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three - Social connectivity and creative approaches to dementia care: the case of a poetry intervention
- Edited by Anna Goulding, Newcastle University, Bruce Davenport, Newcastle University, Andrew Newman, Newcastle University
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- Book:
- Resilience and Ageing
- Published by:
- Bristol University Press
- Published online:
- 19 April 2022
- Print publication:
- 19 December 2018, pp 65-86
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Summary
Editorial introduction
This chapter draws together four concepts – resilience and flourishing, creativity and play – to explore the impact of poetry interventions in the lives of people with dementia living in a care facility. As in other chapters, the impact of the creative interventions is linked to the way that they encourage and enable social interactions that (in turn) support the personhood of the participants. In this chapter, these processes are drawn out through careful observations of interactions during the poetry sessions.
Introduction
This chapter continues the exploration of the proposition that arts offer a means of communication and self-expression that is particularly able to capitalise on the emotional and social capabilities of people living with dementia. The broad term ‘dementia’ (now referred to in the DSM-5 as ‘neurocognitive disorders’) describes a variety of chronic cognitive conditions whose etiologies, time of onset, speed of progression, associated symptoms and characteristics, and duration differ – although all feature problems with memory and learning (Blazer, 2013). Regardless of the type of dementia, however, language is an important way for memory and learning to be expressed and assessed through conversations, diagnostic interviews, formal testing and other interactions (Saunders et al, 2011). The social use of language, both verbal and non-verbal, and its interpretation are therefore a central component of our inquiry. The phrase ‘social use’ is meant to distinguish our inquiry from linguistic studies on language change in dementia, since our focus is not on the ways in which language itself might change with disease progression but, rather, on how changes in opportunities to express oneself through language affect self-expression (Blair et al, 2007) and potentially threaten personhood (Sabat, 2006).
For people living in unrestricted environments (for example, a home in the community where one can come and go at will), there are multiple ways to use and engage others with language such as talking to a friend or neighbour in person, on the phone or through the internet, making small talk with a shopkeeper, and so on. In a restricted environment, such as a secure dementia care ward, residents are limited in how they can engage with others and with whom. Since residents cannot come and go at will, they are, at best, limited to communication with other residents, staff and visitors within the ward.
Association of neuropsychiatric syndromes with global clinical deterioration in Alzheimer's disease patients
- Florindo Stella, Jerson Laks, José Sílvio Govone, Kate de Medeiros, Orestes Vicente Forlenza
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- Journal:
- International Psychogeriatrics / Volume 28 / Issue 5 / May 2016
- Published online by Cambridge University Press:
- 17 December 2015, pp. 779-786
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Background:
Data on the relationship between behavioral disturbances in Alzheimer's disease (AD) and global clinical deterioration is still controversial. The purpose of this study was to explore potential correlations of neuropsychiatric syndromes with global clinical deterioration in patients with AD, with particular consideration on severity levels of dementia.
Methods:AD patients (n = 156) aged 76.7 years from Brazilian clinical centers were assessed to diagnose the five neuropsychiatric syndromes measured by the Neuropsychiatric Inventory-Clinician rating scale (NPI-C): psychosis, agitation, affective, apathy, and sleep. These syndromes were then analyzed for their correlation with the Global Deterioration Scale (GDS). To analyze the association of neuropsychiatric syndromes with the GDS, considering the total sample and patients grouped by dementia severity levels, we applied the coefficient of multiple correlation (Ryy), adjusted multiple linear regression, and the coefficient of determination (R2yx). We tested the significance of correlation coefficients using the Student t-test for simple correlations (a single independent variable) and analysis of variance (ANOVA) for multiple correlations. ANOVA was also used to compare means of demographic and some clinical variables at different levels of dementia.
Results:For the total sample, apathy and agitation syndromes were most strongly correlated (0.74; 0.72, respectively) with clinical deterioration according to the GDS, followed by psychosis (0.59), affective (0.45), and sleep syndromes (0.34). Agitation significantly correlated with mild and moderate dementia (CDR 1: 0.45; and CDR 2: 0.69, respectively). At CDR 2, agitation and affective syndromes were most strongly correlated (0.69; 0.59, respectively) with clinical deterioration while at CDR 3, the apathy syndrome was most strongly correlated with clinical deterioration (0.52).
Conclusions:Agitation, apathy, and affective disorders were the syndromes most strongly correlated with global deterioration in AD patients, becoming more evident at severe stages of dementia.
The Brazilian version of the Neuropsychiatric Inventory-Clinician rating scale (NPI-C): reliability and validity in dementia
- Florindo Stella, Orestes Vicente Forlenza, Jerson Laks, Larissa Pires de Andrade, Michelle A. Ljubetic Avendaño, Elisandra Villela Gasparetto Sé, João de Castilho Cação, Constantine G. Lyketsos, Kate de Medeiros
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- Journal:
- International Psychogeriatrics / Volume 25 / Issue 9 / September 2013
- Published online by Cambridge University Press:
- 14 June 2013, pp. 1503-1511
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Background:
Patients with dementia may be unable to describe their symptoms, and caregivers frequently suffer emotional burden that can interfere with judgment of the patient's behavior. The Neuropsychiatric Inventory-Clinician rating scale (NPI-C) was therefore developed as a comprehensive and versatile instrument to assess and accurately measure neuropsychiatric symptoms (NPS) in dementia, thereby using information from caregiver and patient interviews, and any other relevant available data. The present study is a follow-up to the original, cross-national NPI-C validation, evaluating the reliability and concurrent validity of the NPI-C in quantifying psychopathological symptoms in dementia in a large Brazilian cohort.
Methods:Two blinded raters evaluated 312 participants (156 patient-knowledgeable informant dyads) using the NPI-C for a total of 624 observations in five Brazilian centers. Inter-rater reliability was determined through intraclass correlation coefficients for the NPI-C domains and the traditional NPI. Convergent validity included correlations of specific domains of the NPI-C with the Brief Psychiatric Rating Scale (BPRS), the Cohen-Mansfield Agitation Index (CMAI), the Cornell Scale for Depression in Dementia (CSDD), and the Apathy Inventory (AI).
Results:Inter-rater reliability was strong for all NPI-C domains. There were high correlations between NPI-C/delusions and BPRS, NPI-C/apathy-indifference with the AI, NPI-C/depression-dysphoria with the CSDD, NPI-C/agitation with the CMAI, and NPI-C/aggression with the CMAI. There was moderate correlation between the NPI-C/aberrant vocalizations and CMAI and the NPI-C/hallucinations with the BPRS.
Conclusion:The NPI-C is a comprehensive tool that provides accurate measurement of NPS in dementia with high concurrent validity and inter-rater reliability in the Brazilian setting. In addition to universal assessment, the NPI-C can be completed by individual domains.