We all know the statistics: Currently, 4 to 6 million individuals in the United States have Alzheimer’s disease (AD), with this number growing to between 14 and 17 million by 2050 (Hebert, Scherr, Bienias, Bennett, & Evans, 2003). Of those with AD, the Alzheimer’s Association (2008) has estimated that approximately half are in the early stage of AD. What is not known, however, is what evidence exists in terms of the needs of those in the early stages and the best practices that support these individuals.
As the number of individuals with AD grows both nationally and internationally, the demand for interdisciplinary workgroups to join together to develop innovative, effective, and cost-effective models for meeting the needs of these individuals and their families also grows. The articles that comprise this special issue of the Journal of Gerontological Nursing represent some of the work that one such interdisciplinary group, self-termed the Dementia Day Camp (DDC), has undertaken to advance the science of care for individuals with early-stage AD.
For nearly 9 years, the DDC, an international group composed of nurses, recreational therapists, and gerontologists, has met to share information regarding their practices in caring for people with AD. The DDC has evolved from being a forum for the sharing of ideas and challenges in caring for these individuals to a working group for conducting research into identifying better ways to meet the needs of this population. One important outcome of the group’s work was the writing of a consensus report, commissioned by the Alzheimer’s Association, regarding best practices for people with early-stage AD (Burgener et al., 2007).
For the purposes of the comprehensive review and for the articles in this special issue, early-stage AD was defined by any of the following criteria:
- Mini-Mental State Examination (MMSE) scores of greater than 17 (Folstein, Folstein, & McHugh, 1975).
- Clinical Dementia Rating (CDR) Scale scores of 0.5 to 2.0 (Hughes, Berg, Danziger, Coben, & Martin, 1982).
- Global Deterioration Scale (GDS) scores of 2.0 or less (Reisberg, Ferris, de Leon, & Crook, 1982).
If studies were conducted in the home or community setting, such as in adult day care centers, and no stage criteria were provided, the study was included if reference was made to “early-stage” AD.
Many of the articles in this special issue refer to the “grading of the evidence.” Information regarding the strength of the scientific evidence to support the recommendations (e.g., A1, B2) can be found in the Sidebar. As is evident, much more research is needed in a variety of areas (e.g., support groups, exercise, sleep management) to provide a scientific basis for clinical practice.
The articles in this special issue span a broad range of the vulnerabilities and challenges those with AD face, coupled with a number of articles that outline the evidence for care of this population. Two articles in this issue provide insight into the needs of people with early-stage AD. Bossen, Specht, and McKenzie set forth scientific evidence for the needs of this patient population, whereas Specht, Taylor, and Bossen document scientific evidence coupled with the unique perspectives of a person living with AD.
The article by Yu et al. offers a comprehensive review of the efficacy of a variety of approaches for cognitive stimulation and cognitive rehabilitation. The article by Fick, Kolanowski, Beattie, and McCrow outlines the vulnerability of individuals with AD to delirium. Buettner and Fitzsimmons, whose work is well known in the areas of healthy aging and dementia care, provide a detailed overview of an innovative program to meet the social, cognitive, and physical needs of those with early-stage dementia. Finally, Burgener, Buettner, Beattie, and Rose outline recommendations and identify gaps in the knowledge base regarding best practices for people with early-stage AD. Collectively, the articles in this issue provide a rich picture of the current state of knowledge and practice for a growing number of people who will be affected by AD.
I am privileged to be a member of such a wonderful group of clinicians and scientists who are passionate about caring for people with AD. The articles contained in this special issue are meant to encourage readers to reflect on their own clinical practice and motivate them to work with colleagues, both within and outside of the nursing profession, to create innovative, evidence-based practices and programs to work with individuals with early-stage AD. The old saying is true: There is fun (and knowledge) in numbers!
Karen M. Rose, PhD, RN
Assistant Professor of Nursing
University of Virginia School of Nursing
- Alzheimer’s Association. 2008. Voices of Alzheimer’s disease: A summary report on the nationwide town hall meetings for people with early stage dementia. Retrieved February 3, 2009, from http://www.alz.org/national/documents/report_townhall.pdf
- Burgener, S, Beattie, E, Bossen, A, Buckwalter, K, Buettner, L & Fick, D et al. .2007. Consensus report: Review of scientific evidence addressing prevalence, documented needs, and interdisciplinary research: Persons in early stage Alzheimer’s dementia. Chicago, IL: Alzheimer’s Association.
- Folstein, MF, Folstein, SE & McHugh, PR1975. “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician”. Journal of Psychiatric Research, 12, 189–198. doi:10.1016/0022-3956(75)90026-6 [CrossRef]
- Hebert, JE, Scherr, PA, Bienias, JL, Bennett, DA & Evans, DA2003. Alzheimer disease in the US population: Prevalence estimates using the 2000 census. Archives of Neurology, 60, 1119–1122. doi:10.1001/archneur.60.8.1119 [CrossRef]
- Hughes, CP, Berg, L, Danziger, WL, Coben, LA & Martin, RL1982. A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566–572. doi:10.1192/bjp.140.6.566 [CrossRef]
- Reisberg, B, Ferris, SH, de Leon, MJ & Crook, T1982. The Global Deterioration Scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 1136–1139.