various aspects of affective behavior in patients with probable Alzheimer's disease. It was assumed that peripheral tactile stimulation might activate higher-level brain structures (e.g. the hypothalamus). The present study revealed that patients who were stimulated with tactile stimulation felt less depressed, less anxious, more well tempered, and were more alert. Apart from that, their personal orientation and their environmental orientation in place improved, they were more interested in social contacts and they participated more in activities of daily living. However, the observed effects could not be maintained over a period of six weeks following treatment.

This study provides information on the expectations that family caregivers of Alzheimer's and dementia patients and primary care physicians have of each other in relation to the medical encounter. In many respects, caregiver and physician recollections of what transpired in the medical encounter are similar. Overall, caregivers tend to evaluate their encounters with physicians positively. However, compared to physicians, caregivers tend to rate more highly the amount of information given to and the attention paid to the concerns and expectations of family caregivers. This is particularly true in relation to issues such as physician sensitivity to caregiver distress, making caregivers feel that what they say is important, telling caregivers all they need to know about the illness, and verbal acknowledgement of the caregivers' contributions. In an era of managed care, physicians may have to devise new strategies to effectively meet the needs and expectations of their Alzheimer V/dementia patients and their family caregivers.

More than two decades have passed since elder abuse first emerged as a social problem. Although found to be a very complex phenomenon of multiple types occurring in various settings, the original formulation of elder abuse as caregiver stress still resonates strongly with the public, the press and policy makers. In examining elder mistreatment within the context of caregiving and Alzheimer's disease (AD), we not only have the opportunity to learn more about the caregiver stress model, but also to gain greater understanding about prevention and treatment of elder abuse in families with AD members.

This paper provides a preliminary model of latent grief, the very unique and hidden grief experience of family caregivers of individuals with dementia. This model is based on a critical review of both grief and dementia care literature, as well as our own clinical experience in working with these families. The model describes three dimensions of loss and a number of dynamics that contribute to the latency of the grief process. We see latent grief as a major factor in caregiver stress and burnout, and believe that an understanding of this process will help to validate the ongoing grief that is part of the caregivers' experience. This will allow caregivers to recognize that their emotional turmoil, which they perceive to be a result of the burden of care, is also in large part due to the losses they endure on a daily basis.

There are millions of families who are faced with the pains of Alzheimer's disease (AD) every day. One of the most salient and pervasive issues they encounter is related to their loved ones' decline in communication. As a person progresses through AD, their ability to communicate deteriorates. This paper offers the use of Validation Therapy (VT) as a tool for meaningful communication for families and persons with AD. The principles and techniques of VT are presented. A case study employing the use of VT between a man with AD and his daughter demonstrates the process of VT between family members. The benefits that VT holds for families specifically is explored. This paper emphasizes the need for families to be informed of options and of alternatives to standard communication and supports VT as a viable tool.

In December, 1992, Clinical Gerontologist published the results of my dissertation research single subject experiments in which two early Alzheimer patients (Folstein MMSE scores of 23) were assisted to relearn two sets of forgotten biographical information by means of informational narratives and interactive quizzes presented via audio cassette recorder¹I Subsequent articles in this journal have discussed my memory training work in the context of a multi-modal treatment program,² and presented findings from a research study that compared quizzing to repetition as a means of reteaching forgotten information.³ Since none of the previously published articles referred to memory training in their titles, it is conceivable that researchers and practitioners might not find these articles in routine literature searches.

This article brings together in one place a summary of my memory training work with the 14 Alzheimer's patients and one undiagnosed amnestic patient with whom I have used the tape-recorded intervention. During the next five years, the technique will be tested, among other interventions, with 18 of 28 early stage Alzheimer patients with whom I'll be working under a grant from the National Institute on Aging.

So far, the technique has resulted in substantial learning in 13 of the 15 subjects with whom it was tried. MMSE scores of successful learners ranged from 10 to 27. The two who failed to learn had the highest and lowest mental status scores of the Alzheimer subjects: eight and 26, respectively. One or two week follow-up was done in 12 studies. In 11 of the 12 studies, 78 to 100 percent of questions answered correctly at post-test were answered correctly at follow-up.