The Peaceful Mind Program: A Pilot Test of a Cognitive-Behavioral Therapy-Based Intervention for Anxious Patients With Dementia.
ABSTRACT OBJECTIVES:: To assess feasibility and to conduct a preliminary evaluation of outcomes following Peaceful Mind, a cognitive-behavioral therapy-based intervention for anxiety in dementia, relative to usual care. DESIGN:: Pilot randomized controlled trial including assessments at baseline and 3 and 6 months. SETTING:: Houston, TX. PARTICIPANTS:: Thirty-two outpatients diagnosed with mild (47%) or moderate (53%) dementia receiving care through outpatient clinics at the Veterans Affairs medical center, Baylor College of Medicine, Harris County Hospital District, and community day centers for dementia, and their collaterals, who spent at least 8 hours a week with them. INTERVENTION:: Peaceful Mind included up to 12 weekly in-home sessions (mean: 8.7, SD: 2.27) during the initial 3 months and up to eight brief telephone sessions (mean: 5.4, SD: 3.17) during months 3-6, involving self-monitoring for anxiety, deep breathing, and optional skills (coping self-statements, behavioral activation, and sleep management). Patients learned skills, and collaterals served as coaches. In usual care, patients received diagnostic feedback, and providers were informed of inclusion status. MEASUREMENTS:: Neuropsychiatric Inventory-Anxiety subscale, Rating Anxiety in Dementia scale, Penn State Worry Questionnaire-Abbreviated, Geriatric Anxiety Inventory, Geriatric Depression Scale, Quality of Life in Alzheimer disease, Patient Health Questionnaire, and Client Satisfaction Questionnaire. RESULTS:: Feasibility was demonstrated with regard to recruitment, attrition, and treatment characteristics. At 3 months, clinicians rated patients receiving Peaceful Mind as less anxious, and patients rated themselves as having higher quality of life; collaterals reported less distress related to loved ones' anxiety. Although significant positive effects were not noted in other outcomes or at 6-month follow-up, the pilot nature of the trial prohibits conclusions about efficacy. CONCLUSIONS:: Results support that Peaceful Mind is ready for future comparative clinical trials.
- SourceAvailable from: Diana Klein[Show abstract] [Hide abstract]
ABSTRACT: Within the last years various interventions for cognitively impaired persons and their informal caregivers have been developed and evaluated. As different these interventions are, as different are the outcome dimensions and instruments used. There might be the potential to affect outcomes on both sides. Therefore, the aim of this review is to analyze the amount of studies that report on care recipient outcomes, to show what main outcome dimensions can be categorized, and which validated instruments are most frequently used. A systematic literature search of the electronic databases PubMed, Medline and PsycINFO was conducted. Overall 1547 studies were identified. After exclusion of duplicates and screening of titles and abstracts 162 records remained. Of those 105 would have met the inclusion criteria but 36 records (34.3%) didn’t assess any care recipient outcomes. Sixty nine studies (65.7%) reported on care recipient outcomes and were finally analyzed. The following assessments were used most in the main outcome dimensions: the Revised Memory and Behavior Problem Checklist and the Neuro-Psychiatric Inventory for problem behaviors, the Cornell Scale for Depression in Dementia for depressive symptoms, Quality of Life in Alzheimer's Disease for quality of life, the Mini Mental State Examination for cognition, and Lawton and Brody’s Instrumental Activities of Daily Living scale for activities of daily living. In dementia caregiver studies care recipient outcomes should more often be assessed. For a better comparability between interventions and target groups more homogeneity of the instruments is necessary. Instruments that are not specifically developed for cognitively impaired persons should only be used if they have been validated for persons with a comparable cognitive status.International journal of emergency mental health 03/2015; 17(2):451-426. DOI:10.4172/1522-4821.1000186
- [Show abstract] [Hide abstract]
ABSTRACT: We compared the psychometric performance of two validated self-report anxiety symptom measures when rated by people with dementia versus collaterals (as proxies). Forty-one participants with mild-to-moderate dementia and their respective collaterals completed the Geriatric Anxiety Inventory, the Penn State Worry Questionnaire-Abbreviated, and a structured diagnostic interview. We used descriptive and nonparametric statistics to compare scores according to respondent characteristics. Receiver operating characteristic (ROC) curves were calculated to establish the predictive validity of each instrument by rater type against a clinical diagnosis of an anxiety disorder. Participant and collateral ratings performed comparably for both instruments. However, collaterals tended to give more severe symptom ratings, and the best-performing cut-off scores were higher for collaterals. Our findings suggest that people with mild-to-moderate dementia can give reliable self-reports of anxiety symptoms, with validity comparable to reports obtained from collaterals. Scores obtained from multiple informants should be interpreted in context.Journal of anxiety disorders 11/2012; 27(1):125-130. DOI:10.1016/j.janxdis.2012.11.001 · 2.68 Impact Factor