Author ORCID Identifier

Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Public Health



First Advisor

Dr. Graham D. Rowles


Behavioral and psychological symptoms of dementia create challenges for those living with neurodegenerative cognitive impairment and their care partners. Pharmacological approaches for treatment of challenging behaviors seen in dementia have limited success and serious side effects. Because of this, nonpharmacological approaches are being investigated with increasing frequency. Of particular interest are nonpharmacological approaches involving environmental stimulation to change behaviors. Success of such approaches relies on sensory processing systems, personal preferences, and environmental congruence. There is limited evidence describing behaviors of persons with cognitive impairment in relation to these components. Currently, there is no guiding model for implementation of environmental and sensory-based strategies with this population. The overall goal of this project is to elaborate on an emerging model describing the relationship among environment, behavior, sensation, and cognitive impairment for community-dwelling adults with mild cognitive impairment or dementia.

Three studies allow for deeper understanding of this relationship. Study one compared behaviors seen in autism spectrum disorder (ASD) with exhibited behaviors of individuals with mild cognitive impairment or dementia. Of neurological conditions similar to dementia, ASD has been chosen as an exemplar for comparison of behavioral expression because evidence supports sensory-based theory and interventions to improve behaviors for those with ASD. Results indicate that ASD behaviors are reported in those assessed, with highest rates of behaviors in those with young age of onset and advanced cognitive impairment severity.

Study two described presentation of behavior, sensory processing, and environment for community-dwelling adults with cognitive impairment in the context of the caregiver situation. Findings reflect dyadic experiences for the person with cognitive impairment and the primary care partner. Emergent themes included consideration of the passage of time, environmental contexts, behavioral adjustments while aging, and overall influences of living with cognitive impairment. Sensory processing assessment using the Adult Sensory Profile identified that all participants had some atypical sensory processing patterns, highlighting a need for attention to environmental congruence to promote adaptive behaviors.

Using data collected in study one and study two, a model was created describing interactions among the person with cognitive impairment, sensation, and the environment as these interactions evolve over time. Areas for future research are conceptualized for implementation of the model. Future research is needed for assessment of the model to test for validity and reliability. Creation of an instrument is needed to place individuals within the model given their behavior and cognitive impairment progression. And, future research is needed to create and test interventions in order to aid in environmental congruence. Long-term goals are to improve care for adults with cognitive impairment and dementia via environmental interventions.

Digital Object Identifier (DOI)

Funding Information

The studies of this dissertation utilized University of Kentucky Alzheimer’s Disease Cohort participants with funding provided by NIH/NIA P30 AG028383.

Included in

Gerontology Commons