The Effectiveness of an Environmental and Behavioral Approach to Treat Behavior Problems in a Patient with Dementia with Lewy Bodies: A Case Study

Abstract

This case describes and reports the effects of a multi-component collaborative intervention to treat difficult behaviors in a 79-year-old woman with dementia with Lewy bodies (DLB). To assess for cognitive status and disruptive behavior patterns, we collected a cognitive screen, history of presenting illness, and measures of behavior problems prior to the intervention. The intervention included 32 weekly 1-hour sessions with the patient, 1-hour sessions with the patient's assigned caregiver and regular interactions with the patient's family and medical treatment team. All sessions were conducted at the patient's long-term residential care facility. We assessed behavior disturbances with the Cohen-Mansfield Agitation Inventory (CMAI). We assessed functional abilities with the Katz Activities of Daily Living (K-ADL), and assessed cognitive function with the Mini-Mental Status Exam (MMSE). At the closing session (week 32) caregiver ratings indicated significantly reduced scores on the CMAI (Baseline = 75 to Endpoint = 30) and maintenance in ADLs (Baseline=3 to Endpoint=3). Caregivers reported enhanced efficacy in treating behaviors and improvement in their relationship with the patient. Results demonstrate the benefits of a multi-component collaborative intervention, based on an enhanced environment and behavioral approach, in treating behavior problems related to DLB.

Figure 1

Cohen-Mansfield Agitation Inventory (CMAI) Total Scores.* ^*Notes: 1) A total score of 30 would indicate that the client never showed any of the presented disruptive behaviors in the past week. A high of 120 points is possible. 2) Although outcome measures were acquired every two weeks, the figures demonstrate behaviors at the beginning of each month to facilitate data presentation.

Figure 2

Change scores on target behaviors at baseline on the CMAI. Scores: 1=Never, 2=Less than once a week, 3= One or two times a week, 4=Several times a week, 5=Once or twice a day, 6=Several times a day, 7=Several times an hour.