Cynthia Steele

Quality of life in dementia patients in long-term care.

To evaluate variables associated with quality of life (QOL) in dementia residents in a long‐term care facility using a recently standardized and validated dementia‐specific QOL scale (ADRQL).

A randomized, controlled trial of bright light therapy for agitated behaviors in dementia patients residing in long-term care.

Agitated behaviors are common in dementia patients residing in chronic care settings. Their occurrence may be associated with lack of adequate exposure to sunlight and with circadian rhythm disturbances.

The Maryland Assisted Living Study: Prevalence, Recognition, and Treatment of Dementia and Other Psychiatric Disorders in the Assisted Living Population of Central Maryland

Objectives: To obtain a direct estimate of the prevalence of dementia and other psychiatric disorders in residents of assisted living (AL) in Central Maryland, and their rates of recognition and treatment.

Wandering behaviour in community-residing persons with dementia.

To examine wandering behaviour in elderly demented persons in the community setting with respect to dementia characteristics and other factors that might influence wandering behaviour; to generate a statistical model to assess the relative importance of these various factors in predicting wandering behaviour.

Characteristics and outcomes of dementia residents in an assisted living facility

Assisted living (AL) is the fastest growing segment of residential long‐term care in the US. At least half of the estimated 1 million AL residents have dementia or cognitive impairment, with many AL facilities offering specialized dementia services. Little research has been done on the demographics, outcomes, or clinical variables of this population.

Depression in assisted living is common and related to physical burden

OBJECTIVEnThe objective of this study was to obtain a direct estimate of the prevalence of depression, its associated factors, and rates of treatment among residents of assisted living (AL) facilities in central Maryland.nnnMETHODnOne hundred ninety-six AL residents were recruited from 22 (10 large and 12 small) randomly selected AL facilities in the city of Baltimore and seven Maryland counties. Chart review, staff and family history, comprehensive in-person resident evaluation, and the Cornell Scale for Depression in Dementia (CSDD) were administered by an experienced team of geriatric psychiatry clinicians. Those scoring >7 on the CSDD, a cut point repeatedly associated with poor outcomes, were considered clinically depressed.nnnRESULTSnParticipants had an average age of 86 years, most were female and widowed, and 68% met consensus criteria for dementia. Twenty-four percent (47 of 196) of the sample was depressed. In bivariate analyses, depression was significantly related to medical comorbidity, need for activities of daily living (ADLs) assistance, more days spent in bed, and less participation in organized activities. After controlling for pertinent covariates in a regression model, only need for ADL assistance remained significantly associated with depression. Forty-three percent of those currently depressed were receiving antidepressants and were more likely to receive them if they lived in a large AL facility. Sixty percent of depressed residents had no regular source of psychiatric care.nnnCONCLUSIONSnIn the first clinical study implemented by geriatric psychiatry professionals in AL, depression was found to be common, undertreated, and related to physical burden. AL is a rapidly growing segment of long-term care and represents an important setting in which to find and treat serious depression.

A Scale to Measure Impairment in Severe Dementia and Similar Conditions

The authors describe an 11-item, 22-point scale that measures cognitive capacity in severely cognitively impaired individuals. The Severe Impairment Rating Scale (SIRS) has acceptable interrater reliability (r = 0.992; P < 0.001), test-retest reliability (r = 0.97; P < 0.0001), and internal consistency (Chronbachs alpha = 0.76). Validity is supported by correlations with the Glasgow Coma Scale (r = 0.866; P < 0.001) and Mini-Mental State Examination (r = 0.770; P < 0.001).

Cognitive response to pharmacological treatment for depression in Alzheimer disease: Secondary outcomes from the depression in Alzheimer's disease study (DIADS)

OBJECTIVEnThe authors assessed the cognitive effects of depression treatment with sertraline in patients with Alzheimer disease (AD) and major depression.nnnMETHODSnForty-four patients with probable AD and major depression were enrolled in a double-blind, placebo-controlled clinical trial of sertraline. Cognitive testing was done at baseline and at 3-week intervals throughout the 12-week study. At the 12th week, subjects were categorized by treatment response (full, partial, or no response). Cognitive data from 41 participants who completed three or more testing sessions and 36 who completed all five study visits were included in the analyses.nnnRESULTSnNeither improved mood nor use of sertraline was associated with cognitive change over time in AD patients. Post-hoc exploration of the data, however, suggested a sex difference in cognitive response to sertraline such that women treated with sertraline demonstrated improved cognition compared with women on placebo, whereas men treated with sertraline worsened significantly in cognition compared with men on placebo.nnnCONCLUSIONSnIn this study, among depressed AD patients after treatment with sertraline or placebo, there was no evidence that improved mood was associated with cognitive improvement. Future studies aimed at increasing power to detect mood as well as medication effects will be valuable in determining the relationship between cognition and treatment of depression in AD patients.