Research

Introduction

A primary goal of the Louis and Anne Green Memory and Wellness Center is to research innovative approaches to the diagnosis and treatment of memory disorders. Many studies focus on new interventions designed to help individuals with memory problems to maintain the highest possible level of functioning. Additional studies focus on interventions designed to assist family members/caregivers in their roles.

Recent Research Studies

Using Story Theory to Understand the Health Challenge of Living with Mild Memory Impairment

Principle Investigator: Theris Touhy, DNP, APRN, BC

Abstract Narrative: The preponderance of the research on dementia has focused on persons with middle to late stage disease and their caregivers. Less is known about the experience of persons with mild memory impairment. With increasing knowledge of dementia, clinicians are diagnosing and working with people much earlier in the disease process. The knowledge base for therapeutic interventions for those in the mild stages is just beginning to be developed. The purpose of this study was to explore the experience of living with the health challenge of mild memory loss from multiple perspectives: the individual with memory loss; the spouse of the person with memory loss; and the dyad of the person and spouse. Story path, a data gathering method guided by the theory of attentively embracing story (Liehr & Smith, 2000) was utilized to gather stories from the participants of what it is like now to be living with memory loss as well as their hopes and dreams for the future. Themes emerging from qualitative analysis of the stories will provide a descriptive structure of the experience of living with the challenge of mild memory loss. A new model of support and services will be derived from hearing what people living with this health challenge need to meet the challenges and what matters most to them.

What Matters Most to Carers of People with Mild to Moderate Dementia as Evidence for Transforming Care

Principle Investigator: Theris Touhy, DNP, APRN, BC

Abstract Narrative: Earlier diagnosis of diseases causing memory loss provides opportunities to begin therapeutic interventions that will nurture the wholeness of persons and family caregivers3 experiencing early stage memory loss. There is scant research on the experience and needs of persons on this journey and little evidence-based data to guide interventions. The majority of current caregiver interventions focus on providing support in the late stages of memory loss and many of the issues addressed are not relevant to those in the early stages and can be frightening and misleading as well. Interventions must be designed based on the stage-specific needs of caregivers (Kuhn and Fulton, 2004). Offering new caregivers the opportunity to tell their stories and share what matters most to them at this point in time will provide the foundation for the design of individualized responses and on-going support to assist with their concerns now and at later points when the memory loss has progressed and the caregiver role may become more stressful (Adams, 2006). This study will be conducted as part of a longitudinal study at the Louis and Anne Green Memory and Wellness Center in which caregivers of persons with memory loss will receive individualized consultations with a GNP.

Adherence to Treatment Recommendations Following Memory Disorder Diagnosis

Principle Investigator: Denise Sparks, PhD; Co-Investigator: Ruth Tappen, EdD

Abstract Narrative: Although much research has been done on medication adherence, there has been very little attention to adherence to recommendations after a diagnosis of a memory disorder. Yet the clinical importance on this issue is rapidly increasing as individuals seek diagnosis earlier and both pharmaceutical and behavioral intervention efficacy increases. This study will involve a post-diagnosis, follow-up interview with both the patient and family member/caregiver to ascertain which recommendations have been followed and which have not. In addition, a number of factors that are expected to influence adherence will be assessed.

This project is funded by a grant from the Johnnie B. Byrd, Sr., Alzheimer's Center and Research Institute.

Cognitive Retraining for Individuals with Early Stage Alzheimer's Disease

Principle Investigator: Ruth Tappen, EdD

Abstract Narrative: With earlier diagnosis of Alzheimer's Disease (AD), the number of people seeking effective treatment targeted to maintaining functional independence as long as possible is increasing rapidly. Yet research on the effectiveness of non-pharmacological interventions such as cognitive retraining is still sparse. There is some evidence to suggest that an intensive intervention delivered in the patient's own home -- employing specific strategies and the support of caregivers -- may be most effective. The purpose of this study was to evaluate the effectiveness of a 12-week, functionally-oriented, in-home cognitive retraining program for individuals with early stage AD or mild cognitive impairment which was be compared with a life history intervention of equivalent intensity and duration.

This study was funded by the Alzheimer's Association.

Effect of Group Based Intervention to Improve Functional Communication in

Individuals with Early Alzheimer's Disease

Principle Investigator: Ruth Tappen, EdD

Abstract Narrative: This study was designed for individuals with mild memory problems. Participants were randomly assigned to one of two groups prior to intervention. In one group, participants performed a variety of light physical exercises using hand weights, bands, floor bikes, etc. In the other group participants engaged in various language and communication exercises. Participants attended two sessions per week, for 12 weeks. Each group consisted of a small number of participants. Participants were administered a battery of tests prior to and following intervention in order to assess the effectiveness of the study.

This study was funded by a grant from the Johnnie B. Byrd, Sr., Alzheimer's Center and Research Institute.

Mild Cognitive Impairment Screening Study

Principle Investigator: Ruth Tappen, EdD

Abstract Narrative: As new treatments and interventions for persons with memory disorders become available, early detection of persons who might benefit from these becomes increasingly important. The main purpose of this study is to evaluate the ability of a newly refined series of short tests and questionnaires to identify mild memory problems in people living in the community. If found effective with a broad population of people, these tests could be used for community screenings on the basis of which referrals for more comprehensive evaluations could be made. A secondary purpose of the study is to learn more about people's attitudes about being screened for memory problems.

This study was done in conjunction with the Johnnie B. Byrd, Sr., Alzheimer's Center and Research Institute and the Florida Alzheimer's Disease Research Center.

Couples Communication Intervention for Dementia: Pilot Study

Principle Investigator: Christine L. Williams, DNSc, APRN, BC

Abstract Narrative: As communication abilities decline, persons with dementia and their spouse caregivers are particularly vulnerable to communication breakdown. Misunderstandings, conflict and distress often characterize these relationships. The long-term goal of this program of research is to improve quality of life for community-dwelling persons with dementia and their spouse caregivers and to delay or prevent institutionalization. The primary purpose of this project is to examine feasibility and effectiveness of a communication intervention for dementia diagnosed couples.

Spouses make up the largest group of dementia caregivers and have unique needs that should be addressed separately from other family caregivers. Qualitative methods will be used to examine feasibility and acceptability of the intervention. Quantitative data will be collected to describe the sample and to examine changes in caregivers, care recipients and dyadic relationships including communication patterns, depression, caregiver burden, and marital satisfaction.

Designing and testing interventions for improving communication between dementia caregivers and care recipients in dementia is an area of investigation in need of further development. A 10 session program manual was developed to address the need and a study to evaluate the effectiveness of the program is underway. The program includes caregiver education and communication practice exercises to include the spouse caregiver and the care receiver. The couple receives a copy of the program manual and participates in 60 minute, weekly sessions that take place in the home over a period of 10 weeks. The researcher spends time with the caregiver alone reviewing the educational material for that week and discussing any communication challenges that may have developed between sessions. Next the researcher works with the care receiver alone to encourage expression of ideas and feelings. Finally the couple is seen together to monitor progress on implementation of the recommended communication strategies. The couple is videotaped during a ten minute conversation. The videotaped conversation is analyzed by the researcher and used to direct future educational efforts. Couples are encouraged to practice recommended strategies to improve communication between sessions. Thus far, 14 couples have completed the program including evaluation of outcomes. Data analysis is in progress.