The Impact of Stimuli on Affect in Persons With Dementia

Abstract

Objective To examine how presentation of different stimuli impacts affect in nursing home residents with dementia. Method Participants were 193 residents aged 60 to 101 years from 7 Maryland nursing homes who had a diagnosis of dementia (derived from the medical chart or obtained from the attending physician). Cognitive functioning was assessed via the Mini-Mental State Examination (MMSE), and data pertaining to activities of daily living were obtained through the Minimum Data Set. Affect was assessed using observations of the 5 moods from Lawton’s Modified Behavior Stream. Baseline observations of affect were performed for comparisons. During the study, each participant was presented with 25 predetermined engagement stimuli in random order over a period of 3 weeks. Stimuli were categorized as live social, simulated social, manipulative, work/task-related, music, reading, or individualized to the participant’s self-identity. The dates of data collection were 2005–2007. Results Differences between stimulus categories were significant for pleasure (F6,144 = 25.137, P < .001) and interest (F6,144 = 18.792, P < .001) but not for negative affect. Pleasure and interest were highest for the live social category, followed by self-identity and simulated social stimuli for pleasure, and for manipulative stimuli in terms of the effect on interest. The lowest levels of pleasure and interest were observed for music. Participants with higher cognitive function had significantly higher pleasure (F1,97 = 6.27, P < .05). Although the general trend of the impact of the different categories was similar for different levels of cognitive function, there were significant differences in pleasure in response to specific stimuli (interaction effect: F6,92 = 2.31, P < .05). Overall, social stimuli have the highest impact on affect in persons with dementia. Conclusions The findings of the present study are important, as affect is a major indicator of quality of life and this study is the first to systematically examine the impact of specific types of stimuli on affect. As live social stimuli are not always readily available, particularly in busy nursing home environments, simulated social stimuli can serve as an effective substitute, and other stimuli should have a role in the activity tool kit in the nursing home. The relative ranking of stimuli was different for interest and pleasure. The findings demonstrate the differential effect of presentation of different types of stimuli on the affect of persons with dementia, and that, while the impact is greater on persons with higher levels of cognitive function, there is a different effect of varying stimuli even in persons with MMSE scores of 3 or lower. Future research should attempt to ascertain a person’s degree of interest in stimuli prior to developing an intervention.

The relation between mood, activity, and interaction in long-term dementia care

“…Studies which have used questionnaires to assess associations with mood indicate that depressive symptoms of PwD living in long-term care facilities are associated with negative outcomes such as a decreased QoL, worse physical health, a decreased ability to perform activities of daily living, a lack of social support, pain, loneliness, and negative life events (Barca, Engedal, Laks, & Selbaek, 2010;Beerens et al, 2013;Jongenelis et al, 2004). Studies which used real-time observational assessments indicate that negative affect was associated with the presence of agitated behaviour (Cohen-Mansfield, Dakheel-Ali, Jensen, Marx, & Thein, 2012) and positive affect is associated with social stimulation and recreational activities (Cohen-Mansfield, Marx, Thein, & Dakheel-Ali, 2011;Schreiner, Yamamoto, & Shiotani, 2005).…”

Effects of a high‐intensity functional exercise program on depressive symptoms among people with dementia in residential care: a randomized controlled trial

“…These results are of particular interest, as antidepressants seem to have little or no effect in this population (Nelson and Devanand, ; Banerjee et al ., ). As the exercise per se did not seem to reduce depressive symptoms in the present study, it suggests that maybe the social contacts mediated in both group activities could be a part of the explanations why positive effects were found in participants with high levels of depressive symptoms (Lenze et al ., ; Yang, ; Cohen‐Mansfield et al ., ). However, as the exercise and control interventions were not compared with usual care in the present study, we cannot disregard the possibility that the observed effects reflect the natural course of depressive symptoms in this group.…”

A multidisciplinary approach for the optimal treatment of problem behaviour in dementia

“…Uit onderzoek blijkt dat het aanbieden van verschillende (sociale) activiteiten kan leiden tot een verbetering van het algeheel functioneren, vooral een toename van interesse en plezier [13]. Samen met de activiteitenbegeleidster is een individueel activiteitenaanbod opgesteld bestaande uit lichaamsbeweging, cognitieve activiteiten, ADL en zingeving [9].…”