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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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References

Allison, J. J. et al. (2000). The art and science of chart review. The Joint Commission Journal on Quality Improvement, 26, 115–136.Google Scholar
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision (SM-IV-TR). Washington, DC: American Psychiatric Press, Inc.Google Scholar
Bhat, R. and Rockwood, K. (2007). Delirium as a disorder of consciousness. Journal of Neurology, Neurosurgery, and Psychiatry, 78, 1167–1170. doi:10.1136/jnnp.2007.115998.CrossRefGoogle ScholarPubMed
Bradshaw, J., Saling, M., Hopwood, M., Anderson, V. and Brodtmann, A. (2004) Fluctuating cognition in dementia with Lewy bodies and Alzheimer's disease is qualitatively distinct. Journal of Neurology, Neurosurgery, and Psychiatry, 75, 382–387. doi:10.1136/jnnp.2002.002576.CrossRefGoogle ScholarPubMed
Cook, C., Fay, S. and Rockwood, K. (2008). Decreased initiation of usual activities in people with mild-to-moderate Alzheimer's disease: a descriptive analysis from the VISTA clinical trial. International Psychogeriatrics, 5, 952–963. doi:10.1017/S1041610208007230.Google Scholar
Cook, C., Fay, S. and Rockwood, K. (2009). Symptom fluctuation in patients with Alzheimer's disease in the VISTA clinical trial. Canadian Journal of Geriatrics, 12, 177–182.Google Scholar
Cook, C., Fay, S. and Rockwood, K. (2009). Verbal repetition in people with mild-moderate Alzheimer's disease: a descriptive analysis for the VISTA clinical trial. Alzheimer Disease and Associated Disorders, 23, 146–151. doi:10.1097/WAD.0b013e318193cbef.CrossRefGoogle Scholar
Ferman, T. J. et al. (2004). DLB fluctuations: specific features that reliably differentiate DLB from AD and normal aging. Neurology, 62, 181–187. doi:10.1212/WNL.62.2.181.Google Scholar
Findley, T. W. and Daum, M. C. (1989). Research in physical medicine and rehabilitation. III. The chart review or how to use clinical data for exploratory retrospective studies. American Journal of Physical Medicine and Rehabilitation, 68, 150–157.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Hamilton, L., Fay, S. and Rockwood, K. (2009). Misplacing objects in mild to moderate Alzheimer's disease: a descriptive analysis from the VISTA clinical trial. Journal of Neurology, Neurosurgery, and Psychiatry, 80, 960–965. doi:10.1136/jnnp.2008.166801.Google Scholar
Haupt, M. (1996). Emotional lability, intrusiveness, and catastrophic reactions. International Psychogeriatrics, 8, 409–414. doi:10.1017/S1041610297003736.Google Scholar
Hess, D. R. (2004). Retrospective studies and chart reviews. Respiratory Care, 49, 1171–1174.Google Scholar
Hultsch, D. F., MacDonald, S. W., Hunter, M. A., Levy-Bencheton, J. and Strauss, E. (2000) Intraindividual variability in cognitive performance in older adults: comparison of adults with mild dementia, adults with arthritis, and healthy adults. Neuropsychology, 14, 588–598. doi:10.1037/0894-4105.14.4.588.Google Scholar
Koerner, S. S. and Kenyon, B. B. (2007). Understanding “Good Days” and “Bad Days”: emotional and physical reactivity among caregivers for elder relatives. Family Relations, 56, 1–11. doi:10.1111/j.1741-3729.2007.00435.x.CrossRefGoogle Scholar
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179–186. doi:10.1093/geront/9.3_Part_1.179.CrossRefGoogle ScholarPubMed
McKeith, I. (2007). Dementia with Lewy bodies. Handbook of Clinical Neurology, 84, 531–548. doi:10.1016/S0072-9752(07)84060-7.Google Scholar
Mitnitski, A., Fallah, N., Wu, Y., Rockwood, K. and Borenstein, A. R. (2010). Changes in cognition during the course of eight years in elderly Japanese Americans: a multistate transition model. Annals of Epidemiology, 20, 480–486. doi:10.1016/j.annepidem.2010.03.013.CrossRefGoogle ScholarPubMed
Mitnitski, A., Fallah, N. and Rockwood, K. (2011). A multistate model of cognitive dynamics in relation to frailty in older adults. Annals of Epidemiology, 21, 507–516. doi:10.1016/j.annepidem.2011.01.006.CrossRefGoogle ScholarPubMed
Normann, H. K., Asplund, K. and Norberg, A. (1998). Episodes of lucidity in people with severe dementia as narrated by formal carers. Journal of Advanced Nursing, 28, 1295–1300. doi:10.1046/j.1365–2648.1998.00845.x.CrossRefGoogle ScholarPubMed
Polk, D. M. (2005). Communication and family caregiving for Alzheimer's dementia: linking attributions and problematic integration. Health Communication, 18, 257–273. doi:10.1207/s15327027hc1803_4.Google Scholar
Reisberg, B. (1988). Functional assessment staging (FAST). Psychopharmacology Bulletin, 24, 653–659.Google Scholar
Reisberg, B., Ferris, S. H., de Leon, M. J. and Crook, T. (1982). The Global Deterioration Scale for assessment of primary degenerative dementia. The American Journal of Psychiatry, 139, 1136–1139.Google ScholarPubMed
Ritchie, J. and Spencer, L. (2002). Qualitative data analysis for applied policy research. In Bryman, A. and Burgess, R. (eds.), Analysing Qualitative Data, e-book edn (pp. 240–260). New York, NY: Routledge. doi:10.4135/9781412986274.Google Scholar
Rockwood, K., Fay, S., Song, X., MacKnight, C., Gorman, M. and Video-Imaging Synthesis of Treating Alzheimer's Disease (VISTA) Investigators. (2006). Attainment of treatment goals by people with Alzheimer's disease receiving galantamine: a randomized controlled trial. Canadian Medical Association Journal, 174, 1099–1105. doi:10.1503/cmaj.051432.Google Scholar
Rockwood, K., Fay, S., Jarrett, P. and Asp, E. (2007). Effect of galantamine on verbal repetition in AD: a secondary analysis of the VISTA trial. Neurology, 68, 1116–1121. doi:10.1212/01.wnl.0000258661.61577.b7.CrossRefGoogle Scholar
Serrano, C. and Garcia-Borreguero, D. (2004). Fluctuations in cognition and alertness in Parkinson's disease and dementia. Neurology, 63, S31–S34. doi:10.1212/WNL.63.8_suppl_3.S31.CrossRefGoogle ScholarPubMed
Song, X., Mitnitski, A., Zhang, N., Chen, W., Rockwood, K. and Alzheimer's Disease Neuroimaging Initiative. (2013). Dynamics of brain structure and cognitive function in the Alzheimer's disease neuroimaging initiative. Journal of Neurology, Neurosurgery, and Psychiatry, 84, 71–78. doi:10.1136/jnnp-2012-303579.CrossRefGoogle ScholarPubMed
Walker, M. P. et al. (2000a). The clinician assessment of fluctuation and the one day fluctuation assessment scale: two methods to assess fluctuating confusion in dementia. The British Journal of Psychiatry, 177, 252–256. doi:10.1192/bjp.177.3.252.CrossRefGoogle ScholarPubMed
Walker, M. P. et al. (2000b). Quantifying fluctuation in dementia with Lewy bodies, Alzheimer's disease, and vascular dementia. Neurology, 54, 1616–1625. doi:10.1212/WNL.54.8.1616.Google Scholar