American Journal of Alzheimer's Disease & Other Dementias®

Creutzfeldt-Jakob disease (CJD) is a rare neurodegenerative disease. Alzheimer's disease is the most common neurodegenerative disease in the United States. The onsetof CJD is often heralded by behavioral changes, depression, and amnesia. Progressive dementia and myoclonus (often in response to sensory stimuli) invariably occur.

It is important to evaluate all new nursing home residents who have an admitting diagnosis of dementia. Dementia in the elderly is not always caused by Alzheimer's disease. This report identifies a rare cause of dementia in an elderly woman.

There is a predictable decline in functioning among individuals with progressive dementias. In addition, independent of the disease process, there can be “excess disabilities” due to incompatible components of the social and physical environment. We review the nature and sources of these excess disabilities and examine the literature on ameliorative interventions in special care units.

The number of progressive dementia patients being caredfor in long term institutions is increasing. As medical science continues to search for answers to treatment and cure, caregivers continue to struggle with managing cares and promoting patient dignity. Evaluation and identification of individual patient cognitive assets and limitations is essential in planning patient cares. The purpose of this study is to describe two tools, used in a team aproach, to facilitate managing basic daily cares. The study compares the scoring of the two tools indicating a substantial relationship between the two instruments and suggests that the Cognitive Performance Test (CPT) and the Self Care Performance Test (SCPT) rate behavior and task performance in a consistently similar manner. The results suggest that the scales are an accurate predictor of demented patients cognitive abilities and limitations and can facilitate designing nursng care plans. The CPT(which can be given in about 20 minutes) can be completed upon admission, the test score shared with nursing and the SCPT can guide plans of care. Cares planned in this manner are likely to allow the patients independence in performing those cares they are capable of and not frustrating them by expecting them to perform skills they have lost.

This study focuses on patients in the later stages of progressive dementia. Fifty-eight subjects were rated using the two tools. Fifty-one of the 58 subjects in the study received a rating level offour or lower. (Allen 's levels of rating progressive dementia with level six being normalfunctioning.) Patient scores for both the CPT and the SCPT are based on observance of performance and do not require verbal responses and therefore lower level dementia patients can be more reliably rated.

Dysfunctional communication, behaviorproblems, and the lack of meaningful exchanges make it difficult for the nursing assistant (NA) to establish a relationship with the nursing home resident who has Alzheimer's disease (AD). As a result, the NA may avoid communication. Long term care is inevitable for many persons with AD. Therefore, it is important to understand the impact of verbal and nonverbal communication on the caregiving relationship between the formal caregiver in the nursing home and the person with AD.

The purpose of the study was to describe communication barriers and successes identified by NAs. NAs did not understand resident behaviors such as fearfulness, agitation and wandering. They were also frustrated with the demands of family members. Results indicated that NAs did not have the necessary education orsupportto communicate effectively with the individual with AD and the family, and that training NAs to work more effectively should be a priority for nursing homes.

Alzheimer's disease is a progressive, degenerative terminal disease. It has been the fourth leading cause of death among adults during the past decade, taking more than 100,000 lives annually. Approximately 10 percent of people age 65 and over have probable Alzheimer's disease and 47 percent of those over age 85 suffer from the disease. The National Institute of Aging predicts that there will be 14 million people with Alzheimer's disease by the year 2050.

This study examined the helpline of the Alzheimer's Association of Eastern Massachusetts. Its stated mission is to provide access to comprehensive services as well as provide support to callers who are caring for someone with dementia. How information is provided and perceived may impact upon a caller's overall satisfaction with the helpline and their consequent decision tofollow through on referrals.

Helpline staff identified callers who sought information regarding a specific family member or patient during November 1991. About 70 percent (100) of the callers consented to afollow-up telephone interview by a social work graduate student in January 1992. Approximately 63 percent of the calls regarded someone who was post diagnosis. Memory loss, confusion, and repetitive questioning were the major problem behaviors noted. The mostfrequent inquiries regarded nursing home placements, family support groups, and diagnostic referrals. Over 75 percent of the callers were not affiliated with the Alzheimer's Association or with a family support group.

While overall satisfaction with the helpline was high, callers who received follow-up information through the mail tended to report greater satisfaction. The majority (87 percent) noted they would call the helpline again as concerns arose in the future.

The study highlighted the need for professionals to be better informed about Alzheimer's disease and its impact on families. It also emphasized the lack of knowledge concerning available resources. The Alzheimer's Association through its network of helplines can provide valuable information to both informal and professional caregivers regarding the progression of the disease and its management. The Helpline should be recognized as a resource that may provide ongoing support through the duration of the disease.