Literature Review

Introduction

The phenomenon of Dementia/ Alzheimer’s Disease (AD) among elderly is very prevalent in Qatar, where a need for professional and psychological help is needed, not just clinical help. The aim of this review is to explore the behavioral and psychological patterns that AD patients face through the progression of the disease. Within these patterns arises an overlap of the behavioral actions of AD patients and caregivers. A comprehensive understanding of how behavioral patterns of caregivers and AD patients intercorrelate will be achieved within this review.

Dementia patients face psychological issues that are encompassed within the AD scope. Within this observed pattern, an overall trend has been established within the researched academic articles. The trends follow the theme of emotional and behavioral problems that affect the AD diagnosed elderly. A prevalent theme that emphasizes on these problems is how behavioral problems occur to both AD patients and caregivers, where each is impacted by the other.

The point of view that is highlighted within the conducted research is to provide a breakdown analysis of the behavioral attributes that encompass what it is like being an AD diagnosed elderly. The criteria followed for analyzing the literary articles will follow an understanding of the symptoms of the AD diagnosed elderly, a breakdown of similar symptoms that caregiver’s have, and an established overlap between both. The research solely focuses on factors that affect the behavioral and emotional patterns of the AD diagnosed elderly not clinical challenges as it fits the research gap and the main purpose of the proposal.

Alzheimer’s Patient Behavioral Symptoms

Another article that provides supporting research of the emotional and behavioral patterns, “Alzheimer’s Disease and Depression,” is an academic journal written by Linda Teri and Amy Wagner that highlights the phenomenon of depression, as an emotional distress symptom among AD patients. Through their findings, it’s been established that dementia can result to depression. They’ve reviewed the prevalence of both in terms of physiological and psychological theories, where depression could result from damages that occur because of dementia, or depression could result from the loss of skills and abilities of dementia. They argue that it is unlikely that both, depression and dementia, are unlinked.

Teri and Wagner observed and highlighted a gap where they’ve stated that making the correlation can be problematic since if the AD diagnosed elderly makes the observation that they’re showing symptoms of depression, their observation could be unreliable. The reason behind that is because with the dementia comes symptoms that overlap with depression. Loss of interest, for example, could be due to cognitive recession of dementia but it could also be apathy of depression. The research establishes a way to analyze these symptoms and classify them under either one of the categories. Professional clinicians and researchers often take the word of the caregivers as the biggest tell on what the AD patient’s symptoms entail. Since they’ve established a sense of reliability of depression with AD patients, they’ve observed depressive symptoms such as social withdrawal, loss of interest, feeling constant guilt and worthlessness, and suicidal thoughts. Through that, an informed observation has been made that patients with both dementia and depression experience heavier demented symptoms, such as behavioral disturbances and delusions.

To understand the behavioral and emotional symptoms that occur in AD diagnosed patients, the article “Changes in Emotional and Behavioral Symptoms of Alzheimer’s Disease” by Michelle M. Lee, Milton E. Strauss, and Deborah V. Dawson discusses the behavioral and disruptive actions that are resulted because of AD. Their research focuses on the emotional distress, such as depression and anxiety, and the disruptive behaviors, such as agitation, aggression, and wandering, that AD patients face. The aim of their research is to report results of their investigation of the progression of emotional and disruptive behavioral symptoms over the course of three years. Through this conducted case study, an assessment of the emotional distress and disruptive behaviors of 26 AD diagnosed people has been registered once at the time and again three years later, to observe the progression of these behavioral changes. The results of the assessment showed that patients had a 22% increase in the disruptive behaviors. However, patients also showed a 46% decrease in the emotional symptoms. As their research was in a cluster format, a big decline in the results of emotional distress was found. Nonetheless, they have found that in terms of individual patients, the results showed stability, where if one patient had high levels of emotional distress, there is not much of a change 3 years later.17

However, a study by Juan Lasprilla, Alexander Moreno, Heather Rogers, and Kathryn Francis in the article “The Effect of Dementia Patient’s Physical, Cognitive, and Emotional/ Behavioral Problems on Caregiver Well-Being” shows different results in the behavioral and emotional problems that AD patients face. Through their case study, 90% of the studied AD patients showed signs of depression, 83% showed extreme dependency on caregivers, and 82% showed lack of interest.18

Caregivers Behavioral Symptoms

As AD directly causes complications for the AD patients, it also affects the caregivers in a similar way. “The Effect of Dementia Patient’s Physical, Cognitive, and Emotional/ Behavioral Problems on Caregiver Well-Being,” an article written by Juan Lasprilla et al highlights the negative impact that the AD patients have on the caregiver’s social and emotional well-being. Lasprilla, Moreno, Rogers, and Francis recruited 73 caregivers for AD patients where they’ve been studied for behavioral and emotional problems that they face as a caregiver. Established negative features that the selected caregivers include are depression, anxiety, guilt, anger, burden, and worry. The results of the conducted case study show that 31% of the caregivers reported no burden, 32% mild burden, 27% moderate burden, and 10% severe burden. In terms of depression, 60.3% of the caregivers reported no signs of depression, 23.3% mild depression, 13.7% moderate depression, 2.8% severe depression. The research then starts to develop the overlap between the behavioral/emotional problems of caregivers and AD diagnosed elderly. 19 Overlap of Behavioral/Emotional Symptoms of AD Patients and Caregivers

Lasprilla, Moreno, Rogers, and Francis’s research began to question the correlation of behavioral problems that caregivers and AD patients face. As their research mentions that some studies establish this association, while others do not, they’ve concluded that the overlap between the behavioral problems of AD patients and emotional burden of caregivers might only be applicable when the problems are ordinary and not drastic. Within their study, they found that caregiver burden influences the behavioral problems of the patients in the conducted sample. The study also establishes that the cognitive and emotional/behavioral problems of AD patients predicted the depression and burden of the caregivers. The study indicated that with the high levels of depression with the caregiver, the AD patient’s emotional problems increase.20

“The Effects of Incident and Persistent Behavioral Problems on Change in Caregiver Burden and Nursing Home Admission of Persons with Dementia,” written by Joseph E. Gaugler et al, also highlights the behavioral patterns that AD patients face and how caregiver’s emotional distress can add onto the behavioral imbalances of AD patients. Through their research, they’ve concluded that with the increase of the behavioral disturbances that the AD patient goes through, the caregiver burden and depression follow that of the patient. The research establishes that with the increase of caregiver burden, the more frequent the AD patient behavioral problems occur. Therefore, this establishes a solid link between the emotional distress of the caregivers and the behavioral problems of the AD patient.21 Another article, “A prospective study of the effects of behavioral symptoms on the institutionalization of patients with dementia,” offers the same insight as the previously mentioned study. However, this study establishes that with this overlap in caregiver emotional distress and patient behavioral problems, a sooner institutionalization of the AD patients is resulted, where the AD patients are sent to nursing homes.22

Conclusion

In summary, the research sources establish an understanding of what the AD patient behavioral and emotional problems encompass, such as: depression, anxiety, loss of interest etc. An established understanding of the symptom’s caregivers encounter is reviewed through the research sources. With the information provided about both subjects, other sources elaborate on the interrelation of the symptoms both face and how they affect one another.

The bodies of literature reviewed provide a strong understanding of the intended research topic. However, as the sources do provide valid information, there is a gap in the resolution aspect. The research sources provide the factual information but do not provide possible solutions and treatments of the behavioral and emotional problems of AD patients. As the conducted research has provided a thorough analysis of the AD patient problems, the overall research helps develop ideas of a space for the AD diagnosed elderly where the highlighted aspects are targeted and tackled through design. As stated, AD patients face many emotional and behavioral issues. With that acknowledged, the proposed Alzheimer’s elderly home will provide spaces targeted for tackling this issue, and ways to decrease negative impacts on the AD diagnosed elderly.

1. Michelle M. Lee, Milton E. Strauss, and Deborah V. Dawson, “Changes in Emotional and Behavioral Symptoms of Alzheimer’s Disease,” American Journal of Alzheimer’s Disease 15, no. 3 (2000): pp. 176-179, https://doi.org/10.1177/153331750001500305.

2. Juan Carlos Arango Lasprilla et al., “The Effect of Dementia Patient’s Physical, Cognitive, and Emotional/ Behavioral Problems on Caregiver Well-Being: Findings From a Spanish-Speaking Sample From Colombia, South America,” American Journal of Alzheimer’s Disease & Other Dementiasr 24, no. 5 (2009): pp. 384-395, https://doi.org/10.1177/1533317509341465.

3. Linda Teri, and Amy Wagner. “Alzheimer’s Disease and Depression.” Journal of Consulting and Clinical Psychology, The Emotional Concomitants of Brain Damage, 60, no. 3 (June 1992): 379–91. doi:10.1037/0022-006X.60.3.379.

4. Juan Carlos Arango Lasprilla et al., “The Effect of Dementia Patient’s Physical, Cognitive, and Emotional/ Behavioral Problems on Caregiver Well-Being: Findings From a Spanish-Speaking Sample From Colombia, South America,” American Journal of Alzheimer’s Disease & Other Dementiasr 24, no. 5 (2009): pp. 384-395, https://doi.org/10.1177/1533317509341465.

5. Juan Carlos Arango Lasprilla et al., “The Effect of Dementia Patient’s Physical, Cognitive, and Emotional/ Behavioral Problems on Caregiver Well-Being: Findings From a Spanish-Speaking Sample From Colombia, South America,” American Journal of Alzheimer’s Disease & Other Dementiasr 24, no. 5 (2009): pp. 384-395, https://doi.org/10.1177/1533317509341465.

6. Joseph E. Gaugler, Melanie M. Wall, Robert L. Kane, Jeremiah S. Menk, Khaled Sarsour, Joseph A. Johnston, Don Beusching, and Robert Newcomer. “The Effects of Incident and Persistent Behavioral Problems on Change in Caregiver Burden and Nursing Home Admission of Persons With Dementia.” Medical Care 48, no. 10 (2010): 875-83. http://www.jstor.org/stable/25750573.

7. Marjolein E. De Vugt et al., “A Prospective Study of the Effects of Behavioral Symptoms on the Institutionalization of Patients with Dementia,” International Psychogeriatrics 17, no. 4 (2005): pp. 577589, https://doi.org/10.1017/s1041610205002292.