Abstract
The purpose of this 3-year study was to test the efficacy of using a theoretical model based on Piaget’s cognitive developmental stages for consistent behavioral and environmental interventions for persons at all stages of Alzheimer’s disease and related disorders (ADRD) in nursing home and special care units. The specific aims were to reduce problematic behavioral symptoms and the number, amount and frequency of use of psychotropic medications. After 18 months, problem behaviors and some types of psychotropic medications significantly decreased in the treatment group but not in the control group. Results of the study indicate that using behavioral and environmental interventions based on Piaget levels of cognitive development may be an effective method of managing problematic behavioral symptoms and decreasing the use of psychotropic medications in institutionalized ADRD patients.
Similar content being viewed by others
References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed. 4. Washington, D.C., 1994.
Ray W.A., Taylor J.A., Meador K.G., Lichtenstein M.J., Griffin M.R., Gought R., Adams M.L., Blazer D.G.: Reducing antipsychotic drug use in nursing homes: a controlled trial of provider education. Arch. Intern. Med. 153: 713–721, 1993.
Ray W.A.: Psychotropic drugs and injuries among the elderly: a review. J. Clin. Psychopharmacol. 12: 386–396, 1992.
Thapa P.B., Gideon P., Fought R.L., Ray W.A.: Psychotropic drugs and the risk of recurrent falls. Am. J. Epidemiol. 142: 202–211, 1995.
Pollock B.G., Mulsant B.H.: Antipsychotics in older patients. A safety perspective. Drugs Aging 6: 312–323, 1995.
Schneider L.S., Pollock V.E., Lyness S.A.: A metaanalysis of controlled trials of neuroleptic treatment in dementia. J. Am. Geriatr. Soc. 38: 553–563, 1990.
Health Care Financing Administration. Medicare and Medicaid; requirements for long term care facilities. Final rule with request for comments. Federal Register 54: 5316–5336, 1989.
Garrard J., Lukas M., Dunham T., Heston L.L., Cooper S., Ratner E.R., Zelterman D., Kane R.L.: Evaluation of neuroleptic drug use by nursing home elderly under proposed Medicare and Medicaid regulations. JAMA 265: 463–467, 1991.
Semla T.P., Palla K., Poddig B., Brauner D.J.: Effect of Omnibus Reconciliation Act 1987 on antipsychotic prescribing in nursing homes. J. Am. Geriatr. Soc. 42: 648–652, 1994.
Rovner B.W., Steele C.D., Shmuely Y., Folstein M.F.: A randomized trial of dementia care in nursing homes. J. Am. Geriatr. Soc. 44: 7–13, 1996.
Thapa P.B., Meador K.G., Gideon P., Fought R.L., Ray W.A.: Effects of antipsychotic withdrawal in elderly nursing home residents. J. Am. Geriatr. Soc. 42: 280–286, 1994.
Beck C., Heacock P., Mercer S., Walton C.: Decreasing demented older adults’ need for assistance with dressing. Third National Conference on Research for Clinical Practice: Key Aspects of Elder Care: Managing Falls, Incontinence and Cognitive Impairment. The University of North Carolina, Chapel Hill, N.C., 1991.
Maas M.: Management of patients with Alzheimer’s disease in long-term care facilities. Nurs. Clin. North Am. 23: 57–64, 1988.
Steward J.T.: Management of behavior problems in the demented patient. Am. Fam. Physician 52: 2311–2317, 2321–2322, 1995.
Rapp M.S., Flint A.J., Herrmann N., Proulx G.B.: Behavioural disturbances in the demented elderly: phenomenology, pharmacotherapy and behavioural management. Can. J. Psychiatry 37: 651–657, 1992.
Syme S.: Independence through finger food. Contemporary Nurse 4: 80–81, 1995.
Jorm A.F.: Disability in dementia: assessment, prevention, and rehabilitation. Disabil. Rehabil. 16: 98–109, 1994.
Hellner B.M., Norberg A.: Intuition: two caregivers’ descriptions of how they provide severely demented patients with loving care. Int. J. Aging Hum. Dev. 38: 327–338, 1994.
Hall G.R.: Chronic dementia. Challenges in feeding a patient. J. Gerontol. Nurs. 20: 21–30, 1994.
Ryden M.B., Feldt K.S.: Goal-directed care: caring for aggressive nursing home residents with dementia. J. Gerontol. Nurs. 18: 35–42, 1992.
Peisah C., Brodaty H.: Practical guidelines for the treatment of behavioural complications of dementia. Med. J. Austr. 161: 558–563, 1994.
Snyder M., Egan E.C., Burns K.R.: Efficacy of hand massage in decreasing agitation behaviors associated with care activities in persons with dementia. Geriatr. Nurs. 16: 60–63, 1995.
Casby J.A., Holm M.B.: The effect of music on repetitive disruptive vocalizations of persons with dementia. Am. J. Occup. Ther. 48: 883–889, 1994.
Boehm S., Whall A.L., Cosgrove K.L., Locke J.D., Schlenk E.A.: Behavioral analysis and nursing interventions for reducing disruptive behaviors of patients with dementia. Appl. Nurs. Res. 8: 118–122, 1995.
Whall A.L.: Disruptive behavior in late stage dementia: using natural environments to decrease distress. J. Gerontol. Nurs. 21: 56–57, 1995.
Taft L.B., Delaney K., Seman D., Stansell J.: Dementia care creating a therapeutic milieu. J. Gerontol. Nurs. 19: 30–39, 1993.
Cox K.: Milieu therapy. Geriatr. Nurs. 6: 152–156, 1985.
Hussian R.A., Brown D.C.: Use of two-dimensional grid patterns to limit hazardous ambulation in demented patients. J. Gerontol. 42: 558–560, 1987.
Namazi K.H., Rosner T.T., Calkins M.P.: Visual barriers to prevent Alzheimer’s patients from exiting through an emergency door. Gerontology 29: 699–702, 1989.
Roberts B.L., Algase D.L.: Victims of Alzheimer’s disease and the environment. Nurs. Clin. North Am. 23: 83–93, 1988.
Dickinson J.I., McLain-Kark J., Marshall-Baker A.: The effect of visual barriers on exiting behavior in a dementia care unit. Gerontology 35: 127–130, 1995.
Franssen E.H., Kluger A., Torossian C.L., Reisberg B.: The neurologic syndrome of severe Alzheimer’s disease: relationship to functional decline. Arch. Neurol. 50: 1029–1039, 1993.
Franssen E.H., Reisberg B., Kluger A., Sinaiko E., Boja C.: Cognition-independent neurological symptoms in normal aging and probable Alzheimer’s disease. Arch. Neurol. 48: 148–154, 1991.
Feldman H., Schulzer M., Wang S., Tuokko H., Beattie L.: The Functional Rating Scale in Alzheimer’s disease assessment: a longitudinal study. In: Iqbal K., Mortimer J., Winblad B., Wisniewski, H. (Eds.), Research advances in Alzheimer’s Disease and Related Disorders. John Wiley and Sons, New York, 1995, pp. 235–241.
Flicker C., Ferris S.H., Reisberg B.: A two-year longitudinal study of cognitive function in normal aging and Alzheimer’s disease. J. Geriatr. Psychiatr. Neurol. 6: 84–96, 1993.
Hughes C.P., Berg L., Danzinger W.L.: A new clinical scale for the staging of dementia. Br. J. Psychiatry 140: 566–572, 1982.
Crockett D., Tuokko H., Koch W., Parks R.: The assessment of everyday functioning using the Present Functioning Questionnaire and the Functional Rating Scale in elderly samples. Clin. Gerontol. 9: 3–25, 1989.
Almkvist O., Basun H., Wahlund L., Lannfelt L.: Cognitive functions of family members with and without the APP670/671 mutation. In: Iqbal K., Mortimer J., Winblad B., Wisniewski H. (Eds.), Research Advances in Alzheimer’s Disease and Related Disorders. John Wiley and Sons, New York, 1995, pp. 251–259.
O’Carroll R.E., Prentice N., Murray C., van Beck M., Ebmeier K.P., Goodwin G.M.: Further evidence that reading ability is not preserved in Alzheimer’s disease. Br. J. Psychiatry 167: 659–662, 1995.
Reisberg B., Sclan S.G., Franssen E., Kluger A., Ferris S.: Dementia staging and chronic care populations. Alzheimer Dis. Assoc. Disord. 8 (Suppl. 1): S188–S205, 1994.
Reisberg B., Ferris S.H., deLeon M.J., Crook T.: The Global Deterioration Scale for assessment of primary degenerative dementia. Am. J. Psychiatry 139: 1136–1139, 1982.
Reisberg B., Ferris S.H., Franssen E.: An ordinal functional assessment tool for Alzheimer’s-type dementia. Hosp. Community Psychiatry 36: 593–595, 1985.
Reisberg B., Pattschull-Furlan A., Franssen E., Sclan S.G., Kluger A., Dingcong L., Ferris S.H.: Dementia of the Alzheimer type recapitulates ontogoeny inversely on specific ordinal and temporal parameters. In: Rostovic M.T., Knezezic S., Siwniewski H., Spilich G. (Eds.), Neurodevelopment, Aging, and Cognition. Birkhauser, Boston, 1992, pp. 345–369.
Piaget J.: The Origins of Intelligence in Children. (M. Cook, trans.) International Universities Press, New York, 1952.
Turkington C.: Alzheimer’s losses reverse child’s gains. Am. Psychol. Assoc. Monitor 11: 17, 1985.
Reisberg B.: Stages of cognitive decline. Am. J. Nurs. 84: 225–228, 1984.
Gardner H.: The Unschooled Mind: How Children Think & How Schools Should Teach. Basic Books, NY, 1991.
Lucca U., Comelli M., Tettamanti M., Tiraboschi P., Spagnoli A.: Rate of progression and prognostic factors in Alzheimer’s disease: a prospective study. J. Am. Geriatr. Soc. 41: 45–49, 1993.
Binetti G., Magni E., Padovani A., Cappa S.F., Bianchetti A., Trabucchi M.: Neuropsychological heterogeneity in mild Alzheimer’s disease. Dementia 4: 321–326, 1993.
Flicker C., Ferris S.H., Crook T., Bartus R.T.: A visual recognition memory test for the assessment of cognitive function in aging and dementia. Exp. Aging Res. 13: 127–132, 1987.
Jacobs D.M., Sano M., Dooneief G., Marder K., Bell K.L., Stern Y.: Neuropsychological detection and characterization of preclinical Alzheimer’s disease. Neurology 45: 956–962, 1995.
Mitrushina M., Uchiyama C., Satz P.: Heterogeneity of cognitive profiles in normal aging: implications for early manifestations of Alzheimer’s disease. J. Clin. Exp. Neuropsychol. 17: 374–382, 1995.
Emery O.B.: Language and aging. Exp. Aging Res. 11: 3–60, 1985.
Emery O.B., Breslau L.: The acceleration process in Alzheimer’s disease: Thought dissolution in Alzheimer’s disease early onset and senile dementia Alzheimer’s type. Am. J. Alzh. Care Rel. Disorders & Research 9/10: 24–30, 1987.
Thornbury J.M.: The use of Piaget’s theory in Alzheimer’s disease. Am. J. Alzh. Care Rel. Disorders & Research 7/8: 16–21, 1993.
Matteson M.A., Linton A.D., Barnes S., Cleary B.L., Lichtenstein M.J.: The relationship between Piaget and cognitive levels in persons with Alzheimer’s disease and related disorders. Aging Clin. Exp. Res. 8: 61–69, 1996.
Matteson M.A., Linton A.D., Barnes S.J.: The cognitive developmental approach to dementia. Image: J. Nurs. Scholarship 28: 233–240, 1996.
Ray W., Taylor J.A., Lichtenstein M.J., Meador K.G.: The nursing home behavior problem scale. J. Gerontol. 47: M9–M16, 1992.
Moos R.H., Lemke S.: Multiphasic Environmental Assessment Procedure (MEAP) Manual. Sheltered Care Project, Social Ecology Laboratory and Geriatric Research, Educational and Clinical Center, Veterans Administration and Stanford University Medical Center. Palo Alto, CA, 1984.
Lemke S., Moos R.H.: Measuring the social climate of congregate residences for older people: The sheltered care environment scale. Psychol. Aging 2: 20–29, 1987.
McKhann G., Drachman D., Folstein M., Katzman T., Price D., Stallan E.M.: Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA work group under the auspices of the Department of Health and Human Services task force on Alzheimer’s disease. Neurology 34: 939–944, 1984.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Matteson, M.A., Linton, A.D., Cleary, B.L. et al. Management of problematic behavioral symptoms associated with dementia: A cognitive developmental approach. Aging Clin Exp Res 9, 342–355 (1997). https://doi.org/10.1007/BF03339613
Received:
Revised:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03339613