Wandering in Alzheimer's Disease: Clinical and Neurobiological Perspectives
Jeanne P. Ryan State University of New York at Plattsburgh
Alzheimer's disease is the primary cause of dementia in the United States, with prevalence estimates at 0.5% in individuals aged 65 years, increasing to 3% at age 75 and 10% at age 85 ( Breteler, Claus, van Duijn, Launer, & Hofman, 1992). During the course of the disease, the Alzheimer's disease patients exhibit a sequence of neurobehavioral disturbances. The loss of recent memory emerges at the onset of the disease and continues to deteriorate as the disease progresses. A behavior referred to as "wandering" also emerges in the early stages and is exacerbated during the course of the disease. The memory loss, one of the disease's cognitive differential diagnostic markers, has received considerable attention in the scientific literature ( Chui, 1989; Khachaturian, 1985). In contrast, although wandering is another characteristic feature that has been reported as a primary problem by over 70% of the caregivers, it has received scant attention by the scientific community ( Cummings & Victoroff, 1990).
Wandering poses a tremendous burden on caregivers, who must be continually vigilant to the activities of the patients. Wandering Alzheimer's patients engage in greater movement, sometimes described as hyperactive ( Dawson & Reed, 1987; Snyder, Ruppercht, Pyrek, Brekus, & Moss, 1978), and are at greater risk of injury to themselves and to others. They are three times more likely to sustain a hip injury or to contribute to accidents ( Buchner & Larson, 1987). Patients living at home become unmanageable, which makes wandering the primary reason for the institutionalization of the patients during the mild to moderate stages of the disease ( Light & Lebowitz, 1989).