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Conditions Associated with Wandering in People With Dementia From the Viewpoint of Self-Awareness: Five Case Reports

Originally Published:
2012
Key Point Summary
Key Point Summary Author(s):
Varadarajan, Ranjani
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Key Concepts/Context

One of the conditions of behavioral and psychological symptoms of dementia (BPSD), namely, wandering, which can trigger a need for institutionalization and can cause traffic accidents was investigated.

Objectives

To study the words and actions of five people admitted to long-term health care facilities who often exhibited wandering behavior based on authors' self-awareness model (consisting of ‘‘theory of mind,’’ ‘‘self-evaluation,’’ and ‘‘self-consciousness’’).

Methods

Authors observed and recorded the words and actions of the five participants for three days (from 9 a.m. to 6 p.m.). Assessments included:

  • Presence or absence of theory of mind was judged using four picture cards that required using presence of mind.
  • Presence or absence of self-consciousness was assessed by depicting actions that drew attention to the subject.
  • Presence or absence of self-evaluation was based on understanding basic rules and standards of (Japanese) society as seen from four pairs of picture cards, one pair at a time.


Assessment of the Severity of Impairment in General Cognitive Function was using the Clinical Dementia Rating.
Participants were classified into four stages:

  • Those who had passed the theory of mind task
  • Those who had not passed the theory of mind task but had passed the self-evaluation tasks
  • Those who had not passed the self-evaluation tasks but had passed the self-consciousness tasks
  • Those who had not passed the self-consciousness task

Next, scenes of wandering and scenes related to self-awareness apart from that of wandering were put in order for each participant and the conditions associated with wandering were investigated.
 

Design Implications
In the absence of self-evaluation, not only is the purpose of wandering lost but the person also becomes unaware of his or her own decrease in intellectual functions, resulting in a marked decrease in a sense of pride or shame. Therefore, one becomes unable to show persistent irritation and anxiety. As a result, wandering caused by irritation or depression and anxiety is unlikely to occur, which contradicts the very conditions associated with wandering, i.e., irritation and depression
Findings

One person who had not passed the theory of mind task but had passed the self-evaluation task was aware of her wandering but she could not understand where she wanted to go or for what purpose. 

Limitations

According to authors, the model of this article is based on the lower levels of self-awareness. 

Outcome Category
Patient / resident health outcomes
Key Point Summary Author(s):
Varadarajan, Ranjani
Primary Author
Yokoi, T.