A literature review of spirituality in coping with early-stage Alzheimer's disease

The expectations and experiences of patients regarding the diagnostic workup at a specialized memory clinic: An interview study

BACKGROUND

Because of the shift towards earlier diagnosis of dementia and/or Alzheimer's disease (AD), increasing numbers of individuals with subjective cognitive decline (SCD) and mild cognitive impairment (MCI) are seen in memory clinics. Yet, evidence indicates that there is room for improvement when it comes to tailoring of the diagnostic work-up to the needs of individual patients. To optimize the quality of care, we explored patients' perspectives regarding the diagnostic work-up at a specialized memory clinic.

METHODS

This interview study was conducted at Karolinska University Hospital (Sweden). The comprehensive diagnostic work-up for dementia at the memory clinic in Solna is conducted within 1 week. A sample of 15 patients (8 female; mean age = 61 years [range 50-72]; 11 SCD, 1 MCI and 3 AD dementia) was purposively selected for a series of three semistructured interviews, focussing on (1) needs and expectations (during the week of diagnostic testing), (2) experiences (within 2 weeks after test-result disclosure) and (3) reflections and evaluation (3 months after disclosure). Transcribed audio-recorded data were analyzed using thematic content analysis (using MaxQDA software).

RESULTS

Three key themes were identified: (1) the expectations and motivations of individuals for visiting the memory clinic strongly impacted their experience; (2) the diagnostic work-up impacted individuals psychosocially and (3) the diagnostic work-up provided an opportunity to motivate individuals to adopt a healthier lifestyle.

CONCLUSION

Our findings underscore the importance of enquiring about the expectations and needs of individuals referred to a specialized memory clinic, allowing for expectation management and personalization of provided information/advice, and potentially informing the selection of patients in need of a comprehensive diagnostic work-up. Structural guidance might be needed to support those with SCD and MCI to help them cope with uncertainty, potentially resolve their issues, and/or stimulate brain health.

PATIENT OR PUBLIC CONTRIBUTION

We gathered the perspectives of 15 individuals who had been referred to the memory clinic at three different time points through semistructured interviews, and these interviews were the primary data source.

Better spiritual support for people living with early stage dementia: Developing the diamond conversation model

BACKGROUND

People with early-stage dementia could benefit greatly from on-going spiritual support. However, health care professionals working in dementia care often do not have a clear idea of what such support might entail. There is a lack of tools that can help professionals provide such support. The Diamond conversation model used in palliative care could provide such a support. Aims: To develop the Diamond model for early-stage dementia so that professionals can provide better spiritual support.

METHODS

Participatory research was conducted. Reflective interviews with chaplains, case managers and health psychologists identified frequently occurring existential and spiritual issues of clients and family members. A core participatory group consisting of chaplains, a psychologist and a researcher further analysed these issues thematically and co-developed the Diamond model for early stage dementia over three co-creation sessions. Researchers with Diamond model expertise provided feedback to the core participatory group in between these sessions based on the session output.

FINDINGS

Central existential and spiritual issues were found to be: self-confidence and -worth, adaptability and capacity, security and loss, burden and enrichment of memory and faith and meaning. The five polarities of the Diamond model were found helpful to understand tensions surrounding these issues. Specific tensions were identified between maintaining a self and being valued, finding direction in what to do and a way to bear changes in ability, a strong need for attachment and letting go of past ways to relate to one another, the renewed intensity of long term memories and decline of the short term ones and surrendering to one's life situation and wanting certainty and meaning.

CONCLUSIONS

The newly developed Diamond model for people with early-stage dementia offers a valuable framework to help professionals provide conversational support. More research needs to be done to further test and develop the model in practice.

The Role of Religion and Spirituality to Cope with COVID-19 Infections Among People of Lower Socioeconomic Status in Pakistan: An Exploratory Qualitative Study

Religion and spirituality have been key coping mechanisms of Pakistani Muslims amidst natural calamities such as the COVID-19 pandemic. This study aimed to identify and explore the role of religion and spirituality in the recovery of COVID-19 patients in lower socioeconomics. The data for this qualitative research study were collected from 13 people in Pakistan who survived COVID-19 infection during the wave of the Omicron variant. The participants of this study referenced four key themes about their story of getting infected by COVID-19 and recovering from it and referenced religion and spirituality as an overarching aspect of that story. The patients who recovered believed that COVID-19 was a punishment from God for sinful humanity, which was unavoidable. Amidst such a belief, the studied patients tried to avoid hospitalization but prayed to God for mercy, forgiveness, and help in their recovery. A few who took medical treatment also established and/or strengthened their spiritual connections seeking quick recovery from the infection. The participants of this study believed that their religion or spirituality played a medicinal role in their recovery from COVID-19 infection.

Spiritual Needs of Older Adults Living with Dementia: An Integrative Review

Older adults living with dementia experience progressive decline, prompting reliance on others for spiritual care and support. Despite a growing interest in studying persons living with dementia (PLwDs), empirical evidence on the spiritual needs of PLwDs has not been synthesized. Using the Whittemore and Knafl method, this integrative review examined the literature from 2000 to 2022 on the spiritual care needs of PLwDs. We sought to identify characteristics of the spiritual needs of PLwDs and ways to address them. The ATLA Religion, CINAHL, PsycINFO, PubMed, and Socindex databases were used to search the literature, and 12 peer-reviewed articles met the inclusion criteria. Spiritual care needs varied across studies. Overall, findings support the importance of identifying PLwDs' religious and spiritual backgrounds to inform person-centered care. Spiritual needs were identified as verbal and non-verbal expressions related to past meaning and religious and spiritual background and were not consistently addressed in care. Providers reported observing spiritual distress in the mild stage prompting the need for spiritual care. There is a great need for dementia-specific spiritual assessment tools and spiritual care interventions to support spiritual well-being in dementia care. Spiritual care involves facilitating religious rituals and providing spiritual group therapy and religious and spiritual activities.

The Role of Religiosity and Spirituality in Helping Polish Subjects Adapt to Their Tinnitus

This study aims to assess whether religiosity and spirituality might be significant internal resources that help people with tinnitus to adapt to their condition. The study group comprised 256 Polish patients with tinnitus (123 women and 133 men) who answered the Tinnitus Handicap Inventory and Tinnitus Functional Index (both of which measure tinnitus annoyance) and the Self-Description Questionnaire (which measures: religious attitudes, ethical sensitivity, and harmony). Significant positive correlations between religious attitudes and tinnitus annoyance were found in subjects with tinnitus. The higher the religiosity, the higher tinnitus the annoyance, at least in the two TFI questionnaire dimensions: sense of control and quality of life (although these correlations were statistically significant only for men). Religiosity was found to be a positive predictor of tinnitus annoyance. Also, ethical sensitivity positively predicted tinnitus annoyance, whereas harmony was a negative predictor. We suggest that psychologists and audiologists should, in their diagnostic and therapeutic work with patients with tinnitus, pay attention to the religious and spiritual aspects of their patients' lives.

Worth-Conscious theory: Understanding the role of birthright self-worth and application to clinical practice

In this article, we introduce a theory of worth consciousness that builds on the research from self-worth with attention to the importance of honoring birthright self-worth (BSW), which is foundational to human dignity. This new empirically testable construct, Worth-Conscious theory (WCT), concerns human worth and requires individuals to recognize and acknowledge their value and significance (i.e., worth) even when smaller (e.g., family) and larger (e.g., community and society) systems fail to support them in affirming and repairing their worth. Self-worth is the birthright of all individuals; hence our central aim is to introduce and explain the four pillars of self-worth, which are major tenets of WCT that align with Erikson’s developmental stages. These four pillars of self-worth (self-awareness, self-respect, self-esteem(ed), and self-confidence) are instrumental in understanding clients’ life challenges, presenting issues, and how to assist them in repairing and maintaining their worth. More specifically, many clients’ mental health issues, interpersonal conflicts, and other concerns can be directly or indirectly related to the experience of negative and critical beliefs about their worth and, more specifically, that their BSW has not been affirmed or realized throughout the lifespan.

'Redeemed' or 'isolated': A systematic review of the experiences of older adults receiving a mild cognitive impairment diagnosis

BACKGROUND

Understanding the experiences of older adults living with MCI can benefit healthcare professionals in diagnosing and implementing early interventions to delay cognitive decline.

OBJECTIVE

To assess and synthesize qualitative research exploring the experience of older adults diagnosed with MCI.

METHODS

PubMed, Embase, CINAHL, Web of Science, and PsycINFO databases were searched. Studies involving the experience of being diagnosed with MCI in older adults were included. Thomas and Harden's methodology of synthesizing qualitative studies was used.

RESULTS

Eleven studies were included. Three themes were identified: perceived reality of the MCI diagnosis; emotional and psychological responses to the MCI label; coping engaged in parallel processing. Older adults had confusing perspectives on the MCI diagnosis, leading to complicated and diverse emotional reactions and coping measures.

CONCLUSIONS

The relationship between perspectives, emotional reactions, and coping methods might be the key for healthcare professionals to break through the early diagnosis and intervention of MCI.

The role of spirituality and religiosity on the cognitive decline of community-dwelling older adults: a 4-year longitudinal study

OBJECTIVES

This study aims to assess whether having religious beliefs, attending religious services and using spiritual-religious coping (SRC) are longitudinally associated with cognitive decline in community-dwelling older adults.

METHODS

A 4-year longitudinal study of 261 Brazilian older adults was conducted. Hierarchical adjusted linear regression models and logistic regression models were performed to evaluate the longitudinal effects of religious beliefs, church attendance and positive and negative SRC on cognitive decline.

RESULTS

The findings revealed that spiritual and religious beliefs at baseline could affect cognitive function in two different ways. When older adults use religiosity and spirituality (RS) in a functional positive manner, it results in better cognitive outcomes and a slower rate of decline. However, when used in a negative manner, it results in worse cognitive outcomes.

CONCLUSION

These results could help health care professionals address SRC among older adults, particularly those at a higher risk of cognitive decline. Considering that RS is very important for older adults, health care professionals should be aware of the beliefs of their patients and address RS in clinical practice.

The spiritual experience of dementia from the health care provider perspective: Implications for intervention

BACKGROUND AND OBJECTIVES

Spiritual care aims to counter negative outcomes from spiritual distress and is beneficial to persons living with dementia. Such care needs dementia-appropriate customization. We explored the salient spiritual needs in dementia to inform future intervention development. Health care providers are well-situated to observe the nature of spiritual needs across and within medical conditions.

RESEARCH DESIGN AND METHODS

We conducted semi-structured qualitative interviews with providers. We sampled purposively by discipline (chaplains, nursing staff, social workers, activities professionals) and religious tradition (for chaplains). Our interview guide inquired about, e.g., the nature of spiritual needs in dementia and stakeholders' roles in addressing them. Inductive / deductive thematic analysis was employed.

RESULTS

Twenty-four providers participated. The thematic structure consisted of two themes: 1) spiritual experience in dementia differs from that in other medical conditions (sub-themes: fear, profound loss of self, progressive and incurable nature, and impacted ability to access faith); and 2) the need for spiritual intervention at the mild stage of dementia (sub-themes: awareness in mild dementia and its influence on spiritual distress, and a window of opportunity).

DISCUSSION AND IMPLICATIONS

We learned about the potential "what" of spiritual needs and "who" and "when" of implementing spiritual care. Implications included the imperative for dementia-specific spiritual assessment tools, interventions targeting fear and loss of self early in symptom progression, and stakeholder training. Researchers should study additionally the "how" of dementia-appropriate spiritual care. Conjointly, these efforts could promote spiritual well-being in persons living with dementia worldwide.

A Qualitative Exploration of the Needs of Community-Dwelling Patients Living with Moderate Dementia

Few studies have focused on developing a better understanding of the needs of patients with moderate-stage dementia. This study aimed to explore the needs of people living with moderate dementia and receiving home-care services from a local mental hospital. The study adopted a descriptive qualitative approach with purposive sampling to recruit patients with moderate dementia and receiving home-care services. Data were collected by face-to-face interviews and content analysis was used to interpret the experiences in the dialogue data. The results showed that the needs of people living with moderate dementia receiving home-care services contained four themes: the demand for company and care, the wish to recall familiar images, the need of reaffirming life purpose and value through reflection and reminiscence, and the desire for making autonomous end-of-life decisions. In addition to daily care, people living with moderate dementia crave companionship, expect meaningful exchanges of experiences to share their life, and have demands to have a voice in going through the final stage of life. The participants tended to focus more on issues related to the connections between living and dying. The results provide caregivers and home-care service providers with some insights into offering better care for people living with moderate dementia.

Neuroprotective potential of Malva neglecta is mediated via down-regulation of cholinesterase and modulation of oxidative stress markers

Alzheimer's disease affects daily routine due to loss of memory and decline in cognition. In vitro data showed acetylcholine esterase inhibition activity of Malva neglecta but no in vivo evidence is available. The current study aims to investigate the anti-Alzheimer's activity of Malva neglecta methanolic extract in the AlCl₃-induced Alzheimer disease rats' model. Thirty Wistar rats were divided into six groups and respective doses were given orally for 21 days. Behavioural observations were recorded and biochemical analysis was performed on brain homogenate. Improvement in memory and cognition was noted in treated rats as compared to disease control. A dose-dependent decrease (0.530 ± 0.009 at 200 mg/kg, 0.212 ± 0.007 at 400 mg/kg, 0.173 ± 0.005 at 600 mg/kg) in AChE activity was noted in the treatment groups with reference to disease control value (1.572 ± 0.013). This decrease in AChE activity is linked with an increase in acetylcholine in the brain which plays a key role in retaining memory. Oxidative stress biomarkers; GSH (66.77 ± 0.01 at 600 mg/kg), SOD (26.60 ± 0.10 at 600 mg/kg), CAT (21.46 ± 0.01 at 600 mg/kg) levels were increased with a decrease in MDA (103.33 ±0.49 at 600 mg/kg) level in a dose-dependently manner in the treatment groups as compared to disease control respective values. It is concluded that Malva neglecta could ameliorate Alzheimer's symptoms possibly by decreasing AChE activity and oxidative stress.

Quality of life in patients with mild Alzheimer disease: the mediator role of mindfulness and spirituality

OBJECTIVES

This study examined the mediator role of mindfulness and spirituality in the relationship between psychological morbidity, awareness of the disease, functionality, social support, family satisfaction, and quality of life (QoL) in patients with mild AD.

METHOD

The sample consisted of 128 patients who answered the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R), the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), the Hospital Anxiety and Depression Scales (HADS), the Satisfaction with Social Support Scale (SSSS), the Family Satisfaction Scale (FSS), the Spiritual and Religious Attitudes in Dealing with Illness (SpREUK), the Index of Barthel, and the Quality of Life-Alzheimer's Disease (QoL-AD).

RESULTS

Mindfulness and spirituality mediated the relationship between functionality, awareness of the disease, family satisfaction and QoL. Psychological morbidity had a direct negative impact on QoL and was negatively associated with awareness of the disease, family satisfaction and social support. Mindfulness was negatively associated with spirituality and the latter was negatively associated with QoL. More social support was associated with greater awareness of the disease and family satisfaction. More functionality, awareness of the disease and family satisfaction contributed to more QoL and this relationship was mediated by mindfulness and spirituality.

CONCLUSION

Interventions directed at the promotion of the QoL of patients with mild AD should focus on the promotion of mindfulness skills in AD patients, in addition to the reduction of psychological morbidity and the promotion of functionality, awareness of the disease, family relationships and social support.

Predictors and Moderators of Quality of Life in Alzheimer's Disease Patients

BACKGROUND

Alzheimer's disease (AD) is a chronic degenerative disease leading to global cognitive and functional decline. Quality of Life (QOL) is an important variable in the effectiveness of intervention programs in dementia.

OBJECTIVE

This study analyzed the relationships between gender, psychological variables and QOL, the predictors of QOL, and the role of spirituality as a moderator between functionality and QOL.

METHOD

A cross-sectional study was conducted with 128 patients with mild AD.

RESULTS

Being a male, good social support, and high functionality were significant predictors of better QOL. Spirituality was a moderator in the relationship between functionality and QOL.

CONCLUSION

These results reinforce the importance of gender, psychological morbidity, social support, and functionality, with special emphasis on the role of spirituality, regarding intervention programs that promote QOL, in patients with mild AD.

Anti-Alzheimer activity of isolated karanjin from Pongamia pinnata (L.) pierre and embelin from Embelia ribes Burm.f

Aim:

The aim of this study is to find out the anti-Alzheimer’s activity of isolated karanjin and embelin.

Materials and Methods:

Karanjin isolated from Pongamia pinnata (L.) pierre and embelin from Embelia ribes Burm.f. and their purity was confirmed by ultraviolet spectrophotometric and Thin layer chromatography based study. Anti-Alzheimer’s activity of isolated compounds were evaluated through elevated plus maze and Morris water maze model on Swiss albino mice. Diazepam (1 mg/kg body weight, intraperitoneally) was used for the induction of Alzheimer’s like effects (amnesia) on Swiss albino mice and piracetam (200 mg/kg body weight, oral) used as a standard treatment.

Results:

In EPM, embelin and karanjin decrease the transfer latency time in dose dependent manner and escape latency time in MWM method. A significant (P < 0.01) reduction in amnesia with an anti-Alzheimer’s effect found when results of isolated compounds were compared with standard and vehicle control. Diazepam (1 mg/kg) treated group showed significant increase in escape latency and transfer latency when compared with vehicle control; which indicates impairment in learning and memory.

Conclusion:

Both isolated compounds and standard significantly reversed the amnesia induced by diazepam and improved learning and memory of mice in dose and time dependent manner. This study supports the ethnobotanical use of these two plants in India for the management of nerve or brain related problems.

Review of Positive Psychology Outcome Measures for Chronic Illness, Traumatic Brain Injury and Older Adults: Adaptability in Dementia?

BACKGROUND

Despite positive psychology being increasingly recognised as an important agent in well-being, there is a lack of standardised outcome measures for psychosocial dementia research. This review assessed positive psychology outcome measures using standardised criterion in populations that were identified as having shared characteristics. It aimed to identify robust measures that were suitable for potential adaption or use within a dementia population.

SUMMARY

The review identified 16 positive psychology outcome measures (and 8 further psychometric assessments of these) within the constructs of resilience, self-efficacy, religiousness/spirituality, life valuation, sense of coherence, autonomy, resourcefulness and a combined measure (CASP-19). Scale development studies were subject to a quality assessment, and most were found to be lacking information on reproducibility and responsiveness.

KEY MESSAGES

A wide range of measures within the constructs of positive psychology was identified as having potential utility for psychosocial research within a dementia population. Examples included the CD-RISC, GSWB, SWLS, MPAQ, RSOA and CASP-19. It is recommended that such scales are further adapted or validated for people with dementia. Underreporting of appropriate psychometric analyses hampered this review, and it is recommended that future authors endeavour to report such analyses.

Spiritual care to persons with dementia in nursing homes; a qualitative study of nurses and care workers experiences

BACKGROUND

Spiritual care for people with dementia who are in nursing homes is one aspect of the holistic care provided by nurses. A number of studies have explored the concepts of spirituality and religiosity, but fewer studies describe how nurses provide spiritual care in practice. The Purpose of the study was thus to investigate how nurses and care workers can provide spiritual care for people with dementia who live in nursing homes.

METHODS

This is a qualitative study with an exploratory design using a phenomenological-hermeneutic approach. Interviews were conducted in eight focus groups with 31 nurses and care workers in 4 Norwegian nursing homes.

RESULTS

The nurses were unsure about whether they actually provided spiritual care. Through discussions in the focus groups, a new understanding and insight was developed. The spiritual care that the nurses provided included: (1) integrating spiritual care into general care, described as 'physical touch' and 'responsiveness and intuition'; (2) spiritual care in terms of togetherness, described as 'being present' and 'sensitivity in communication'; and (3) spiritual care as providing meaningful activities for everyday life, described as 'facilitating activities' and 'meeting the residents' religious needs'.

CONCLUSIONS

This study demonstrates the need for nurses and care workers to discuss and reflect on how to understand and describe spiritual care for people with dementia in practice. There is a need to develop and expand the knowledge about how to teach carers to recognize resident's spiritual needs and expressions of spirituality and to establish a comprehensive view of spiritual care for people with dementia in nursing homes.

Physical and Psychological Distress Are Related to Dying Peacefully in Residents With Dementia in Long-Term Care Facilities

CONTEXT

Although dying peacefully is considered an important outcome of high-quality palliative care, large-scale quantitative research on dying peacefully and the factors associated with a peaceful death is lacking.

OBJECTIVES

To gain insight into how many residents with dementia in long-term care facilities die peacefully, according to their relatives, and whether that assessment is correlated with observed physical and psychological distress.

METHODS

This was a retrospective cross-sectional study of deceased nursing home residents in a representative sample of long-term care facilities in Flanders, Belgium (2010). Structured post-mortem questionnaires were completed by relatives of the resident, who were asked to what extent they agreed that the resident "appeared to be at peace" during the dying process. Spearman correlation coefficients gave the correlations between physical and psychological distress (as measured using the Symptom Management at the End of Life with Dementia and Comfort Assessment in Dying at the End of Life with Dementia scales) and dying peacefully (as measured using the Quality of Dying in Long Term Care instrument).

RESULTS

The sample comprised 92 relatives of deceased residents with dementia. In 54% of cases, relatives indicated that the resident died peacefully. Weak-to-moderate correlations (0.2-0.57) were found between dying peacefully and physical distress in the last week of life. Regarding psychological distress, weak-to-moderate correlations were found for both the last week (0.33-0.44) and last month of life (0.28-0.47).

CONCLUSION

Only half of the residents with dementia died peacefully as perceived by their relatives. Relatives' assessment of whether death was peaceful is related to both physical and psychological distress. Further qualitative research is recommended to gain more in-depth insights into the aspects on which relatives base their judgment of dying peacefully.

Spirituality and religion in older adults with dementia: a systematic review

BACKGROUND

Religious and spiritual issues are clearly important to the older adult population and may play a positive role in maintaining health and recovering from illness. This study systematically reviewed the literature examining the effects of religion and spirituality on health outcomes such as cognitive functioning, coping strategies, and quality of life in people with dementia.

METHODS

First, 51 articles with defined keywords were collected from online databases. Then, using inclusion and exclusion criteria, 11 articles were selected. These were classified according to methodological quality before being analyzed one by one.

RESULTS

The findings highlight the benefits of spirituality and religion on health outcomes. Three articles showed that in participants who used their spirituality or religion more, through their faith, their practices and in maintaining social interactions, their cognitive disorders tended to reduce or stabilize. In the other eight articles, use of spirituality or faith in daily life enabled people to develop coping strategies to help accept their disease, maintain their relationships, maintain hope, and find meaning in their lives, thereby improving their quality of life.

CONCLUSIONS

Spirituality and religion appear to slow cognitive decline, and help people use coping strategies to deal their disease and have a better quality of life. This literature review allows us to take stock of research over the last decade on spirituality/religion and health outcomes. The benefits observed should be considered with caution and included in rigorous experimental research in the future.

Practical implications of Procedural and Emotional Religion Activity Therapy for nursing

Procedural and Emotional Religious Activity Therapy encapsulates an approach to engaging older adults with Alzheimer's disease in meaningful activities that can be performed within the parameters of their cognitive functioning. Alzheimer's disease disrupts some brain structures more than others, resulting in a disproportionate loss of certain cognitive abilities. Explicit (conscious) memory skills are disrupted first, followed by implicit (unconscious) memory skills, and lastly emotional memory. Activities relying more on implicit and emotional memory, such as specially selected religious activities, are more likely to be used by patients. Steps and caveats of using this approach are provided.

Practical implications of Procedural and Emotional Religion Activity Therapy for nursing

Procedural and Emotional Religious Activity Therapy encapsulates an approach to engaging older adults with Alzheimer's disease in meaningful activities that can be performed within the parameters of their cognitive functioning. Alzheimer's disease disrupts some brain structures more than others, resulting in a disproportionate loss of certain cognitive abilities. Explicit (conscious) memory skills are disrupted first, followed by implicit (unconscious) memory skills, and lastly emotional memory. Activities relying more on implicit and emotional memory, such as specially selected religious activities, are more likely to be used by patients. Steps and caveats of using this approach are provided.

Using spirituality to cope with early-stage Alzheimer's disease

Alzheimer's disease (AD) robs persons living with the disease of their independence and self-esteem, which can lead to depression, anxiety, and loneliness. Understanding how people with early-stage AD cope is a critical step in enhancing their adaptive abilities and ultimately improving their quality of life. This qualitative study describes how individuals with early-stage AD use spirituality to cope with the losses of self-esteem, independence, and social interaction that they face. The purposive sample for this focused ethnographic study consisted of 15 participants living at home in central Arkansas. Holding onto faith, seeking reassurance and hope, and staying connected were the global themes. Personal faith, prayer, connection to church, and family support enhanced the ability of people with early-stage AD to keep a positive attitude as they face living with AD.