Dementia
Define dementia
Cognitive impairment in older adults (intelligence is not affected)
Cognitive function includes memory, thinking, reasoning, understanding, judgement, and behavior
Does not refer to a single disease, rather it is a general term used to refer to a variety of symptoms
Age Related Changes to Brain
Decreased blood flow
Brain cells shrink
Decreased neurotransmitters
Decreased myelin sheath
Triggers for negative/responsive behaviors? Name 3
1) Emotional and Physical Health (ill, pain, tired, scared, stressed
2) Environment (noisy, busy, hot, cold)
3) Tasks or Demands (too complex, rushed)
(when the correct trigger can be identified it can be removed or changed so that it no longer provokes the same behaviors, and remember that the behavior is a result of a brain disease and they are NOT doing it to annoy you)
A progressive degenerative neurological disorder, no cure, plaques and neurofibrillary tangles develop, brain cells shrink...what is it
Alzheimers
results in a change in abilities and or behaviours as the different areas of the brain are impacted
How can we modify the environment to assist those with dementia, list 5 things
good lighting
dont change placement of things
bed at appropriate ht
memory cues
watch color of things considering perceptual difficulties
water temp not too hot
lock away unsafe items
call bell
room to wander
places to rest
things to look at and handle
music
not too many people or distractions
What is 1) Amnesia 2)Aphagia 3)Agnosia
Loss of 1)memory 2)language 3)recognition of sounds, people, objects
Causes of cognitive impairment can be separated into two groups
Reversible/temporary
Irreversible/permanent
Give 4 examples of Reversible
Infections
Drug/alcohol toxicity
Vitamine deficiencies
Thyroid disease
Food poisoning
Dehydration/electrolyte imbalances
Emotional trauma/depression
To understand responsive behaviors it is helpful to describe it accurately, how can we best do this?
What was the person doing described objectively not subjectively...
Were there warning signs, time of day, location, is this a one off?
(the challenge is to understand why we see the behavior and remember every action has a purpose and meaning, and when we can understand this we can develop appropriate interventions)
Can happen at any time and is liked to PVD and CAD. Is progressive and there is no cure
Vascular Dementia
Changes in cognition depends on where the damage is done
Communication with someone experiencing demential should focus on 4 things, what are they?
The setting - free from distraction and noise
The approach - slow, open, calm, from front, call person by name, eye contact, identify self, body language congruent with words
The message - slow, simple, non verbals, tone, concrete not abstract, yes no ?, dont argue, be flexible
The individuals response- be sensitive to persons tone and body language, respect and acknowledge feelings, active listening, utilize family and friends
What is 1)Apraxia 2)Altered Perception 3)Apathy
Loss of 1)purposeful movement (inability to plan sequence and perform tasks) 2)ability to perceive env. cues 3)ability to initiate or start things (such as conversation or activity, not a lack of desire just doesn't know how)
What is Delirium
A state of Temporary mental confusion that can occur suddently and is caused by a treatable issue (Acute)
Confusion and Cognitive impairment are not the same. Confusion is a mental state where the person is unable to think with usual clarity and speed, can impact memory, judgement, and the person is disorientated.
Delirium is a medical emergency
General principles when intervening with responsive behaviors? Name 5
Stop and think before you approach
Smile (body language and nonverbals), go slow, or go away
Do not invade personal space
Stand aside and out of reach, know your exit
Use distraction
Do not argue
Genetically inherited mutation of the DNA. Neurons are destroyed causing many symptoms, no cure and is seen between 20-60
Huntingtons Disease
define wandering and sundowning
walking around often times on a mission
increase in signs and symptoms of dementia as the day goes on, could be related to fatigue and lighting
What does progressive Amnesia?
Memory is lost in reverse
Describe how delirium is diagnosed and treated
We are looking to diagnose and treat the underlying condition, so could be lab test, scans to Dx and medicines, O2 or fluids to Tx
Describe what person centered care means?
Dont treat clients as a collection, focus on the individuals unique qualities, abilities, interests, preferences and needs. ***Place the individual before the task
Describe the difference in cause between MS and Parkinsons
MS- decrease in myelin sheath (autoimmune)
Parkinsons- dopamine (is a chemical messenger) producing cells die (decreased dopamine impacts normal brain activity
Name 3 of the 6 Principles of caring for those with dementia
1)Every action has a purpose to the person performing the action
2)Every action has meaning for the person doing it
3)The way the individual perceives his/her world is as real to them as our world is to us
4)A person may lose words, but never loses feelings
5)You are the person who must adapt and change
6)Your approach to the client will determine whether or not communication is successful
Describe the different types of Aphasia
difficulty 1)speaking 2)understanding 3)reading 4)writing
Comprehension vs Expression
How to decide if it is delirium not just dementia
Delirium is abrupt and can emerge over hours
Delirium represents a sudden change for persons previous course of dementia
Alertness may vary, may be lethargic or hyper-alert
Individual can not focus to complete task that they previously could do
How do you manage 1)Repetitive Behaviors 2)Hoarding 3)Sexual behaviors
1)If not hurtful should be permitted or if harmful the client can be distracted
2)try to understand if there is a history that supports the items hoarded, only remove items if they pose a danger
3)can have different causes, ignore if appropriate and give privacy or redirect, they may be seeing connection, may be having other emotions such as anxiety, think TOILETING
Frontal and Temporal lobes affected, emotional responses and social funtioning altered, language skills diminish. No cure
Picks Disease (aka frontal lobe dementia)
How to promote normal sleep patterns, name 5
think side effects of medications
pain
too much napping in day
not enough exercise
unmet needs such as hunger, temp
caffine
noise
fear or anxiety