712 CHAPTER 15
Mr. Rodrigues?”) and remind the patient of the day and time; calendars and clocks
are located where the patient can see them easily. Patients whose cognitive function-
ing is impaired to the point where they are in residential centers are encouraged to
join in activities rather than isolate themselves.
Another method that may decrease the depression and anxiety that can accom-
pany progressive cognitive decline is reminiscence therapy, which stimulates the
patients’ memories that are least affected by dementia—those of their early lives.
When providing this treatment, the therapist focuses on patients’ life histories and
asks patients to explore and share their experiences with group members or with
the therapist; patients may feel relief at being able to remember some information,
and their anxiety decreases and their mood then improves (Woods et al., 1998).
To treat behavioral disturbances such as agitation and aggression that some-
times arise with dementia, caregivers—family members and paid caretakers—may
fi rst be asked to identify the antecedents and consequences of the problematic be-
havior (Ayalon et al., 2006; Livingston et al., 2005; Spira & Edelstein, 2006); then,
they are advised on how to modify those aspects of the environment or the interac-
tions, when feasible. For instance, if a patient becomes aggressive only at night after
waking up to go to the bathroom, a night-light in his or her room may help reduce
any anxiety that arises because the patient is confused upon awakening.Targeting Social Factors
As cognitive and physical functioning declines, patients with dementia may receive
services that target social factors—such as elder day care, which is a day treatment
program for older adults with cognitive or physical impairments. Such day treat-
ment provides a respite for family members who care for the patient and an op-
portunity for the patient to interact with other people. As the patient continues to
decline, however, he or she may require live-in caretakers or full-time care in a nurs-
ing home or other residential facility. In addition, the methods used with amnestic
patients to create a less cognitively taxing physical environment (for example, label-
ing doors) may also be used with patients who have dementia.
Taking care of a family member who has Alzheimer’s disease is often extremely
stressful, and this stress increases the caretaker’s risk of developing a psychologi-
cal or medical disorder. (For example, patients may not recognize a family mem-
ber, and so believe that the family member is an intruder and try to attack him
or her or cower in fear.) In recent years, those involved in treating patients with
dementia have also reached out to family members who act as caretakers to provide
education, support, and, when needed, treatment to help these people develop less
stressful ways of interacting with the patients. Such interventions help family mem-
bers (and indirectly, the patients themselves) function as well as possible under the
circumstances.Diagnosing Mrs. B.’s Problems
Let’s reconsider the specifi c nature of Mrs. B.’s problems. The neuropsychologist re-
counted that Mrs B. knew who and where she was and understood the test instruc-
tions. Results of tests of her ability to remember information both immediately after
learning it and after a 30-minute delay were normal for her age, which indicated
that she probably did not have Alzheimer’s disease or another disorder that involves
signifi cant memory impairment (such as amnestic disorder). Instead, the neurop-
sychologist suggested that Mrs. B.’s problems refl ected a mild dementia combined
with depression and chronic pain. The neuropsychologist wrote in her report:
“Feedback to Mrs. B. reinforced her belief that her current memory problems do not
suggest [Alzheimer’s disease]. She was asked about activities that she enjoys, and we ex-
plored ways of increasing her opportunities for these activities with her attendant (e.g.,
she has recently visited a senior day-care program and hopes to attend one or two days
a week). She was encouraged to give her current living situation a longer try, working