WANDERING AND ITS SEQUELAE--COGNITION AND AGITATION

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As an extension of current work, the goals of this study are to further improve the measurement strategy for wandering behavior and to extend the study of wandering in the context of rhythm theory. Level and type of cognitive impairment and agitation, viewed an endogenous pacers, are examined for their impact on wandering. Falls and elopements, outcomes of disrupted wandering rhythm, are also examined. Four biomechanical devices assessing activity are evaluated for their ability to substitute for direct observation in estimating wandering behavior. Using measures indicating level of cognitive impairment (Mini-Mental State Exam; Mattis Dementia Rating Scale; Reisberg Global Deterioration Scale; Test for Severe Impairment) and other instruments assessing the relative severity of right vs left hemispheric damage (Bloomer Block Assessment Protocol; Benton Visual Retention Test; Block Design and Object Assembly sub-tests of the Wechsler Adult Intelligence Scale-Revised), cognitive impairment is examined for its influence on variations in the rhythm, patterns, and sequelae of wandering behavior. Using a form of the Cohen-Mansfield Agitation Inventory, agitation status and type (verbal, physical, and physically nonagressive) are examined for influence on the same dependent variables. A descriptive survey design is used to obtain biomechanical measures of activity and to observe, time, and code wandering variables (rhythm, pattern sequelae) twice over two randomly assigned 4-hour time blocks (16 hours total) for each subject. The targeted population will be 268 cognitively impaired nursing home residents from 14 nursing homes.. Each subject will be categorized as to level of cognitive impairment (mild, moderate, severe), dominant impairment type (right vs left hemisphere), severity of agitation status (none through severe), and type of agitation (verbal, physical, physically nonagressive, or mixed), if agitated. Pearson correlates are planned to evaluate biomechanical devices against direct observation of wandering and between each other. Estimates of clinical acceptability will be refined through factors analyses and reliability assessed using Cronback's alpha. Clinical acceptability of devices will be evaluated using ANOVAs. As determined to be appropriate, analysis of variance techniques, logistical regressions and canonical correlation will be used to examine effects of cognition and agitation on wandering rhythm, pattern and sequelae.