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• W4256204493 abstract "To the Editor:—Dr Gilleard's letter raises four points that will be addressed in order. . Caregivers of DAT patients do not face unique problems. While we agree that problems faced by caregivers of DAT patients may be similar to problems faced by caregivers of patients with comparable cognitive deficits, we do not agree that their problems are similar to all other “diagnostic groups.” This may be a fundamental difference of opinion, since all of the studies Dr. Gilleard cites are studies which combine highly diverse diagnostic groups (including patients with dementia and those with amputations, arthritis, diabetes, hemiplegia, and nondefined “functional,” “organic,” “psychiatric,” and “physical” illnesses) with no discussion of how these diverse groups differ. Whether DAT patients are, or are not, unique is a legitimate question for empirical scrutiny as well as clinical examination. We believe there are likely to be important differences in demands presented by DAT patients. Further, the more we learn of DAT the more heterogeneous it appears.1-3 Studies of DAT may benefit from more specificity, not less. . References 2–6 provide a “greater degree of specificity in problem description.” A number of major differences between the five references cited by Dr Gilleard and our study preclude any comparison of specificity. As already discussed, all references cited by Dr. Gilleard group an array of diagnostic conditions together. In addition, no study provided any information on cognitive status, thereby no information is available on the relationship of behavioral problems to level of cognitive function (a focus of our study). Finally, the studies cited by Dr Gilleard relied on caregiver report, rather than direct patient observation; used samples selected from psychiatric and/or geriatric hospitals, rather than outpatient settings (the one exception to this was Sainsbury et al (1970) which reviewed a hospital-based home and outpatient service); and involved patients from England and Scotland, rather than from the US. Any one of these latter differences may not be significant, but combined they cause us to suspect the relevance of these citations to our study. (It should be noted that these are not criticisms of the studies themselves. They were simply not designed to test the same hypotheses we put forth.) . … “the modal number of problems presented by severely demented people is 1.” Table 1 of our study indicated that for severely demented patients the modal number of problems was 4 out of 8 problems evaluated. That table also indicated that 55% of patients had four or more problems. . Readers should turn to “other resources,” such as the references cited. While the citations provided by Dr Gilleard are interesting, they do not (nor did they intend to) address the substantive issues raised by Teri et al.4 However, instead of suggesting readers turn to one or the other article, we encourage readers to turn to as many additional resources to gather as much information as possible. There is an ongoing need to provide empirical data on the problems faced by DAT patients and their caregivers. We need reliable information to help patients, caregivers and health care professionals manage the problems they encounter. Only in this way can we learn how to improve the care of patients and further our understanding of the disease." @default.
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• W4256204493 date "1988-11-01" @default.
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• W4256204493 doi "https://doi.org/10.1111/j.1532-5415.1988.tb04386.x" @default.
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