Effects of donepezil on emotional/behavioral symptoms in Alzheimer's disease patients.

BACKGROUND: This open-label study examined the effects of the reversible cholinesterase inhibitor donepezil on emotional/behavioral symptoms in Alzheimer's disease (AD) patients. METHOD: Patients were diagnosed as having probable/possible AD by National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS/ADRDA) criteria. This study used the CERAD Behavior Rating Scale for Dementia (CBRSD) and its subscales to evaluate a group of 25 AD patients treated with donepezil. Dosage was increased at 4 months for most patients from 5 to 10 mg q.h.s. Analysis of variance was used to compare scores over a period of 12 months. These patients were also compared, using t tests, to a reference group that had received no donepezil or other anticholinesterase. RESULTS: Donepezil administration was associated with improvement in Mini-Mental State Examination (MMSE) and CBRSD total scores at 3-month evaluation (p< or =.05). CBRSD depression and behavioral dysregulation scores improved transiently at 4 months (p< or =.05). MMSE, CBRSD total, CBRSD depression, and CBRSD behavioral dysregulation scores returned to baseline levels at 12 months, in contrast to the reference group, whose MMSE and CBRSD total scores worsened minimally over the 12 months. CONCLUSION: Donepezil has a mildly positive effect on emotional/behavioral symptoms in AD in addition to its effect on cognitive function.

The quality of life in late-stage dementia (QUALID) scale.

OBJECTIVES: To develop a valid and reliable instrument for rating quality of life in persons with late-stage Alzheimer's disease and other dementing illnesses. DESIGN: A group of clinicians with extensive experience in dealing with dementia patients developed by consensus the Quality of Life in Dementia Scale (QUALID), an 11-item scale. The window of observation for each subject was 7 days. A 5-point scale captured the frequency of each item (total score ranging from 11 to 55). Lower scores reflected a higher quality of life (QOL). Validity was assessed by comparison with other measures. SETTING: Dementia special care unit. PARTICIPANTS: Professional caregivers of 42 patients. MEASUREMENTS: QUALID, Mini-Mental State Exam (MMSE), Physical Self-Maintenance Scale (PSMS), Neuropsychiatric Inventory (NPI), and Geriatric Depression Scale (GDS). RESULTS: QUALID scores ranged from 12 to 45 points and were skewed toward higher QOL (lower scores). Internal consistency of items was high, as were test-retest reliability and consistency across recorders. As expected, there was no relationship between QUALID and MMSE or PSMS scores, but there was a statistically significant, although moderate, relationship between QUALID and NPI, and GDS scores. CONCLUSION: The QUALID is a reliable and valid scale, administered to caregivers, for rating QOL in persons with late-stage dementing illness.

Specialty nursing council: a peer support group for nurses in independent roles.

As nurses move into more nontraditional, expanded roles, they sometimes lack a social and professional support group within the work setting. Feeling isolated and lacking support, several clinical nurse specialists (CNSs) at a large county institution began the Specialty Nursing Council. The Specialty Nursing Council provides a means of networking and support for nurses in specialty roles in a three institution health care campus. Monthly meetings are conducted to bring members together and for continuing education programs. The keys to success in forming this type of council are: 1) a dedicated group that plans, organizes, and distributes informational material; 2) common goals and objectives; 3) direct benefits to members.