Multicomponent Intervention for Agitated Behavior in a Person With Alzheimer's Disease

Abstract

We evaluated a multicomponent intervention for agitated behavior in a man with probable Alzheimer's disease. Hypotheses about variables controlling his agitated behavior guided intervention design. Based on staff interviews, direct observations, and brief experimental probes, intervention components were chosen to increase rate of reinforcement and decrease aversive aspects of his job. Intervention reduced agitated behavior without disrupting his work rate.

Effectiveness of Nonpharmacological Interventions for the Management of Neuropsychiatric Symptoms in Patients With Dementia

“…[19][20][21][22] These interventions manage NPS through contingency management such as removing rewards (eg, giving attention for NPS), delivering rewards for prosocial behaviors, or behavioral redirection. Based on observational data, all SCDs found a significant reduction in disruptive behaviors following intervention (a reduction of 80% or more in out-ofseat behavior intervals [mean percentage of out-of-seat behavior intervals at baseline, 18.3%; mean percentage of intervals following intervention, 3.85%] and agitated speech [mean percentage of agitated speech intervals at baseline, 33.7%; mean percentage of intervals following intervention, 9.6%]) 19 ; 95% reduction in entry into a restricted area (mean entries per hour at baseline, 7.6; mean entries following intervention, 0.4) 20 ; a 50% to 80% reduction in wandering frequency across participants 21 ; a 100% reduction in physical and/or verbal aggression during treatment phase across participants (number of agitated assaults ranged from 1 to 3 at baseline). 22 Because of the limited scale of these SCDs and given their positive outcomes, individualized behavioral interventions are possibly efficacious, pending further research.…”

An historical view of the clinical and research base of functional analysis

“…Empirical research on functional analysis and its approach to treatment has expanded recently to other clientele with a variety of behavior problems, including chronic food refusal (Munk & Repp, 1994), classroom appropriate and problem behavior (Dunlap et al, 1993;Kern, Childs, Dunlap, Clarke, & Falk 1994;Lewis & Sugai, 1996;Taylor & Romanczyk, 1994), cigarette pica (Piazza, Hanley, & Fisher, 1996), pica (Fisher et al, 1994;Mace & Knight, 1986;Piazza et al, 1998), bizarre speech , reluctant speech (Mace & West, 1986), diagnosis of a tic disorder (Carr, Taylor, Wallander, & Reiss, 1996), attention deficit hyperactivity disorder (DuPaul & Ervin, 1996;Ervin et al, 1998;Gulley & Northrup, 1997), behavior disorders (Blair, Umbreit, & Boss, 1999;Clarke et al, 1995), patients with Alzheimer's disease (Bakke et al, 1994), and schizophrenic delusions (Schock, Clay, & Cipani, 1998). For example, the conduct of an analysis of the behavioral function of the delusional statements of adults with schizophrenia provided the venue for the design of effective behavioral treatment for such statements (Schock et al, 1998).…”

Handbook of Neuropsychology and Aging

“…There are many other examples of studies that have used behavior modification or multicomponent treatments that include behavior modification to treat aggressive behavior among older adults (e.g., Bakke et al, 1994;Davis & Boster, 1988;Hinchliffe, Hyman, Blizard, & Livingston, 1992;Mishara & Kastenbaum, 1973;Rapp, Flint, Herrmann, & Proulx, 1992). Thus, there is no question that behavior modification techniques can help ameliorate aggressive behavior difficulties among older adults, even if the patients have significant cognitive impairment.…”