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The Northern California chronic care network for dementia brought together California's major managed care, community-based care, consumer education and advocacy providers in new partnerships to improve the care of persons with dementia, enrolled in managed care plans and their family caregivers. Description of the Northern California network's partnerships and its intervention and challenges are presented.

Dementia is a common disorder affecting an estimated 20 to 47 percent of persons over the age of 85.1In addition No the pervasive cognitive deficits found in dementia, various behavioral disturbances are common.2Wandering is one of the most troubling behaviors associate with dementia and has been found to lead to institutionalization and increased risk for injury. It continues to Tee common practice for wanderers to be physically or chemically restrained in order to prevent them from leavings home. This practice leads to extreme limitations on nobility and freedom for the client as well as extra demands on caregivers. To develop less restrictive and efficient interventions it is essential to understand how to assess, predict, and alter wandering patterns.4We examined the relationship between cognitive impairments and wandering. Neuropsychological tests were administered to 29 residents of two special care units. Exiting attempts, the level of activity, and staff ratings of wandering were correlated with measures of global impairments (as measured by the Mini Mental State Examination) as well as focal deficits (assessed by the Token Test, the Benton Visual Retention Test-revised, the nine item dementia form of the California Test of Verbal Learning, and the Information Subtest of the WAIS-R).The Mini Mental State Examination was the best predictor of staff ratings of wandering. Poor performance on the CVLT-AD best predicted the level of activity. Exiting did not significantly correlate to staff ratings of wandering or cognitive deficits. Data were analyzed also by means of a principal components analysis and entered into a multiple regression equation. Neuropsychological tests loaded heavily on one factor relating to global deterioration which was predictive of staff ratings of wandering as well as behavioral observations of activity. Exit-seeking behavior was not associated with this index of the severity of dementia.