Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial. A pilot study examining the effectiveness of maintenance Cognitive Stimulation Therapy (MCST) for people with dementia. Neuropsychiatric symptoms of dementia: cross-sectional analysis from a prospective, longitudinal Belgian study. The effect of planned walking on communication in Alzheimer's disease. Language impairment in dementia: impact on symptoms and care needs in residential homes. Actions seen as demanding in patients with severe dementia during one year of intervention. Comparison with controls. Effects of Clinical Supervision on Nurse-Patient Cooperation Quality The Effects of a Walking/Talking Program on Communication, Ambulation, and Functional Status in Residents with Alzheimer Disease Effects of Behavioral Interventions on Disruptive Behavior and Affect in Demented Nursing Home Residents The effect of integrated emotion-oriented care versus usual care on elderly persons with dementia in the nursing home and on nursing assistants: a randomized clinical trial. Educating nursing assistants to communicate more effectively with nursing home residents with dementia. Impact of training dementia caregivers in sensitivity to nonverbal emotion signals. The Effects of a Life Review Program on Disorientation, Social Interaction and Self-Esteem of Nursing Home Residents Conversation Intervention with Alzheimer's Patients Teaching and maintaining behavior management skills in the nursing home. A randomized, controlled, clinical trial of activity therapy for apathy in patients with dementia residing in long-term care. Effects of an abilities-focused program of morning care on residents who have dementia and on caregivers. Effects of snoezelen, integrated in 24 h dementia care, on nurse-patient communication during morning care.
BACKGROUND A recent Cochrane review of reality orientation therapy identified the need for large , well- design ed , multi-centre trials . AIMS To test the hypothesis that cognitive stimulation therapy ( CST ) for older people with dementia would benefit cognition and quality of life . METHOD A single-blind , multi-centre , r and omised controlled trial recruited 201 older people with dementia . The main outcome measures were change in cognitive function and quality of life . An intention-to-treat analysis used analysis of covariance to control for potential variability in baseline measures . RESULTS One hundred and fifteen people were r and omised within centres to the  intervention group and 86 to the control group .  At follow-up the intervention group had significantly improved relative to the control group on the Mini-Mental State Examination ( P=0.044 ) , the Alzheimer 's Disease Assessment Scale - Cognition ( ADAS-Cog ) ( P=0.014 ) and Quality of Life - Alzheimer 's Disease scales ( P=0.028 ) . Using criteria of 4 points or more improvement on the ADAS-Cog the number needed to treat was 6 for the intervention group . CONCLUSION The results compare favourably with trials of drugs for dementia . CST groups may have worthwhile benefits for many people with dementia BACKGROUND A recent r and omised controlled trial on Cognitive Stimulation Therapy ( CST ) identified the need to evaluate its more long-term benefits for people with dementia . This study evaluates the effectiveness of a weekly maintenance CST programme for people with dementia in residential care . METHOD Thirty-five people with dementia were included , following on from a seven-week twice-weekly study of  CST . The maintenance CST sessions ran in two residential homes using a once a week programme of CST over an additional 16 weeks . Two control homes did not receive the maintenance intervention . RESULTS Using repeated measures ANOVAS , there was a continuous , significant improvement in cognitive function ( MMSE ) for those receiving MCST ( CST+maintenance CST sessions ) as compared to CST alone or no treatment ( p = 0.012 ) . There were no effects on quality of life , behaviour or communication following maintenance sessions . The initial cognitive improvements following CST were only sustained at follow-up when followed by the programme of maintenance CST sessions . CONCLUSIONS The cognitive benefits of CST can be maintained by weekly sessions for around 6 months . A large-scale , multi-centre maintenance CST trial is required to clarify potential longer-term benefits of maintenance CST for dementia OBJECTIVE Given the rather limited knowledge on profiles of neuropsychiatric symptoms ( behavioural and psychological signs and symptoms of dementia , BPSD ) in several degenerative dementias , we design ed a prospect i ve study of which we here present the baseline data . METHODS Diagnosed according to strictly applied clinical diagnostic criteria , patients with probable Alzheimer 's disease ( AD ) ( n = 205 ) , frontotemporal dementia ( FTD ) ( n = 29 ) , mixed dementia ( MXD ) ( n = 39 ) and dementia with Lewy bodies ( DLB ) ( n = 23 ) were included . All patients underwent a neuropsychological examination and behavioural assessment by means of a battery of scales ( Middelheim Frontality Score ( MFS ) , Behave-AD , Cohen-Mansfield Agitation Inventory , Cornell Scale for Depression in Dementia ) . RESULTS In AD and MXD , activity disturbances and aggressiveness occurred in more than 80 % of the patients . With a prevalence of 70 % , apathy was very common whereas delusions and hallucinations were rare in FTD patients . Frequently used behavioural assessment scales like the Behave-AD systematic ally underestimated BPSD in FTD whereas the MFS displayed high sensitivity for frontal lobe symptoms . Hallucinations discriminated DLB patients from other dementias . A high prevalence of disinhibition ( 65 % ) in DLB pointed to frontal lobe involvement . CONCLUSIONS Behavioural assessment may help differentiating between different forms of dementia , further stressing the need for the development of new and more sensitive behavioural assessment scales . By means of the MFS , frontal lobe involvement was frequently observed in DLB . As 70 % of FTD patients displayed apathy , prevalence was about two times higher compared to the other disease groups , meanwhile indicating that apathy is frequently observed in dementia , irrespective of its etiology One of the effects of Alzheimer 's disease is a diminution in the ability to communicate . A r and omized , non-blinded two-group experimental study was undertaken to determine if planned walking has the capacity to improve the communication performance of patients with moderate to severe Alzheimer 's disease . Thirty subjects meeting NINCDS-ADRDA diagnostic criteria for probable Alzheimer 's disease , selected from two nursing homes , participated in the study . Intervention and comparison groups were each made up of subjects from both nursing homes . Subjects in one group were walked individually for 30 minutes three times a week for 10 weeks . Subjects in the comparison group were engaged in conversation for the same amount of time for 10 weeks . A multivariate analysis of variance ( MANOVA ) was performed on the communication data . Analysis of the data at post-testing indicated that communication performance improved significantly in the planned walking group over the conversation-only group ( f = 4.29 ; df = 2.28 ; P = 0.024 ) . The results suggest that a planned walking program has the capacity to improve the communication performance of patients with Alzheimer 's disease BACKGROUND Impairment of language skills affects the level of functioning of an individual , interferes with effective communication and can result in development of disruptive behaviour . Social skills and capacity for self care may be compromised . Few studies have evaluated the impact of language problems on symptoms and socialization in people with dementia in care environments . METHOD 315 elderly residents with dementia ( 29 % living in nursing homes , 71 % in social care facilities ) were assessed using st and ardized psychiatric schedules including the Sheffield Screening Test for Acquired Language Disorders and Neuropsychiatric Inventory . Dementia Care Mapping was undertaken at r and om in at least 50 % of residents in each facility . RESULTS Expressive language impairment was associated with the presence of delusions even when severity of dementia was controlled for ( p=0.02 ) and showed a tendency of association with depression ( p=0.06 ) . Receptive language difficulties were strongly associated with presence of Aberrant Motor Behaviour , even controlling for severity of dementia ( p=0.04 ) . Decreased participation in social activities was correlated with both expressive ( p=0.048 ) and receptive aspects of language ( p<0.01 ) but social withdrawal was only correlated with receptive language difficulties ( p=0.01 ) . CONCLUSION Language disorders are associated with both behavioural and psychological symptoms of dementia even when severity of dementia is controlled for . Patients ' needs in communication skills should be addressed earlier to help them maintain social interactions and reduce the impact on behavioural problems and patients ' quality of life Behaviours , viewed by nurses as dem and ing , performed by patients with severe dementia were investigated during one year of intervention . Supervised implementation of individually planned care and systematic clinical supervision were implemented on one experimental ward ( EW ) while another ward ( CW ) served as control . Each ward had 11 patients . At baseline and after 6 and 12 months of intervention structured interviews with the patients ' assigned nurses were conducted based on the Dem and ing Behaviour Assessment Scale and Multi Dimensional Dementia Assessment Scale . At the EW there was a decreased frequency ( p=0.000 ) and a reduced occurrence of physical behaviours ( p=0.008 ) , a decreased frequency ( p=0.029 ) and a reduced occurrence of vocal behaviours ( p=0.002 ) . No significant changes were seen at the CW . Bearing the small sample size in mind , the findings indicate that individually planned care and systematic clinical supervision could be a means of reducing the frequency , and /or effect the nurses ' attitude and interpretation of the patients ' behaviour as dem and ing . The findings , however , can only be seen as indications for further research , but point to the importance of including effect variables related to patients when intervening in nursing care An intervention consisting of individualized planned care for patients and regular clinical systematic supervision for nurses  was carried out on a ward for dementia care ( the experimental ward , EW ) . On a similar control ward ( CW ) , no changes were made . Observations of  nurse-patient  cooperation during morning care were collected at both wards , before and during the intervention . The observations ( N = 107 ) were analyzed blindly and sorted into already-developed categories . The distribution of the cooperation-style categories was then analyzed statistically . The patients who survived throughout the study period ( N = 18 ) were also compared over time . Nurse-patient cooperation at the EW improved significantly during the intervention period , whereas , at the CW , it deteriorated ( p = .02 ) . Status of surviving patients followed the same pattern ( p = .001 ) . The findings indicate that such interventions can improve the quality of nurse-patient cooperation in dementia care The purpose of this study was to investigate the effects of a walking/talking program on residents ' communication , ambulation , and level of function when there were two residents to one care provider ( 2:1 ) . A r and omized control trial design was used . Subjects were residents with Alzheimer disease in three geriatric long-term care facilities in Metropolitan Toronto . Residents who met the inclusion criteria were r and omly assigned to one of three groups : walk- and -talk group ( 30 min , 5 times per week for 16 weeks , walking/talking in pairs ) , talk-only group ( 30 min , 5 times per week for 16 weeks , talk only in pairs ) , or no intervention . The outcome measures were the Functional Assessment of Communication Skills for Adults , the 2-min walk test , and London Psychogeriatric Rating Scale .  Residents who received the walk- and -talk intervention did not demonstrate statistically significant differences in the outcome variables measured posttest when compared with residents who received the talk-only intervention or no intervention , even after controlling for individual differences . Variability in the outcomes measured posttest is explained by differences in the residents '  level of cognitive impairment before the study rather than by study group membership . These findings are contradictory to those of previous studies Background Disruptive behaviors are prevalent in nursing home residents with dementia and often have negative consequences for the resident , caregiver , and others in the environment . Behavioral interventions might ameliorate them and have a positive effect on residents ’ mood ( affect ) . Objectives This study tested two interventions —an activities of daily living and a psychosocial activity intervention— and a combination of the two to determine their efficacy in reducing disruptive behaviors and improving affect in nursing home residents with dementia . Methods The study had three treatment groups ( activities of daily living , psychosocial activity , and a combination ) and two control groups ( placebo and no intervention ) . Nursing assistants hired specifically for this study enacted the interventions under the direction of a master ’s prepared gerontological clinical nurse specialist . Nursing assistants employed at the nursing homes recorded the occurrence of  disruptive behaviors  . Raters analyzed videotapes filmed during the study to determine the interventions ’ influence on affect . Results Findings indicated significantly more positive affect but not reduced disruptive behaviors in treatment groups compared to control groups . Conclusions The treatments did not specifically address the factors that may have been triggering disruptive behaviors . Interventions much more precisely design ed than those employed in this study require development to quell disruptive behaviors . Nontargeted interventions might increase positive affect . Treatments that produce even a brief improvement in affect indicate improved quality of mental health as m and ated by federal law OBJECTIVES To examine the effect of integrated emotion-oriented care on nursing home residents with dementia and nursing assistants . DESIGN A multi-site r and omized clinical trial with matched groups , and measurements at baseline and after seven months . SETTING Sixteen psychogeriatric wards in fourteen nursing homes in the Netherl and s. PARTICIPANTS One hundred and forty-six elderly residents with the diagnosis dementia of the Alzheimer ( DAT ) type , mixed DAT and vascular dementia , and dementia syndrome ( NAO ) and 99 nursing assistants . INTERVENTIONS Integrated emotion-oriented care and usual care . MESUREMENTS : Demented elderly : Behaviour and mood related to adaptation to the illness and the institutionalization . Nursing assistants : General health as measured by feelings of stress , stress reactions , feeling of competence and illness . RESULTS Positive effects in favour of the integrated emotion-oriented care were found in mild to moderately demented residents on two adaptive tasks : maintaining an emotional balance ( less anxiety ) and preserving a positive self-image ( less dissatisfaction ) . In the trained group of nursing assistants fewer stress reactions were found only in those who perceived improvement in their emotion-oriented care skills after training . CONCLUSION Emotion-oriented care is more effective with regard to the emotional adaptation in nursing homes of persons with a mild to moderate dementia . For the severely demented elderly we did not find this surplus value . This outcome is of clinical importance for elderly persons with dementia who are cared for in nursing homes . With respect to the nursing assistants it is concluded that emotion-oriented care has a positive influence on stress reactions in some of them This article describes the development and evaluation of a Nursing Assistant Communication Skills Program ( NACSP ) . NACSP was design ed to help nursing assistants ( NAs ) interact more effectively with nursing home residents with moderate and severe dementia . In two skilled-care nursing homes , NAs in four units were r and omly assigned by unit to NACSP or to a wait-list control condition ( UC ) and were assessed at baseline , 3 months , and 6 months . NACSP result ed in improvement in the well-being of nursing home residents being cared for by NAs who had received the NACSP training . It was also found that NACSP result ed in greater knowledge of caregiving responses and reduced turnover rates among NAs , but the program had no impact on their knowledge of dementia . To disseminate the NACSP program , a leader manual , an accompanying training videotape , and a workbook for participants were developed Ninety-one mid- to late-stage dementia patients residing in nursing homes , along with their staff caregivers , participated in a study design ed to assess whether training caregivers in sensitivity to nonverbal communication could enhance mood and reduce symptoms in patients and improve psychological well-being in caregivers . Patients and staff at three nursing homes comprised three groups that were r and omly assigned to either a nonverbal sensitivity group , a behavioral placebo group that received instruction in the cognitive and behavioral aspects of dementia , and a wait-list control . Training consisted of 10 one-hour sessions taught by a clinical psychologist using prepared material s. Patient measures , which were taken at baseline and at 4 three-week intervals , included patient symptomatology ( depression , agitation , behavioral symptoms ) , as reported by the staff caregivers , and positive and negative facial expressions of emotion elicited during a face-to-face interview and coded by trained research staff . Results indicated that positive affect increased sharply during the first 6 weeks after intervention in the nonverbal group , with the placebo and wait-list controls showing no change . There was also a decline in negative affect across time for all groups . Effects with respect to patient symptomatology did not reach significance . Caregivers in both training groups showed a decline in symptomatology , whereas the wait-list control group did not This study examined the effects on veteran and novice participants of a life review program design ed for nursing home residents with Alzheimer 's disease or severe cognitive disfunction . Using a pre-post test experimental design , veterans , novices and the control group were tested for changes in disorientation , social interaction , and self-esteem . The results confirm the findings of an earlier study [ 1 ] that there is an impact of the Life Review Program on level of disorientation , social interaction and life review . There is some evidence to suggest that the improvements may be somehow stored in memory and triggered when the program is repeated Abstract The effectiveness of conversation in improving verbal communication of nursing home residents with Alzheimer 's disease was compared to exercise and a combination of both interventions . Fifty-five participants were r and omly assigned to treatment group and raters were blinded . Treatment was given three times weekly for 30 minutes , for 16 weeks . Although all groups evidence d decline in the total number of words used as a group , the conversation-only subjects ' performance was significantly better in terms of the number of nonredundant units of information produced ( p = .0433 ) and conciseness ( p = .0101 ) using analysis of covariance controlling for baseline performance . Individual subjects ' change in performance was also examined . Active engagement in structured one-on-one conversation may improve relevance of communication in this population PURPOSE To examine the efficacy of a comprehensive behavior management skills training program for improving certified nursing assistants ' ( CNA ) skill performance in the nursing home , to assess the effectiveness of a staff motivational system for maintaining newly acquired behavior management skills for a 6-month period , and to evaluate any result ing effects on resident agitation . DESIGN AND METHODS This study used a r and omized clinical trial of 88 residents with behavior disturbances and 106 CNAs who cared for them in two urban nursing homes . After CNAs received 4 weeks of behavior management training , supervisory nursing staff implemented formal staff management ( FSM ) , design ed to maintain training effects over time . The supervisory staff used conventional staff management ( CSM , usual supervisory routine ) on control units . We completed behavioral observations and paper- and -pen assessment s at baseline and repeated them during a 4-week post-intervention phase and at 3- and 6-month follow-ups . RESULTS During the immediate post-training phase , both the FSM and CSM groups improved five out of seven communication skills and the ability to delay physical assistance during care routines . Although CNAs showed a reduction in the use of ineffective behavior management strategies , they did not increase their use of effective behavioral strategies . Follow-up assessment s suggested that the FSM system was more effective than CSM for maintaining and even improving communication skills over time . Resident agitation was reduced during care interactions and maintained at follow-up . IMPLICATION S The behavior management skills training program improved CNAs ' ability to interact with behaviorally disturbed nursing home residents and produced sustained reductions in agitation . The FSM system was more effective for maintaining communication skills 6 months after training BACKGROUND Apathy is a common symptom in patients with dementia and has adverse consequences for patients and caregivers . Most treatments for apathy , particularly non-pharmacologic interventions , have not been evaluated in controlled trials . OBJECTIVES This study evaluated the efficacy of a kit-based activity intervention , compared to a time and attention control ( one-on-one meetings with an activity therapist ) in reducing apathy and improving quality of life in 37 patients with dementia . METHODS The design was a r and omized , controlled , partially masked clinical trial . All outcome measures were administered at baseline and follow-up . The primary outcome measure was the apathy score of the Neuropsychiatric Inventory ( NPI ) . Other outcome measures were the NPI total score , the Alzheimer Disease Related Quality of Life scale(ADQRL ) , and the Copper Ridge Activity Index ( CRAI ) . RESULTS There was a significant reduction in NPI apathy scores in both treatment groups . The only significant difference between the two treatment groups was a modest advantage for the control intervention on the CRAI cueing subscale ( p = 0.027 ) , but not on the other CRAI subscales . There was also a greater within group improvement in quality of life ratings in the control intervention ( p=0.03 ) . CONCLUSIONS Despite the substantial improvement in apathy scores during the course of the study , there was no clear advantage to the reminiscence-based intervention over the time and attention , one-on-one control intervention . More research is needed to develop specific behavioral interventions for apathy in patients with dementia OBJECTIVE To conduct a controlled investigation to examine the effects of an abilities-focused program of morning care on the interaction behaviors and functioning of residents with dementia and on caregivers ' interaction behaviors and perceptions of caregiving . DESIGN A quasi-experimental , repeated measures design . SETTING The study was conducted on four , nursing-home-level cognitive supports units in a geriatric care center . One of the units was r and omly selected as the experimental unit ; the other three served as controls . PARTICIPANTS The final sample consisted of 40 residents ( 20 each in the experimental and three control groups ) and 44 caregivers ( 16 on the experimental unit and 28 on the three control units ) . INTERVENTION An educational program on delivering abilities-focused morning care , design ed by the authors , was provided to caregivers on the experimental unit . MEASUREMENTS Measures were taken at baseline and at 3 and 6 months postintervention with regard to residents ' interaction behaviors , level of agitation , and level of function and to caregivers ' interaction behaviors , perceived ease of caregiving , and level of stress . RESULTS Repeated measures analysis of variance ( RM-ANOVA ) was used to compare the experimental and control groups in regard to changes in the outcomes over time . Results indicated that the abilities-focused program had statistically significant effects on ( a ) residents ' personal attending and calm/functional behaviors , level of agitation , and levels of overall and social function , and ( b ) caregivers ' verbal relevance and personal attending , relaxed , and social/flexible behaviors . CONCLUSIONS The evidence suggests that both residents and caregivers benefit from morning care that is oriented toward the abilities of people with dementia OBJECTIVE To investigate the effectiveness of snoezelen , integrated in 24-hour care , on the communication of Certified Nursing Assistants ( CNAs ) and demented nursing home residents during morning care . METHODS A quasi-experimental pre- and post-test design was conducted , comparing sic psychogeriatric wards , that implemented snoezelen , to six control wards , that continued in giving usual care . Measurements were performed at baseline and 18 months after a training ' snoezelen for caregivers ' . Independent assessors analysed 250 video-recordings directly from the computer , using an adapted version of the  Roter Interaction Analysis System ( RIAS ) and non-verbal measurements . RESULTS Trained CNAs showed a significant increase of resident-directed gaze , affective touch and smiling . The total number of verbal utterances also increased ( more social conversation , agreement , talking about sensory stimuli , information and autonomy ) . Regarding residents , a significant treatment effect was found for smiling , CNA-directed gaze , negative verbal behaviours ( less disapproval and anger ) and verbal expressed autonomy . CONCLUSION The implementation of snoezelen improved the actual communication during morning care . PRACTICE IMPLICATION S Teaching CNAs to provide snoezelen has added value for the quality of care . Morning care by trained CNAs appeared to take more time . This suggests that ( some ) time investment might be required to achieve positive effects on CNA- resident communication
BACKGROUND The impairment of verbal skills of people with dementia challenges communication .
The aim of this review was to study the effects of nonpharmacological interventions in residential and nursing homes on ( 1 ) communication between residents with dementia and care staff , and ( 2 ) the neuropsychiatric symptoms of residents with dementia .