Alzheimer Disease: Logsdon RG

Logsdon RG, McCurry SM, Teri L. · Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA 98155-2053, USA. · Psychol Aging. · Pubmed #17385980 No free full text.

Abstract: In this article, the authors review the literature regarding evidence-based psychological treatments (EBTs) for behavioral disturbances in older adults with dementia, as proposed by the American Psychological Association's Committee on Science and Practice of the Society for Clinical Psychology. Fifty-seven randomized clinical trials were reviewed for inclusion on the basis of titles or abstract information. Forty-three were excluded either because they did not meet EBT methodological criteria or because they involved environmental or psychoeducational nursing interventions in which the psychological component could not be separately evaluated. Fourteen studies were considered for inclusion as EBTs; of these, 8 showed significant differences between treatment and control groups. Results of this review indicate that behavioral problem-solving therapies that identify and modify antecedents and consequences of problem behaviors and increase pleasant events and individualized interventions based on progressively lowered stress threshold models that include problem solving and environmental modification meet EBT criteria. Additional randomized clinical trials are needed to evaluate the generalizability and efficacy of these and other promising psychological interventions in a variety of settings with individuals who have a range of cognitive, functional, and physical strengths and limitations.

McCurry SM, Logsdon RG, Teri L, Vitiello MV. · Department of Psychosocial and Community Health, School of Nursing, University of Washington, 9709 3rd Avenue, NE, Ste. 507 Seattle, WA 98115-2053, USA. · Sleep Med Rev. · Pubmed #17287134 links to  free full text

Abstract: Estimates suggest that there are more than 10 million adult caregivers of persons with dementia, two-thirds of who experience some form of sleep disturbance during the course of their caregiving career. Health care professionals are in the best position to detect and address this significant public health problem. Three major contributors to caregiver sleep disturbance are discussed in this paper: (1) the presence of caregiver disrupted sleep routines; (2) caregiver burden and depression; and, (3) the caregiver's physical health status. Successful treatment of a caregiver's sleep disturbance requires careful consideration of each of these contributors. We review and analyze the scientific literature concerning the multiple complex factors associated with the development and maintenance of sleep disturbances in caregivers. We provide a clinical vignette that illustrates the interplay of these contributing factors, and close by providing recommendations for clinicians and researchers treating and investigating the development and maintenance of sleep problems in family caregivers.

Teri L, Logsdon RG, McCurry SM. · Department of Psychosocial and Community Health, University of Washington, 9709 3rd Avenue NE, Suite 507, Seattle, WA 98115, USA. · Med Clin North Am. · Pubmed #12168563 No free full text.

Abstract: This article provides an overview of the current literature on non-pharmacologic treatment of behavioral problems in patients with dementia, and offers practical guidelines for healthcare professionals interested in using this approach with their patients. Because effective treatment begins with accurate assessment, we provide a brief discussion of the state-of-the-art in assessment of behavioral problems. The article discusses current trends in clinical care along with specific strategies for treating and preventing some of the most common and debilitating behavioral problems of dementia patients: depression, agitation/aggression, wandering, and sleep disturbance. Because caregivers are essential informants and participants in patient care, we conclude by addressing the role of the caregiver in nonpharmacologic treatment.

Teri L, Logsdon RG. · Dept. of Psychosocial and Community Health, University of Washington, Seattle 98195-7263, USA. · Compr Ther. · Pubmed #10984821 No free full text.

Abstract: This article provides an update and review of strategies for assessing and treating behavioral changes in patients with Alzheimer disease. It discusses the impact of behavioral disturbances on patients, presents guidelines for identifying and monitoring behavioral changes, and presents behavioral treatment approaches.

McCurry SM, Gibbons LE, Logsdon RG, Vitiello MV, Teri L. · Department of Psychosocial and Community Health, University of Washington, Seattle, Washington 98115, USA. · J Am Geriatr Soc. · Pubmed #15877554 No free full text.

Abstract: OBJECTIVES: To evaluate whether a comprehensive sleep education program (Nighttime Insomnia Treatment and Education for Alzheimer's Disease (NITE-AD)) could improve sleep in dementia patients living at home with their family caregivers. DESIGN: A randomized, controlled trial. PARTICIPANTS: Thirty-six community-dwelling patients with Alzheimer's disease (AD) and their family caregivers. INTERVENTION: All participants received written materials describing age- and dementia-related changes in sleep and standard principles of good sleep hygiene. Caregivers in active treatment (n=17) received specific recommendations about setting up and implementing a sleep hygiene program for the dementia patient and training in behavior management skills. Patients in active treatment were also instructed to walk daily and increase daytime light exposure with the use of a light box. Control subjects (n=19) received general dementia education and caregiver support. MEASUREMENTS: Primary sleep outcomes were derived for patients and caregivers from 1 week of sleep-wake activity measured at baseline, posttest (2 months), and 6-month follow-up using an Actillume wrist-movement recorder. Secondary patient outcomes included the Epworth Sleepiness Scale, the Cornell Depression Scale, and the Revised Memory and Behavior Problem Checklist. Caregiver self-reports included the Pittsburgh Sleep Quality Index and the Center for Epidemiological Study of Depression Scale. RESULTS: Patients participating in NITE-AD showed significantly greater (P<.05) posttest reductions in number of nighttime awakenings, total time awake at night, and depression, and increases in weekly exercise days than control subjects. At 6-month follow-up, treatment gains were maintained, and additional significant improvements in duration of night awakenings emerged. When cognitive level was controlled, NITE-AD patients had lower longitudinal ratings of daytime sleepiness than controls. There was a trend for control subjects to spend more time in bed at 6 months than NITE-AD patients. CONCLUSION: This study provides the first evidence that patients with AD who are experiencing sleep problems can benefit from behavioral techniques (specifically, sleep hygiene education, daily walking, and increased light exposure) that are known to improve sleep in nondemented, institutionalized older adults.

Teri L, Gibbons LE, McCurry SM, Logsdon RG, Buchner DM, Barlow WE, Kukull WA, LaCroix AZ, McCormick W, Larson EB. · Department of Psychosocial and Community Health, University of Washington, Seattle 98195, USA. · JAMA. · Pubmed #14559955 links to  free full text

Abstract: CONTEXT: Exercise training for patients with Alzheimer disease combined with teaching caregivers how to manage behavioral problems may help decrease the frailty and behavioral impairment that are often prevalent in patients with Alzheimer disease. OBJECTIVE: To determine whether a home-based exercise program combined with caregiver training in behavioral management techniques would reduce functional dependence and delay institutionalization among patients with Alzheimer disease. DESIGN, SETTING, AND PATIENTS: Randomized controlled trial of 153 community-dwelling patients meeting National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer Disease and Related Disorders Association criteria for Alzheimer disease, conducted between June 1994 and April 1999. INTERVENTIONS: Patient-caregiver dyads were randomly assigned to the combined exercise and caregiver training program, Reducing Disability in Alzheimer Disease (RDAD), or to routine medical care (RMC). The RDAD program was conducted in the patients' home over 3 months. MAIN OUTCOME MEASURES: Physical health and function (36-item Short-Form Health Survey's [SF-36] physical functioning and physical role functioning subscales and Sickness Impact Profile's Mobility subscale), and affective status (Hamilton Depression Rating Scale and Cornell Depression Scale for Depression in Dementia). RESULTS: At 3 months, in comparison with the routine care patients, more patients in the RDAD group exercised at least 60 min/wk (odds ratio [OR], 2.82; 95% confidence interval [CI], 1.25-6.39; P =.01) and had fewer days of restricted activity (OR, 3.10; 95% CI, 1.08-8.95; P<.001). Patients in the RDAD group also had improved scores for physical role functioning compared with worse scores for patients in the RMC group (mean difference, 19.29; 95% CI, 8.75-29.83; P<.001). Patients in the RDAD group had improved Cornell Depression Scale for Depression in Dementia scores while the patients in the RMC group had worse scores (mean difference, -1.03; 95% CI, -0.17 to -1.91; P =.02). At 2 years, the RDAD patients continued to have better physical role functioning scores than the RMC patients (mean difference, 10.89; 95% CI, 3.62-18.16; P =.003) and showed a trend (19% vs 50%) for less institutionalization due to behavioral disturbance. For patients with higher depression scores at baseline, those in the RDAD group improved significantly more at 3 months on the Hamilton Depression Rating Scale (mean difference, 2.21; 95% CI, 0.22-4.20; P =.04) and maintained that improvement at 24 months (mean difference, 2.14; 95% CI, 0.14-4.17; P =.04). CONCLUSION: Exercise training combined with teaching caregivers behavioral management techniques improved physical health and depression in patients with Alzheimer disease.

McCurry SM, Gibbons LE, Logsdon RG, Vitiello M, Teri L. · Department of Psychosocial and Community Health Psychiatry, University of Washington, Seattle, Washington 98115, USA. · J Am Geriatr Soc. · Pubmed #14511168 No free full text.

Abstract: OBJECTIVES: To examine the feasibility of training caregivers to implement sleep hygiene recommendations in dementia patients. DESIGN: A randomized, controlled trial. SETTING: Community. PARTICIPANTS: Twenty-two community-dwelling patients with Alzheimer's disease (AD) and their family caregivers. INTERVENTIONS: All participants received written materials describing age- and dementia-related changes in sleep and standard principles of good sleep hygiene. Caregivers in active treatment (n=10) also received specific recommendations about setting up and implementing a sleep hygiene program for the dementia patient. Control subjects (n=12) received general dementia education and caregiver support. MEASUREMENTS: Success implementing sleep hygiene recommendations was measured using daily log reports to calculate the percentage of days that caregivers reported that patients met individualized sleep scheduling, daytime-napping, and walking goals. RESULTS: Caregivers in active treatment were more successful in setting goals related to sleep scheduling and increasing daytime activity than control caregivers who received written materials only. Among patients who were candidates for sleep hygiene changes, active treatment subjects were also significantly (P<.01) more likely than controls to maintain a consistent bedtime (83% vs 38% of days attempted) and a consistent rising time (96% vs 59%), to nap less during the day (70% vs 28%), and to walk daily (86% vs 7%). CONCLUSION: This study provides evidence that sleep hygiene interventions are feasible with community-dwelling AD patients. Caregivers were able to help patients change sleep scheduling, napping, and walking routines, but clinicians who recommend sleep hygiene changes for their dementia patients should be aware that many caregivers need active assistance setting up and implementing a sleep hygiene program. Simply providing caregivers with education is often insufficient.

Teri L, Logsdon RG, Peskind E, Raskind M, Weiner MF, Tractenberg RE, Foster NL, Schneider LS, Sano M, Whitehouse P, Tariot P, Mellow AM, Auchus AP, Grundman M, Thomas RG, Schafer K, Thal LJ, Anonymous00040. · University of Washington, Department of Psychosocial and Community Health, Seattle 98195-7263, USA. · Neurology. · Pubmed #11087767 No free full text.

Abstract: BACKGROUND: Treatment of agitation is a crucial problem in the care of patients with AD. Although antipsychotic and antidepressant medications and behavior management techniques (BMT) have each been used to treat agitation, clinical trials of these treatments have been characterized by small sample sizes and uncontrolled treatment designs. OBJECTIVE: To compare haloperidol, trazodone, and BMT with placebo in the treatment of agitation in AD outpatients. METHODS: A total of 149 patients with AD and their caregivers participated in a randomized, placebo-controlled, multicenter trial. Blind assessment was conducted at baseline and after 16 weeks of treatment. The three active treatments were haloperidol, trazodone, and BMT. The Alzheimer's Disease Cooperative Study Clinical Global Impression of Change was the primary outcome measure. Secondary outcomes included patient agitation, cognition, and function, and caregiver burden. RESULTS: Thirty-four percent of subjects improved relative to baseline. No significant differences on outcome were obtained between haloperidol (mean dose, 1.8 mg/d), trazodone (mean dose, 200 mg/d), BMT, or placebo. Significantly fewer adverse events of bradykinesia and parkinsonian gait were evident in the BMT arm. No other significant difference in adverse events was seen. Symptoms did not respond differentially to the different treatments. CONCLUSIONS: Comparable modest reductions in agitation occurred in patients receiving haloperidol, trazodone, BMT, and placebo. More effective pharmacologic, nonpharmacologic, and combination treatments are needed.

Logsdon RG, Teri L, Weiner MF, Gibbons LE, Raskind M, Peskind E, Grundman M, Koss E, Thomas RG, Thal LJ. · University of Washington, Seattle 98195-7263, USA. · J Am Geriatr Soc. · Pubmed #10573447 No free full text.

Abstract: OBJECTIVES: To develop and evaluate the psychometric properties of a new measure of agitation, the Agitated Behavior in Dementia scale (ABID). The ABID consists of 16 items designed specifically to evaluate frequency of and caregiver reaction to common agitated behaviors in community-residing dementia patients. DESIGN: The ABID was administered at the baseline assessment of a multi-site controlled treatment study to reduce agitation in Alzheimer's Disease (AD). Reliability was assessed by evaluating internal consistency and test-retest correlations. Validity was assessed by examining correlations with other constructs, including demographics, cognitive status, and overall behavioral disturbance. SETTING: Twenty-one sites across the US, comprising the Alzheimer's Disease Cooperative Study, contributed subjects to the investigation. PARTICIPANTS: A total of 148 community-residing AD patients, living with a spouse or adult relative who acted as an informant. Mean age was 75 years, and mean Mini-Mental State Exam (MMSE) score was 13. MEASUREMENTS: Cognitive status was assessed using the MMSE. Behavioral disturbance was assessed using the Behavior Rating Scale for Dementia of the Consortium to Establish a Registry for Alzheimer's Disease, the Revised Memory and Behavior Problems Checklist, and the Cohen-Mansfield Agitation Inventory. RESULTS: Reliability of the ABID was excellent, with internal consistency of 0.70 and test-retest reliability of 0.60 to 0.73. Validity was confirmed by correlations with related measures and lack of correlation with unrelated constructs. CONCLUSIONS: The ABID is brief, easy to administer, and provides objectively anchored observations of problems. It is a promising measure for studies of community-residing AD patients.

Logsdon RG. · Psychosocial & Community Health, University of Washington School of Nursing, Seattle, WA 98115, USA. · Lancet. · Pubmed #18640438 No free full text.

This publication has no abstract.

McCurry SM, Pike KC, Vitiello MV, Logsdon RG, Teri L. · University of Washington, Seattle, WA 98115-2053, USA. · Sleep. · Pubmed #18517044 links to  free full text

Abstract: STUDY OBJECTIVES: To describe the day-to-day variation in sleep characteristics and the concordance between nighttime sleep of persons with Alzheimer's disease (AD) and their family caregivers. PARTICIPANTS: N = 44 community-dwelling older adults with probable or possible AD and their co-residing family caregivers. DESIGN: Participants wore an Actillume (Ambulatory Monitoring, Inc) for one week and completed an assessment battery to evaluate patient and caregiver mood, physical function, medication use, caregiver behavior management style, and patient cognitive status. MEASUREMENTS AND RESULTS: Actigraphically derived sleep measures included bedtime, rising time, total time in bed, total sleep time, number of awakenings, total wake time, and sleep percent (efficiency). For each sleep parameter, total variance was determined for between-subject variance and within-subject variance from day-to-day. Sleep concordance was examined using multinomial logistic regression to compare trichotomous patient-caregiver combinations of good and bad sleepers. For both patients and caregivers, between-subject daily variability accounted for more of the variance in sleep than within-subject variability. Patient depression and caregiver management style were significant predictors both for concordant poor sleep (both patient and caregiver with sleep efficiency < or =85%) and patient-caregiver sleep discordance. CONCLUSIONS: This study provides data that sleep disturbances for persons with AD and their family caregivers vary considerably night to night, and that poor sleep in one member of the caregiving dyad is not necessarily linked to disturbed sleep in the other. Understanding the complex interrelationship of sleep in AD patients and caregivers is an important first step towards the development of individualized and effective treatment strategies.

Logsdon RG, McCurry SM, Teri L. · Department of Psychosocial and Community Health, University of Washington, Seattle, USA. · Care Manag J. · Pubmed #16544870 No free full text.

Abstract: Regular exercise is a mainstay of preventive health care for individuals of all ages. Research with older adults has shown that exercise reduces risk of chronic illness, maintains mobility and function, enhances mood, and may even improve cognitive function. For individuals with dementia, exercise programs are particularly likely to improve health, mood, and quality of life; the challenge at this time is to make exercise accessible and enjoyable, demonstrate its benefits, and convince family caregivers of its worth for individuals with dementia. Home health providers are uniquely positioned to assist caregivers in developing and implementing a home exercise program for their care recipient with dementia. Results of a controlled critical trial conducted at the University of Washington have demonstrated the feasibility and efficacy of a home health exercise and problem solving intervention (Reducing Disability in Alzheimer's Disease, or RDAD) for decreasing physical, psychological, and behavioral disabilities associated with dementia. This article describes the RDAD program, discusses the role of home health providers in its delivery, and provides an example of its implementation.

McCurry SM, Vitiello MV, Gibbons LE, Logsdon RG, Teri L. · Department of Psychosocial and Community Health, University of Washington, Seattle, WA 98115-2053, USA. · Am J Geriatr Psychiatry. · Pubmed #16473975 No free full text.

Abstract: OBJECTIVE: This investigation examined the relationship between caregivers' reports of sleep disturbances in persons with Alzheimer disease (AD) and actigraphic records of patients' sleep-wake activity, and explored the factors associated with discrepancies in this relationship. METHOD: Forty-six patients with AD living with their caregivers participated. Before study entry, all caregivers reported poor patient sleep quality using the Neuropsychiatric Inventory (NPI) Nighttime Behavior Scale. Patient sleep-wake activity was recorded for one week using an Actillume wrist-movement recorder. RESULTS: Although all patients were reported by caregivers to have multiple sleep disturbances, 41% of patients had actigraphic sleep efficiencies in the normal range and 43% averaged eight or more hours of sleep nightly. In bivariate analyses, greater patient percent nighttime sleep (indicative of more discrepancy between subjective reports and objective outcomes) was associated with less patient cognitive, physical and functional impairment, lower self-rated depression, higher self-rated quality of life, and less daytime sleepiness. No patient variable significantly predicted total patient nocturnal sleep time. In both bivariate and multivariate analyses, greater patient percent sleep and total sleep time were also associated with caregiver factors, particularly greater use of criticism as a behavior management strategy. CONCLUSION: The study suggests that both patient and caregiver factors contribute to reported sleep problems in community-dwelling patients with AD, and that caregiver reports and objective sleep assessments frequently may not agree. Treatments should consider these dyadic contributions rather than focusing on caregiver reports of patient symptoms alone.

McCurry SM, Logsdon RG, Vitiello MV, Teri L. · Department of Psychosocial and Community Health, University of Washington, 9709 3rd Avenue N.E., Suite 507, Seattle, WA 98115-2053, USA. · Sleep Med. · Pubmed #15222994 No free full text.

Abstract: BACKGROUND AND PURPOSES: Sleep and nighttime behavioral disturbances are widespread in community-dwelling dementia patients, but little is known about the usefulness of behavioral interventions for treating them. This article presents data from three cases enrolled in an ongoing study of sleep problems in community-dwelling Alzheimer's disease (AD) patients: nighttime insomnia treatment and education for Alzheimer's disease. PATIENTS AND METHODS: All subjects received written materials describing age- and dementia-related changes in sleep, and standard principles of good sleep hygiene. Caregivers also received education about dementia, listings of relevant community resources, and general support. Subjects' sleep-wake activity was measured at baseline, post-test (2 months), and 6-month follow-up using an Actillume wrist-movement recorder, which was worn continuously for 1 week. RESULTS: Post-test actigraphic improvements in sleep quantity and sleep efficiency, number of nighttime awakenings, and amount of daytime sleep, as well as subjective sleep ratings were observed. One subject maintained improvements at 6-month follow-up. Subjects varied widely in the type of sleep problems reported and behavioral strategies implemented by family caregivers, illustrating the complexity that characterizes nighttime behavioral disturbances in AD. CONCLUSIONS: This paper provides clinical and empirical evidences that behavioral strategies including standard sleep hygiene recommendations can be helpful in treating sleep and nighttime behavioral disturbances in dementia patients.

McCurry SM, Gibbons LE, Logsdon RG, Teri L. · Department of Psychosocial and Community Health, University of Washington, Box 357263, Seattle, WA 98195-7263, USA. · J Gerontol Nurs. · Pubmed #14753054 No free full text.

Abstract: This study was conducted to describe the relationship between anxiety and nighttime behavioral disturbance in a community-dwelling sample of patients with Alzheimer's disease (AD). Data from 153 patients with probable or possible AD and their family caregivers were analyzed using logistic regression modeling. Ratings of nighttime behavioral disturbance were based on caregiver reports of how often patients had awakened them at night during the past week. Standardized ratings for patient cognitive, functional, and behavioral status, and for caregiver sleep, depression, and burden were collected. Fifty-six percent of the patients with AD showed symptoms of anxiety, and 29% had awakened their caregiver at least once at night during the past week. Patient awakening was associated with higher levels of patient anxiety (odds ratio [OR] = 2.1; confidence Interval [CI] = 1.4, 2.9) and patient impairments in activities of daily living (OR = 1.6, CI = 1.2, 2.3). No other demographic, cognitive, functional, or behavioral variables were significant, including depression. In univariate analyses, individual patient anxiety symptoms (e.g., feeling anxious; showing physical signs of anxiety, agitation, and irritability) were significant risk factors for patient awakenings. Of these, showing physical signs of anxiety remained a significant risk factor in multivariate analyses. Results suggest that anxiety and nighttime awakening are highly interrelated in patients with moderate dementia due to AD, and treatments targeting both may be more efficacious than those focusing on anxiety or sleep alone. They also reveal the importance of assessing anxiety as well as depression in the research and clinical care of patients with AD.

Logsdon RG, Gibbons LE, McCurry SM, Teri L. · Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, Washington 98195-8733, USA. · Psychosom Med. · Pubmed #12021425 links to  free full text

Abstract: OBJECTIVE: This article discusses theoretical, psychometric, and practical considerations of quality of life assessment in older adults with cognitive impairment. It describes a new measure of quality of life in dementia, the QOL-AD, and examines the reliability and validity of patient and caregiver reports of patient quality of life. METHODS: Subjects were 177 patient/caregiver dyads. Patient Mini Mental State Exam scores ranged from 0 to 29, with a mean score of 16 (SD = 7). Each patient and caregiver rated the patient's quality of life on the QOL-AD. Patient functional and cognitive status, psychological state, physical function, and behavior problems were also assessed. Reliability and validity of patient QOL-AD reports were examined across three levels of cognitive impairment. RESULTS: One hundred, fifty-five patients were able to complete the QOL-AD. Completers scored between 4 and 29 on the Mini Mental State Exam, whereas noncompleters all scored 10 or lower. Reliability for both patient and caregiver reports on the QOL-AD was good (alpha values ranged from 0.83 to 0.90). Validity of patient and caregiver reports across cognitive levels was supported by correlation with measures of depression (r = -0.41 to -0.65), day-to-day functioning (r = -0.10 to -0.45), and pleasant events frequency (r = 0.18 to 0.51). Intraclass correlation between patient and caregiver reports was positive across all cognitive levels (r = 0.14 to 0.39). CONCLUSIONS: The QOL-AD seems to be reliable and valid for individuals with MMSE scores greater than 10. Further research is needed to clarify the relationship between patient and caregiver reports of patient quality of life and to identify factors that influence quality of life throughout the progression of dementia.

McCurry SM, Logsdon RG, Teri L, Gibbons LE, Kukull WA, Bowen JD, McCormick WC, Larson EB. · Department of Psychosocial and Community Health, University of Washington, Seattle 98195-7263, USA. · J Geriatr Psychiatry Neurol. · Pubmed #10483925 No free full text.

Abstract: This study examined the frequency, predictors, and impact of sleep problems in a population-based sample of 205 Alzheimer's disease (AD) patients. Sleeping more than usual and early morning awakenings were the most common sleep problems reported but were the least disturbing behaviors for caregivers. Night-time awakenings were less common but were most disturbing to caregivers. Using logistic regression analyses, the factors most strongly associated with night awakenings among patients were male gender, greater memory problems, and decreased functional status. Patient depression increased the risk for caregivers to rate patient sleep problems as more disturbing overall. Cluster analyses revealed three characteristic groups of patients who awakened caregivers: one group was inactive during the day but had few other behavior problems; one group had increased levels of fearfulness, fidgeting, and occasional sadness; and the third group had multiple behavior problems, including frequent episodes of sadness, fearfulness, inactivity, fidgeting, and hallucinations. These findings indicate that the nature of sleep problems in AD is multifaceted; future research on the occurrence and treatment of sleep disturbance in dementia patients should consider the patterns of individual differences that may influence its development.

Teri L, Ferretti LE, Gibbons LE, Logsdon RG, McCurry SM, Kukull WA, McCormick WC, Bowen JD, Larson EB. · Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle 98195-7563, USA. · J Gerontol A Biol Sci Med Sci. · Pubmed #10462166 No free full text.

Abstract: BACKGROUND: Anxiety may be associated with psychiatric morbidity, disability, increased health care utilization, and mortality in Alzheimer's disease (AD) patients as it is in the general adult population. However, the phenomenology of anxiety symptoms in AD and its relationship to dementia progression, comorbid depression, and the presence of other problematic behaviors have not yet been examined. METHOD: Data on anxiety symptoms and their coexistence with other factors were obtained in 523 community-dwelling AD patients through interviews with their caregivers and direct physical examination. The prevalence of anxiety symptoms and their association to patient depression, other behavioral problems, gender, and age was investigated. RESULTS: Anxiety symptoms were common, occurring in 70% of subjects. Anxiety symptoms were significantly correlated with ADL impairment and other behavioral disturbances, including wandering, sexual misconduct, hallucinations, verbal threats, and physical abuse. Comorbidity of anxiety-depression was also prevalent: 54% of the sample had both anxiety and depression symptoms. ADL impairment and problem behaviors were significantly associated with comorbidity; however, the latter association was explained entirely by the presence of anxiety. CONCLUSION: Anxiety symptoms were common and significantly related to ADL and additional neuropsychiatric problems in this sample. These results indicate the need for additional research into the phenomenology of anxiety and comorbid anxiety-depression in AD and for the development and investigation of effective assessment and treatment of anxiety in AD clinical practice.