PROBLEMATIC VOCALIZATIONS--BACKROUND AND PROXIMAL FACTOR

痴呆症患者经常表现出有问题的发声和其他与痴呆症相关的行为，使环境中的其他人感到困惑、沮丧或恼火。这些行为往往会给患者带来负面后果，照顾者缺乏基于理论的干预措施来解决这些问题。基于广泛的文献综述，我们的互动研究项目组将它们重新定义为基于需求的痴呆症妥协行为(NDB)，我们现在建议检查预测哪些痴呆症患者最有可能展示它们的变量，以及在什么情况下最有可能发生这些行为。我们的研究是三个互动项目之一，其目的是开发一个有问题的发声的初步解释模型，作为有针对性的干预措施的经验测试的基础，最终将改善痴呆症患者及其照顾者的生活质量。我们的具体目标是：1)建立影响痴呆症患者问题发声的背景(相对稳定)和近端(更可变)变量的模型；以及2)评估我们的问题发声测量的收敛有效性；与科恩-曼斯菲尔德激动量表的言语激越行为相结合。采用多元横断面描述性设计，随机抽取9家养老院的236名居民作为研究样本。背景变量的测量包括与参与者和同意的家庭告密者一起进行的体检和器械。邻近变量的测量包括图表查看、对参与者的提问、对环境氛围的评估，以及对参与者的运动、环境光、噪声和热指数的机械测量。有问题的发声措施将来自14个10分钟的观察过程中制作的录像带和录音带。分层线性模型将被用来测试有问题的发声模型。由此产生的初步模型将在为相关项目获得的两个独立样本中进一步测试。此外，将结合三个互动项目共有的一组核心背景因素和邻近因素的数据，以开发一个在一般情况下产生国家数据库的因素模型。

Persons with dementia display frequent problematic vocalizations and other dementia-related behaviors that perplex, dismay, or annoy others in the environment. These behaviors often lead to negative consequences for the patient, and caregivers lack theoretically-based interventions to address them. Based on an extensive literature review, our interactive research project group has reconceptualized them as need-based dementia-compromised behaviors (NDBs) and we now propose to examine variables that predict which persons with dementia are most at risk for displaying them and under what conditions they are most likely to occur. The purpose of our study, one of a trio of interactive projects is to develop a preliminary explanatory model of problematic vocalizations that will serve as a basis for empirical testing of targeted interventions that ultimately will improve the quality of life for persons with dementia and their caregivers. Our specific aims are to: 1) develop a model of background (relatively stable) and proximal (more changeable) variables affecting problematic vocalizations in persons with dementia; and 2) assess convergent validity of our measures of problematic vocalizations; with the verbally agitated behaviors of the Cohen- Mansfield Agitation Inventory. Using a multivariate cross-sectional descriptive design, we will enroll a cluster sample of 236 residents from nine randomly selected nursing homes. Measures of background variables include physical examination and instrumentation with participants and a consenting family informant. Measures of proximal variables include chart review, questioning of participants, assessment of environmental ambiance, and mechanical measurements of participants' movement, environmental light, noise, and heat index. Measures of problematic vocalizations will come from videotapes and audiotapes made during 14 ten-minute observations. Hierarchical linear modeling will be used to test a model of problematic vocalizations. The resulting preliminary model will be further tested in two independent samples obtained for the accompanying projects. Further, data from a core set of background and proximal factors common across the three interactive projects will be combined to develop a model of factors operative in producing NDBs in general.