| Learning Objective #1: Explain how Alzheimer's Disease (AD) patients with behaviors from past self identities (BPSI) are different from AD patients without BPSI | |||
| Learning Objective #2: Explain the cognitive, memory, and self identity trends associated with BPSI and use this information when working with patients and advising their caregivers |
Caring for people with Alzheimer's disease (AD) is a growing nursing challenge because of the significant behavior problems associated with it. Problem: To determine if there are memory and cognitive differences between Alzheimer's Disease (AD) subjects with and without "Behaviors from Past Self Identities" (BPSI). BPSI are defined as dementia behaviors that reflect active use of an accurate past self identity. Examples include AD patients who insist they must go to work or find their young children. The behaviors can be disruptive yet no studies were found that explain BPSI or guide nursing interventions. Pilot work on BPSI (2001) found family caregivers reported twenty percent (20%) of mild to moderate AD patients had BPSI. Practice level framework hypothesized that BPSI subjects are different from other AD subjects in perception of past identities, autobiographical memory (AM),attention skills, and fluency. This cross-sectional between group design study recruited a convenience sample of forty-four (44) mild to moderate AD subjects through the an Alzheimer Disease Research Center (ADRC). Subjects completed a battery of measures for fluency, attention, and autobiographical memory. Subjects were 98% Caucasian, 54% male, and 76% resided at home. Sample means were age 77 years, 14 years education, and 16 on Mini-Mental State Exam (MMSE) which is moderate staged dementia. Results: Twenty percent of moderate staged AD subjects had BPSI. Mean MMSE for BPSI subjects was 13.2. BPSI subjects scored significantly worse on a measure of selective attention (p=.004) (Trails Making Tests) and on past incidents in autobiographical memory (AM) (p=.008). No fluency differences emerged. No differences in importance of past self identities emerged although trends for changes in self identity as dementia progressses were observed. Conclusions: BPSI are common behaviors among moderate AD patients. An impoverished past self memory and impaired attention contribute to these behaviors.
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