A comparison of Alzheimer's disease subjects with and without behaviors from past self -identity (BPSI).

Millions of people who develop Alzheimer's disease (AD) in the next decade will display dementia behaviors known as behaviors from past self-identity (BPSI). These newly characterized AD behaviors are defined as verbal and behavioral actions, consistent with an accurate past self-identity, yet performed without awareness that it is incongruent with the present. Although BPSI, such as eloping to go to work, were displayed by approximately twenty-five percent of AD patients in a previous study, no studies have characterized AD subjects with and without BPSI. Caregivers, frustrated by BPSI, need to understand differences between AD patients with and without BPSI to improve their care of BPSI. The conceptual framework postulated that both memory and cognition contributed to BPSI. The study tested four hypotheses to determine if differences existed in memory and cognitive functions between AD subjects with and without BPSI. Study design was cross-sectional with group comparisons between AD subjects with and without BPSI. Memory measures included Autobiographical Memory Index and Cohen-Mansfield Self-Identity questionnaire. Cognitive measures included two attention tasks, Trail Making Test and Stroop and a fluency task, the Controlled Oral Word Association. A convenience sample of forty-three (43) mild to moderate stage AD subjects was recruited through an Alzheimer's disease research center. Thirty percent of subjects had BPSI. All were in the moderate stage of AD. Subjects with BPSI had significantly fewer recent and remote autobiographical (self) memories and were also significantly slower on selective attention tasks. Two types of BPSI were identified: Verbal-only and Active Behaviors. Post hoc analyses with ANCOVA controlling for MMSE scores revealed Active BPSI subjects had significantly better verbal fluency skills. AD patients displaying BPSI represent a subset of the AD population, demonstrating unique memory and cognitive profiles. Impoverished self-memory and slowed shifting of attention contribute to BPSI. Discoveries about Active and Verbal BPSI subjects suggest a possible behavior trajectory. Although some Active BPSI have negative consequences, nursing's goal is not to extinguish BPSI, but to develop effective and safe behavioral interventions. Tailoring interventions to remaining self-memories and slower cognitive skills may improve nursing care for AD patients displaying BPSI.PhDHealth and Environmental SciencesNursingPsychobiologyPsychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/123853/2/3106073.pd