Browsing by Author "Stanley, Melinda A."

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    Aggression Prevention Training for Individuals With Dementia and Their Caregivers: A Randomized Controlled Trial
    (Elsevier, 2020) Kunik, Mark E.; Stanley, Melinda A.; Shrestha, Srijana; Ramsey, David; Richey, Sheila; Snow, Lynn; Freshour, Jessica; Evans, Tracy; Newmark, Michael; Williams, Susan; Wilson, Nancy; Amspoker, Amber B.; Baylor College of Medicine; University of Alabama Tuscaloosa
    Objective: International appeals call for interventions to prevent aggression and other behavioral problems in individuals with dementia (IWD). Aggression Prevention Training (APT), based on intervening in three contributors to development of aggression (IWD pain, IWD depression, and caregiver-IWD relationship problems) aims to reduce incidence of aggression in IWD over 1 year. Design: Randomized, controlled trial. Setting: Three clinics that assess, diagnose, and treat dementia. Participants: Two hundred twenty-eight caregiver-IWD dyads who screened positive for IWD pain, IWD depression, or caregiver-IWD relationship problems randomized to APT or Enhanced Usual Primary Care (EU-PC). Intervention: APT, a skills-based intervention delivered over 3 months to address pain/depression/caregiver-IWD relationship issues. EU-PC included printed material on dementia and community resources; and eight brief, weekly support calls. Measurements: The primary outcome was incidence of aggression over 1 year, determined by the Cohen Mansfield Agitation Inventory-Aggression Subscale. Secondary outcomes included pain, depression, caregiver- IWD relationship, caregiver burden, positive caregiving, behavior problems, and anxiety. Results: Aggression incidence and secondary outcomes did not differ between groups. However, in those screening positive for IWD depression or caregiver-IWD relationship problems, those receiving EU-PC had significant increases in depression and significant decreases in quality of the caregiver-IWD relationship, whereas those receiving APT showed no changes in these outcomes over time. Conclusion: The cost to patients, family, and society of behavioral problems in IWD, along with modest efficacy of most pharmacologic and nonpharmacologic interventions, calls for more study of novel preventive approaches.
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    Concordance of self- and proxy-rated worry and anxiety symptoms in older adults with dementia
    (Pergamon, 2013) Bradford, Andrea; Brenes, Gretchen A.; Robinson, Roberta A.; Wilson, Nancy; Snow, A. Lynn; Kunik, Mark E.; Calleo, Jessica; Petersen, Nancy J.; Stanley, Melinda A.; Amspoker, Amber B.; UTMD Anderson Cancer Center; Wake Forest University; Wake Forest Baptist Medical Center; Baylor College of Medicine; University of Alabama Tuscaloosa
    We compared the psychometric performance of two validated self-report anxiety symptom measures when rated by people with dementia versus collaterals (as proxies). Forty-one participants with mild-to-moderate dementia and their respective collaterals Completed the Geriatric Anxiety Inventory, the Penn State Worry Questionnaire-Abbreviated, and a structured diagnostic interview. We used descriptive and nonparametric statistics to compare scores according to respondent characteristics. Receiver operating characteristic (ROC) curves were calculated to establish the predictive validity of each instrument by rater type against a clinical diagnosis of an anxiety disorder. Participant and collateral ratings performed comparably for both instruments. However, collaterals tended to give more severe symptom ratings, and the best-performing cut-off scores were higher for collaterals. Our findings suggest that people with mild-to-moderate dementia can give reliable self-reports of anxiety symptoms, with validity comparable to reports obtained from collaterals. Scores obtained from multiple informants should be interpreted in context. (C) 2012 Elsevier Ltd. All rights reserved.
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    The Peaceful Mind Manual: A Protocol for Treating Anxiety in Persons With Dementia
    (Sage, 2013) Paukert, Amber L.; Kraus-Schuman, Cynthia; Wilson, Nancy; Snow, A. Lynn; Calleo, Jessica; Kunik, Mark E.; Stanley, Melinda A.; Baylor College of Medicine; University of Alabama Tuscaloosa
    Anxiety disorders are highly prevalent among individuals with dementia and have a significant negative impact on their lives. Peaceful Mind is a form of cognitive-behavioral therapy for anxiety in persons with dementia. The Peaceful Mind manual was developed, piloted, and modified over 2 years. In an open trial and a small randomized, controlled trial, it decreased anxiety and caregiver distress. The treatment meets the unique needs of individuals with dementia by emphasizing behavioral rather than cognitive interventions, slowing the pace, limiting the material to be learned, increasing repetition and practice, using cues to stimulate memory, including a friend or family member in treatment as a coach, and providing sessions in the home. The manual presented here includes modules that teach specific skills, including awareness, breathing, calming self-statements, increasing activity, and sleep management, as well as general suggestions for treatment delivery.
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    The Peaceful Mind Program: A Pilot Test of a Cognitive-Behavioral Therapy Based Intervention for Anxious Patients with Dementia
    (Elsevier, 2013) Stanley, Melinda A.; Calleo, Jessica; Bush, Amber L.; Wilson, Nancy; Snow, A. Lynn; Kraus-Schuman, Cynthia; Paukert, Amber L.; Petersen, Nancy J.; Brenes, Gretchen A.; Schulz, Paul E.; Williams, Susan P.; Kunik, Mark E.; Baylor College of Medicine; University of Alabama Tuscaloosa; Wake Forest University; University of Texas Health Science Center Houston
    Objectives: To assess feasibility and to conduct a preliminary evaluation of outcomes following Peaceful Mind, a cognitive-behavioral therapy-based intervention for anxiety in dementia, relative to usual care. Design: Pilot randomized controlled trial including assessments at baseline and 3 and 6 months. Setting: Houston, TX Participants: Thirty-two outpatients diagnosed with mild (47%) or moderate (53%) dementia receiving care through outpatient clinics at the Veterans Affairs medical center, Baylor College of Medicine, Harris County Hospital District, and community day centers for dementia, and their collaterals, who spent at least 8 hours a week with them. Intervention: Peaceful Mind included up to 12 weekly in-home sessions (mean: 8.7, SD: 2.27) during the initial 3 months and up to eight brief telephone sessions (mean: 5.4, SD: 3.17) during months 3-6, involving self-monitoring for anxiety, deep breathing, and optional skills (coping self-statements, behavioral activation, and sleep management). Patients learned skills, and collaterals served as coaches. In usual care, patients received diagnostic feedback, and providers were informed of inclusion status. Measurements: Neuropsychiatric Inventory-Anxiety subscale, Rating Anxiety in Dementia scale, Penn State Worry Questionnaire-Abbreviated, Geriatric Anxiety Inventory, Geriatric Depression Scale, Quality of Life in Alzheimer disease, Patient Health Questionnaire, and Client Satisfaction Questionnaire. Results: Feasibility was demonstrated with regard to recruitment, attrition, and treatment characteristics. At 3 months, clinicians rated patients receiving Peaceful Mind as less anxious, and patients rated themselves as having higher quality of life; collaterals reported less distress related to loved ones' anxiety. Although significant positive effects were not noted in other outcomes or at 6-month follow-up, the pilot nature of the trial prohibits conclusions about efficacy. Conclusions: Results support that Peaceful Mind is ready for future comparative clinical trials.
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    Psychometric properties of a structured interview guide for the rating for anxiety in dementia
    (Routledge, 2012) Snow, A. Lynn; Huddleston, Cashuna; Robinson, Christina; Kunik, Mark E.; Bush, Amber L.; Wilson, Nancy; Calleo, Jessica; Paukert, Amber; Kraus-Schuman, Cynthia; Petersen, Nancy J.; Stanley, Melinda A.; University of Alabama Tuscaloosa; Baylor College of Medicine; University of Houston
    Objectives: The Rating Anxiety in Dementia (RAID; Shankar, K. K., Walker, M., Frost, D., & Orrell, M. W. (1999). The development of a valid and reliable scale for rating anxiety in dementia (RAID). Aging and Mental Health, 3, 39-49.) is a clinical rating scale developed to evaluate anxiety in persons with dementia. This report explores the psychometric properties and clinical utility of a new structured interview format of the RAID (RAID-SI), developed to standardize administration and scoring based on information obtained from the patient, an identified collateral, and rater observation. Method: The RAID-SI was administered by trained master's level raters. Participants were 32 persons with dementia who qualified for an anxiety treatment outcome study. Self-report anxiety, depression, and quality of life measures were administered to both the person with dementia and a collateral. Results: The RAID-SI exhibited adequate internal consistency reliability and inter-rater reliability. There was also some evidence of construct validity as indicated by significant correlations with other measures of patient-reported and collateral-reported anxiety, and non-significant correlations with collateral reports of patient depression and quality of life. Further, RAID-SI scores were significantly higher in persons with an anxiety diagnosis compared to those without an anxiety diagnosis. Conclusion: There is evidence that the RAID-SI exhibits good reliability and validity in older adults with dementia. The advantage of the structured interview format is increased standardization in administration and scoring, which may be particularly important when RAID raters are not experienced clinicians.