Intellectual changes in dementia
Aphasia is a loss of language (comprehension and expression). What might you see in a resident with aphasia?
Return to first language, may resist care because they have difficulty following verbal directions, appears frustrated with inability to express personal needs.
Which of these can trigger responsive behaviors in a person with dementia?
a) Unmet physical needs
b) Environmental overstimulation
c) Changes in routine
d) All of the above
d) All of the above
What is the most common type of dementia?
Alzheimer's disease is the most common, affecting 60–80% of those with dementia.
There are many things that are helpful to know - understanding the whole person—their history, personality, values, and needs helps in planning care that is respectful and effective.
True or false- there are medication that are highly effective in treating dementia?
Unfortunately, false. Medications for dementia offer modest, variable effectiveness, typically slowing decline or managing symptoms rather than curing the disease, with benefits often small, lasting 6-12 months, and not working for everyone. New therapies like monoclonal antibodies (e.g., lecanemab) can target Alzheimer's pathology in early stages but are not a cure.
Anosognosia is a lack of awareness or denial of one's illness. Describe behaviours you might see in a resident experiencing this.
Denying having memory loss, difficulty managing own personal care, trying to leave facility, refusing help
Why do we use the BSO-DOS© to track behaviours?
The BSO-DOS© provides objective data about a person’s behaviour. The data collected is used to identify patterns, trends, and contributing factors associated with responsive behaviours/personal expressions.
What changes might you see in someone with Alzheimer's disease?
When communicating with someone with dementia, you should:
a) Use long, detailed sentences
b) Speak slowly and use simple words
c) Avoid eye contact
d) Repeat instructions loudly
b) Speak slowly and use simple words
Why do antipsychotic medications need to be used cautiously in persons with dementia?
Antipsychotic medications carry serious risks and side effects such as increasing the risk of stroke, have sedative effects, increased risk of falls and resultant fractures, myocardial infarction, heart failure etc
Apraxia is the loss of ability to move and coordinate body and limb movement in a purposeful way-what might you see for a resident with apraxia?
May look like they are resisting care (e.g. unable to follow instructions to dress, brush teeth, shaving, eating food).
A resident with dementia repetitively calls out. What should I do?
a) ask the nurse to give them a medication.
b) see if they have any unmet needs.
b) See if they have any unmet needs- are they uncomfortable, in pain, need to toilet, thirsty, bored, frustrated, fearful, disoriented etc.?
This type of dementia typically affect the areas of the brain that involve thinking and movement.
Lewy body dementia
A resident is asking when her mother (who passed away 10 years ago) will pick her up. How do you respond?
Name 3 behaviours that are unlikely to respond to medications
Wandering
Vocally disruptive behaviour
Hiding & hoarding
Repetitive activity
Inappropriate voiding
Inappropriate dressing/undressing
Tugging at seatbelts
Residents with altered perception have trouble perceiving the world around them correctly- what might you see in someone experiencing this?
May refuse to move if it requires stepping over a shadow or dark floor tile, may become frustrated with inability to reach an item, urinating next to toilet.
You are trying to provide care to a resident and they begin to get angry at you and refuse all care. What should you do?
If the person becomes aggressive when you suggest washing, change the subject or distract them and try again later.
Give them time and space to settle.
Allow them the right to refuse.
Inform the nurse.
Review their behavioral care plan for individualized care approaches.
See if a colleague who they are more familiar with can help.
What is the second most common type of dementia?
Vascular dementia is the second most common, affecting about 20% of persons with dementia.
Name 3 strategies to enhance communication with a resident living with dementia
-make sure they have clean glasses/working hearing aides if in use
-make eye contact and use their preferred name
-reduce distractions in the environment ie. turn down the TV
-approach in a calm, relaxed manner
Name 3 Behavioural and Psychological Symptoms That May Respond to Medications
Anxiety
Depressive symptoms
Sleep disturbance
Manic-like symptoms
Delusions and/or hallucinations
Verbal aggression
Physical aggression
Sexually inappropriate behaviours
Agnosia is the loss of ability to recognize people/ self/objects, sounds, and taste resulting in misidentification- what behaviours might you see in a resident experiencing agnosia?
Possible behaviours may include putting non-food items in the mouth, yelling/being afraid of reflection in mirror, using objects incorrectly (e.g. combing hair with fork), may appear frightened when unable to recognize others.
Conversations with a person with dementia can be challenging- what are strategies to avoid arguing?
This type of dementia primarily affects the frontal and temporal regions of the brain – the areas generally associated with personality and behaviour.
What is Frontotemporal dementia?
A resident you are caring for is refusing to have a bath. What are possible reasons?
-They might be shy or embarrassed; think about their personal space and privacy. Try uncovering only the part of their body that you are washing.
- They may forget when they last bathed, how to use facilities, or fail to recognize the need for hygiene.
-Sensory sensitivity: Some people become highly sensitive to sound, light, or touch, making the bathing environment overwhelming
- Fear and confusion: Water may seem frightening, the bathroom dark/scary, or the mirror reflection interpreted as a stranger.
Which medication class is commonly used to manage severe agitation in dementia but carries a black box warning for increased mortality?
a) SSRIs
b) Antipsychotics
c) Benzodiazepines
d) Cholinesterase inhibitors
b) Antipsychotics