Dancing Away Memory Blues

Going Dormant

2008-12-04T11:21:00.005-06:00

It was hoped that this site would evoke some interest in activities which can help persons enjoy life. What could be more important?

It was hoped that members of the dementia care empire would comment on and add to the results of the literature review.

[Links to the results by category are at the top of the right column.]

These hopes have not been realized for reasons all too familiar. It is time to cut losses and let the site go dormant.

The site will not be removed because results of the literature review do show the state of the art at the time of first posting 08 April 2008.

You can see some comments which might have been added here via this musings link.

2008-12-03T08:54:00.001-06:00

"Alzheimer's" Research, "Alzheimer's" Gadfly – Part 4
Part 1, Part 2, Part 3

Imagine what happens if Tree and Wall and Snake and Rope cooperate.

Wall gets down on all fours and Tree stands on Wall's back to feel his way up the tree. Soon Tree says that he's found the wall. Wall crawls along and Tree finds another tree. Wall stands on Tree's shoulders to find the top of the wall.

Soon Wall finds that the wall has a top and another side where there are two more trees. Snake stands on Rope's shoulders to find the end of the snake and soon finds lots of new pieces to the puzzle.

Now Snake, Tree, Wall, and Rope compare all of their observations and put together a very good picture of the elephant.

Competition provided a wealth of ideas and cooperation led to learning how the ideas were connected to get a good result.

Note that there is no "leadership" here. All participants are treated equally because it is not possible to guess where good ideas will come from.

This productive combination of competition and cooperation is not the rule in research relevant to memory challenges. The prevailing "leadership" cooperate to bias research funding toward perfecting the prevailing view, which limits funds for research which might reveal new parts of the beast.

And, there's another biasing problem because interests of big drug companies are too influential in the Alzheimer's empire and not so subtly bias research toward topics which might lead to money-making, patented drugs.

Since they don't see opportunities for making money by supporting research on non-drug activities which can help persons enjoy lives, research which could reliably evaluate these activities is stifled.

The literature review reported here – see the links at the top of the right hand column – showed many suggestions that activities – such as music, dance, and drama – can help persons with memory challenges enjoy life. These suggestions should be tested with reliable research designs.

Research using reliable research designs is expensive and, for the reasons discussed above, is not supported by the Alzheimer's empire – a sad, sad consequence of a flawed model driving research.

Contributed by Don Moyer, physicist, historian, teacher, patent agent, advocate, gadfly.

"Alzheimer's" Research, "Alzheimer's" Gadfly – Part 3

2008-12-02T14:36:00.003-06:00

Part 1, Part 2

Science progresses by combining competition and cooperation, which I argued in an obscure paper published many years ago.

Competition without cooperation leads to limited isolated success. Progress does not come by forcing acceptance of one idea over another.

Cooperation without competing ideas can lead to the stagnation of groupthink. Progress does not come when ideas are not challenged.

Competition can provide a wealth of ideas. Cooperation can put them together creatively. The old story of persons encountering a stuffed elephant in a dark room illustrates this nicely.

One of the persons touches a leg and says that it's a tree. Let's call this person Tree. Another person touches the side and says that it's a wall. Let's call this person Wall.

A third person touches the trunk and says it's a snake. Let's call this person Snake. A fourth person touches the tail and says that it's a rope. Let's call this person Rope.

This chaos of competing views is often used as a description of science where we always have limited information. A school of thought actually argues that Rope, Snake, Tree, and Wall just fight it out to see which of the competing views prevails, making science just like any other battleground – like base ideological battles where people will do anything to win.

But, here's the payoff . . . . . Next time.

Contributed by Don Moyer, physicist, historian, teacher, patent agent, advocate, gadfly.

"Alzheimer's" Research, "Alzheimer's" Gadfly – Part 2

2008-12-01T10:45:00.001-06:00

Part 1

One of my professional guises is historian of science.

One clear lesson one learns from that field is that seldom is the first prevailing view of a phenomena correct. And, seldom is the second prevailing view correct.

Getting to a correct view requires much challenging of prevailing views. and that takes well funded and well managed research.

When funds are not sufficient, almost all can go to perfecting an erroneous prevailing view. Even when research is well funded, funders must be sure to allocate funds for challenges to the prevailing view.

Doing much research in the history of physics taught me a key lesson which is not securely operating in other fields – and may not be fully operating physics now with funding shortfalls.

It's not a short story. I'll start it next time.

Contributed by Don Moyer, physicist, historian, patent agent, teacher, advocate, gadfly

"Alzheimer's" Research, "Alzheimer's" Gadfly – Part 1

2008-11-28T09:51:00.001-06:00

My Alzheimer's empire contribution is to be a gadfly and challenge the imperial orthodoxies.

So why did I post the public policy alert Wednesday?

The shamefully low funding for research on phenomena leading to a diagnosis of "Alzheimer's" allows prevailing views to reign with too little challenge.

Challenge there must be, so at least we need to greatly increase funding for research and programs

I'll explain this more in a post tomorrow.

Contributed by Don Moyer, physicist, historian, patent agent, teacher, advocate, gadfly

Alzheimers and Election 2008

2008-11-26T12:20:00.000-06:00

Emailed 25 Nov 2008 by Kate Gordon from the Washington DC Office of the Alzheimer's Association.

Election 2008

The recent election results delivered a clear message that the public wants change.

The nation’s capital is buzzing with excitement and caution. Expectations run high that President-elect Obama and the new Congress will finally take on health care reform. At the same time, they must tackle unemployment, foreclosures and the credit markets.

Where does this leave Alzheimer’s issues?

The Alzheimer’s Association is working hard to integrate our priorities into the upcoming health care debate. We emphasize that reform is essential to restoring America’s overall economy and the financial security of Alzheimer families.

We want ending the two-year waiting period for Medicare coverage for people under 65 with disabilities, such as dementia, to be front and center in the reform discussions. We are already seeing progress (see below for details).

In the meantime, one of the first orders of business when Congress convenes in January is completion of legislation that funds Alzheimer research and services.

What Can I Do Now?

1. Sign the Proclamation to President Obama
Tell President-elect Obama to make Alzheimer's a national priority. We need 50,000 signatures to be delivered to the new president in January.

2. Tell others to sign on! http://alz.kintera.org/proclamation
We will deliver this message, along with your "signature", in January after Inauguration Day. That may seem far away, but we don’t have any time to waste.

3. Your District. Your Voice. Our Movement. We're looking for at least one Alzheimer advocate from every U.S congressional district to build a movement to make Alzheimer's a national priority. Our Public Policy Forum offers you the chance to present our new Congress the case for why Alzheimer's disease must become a national focus. Watch for registration details or visit www.alz.org/publicpolicyforum for information. Registration will open by mid December. Be sure to register online for early-bird savings!

Advocate In Action

Last week, Alzheimer advocate Teresa Lambert (North Central Texas Chapter) shared her story about "life in the two-year wait period" during a press conference on Capitol Hill. Rep. Gene Green (D-TX), author of House legislation ending the two-year wait for Medicare, was also featured. The Alzheimer's Association and more than 65 other organizations have joined forces to urge Congress to end the wait for Medicare coverage faced by people with disabilities under age 65.

We thank Teresa for her courageous stand against the two-year wait.

Health Care Reform Proposals

Policies important to people with Alzheimer’s and their families are making it into health care reform proposals. Senator Max Baucus (D-MT), Chairman of the Senate Finance Committee, recently introduced a “Call to Action, Health Care Reform 2009”, outlining his plans for improving health care. Phasing out the two-year wait for Medicare, making health care affordable and available to individuals with pre-existing health conditions, expanding home and community based services and supporting family caregivers are all mentioned in the report. Senator Baucus plans to work with Congressional leaders and President-elect Obama to keep health reform moving forward in 2009.

We’ll keep you posted on how you can help advance these efforts in upcoming months.

Would you like to receive this monthly update in your inbox? Sign up today!

Contributed by Don Moyer, physicist, historian, teacher, patent agent, advocate, gadfly.

Alzheimer's cured by drama?

2008-11-25T08:39:00.000-06:00

At a very basic level drama combines music and dance.

This is clear in musical comedy and grand opera and is still there in spoken drama.

Recent posts commented on music cures and dance cures.

Here's a link to some evidence about a drama cure.

Yes, I'm using "cure" odly to mean that with music, dance, drama, singing and dancing challenges become meaningless and enjoyment of life blazes.

Healthy Living Posts

2008-11-24T08:51:00.000-06:00

Mona Johnson has posted a supremely important series on her excellent blog.

You can see the series via this Tangled Neuron link.

I would make only one change and put reduce stress at the top of any list of healthy living recomendations.

We follow the recomendations very closely and it works.

Contributed by Don Moyer, physicist, historian, teacher, patent agent, advocate, gadfly.

Alzheimer's Cured by Dancing?

2008-11-23T09:26:00.000-06:00

Can Alzheimer's and related dementias be cured by dancing?

I saw the symptoms which led to the diagnosis become meaningless in the dance.

I saw the dance communicate in ways which surmount memory and cognitive challenges.

I saw a person transformed by the dance from sadness about his challenges to having new purpose in life.

Here's an interesting dance link I found. And, you can visit our annotated results about dance from our literature review via this link.

Contributed by Don Moyer, physicist, historian, teacher, patent agent, advocate, gadfly.

Music and Alzheimer's Diagnosis

2008-11-22T13:46:00.001-06:00

Music helping persons having an Alzheimer's diagnosis and related diagnoses is the subject of the report you can see via this link.

And visit the annotated results of our literature review below via this link.

Contributed by Don Moyer, physicist, historian, teacher, patent agent, advocate, gadfly.

Healthy Aging aka Healthy Living

2008-11-16T16:01:00.001-06:00

Healthy aging aka healthy living blog roll category added today along the right column. There is no living without aging!

If you know other sites which should be included there please add a comment or email me.

Thanks. Don

Contributed by Don Moyer, physicist, historian, teacher, patent agent, health advocate, gadfly.

Loss of Self – A Case of Bad Judgment

2008-10-10T09:04:00.003-05:00

In the last half dozen plus years I've come to know many persons greatly hurt because of judgments by self-anointed Alzheimer's experts made years ago. Seeking to increase funding for research they organized around a party line which framed a dread disease leading to loss of self thereby creating a very hurtful stigma, hurting even their own cause. That was very bad judgment.

Good judgment, for this old physicist, has a few clear basic pillars: Use the best evidence, with no logical fallacies and with clear understanding of all approximations. Use every reliable tool to anticipate consequences of a proposed course, where reliable tools are vetted by an appropriate expert body such as the National Academy of Sciences.

Teaching loss of self fails on all counts: There is no evidence. It is logically fallacious because there is no definition of self such that this self could be lost. It is mo more than an assumption, the most dangerous kind of approximation. The consequences of hurting persons, and hurting the cause of increasing funding, were not anticipated, but should have been, and could have been.

Objection: "I feel that I am losing my self" is often said by persons with memory challenges.
Answer one: They were taught to say this.
Answer two: This sentence is self-contradictory because the words "I feel that I am" are an affirmation of self.

Often good judgment can't be made with just those basic pillars. What are the options when these pillars do not point to a course sure to succeed? Defer judgment? Roll the dice? Look for a reasonable chance of success with course correction measures built in?

We now have evidence that decision making improves as diversity of council increases. So good judgment about which of those options to choose and about reasonable chance of success is best made by finding consensus in maximally diverse council.

Unfortunately this is usually contrary to organizations' traditions, even when working on science related issues. Gadflies are rarely tolerated on boards of directors, on science advisory groups, on staff. Lack of gadflies often leads to groupthink which can corrupt judgment.

Judgment can also be corrupted by faulty perception, when manipulated by appeal to emotion, when driven by selfish and perverse goals. Using reliable tools to anticipate consequences and finding consensus in maximally diverse council can minimize this corruption, or at least detect it.

What's the best way forward when parties do seek to drive judgments by appeal to emotions such as fear, pity, envy, hatred, pride, greed, ignorance, authority? Attempts to fight about differences arising here lead to zero-sum games with winners and losers and long term resentments which help appeals to emotions. Here we have a major consensus-finding challenge.

Consensus-finding requires understanding and honoring all parties even when their views are contrary to evidence, are based on logical fallacies, are driven by base motives. This is also usually contrary to traditions of organizations. Rarely are these traditions transcended.

Organizations should welcome and honor gadflies in order to avoid bad judgment. Should bad judgments – which could have been avoided – ever be excused by good intentions?

Exercise may help improve memory problems

2008-09-03T08:31:00.002-05:00

Adults with memory problems who participated in a home-based physical activity program experienced a modest improvement in cognitive function, compared to those who did not participate in the program, according to a study in the September 3 issue of JAMA.

As the world population ages, the number of older adults living with Alzheimer disease (AD) is estimated to increase from the current 26.6 million to 106.2 million by 2050. "If illness onset could be delayed by 12 months, 9.2 million fewer cases of AD would occur worldwide. For this reason, attempts have been made to identify individuals who are at increased risk of AD and to test interventions that might delay the progression of prodromal symptoms [early non-specific symptom, or set of symptoms] to full-blown dementia," the authors write.

Nicola T. Lautenschlager, M.D., of the University of Melbourne, Australia, and colleagues conducted a randomized controlled trial to test whether a physical activity intervention would reduce the rate of cognitive decline among 138 adults age 50 years and older at increased risk of dementia. The participants, who reported memory problems but did not meet criteria for dementia, were randomly allocated to an education and usual care group or to a 24-week home-based program of physical activity.

The aim of the intervention was to encourage participants to perform at least 150 minutes of moderate-intensity physical activity per week, which participants were asked to complete in three 50-minute sessions each week. The most frequently recommended type of activity was walking. The intervention resulted in 142 minutes more physical activity per week or 20 minutes per day than with usual care. Cognitive function was assessed with the Alzheimer Disease Assessment Scale–Cognitive Subscale (ADAS-Cog; a measuring tool that consists of a number of cognitive tests) over 18 months.

The researchers found that by study end, participants in the exercise group had better ADAS-Cog scores and delayed recall than those in the usual care control group. Participants in the physical activity group also had lower Clinical Dementia Rating scores than those in the usual care group.

"To our knowledge, this trial is the first to demonstrate that exercise improves cognitive function in older adults with subjective and objective mild cognitive impairment. The benefits of physical activity were apparent after 6 months and persisted for at least another 12 months after the intervention had been discontinued. The average improvement of 0.69 points on the ADAS-Cog score compared with the usual care control group at 18 months is small but potentially important when one considers the relatively modest amount of physical activity undertaken by participants in the study," the authors write.

"Unlike medication, which was found to have no significant effect on mild cognitive impairment at 36 months, physical activity has the advantage of health benefits that are not confined to cognitive function alone, as suggested by findings on depression, quality of life, falls, cardiovascular function, and disability."

(JAMA. 2008;300[9]:1027-1037.)

[Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.]

Editorial: Physical Activity for Older Adults at Risk for Alzheimer Disease

In an accompanying editorial, Eric B. Larson, M.D., of the Group Health Center for Health Studies, Seattle, comments on the findings regarding exercise and cognitive function.

"Health advances of the past century have led to more individuals surviving to extreme old age, when their risk of Alzheimer disease and related dementias increases substantially. Exercise—and possibly other lifestyle factors—appear to affect vascular risk and late-life brain health. In addition to traditional medical approaches to prevent this dreaded disease, social factors such as providing universal education, general medical care, a suitable environment, adequate nutrition, habitual exercise, and opportunities for continued social interactions throughout the lifespan also may contribute significantly to improve well-being in late life."

(JAMA. 2008;300[9]:1078-1079.)

[Please see the article for additional information, including financial disclosures, funding and support, etc.]

Contact: Janine Sim-Jones
61-040-089-3378
University of Melbourne

Contact: Nicola T. Lautenschlager, M.D.

Contributed by Don Moyer. [slightly revised from press release posted 1 Sept 2008 on http://www.eurekalert.org/pubnews.php]

Alzheimer's or brain injury -- what's the difference?

2008-08-22T12:17:00.001-05:00

A Brain Injury Association of America website link was recently added to the sites section down the right column here. I especially like their vision statement:

"A world where all preventable brain injuries are prevented, all unpreventable brain injuries are minimized, and all individuals who have experienced brain injury maximize their quality of life."

That last quality-of life clause is also the vision for this site.

A growing number of my fellow gadflies are exploring the idea that the memory challenges – whether called "Alzheimer's" or some other related category – should be thought of as brain injury issues. This might expand research and program agendas which we think are now trapped by limited orthodoxy. There's also growing suspicion that molecular events behind memory challenges do start with a brain injury, however mild and unidentifiable, followed by the brain's repair system(s) going haywire.

However this works out -- however we prevent preventable memory challenges and minimize memory challenges -- we have no excuse for delaying any work to maximize quality of life.

Contributed by Don Moyer.

Clues for Researchers

2008-08-04T12:12:00.003-05:00

Earlier this year Nature published a series of essays on science and music. It contains many clues for researchers interested in music as a life enriching activity for persons living with memory challenges.

You can access the full series via this Nature: science and music link.

Contributed by Don Moyer.

Please Help

2008-07-28T12:39:00.002-05:00

Please help our co-author Renee Beard finish a very important project.

Her work creates great progress toward managing challenges and enjoying life.

She needs to talk with a few more persons.

You can see details via this link.

Renee's email: rbeard@uic.edu

Contributed by Don Moyer.

Best Therapy

2008-06-28T14:52:00.003-05:00

[This was first posted 11 February 2008 elsewhere – it belongs here.]

I saw it again yesterday: The best therapy is getting together with fellow travelers!

Twelve of us spent several hours having pizza and beer – six of us also having serious memory challenges.

Most of those challenges vanished amidst the wisecracking and laughter.

It's so simple. Why doesn't this happen more often?

Contributed by Don Moyer.

A Great Singing and Dancing Party

2008-06-26T09:27:00.003-05:00

We've been gathering for several years with early onset fellow travelers brought together by the Alzheimer's Research Center at Rush Medical Center. The gathering got so large that part of the time we meet in sub-groups.

One sub-group of Jenny's fellow travelers spends time with music activities. Jenny added dancing and now it's a great singing and dancing party which can't be stopped.

This is why I so clearly see the importance of the Nystrom entry in the Dance category here, which suggests seeing dance as communication; why I resonate with the charge to treat dance as activity rather than therapy made in the Killick entry; and why I cheer the observations in the Coaten entry.

Contributed by Don Moyer.

Additions to the Music Category

2008-06-20T10:38:00.003-05:00

Here are three additions to be added to the Music category contributed by Anne Basting.

Palo-Bengtsson L, Ekman S. (1997). Social dancing in the care of persons with dementia in a nursing home setting: A phenomenological study. Scholarly Inquiry for Nursing Practice: An International Journal, 11, 101-123.

Palo-Bengtsson L, Winblad, B., & Ekman S. (1998). Social dancing: A way to support intellectual, emotional and motor functions in persons with dementia. Journal of Psychiatric and Mental Health Nursing, 5, 545-554.

Verghese, J., Lipton, R. B., Katz, M. J., Hall, C. B., Derby, C. A., Kuslansky, G., Ambrose, A. F., Sliwinski, M., & Buschke, H. (2003). New England Journal of Medicine, 348, 2508-2516.

Palo-Bengston, L., & Ekman, S. L. (2002). Emotional response to social dancing and walks in persons with dementia. American Journal of Alzheimer's Disease And Other Dementias, 17, 149-153.

And, here is another addition just published:

Raglio, Alfredo MT; Bellelli, Giuseppe MD; Traficante, Daniela PsyD, PhD; Gianotti, Marta MT; Ubezio, Maria Chiara MD; Villani, Daniele MD; Trabucchi, Marco MD. Efficacy of Music Therapy in the Treatment of Behavioral and Psychiatric Symptoms of Dementia. Alzheimer Disease & Associated Disorders. 22(2):158-162, April/June 2008.

Contributed by Don Moyer.

Biased about Drama

2008-06-02T09:51:00.007-05:00

I'm greatly encouraged by the "Drama" annotations. I admit to bias since drama is one of my great loves.

My first publication with a sociologist (citation below) used the Aristotelean dramatic unities to explain ways issues become social problems. I think that drama connects profoundly with our brains – which may help explain our fixation on celebrities and sports.

The drama annotations seem to bear this out. The Wilkinson, Snow, Jenny, and Casson entries show several very interesting models. The Pendzik, Noice, McKee, and Batson entries also show that there is great potential for drama to be life enriching in even the most advanced stages of memory blues.

I'm also a big fan of the TimeSlips program and have heard many favorable comments from persons involved with this.

(Donald Moyer and Remi Clignet, Science and Social Problems. Knowledte: Creation, Diffusion, Utilization, 2 September 1980, 93-116)

Contributed by Don Moyer.

A Wild Idea

2008-06-01T12:36:00.004-05:00

Reading carefully through the "Other" category of annotations below I found four entries which for me are especially important.

For me the Zeisel entry most clearly shows the correct path ahead. The Scholzel-Dorenbox and the Hellestrom entries provide excellent guidance for traveling this path.

The Camp entry resonates especially well with me. I've long pointed out that persons living with our challenges talk much differently among our selves than we do when professionals are interviewing or "guiding" us. What a wild idea it would be to have early stage peers ask the research questions!

Contributed by Don Moyer.

Why No Articles on Memory Training?

2008-05-30T08:10:00.004-05:00

Articles on memory training were not reviewed here because we see this as not directly life enriching.

True, memory training like medications, diet, physical activity, and mental activity, inasmuch as they do mitigate challenges, do enable life enrichment. These enablements are appropriate for a different study.

It is also true that persons engaging in memory training have testified that this gave them a sense of accomplishment, which they found life enriching. Life enriching sense of accomplishment is real and can be had from no end of activities. We limited ourselves to a small set of activities where each activity can be well defined so that replicable results can be obtained.

Contributed by Don Moyer.

Answering some Questions about this Blog

2008-05-28T09:25:00.008-05:00

Mona Johnson asked me several very good questions about this blog and I'll share my answers here.

The persons I hope will use the blog comprise pros in the field and activists like Mona like me like many DASNI members and even persons living with the challenges.

Getting all the best existing research in one place and annotated by Renee from the point of view of a researcher having excellent grasp of reliable research methods shows the state of the art and gives us the opportunity to look at the annotated results for answers to our original three questions:

1 What do we know about means for enriching lives of persons having memory blues?

2 Can these means be helpful to these persons living at home?

3 Can information technologies be used to help implement these means for these persons living at home?

One conclusion is that the state of the art speaks mainly to other questions. I haven't fully digested the results yet; as I do I'll likely form other conclusions.

Conclusions etc. from other users of these results are desired. One reason for posting the results in this form is so that others can ask questions of the state of the art and draw their conclusions and make suggestions.

I hope that pros will see opportunities for research which will speak more to our questions and will produce useful and reliable results. And, I hope that pros will see opportunities to adapt activities – using information technologies for example – to help persons living at home; I've been waving this banner for years since I know that it can be done, but nothing happens. I hope activists will push and aid pros to grasp these opportunities, where "grasp" should be understood in the sense of understand and in the sense of take hold of.

I also hope that the model will catch on, the model being where lay persons take research ideas to researchers, participate in designing research, raise funds to pay for the research, etc. etc. (as many persons did for AIDS research for example).

Renee will write a scholarly paper giving more context, drawing conclusions, and making suggestions.

Contributed by Don Moyer.

Annotated Results: 6 Other

2008-05-14T08:01:00.003-05:00

Please add comments. Tell us about work we've missed. Add work published after we closed our review.

In your annotated additions please tell what was studied, what benefits were found, what quality of life benefits were found, and how well benefits were sustained.

Thanks. Don

6. Other

Alessi, C.A.; Yoon, E.J.; Schnelle, J.F.; Al-Samarrai, N.R.; Cruise, P.A. (1999). A randomized trial of a combined physical activity and environmental intervention in nursing home residents: do sleep and agitation improve? Journal of the American Geriatric Society, 47, 784-791.
The study tested whether an intervention combining increased daytime physical activity with improvement in the nighttime environment improves sleep and decreases agitation in nursing home residents using a randomized trial in one community nursing home in the Los Angeles, California area. It included twenty-nine incontinent residents (mean age 88.3 years, 90% female) randomized to receive either (1) an intervention combining increased daytime physical activity (14 weeks in duration) plus a nighttime program (5 nights in duration) to decrease noise and sleep-disruptive nursing care practices (intervention group), or (2) the nighttime program alone (control group). Measurements included daytime physical activity monitors and structured physical function assessments; nighttime wrist activity monitors to estimate nighttime sleep; and timed daytime behavioral observations of sleep versus wakefulness, either in or out of bed, and agitation. Physical function measures did not change significantly. Wrist actigraphy estimation of nighttime percent sleep increased in intervention subjects from 51.7% at baseline to 62.5% at follow-up compared with 67.0% at baseline to 66.3% at follow-up in controls. At follow-up, intervention subjects averaged a 32% decrease in the percent of daytime observations in bed compared with baseline, with essentially no change in controls. Seven of 15 intervention subjects had a decrease in observed agitation at follow-up, compared with baseline, versus only 1 of 14 controls with a decrease in observed agitation. The authors contend that this study provides preliminary evidence that an intervention combining increased physical activity with improvement in the nighttime nursing home environment improves sleep and decreases agitation in nursing home residents.

Bober, S.J.; McLellan, E.; McBee, L.; & Westreich, L. (2002). The Feelings Art Group a vehicle for personal expression in skilled nursing home residents with dementia. Journal-of-Social-Work-in-Long-Term-Care, 1(4), 73-87.
Based on the assumption that dementia sufferers continue to experience emotions even in the severe stages of the disease and despite profound declines in cognitive functioning, the authors argue that many struggle to communicate these emotions verbally. This article looks at the Feelings Art Group, a social work led group on a dementia Special Care Unit within a 514-bed academic nursing home offered an ongoing group therapy program for skilled nursing residents with Alzheimer's type and other dementias. This group therapy program employed art-based activities as a stimulus to facilitate uncommunicated emotions in severely demented nursing home residents. The intervention was designed to tap into resident's feelings on a series of universal topics including family, work, holidays and seasons, using art as a vehicle for the expression of emotions. Employing visual, tactile, olfactory and audio stimulation, dementia sufferers were helped to find "voice" for their feelings. Before and after the group, residents with limited verbal abilities were able to identify feelings using a visual recognition scale and verbal cues. Outcomes included a heightened ability to identify emotions and increased socialization among group members.

Brooker, D.J. & Duce, L. (2000). Well-being and activity in dementia: a comparison of group reminiscence therapy, structured goal-directed activity, and unstructured time. Aging and Mental Health, 4 (4), 354-358.
A comparison of well-being levels of 25 individuals with mild to moderate dementia during three types of activity was made. The first was group reminiscence therapy (RT), the second was group activities (GA), and the third was unstructured time (UT). These activities were all part of the usual program of activities within three day hospitals where the study took place. Dementia Care Mapping results indicated that individuals experienced a greater level of relative wellbeing during RT than GA. The level of wellbeing in both RT and GA was significantly higher than in UT.

Brooker, D.J. (2001). Enriching Lives: evaluation of the ExtraCare activity challenge. Journal of Dementia Care, May/June, 33-37.
This article evaluates the ExtraCare activity, which took 19 PWD out of their normal environment for an “exciting 5-day outdoor activity holiday,” including canoeing, hot air ballooningm pony trap riding, abseiling, the zip wire, swimming in the heated pool and the Jacuzzi. The author argues that the intervention of “going on holiday” has not been systematically evaluated as an experience for PWD. Through the use of dementia care mapping (DCM), the well-being of residents was systematically evaluated before, during and one month after the ExraCare challenge to understand the experiences of participants and benefits for both residents and staff. Blinded staff reports suggest that residents with dementia gain enormous increases in self esteem from their achievements on these holidays, in addition to significant improvements in sleep, continence and mobility. In particular, as a group well-being was significantly higher while participants were on holiday and a month later well-being was similar to what it had been prior to the holiday. The control group, who did not go on the holiday, experienced only slight changes in well-being over the same time period.

Brooker, D.J. & Woolley, R.J. (2007). Enriching opportunities for people living with dementia: the development of a blueprint for a sustainable activity-based model. Aging and Mental Health, 11(4), 371-383.
This study includes a lit review (of medline, CINAHL, Cocharne using key words such as AD, activity/occupation, therapy, long term care/homes) but focuses on an expert working group featuring the special expertise of the locksmith, “whose raison d’etre was to ensure residents and tenants reach their potential for well-being” (373). The locksmith’s title is chosen to reflect responsibility in discovering and developing keys that “would unlock the potential for well-being in individuals with dementia” (373). Their role was described as pivotal as resource and leader, with a firm commitment that PWD are entitled to and able to enjoy life. Focus group data was gathered and analyzed to determine how people felt about the project, what life was like for residents/tenants, what were identified as barriers to an enriched life, and what helped facilitate an enriched life.

Brooker, D.J.; Woolley, R.J. & Lee, D. (2007). Enriching opportunities for people living with dementia in nursing homes: an evaluation of a multi-level activity-based model of care. Aging and Mental Health, 11(4), 361-370.
The main facets of this program and its approach have already been summarized in Brooker & Woolley (2007), based on 127 subjects diagnosed with dementia or enduring mental health problems in 3 specialist nursing homes in the UK. However, an interesting distinction was noted in this report between the success of the program in nursing homes and the challenges it faced in extra care housing schemes: “The nursing homes had an established person-centered pattern of working with PWD and specialized in this area” whereas the extra care housing staff had little training and a population more diverse in their problems. Again, the level of long term in-depth commitment from locksmiths was emphasized as a factor explaining why the program was successful. Core components of the program involved general good quality person-centered care, individualized simple and fun activity that occurred everyday, communal space and equipment, and opportunities to get out of the facility (19).

Camp, C. J. & Skrajner, M.J. (2004). Resident-assisted Montessori programming (RAMP): training persons with dementia to serve as group activity leaders. The Gerontologist, 44(3), 426-431.
Four women with ESD were trained to serve as leaders for a small group activity (memory bingo) played by nine persons with more advanced dementia. They demonstrated the potential to fill the role effectively, were described as exhibiting “assisted leadership,” (430) and needing “external cueing” (426), expressed satisfaction with role, and the players showed higher levels of positive engagement and pleasure (measured by the MPES, which looks at four kinds of engagement: constructive, passive, non, and other (428)). The authors contend “that persons with dementia can be trained to produce effects similar to those produced by activity staff.” They state, “We believe that it will one day be possible for dementia residents to lead Montessori-based activities virtually unassisted,” and that satisfaction and self worth are heightened through this work which creates a meaningful social role for leaders as well as engagement for participants. They also state they would like to see it applied to other settings. Activities are defined as rehabilitative “if they can increase or prevent further decline in adaptation and functional levels” (426).

Cartwright, J.C.; Archbold, P.G.; Stewart, B.J.; & Limandri, B. (1994). Enrichment Processes in Family Caregiving to Frail Elders. Advances in Nursing Science, 17(1), 31-43.
This article looks at the role of enrichment and the associated AT activities for family caregivers of frail seniors. It is one of the few studies that examines “enrichment.”

Cheston, (1998). Psychotherapeutic work with people with dementia: A review of the literature. British Journal of Medical Psychology, 71, 211-231.
This article reviews the literature on the utility and outcomes of psychotherapy with people who have dementia.

Chung, J. (2004). Activity Participation and Well-being of People with dementia in long term care settings. Occupation, Participation, and Health, 24(1), 22-31.
43 subjects in Hong Kong long term residential services were evaluated during a 6 hour period. Those with severe dementia “engaged in significantly more passive activities” than those with mild/moderate dementia, and “had fewer social interactions and displayed more negative behavior” (22). The overall research question of the study was: “What were the states of well-being of long term care residents with dementia when participating in their usual activity patterns?” (23). The results described were that participants spent 1/3 time in a passive state, 21% time in passive watching, and 12% of time asleep (29). The greatest amount of time observed was spent engaging in passive activities (43%), double that of those engaged in daily living activities (21%). 15% of respondents spent time in mobility and action activities and the least amount of time was spent engaged in therapeutic/leisure activities. A significant association was found between activity participation and well being. Eating and drinking was listed as the second most important activity. This study did not examine the physical and social environments of the two participating nursing homes, which the authors state “may have had an impact on performance” (30).

Cohen-Mansfield, J. (2005). Nonpharmacological Interventions for Persons with Dementia. Alzheimer, 6(2), 129-145.
Nonpharmacological approaches to the care of persons with dementia differ from pharmacological treatment in that they consider the interaction between the person, caregiver, environment, and system of care in the treatment design. Such interventions generally provide more personalized care for these individuals, addressing their needs, and considering their preferences. Nonpharmacological interventions have been used to enhance cognition, affect, and performance of activities of daily living; to reinforce a positive sense of self; and to reduce agitation/behavior problems and psychotic symptoms. This article presents a framework for implementing such interventions, provides examples from the literature of existing interventions, and argues for increased advocacy to support their research and use.

Devlin, B. (2006). The art of healing and knowing in cancer and palliative care. International Journal of Palliative Nursing, 12(1), 16-19.
This article looks at the role of AT in healing and living with cancer and end-of-life care. It discusses the meaning and therapeutic processes of AT for participants.

Dowd S.B, & Davidhizar, R. (2004). Chess and gardening: the Rx for Alzheimer's?
Caring : National Association for Home Care Magazine, 23(6), 34-38
This article looks at the benefits of activities such as playing chess and gardening as an intervention in the behavioral symptoms associated with dementia.

Dowd S.B, & Davidhizar, R. (2003). Can mental and physical activities such as chess and gardening help in the prevention and treatment of Alzheimer's? Healthy aging through stimulation of the mind. Journal of Practical Nursing, 53(3), 11-13.
This article looks at the role of physical and mental activities (AT), including chess and gardening, in preventing and reducing the behavioral symptoms of AD. It touts a “use it or lose it” approach to brain health and aging generally.

Ehrenfeld, M. (2003). Using therapeutic dolls with psychogeriatric patients. In Schaefer C.E. (Ed.), Play therapy with adults. New York: John Wiley & Sons.
This article reports on the potential usefulness of doll therapy approaches to reduce challenging behaviors, including “acting out” and “non-active” presentations, in seniors with PWD who are agitated, distressed, have communication difficulties, or are withdrawn.

Gigliotti, C.M.; Jarrott S.E.; & Yorgason, J. (2004). Harvesting Health: effects of three types of horticultural therapy activities for persons with dementia. Dementia 3(2), 161-180.
HT uses plant materials to achieve measurable treatment goals with special populations. All 3 types of HT, cooking, crafts, and planting, were used 3 times a week at an adult day service program (averaging 5-19 participants) over nine weeks. DCM and observation were used to map response. Individual codes used were Social, HT (horticulture behavior), productive, nothing. High levels of positive affect, pride, and constructive engagement were observed during all activities. No measurable difference was noted between each of the three. HT utilized Montessori-based activity modifications known as “extensions” to minimize risk of failure, maximize success, and accommodate all individuals within a group setting.

Heath, Y. (2004). Evaluating the effect of therapeutic gardens. American Journal of Alzheimer’s Disease and Other Dementias, 19, 239-242.
This article explores how the visitors to therapeutic gardens do not necessarily always experience the garden the way the designers intended. A postoccupancy evaluation (POE) can reveal discrepancies between the designer’s intentions and use of the environment by the actual visitors. A POE is a user-oriented assessment that elicits the opinions of the visitors to a building, facility, or environment. This paper describes a POE of therapeutic gardens at a multilevel care facility for the aged. The population included patients at various stages of Alzheimer’s disease progression.

Hellestrom, I.; Nolan, M.; & Lundh, U. (2007). Sustaining ‘Couplehood’: Spouses strategies for living positively with dementia. Dementia, 6(3), 383-409.
This study involved 152 interviews with twenty couples over five years. Using constructivist grounded theory methodology, three main phases were identified as “sustaining couplehood,” “maintaining involvement,” and “moving on.” Interviews were structured around the themes of the home, memory disturbance, quality of relationship, everyday life, and dignity and autonomy. In all cases there was an awareness of the diagnosis of dementia but in the majority of cases, a conscious decision was reached not to dwell upon the implications of this, but to focus on the present, and make life as meaningful and enjoyable as possible (enriching). While affirming that the caring role required “work” by the spouse, this work was not seen as burdensome, and carers expressed that they gained as much from their relationships as did PWD. Both parties, especially in the early stages of illness, were found to strive to maintain quality and closeness in their relationship by creating a “nurturative relational context.” The authors describe the gradual way a PWD “hands over” or “let’s go” of responsibilities to their partner.

Kolanowski, A. & Richards, K. (2002). Introverts and extroverts: leisure activity behavior in persons with dementia. Activities, Adaptation, and Aging, 26(4),1-16.
This article looks at the role of AT in reducing the behavioral symptoms of persons with dementia, namely encouraging social interaction and discouraging social withdrawal.

Kovach, C. & Henschel, H. (1996). Planning activities for patients with dementia. Journal of Gerontological Nursing, 22(9), 33-38.
This article examines the effect of various MT interventions on the attention span of persons with dementia. It suggests that MT can increase the attention span of participants.

Larner, A.J. (2005). Gardening and dementia. International Journal of Geriatric Psychiatry, 20(8), 796.
This letter to the editor discusses the positive role that gardening can have in the lives of stimulating persons with dementia. The author suggests that if gardening is contemplated as a component of occupational therapy for dementia patients, an individual approach tailored to cognitive abilities and deficits may be required.

Lee, Y. & Kim, S. (2008). Effects of indoor gardening on sleep, agitation, and cognition in dementia patients-a pilot study. International Journal of Geriatric Psychiatry, 23(5), 485-489.
This pilot study examined the efficacy of indoor gardening on sleep, agitation and cognition of dementia patients. Twenty-three institutionalized dementia patients who had sleep disturbance and/or agitation participated in a 5-week study protocol of 1 week of baseline and 4 weeks of treatment. The study design was a one group repeated measures study. For the first and fifth week of the study period, sleep patterns, agitation, and cognition were evaluated using a sleep diary, Modified Cohen-Mansfield Agitation Inventory and revised Hasegawa Dementia Scale respectively. Significant improvement in wake after sleep onset, nap, nocturnal sleep time, and nocturnal sleep efficiency was identified. On the contrary sleep onset time, wake-up time, total sleep time did not change after indoor gardening. Agitation and cognition score was significantly improved. The authors conclude that indoor gardening was found to be effective for sleep, agitation, and cognition of dementia patients but note that randomized controlled studies of larger sample size are needed to confirm treatment effect.

Libin, A. & Cohen-Mansfield, J. (2004). Therapeutic robocat for nursing home residents with dementia: preliminary inquiry. American Journal of Alzheimer’s Disease and Other Dementias, 19, 111-116.
This article looks at the use of a therapeutic robocat doll for play with PWD living in nursing homes. It reports positive effects of dolls on the lives of seniors with dementia.

Marshall, M. & Hutchingson, S. (2001). A critique of research on the use of activities with persons with Alzheimer’s Disease: a systematic literature review. Journal of Advanced Nursing, 35(4), 488-496.
This critique of research on the use of therapeutic activities found many articles did emphasize QOL and enrichment as goals and stated the benefits of such activities, but concluded the knowledge is still “minimal and fragmented” (489). Theoretical and methodological weaknesses were outlined, research was described as mostly anecdotal, and gaps in research were identified such as a “lack of emphasis on gender, ethnic, racial, or cultural differences” (488). It was also noted that music was used in 16 studies making it by far the intervention activity of choice. The authors found that the nursing literature in particular emphasized pleasure, dignity, friendship, meaning-making, and self-esteem, supporting the use of therapeutic activities, over insufficient long-term results.

Orsulic-Jeras, S.; Judge, K.; & Camp, C. (2000).Use of Montessori-based activities for clients with dementia in adult day care: effects on engagement. American Journal of Alzheimer’s Disease and Other Dementias, 15(1), 42-46.
The results of this study are not clear as to why both greater pleasure and lower anxiety/fear were found in Montessori-based activities for 16 residents in a dementia unit of a Jewish facility. A key issue discussed is whether long-term care staff and volunteers can conduct Montessori-based activities within existing schedules and organizational constraints. The authors state it is their hope that their programs can be implemented across settings.

Phinney, A.; Chaudhury, H.; & O’Connor, D. (2007). Doing as much as I can do: The meaning of activity for people with dementia. Aging and Mental Health, 11(4), 384-393.
Eight subjects with mild to moderate dementia were interviewed 2-6 months, with the goal of ascertaining what type of activities people with mild/moderate dementia identify as important in their everyday lives, and what their involvement in these types of activities means to them. The results emphasize the benefits of meaningful activity to retain autonomy and identity through leisure and recreation, chores, work, and social relationships. These activities were described as meaningful by virtue of their bringing pleasure and enjoyment, a sense of connection and belonging. The authors suggest that changes that accompany dementia may be less traumatic when the person is in a familiar place, surrounded by familiar objects, and engaging in activities that have long been part of their life, so as to establish continuity. The article emphasizes that pleasure can be derived from activities that rely on an “embodied geography” or a “physical insideness.”

Robinson, L.; Hutchings D.; & Corner, L. et al. (2006). A systematic literature review of the effectiveness of non-pharmacological interventions to prevent wandering in dementia and evaluation of the ethical implications and acceptability of their use. Health Technology Assessment, 10, 26.
This article reviews the literature on the efficacy of non-pharmacological interventions to reduce behavioral symptoms thought to be associated with dementia, namely wandering. It also evaluates the ethics of various techniques.

Scholzel-Dorenbox, C.J.M.; Ettema, T.P.; Bos, J.;Boelens-van der Knoop, E.; Gerritsen, D.L.; Hoogeveen, F.; de Lange, J.; Meihuizen, L. & Droes, R-M. (2007). Evaluating the outcome of interventions on quality of life in dementia: selection of the appropriate scale. International Journal of Geriatric Psychiatry, 22, 511-519.
This study shows how the severity of dementia, care type, setting and the specific QOL domains an intervention focuses on can determine which QOL instrument is appropriate. It cites evidence for difference in views on QOL between patients, caregivers, and theoretical models. The authors argue that while caregivers focus on most of the domains that patients consider important, domains that PWD consider important such as financial situation, self-determination/freedom, and being useful/giving meaning to life are focused on least (Rabins 2000) (512). They determine that “…patients can rate their own QOL until late stages of dementia and that caregiver ratings do not substitute for patient ratings…” (517), and that patient’s subjective ratings should be the gold standard, while acknowledging that independent observational ratings are of benefit for patients with (very) severe dementia.

Thelander, V.B.; Wahlin, T-B.R.; Olofsson, L.; Heikkilä, K.; & Sonde, L. (2008). Gardening activities for nursing home residents with dementia. Advances in Physiotherapy,10(1), 53-56.
This article looks at the benefits of gardening, as a type of activity therapy, for persons with dementia in nursing homes. The focus is on the reduction of behavioral problems believed to be association with the condition.

Threadgold, M. (1995). Touching the soul through the senses. Journal of Dementia Care, 3(4), 18-19.
This article reports on an approach called Sonas aPc, which utilizes a series of preplanned and ordered activities including listening to music, singing, touch, exercise, relaxation and reminiscence with groups of up to 8 people with significant communication difficulties. The authors report that participants become more physically responsive and socially aware. Allegedly, they relax and demonstrate evidence of enjoyment, and show signs of heightened cognitive functioning (e.g., talking more spontaneously and recalling memories). In terms of promoting communication, Sonas aPc can be seen as a tool rather than simply an activity.

Truscott, M. (2004). Adapting leisure and creative activities for people with early stage dementia (ESD). Alzheimer’s Care Quarterly, 5, 92-102.
The author, who has ESD, describes her adaptations, and family support, in finding creative outlets despite her loss of cognitive abilities. She focuses on process and pleasure rather than content and suggests hobbies and activities for other PWD.

Vernooij-dassen, M. (2007). Meaningful Activities for People with Dementia. Aging Mental Health,11(4), 359-360.
This editorial reviews the Brooker & Woolley (2007) Enriching Opportunities model of activities with dementia care. It praises the role/style of the locksmith and the programs’ practical approach. Accordingly, “the activities of PWD become meaningful through feelings of pleasure and involvement, a sense of connection and belonging, and a sense of autonomy and self-identity….activities show a striking resemblance to those meaningful for other adults…the question is how can these activities be stimulated…” (359)

Volicer L.; Simard, J.; Pupa J.H. et al. (2006). Effects of continuous activity programming on behavioral symptoms of dementia. Journal of the American Medical Directors Association, 7(7), 426-731.
This article looks at the impact of AT on reducing the behavioral symptoms of dementia. The focus is on behavior modification/management from the perspective of staff in residential settings.

Zeisel, J. & Raia, P. (2000). Nonpharmacological treatment for Alzheimer's disease: A mind-brain approach. American Journal of Alzheimer’s Disease and Other Dementias, 15(6), 331-340.
This article looks at the use of non-pharmacological treatments of AD, such as various art therapies, that can produce behavioral improvements. The authors argue that a new paradigm is needed that focuses on minimizing the symptoms of AD rather than focusing only on a search for a cure. To include AD in the same class of diseases as cancer, multiple sclerosis, diabetes, congestive heart failure, and degenerative arthritis places AD in the realm of the medically and psychosocially understandable and manageable. A critical first step toward making this shift is to examine carefully the way in which we define the disease. An approach to care for people with AD results in treatment when it systematically compensates for functional losses of dementia by linking caregiving actions and environments to specific brain dysfunctions; namely, the neuropathology of the disease. The ultimate measures of success of such a treatment approach are improved quality of life, delayed institutionalization, slowed rate of progression of the disease, people who achieve their potential, and reduced need for medication.

Annotated Results: 5 Mixed

2008-05-13T07:54:00.001-05:00

coming soon

Please add comments. Tell us about work we've missed. Add work published after we closed our review.

In your annotated additions please tell what was studied, what benefits were found, what quality of life benefits were found, and how well benefits were sustained.

Thanks. Don