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Cognitive Predictors of Resistiveness in Dementia Patients

Received July 22, 1997; revised July 2, 1998; accepted October 26, 1998. From the Bay Pines VA Medical Center, Bay Pines, FL, and the University of South Florida College of Medicine. Address correspondence to Dr. Stewart, Chief, Geropsychiatry Section, Bay Pines VA Medical Center (116A), Bay Pines, FL 33744.

Resistiveness to physical care among patients with dementia is a common and burdensome problem. Forty-nine nursing home residents with dementia were administered the Mini-Mental State Exam (MMSE) and the Royall Executive Interview (EXIT), a specific test of frontal-subcortical function. Nurses rated resistiveness on every shift for 3 days. Correlation with resistiveness ratings was stronger for the EXIT (r=0. 73) than for the MMSE (r=–0. 46); logistic modeling found the EXIT to be a strong independent predictor of resistiveness. Executive dysfunction as measured by the EXIT is a major determinant of resistiveness to care in long-term care residents with dementia, possibly as a result of such patients' tendency toward inertia.

Key Words: Long-Term Care • Dementias (General) • Treatment Compliance

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