Group, individual, and staff therapy: an efficient and effective cognitive behavioral therapy in long-term care.

OBJECTIVE: Depression is a major problem in long-term care (LTC) as is the lack of related empirically supported psychological treatments. This small study addressed a variant of cognitive behavioral therapy, GIST (group, individual, and staff therapy), against treatment as usual (TAU) in long-term care. METHOD: 25 residents with depression were randomized to GIST (n = 13) or TAU (n = 12). Outcome measures included geriatric depression scale-short form (GDS-S), life satisfaction index Z (LSI-Z), and subjective ratings of treatment satisfaction. The GIST group participated in 15 group sessions. TAU crossed over to GIST at the end of the treatment trial. RESULTS: There were significant differences between GIST and TAU in favor of GIST on the GDS-S and LSI-Z. The GIST group maintained improvements over another 14 sessions. After crossover to GIST, TAU members showed significant improvement from baseline. Participants also reported high subjective ratings of treatment satisfaction. DISCUSSION: This trial demonstrated GIST to be more effective for depression in LTC than standard treatments.

A comparison of cognitive functioning in older adults with and without traumatic brain injury.

OBJECTIVE: Cognitive impairments are common sequelae of traumatic brain injury (TBI) and are often associated with the natural process of aging. Few studies have examined the effect of both age and TBI on cognitive functioning. The purpose of this study was to compare cognitive functioning between older adults who sustained a TBI to an age-matched group of individuals without a brain injury and to determine whether the presence or absence of a genetic marker apolipoprotein epsilon (APOEepsilon4 allele) accounts for additional cognitive decline in both groups examined. METHODS AND PROCEDURES: Cognitive performance was measured by 11 neuropsychological tests, in 54 adults with TBI aged 55 and older and 40 age-matched control participants. All participants were reexamined 2 to 5 years later. SETTING: Community volunteer-based sample examined at a large, urban medical center. MAIN OUTCOME MEASURE(S): California Verbal Learning Test; Wechsler Memory Scale-III (Logical Memory I & II; Visual Reproduction I & II); Grooved Pegboard; Woodcock-Johnson Test of Cognitive Ability (Visual Matching and Cross-out); Wisconsin Card Sorting Test; Trail Making Test A & B; Conners' Continuous Performance Task; Wechsler Adult Intelligence Scale-III (Vocabulary); Controlled Oral Word Association Test; and Boston Naming Test. RESULTS: Participants with TBI had lower scores on tests of attention and verbal memory than did participants with no disability. Neither group exhibited a significant decline in cognitive function over time. The presence of the APOEepsilon4 allele did not account for additional decline in cognitive function in either group. CONCLUSION(S): The findings suggest that older adults with TBI may not be at increased risk for cognitive decline over short time periods (2 to 5 years) even if they are carriers of the APOEepsilon4 allele.

Cognitive functioning among individuals with traumatic brain injury, Alzheimer's disease, and no cognitive impairments.

OBJECTIVE: To compare patterns of cognitive functioning in older adults with traumatic brain injury (TBI), Alzheimer's disease (AD), and no neurological disorder (ND). DESIGN: Group comparison. SETTING: Outpatient setting of a large urban tertiary care medical center. PARTICIPANTS: Older adults: 56 with TBI, 64 with AD, and 50 with neurological disorder. INTERVENTION(S): None. RESULTS: Older adults with AD and TBI had lower scores in most areas of cognitive functioning examined than the individuals with neurological disorder. Individuals with AD had lower scores in memory, processing speed, and verbal fluency than did individuals with TBI. Specifically, individuals with AD did not retain learned information over time. CONCLUSION(S): Cognitive impairments were present in older adults with AD and TBI. However, individuals with TBI were better able to learn and retain new information than were individuals with AD.

The effects of Snoezelen (multi-sensory behavior therapy) and psychiatric care on agitation, apathy, and activities of daily living in dementia patients on a short term geriatric psychiatric inpatient unit.

A randomized, controlled, single-blinded, between group study of 24 participants with moderate to severe dementia was conducted on a geriatric psychiatric unit. All participants received pharmacological therapy, occupational therapy, structured hospital environment, and were randomized to receive multi sensory behavior therapy (MSBT) or a structured activity session. Greater independence in activities of daily living (ADLs) was observed for the group treated with MSBT and standard psychiatric inpatient care on the Katz Index of Activities of Daily Living (KI-ADL; P = 0.05) than standard psychiatric inpatient care alone. The combination treatment of MSBT and standard psychiatric care also reduced agitation and apathy greater than standard psychiatric inpatient care alone as measured with the Pittsburgh Agitation Scale and the Scale for the Assessment of Negative Symptoms in Alzheimer's Disease (P = 0.05). Multiple regression analysis predicted that within the multi-sensory group, activities of daily living (KI-ADL) increased as apathy and agitation reduced (R2 = 0.42; p = 0.03). These data suggest that utilizing MSBT with standard psychiatric inpatient care may reduce apathy and agitation and additionally improve activities of daily living in hospitalized people with moderate to severe dementia more than standard care alone.