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Article Excerpt
Dementia is characterized by memory impairments and cognitive deficits affecting conversational discourse skills. The discourse of individuals with dementia has been described as lacking thematic structure and limited in the number of ideas produced. This investigation assessed the effect of memory books on the number of on-topic facts stated for three topics (life, family, and day), by four individuals with severe dementia who resided in a residential facility. A multiple baseline design across communication behaviors revealed that all subjects stated more on-topic facts using the memory books than during the baseline condition. Subjects' improvement varied according to the topic and the amount of time spent with the memory book. These results were obtained with minimal cues and without intensive training. Therefore, the results of this study support the clinical utility and potential of memory books to facilitate communication skills, even for individuals with severe dementia.
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A dominant feature of dementia is memory impairment, and the communication deficits associated with dementia are often attributed to these significant memory deficits (Swihart & Pirozzolo, 1988). Such memory deficits contribute to conversational discourse that has been described as confused, incoherent, perseverative, and ambiguous with few factual and on-topic statements (Appell, Kertesz, & Fisman, 1982; Bayles & Kaszniak, 1987; Ripich & Terrell, 1988). These communication deficits can render it difficult for listeners to retrieve and understand the spoken message, and thus interfere substantially with meaningful interactions between the individual with dementia and others (Bourgeois, 1990, 1992; Fromm & Holland, 1989). Although the cognitive and language deficits associated with dementia are well documented, there is little agreement as to how to effectively manage these deficits and thus improve the quality of interactions with family, friends, and caregivers.
In this regard, memory aids have recently received attention as useful tools to improve the communication skills of individuals with dementia. Bourgeois (1990, 1992, 1993, 1996) has pioneered this research effort and has conducted several investigations to assess the effectiveness of memory wallets and memory books to improve conversational skills. In her original 1990 study, she reported that individuals with moderate dementia made more factual statements and fewer ambiguous utterances after they had been trained to use memory wallets in conversation with familiar partners. In research expanding on her original study, Bourgeois (1992) determined that less intensive training with the memory wallets also produced an increase in statements of factual information and a decrease in ambiguous statements when conversing with caregivers. The nine subjects, who lived at home or in a "personal care" facility, were judged to have mild-to-moderate dementia. The results also indicated that the observed improvements were maintained at 24 to 30 months following the treatment phase of the study.
Soon after, Bourgeois (1993) confirmed that quality of information content improved when six individuals with moderate-to-severe dementia were trained to use memory wallets when communicating with partners who also had dementia. This study was conducted in an adult daycare for four subjects and a nursing home for the other two subjects. Later, Bourgeois (1996) reported that individuals with mild and severe dementia increased the number of factual statements and decreased ambiguous, unintelligible, and perseverative utterances when using memory wallets with daycare center volunteers. Hence the presence of the memory aid, without intensive training, improved the conversation skills of individuals with mild and severe dementia. However, because of the small number of individuals classified as severely demented (N = 2), more information regarding the effects of memory books (without intensive training) with severely involved individuals is needed.
In addition to the work of Bourgeois, other researchers have begun to assess the benefits of memory books for dementia. Allen-Burge and colleagues (2001) recently evaluated the effects of memory books (along with communication skills training for nursing staff) for nursing facility residents with moderate dementia. Although the intervention was sporadic due to nursing staff turnover, some important improvements were observed. First, there was an increase in the amount of time spent talking with the residents by individuals other than nursing staff. Second, there was an...
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