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| Clinical overview of Alzheimer's Disease with Experimental and Applied Behavior Analyses |
| Thursday, November 29, 2001 |
| 2:00 PM–2:50 PM |
| Photographs Hall |
| Area: DEV; Domain: Applied Behavior Analysis |
| Chair: Bruce L. Bakke (Minnesota Veterans Home, Minneapolis) |
| Abstract: While science has dramatically increased life expectancy over the past century, the number of people with chronic disabling conditions has increased correspondingly. One of those conditions, Alzheimer's disease (AD), is the leading cause of dementia and is a common diagnosis among residents living in long term care facilities. AD produces a progressive loss of cognitive abilities and an increase in problem behavior that destroys quality of life. This symposium provides an introduction to the cognitive and behavioral changes characteristic of AD, describes our current programs of experimental and applied behavior analysis, and suggests promising areas of AD research. In the overview, Dr. McCarten describes the clinical presentation and symptoms of AD.
Dr. Cleary relates the effect of new anti-inflammatory treatments using a transgenic mouse model for AD. Dr. Bakke presents treatments based on functional assessment of problem behaviors in a series of nursing home residents with AD. |
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| The Clinical Features and Course of Alzheimer's Disease |
| J. RILEY MCCARTEN (Minneapolis Veterans Affairs Medical Center) |
| Abstract: Alzheimer's disease (AD) is a degenerative brain disease that is responsible for up to 80% of dementia cases in the elderly. AD begins insidiously and progresses gradually over many years. Typical early symptoms of AD relate to memory loss for recent events and are manifest as repetitious questions and comments, increased reliance on notes and calendars, and getting lost while driving. As the disease progresses, memory loss becomes more severe and a variety of other cognitive problems emerge, including difficulties with language, motor skills, spatial and temporal orientation, and executive functions (e.g., reasoning and judgment). Eventually, even basic functions such as walking, eating, and toileting are compromised. In the end stages of AD patients are bedridden and minimally responsive and succumb to concurrent illnesses. Behavior problems also are recognized as a fundamental part of AD and are largely responsible for the heavy demand for health care resources. Sleep disturbances, irritability, restlessness, aggression, apathy, and psychotic symptoms are among the common behavior changes that may develop even early in AD. Medications to manage behaviors are the mainstay of treatment, and sophisticated behavioral assessment is largely absent in the Alzheimer's literature. |
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| Cyclooxygenase-2 Inhibition of Inflammation in a Mouse Model of Alzheimer's Disease |
| JAMES P. CLEARY (Minneapolis Veterans Affairs Medical Center), J. Hofmeister (Minneapolis Veterans Affairs Medical Center), D. Zimprich (Minneapolis Veterans Affairs Medical Center), Karen H. Ashe (Minneapolis Veterans Affairs Medical Center), W. Gibson Wood (Minneapolis Veterans Affairs Medical Center), Eugene Ohare (University of Ulster-Jordanstown) |
| Abstract: The characteristic neuropathology of Alzheimer's disease is the presence of neuritic plaques and neurofibrillary tangles in the brain. Recent models employing Aß as a primary pathogenic agent postulate a chronic inflammatory process due to Aß plaques that eventually exceeds the brain's ability to protect itself. As in arthritis, the inflammation is the source of the pathology.
While treatment with NSAIDs has shown promise in AD, their use has not been recommended because of potentially serious untoward effects due to inhibition of the protective COX-1 enzyme. Newer COX-2 inhibitors that exhibit substantial anti-inflammatory activity without inhibiting the COX-1 enzyme are promising therapeutic agents for the elderly.
Transgenic mice (Tg 2576) overexpressing amyloid precursor protein and littermate controls were trained to stable performance under a fixed consecutive number 5 schedule of reinforcement (FCN 5). Mice were required to press 5 times or more on the left lever, then switch to the right lever which delivered food reinforcement for a single press.
Starting at 4 months of age and through the 12th month, mice were fed a diet containing a COX-2 inhibitor or vehicle.
CNS inflammatory markers and immunohistochemistry were assessed. (Supported by an Unrestricted Grant from Merck & Co., Inc.). |
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| Functional Assessment and Treatment of Problem Behaviors in People with Alzheimer's Disease |
| BRUCE L. BAKKE (Minnesota Veterans Home - Minneapolis), Susan A. Parenteau (Minnesota Veterans Home - Minneapolis), Angela K. Hochhalter (University of Minnesota) |
| Abstract: Agitation, aggression, and other problem behaviors seen in individuals with developmental disabilities are also commonly exhibited by people with Alzheimer's disease (AD). These behaviors reduce quality of life and often lead to placement in a nursing home. Applied behavior analysis is now the predominant nonpharmacological approach to problem behaviors in people with developmental disabilities, but is just beginning to be used for similar behaviors in people with AD. In applied behavior analysis, "functional assessment" describes the process of identifying environmental and other factors influencing a problem behavior, including especially the function or purpose the problem behavior serves for the individual. To illustrate this method we describe a series of cases employing interventions based on functional assessment.
A variety of problem behaviors--including agitated speech, disruptive table shaking, and entering other residents' rooms--were addressed in men with AD and moderate to severe dementia. Promising approaches to overcoming the memory and learning deficits seen in AD are also discussed, including spaced retrieval and the differential outcomes |
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