Dementia

Question 1

Alzheimer’s Disease

Answer 1

cortical atrophy of the frontal, parietal, and temporal lobes as well as the hippocampal region caused by accumulation of amyloid-beta senile plaques and tau protein neurofibrillary tangles.
Progressive impairment of memory, executive functioning, attention, language, visual processing and praxis. course is slow and progressive until death with three distinct stages leading to increase behavior and personality changes

Question 2

Vascular Dementia

Answer 2

cerebrovascular disease leading to focal lesions on the brain and neurotransmitter disruption. cognitive decline similar to AD but less severe memory involvement, gait disturbances, abrupt or stepwise decline rather than continuous

Question 3

Frontotemporal Dementia (Phyllis)

Answer 3

neuronal, intranuclear inclusions. progressive aphasia, corticobasal syndrome. Immediate distinct onset, progressive,

Question 4

Dementia with Lewy Bodies

Answer 4

lewy body proteins present in brain and overall decline in acetylcholine and dopamine levels

Progressive deficits in attention and executive funcitoning, visual hallucination, parkinsonianism, autonomic dysfunction, REM, sleep disorder,

Question 5

Signs and Symptoms

Answer 5

Memory Impairment (recent, procedural, semantic, episodic), Cognitive Deficits (aphasia, apraxia, agnosia, executive functioning), Other Cognitive or Personality symptoms (orientation, spatial perception, judgement and safety), Motor Deficits (gait disturbance, hyperflexia, paratonia, dysphagia)

Question 6

Occupational Performance in Early Stage

Answer 6

ADLs are intact, first signs of memory loss are in IADLs, affects orientation and community mobility, may become disoriented in travel away from home, financial management is impaired, meal prep is impaired, health management impaired, learning and reading become difficult, relationships with coworkers are affected and may lead to unemployment, clings to old habits and repetitive routines, neglects old habits and routines, cultural and spiritual context remain but participation may deteriorate.

Question 7

Occupational Performance in Middle Stage

Answer 7

impairments occur in all areas of occupation, can no longer live alone, no longer attend to IADLs, eating problems and weight loss, simple home management requires assistance, dependent in community mobility, financial management, shopping, safety is major concern, leisure and social participation are limited, cannot differentiate days, cultural contexts begins to diminish, , person and time contexts are confused

Question 8

Occupational Performance in Late Stage

Answer 8

all areas of occupation are lost, person is total dependence, no longer ambulate safely, communication is lost, no understanding of context

Question 9

Assessing a Client with Dementia

Answer 9

Clinical Observation, Function-BAsed cognitive screening (ACL, AMPS, cognitive performance test, EFPT, Kitchen Task Assessment, ADL neurobehavior evaluation)

Question 10

ACL 6 - Planned Actions

Answer 10

client is independent, disability is absent

Question 11

ACL 5 - Exploratory Actions

Answer 11

caregiver standby or supervision needed for cognition, learns through visible, concrete, and meaningful stimuli, external cuing can be used, explores effect of self-initiated motor actions, client uses trial and error problem solving, can follow four or five steps and learn a concrete idea, difficulties with judgement/reasoning/planning/semantic memory/episodic memory

Question 12

ACL 4 - Goal Direction Actions

Answer 12

Min Cog A, visual and tactile cues for attention, able to understand cause and effect, no longer solve problems, can follow two or three step activities, task set-up required, eats with supervision, protection against hazards and wandering, 24-hour supervision

Question 13

ACL 3 - Manual Actions

Answer 13

Mod Cog A, attention directed to tactile cues, goals are not related to outcomes, motor actions are one step and familiar, cannot learn new behaviors, needs a routine, 24 hour supervision

Question 14

ACL 2 - Postural Actions

Answer 14

Max Cog A, thinking is highly distorted, attention involves internal cues, motor actions are gross and one step, ADLs can be accomplished by imitation of caregiver, spontaneous behaviors are common, taken to restroom every two hours, paces and wanders

Question 15

ACL 1 - Automatic Actions

Answer 15

Total cognitive assistance, attention is limited to internal subliminal cues, motor actions are in response to one word, rear reflexive actions, needs assistance with ambulation and transfers, ROM for prevention of bed sores, 24 hour supervision

Question 16

Behavior Management: Communication

Answer 16

avoid reasoning with client, listen, maintain a trusting relationship, offer choices when possible, decrease demanding social situations

Question 17

Behavior Management: Sundowning

Answer 17

use adequate lighting, provide safe area for physical activity, provide reassurance in a calm and caring manner, provide client with fluids throughout the day, reduce noise and clutter, avoid using restraints

Question 18

Behavior Management: Anger

Answer 18

anticipate problems and stressors, rephrase negatives to positives, sitract the client by using food or asking for assistance, adhere to familiar routines, allow time for response, allow physical movement,