Background: Elderly people who demonstrate memory impairment that falls short of dementia, are referred to as having amnestic Mild Cognitive Impairment (aMCI). AMCI patients have an elevated risk of developing dementia, although not all will do so. Clinical criteria for Alzheimer's Disease (AD) and aMCI do not specify how impairment of a cognitive nature should be defined. The process of differentially diagnosing these conditions can be improved, if knowledge of neuropsychological measures that best discriminate between neurodegenerative and non-neurodegenerative cognitive impairment is used to implement diagnostic criteria for aMCI and AD. Aims: We sought to 1) determine the frequency of aMCI referrals to our specialist memory clinic, 2) characterise the detailed neuropsychology of a group of patients with aMCI, 3) determine the utility in differential diagnosis and test-retest reliability of these neuropsychological measures, and 4) establish a subset of neuropsychological measures that were of prognostic utility in aMCI. Methods: The case notes of 187 consecutive referrals received by our Royal Edinburgh Hospital memory assessment service across an 18-month period were reviewed retrospectively and numbers of patients fulfilling aMCI criteria were recorded. The baseline neuropsychological performances of 46 patients with aMCI, 20 patients with very early stage AD, 20 elderly patients with depressive symptoms and 24 healthy elderly participants were compared in order to determine their usefulness in differential diagnosis. AMCI participants were followed-up across an average of 4 years. Baseline neuropsychological performances of the aMCI dementia converters and aMCI non-converters were compared. Logistic regression analysis was applied to ascertain the predictive accuracy of a combination of these. Results: One quarter of referrals received by our memory assessment service met criteria for aMCI, most of whom displayed additional neuropsychological impairments of a non-memory nature, all the while performing above the highest cut off points on even the most comprehensive dementia screening measures. A number of neuropsychological measures were highly sensitive and specific to early AD however, similar combinations of both high sensitivity and specificity to aMCI were not achieved. Forty one percent of patients presenting to our service who fulfilled criteria for aMCI, received a clinical diagnosis of dementia across an average 4-year period. Performances on a comprehensive cognitive screening measure and a measure of delayed word recognition accuracy at baseline, classified 74% of aMCI patients comprising our clinic sample in accordance with their prognostic fate. Conclusion: A significant proportion of patients presenting to specialist memory clinics display episodic and semantic memory or executive impairment that falls short of dementia and that is not detectable using traditional bedside screening measures. The vast majority of such patients (i.e. 72%) experience persisting or progressive cognitive impairment, and a significant proportion (41%) go on to receive a clinical diagnosis of dementia. The baseline neuropsychological performance of aMCI patients who do and do not develop dementia differs, and contributes over and above clinical information to the prediction of long-term diagnostic outcome. The high frequency with which aMCI is encountered in clinical practice, coupled with the minority of aMCI patients who experience resolution of their cognitive impairment, and the sensitivity and prognostic utility of several neuropsychological tasks, has implications for the clinical management of patients with aMCI.

As the baby boomers age, the number of individuals diagnosed with Alzheimer's disease and related disorders (ADRD) will increase. The following study was a part of a larger study that was concerned with the relationship between the stigma of dementia and overall quality of life (QoL) in persons diagnosed with early stage dementia. The study in this paper examined the relationship between the stigma of dementia and anxiety symptoms. Anxiety is a type of behavioral and psychological symptom of dementia (BPSD) that is common in persons with dementia (PwD). Anxiety may be exacerbated in PwD as a result of unfamiliar situations, changes in routine, awareness of cognitive deficits, inability to express their needs, or worries about how others will respond to their diagnosis. In town hall meetings across the nation, Voices of Alzheimer's disease, persons who had been diagnosed with dementia in the early stages indicated that the stigma of dementia was a predominant concern. The stigma of dementia seemed to be perpetuated by negative societal attitudes and misconceptions of the disease, possibly impacting PwD's anxiety levels and consequently, their QoL. In this study, there was a significant relationship between perceived stigma and anxiety levels in PwD (r=.35; p=.022) at the .05 level in the second visit (T2). It could not be concluded that the relationship between perceived stigma and anxiety levels in PwD changed between visit two (T2) and visit three (T3). Finally, it could not be concluded that social support, demographic variables, stage of disease, or mental ability mediated the relationship between perceived stigma and anxiety.

In 2011, 5 million Americans had dementia and this number is predicted to increase. As the number of people with dementia increases, the need for quality nursing care, education, and treatment for patients with dementia increases. To address the need, nurses not only must be prepared with the knowledge, skills, and abilities to care for patients with dementia, but they must also have the self-efficacy to provide quality care. The practice focused question guiding the project was to determine the level of self-efficacy for caring for dementia patients among long-term care nursing staff. Using Bandura's social cognitive theory, the purpose of this project was to gain information about the self-efficacy of nurses caring for dementia patients at one long-term care facility. Forty nurse participants each completed the 25-item, 5-point Likert scale Self-Efficacy in Dementia Care Survey. The quantitative data were descriptively analyzed to identify nursing training needed for tasks related to dementia patient care. Administrating medications, providing early management information, educating patient families, maneuvering the environment, and influencing the emotional response of patients were areas of knowledge and skill deficit for nurse participants. Findings from the project will be used to guide education and training to improve nurse self-efficacy in working with dementia patients. When nurses in long-term care facilities enhance their skills and knowledge, they may be able to provide better care to dementia patients, therefore promoting social change.

As dementia progresses older adults may lose the ability to communicate their pain experiences to healthcare providers, relying on the ability of the provider to infer their pain (Kelley, Siegler, & Reid, 2008; Pesonen et al., 2009). In the long-term care setting, the licensed nurse and certified nurse aide provide direct patient care to these residents and may be more likely to identify nonverbal behaviors that may indicate pain (Nygaard & Jarland, 2006; Pautex, Herrmann, Michon, Giannakopoulos, & Gold, 2007). The Conceptual Model for Assessing Pain in Nonverbal Persons with Dementia highlights provider, patient, and method-related factors that can hinder the process of inferring pain in nonverbal persons with dementia. The purpose of this dissertation is to explore the impact of these potential barriers on pain assessment/screening. Each chapter of this dissertation explores provider, patient, or method-related factors that impair the judgment of pain in others, either through an integrative review of the literature or by secondary analysis of a data set that was originally collected for the psychometric evaluation of the Non-communicative Patient's Pain Assessment Instrument. Statistical analysis was completed using SPSS version 21.0. Results indicate that nurse-related factors are well supported in the literature as barriers to pain assessment and can impair the nurses' pain assessment decisions. Ethnic differences in the expression of the nonverbal pain behavior "pain words," signify the role of patient-related factors on the pain assessment process. Lastly, examination of method-related factors support the benefits of training staff to use nonverbal pain assessment tools, with those staff members who were trained having greater accuracy in pain assessment when compared to untrained raters. In closing, this dissertation has implications for nursing science, education, policy, and practice and serves as a valuable contribution to the current literature.

<p>In Alzheimer association’s clinique practice, there was a need to communicate with people with mild dementia. Videophone is considered as one of the best assistive communication tool for these people since video communication is not only a tool to break an isolation caused by the disease, but also a powerful way to help people demonstrate their ideas and understand what is said in a conversation with pictures, signs and body language. Therefore, an easy-to-use videophone for people with mild dementia is needed.</p><p>The goal of this master thesis is to design a graphical user interface (GUI) of an easy-to-use videophone for people with mild dementia according to their characteristics and difficulties of using everyday technology. User centered design (UCD) was used in the design. To get familiar with the user, literature research was conducted before design.</p><p>Low-fidelity prototype was created. With the help of Karolinska institute’ research group on people with dementia, the prototype was refined twice. Based on the refined low-fidelity prototype, an interactive prototype with navigation, sound and animation effect was created. A usability testing was conducted on older adults with this interactive prototype.</p><p>In addition to the GUI of functions for people with mild dementia, GUI of functions for other care givers was also created and presented in this master thesis.</p>

In Alzheimer association’s clinique practice, there was a need to communicate with people with mild dementia. Videophone is considered as one of the best assistive communication tool for these people since video communication is not only a tool to break an isolation caused by the disease, but also a powerful way to help people demonstrate their ideas and understand what is said in a conversation with pictures, signs and body language. Therefore, an easy-to-use videophone for people with mild dementia is needed. The goal of this master thesis is to design a graphical user interface (GUI) of an easy-to-use videophone for people with mild dementia according to their characteristics and difficulties of using everyday technology. User centered design (UCD) was used in the design. To get familiar with the user, literature research was conducted before design. Low-fidelity prototype was created. With the help of Karolinska institute’ research group on people with dementia, the prototype was refined twice. Based on the refined low-fidelity prototype, an interactive prototype with navigation, sound and animation effect was created. A usability testing was conducted on older adults with this interactive prototype. In addition to the GUI of functions for people with mild dementia, GUI of functions for other care givers was also created and presented in this master thesis.

Little is known about Registered Nurses (RNs) and their work in northern Canada and the care of older adults with dementia in this setting. As the prevalence of dementia is predicted to increase over the next 30 years, the purpose of this project was to discover key concepts that depicted salient issues in dementia care in northern Saskatchewan from the perspective of RNs working in northern health care facilities. A sequential exploratory mixed method design was chosen for this study with a qualitative lead complemented by a secondary analysis of quantitative data. <p>Interviews were conducted with 14 RNs, employed in small northern Saskatchewan communities, about their experiences with dementia caregiving and their perceptions of dementia care resources. The grounded theory method used in analysis of the interview data resulted in the construction of the theory, Insulating and Expanding the Awareness of Dementia in Northern Nursing. The study identified three categories of conditions that influenced awareness of dementia: Dementia Care and Community Caregiving, Characteristics of the Northern RN, and Northern Nursing Worklife. The quantitative secondary analysis, using a north-south comparison of data from the national survey (Stewart et al., 2005) in the multi-method study The Nature of Nursing Practice in Rural and Remote Canada (MacLeod et al., 2004), was used to explore contextual elements identified in the grounded theory analysis. The comparison of nursing practice in northern (n = 597) and southern (n = 2154) rural and small town communities found that fewer RNs in northern Canada reported dementia as a client characteristic, worked in long-term care, or in home care nursing positions, compared to RNs in southern Canada. Findings from both the qualitative and quantitative studies contribute to an understanding of the RNs awareness of dementia. Recommendations for increasing the awareness of dementia in northern nursing practice include enhancing the resources and services available to older adults with dementia in small northern communities. It is hoped that further exploration of dementia within northern communities will result in improved care for individuals with dementia and their families.

As the Canadian population ages, the burden on our community and health care systems of age-related conditions, such as dementia, is increasing and research in these areas is becoming more critical. Dementia is a major health concern for adults as they age. Although dementia is the most common neurological disease in older adults, headaches are the most common neurological disorder across all ages. Migraines are a common form of headache disorders that affect millions of people worldwide. Both neurological disorders—dementia and migraines—cause significant impairment for the individual and strain on their caregivers, as well as substantial economic impact on society. The relationship between migraines and late-life cognitive health outcomes has not yet been thoroughly explored. Using data from the Manitoba Study of Health and Aging (MSHA), the relationship between migraines and various late-life cognitive health outcomes, including overall dementia, Alzheimer’s disease (AD), vascular dementia (VaD) and cognitive impairment-no dementia (CIND), was examined. As migraines and cognitive impairments are often associated with various comorbid disorders, analyses also investigated the impact of possible associated intervening variables: hypertension, diabetes, stroke, myocardial infarction and other heart conditions. A secondary focus of this project was to examine whether the association between migraines and late-life cognitive health outcomes varied by sex and family history of dementia. Migraines were a significant risk factor for both overall dementia and AD. However, the relationship between migraines and overall dementia appeared to be driven by the significant relationship between migraines and AD. Having a history of migraines was not significantly related to VaD. However, stroke was a statistically significant intervening variable in the relationship between migraines and VaD, indicating that the vascular event, stroke, plays an important part in the migraine-VaD relationship. A history of migraines was not a significant risk factor for CIND. Results could not be stratified by sex because of all participants with migraines, no men developed dementia and only one man developed CIND. Furthermore, despite a lack of significant results from models stratified by family history of dementia, the results are suggestive of possible genetic influences in the relationship between migraines and AD. Overall, this study supports the conclusion that migraines are a significant risk factor for late-life cognitive health, specifically AD. In addition, this study highlights the possibility that vascular events, such as stroke, may play an important role in the relationship between migraines and VaD. Increased understanding of mid-life risk factors for late-life cognitive health outcomes has important implications for researchers and clinicians in the form of interventions, preventative treatments and medications. In addition, this study suggests that there is a need for further research regarding possible genetic influences in the relationship between migraines and AD. As it was unable to be fully addressed in this study, future studies should investigate gender differences among individuals with migraines developing late-life cognitive health outcomes. This research aims to help develop new strategies that could aid in the prevention of cognitive decline, improve quality of life, and increase the likelihood of healthy aging.

Little is known about Registered Nurses (RNs) and their work in northern Canada and the care of older adults with dementia in this setting. As the prevalence of dementia is predicted to increase over the next 30 years, the purpose of this project was to discover key concepts that depicted salient issues in dementia care in northern Saskatchewan from the perspective of RNs working in northern health care facilities. A sequential exploratory mixed method design was chosen for this study with a qualitative lead complemented by a secondary analysis of quantitative data. <p>Interviews were conducted with 14 RNs, employed in small northern Saskatchewan communities, about their experiences with dementia caregiving and their perceptions of dementia care resources. The grounded theory method used in analysis of the interview data resulted in the construction of the theory, Insulating and Expanding the Awareness of Dementia in Northern Nursing. The study identified three categories of conditions that influenced awareness of dementia: Dementia Care and Community Caregiving, Characteristics of the Northern RN, and Northern Nursing Worklife. The quantitative secondary analysis, using a north-south comparison of data from the national survey (Stewart et al., 2005) in the multi-method study The Nature of Nursing Practice in Rural and Remote Canada (MacLeod et al., 2004), was used to explore contextual elements identified in the grounded theory analysis. The comparison of nursing practice in northern (n = 597) and southern (n = 2154) rural and small town communities found that fewer RNs in northern Canada reported dementia as a client characteristic, worked in long-term care, or in home care nursing positions, compared to RNs in southern Canada. Findings from both the qualitative and quantitative studies contribute to an understanding of the RNs awareness of dementia. Recommendations for increasing the awareness of dementia in northern nursing practice include enhancing the resources and services available to older adults with dementia in small northern communities. It is hoped that further exploration of dementia within northern communities will result in improved care for individuals with dementia and their families.

Thesis (Ph. D.)--Washington State University, December 2009. / Title from PDF title page (viewed on Dec. 16, 2009). "School of Economic Sciences." Includes bibliographical references.