The QOL-AD seems to be reliable and valid for individuals with MMSE scores greater than 10. Further research is needed to clarify the relationship between patient and caregiver reports of patient quality of life and to identify factors that influence quality of life throughout the progression of dementia.

Checklist (RMBPC), a 24-item, caregiver-report measure of observable behavioral problems in dementia patients, provides 1 total score and 3 subscale scores for patient problems (memory-related, depression, and disruptive behaviors) and parallel scores for caregiver reaction. Data were obtained from 201 geriatric patients and their caregivers. Factor analysis confirmed 3 first-order factors, consistent with subscales just named, and 1 general factor of behavioral disturbance. Overall scale reliability was good, with alphas of .84 for patient behavior and .90 for caregiver reaction. Subscale alphas ranged from .67 to .89. Validity was confirmed through comparison of RMBPC scores with well-established indexes of depression, cognitive impairment, and caregiver burden. The RMBPC is recommended as a reliable and valid tool for the clinical and empirical assessment of behavior problems in dementia patients.

T IS WELL-KNOWN THAT ALZHEIMER disease adversely affects cognitive, emotional, and behavioral functioning. 1 Less well-known are the deleterious effects of Alzheimer disease on physical conditioning. However, there are a number of studies linking Alzheimer disease with physical deterioration. For example, when compared with age-matched controls, Alzheimer disease patients show more signs of undernutrition, 2 higher risk of falls and fractures, 3-6 and more rapid decline on measures of mobility. 7,8 Once injured, Alzheimer disease patients are at greater risk of subsequent injury than age-and sex-matched controls. 3 Reduced muscle mass has also been associated with loss of independence. 9 Consequently, improved physical conditioning for patients with Alzheimer disease may extend their independent mobility and enhance their quality of life despite progression of the disease. Research is accumulating to suggest that even the oldest adults can improve cardiovascular function and in-Author Affiliations are listed at the end of this article.

The current study is a controlled clinical investigation of two nonpharmacological treatments of depression in patients with Alzheimer's disease. Two active behavioral treatments, one emphasizing patient pleasant events and one emphasizing caregiver problem solving, were compared to an equal-duration typical care condition and a wait list control. Seventy-two patient-caregiver dyads were randomly assigned to one of four conditions and assessed pre-, post-, and at 6-months follow-up. Patients in both behavioral treatment conditions showed significant improvement in depression symptoms and diagnosis as compared with the two other conditions. These gains were maintained at 6-month follow-up. Caregivers in each behavioral condition also showed significant improvement in their own depressive symptoms, while caregivers in the two other conditions did not. Results indicate that behavioral interventions for depression are important and effective strategies for treating demented patients and their caregivers.

Estimates suggest that there are more than 10 million adult caregivers of persons with dementia, twothirds of who experience some form of sleep disturbance during the course of their caregiving career. Health care professionals are in the best position to detect and address this significant public health problem. Three major contributors to caregiver sleep disturbance are discussed in this paper: 1) the presence of caregiver disrupted sleep routines; 2) caregiver burden and depression; and, 3) the caregiver's physical health status. Successful treatment of a caregiver's sleep disturbance requires careful consideration of each of these contributors. We review and analyze the scientific literature concerning the multiple complex factors associated with the development and maintenance of sleep disturbances in caregivers. We provide a clinical vignette that illustrates the interplay of these contributing factors, and close by providing recommendations for clinicians and researchers treating and investigating the development and maintenance of sleep problems in family caregivers. Keywordssleep; insomnia; caregivers; Alzheimer's disease; dementia; depression The National Alliance for Caregivers estimates that there are 44.4 million caregivers age 18 and older in the United States, representing 21% of all U.S. households. (1) The vast majority of these caregivers are women, who are either living with the care-recipient or visiting them at least weekly, and who receive no paid and very little unpaid assistance with their family member's care. In a 2003 national survey, 23% of caregivers reported that they were caring for someone with Alzheimer's disease, dementia, or other mental confusion. (1) Sleep disturbances are common among dementia caregivers. Studies over the past 15 years have reported that approximately two-thirds of older adult caregivers have some form of sleep disturbance. (2-4) Caregiver sleep problems are often presumed to be linked to nighttime behaviors in the care-recipient. Obviously, if a person with dementia is awake and roaming around the house at night, this behavior impacts the caregiver's sleep as well. In fact, research Corresponding author: Susan M. McCurry, Ph.D. UW School of Nursing 9709 3 rd Ave. NE, Ste. 507 Seattle, WA 98115-2053 smccurry@u.washington.edu 206-685-9113 (telephone) 206-616-5588 (fax). Co-authors: Logsdon, Teri: same mailing address/fax as phone/emails: 206-685-1758, logsdon@u.washington.edu; 206-543-0715, lteri@u.washington.edu Vitiello: University of Washington, Box 356560, Seattle, vitiello@u.washington.edu Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaim...