Objective: Knowledge of the order of the loss and preservation of abilities among persons with dementia would be useful for care planning and refining approaches for communicating about the manifestation and course of dementia. This study is an analysis of axes’ ratings of abilities resulting from the routine administration of the Brief Cognitive Rating Scale (BCRS) to identify the course and sequence of the decline of cognitive abilities and self-care functioning.
Design: Cross sectional study.
Materials and Methods: The BCRS was administered to 54 female and 31 male residents of a psychiatric nursing home service who ranged in age from 41 to 102 years (M = 78, sd =10.4). Fifty-one of these residents had been diagnosed and treated for psychiatric illnesses such as Bipolar Disorder and Schizophrenia prior to being diagnosed with probable Alzheimer’s disease or other dementias. Their BCRS ability or axes’ ratings were submitted to an order analysis procedure to explore the sequence of the decline of abilities. Order analysis procedure requires that the axes’ ratings be dichotomized as either pass (score "1") or fail (score "0"). According to the guidelines for scoring the BCRS, a pass includes the degrees of impairment defined as from normal (rating =1), very mild (rating = 2), mild (rating = 3), moderate (rating = 4), moderately severe (rating = 5), some residual capacity in ability (rating = 6) to fail, which indicates no residual capacity of ability (rating = 7). Axes’ ratings matrices were prepared and analyzed to generate an ordering among the abilities measured via the axes.
Results: Ratings on the BCRS identified 23 residents as very mildly to moderately severely impaired and 62 as severely to very severely impaired. The trend of the course and sequence of decline in cognitive abilities among this group of psychiatric nursing home residents with probable dementia was the loss singly and/or concurrently of the abilities of concentration and recent memory, then followed by past memory and by orientation. There appears to be an unpredictable relationship between the cognitive abilities and self-care functioning except among individuals with some level of preservation of all of their cognitive abilities or the complete loss of them.
Conclusion: Preserved abilities were found even among individuals rendered moderately severely to severely impaired by dementia. Among the enduring preserved abilities were: 1) past memory, that our nursing home staff found they could stimulate via the paraphernalia of former occupations, reminiscence groups, music, and religious services; and 2) orientation, manifested when individuals were consistently addressed with their own names. The findings support the notion that long-term care facilities can optimize the impact of programs and activities by focusing on and adapting to the preserved abilities of individuals with dementia.
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