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UVA School of Medicine

Physicians and Healthcare Providers

An Overview of the Collaborative Approach for Behavioral Problems in Patients With Dementia

Psychiatric Times. Vol. 27 No. 12


Time for Teamwork

An Overview of the Collaborative Approach for Behavioral Problems in Patients With Dementia

By Amita Patel, MD and Mark Shideler, MD | December 15, 2010

Dr Patel is associate clinical professor and Dr Shideler is a fourth-year psychiatry resident in the department of psychiatry at the Boonshoft School of Medicine of Wright State University in Dayton, Ohio. Dr Patel reports that she is on the speakers bureau of Lilly, AstraZeneca, Bristol-Myers Squibb, Pamlab, Pfizer, and Novartis. Dr Shideler reports that he has no conflicts of interest concerning the subject matter of this article.

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Non-Clinical Benefits of Getting an Early diagnosis of Alzheimer's Disease

William Thies, Medical and Scientific Director for the National Alzheimer's Association's Medical Director discusses the non-clinical benefits of getting an early diagnosis of Alzheimer's disease.

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The Impact of Time of Day on Cognitive Function in Patients With Dementia

In the article, Cognitive Status Changes Based on Time of Day In Nursing Home Patients With and Without Dementia, disruptions of the circadian rhythm and its effects on cognition are explored in patients with and without dementia. The study results indicated that the effects of time-of-day on administration of Mini-Mental State Examinations in nursing home patients with dementia was such that men and women perform equally in the morning, while women performed marginally worse in the afternoon. These results were especially pronounced for areas of orientation and immediate recall. On the contrary, men performed significantly better in the afternoon than they did in the morning. However, given the small number of study participants (38), the results are not significant enough to recommend any change in time of day assessments for patients with dementia.

A new screening tool for evaluating at-risk drivers

The 4Cs (Crash History, Family Concerns, Clinical Condition, and Cognitive Functions): A Screening Tool for the Evaluation of the At-Risk Driver provides preliminary data, which seeks to accurately identify at-risk drivers, while also providing a practical means for physicians to do so. With the growing aging population, and the fact that many physicians are uncertain as to whether they have the expertise or time to make correct judgments about patients' driving competence, such a measure is necessary.

The 4Cs assessment includes a measure of crash history, family concerns, clinical condition, and cognitive functions. Information regarding each domain is obtained during a standard medical interview, either through direct observation, or on the basis of questions posed by the clinician. It does not require specialized training, and it is relatively quick to administer.

Of the participants in the study, over half had a neurodegenerative disease such as Alzheimer's. The domains most strongly associated with road test outcome were cognitive function and family concerns. Scores of 9 or greater on the 4Cs correctly identified 84% of participants who were at risk for poor road test performance based on a Drive Wise driving simulation. While the findings provide only preliminary data, it is hoped that this interview based screening tool may offer the physician a starting point for having an important discussion about driving with their patients.

Dementia-Related Behaviors

Discussing Dementia-Related Behaviors During Medical Visits for People With Alzheimer's Disease

seeks to assess the frequency of discussion about dementia-related behaviors (DRB's) during PCP visits. In turn, this frequency is then compared to the caregiver's report of these same behaviors on the Revised Memory and Behavior Problems Checklist (RMBPC). Findings show that memory-related behaviors were discussed three times more often, and that while disruptive behaviors were reported by 80% of caregivers on the RMBPC, they were discussed in only 23% of medical visits. This discussion occurred most frequently with caregivers who reported significantly higher DRB frequency and an increased level of behavior-related burden.

As DRB's have been shown to have a stronger relationship to caregiver burden than other dementia symptoms, and to significantly decrease the quality of life of the person with dementia, it is important that these behaviors are addressed. The differences between reports on the RMBPC and in-office discussion of the DRB's may signify a perception by caregivers that these behaviors are not important enough to be raised during a primary care visit. Overall, the results of this study indicate that both health care providers and caregivers may benefit from training on how to successfully discuss sensitive topics like DRB's in a primary care setting.

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