Alzheimer’s Dementia (AD) is among the most common diseases in the Geriatric population, and its prevalence is expected to quadruple by 2047.Vascular Dementia (VaD) is the second most frequent cause of dementia, with studies indicating VaD accounts for 10-20% of dementia cases across the globe. A diagnostic model differentiating AD and VaD would be clinically and scientifically valuable, considering the treatment approaches for these conditions are different. Although there are differences between AD and VaD on their neuropsychological profiles, a diagnostic model that successfully differentiates AD and VaD on neuropsychological testing has not been developed, despite previous attempts. Our study addresses this gap in the literature by examining two diagnostic models used to predict the conversion of AD from mild cognitive impairment, and a third model was proposed to differentiate AD from VaD. We conducted ROC Analyses using the variables LM II Standard Score, Animals Total, and CDRS Sum based on a previous diagnostic model. The sensitivity and specificity for the diagnosis of mild VaD were calculated for all possible scores of each test measure. The Animals Total cutoff score of 7 achieved excellent sensitivity and specificity, receiving 96% and 92%, respectively. In this sample, patients who could name at least seven animals under 60 seconds were highly likely to be diagnosed with VaD. LM II Scaled Score also achieved statistical significance (p <0.001) and a cutoff score of 4 received 96% sensitivity and 77% specificity. Patients who achieved an LM II Scaled Score of 4 or higher were highly likely to be diagnosed with VaD.

There is a paucity of research studies exploring the changes to social connectedness of people diagnosed with bvFTD and their families, from the premorbid to late stages of the condition. The purpose of this exploratory study was to establish how and why social connectedness changed for the study families over the progression of bvFTD. Social citizenship was selected as the conceptual framework and case study research as the methodology. Five families living with the effects of bvFTD volunteered for the research, and each person with the diagnosis was in the middle/late stages of the condition. Data was collected from the case study families and contacts, using a range of data collection tools (semi structured interviews; document review; diaries and participant observations). Thematic analysis was selected to examine the data collected from each family (within case analysis) and then the findings were compared and contrasted with the other families studied (cross case analysis). Six themes were identified from the collected data: i).“Why are they behaving like this?:Finding a reason; ii).“What is happening to our family? Changing family relationships.; iii).“Other people are noticing”; iv).“Getting a diagnosis”; v).“Now we know what it is.” and vi). “Grief and loss”. Findings indicated that relationships and social connectedness deteriorated in the pre diagnosis stage, and families stated it was largely due to the behavior, personality and social functioning changes of their family member, and the belief that these changes were intentional. By the time a diagnosis was given, the relationships and social connectedness had broken down to such a degree that they could not be rebuilt. The families described how they were no longer invited to social events in the same way as before and their social network reduced significantly. The families also stated that they tended to withdraw from social networks and events due to the embarrassment caused by their family member’s changed behavior. In conclusion, if bvFTD was recognized, diagnosed and specialist advice and support, given earlier by practitioners it could enable families to understand the effects of bvFTD on their family member’s behaviour. This could enable the family to retain relationships and connectedness, develop coping strategies, build resilience and prevent crises. Recommendations for clinical practice: i) increased training for medical practitioners, health and social care staff regarding early recognition and diagnosis of bvFTD; ii) specialist post diagnostic support offered immediately after diagnosis, and iii) awareness raising through campaigns which could include workplace awareness training.

The thesis explores the experience of Christian faith for those who live with mild to moderate dementia. Whilst spirituality is increasingly recognised as a factor in wellbeing, there has been relatively little in-depth exploration of how dementia affects faith, or conversely, how faith affects the experience of dementia, particularly, within the context of the evangelical faith tradition. Located within the field of Practical Theology, Osmer's four tasks provide structure for the research and discussion. The qualitative study uses a hermeneutic phenomenological methodology to discover insight from the lived experience of eight Christians who live with mild to moderate dementia. Theological reflection on issues arising from the phenomenological accounts, seeks understanding of the profound questions which dementia brings to faith experience. In conversation with theological writing, Christian tradition, and in the light of Scripture, the discussion looks for mutually critical correlation between experience and theology, investigating what it means to be a Christian living with dementia. The reflections are structured using a model of orientation, disorientation and reorientation, reminiscent of Brueggemann's scheme, looking for what this discloses about how faith is experienced in the life-changing challenges brought by dementia. Gadamer's notion of fusion of horizons discloses ongoing insight into the thesis question. The study concludes that faith is dependent primarily on relationship with God, expressed within the community of faith. Counterintuitively, it reveals a growing, positive experience of faith in the light of dementia, and highlights the significance of Christian hope. The thesis contends that faith experience and growth do not end with diagnosis, even though experience and practice begin to change in some respects. The research brings fresh theological insights, and highlights the need for new, creative practices which enable the faith nurture and support of disciples of Christ who are living with this disease. This period of early to moderate dementia provides opportunity for consideration of these issues, and for hearing the voices of those who live with dementia.

No description available.

Research into the lived experience of dementia, which has tended to focus on people with dementia and their spouses (carers) separately, has identified that that spousal relationships play a crucial role in this experience. However, there is a lack of knowledge as to how the dyadic interactions in spousal relationships affect the experience of dementia for couples. This thesis aimed to address this gap by exploring how couples in which one partner had mild dementia described the impact of dementia and their attempts to cope with it. It was a qualitative study which followed the theoretical and methodological stance of Interpretative Phenomenological Analysis. Face to face semi-structured interviews were conducted with twelve couples, with each partner interviewed separately. Results illustrated that couples’ reported their experience as a chronological process and were motivated to get on with their lives by maintaining a sense of normality. This study contributed to the literature by revealing how both partners experienced and coped with dementia, and the impact that their actions had on their spouse. Couples maintained normality through developing positive cognitions, keeping active, lessening the load and direct discussion and support. It was clear that couples’ (particularly carers’) awareness of dementia and its implications, combined with their knowledge of their spouse, affected how they experienced and coped with dementia. It was also clear that couples had different expectations about what constituted an acceptable level of communication, which thereby affected choice of coping strategy. The idea of a Relationship Continuum as a way to consider the impact of pre-morbid relationship styles on couples’ responses to dementia was explored. Results were discussed in terms of existing knowledge and ways in which this thesis has added to the literature were highlighted. Professional and practice implications, limitations and future research were discussed.

For most people, everyday tasks, such as tea making, are familiar, routine tasks that are normally performed without effort. A diagnostic feature of dementia, however, is an insidious decline in the ability to perform everyday tasks. Through a series of six studies, I examined how everyday task performance changes in people with dementia and I piloted two behavioural strategies that might enhance memory for everyday tasks in people with dementia. Study 1 developed a detailed error and error-monitoring taxonomy to explore the minutia of everyday task performance in healthy ageing. The study demonstrated that older adults without dementia rarely make errors in everyday tasks, even when conditions are manipulated to reduce cognitive resources. Study 2 documented errors and error-monitoring of everyday task performance in individuals with a developing dementia, using archive data to chart performance change over 5 years. While errors increased with dementia progression, there was no reactive increase in error-monitoring, suggesting a lack of awareness characterises the breakdown of task performance. Study 3a explored the impact of verbally instructing another person how to perform an everyday task on recall of an everyday task. People with dementia were able to do this surprisingly well, appearing to use both visual and motor cues to support recall. Study 3b piloted the impact of verbal self-explanation on everyday task performance, in four people with dementia. Self-explanation did not benefit recall and implementation of a familiar task. Study 4a compared observation with verbal instruction on acquisition of a novel routine. Results showed that people with mild-moderate dementia learned a new routine better under observation compared to verbal instruction. Study 4b tested observational learning of an everyday task over five weeks in three people with dementia. The initial benefit over verbal instruction was sustained, but did not increase over time. These studies constitute a detailed and meticulous exploration of everyday task performance in people with dementia and provide pilot evidence of a potential strategy that could support memory of everyday tasks in people with dementia.

This research investigated two groups of patients diagnosed with dementia before the age of sixty-five. The patients were diagnosed with Alzheimer’s Disease (AD, n = 25) and Frontotemporal Dementia (FTD, n = 37). Patients were assessed for approximately 3 years. The study found that FTD is a valid and useful diagnostic category, and can be reliably differentiated from AD. A combination of behavioural, neurological, and neuropsychological assessments were found to be complementary in the early and accurate diagnosis of early-onset dementia, and the differential diagnosis of FTD from AD. FTD patients were found to have relatively preserved visuo-spatial abilities compared to the AD patients. Problems associated with administering neuropsychological tests to early-onset dementia patients were highlighted. FTD patients were found to deteriorate more rapidly than AD patients, and to have significantly increased behavioural disturbances throughout the course of the illness in comparison with the AD patients. Practical guidelines to assist with care and management of early-onset dementia patients were presented. A strengths-based model of care was outlined. Individualised assessments and care plans were recommended for the development and provision of humane services to early-onset dementia patients. Issues surrounding providing palliative care were discussed.

Abstract not available

Thesis (M. Soc. Sc.)--University of Hong Kong, 2003.

Occupation provides valuable information on premorbid ability in dementia. Not only is occupation related to cognitive and brain reserve, but premorbid sub-symptomatic impairment may influence prospective career choice. Frontotemporal lobar degeneration (FTLD) patients with professions dependent upon one hemisphere have demonstrated contralateral degeneration. The present work was the first group study to examine the relationship between atrophy in FTLD and occupation. Chapter one reviews methods for quantifying occupations and introduces the Occupational Information Network database. This database provided quantified occupation attribute data and enabled subsequent multivariate analyses. A principal component analysis yielded five factors that parsimoniously summarized verbal, physical, mechanical, mathematical and visuospatial occupational demands, some with hypothesized neuroanatomical substrates. Chapters two and three tested the hypothesis that occupation characteristics systematically relate to origin of atrophy in FTLD. In a multi-centre chart review of 588 patients, occupation information was related to location of atrophy. Patients with unilateral right atrophy had higher verbal scores than patients with unilateral left or bilateral atrophy. Thus, occupation selection occurring in early adulthood is related to lateralized brain damage in patients who develop FTLD decades later. The finding suggests that verbal occupations may have been pursued due to incipient right-hemisphere functional impairment. Alternatively, long-term engagement of verbal processes contributed to left-hemisphere reserve, right-hemisphere dysfunction, or both. In a subgroup of well-characterized patients with quantified brain imaging data, chapter three replicated and extended these findings. The lateralization effect was limited to the temporal lobes and included both verbal and mathematical ability. This pattern may reflect shared attributes between mathematics and language processing, which are mediated by left-temporal lobe structures. Patients whose professions placed high demands on language had relatively preserved left temporal lobes and atrophy originating in the right temporal lobes at disease onset whereas patients with less challenging linguistic occupations were more susceptible to the onset of atrophy in the left-temporal lobe. In chapter four, the hypothesized relationship between occupational attainment and global degeneration was supported. Patients with highly skilled occupations had less atrophy than patients with lower-skilled occupations. Notably, specific occupational attributes were predictive of brain volume after controlling for demography and disease progression. Overall, a relationship between occupation and FTLD is supported.