Cleveland Clinic Science Internship Program Communicating with Dementia Patients of Different Severity Levels Michael Ciulla, Kurt Karis, CTRS, Tria O’Maille, MA. BC-DMT Department of Geriatric Behavioral Medicine, Euclid Hospital, Cleveland Clinic Research Question Hypothesis According to psychiatrists, communication with patients suffering from a type of dementia must be very direct and personal. The methods that are to be used in order to communicate with such patients are as follows: eye contact, slow, clear voice in a low tone, approaching patient from the front, and formulating simple questions which would require an answer of “yes” or “no” from the patient. The question presented in this research project is as follows: how effective are these means of communication in a patient with mild dementia, a patient with moderate dementia, and a patient with severe dementia? My hypothesis of the research question is that patients with mild dementia will be able to respond to the method of communication proposed by psychiatrists, while the patients with moderate dementia and severe dementia will not be able to respond to such communication in the same way in which the mild dementia patients responded. Methodology The Mini Mental State Exam (MMSE) will be used to evaluate cognitive function of the dementia patients. This exam will give a result out of 30 possible points. The score will be used to determine the loss of cognitive function in each patient. After the exam is completed and score is calculated, patients will be observed during a daily behavioral therapy session as well as a dance and movement therapy session. The way in which the patients respond to the therapists in these therapy sessions will show if these types of communication are effective for patients with different progressions of dementia. ResultsConclusions After observation in group therapy sessions, the following results could be expected: The patients with mild dementia would be able to communicate cognitively, verbally, and through creative expression with a wide to moderate range of movement The patients with moderate dementia would be able to communicate verbally, but with a more narrow vocabulary than that of the mildly demented patients, and most would be able to show some degree of creative expression with a moderate range of movement The patients with severe dementia would communicate verbally, but in short sentences followed by long pauses. At this stage in the disease, the patients’ vocabulary is especially limited. Few of these patients would be able to show creative expression, and if the patient were able, movement would be minimal MMSE Results The MMSE score is calculated out of 30 possible points A score of is considered normal, with little to no cognitive decline A score of is considered mild dementia, with cognitive ability beginning to decline A score of is considered moderate dementia, with a significant amount of cognitive ability lost A score below 10 is considered severe dementia, with the majority of cognitive ability lost The Mini Mental State Exam (above). This exam evaluates the patient's responses to questions regarding date and place orientation, memory and recall, understanding verbal and written commands, and drawing. Comparison of dementias in the United States. Alzheimer’s Disease is the most common form of dementia followed by vascular dementia. Alzheimer's disease, the most common form of dementia in the USA. MRI images through the midbrain of a normal 86-year-old athletic individual (A) and a 77-year-old male (B) with Alzheimer's disease. There is a reduction in the volume of the hippocampus of the patient with Alzheimer's disease (arrows) compared with that of the normal- for-age hippocampus of the older individual. The hippocampus stores long-term and short-term memory and when Alzheimer’s Disease is present, the hippocampus shrinks. This is why the first symptom of Alzheimer’s is memory loss. Acknowledgements Kurt Karis, CRTS Tria O’Maille, MA, BC-DMT Upma Dhingra, MD Nursing staff of Behavioral Medicine at Euclid Hospital Nedra Starling Rosalind Strickland Patrick Finnegan Office of Civic Education Initiatives