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The nursing care of a group of moderately demented patients (n = 11) in a nursing home was improved as a result of an education of the staff. Thus the patients were subjected to an increased emotional and intellectual stimulation during the ordinary daily care and participated in group sessions twice a week. In order to evaluate the effects of the treatment, psychological parameters and cerebrospinal fluid (CSF) HVA (homovanillic acid), 5-HIAA (5-hydroxyindole acetic acid) and HMPG (4-hydroxy, 3-metoxyphenylglucol) were quantified before and after a 2-month treatment period. A group of similar patients (n = 13) in another nursing home constituted a control group. The ratings of concentration, absent mindedness and recent memory showed a more favorable development in the treatment group than in the control group where an intellectual deterioration was evident. Restlessness was rated higher in the treatment group after the treatment period, while the psychological testings showed no significant changes between the groups. CSF HVA concentrations increased in the treatment group and decreased in the control group (P less than 0.05). No change was evident in 5-HIAA or HMPG concentrations in either group. The results suggest that environmental factors influence biochemical markers of transmitter activity which thus possibly may be of etiological importance in dementia.

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