Abstract
This study clarified the characteristic autonomic nervous activity of institutionalized elders diagnosed with dementia using Hasegawa’s Dementia Scale-Revised. Twenty-six healthy adult persons (HPs) in their 20 s - 40 s met the inclusion criteria, and 16 persons (27.6 ± 8.2 years old) completed the research procedure. Of 70 persons with dementia (PDs) residing at the one geriatric health services facilities, only 24 persons met the inclusion criteria, and only nine (N = 9, 83.44 ± 9.45 years old) completed the procedure. Actigraph and ambulatory electrocardiographic instruments measuring autonomic nervous activity were attached to the subjects for 24 hours. Activities and behaviors of PDs and HPs were observed by clinically experienced staff nurses and care workers. High frequency (HF) power indicating parasympathetic activity and LF/HF ratio indicating sympathetic activity were calculated. When awake, PDs’ LF/HF ratio was significantly lower than HP’s (Z = -2.60, p < 0.01), showing significant differences in the LF/HF ratios between waking and sleeping, more than those of the PDs (p < 0.001). Similarly, when awake, significant positive correlations were observed in the LF/HF ratio and actigraph activity count (AC) in 11 HPs and 3 PDs (range r = 0.17 to 0.49, p < 0.05); however, significant negative correlation was found in HF and AC of 12 HPs and 3 PDs (range r = -0.55 to -0.18, p < 0.05). While sleeping, significant positive correlations were observed in LF/HF and AC of 3 HPs and 1 PD (range r = 0.35 to 0.42, p < 0.05) and significant negative correlation was found in the HF and AC of 1 HP (r= -0.32, p < 0.001) and 1 PD (r = -0.32, p < 0.05). The mean value of LF/HF in a wakeful state was significantly lower for PDs than HPs. Combined results of behavioral observation, actigrapy and heart rate variability (HRV) analyses suggested that PDs showed positive correlations between LF/HF and AC in a wakeful state. Compared to those who showed no positive correlation, they did not require much nursing care.
Highlights
In Japan, 20 percent of elderly persons with dementia who enjoy nursing service benefits from the nursing care insurance system live in neighborhood nursing facilities [1]
Significant positive correlation between LF/High frequency (HF) and activity counts (AC) was observed in 3 PDs: No 4 (r = 0.32, p < 0.001), No 7 (r = 0.17, p < 0.05), and No 8 (r = 0.31, p < 0.001)
Significant negative correlation between HF and AC was observed in 3 PDs during waking time
Summary
In Japan, 20 percent of elderly persons with dementia who enjoy nursing service benefits from the nursing care insurance system live in neighborhood nursing facilities [1]. Geriatric health services facilities are places where many elderly Japanese persons with dementia are admitted in order to receive nursing services that might enable them to live at home again [2]. Facilities that accept elderly persons with dementia offer rehabilitation and recreation programs to enable them to maintain and improve their physical functioning and to alleviate symptoms of dementia [5]-[7]. Treiberet et al [8] reported that active cognitive stimulation might keep the functioning of persons with dementia from outright degeneration. Physical activities such as walking, housework or gardening were found to be effective for persons with dementia suffering from depression [9]. In addition to the primary symptoms of memory disorder and disorientation [10] [11], patients with Alzheimer’s dementia, show behavioral and psychological symptoms of dementia (BPSD) [12] [13] such as daytime drowsiness, nighttime delirium, and irritability [14] [15]
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