NDD-Dementia Flashcards
What are the different types of dementia?
Alzheimer’s disease, vascular dementia, frontotemporal dementia, and dementia with Lewy bodies
Which type of dementia results in a progressive impairment of memory, executive function, attention, language, visual processing and praxis with commonly associated behavioral disturbances?
Alzheimer’s disease
What is the pathology of Alzheimer’s disease?
cortical atrophy of the frontal, parietal, and temporal lobes as well as the hippocampal region caused by an accumulation of amyloid beta senile plaques and tau protein neurofibrillary tangles
T or F: Alzheimer’s disease has a rapid progression.
False, it is slow and progressive until death
How many stages are there for Alzheimer’s disease?
Three, early stage, middle stage and late stage
The symptoms of AD gradually lead to…
behavior and personality changes, a decline in cognitive abilities, such as decision-making and language skills and problems recognizing family and friends.
T or F: Medical management for AD includes disease treatment to cure the disease
False, to slow the progression
Medical management to cure symptoms target what areas?
cognitive decline, psychiatric symptoms and behavior disturbances
Pharmacotherapy is used with clients with AD to manage what symptoms?
cognition, depression, delusions, hallucinations, agitation and aggression
What is the pathology for vascular dementia?
cerebrovascular disease (often a series of small strokes) leading to focal lesions in the brain and neurotransmitter disruption
T or F: There is a continuous decline in patients with vascular dementia
False, it is abrupt or step wise
T or F: Cognitive decline in patients with vascular dementia is similar to AD but often has more severe memory involvement
False, it’s often LESS severe memory involvement
What is a common clinical feature in clients with vascular dementia?
Gait disturbance
What is the common course and prognosis of vascular dementia?
sudden appearance of symptoms, with a stepwise pattern of increased symptoms and it may also progress slowly, similar to AD
T or F: Immediate emergency medical treatment isn’t needed for clients with vascular dementia.
False, it is needed
What is involved in the medical management of vascular dementia?
treatment of cardiovascular factors (management of diabetes, high cholesterol and heart disease), pharmacotherapy to prevent future blood clots and in some cases, surgery to remove blockages in blood vessels.
What is the pathology for frontotemporal dementia?
neuronal, intranuclear inclusions
What are the clinical features of frontotemporal dementia?
progressive aphasia, corticobasal syndrome, or symptoms similar to AD or Parkinson’s disease
What is the course and prognosis of frontotemporal dementia?
immediate, distinct onset, progressive, varied symptom patterns among individuals
T or F: Medications have been developed to treat frontotemporal dementia
False, future research needed; medications currently in development
What is the pathology of Dementia with Lewy bodies?
Lewy body proteins present in the brain, usually predominant in the limbic or neocortical areas; overall decline in acetylcholine and dopamine levels
What are the clinical features of Dementia with Lewy bodies?
Progressive deficits in attention and executive function, memory impairment, fluctuation cognition, visual hallucinations, parkinsonism, autonomic dysfunction, and falls
What disorder is a possible prodromal symptom of Dementia with Lewy Bodies?
rapid eye movement sleep behavior disorder
What are some early disease symptoms of dementia with lewy bodies?
problems in exective function, visuospatial abilities, attention and memory function
What are some symptoms of dementia with Lewy bodies over time?
aphasia, apraxia, and spatial disorientation
T or F: The course and prognosis of dementia with lewy bodies is gradual and insidious.
True
What does the medical management for dementia with lewy bodies involve?
It’s similar to that for AD, increased family involvement, safety assessment, neuroleptics, cholinesterase inhibitors
What is procedural memory?
recall of information on how to perform a task, such as knowing how to write or ride a bike
Which type of memory remains intact during the primary signs and symptoms of dementia?
procedural memory
What is recent memory?
recall of recent events
What type of memory is affected first for clients with dementia?
recent memory
What is personal episodic memory?
recall of time-related information about oneself, such as where and whether one ate breakfast
What is semantic memory?
The ability to remember the names of objects
What two types of memory show deficits during the primary signs and symptoms of dementia?
personal episodic memory and semantic memory
What is aphasia?
difficulty with expressive language, receptive language or both
What is apraxia?
loss of skilled, purposeful movements that cannot be attributed to either deficits in primary motor skills or problems in comprehension
What is the inability to recognize the importance of sensory impressions despite being able to recognize the elemental sensation of the stimulus?
agnosia
What is the disruption of the broad band of skills that allow a client to engage in independent, self-directed behavior including volition, planning, purposeful action and self-awareness?
disturbance in executive functioning
What are some cognitive deficits that are primary signs and symptoms of dementia?
aphasia, apraxia, agnosia, and disturbance in executive functioning
What is difficulty with topographic orientation?
orientation of the self within the environment
T or F: Individuals with dementia may experience poor judgement, anxiety and defensiveness, disinhibited behavior, psychotic symptoms and difficulty with spatial tasks
True
What are some motor deficits individuals with dementia show during their primary symptoms?
gait disturbances, hyperflexia, paratonia, and dysphagia
What is hyperflexia?
overflexion of a limb
What is paratonia?
involuntary resistance to passive movement of the extremities
What is known as difficulty swallowing?
dysphagia
How severe are the primary symptoms for individuals with dementia?
sufficient to affect occupational performance and represent a decline from previous functional level
During which stage does dementia affect orientation to place, which affects community mobility?
early stage
T or F: ADLs remain intact during the early stage of dementia
True
The first signs of memory loss manifest during which stage of dementia and what tasks?
early stage, IADLs
During which stage of dementia does financial management, shopping, meal preparation, communication, health management and work performance become impaired?
early stage
During which stage of dementia should driving skills be reevaulated?
early stage
During which stage of dementia does the person withdraw from social participation?
early stage
During which stage of dementia does impairment occur in all areas of occupation?
middle stage
During which stage of dementia can the person no longer live alone?
middle stage
During which stage of dementia do eating problems and weight loss occur?
middle stage
During which stage of dementia is the person dependent in community mobility, financial management and shopping?
middle stage
During which stage of dementia is safety a major concern due to risks of wandering, letting a stranger in the house or causing a fire?
middle stage
What happens during the late stage of dementia?
all areas of occupations are lost, the person is dependent in all ADLs, the person can no longer ambulate safely, communication is lost, the person has no understanding the cultural, social or spiritual contexts
What are some standardized function-based cognitive screening instruments you can use with clients with dementia?
Allen cognitive level screen or the enlarged allen cognitive level screen, assessment of motor and process skills, cognitive performance test, executive function performance test, independent living scales, kitchen task assessment, and Arnadottir OT-ADL neurobehavioral evaluation
What are some standardized cognitive screening instruments you can use with clients with dementia?
blessed dementia scale, cognitive competency test, lowenstein occupational therapy cognitive assessment, middlesex elderly assessment of mental state, mini-mental state exam, modified mini-mental, neurobehavioral cognitive status screening exam, repeatable battery for the assessment of neuropsychological status
What are some memory assessments you can use with clients with dementia?
contextual memory test, hopkins verbal learning test-revised, prospective memory screening and rivermead behavioural memory test-extended version
Which cognitive level is known as planned actions?
level 6
What is characteristic of cognitive level 6?
client is independent and disability is absent
Which cognitive level is known as exploratory actions?
level 5
In which cognitive level does the client have difficulties with judgement, reasoning, planning, semantic memory and episodic memory?
level 5
In which cognitive level can a client follow four to five step processes and learn new concrete ideas?
level 5
In which cognitive level is the caregiver standby or supervision is needed for cognitive assist?
level 5
Which cognitive level is known as goal-directed activity?
level 4
During which cognitive level can a client no longer problem solve?
level 4
During which cognitive level can the client follow two or three step activities?
level 4
In which cognitive level does the client require task set up for bathing and grooming?
level 4
In which cognitive level does the client require 24 hour supervision?
level 4
In which cognitive level can the client eat independently but require supervision for the amount of food eaten?
level 4
In which cognitive level does the client need protection against safety hazards and wandering?
level 4
Which cognitive level is characterized as manual actions?
level 3
In which cognitive level should attention be directed to tactile cues?
level 3
In which cognitive level are motor actions limited to one-step, familiar, and action-oriented activities?
level 3
In which cognitive level can the client no longer learn new behaviors?
level 3
In which cognitive level should adapted activities be used to reinforce the connection between predictable tactile effects on the environment and client actions (i.e. walking, washing cars, drying and washing dishes, wiping countertops, vacuuming)?
level 3
In which cognitive level should the client avoid sensory overload and require a routine?
level 3
In which cognitive level is the client able to wash hands, face and brush teeth while requiring that items be presented to the client one at a time and in sequential order of use?
level 3
What is cognitive level 2 characterized as?
postural actions
In which cognitive level is the client’s thinking highly disorganized?
level 2
In which cognitive level are motor actions one step, imitated, near reflexive and familiar and involve gross motor patterns?
level 2
In which cognitive level can ADLs be accomplished by imitating the caregiver?
level 2
In which cognitive level does the client pace and wander and should be taken to the restroom every 2 hours?
level 2
In which cognitive level does attention involve internal cues and spontaneous behaviors are common?
level 2
What is cognitive level 1 known as?
automatic actions
In which cognitive level do motor actions respond to one-word, near-reflexive directions (i.e. sip)?
level 1
In which cognitive level does the client need passive, active, or assistive ROM for prevention of bed sores, osteoporosis, infections and contractures?
level 1
In which cognitive level should the environment be consistent, familiar and modified to elicit orienting experiences?
level 1
In which cognitive level is the client dependent on caregivers for ADLs, needs monitoring for adequate nutrition, and requires assistance with ambulation and transfers?
level 1
Which cognitive level is the terminal phase of the disease?
level 1
T or F: Death usually occurs before the last stage of cognitive level 1 for patients with dementia
True
What are some things you should do to manage behavior in clients with dementia during communication?
avoid reasoning with the client, listen, maintain a trusting relationship, offer choices when possible, decrease demanding social situations and simplify approaches to the environment during sundowning
What is sundowning?
an increase in activity and often agitation that begins in the late afternoon and extends into the evening or night
What are some things you should do to manage behavior in clients with dementia during sundowning?
use adequate lighting, provide a safe area for physical activity, provide reassurance in a calm and caring manner, provide the client with fluids during the day, reduce noise and clutter and avoid using restraints
What are some things you should do to manage behavior in clients with dementia during anger?
anticipate problems and stressors, rephrase negatives as positives, distract the client by using food or asking for assistance, adhere to familiar routines, simplify tasks, allow time for response, allow physical movement, reduce stimuli in the environment
What are some things you should do to manage behavior in clients with dementia during wandering?
assess the reason for wandering, use a calm approach, provide signs in the environment for cueing, use distraction to interrupt pacing, simplify tasks, provide a rocking chair or opportunities for activities and movement, ensure good lighting, keep area safe/uncluttered, monitor fatigue/fluid intake/client’s feet, walk with client, use medicalert identity wristband and provide reassurance, attentiveness and acceptance
What are some things you should do to manage behavior in clients with dementia during pillaging and rummaging?
learn the client’s favorite hiding spaces, give the client a familiar item to hold, involve the client in activities that involve sorting items, accompany the client to make it fun, provide the client with rummaging closets or areas, do not scold, tease or punish the client or respond with anger, use distractions, etc. (more listed in PDF)
What are some things you should do to manage behavior in clients with dementia during activities and occupations?
focus activity on the client’s abilities (not limitations), be purposeful, provide the client with a sense of belonging, promote positive behaviors and appropriate verbal/nonverbal communication
T or F: Part of your intervention should include caregiver training in activities to enhance the client’s fine and gross motor abilities, provide sensory stimulation, reinforce old learning, self-image and dignity and improve sense of reality.
True
T or F: The promotion of physical activity will help address sleep functioning in clients with dementia
True
What are some sensory-preceptual modifications you can make for clients with dementia?
appropriate lighting, high-contrast coloring or textured surfaces, objects for stimulation, varied, safe and tactile objects, visual blocks and soundproofing
What are some memory enhancement intervention ideas you can do for clients with dementia?
large print calendars, daily schedules, seasonal decorations, familiar furniture, photographs, favorite music, notices of current events
T or F: Simplified and structured environments help to promote ADL task performance in clients with dementia
True
T or F: It is beneficial to have inconspicuous locks on cabinets and doors, safe indoor walking space or garden and a monitoring system for clients with dementia
True
