There are a number of ways in which a clinical diagnosis of dementia of the Alzheimer type can be made – the application of clinical criteria is the commonest but ancillary techniques such as neuroima

Clinical Diagnosis of Alzheimer's Disease

Introduction: Nonpharmacological therapies (NPTs) can improve the quality of life (QoL) of people with Alzheimer’s disease (AD) and their carers. The objective of this study was to evaluate the best evidence on the effects of NPTs in AD and related disorders (ADRD) by performing a systematic review and meta-analysis of the entire field. Methods: Existing reviews and major electronic databases were searched for randomized controlled trials (RCTs). The deadline for study inclusion was September 15, 2008. Intervention categories and outcome domains were predefined by consensus. Two researchers working together detected 1,313 candidate studies of which 179 RCTs belonging to 26 intervention categories were selected. Cognitive deterioration had to be documented in all participants, and degenerative etiology

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Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy

OBJECTIVES: To investigate the effectiveness of an exercise program in improving ability to perform activities of daily living (ADLs), physical performance, and nutritional status and decreasing behavioral disturbance and depression in patients with Alzheimer's disease (AD).

DESIGN: Randomized, controlled trial.

SETTING: Five nursing homes.

PARTICIPANTS: One hundred thirty-four ambulatory patients with mild to severe AD.

INTERVENTION: Collective exercise program (1 hour, twice weekly of walk, strength, balance, and flexibility training) or routine medical care for 12 months.

MEASUREMENTS: ADLs were assessed using the Katz Index of ADLs. Physical performance was evaluated using 6-meter walking speed, the get-up-and-go test, and the one-leg-balance test. Behavioral disturbance, depression, and nutritional status were evaluated using the Neuropsychiatric Inventory, the Montgomery and Asberg Depression Rating Scale, and the Mini-Nutritional Assessment. For each outcome measure, the mean change from baseline to 12 months was calculated using intention-to-treat analysis.

RESULTS: ADL mean change from baseline score for exercise program patients showed a slower decline than in patients receiving routine medical care (12-month mean treatment differences: ADL=0.39, P=.02). A significant difference between the groups in favor of the exercise program was observed for 6-meter walking speed at 12 months. No effect was observed for behavioral disturbance, depression, or nutritional assessment scores. In the intervention group, adherence to the program sessions in exploratory analysis predicted change in ability to perform ADLs. No adverse effects of exercise occurred.

CONCLUSION: A simple exercise program, 1 hour twice a week, led to significantly slower decline in ADL score in patients with AD living in a nursing home than routine medical care.

Exercise Program for Nursing Home Residents with Alzheimer's Disease: A 1-Year Randomized, Controlled Trial

OBJECTIVES: To compare the practicality, reliability, validity, and responsiveness of the timed up and go (TUG), one-leg stand (OLS), functional reach (FR), and Tinetti balance (TB) performance measures in people aged 65 and older. DESIGN: A prospective study. SETTING: Shin-Sher Township of Taichung County, westcentral Taiwan. PARTICIPANTS: Twelve hundred community-dwelling older people. MEASUREMENTS: During an initial assessment at their residences, participants were interviewed for demographics, cognition, fall history, use of a walking aid, and activities of daily living (ADLs), in addition to completing the four balance tests. Falls were ascertained by telephone every 3 months for a 1-year follow-up; the four balance measures and ADLs were also reassessed at the end of the follow-up year. RESULTS: Of the four balance measures, the OLS had the lowest participation rate, and participation of people who were cognitively impaired had fallen in the previous year, used a walking aid, or suffered from an ADL disability was lower than for their counterparts. The time to complete the tests ranged from 58 seconds for OLS, to 160 seconds for the TB. All four balance measures exhibited excellent testretest reliability and discriminant validity but poor responsiveness to fall status. The TB showed better discriminant, convergent, and predictive validities and responsiveness to ADL changes than the other three tests. CONCLUSION: According to psychometric properties, the most suitable performance measure for evaluating balance in community-dwelling older people was the TB, followed by the TUG. J Am Geriatr Soc 52:1343–1348, 2004.

Psychometric Comparisons of the Timed Up and Go, One‐Leg Stand, Functional Reach, and Tinetti Balance Measures in Community‐Dwelling Older People

Primary health care

BACKGROUND: Investigation of the effects of exercise on frail, institutionalized individuals with dementia has been impeded by concerns about the reliability of physical performance measures when used in this population. METHODS: The physical performance of 33 institutionalized subjects with Alzheimer's disease was measured during both the morning and afternoon of day 1 by rater 1 and during both the morning and afternoon of day 2, one week later, by rater 1 and rater 2. Intraclass correlation coefficients (ICCs) were calculated to examine the inter- and intrarater reliability of "sit to stand," "25-foot walk," and "the distance walked in 6 minutes" and walking speed over 25 feet and for 6 minutes. An analysis of variance was performed to determine the components of variance for each test. RESULTS: ICCs for "distance walked in 6 minutes" ranged from .80 to .99 with 77% of the variance explained by inter-subject difference. The ICCs for "time to walk 25 feet" ranged from .57 to .97 with 25% of the variance explained by inter-subject differences. In contrast, the "sit to stand" measure produced ICCs ranging from -.07 to .85 with only 7% of the variance explained by inter-subject differences in this impaired population. CONCLUSION: Our results support the contention that some physical performance measures can be used to test individuals in the later stages of Alzheimer's disease given appropriate modification. Although subjects with Alzheimer's disease may have difficulty following commands and/or require physical assistance, this does not prohibit the reliable assessment of physical performance if measurements are made over longer (6-minute walk) rather than shorter periods (25-foot walk). Language: en

Reliability of physical performance measures in nursing home residents with Alzheimer's disease.

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 randomly assigned to treatment group and raters were blinded. Treatment was given three times weekly for 30 minutes, for 16 weeks. Although all groups evidenced 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.

Conversation Intervention with Alzheimer's Patients: Increasing the Relevance of Communication.

Assessment of affect in advanced Alzheimer's disease: the Dementia Mood Picture Test.

Advances in health care and communication technology have expanded nursing practice to nontraditional environments that preclude the physical presence of the nurse for a caring encounter. An increasing number of nurses are creating and maintaining nurse-patient relationships and practicing in a diverse range of specialties in virtual/distance environments. Can nursing presence as a caring modality be "real" in a virtual/distance environment? A new ontology of nursing presence is offered that transcends people, place, space, and time.

On Virtual Presence.

Research is important to the image, visibility, and viability of school nursing. Each state school nursing association should evaluate member commitment to school nursing research based on their unique set of financial, educational, and organizational resources. A 3-round Delphi study was conducted in which Florida school nurses identified research priorities. The 10 priority research topics were (a) obesity/nutrition, (b) role of the school nurse, (c) legal/ethical issues, (d) emergencies, (e) health education, (f) absenteeism/attendance, (g) diabetes and insulin, (h) injuries, (i) health services, and (j) asthma. These topics form the state research agenda and will be used to guide the development of multisite school nursing studies.

Charlotte D. Barry

Papers

Reliability of physical performance measures in nursing home residents with Alzheimer's disease.

Conversation Intervention with Alzheimer's Patients: Increasing the Relevance of Communication.

Assessment of affect in advanced Alzheimer's disease: the Dementia Mood Picture Test.

On Virtual Presence.

Development of a School Nursing Research Agenda in Florida: A Delphi Study: