Three years of support are requested to conduct an epidemiologic retrospective study of Alzheimer families to identify individual, family and interactive factors that are associated with changes in conflict resolution, including the development of aggressive and violent behavior among individuals with AD, and family members providing care to those persons. In addition to describing antecedent factors and conditions of these behaviors, the proposed research will concentrate and define factors that place both caregivers and AD patients at risk for the more severe forms of violent behavior as well as those factors that prohibit the development of the more severe forms of violence. The proposed research plan has four specific aims: (1) to describe how changes in conflict resolution occur in Alzheimer families with the progression of AD; (2) to determine specific rates of occurrence for various forms of conflict resolution, with an emphasis on the rates of aggressive, violent, and severely violent behavior; (3) to determine specific patient and caregiver characteristics that place families at risk for aggression and violence; (4) to specify characteristics that tend to prohibit the development of violence or aggression in families caring for a member with AD. Patient and caregiver participants for the proposed project will be solicited from six of the Memory Disorder Clinics funded through the State of Florida's Alzheimer Disease Initiative and will include all persons (and designated caregivers) diagnosed with AD according to NINCDS/ADRDA criteria or a diagnosis of Primary Degenerative Dementia of the Alzheimer's Type according to DSM-III-R or Dementia of the Alzheimer's Type according to DSM-IV or with mixed AD and vascular dementia, with an initial diagnosis of AD or mixed AD made at least one year prior to being contacted for the study. Data on 1,500 families will be collected using a 1) Caregiver Mailed Questionnaire designed to collect basic information about the family's demographics, the caregiver's experience with the caregiving role, and perceptions of the care-recipient's behavior; 2) Caregiver Face-to-Face Interview designed to obtain additional information about the caregiver including sensitive information about aggression and abuse; and 3) Patient Face-to-Face Interview designed to obtain information about the patients' own perceptions of their functioning levels of aggression and abuse in the caregiving relationship. Data analytic techniques are designed to address the specific aims of this research. Analytic methods will include path analysis, discriminate function analysis, and multiple logistic regression. These techniques will allow us to determine the characteristics that are both risk and protective factors for aggressive and violent behavior in families caring for members with AD.
