1
Q
what is dementia
A
syndrome in which there is disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehrenshion
2
Q
most common types of dementia
A
- Alzhiemers disease
- Vascular dementia
- Dementia with Lewy bodies
3
Q
risk factors for dementia
A
- Multiple transient ischaemic attacks (TIA) or strokes –for vascular type dementia
- Repeated head trauma (Alzheimer’s disease & dementia related to Parkinson’s disease).
- Strong family history
- Prolonged hypertension
- Uncontrolled diabetes
- Atrial fibrillation
4
Q
10 early indicators of dementia
A
forgetfullness difficulties with familiar activities language problems problems with spatial and temporal orientation impaired capacity of judgemet problems with abstract things leaving things behind mood swings and behavioural changes personality changes loss of initiative
5
Q
other conditions that mimimic symptoms of dementia but can be treated
A
- Hypothyroidism
- Normal pressure hydrocephalus
- Syphilis
- Brain tumour
- Subdural haematoma
- Depression
- Side effects from prescribed or other drugs
- Delirium resulting from an acute illness
6
Q
differences between demential and delirium
A
- People with Mild and moderate dementia usually are alert and can attend to questions and cognitive tests.
- People with Delirium are usually either hyper aroused or drowsy and easily distracted, clouding of consciousness
7
Q
how is dementia diagnosed
A
- Family history
- Duration of symptoms
- Mini- mental state examination
- Neuroimaging: brain CT or EEG scan- exclude stroke, tumors, subdural, determine atrophy
- MRI- Magnetic reasonce imagery demonstrates pathological or other physiologiaal alterations of living tissues to rule out vasculitis
- PET- position emission tomography
- Blood test (rule out reversible causes eg infections
8
Q
whats the most common for of dementia
A
alzhiemers disease
9
Q
what is alzheimers disease
A
- Plaques and tangles develop in the brain, leading to death of brain cells.
- Shortage of some important chemicals in the brain that transmit messages
- Is a progressive disease
10
Q
how many stages are there of dementia
A
early stage
moderate or mid state
sever or late stage
11
Q
whats early stage of dementia
A
- Impaired mental ability, mood swings
- May lose interest in activates
- May show poor judgement
- Blame others for stealing lost items
- May get more irritable
- May repeat themselves or lose thread of conversation
12
Q
whats moderate/mid stage of dementia
A
- Behavioural disturbances usually increasingly develop ◦ Be confused in time and place
- Forget names of family members
- Leave saucepans and kettles on stove, leave gas on
- Wander the streets, maybe at night
- Behave inappropriately (hide possessions, wear
- inappropriate clothes)
- Become very repetitive
- Neglectful of hygiene or eating
- Become angry, upset or distressed. Easily frustrated
13
Q
whats severe/ late stage of dementia
A
- Various other body functions such as swallowing and the excretion process
- Loss of independence in managing everyday life eg cant remember having eaten
- Altered perception and social relationships eg no recognition of family and friends, restless, fail to recognise familiar items
- Dependent on care eg bathing, toileting, dressing
- Physical problems eg falls prevention
14
Q
care/family member issues of people with dementia
A
- Exhaustion
- Sadness/ grief
- Confusion (whats going on)
- Isolation and loneliness
- Role change
- Fear of future
- Mental health issues (depression
15
Q
occupational therapy assessment for dementia
A
- Cognitive screens/assessments: eg MMSE, Cognistat
- Assessment of motor and process skills (AMPS)
- Personal activities of daily living (PADLS)
- Domestic activates of Daily living
- Driving assessment
16
Q
whats a carer
A
: a person who through family relationships or friendships, looks after a frail older person or someone with a disability or ongoing health condition.
17
Q
whats carer payment
A
- Provides financial support to people who are unable to work due to full time daily care of someone with severe disability/medical condition/frial aged.
- Fortnightly payment $700, career can work 25 hours per week including transport.
- Will also receive career allowance
18
Q
whats carer allowance
A
- fortnightly income supplement for parents or carers providing additional daily care and attention to an adult or dependent child with disability or a medical condition, or to someone who is frail aged.
- Can work with care allowance, not taxed, $130 per fort night
- Has no impact on ability to work
19
Q
direct taskes of carers
A
- Assistant in home, community education setting for all ADL
health/ medical care - Transport
- Support
- Surveillance for safer or to manage risk
- Can happen night or day
20
Q
indirect tasks of carers
A
- Participation responsibilities for persons skill development and maintain/ improve health
- Advocacy- service advocacy
- Organising the service system around care recipient
- Managing people within those service systems eg explaining to people at the supermarket why someone is acting in a particular wat
- Financial responsibility eg pension
- Coordinating and meeting the needs of other family members as influenced by disability/person
21
Q
what is cognition
A
thinking, remembering, reasoning, decision making and making sense of the world
22
Q
whats structural capacity
A
persons limits in processing info, skills, challenges
23
Q
whats personal context
A
personality, coping style, values, motivation, emotions
24
Q
whats self awareness
A
gives an indication to level of insight into their situation whether they know their strengths and weaknesses or not
25
whats processing strategies
: behaviour that effects on performance: memory, problem solving skills, attention.
26
whats examples of higher level process
awareness
| executive funciton
27
whats examples of basic cognitive functions
- Attention
- Concentration
- Memory
- Perception
- Visual attention and scanning
- Thinking (categorising, sequencing
28
what can impact cogniton
language, culture and educaiton
29
whats the difference between a cognitive screen vs cognitive assessment
Screen: to identify if general cognitive issues exists
Assessment: to find out specific problem areas so can plan intervention
30
what are 5 cognitive screening tools
- Clock drawing test
- MMSE
- RUDAS
- MOCA
- ACE- II
31
what is the social environment
availability of relationships, quality of interactions and community and societal attitudes and practices.
32
what is the physical envronment
: spaces where people do things, objects people use including assistive devices. Physical and cognitive accessibility, safety, sensory qualities and availability of space and objects.
33
what is the occupational environment
presence of occupational and activates that reflect the persons interests, roles, capacities. Qualities of occupations and activities and funding and policies that influence occupations and activities
34
whats the clock drawing test
- Clock drawing ability following a stroke is used to evaluate perceptual and cognitive impairments with dementia.
- Quick screening tool, not a diagnostic tool
- Key clinical variables cognition, functional independence, type of stoke, education level, age
- Involves the client correctly drawing and placing the hands and number on a clock face
- 11:10 is considered to be one of the most sensitive for measuring cognitive dysfunction.
35
how is the clock drawing test scored
- 1 for complete circle
- 1 for correct number order
- 1 for symmetrical and accurate number placement
- Score of three= no impairment
36
what errors on the clock drawing test indicate ALzhimeres disease
– perseveration, counter-clock- wise numbers, absence of numbers and irrelevant spatial arrangements or Stroke – spatial neglect, hemianopia, sensory loss
37
whats the mini mental state examination
- Most widely applied test for dementia screening but cannot be the sole assessment
- Scored form of cognitive mental status examination
- 5-10 minutes to administer
- Is standardised and validated
- Screening tool
- Evaluates adults level of cognitive functioning/impairment
38
how is the mini mental state examination administered
- Includes 11 questions
- First section involves verbal response only and covers orientation, memory and attention
- The second part tests ability to name, follow verbal and written commands, write a sentence and copy a polygon. This section is affected by people with severely impair vision
39
scoring of the mini mental state examination
- 27-30 normal cognitive functioning
- 21-26 mild cognitive impairment
- 11-20 moderate cognitive impairment
- 0-10 severe cognitive impairment
- *between a score of 0-17 it is considered unsafe for a person to be living alone
40
abilities and skills physical capacity of ageing
- Postural alignment
- Sway and instability
- Gross motor coordination
- Fine motor coordination, dexterity, strength and endurance
- Walking speed
- Urinary incompetence
41
ACE-III what foes it test
- Five sub domain scores orientation/attention, memory, verbal fluency, language and visuospatial.
- Sensitive to early cognitive dysfunction
- Takes 15-20 minutes
42
what is the ACE-III score that demonstrates dementia
- Cut off core for dementia is 82-88/100
43
whats the MoCA
- Rapid sreening assessment for detection of mild cognitive dysfunction and mild dementia
- Not a diagnostic tool
- Assess attention, concentration, exectuvite function, memory, language, visuoconstructional skills, conceptual thinking, calcualtions, orientation
44
whats the scoring for the MoCA
- Scored out of 30
| - 26 and above is normal
45
whats the RUDAS
- Short cognitive screening instrucment
| - 6 items: memory, visuospatial orientation, praxis, visuocontructional drawing, judhemnt, language
46
whats case management
is a means for improving clients' health and promoting wellness and autonomy through advocacy, communication, education, identification of service resources, and facilitation of service.
47
strategies used to structure the envionemtn to support the needs of a person with dementia
```
increase lighting to reduce falls risk
safer flooring
clear labels and signs
reminder devices
increase social activities and participation
```
48
2 assessment for dementia
standardised mini- mental state examination (SMMSE)
Montreal cognitive assessment (MOCA)
RUDAS
Addenbrookes cognitive examination (ACE-II)
49
tuck mans 5 stage model of team development
```
forming
storming
norming
performing
ajourning
```
50
whats forming in tuck mans model of team development
Little agreement on team aims other than those received from leader. High dependence on leader for direction. Members try & establish their identity and make an impression.
51
whats storming in tuck mans model of team development
Clarity of purpose increases, but decisions don't come easily. Members vie for position, leader might be challenged. Cliques and factions form
52
whats norming in tuck mans model of team development
Beginning agreement on norms & practices (these may be +ve or –ve). Roles and responsibilities clear & accepted. Big decisions made by group agreement. Smaller decisions may be delegated. May engage in fun & social activities.
53
whats performing in tuck mans model of team development
Relies on the ‘norms’ established. Effective teams clear on tasks and roles. Members have a shared vision. Disagreements are resolved positively. Able to simultaneously work towards goals, and attend to relationship and team process issues to continue to grow.
54
whats adjourning in tuck mans model of team development
The break-up of the team, preferably when the task is completed successfully (or may be when members change), its purpose fulfilled; achievements celebrated. Some members may feel a sense of insecurity and regret loss.
55
how to remember tuck mans 5 stage model
```
Feed
Some
Normal
People
Apples
```
56
factors inhibiting group decision making
1. Lack of group maturity: groups need time and experience working together to develop decision making. Can work to strengths
2. Uncritically giving ones dominate response: shortcutting the process of identifying possible alternative and going with the initial majority.
3. Social loafing: hiding in the crowd, a reduction of individual effort when working on tasks that need the summing together of individual input
57
whats vascular dementia
Second most common
Associated with problems in the flow of blood to the brain
Caused by occlusion of cerebral vessels
Multiple strokes in the brain that cause deterioration of mental capabilities
58
whats Lewy body dementia
Caused by neurodegeneration
Lewy bodies are small round inclusions found in nerve cells
Unsteady gait and balance, fluctuation in alertness, motor defects, cognitive impairments
