Lecture 3 - Dementia Flashcards
What are 2 common cognitive screens?
Mini Mental Status Exam
Montreal Cognitive Assessment (MOCA)
when working with patients w/ dementia, In your selected preformance measure, there should be a max of ___ commands/instructions, but likely less
3
Note: you’ll always want to demo and during the actual test provide as little cueing as possible
You’ll want a ____ duration preformance test to prevent cognitive/physical fatigue when working with patients w/ dementia
short
In preformnace measures, ________________ scores can occur with lower cognitive levels
less reliable
(because their cognition might impact their preformance)
What is an effective treatment that can slow cogntive decline, enhance neurogenesis and has minimal side effects?
Exercise
Test administration tips for pt with dementia
Clear speech
friendly face
eye contact
instructions repeated during demo
ask person if they understand
remove distractions
T or F: Aerobic exercise is shown to lessen cogntiive impairment and decrease dementia risk
T
What intensity exercise is best in frail older adults?
High intensity is better than low/moderate
Exercise ____________ appears to be neuroprotective for dementia, and these patients have similar amounts of exercise recommendations as other adults
Volume
When strength training dementia patients, how many days a week and what intensity?
Atleast 2 times a week
mod/high intensity
emphasis on good form
When balance training adults w/ dementia, how many times a week is recommended?
3 times a week
Essential to prevent falls
When giving a home exericse program to adults w/ dementia, they need lots of _______________ first
Lots of reps/practice first to make the movements routine
“errorless learning” - make it to where they don’t get frusterated with too much corrections, build the enviroment to where they can succeed
Keys to exercising adults w/ dementia
- Work in their reality
- Note pain behaviors
- Vary exercise w/ a lot of reps
- make it fun (focus on what they like)
- Be flexible
- Know when to increase cognitive load and when not to
- Blend social interaction and physical activity
According to medicare, is maintence therapy covered for adults w/ dementia?
Yes if it is deemed that they cannot safely/effectively preform it by themselves
What are 2 common ways adults w/ dementia cope with the impairment
Frustration/lashing out
or withdrawing/shutting down
Note: Anxiety and depression is common
Care for adults w/ dementia should focus on ____ and _____
Quality of life and independence
Person-centered care is vital, care providers must relate to the person, not just react to the disease
When working w/ patients that have dementia, should you focus on their strengths or weaknesses?
You should use a strength-based approach
note: Bypass traditional learning methods, and capitalze on remaining long term memory, language, and reading
What are the remaining cognitive strengths in a person w/ dementia
Reading simple words
emotional memory (remembering if something is favorable or unfavorable)
Procedural memory of well-practiced habits
long-term memory
focused attention for simple tasks
production and comprehension of language until late in disease
L/R orientaton
Strategies to use for communication w/ adults that have dementia
approach from front
come to their eye level
remove distraction
eye contact
smile
introduce yourself
simply explain why youre there
invite to participate
What is the patience/acceptance component of communicating w/ adults who have dementia
Allow enough time for them to understand and form a response/action (dont rush them)
What does KISS stand for?
Keep it short and simple
referring to removing unessicary details from your directions
Note: also do not provide them with too many choices
Avoid asking questions based on ______ memory, instead focus on now
Short-term
Ex: Are you having pain now? vs Have you had pain in the last few days?
3 aspects of multi-modal cueing for patients w/ dementia
- Use signs/pictures
- repeat information for them
- physically guide them
T or F, adults w/ dementia should use trial and error learning
F
Adults w/ dementia need errorless learning
Ensure theres only 1 solution for each problem, and use feedback from task/enviroment to ensure they learn the correct information/procedure
What is “learning by modeling”
Utilizing procedural memory/nondeclarative longterm memory
Cargiver provides demo and the person watches, then they preform it themselves
works good for learning any motor task or habit, good for language deficits
What is spaced retrieval learning
building upon maintenance of implicit procedural memory (instead of using explicit memory processing)
Learning without intention/awareness
“The method of retaining information by recalling that information over increasingly longer periods of time”
What does ABLED stand for, in reference to “Exernal memory aids”
Accessible (easily seen)
Bright (good contrast)
Legible (Large and easy to read)
Explicit (simple but adequate explanation)
Done (Lists to cross off)
What are examples of external memory aids
Memory books (Ex: biography, photos)
Day planners
Signs or labels on doors
What is cognitive task analysis and what is it used for?
Breaking down a task into the simplest cognitive components so that each step can be completed easily and decrease cognitive load
used to simplify activities / routines
-
What are coping strategies helpful for dealing with patient’s w/ dementia
reframing- helpful when a situation cannot be fixed
re-evaluating expectations - develop reasonable goals based on their current strengths/abilities
substituting behaviors- replacing undesirable behaviors with more desirable ones
adjusting enviroment - making sure it’s not too over or understimulating
What is the primary barrier that PTs have for patients w/ dementia
Lack of knowledge of their strengths/abilities and their potential for improvement
PTs must see the situation and barriers from the other person’s perspective
PT for dementia clinical pearls
-Patient-centered care
-match patient w/ appropriate clinican
-have backup plan
-verbal and non-verbal communication
-be creative
