Positive Care Approach

T or F: Dementia does not = Alzheimer’s

True

Dementia equals

Brain failure

What changes in the brain with dementia?

• structural changes (permanent)

  • chemical changes (variable)

Four Truths about dementia

1) At least 2 parts of the brain are dying

2) it is chronic and can’t be fixed

3) it is progressive and will get worse

4) it is terminal

Vascular Dementia

Associated with strokes. Damage to the brain from the stroke causes cell damage. Symptoms are typically impaired judgement and decision making rather than memory impairment.

Lewy Body Dementia

Development of abnormal proteins; decreased dopamine and acetylcholine. Fluctuation in alertness and attention; hallucinations; parkinsonian symptoms; autonomic nervous system and sleep disturbances.

Pick’s Disease/Fronto-Temporal Dementia

Onset prior to age 65, language impairment greater than memory

Parkinson’s Disease

Central nervous system, movement disorder. Slowed reaction time, executive functions deficits, set-shifting, decision making, motor planning, Dementia develops later. Commonly due to insufficient dopamine and similar to Lewy body disorder.

Korsakoff Syndrome

Chronic memory disorder caused by alcohol abuse

HIV-associated neurocognitive disorder

cognitive, motor, and behavioral impairments.

Huntington’s Disease

Involuntary movement, changes in personality, mood, and cognitive functions

How should you approach a patient with dementia?

Visual → auditory → physical

What is lost for memory in dementia patients?

Immediate recall, attention to selected information, recent events, relationships

What memory is preserved in memory?

long ago memories, confabulation, emotional memories, motor memories

How is language changed in dementia?

can’t find the right words, word salad, vague language, single phrases, sounds & vocalizing, can’t make needs known.

What is preserved in language?

Singing, automatic speech, swear words

What is lost in understanding language with dementia?

can’t inter

What is preserved in understanding?

can get facial expression, hears tone of voice, can get some non-verbal, learns how to cover

What sensory changes occur with dementia?

Awareness of body and position, ability to locate and express pain, awareness of feeling in most of body

What sensations are preserved in dementia?

4 areas can be sensitive, any of these areas can be hypersensitive, need for sensation

Self-care changes in dementia

initiation & termination, tool manipulation, sequencing.

Preserved ability in self-care

motions and actions, the doing part, cued activity

What should hand-under-hand be used for?

Connecting, guiding, getting eye contact and attention, providing help, offering a sense of control

Validating emotions in early stages of dementia

Label emotion “

Validating emotions in midway stages of dementia

Repeat/reflect their words. Listen for added information, ideas, thoughts. explore the new information by watching and listening

Validating emotions for late stages of dementia

Check out their whole body, observe face, posture, movement, gestures, touching, looking