Topic 2: Dementia Interventions

mild cognitive impairment (MCI)

early stage of cognitive decline where deficits are noticeable but ADLs remain intact

Alzheimer’s

gradual and progressive decline with memory impairment as the first and most prominent symptom

Frontotemporal dementia

typically occurs at a younger age and presents with personality, behavior, and language changes before memory is affected

ACL 0 - Coma

• attention: none/no response to stimuli

• total assistance (24/7)

ACL 1 - Awareness

global cognition PROFOUNDLY impaired

• attention: seconds (internal cues, pain)

• total assistance (24/7)

ACL 2 - Gross Body Movements

global cognition SEVERELY impaired

• attention: minutes (very limited)

• max A

ACL 3 - Manual Actions

global cognition SEVERELY impaired

• attention: up to 30 minutes

• mod A (step by step cues, set-up, re-focus attention)

ACL 4 - Familiar Activity/Goal-Directed Actions

global cognition MODERATELY impaired (can understand cause-effect relationship, awareness of familiar end-product but no independent new learning, relies on visual cues)

• attention: up to 1 hour

• min A

ACL 5 - Learning New Activity/Exploratory actions

global cognition is MILDLY impaired (can learn new ways of doing things through trial and error problem solving, but have poor judgement or lack symbolic thought)

• attention: several hours

• standby assistance (for safety precautions)

ACL 6 - Planning New Actions

NO global cognitive impairment (anticipates errors, good judgement, reflection)

• attention: normal, defined by desires and priorities

• no supervision required, new motor learning able to be done safely and consistently

at what ACL can spaced retrieval be implemented

ACL 3 and 4

what is the global deterioration scale (GDS) used for

• a way of categorizing cognitive deficits

• useful tool in caregiver education

ACL or GDS: which scale has a higher number as more severe deficits in cognition

GDS (1: no impairments → 7: very severe)

ACL (0: most severe → 6 no impairments)

GDS Stage 1

no impairment

GDS Stage 2

very mild cognitive decline , nothing more beyond normal aging

GDS Stage 3

mild cognitive decline is noticeable to family and friends, especially in complex tasks

GDS Stage 4

moderate cognitive decline to point that a formal diagnosis can be made by neurologist, challenges present in short-term memory and basic arithmetic

GDS Stage 5

moderately severe cognitive decline marked by challenges with ADLs, confusion, and disorientation. INDEPENDENT LIVING is a challenge

GDS Stage 6

severe cognitive decline with memory loss, and onset of personality changes and recognizing familiar faces

GDS Stage 7

very severe cognitive decline with significant impairments to memory, communication, and motor control/mobility

GDS Stages Simplified

• none

• very mild

• mild

• moderate (diagnosis made)

• moderately severe (independent living hard)

• severe

• very severe

common OT interventions for dementia

• task simplification

• environmental modification

• compensation

• remediation

• wellness and health promotion

• caregiver training

• topographical orientation/wayfinding