AD leads to decrements in ability to accomplish ADL and to increase in behavioral reactions such as frustration and anger. Existing instruments which measure these problems are too gross to measure the small increments of change which are the probable outcome of most interventions. As a result, few nonpharmacological interventions are well documented.
Specific aims of the project are to: 1) Continue development of the Assessment Scale for Cognitively Impaired Elderly (ASCI) to evaluate activities of daily living (ADL) and problem behaviors of individuals with Alzheimer's disease (AD) to enable sensitive and accurate measurement of performance. 2) Examine relationships between neuropsychological deficits in procedural memory and function. 3) Examine relationships between disturbance in function and presence of behavioral symptoms. 4) Pilot test interventions which address procedural memory through environmental, caregiver, and direct interventions to examine their effectiveness in maximizing functional independence and minimizing behavioral problems in individuals with AD. The ASCI will be administered to 6 subjects at various levels of dementia. Ratings of 20 raters will be analyzed using Rasch and other methods to establish a true scale, and reliability and validity of the instrument. Twenty-eight subjects will be involved in a counterbalanced, time series study, 4 as controls, 24 receiving direct, caregiver, and environmental interventions emphasizing procedural memory. Evaluation will occur at 11 points, to determine which intervention(s), singly or in combination appear to have a positive impact on ADL and behavioral problems.
