Helen D. Davies

REM latency in Alzheimer's disease

Latency to the first episode of rapid eye movement sleep (REML) has been proposed as a potential biomarker for Alzheimers disease (AD). In this study, we compared REML values from 28 AD patients and 28 age- and sex-matched controls. We employed multiple definitions of REML and multiple cutoffs to classify patients and controls. Results indicated that the best REML definition and optimal cutoff criterion resulted in only 65% correct classifications. We discuss the longer REML in AD patients relative to controls in terms of both overall sleep disturbance and selective deterioration of the REM-cholinergic system. As REML may be relatively short in other forms of psychopathology (e.g., affective disorders), REML may still hold promise in the differential diagnosis of dementia and pseudodementia.

The impact of dementia and mild memory impairment (MMI) on intimacy and sexuality in spousal relationships

BACKGROUND Sexuality and intimacy in couples in which one partner is affected by dementia has been widely researched. Few studies have explored these issues in couples where one partner is affected by mild memory impairment (MMI) or mild cognitive impairment (MCI). The objectives of this study were to (1) identify and contrast issues of intimacy and sexuality that spousal caregivers of persons with MMI and dementia may experience, and (2) identify future lines of research in this population. METHODS Fourteen dementia and nine MMI spousal caregivers participated in focus groups conducted between 2008 and 2009 at the Stanford/VA Alzheimers Research Center. Content analyses were conducted to identify themes. RESULTS Five themes emerged: communication, marital cohesion, affectional expression, caregiver burden, and ambiguity concerning the future of the relationship. Dementia caregivers reported more difficulties with communication, cohesion, and perceptions of increased burden than their MMI counterparts. Both groups indicated reduced sexual expression due to physical limitations; substitute activities including hand-holding, massaging, and hugging were noted. Both groups reported difficulty anticipating the future of the relationship due to present stressors. While dementia caregivers could consider future romantic relationships with others, MMI caregivers were primarily able to consider future relationships only for companionship and emotional intimacy. CONCLUSION Early therapeutic interventions may assist couples in modifying activities, behaviors, and expectations about the future of the relationship. Such modifications may help maintain relationship satisfaction, decrease burden, preserve quality of life, and delay time-to-placement. Extending time-to-placement could have cost savings implications for families and the healthcare system.

Sexuality and Intimacy in Alzheimer's Patients and Their Partners

Geriatric Sexuality remains one of the more sensitive and controversial issues to be confronted in todays clinical setting. Research indicates that older adults continue to be sexually active well into later life. Older adults with dementing illnesses experience deleterious changes in sexual functioning that can affect their quality of life. However, few health care professionals ask older adults about their sexual functioning. This paper addresses means of fostering acceptance by professionals and families and creating an environment that nurtures sexuality in couples coping with dementia.

The incidence and correlates of erectile problems in patients with Alzheimer's disease.

Loss of erection was reported in 53% of 55 male Alzheimers disease patients with a mean age of 70.25. Loss of erection is not related to degree of cognitive impairment, age, or depression. Modal time of onset of erectile problems is concurrent with onset of Alzheimers symptoms. Patients with erectile problems were not taking more medications overall than those without problems and had no greater overall incidence of concurrent physical problems. Thus, the evidence suggests that there may be an elevated incidence of erectile failure in patients with Alzheimers disease as a primary problem not attributable to other age-related factors.

'TIL DEATH DO US PART: INTIMACY AND SEXUALITY IN THE MARRIAGES OF ALZHEIMER'S PATIENTS

1. Alzheimers disease (AD) is likely to have a significant effect on sexual behavior, but both patient and partner will still have sexual feelings and needs. 2. Research has shown that a high proportion of men with AD develop erection problems, but causes of their erection difficulties are not understood. 3. Research has shown that inappropriate sexual behavior in AD patients is uncommon, although it can be very troubling to the family and health-care provider if it occurs. 4. More professionals need to be trained to discuss sexual issues openly and sensitively with AD patients and partners and to offer useful clinical suggestions.

Gender differences in sexual behaviors of AD patients and their relationship to spousal caregiver well-being.

Objectives: Little is known about gender differences in sexuality among community-dwelling heterosexual couples in which one partner has Alzheimers disease (AD). Few studies have examined gender differences in specific sexual behaviors or their associations with caregiver well-being. This study evaluated the impact of gender differences on intimacy and sexual satisfaction in marital relationships in which one partner has AD. Method: Baseline measures were collected from 162 AD patients and their partners enrolled in a multi-site study between 2001 and 2009 to evaluate gender differences in measures of intimacy, caregiver well-being, and patient sexual behaviors. Results: While over 70% of all patients initiated physically intimate activities (i.e., kissing, hugging, and intercourse), most did not initiate intercourse specifically. Female caregivers reported higher levels of stress and depressive symptoms than male caregivers (p < 0.01). Satisfaction with intimacy was significantly associated with fewer stress and depressive symptoms in female caregivers (r = −0.29, p < 0.01). Caregiver gender, satisfaction with intimacy, and caring for a patient with mild AD were significant predictors of caregiver depressive symptoms (ps < 0.05). Conclusion: The majority of couples dealing with AD reported engaging in intimacy, suggesting its importance in the relationship. Female caregivers who reported less sexual satisfaction reported more frequent stress and depressive symptoms. Caregiver gender, satisfaction with intimacy, and the AD patients level of cognitive functioning significantly contributed to caregiver well-being. Gender-specific therapies to address patient sexual difficulties and caregiver well-being could potentially maintain or improve the marital relationship.

Alzheimer's disease: β-amyloid precursor protein mRNA expression in mononuclear blood cells

beta-Amyloid precursor protein (beta APP) mRNA was examined in peripheral mononuclear blood cells (PMBCs) in Alzheimers disease, Downs syndrome and control subjects. Total RNA from PMBCs was reverse transcribed and then amplified using the polymerase chain reaction (PCR). The 3 major beta APP transcripts were expressed in PMBCs from all subjects. These results suggest that PMBCs could be a circulating source for abnormal amyloid deposition in the brain and in peripheral tissues.

Desamino-D-arginine-vasopressin (DDAVP) in Alzheimer's disease

Fourteen Alzheimer subjects participated in a parallel group study of desamino-D-arginine-vasopressin (DDAVP, desmopressin). All subjects received one week of single-blind placebo. Then on a double-blind basis, the active group received DDAVP intranasally in doses starting at 30 micrograms per day and increasing over a 3 week period to 180 micrograms per day; the control group received an identical placebo. Using a repeated measures ANOVA, three measures out of thirty-one were found to be statistically significant for DDAVP treatment: the Hamilton depression scale and the affect and interpersonal subscales of the SCAG. However, the magnitude of these changes was probably too small to be clinically significant. Except for one subject who transiently became hyponatremic (Na of 120) and confused while receiving 180 micrograms of DDAVP, there were no adverse effects. There were no significant group changes in sodium, potassium, plasma osmolality, blood pressure, and weight.

Behavioral Problems in Older Adults in Acute Care Settings: Challenges for Staff

Abstract The combination of mental and physical changes with age will impact agencies focusing on both acute and chronic problems. One of the biggest challenges for staff new to such patients is contending with agitated and aggressive behaviors. Conducting a needs assessment with staff is one method of mapping the nature and extent of problem behaviors for a specific setting. In the current study, a total of 71 staff members from different disciplines, across three acute care units and two VA health care facilities, completed a survey assessing the type and frequency of reported behavior problems, the extent to which staff members could identify and document relevant patient risk factors and to identify gaps in their training. Staff reported a large range of problem behaviors. They felt highly confident in their ability to respond effectively to the most frequently observed behaviors, such as patients appearing anxious or having difficulty concentrating and trouble sleeping. However, they felt less prepared for less frequent behaviors, such as physical aggression. This information will be used to design follow-up training for the staff in targeted areas, including the management of various behaviors and the recognition of risk factors for problematic behaviors.