Montessori-based activities for long-term care residents with advanced dementia: effects on engagement and affect.

Sixteen residents in long-term care with advanced dementia (14 women; average age = 88) showed significantly more constructive engagement (defined as motor or verbal behaviors in response to an activity), less passive engagement (defined as passively observing an activity), and more pleasure while participating in Montessori-based programming than in regularly scheduled activities programming. Principles of Montessori-based programming, along with examples of such programming, are presented. Implications of the study and methods for expanding the use of Montessori-based dementia programming are discussed.

An intergenerational program for persons with dementia using Montessori methods.

An intergenerational program bringing together older adults with dementia and preschool children in one-on-one interactions is described. Montessori activities, which have strong ties to physical and occupational therapy, as well as to theories of developmental and cognitive psychology, are used as the context for these interactions. Our experience indicates that older adults with dementia can still serve as effective mentors and teachers to children in an appropriately structured setting.

Vertebral osteomyelitis: nontypeable beta-lactamase-negative Haemophilus influenzae in an adult: case report.

Adult pyogenic vertebral osteomyelitis due to Haemophilus influenzae is exceedingly rare. After a search of the literature, we deemed our case to be the seventh case of H. influenzae pyogenic osteomyelitis. Vertebral osteomyelitis in itself is a rarity. The most common organisms associated with vertebral osteomyelitis are Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. Of the six previously reported cases of adult pyogenic vertebral osteomyelitis due to H. influenzae, four of the six cases were caused by Type B H. influenzae, one case was attributed to Type C, and the other strain was not typed.

Covert versus overt self-recognition in late stage Alzheimer's disease.

Some persons with Alzheimer's disease (AD) lose the ability to recognize themselves, as when they cannot overtly recognize their reflection in a mirror. There is evidence, however, that covert or unconscious self-recognition might be displayed in such individuals. In this study, 3 persons with AD lacking the ability to overtly self-recognize demonstrated multiple instances of unconscious or covert self-recognition. A variety of interventions, inspired by research with prosopagnosics, was implemented to remediate this loss. Interventions enabled all participants to exhibit overt self-recognition, though each did so with the aid of a different intervention. In addition, successful overt self-recognition required a verbal probe and was entirely intervention-dependent: When the intervention was removed, overt self-recognition was lost. Results support a dissociation between explicit-declarative versus implicit-nondeclarative memory systems, and extends this dissociation into the realm of self-recognition in AD.

The InterpreCare System: overcoming language barriers in long-term care.

Differences in the language spoken by residents and staff in long-term care create a variety of problems. The InterpreCare System represents an intervention for dealing with this issue. We describe the nature and purpose of this intervention, and provide detailed instructions on the construction of Language Boards. Examples are given from our experience at Menorah Park Center for the Aging in enabling English-speaking staff to use Russian phrases while delivering care. Beneficial effects produced by the intervention are discussed.

Effects of sudden insight on long-term sentence priming in Alzheimer's disease.

The purpose of this study was to demonstrate spared, long-term sentence priming in individuals with Alzheimer's Disease (AD) using a sentence puzzle task. The sentence puzzle task required a decision--either yes or no--regarding the correctness of an answer supplied for a sentence puzzle. Twelve persons with AD, 12 older controls, and 12 younger controls took part. Speed of response (deciding if a puzzle answer was correct or incorrect) was recorded, with increased speed at retesting after 30-min and 1-week delays used as an index of priming. Individuals with AD demonstrated sentence priming over both a 30-min and 1-week delay, comparable in form to that of controls. In addition, persons with AD were affected by stimulus parameters (correct/incorrect puzzle answers; difficult/easy puzzles) in a similar manner as were controls.

The process of coping with a gross anatomy exam during the first year of medical school.

A total of 42 freshman medical students were evaluated before a major exam, after the exam and before grades were announced and after grades were announced. They completed measures relating to mood, emotions, coping, social support and stakes. Significant time and academic performance differences were found in many domains.

Anosognosia in Alzheimer disease.

This study evaluated Alzheimer disease (AD) patients' awareness of impairment in several domains, including cognitive, psychiatric, and behavioral functioning. Ratings made by 13 patients with moderate to moderately severe probable AD were compared with ratings made by their relatives using the Cognitive Behavior Rating Scales (Williams et al., 1985; Williams, 1987). Unawareness was defined as the discrepancy between informant and patient ratings. Informants consistently rated patients' impairment as more severe than the patients rated themselves. However, the discrepancy between the ratings was statistically significant only for Language Disorder, Higher Cognitive Deficits, Memory Disorder, Dementia, and Apraxia, and not for Agitation, Need for Routine, Depression, and Disorientation scales. Unawareness was not related to severity of memory impairment, as measured by the Rivermead Behavioural Memory Test (Wilson et al., 1985). The results of this small, preliminary study of relatively severely impaired AD patients suggest that awareness of psychiatric and behavioral problems may be relatively preserved compared to awareness of cognitive problems. These findings should be replicated with a larger sample with a broader range of severity.

Memory training in normal and demented elderly populations: the E-I-E-I-O model.

An heuristic classification scheme for memory interventions is described as a 2 x 2 matrix. One dimension of the matrix addresses the use of internal versus external mnemonics, and the other dimension addresses the use of explicit (effortful/conscious) versus implicit (automatic/unconscious) learning. Most attempts at memory interventions in normal older populations, such as the use of mental imagery, fall within the explicit-internal cell of the matrix and require expenditure of large amounts of cognitive effort. As a result, memory interventions in normal older populations, even when "successful," usually produce results that are limited in their generalization and are usually not maintained over time. Such interventions are rarely attempted in demented populations. Interventions are described that require less effort and are representative of other cells in the classification matrix. These may be more effective for demented and normal elders. Information acquired through these alternative means may eventually be stored internally and become consciously available, often producing an "O!" or "aha" experience when the individual realizes a shift to internal, consciously available storage has taken place.

Introducing psychiatric care into nursing homes.

A consultation-liaison psychiatry program in a teaching nursing home helped implement six guiding principles including: make the patient human to the staff; assume no behavior is random; look for depression of psychosis as a source of problems; reduce medications and medication doses; create a more homelike environment; and use conditions in which learning still occurs in dementia.

Prospective memory intervention in Alzheimer's disease.

Four individuals with Alzheimer's disease were trained to remember and to implement an intention for future action. The training program utilized the spaced-retrieval method, which involves active attempts to recall information over expanding intervals of time. All participants learned to select a colored coupon from an array of distractors and offer it to the experimenter after a week's delay. Following one-week retention of the initial task, a different coupon became the new training target. All participants were able to shift to this new task requirement, and all learned three successive coupon colors successfully. These results indicate that individuals with Alzheimer's disease can learn a prospective memory task using spaced-retrieval practice and can make adjustments for changing task requirements.

Curiosity and stimulation seeking across the adult life span: cross-sectional and 6- to 8-year longitudinal findings.

Giambra (1977-1978, 1979-1980) found that 2 scales of the Imaginal Processes Inventory measuring curiosity (i.e., information seeking) did not change across the adult life span, but 2 measuring stimulation seeking (i.e., boredom) for external stimulation need significantly decreased with age. In this study, these outcomes were replicated (1,356 men and 1,080 women 17 to 92 years old). In addition, a 6- to 8-year longitudinal repeat was obtained on 222 men and 124 women. Significant longitudinal declines were obtained for the stimulation-seeking measures. Furthermore, women showed an increase in impersonal-mechanical curiosity and a decline in interpersonal curiosity, though the amount of change was modest. Men were unchanged on both curiosity measures. Gender differences in longitudinal changes apparently reflected effects of socialization as well as tendencies toward displaying increased androgyny with advancing age.

Factorial invariance issues in the study of adult personality: an example using Levenson's locus of control scale.

Confirmatory factor analysis was used to examine factorial invariance across young, middle-aged, and elderly age groups, using Levenson's multidimensional locus of control (LoC) scale, which measures beliefs in Internal Control (I), Control by Powerful Others (P), and Chinese (C). Data were obtained from 563 individuals ranging in age from 25 years to 75 years of age who resided in Southeastern Louisiana. Results indicated that Levenson's 3-factor conceptualization of control was not a valid representation of the samples' responses. A model that specified the elimination of 17 unreliable items and the formation of both an internal and an external control factor that was based on the seven remaining I and P items provided an adequate fit to the data for the three age groups, though when additional constraints were specified, factorial invariance was not demonstrated. The 7-item I and P factor model generated a pattern of relationships with other measures which was similar to the pattern found if all items of the I and P scales were used.

Age and living conditions as related to perceptions of ambiguous figures.

For ambiguous figures, reversing and embedded/hidden subfigures, data were obtained from four groups of 20 subjects each varying in age (young or elderly) and living environments (in college, in the community, and in nursing homes or confined to an institution). 10 men and 10 women were tested in each of the four groups. Dependent measures were the number of reversals passively reported for the Necker cube, the Mach book, the Schroeder staircase within 90 sec. on each task, and the number of embedded/hidden figures located. Younger subjects generally saw more reversals and found more embedded figures than elderly ones. The subjects' living situation, education, and verbal ability also were correlated with perceptual performance. These results suggest generalization of age associations with scores in 90 sec. must be tempered by consideration of other factors which affect intactness, basic competence, and how competence is measured.

Genital herpes. How to relieve patients' physical and psychological symptoms.

Genital herpes simplex virus is being encountered at an increasing rate by the primary care physician. Recurrences of this disease create not only medical but psychological and social problems, of which the physician must be aware. Although acyclovir (Zovirax) has become a useful palliative tool, compassion, sensitivity, and understanding are essential in the treatment of this disease. Physician-provided education is still currently the thrust for prevention.

Beliefs about fact retrieval and inferential reasoning across the adult lifespan.

This study deals with beliefs about question-answering processes involving "world knowledge" utilized by young, middle aged, and older adults. Questions intended to induce either fact retrieval or inferential reasoning were shown to younger (n = 37), middle aged (n = 37) and older (n = 37) adults in both a multiple choice and true/false format. Increasing age level was not related to decreased confidence in either fact retrieval or inferential reasoning. Global assessments about these question-answering processes involving "people in general" and self evaluations were taken from the same individuals. In contrast to personal confidence ratings, adults of all ages generally believed in declining fact retrieval abilities in old age. Inferential reasoning, however, often was believed to remain stable or even increase in ability level with increasing age. This was especially true in the assessments generated by older adults and in self evaluations. Thus, negative global beliefs about memory and aging may be present even when such global beliefs contradict item-specific judgments and personal beliefs about one's own cognition.

Difficulties in diagnosing trichinella encephalitis.

Trichinella encephalitis remains a rare but life-threatening illness. Although well known to clinicians of another era, this disease currently may represent a diagnostic dilemma because of its infrequent occurrence and varied presentations. This report of trichinella encephalitis, presenting as quadriplegia, demonstrates that technological advances such as CAT scan, angiogram, and EEG are of no diagnostic assistance and add nothing to traditional diagnostic modalities, i.e., eosinophilia, sedimentation rate, and muscle biopsy. In some cases of trichinosis encephalitis where hypersensitivity reaction and/or vasculitis is believed to be the inciting factor, cortical steroids may have a role in treatment.

Family outbreak of fatal Yersinia enterocolitica pharyngitis.

A family outbreak of fatal Yersinia enterocolitica pharyngitis is reported. Two members of a family were hospitalized for pharyngitis and posed a diagnostic dilemma until cultures of throat, blood, and stool revealed Y. enterocolitica. Neither patient responded to erythromycin therapy. The first patient died, and her husband's life-threatening illness seemed to respond to aminoglycoside and trimethoprim/sulfamethoxazole therapy. Y. enterocolitica should be considered as an etiologic agent in the differential diagnosis of a patient with pharyngitis whose condition deteriorates during erythromycin or penicillin therapy.

Remembering mnemonics: a three-year follow-up on the effects of mnemonics training in elderly adults.

The purpose of this study was to assess the long-term impact of providing training in mnemonics to a small group of elderly adults. We wished to determine if such training could be utilized effectively some three years (34 months) after initial training. Nine of ten original subjects consented to take part in the retesting exercise. Ages ranged from 66 to 85 yrs (M = 73.5). Our results demonstrate that though loci generally were available for use in remembering a new word list, they usually were not effectively utilized to enhance recall. Our participants also agreed that the training they had received was useful. In spite of this, a majority of the respondents did not use the method of loci after training. However, adults of all ages often do not utilize mnemonics training once its effectiveness has been demonstrated. Therefore, creating effective cognitive interventions may require that we adopt techniques that have been shown to improve compliance in other areas of healthy living.