An intervention to reduce care‐resistant behavior in persons with dementia during oral hygiene: a pilot study

The primary purpose of this pilot study was to test the feasibility of an intervention designed to reduce care‐resistant behaviors (CRBs) in persons with moderate‐to‐severe dementia during oral hygiene activities.The intervention, Managing Oral Hygiene Using Threat Reduction (MOUTh), combined best oral hygiene practices with CRB reduction techniques. Oral health was operationalized as the total score obtained from the Oral Health Assessment Tool (OHAT). CRB was measured using a refinement of the Resistiveness to Care Scale. Seven nursing home residents with dementia received twice daily mouth care for 14 days. The baseline OHAT mean score of 7.29 (SD = 1.25) improved to 1.00 (SD = 1.26, p < .001); CRB improved from 2.43 CRBs/minute (SD = 4.26) to 1.09 CRBs/minute (SD = 1.56, t = 1.97, df 41, p= .06).The findings from this pilot study suggest that the MOUTh intervention is feasible and reduced CRBs, thus allowing more effective oral care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110640/1/j.1754-4505.2011.00190.x.pd

Reducing care-resistant behaviors during oral hygiene in persons with dementia

Abstract Background Nursing home residents with dementia are often dependent on others for mouth care, yet will react with care-resistant behavior when receiving assistance. The oral health of these elders deteriorates in the absence of daily oral hygiene, predisposing them to harmful systemic problems such as pneumonia, hyperglycemia, cardiac disease, and cerebral vascular accidents. The purpose of this study is to determine whether care-resistant behaviors can be reduced, and oral health improved, through the application of an intervention based on the neurobiological principles of threat perception and fear response. The intervention, called Managing Oral Hygiene Using Threat Reduction, combines best mouth care practices with a constellation of behavioral techniques that reduce threat perception and thereby prevent or de-escalate care-resistant behaviors. Methods/Design Using a randomized repeated measures design, 80 elders with dementia from 5 different nursing homes will be randomized at the individual level to the experimental group, which will receive the intervention, or to the control group, which will receive standard mouth care from research team members who receive training in the proper methods for providing mouth care but no training in resistance recognition or prevention/mediation. Oral health assessments and care-resistant behavior measurements will be obtained during a 7-day observation period and a 21-day intervention period. Individual growth models using multilevel analysis will be used to estimate the efficacy of the intervention for reducing care-resistant behaviors in persons with dementia, and to estimate the overall efficacy of the intervention using oral health outcomes. Activity-based costing methods will be used to determine the cost of the proposed intervention. Discussion At the conclusion of this study, the research team anticipates having a proven intervention that prevents and reduces care-resistant within the context of mouth care. Long-term objectives include testing the effect of the intervention on systemic illnesses among persons with dementia; examining the transferability of this intervention to other activities of daily living; and disseminating threat reduction interventions to nursing home staff, which may radically change the manner in which care is provided to persons with dementia. Trial Registration ClinicalTrials.gov: NCT01363258http://deepblue.lib.umich.edu/bitstream/2027.42/112778/1/12903_2011_Article_198.pd

Sex Differences in the Effects of Hippocampal Lesions on Place Navigation.

Evidence from a variety of studies suggest that the hippocampal (HPC) region plays a role in the ability of animals to navigate in their environment. For example, in both human and non-human animals damage to the hippocampal system impairs spatial learning ability. In humans it is thought that damage to the right, but not left, hippocampal region is largely responsible for spatial learning deficits. A few neuroanatomical and neurochemical studies have raised the possibility that the HPC system of non-human animals is also asymmetrically organized, but, whether there is a functional asymmetry in the hippocampal system of non-human animals is not known. Therefore, the purpose of this study was to determine if right HPC lesions produce the same effects as left HPC lesions on the ability of rats to learn a task requiring place navigation. Adult male and female rats received right, left or bilateral HPC lesions or a sham operation. Following recovery, animals were trained on a place navigation task that involved learning to use a fixed array of distal cues to locate a platform hidden under water that they could not see, hear or smell. A number of measures were used to estimate the acquisition of place learning, including latency to reach the goal, and the route taken to the goal. Unilateral HPC lesions impaired place navigation in both male and female rats. In males there was no difference between the effects of left vs right HPC lesions, and in fact, unilateral lesions produced as large a deficit as did bilateral lesions. In contrast, left HPC lesions produced a greater deficit than did right HPC lesions in female rats, although unilateral lesions produced a less severe deficit than did bilateral lesions. Control male and female rats did not differ in place navigation learning ability. These results suggest that there is a functional asymmetry in the organization of the HPC system in female, but not male, rats. Future research will determine whether this functional asymmetry is related to the neuroanatomical and neurochemical asymmetries in the HPC system reported previously.Ph.D.NursingPsychobiologyUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/159296/1/8304614.pd

Working Memory, Cues, and Wayfinding in Older Women

Individuals create cognitive maps based on relationships between cues in the environment. Older individuals are often impaired in wayfinding, especially in environments that lack distinctive features. This study examines how working memory ability in older women is related to wayfinding performance in the presence of salient (distinctive, prominent) or nonsalient cues. The degree of salient cue complexity is also examined, thus leading to the hypothesis that salient, complex cues are important in wayfinding and that working memory capacity is related to wayfinding performance. The virtual computer-generated arena is used to test this hypothesis in 20 healthy older women in three different environmental cue conditions varying in salience and complexity. Data analyses indicate that older women perform best in salient cue conditions. A greater working memory capacity is related to improved performance in the nonsalient cue condition. These findings offer preliminary evidence that cue salience is especially important in wayfinding

Effects of low-dose lipopolysaccharide and age on spatial learning in different Morris water maze protocols

Objectives: Animals administered lipopolysaccharide exhibit dose-related sickness behaviors (decreased food intake, weight loss, and cognitive changes). While research has demonstrated that spatial learning is impaired following a lipopolysaccharide immune challenge, the results differ depending on the methodology used to evaluate spatial learning. Additionally, few studies have evaluated the effects of low-dose lipopolysaccharide on spatial learning. Therefore, we assessed spatial learning, food intake, and weight changes in adult and aged rats after a low-dose lipopolysaccharide immune challenge in the Morris water maze using two water temperatures. Methods: Adult (5–6 months) and aged (22 months) male Brown-Norway rats were administered either 50 or 100 μg/kg lipopolysaccharide or saline, and then tested in the Morris water maze for 5 days, rested for 7 days, and later underwent 2 days of retention tests. Probe trials were conducted at the end of initial and retention testing. Results: Low-dose lipopolysaccharide administration did not result in food intake or weight changes. While the aged experimental group took longest to improve directional heading error in both cold and warm water, heading error was greater in cold water. Behavioral testing revealed an apparent age and water temperature effect on swim time. Retention and probe trial results showed that aged experimental animals had the worst performance in cold water. Conclusion: We conclude that while low-dose lipopolysaccharide did not result in typical sickness behaviors (decreased food intake or weight), spatial learning and memory were impaired in the aged experimental group. These results have important implications for the care of elderly individuals experiencing mild to moderate infections

Impact of cognitive impairment on wandering behavior

The purpose of this study was to explore cognitive impairment as a predictor of wandering rhythm and pattern in a sample of 25 demented residents from two long-term care settings. Parameters of rhythm indicating cycle frequency and structure were examined for wandering patterns (random, lapping, and pacing) and for nonwandering (direct) ambulation. All measures of cognitive impairment (Mini-Mental State Exam, Mattis Dementia Rating Scale, and a neuropsychologist's clinical rating) were significant predictors of parameters signifying frequency of wandering for random and lapping patterns but not for the pacing pattern. In addition, for nonwandering ambulation, cognitive impairment predicted some parameters of cycle structure (mean locomoting and nonlocomoting phase durations) but not those denoting frequency of ambulation. Results indicate that cognitive impairment plays an important role in determining the frequency of wandering cycles, but other factors may better explain parameters that characterize its cycle structure