title: Good days and bad days in dementia: a qualitative chart review of variable symptom expression.
abstract: BACKGROUND
  Despite its importance in the lived experience of dementia, symptom fluctuation has been little studied outside Lewy body dementia. We aimed to characterize symptom fluctuation in patients with Alzheimer's disease (AD) and mixed dementia.
  
  
  METHODS
  A qualitative analysis of health records that included notations on good days and bad days yielded 52 community-dwelling patients (women, n = 30; aged 39-91 years; mild dementia, n = 26, chiefly AD, n = 36).
  
  
  RESULTS
  Good days/bad days were most often described as changes in the same core set of symptoms (e.g. less/more verbal repetition). In other cases, only good or only bad days were described (e.g., no bad days, better sense of humor on good days). Good days were typically associated with improved global cognition, function, interest, and initiation. Bad days were associated with frequent verbal repetition, poor memory, increased agitation and other disruptive behaviors.
  
  
  CONCLUSIONS
  Clinically important variability in symptoms appears common in AD and mixed dementia. Even so, what makes a day "good" is not simply more (or less) of what makes a day "bad". Further investigation of the factors that facilitate or encourage good days and mitigate bad days may help improve quality of life for patients and caregivers.
authors.affiliation: Geriatric Medicine Research Unit,Capital District Health Authority and Dalhousie University,Halifax,Nova Scotia,Canada.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
authors.affiliation: Geriatric Medicine Research Unit,Capital District Health Authority and Dalhousie University,Halifax,Nova Scotia,Canada.
authors.forename: Sherri
authors.initials: S
authors.lastname: Fay
authors.affiliation: Geriatric Medicine Research Unit,Capital District Health Authority and Dalhousie University,Halifax,Nova Scotia,Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Hamilton
authors.affiliation: Geriatric Medicine Research Unit,Capital District Health Authority and Dalhousie University,Halifax,Nova Scotia,Canada.
authors.forename: Elyse
authors.initials: E
authors.lastname: Ross
authors.affiliation: Geriatric Medicine Research Unit,Capital District Health Authority and Dalhousie University,Halifax,Nova Scotia,Canada.
authors.forename: Paige
authors.initials: P
authors.lastname: Moorhouse
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001526:Behavioral Symptoms / Q000209:etiology*; D017028:Caregivers / Q000523:psychology; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D003704:Dementia / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008501:Medical Records, Problem-Oriented; D016743:Mental Competency; D008875:Middle Aged; D010507:Periodicity; D011569:Psychiatric Status Rating Scales; D011595:Psychomotor Agitation / Q000209:etiology; D011788:Quality of Life; D012189:Retrospective Studies