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Good days and bad days in dementia: a qualitative chart review of variable symptom expression

Published online by Cambridge University Press:  24 February 2014

Kenneth Rockwood ,
Sherri Fay ,
Laura Hamilton ,
Elyse Ross  and
Paige Moorhouse
Kenneth Rockwood*
Affiliation:
Geriatric Medicine Research Unit, Capital District Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada Division of Geriatric Medicine, Capital District Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
Sherri Fay
Affiliation:
Geriatric Medicine Research Unit, Capital District Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
Laura Hamilton
Affiliation:
Geriatric Medicine Research Unit, Capital District Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
Elyse Ross
Affiliation:
Geriatric Medicine Research Unit, Capital District Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
Paige Moorhouse
Affiliation:
Geriatric Medicine Research Unit, Capital District Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada Division of Geriatric Medicine, Capital District Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
*
Correspondence should be addressed to: Kenneth Rockwood, MD, Divisions of Geriatric Medicine and Neurology, Dalhousie University/Capital Health, 1421–5955 Veterans’ Memorial Lane, Halifax, Nova Scotia B3H 2E1, Canada. Phone: +902-473-8687; Fax: +902-473-1050. Email: Kenneth.Rockwood@Dal.ca.
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Abstract

Background:

Despite its importance in the lived experience of dementia, symptom fluctuation has been little studied outside Lewy body dementia. We aimed to characterize symptom fluctuation in patients with Alzheimer's disease (AD) and mixed dementia.

Methods:

A qualitative analysis of health records that included notations on good days and bad days yielded 52 community-dwelling patients (women, n = 30; aged 39–91 years; mild dementia, n = 26, chiefly AD, n = 36).

Results:

Good days/bad days were most often described as changes in the same core set of symptoms (e.g. less/more verbal repetition). In other cases, only good or only bad days were described (e.g. no bad days, better sense of humor on good days). Good days were typically associated with improved global cognition, function, interest, and initiation. Bad days were associated with frequent verbal repetition, poor memory, increased agitation and other disruptive behaviors.

Conclusions:

Clinically important variability in symptoms appears common in AD and mixed dementia. Even so, what makes a day “good” is not simply more (or less) of what makes a day “bad”. Further investigation of the factors that facilitate or encourage good days and mitigate bad days may help improve quality of life for patients and caregivers.

Keywords

dementiaAlzheimer's diseasesymptom variabilityfluctuationchart reviewqualitative
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 8 , August 2014 , pp. 1239 - 1246
Copyright
Copyright © International Psychogeriatric Association 2014 

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