Dementia Flashcards
Dementia Cause
permanent degeneration and damage to nerve cells in the brain
Dementia symptoms
Loss of memory, Judgment, Language, Object recognition, Motor skills, Decreased perceptual skills, Personality changes, Impaired executive function,Planning, organization, abstract reasoning
Non-modifiable RF
Genetics, Advanced age, Chronic illness
Modifiable RF
Heavy alcohol use, Obesity, Hyperlipidemia, Smoking, Depression, Head injury, Diabetes, Stroke, Cardio pulmonary conditions, Lack of social stimulation, Drug toxicity
Delirium
• Disturbance in consciousness with reduced ability to sustain attention & cognition
• Develops over short period of time and fluctuates
Caused by a medical condition: Dehydration, drug toxicity, blood pressure changes, blood sugar changes, anesthesia REVERSIBLE
DSM criteria:
Must have memory impairment and at least one of the following:
– Aphasia: Difficulty speaking
– Apraxia: Difficulty with motor planning
– Agnosia: Difficulty recognizing objects
– Disturbance in executive functioning: Planning, problem solving, sequencing…
Early onset
before age 65
Most common form dementia
Alzheimer 60-80% Progressive, degenerative disease of brain tissue
Stage 1: Alzheimer
Very mild to mild cognitive deficits (1-3 years)
Angry outbursts, personality changes, denial , preference for familiar settings
Memory loss, greater for recent events
Decline complex cognitive tasks, decision making, planning, attention, initiation
Stage II: Alzheimer
Mild to moderate decline (5-7 years)
Questioning, wandering, pacing, rummaging
Chronic recent memory loss, difficulty with written and spoken language
Needs assist with ADL’s more difficulty with familiar tasks
Stage III:Alzheimer
moderate to moderately severe decline (2-3 years)
Repititious movement or sounds
Misidentificaiton of familiar objects, decreased vocab need HOH assis
ADL dependent, incontinence, diff eating, impaired gait increase falls
Stage IV: Alzheimer
Severe cognitive deficits & physical decline (average 3 months- 1 year)Terminal stage, fleeting attention, may respond to touch or music
Utters vs. saying words, decreased visual tracking, contracture/skin integrity
Bed or w/c dependent, TOT dependent in self-care, dysphasia, loss of appetite
Need to evaluate:Person with dementia,
Cognition, orientation, safety awareness, visual perceptual abilities, Hearing, touch, strength, ROM, Functioning in daily activities, The caregiver(s), Medications, routines, The contexts, Home assessment, fall risk, supports and barriers leads to memory loss and problems
Structural changes Alzheimer
Beta amyloid plaques Twisted strands tau protein (tangles) Nerve cell damage and death Acetylcholine (ACh) transmission reduction/Reduction of AChR
• Secondary dementia
2nd most common dementia
Vascular dementia 20-30% of cases Multi infarct/post CVA
Post CVA
Confusion, disorientation, global aphasia, vision loss
Multi infarct (small strokes or vascular issues) –
Gradual changes as damage accumulates
– Impaired planning , attention, problem solving and judgment, emotional lability, word finding deficits, impaired social functioning
Dementia with Lewy Bodies
(usually seen with PD) Structural changes
Abnormal aggregations of protein alpha-synuclein Disrupts dopamine projections to frontal cortex and basal ganglia Dementia/cognitive decline Parkinsonian motor disturbances Shuffling gait, tremor, mask like appearance, rigidity, flexed posturing
Frontotemporal dementia
Group of disorders caused by progressive cell degeneration in frontal and/or temporal lobes 10-15% all cases Diagnosed earlier ages (50’s to 60’s) Family history ALS
Sub-types:-Behavioral Variant (bvFTD)-
Primary Progressive Aphasia-
FTD Movement Disorders
Corticobasal degeneration
Progressive supranuclear palsy
FTD Symptoms:
- Behavioral changes often earliest symptom
- Deficits in spatial orientation
- Speech deficits: word finding, increased generalized speech, difficulties with written expression.
- Hallucinations and delusions uncommon
Secondary to other medical conditions
Creutzfeldt-Jakob Disease: transmissible spongiform encephalopathy caused by abnormal proteins (prions), rapidly fatal.
Wernicke-Korsakoff Syndrome: Severe B-1 deficiency. Most common cause ETOH abuse, creates chronic memory dysfunction.
Huntington’s Disease progression
Parkinson’s Disease progression
HIV/AIDS Related
Medication induced dementia Symptoms persist when substance is withdrawn, 12% of persons diagnosed with dementia,
Result of: Substance abuse, Medication, Toxic exposure
Aggressive behaviors
Hitting, biting, screaming, pacing
Strategies: Be calm, stay out of reach, redirect
Hallucinations and delusions
Auditory, tactile, visual, olfactory
Most common involve theft or spouse (unfaithful or imposter) Strategies: Distraction
“Sundowner’s Syndrome” or “Sundowning”
Agitation, confusion, wandering and/or disorientation at end of day Strategies: Picture schedule for day/night routine, Improve lighting during day, Physical touch, Redirect, Find activities of interest, Social interaction, Provide structured routine, Temperature control
Repetitive actions
Pacing, rummaging, repeating, gestures, self abusive behaviors, disruptive/irritating to carers Strategies: Engage in other activities – folding trash bags, holding teddy bear/doll, rocking chairs, music, modify familiar and enjoyed ax
Catastrophic reactions
Extreme outburst to minor stressors -Verbal/physical aggression or social isolation -May be brought on by fatigue (ill, tired)Strategies: Redirect Know triggers Take out of environment Be calm Predictable/no surprises Short naps Read cues
Impaired Verbal abilities
Difficulty with using nouns, Rely more on nonverbal gestures and sounds, Can sing familiar songs, may revert to primary language Strategies: Speak slowly and calmly, Use simple, short sentences, Clearly enunciate words, Write short phrases/words, Ask yes/no questions, Minimize distractions, Allow extra time, Listen for true meaning, Use positive words, Do not use baby talk
OT Scope of practice
-Educate family members and those in the early stages of disease about dementia and its functional effects.
- Evaluate persons with dementia to determine strengths, impairments, and performance areas needing assistance.
- Assist person with dementia to improve function through compensation or adaptation.
- Assist caregivers to help them cope with difficult, and yet often rewarding, role.
Observation of functional tasks Assessment Need to evaluate: Cognition, orientation, safety awareness, visual perceptual abilities Hearing, touch, strength, ROM Functioning in daily activities
The caregiver(s) Medications, routines
The contexts Home assessment, fall risk, supports and barriers
Dementia assesments
MMSE/MoCA, Kitchen Task Assessment (replaced by Rabideau), Executive Function Performance Test, Allen Cognitive Level, Cleveland Scales for ADL, Katz ADL, Disability Assessment for Dementia, Independent Living Scales, Caregiver’s Strain Questionnaire
Interventions: Health promotion
Maintain strengths of clients Promoting wellness care providers
Interventions: Remediation
Physical skills (ROM, Strength, Endurance)
Interventions: Maintenance
Provide supports to ensure skills are maintained as long as possible
Interventions: Modification
Safe and supportive environments through adaptation and compensation
Interventions: Spaced retrieval
Procedural memory over declarative memory Compensation strategies for memory ie: Repetition priming and external aids
Interventions: Behavioral functional analysis
A: antecedent B: Behavior to change C: Resulting consequence
Reminiscence therapy
Discussion of past events, activities, and experiences with person or group
Tangible prompts:
photographs, familiar items, music and archive recordings.
Barriers for wandering behavior
Wallpaper doors Stop signs/caution tape (recognizable warning signs) Enclose outdoor areas
Safety
Home modifications/fall prevention DME, contrasting colors Lock doors and cabinets Medications, sharps
ADL
Dressing Routine, hand over hand, mirrored approach Grooming/hygiene Safety considerations, shaving using a mirror? Keep medications and scissors/sharps locked up
Toileting
Place picture of toilet on bathroom door Extra set of incontinence pads/clothing for community Establish routine: Same time every day, limit caffeine in evening.
Feeding/eating
Watch for eating non edibles Quiet and distraction free environment Social environment (may mimic others eating) Use color contrasting plates for table/table cloths No plastic utensils – could bite/breakOffer finger foods, sippy cups, straws
Bathing
Plan for best part of day Warm up room ahead of time Hand-held shower/ over head can be scary Offer choice bath or shower
Sleep Routine
Light exercise/physical activity (walking etc), Restrict caffeine after 2 pm, Play soothing and calm music
Sensory Stimulation:
Animal assisted therapy, Multisensory stimulation, Montessori methods, Sensory diet cards, Snoezelen rooms, Aromatherapy
Training Maintenance of function,
Task analysis and grading, Provide written instruction, Behavior modification, Environmental modifications, Support, Connect with support groups, Respite care Health
