Dimentia

Question 1

Very mild to Mild cognitive decline (pre-dementia)

Answer 1

“Is there a problem?”

• ADLs and IADLs are intact
• Mild memory problems
• perceived loss of control
• Anxious and fearful
• Socially and physically intact
• Use calendar, checklists
• Exercise/well-being

Question 2

Interventions for very mild to mild cognitive deficits (pre-dementia)

Answer 2

• New tasks are possible: grade for success!
• Calendar, checklists
• Exercise, destress

Question 3

Mild dementia/Early stage

Answer 3

“I just want to be alone”

• ADLs mostly intact, mild deficits
• IADLs mod A
• Moderate memory loss
• Denial, moody, paranoia
• Difficulty learning new tasks
• Lose valued objects
• Affects orientation to place, which affects community mobility
• Become disoriented while traveling away from home
• Financial management, shopping, meal prep
• Driving should be reevaluated
• Communication impaired
• Clings to old habits and repetitive routines or neglects old habits and routines
• Participation declines

Question 4

Interventions for mild dementia

Answer 4

• Use SIMPLE instructions (no new tasks)
• Family is important
• Exercise
• Community resources e.g., volunteers, daycare, community dinners

Question 5

moderate/middle dementia

Answer 5

“Go Away! Who are you?”

• Impairments in all areas of occupation
• Can’t live alone
• Eating problems and weight loss
• Dependent for community mobility, finances, shopping
• Safety is a huge concern…wandering, letting stranger in home, causing fire
• Limited leisure
• Some cleaning and cooking with supervision
• No ADLs or IADLs intact
• Disoriented to time/place
• Sleep disturbances/repetitive behavior
• Wandering
• Impaired visual and spacial orientation
• Delusions/paranoid
• Emotional changes
• Maybe incontenance
• Limited social participation to caregivers

Question 6

At what stage of dementia does wandering occur?

Answer 6

Moderate

Safety first!

Question 7

Interventions for Moderate dementia/middle

Answer 7

• Overlearned tasks with less than 2-3 steps
• Caregiver instruction
• Cuing
• Adapt environment
• Safety first! They’re wandering around! e.g., i.d. tags, footwear

Question 8

Late dementia

Answer 8

“Err no her”

• No ADLs or IADLs
• All areas of occupation lost
• Dependent on all ADLS
• Can’t ambulate safely
• No understanding of cultural, social, or spiritual contexts
• Generalized motor slowing –> bedridden
• Incontinent
• Unable to communicate –> one word

Question 9

Interventions for severe cognitive and physical decline (moderately severe/severe dementia)

Answer 9

Maintain proper positioning

• family support
• nature/nice, comforting environment

Question 10

Level of dementia when person may begin to notice and complain of memory problems, have forgetfulness, trouble finding familiar objects, but no deficits in social life and employment. Fam and friends may not notice

Answer 10

Very mild cognitive deficit (pre-dementia)

Question 11

Stage of dementia when others begin to notice deficits. Have increased forgetfulness and begin to see decreased performance in work and social environment

Answer 11

Mild Cognitive decline (pre-dementia) (Miri’s mom cut dog’s hair!)

Question 12

Stage of dementia when it’s first possible to get a dx

Answer 12

Mild dementia/early

Question 13

Stage of dementia when you are still oriented to time and place and can recognize familiar faces; difficulty will IADLs e.g., finances, shopping, ordering food; decreased sequencing and planning; denial as defense mechanism; can still live at home with support

Answer 13

Mild dementia/early stage

Question 14

Stage of dementia in which client can’t live alone anymore–can’t function independently and requires cues and assistance for ADLs and IADLs

Answer 14

Moderate dementia/middle stage

Question 15

Stage of dementia in which client can’t recall major life events, phone numbers and addresses; disoriented to time and place; can’t drive safely; distraught and confused

Answer 15

Moderate dementia/middle stage

Question 16

Stage of dementia when person forming incomplete sentences, can’t follow 2 step tasks, personality and emotional changes; frustration, agitated, anxious, obsessive, delusional behavior; dependent for all ADLs and IADLs; incontinent

Answer 16

Moderately severe dementia (middle-late)

Question 17

Stage of dementia when person is bedbound; unintelligible utterences; may be in vegetative state; total A

Answer 17

Severe/late dementia. Aware of secondary complications e.g., disease, infection, fall, pneumonia

Question 18

Standardized function based cognitive screening instruments for dementia

Answer 18

• Allen Cognitive Level screen
• AMPS
• Cognitive Performance Test
• Executive Function Performance Test
• Independent Living Scales
• Kitchen Task Assessment
• Arnadottir OT-ADL Neurobehavioral Eval

Question 19

Standardized cognitive screening instruments for Dementia

Answer 19

• Blessed Dementia Scale
• Cognitive Competency Test
• Lowestein OT Cognitive assessment
• Middlesex Elderly Assessment of Mental State
• Mini-Mental State Examination and Modified
• Neurobehavioral Cognitive Status Screening Examination
• Repeatable Battery for the assessment of Neuropsychological Status

Question 20

The Allen’s Cognitive Disability Theory is often used with what condition

Answer 20

Dementia

Question 21

Strategies for sundowning behaviors with dementia pt

Answer 21

• Adequate lighting
• Provide safe area of physical activity
• provide reassurance in a calm and caring manner
• Provide client with fluids during day
• Reduce noise and clutter
• Avoid using restraints

Question 22

Cognitive functioning approaches for Dementia

Answer 22

• Psychoeducation during early stages for family and caregivers
• Cognitive facilitation and stimulation e.g., reminiscing groups
• Relaxation techniques e.g., rocking chairs, soothing music
• Structured communicative approaches
• Environmental structuring to compensate for functional deficits e.g., visual aids, home setup
• Sensorimotor therapy