Cognitive and Perceptual Deficits

Stats

More than 5.8 million Americans have Alzheimer’s

1 in 3 people over the age of 85 currently have Alzheimer’s

Every 65 seconds someone in America will develop dementia

Over 4500 people in Smith County have some kind of dementia

• Of those, 70-80% will develop the tendency to wander

1 out of 7 Americans is currently caring for someone with dementia

Alzheimer’s disease cost the Texas economy $18 billion in unpaid caregiving hours

Alzheimer’s disease makes up 70-80% of all dementia cases

Cognition

“process of knowing (awareness, reasoning, judgment, intuition, and memory)”

Executive functions

these are higher cognitive functions

(capacity to plan, manipulate info, initiate and end activities, recognize errors, problem solve, judgement and abstract thinking)

Perception

Taking sensory input -> interpreting it -> understanding what is happening

Cognitive and Perceptual Impairments include:

Attention deficits

Memory impairments

Impairments of executive function

Body scheme and image impairments

Spatial impairments

Agnosia

Apraxia

Attention deficits

“the ability to attend to a specific stimulus while simultaneously suppressing extraneous stimuli”

Memory impairments

“mental process that allows someone to store experiences and perceptions for later recall”

Three levels:

• Immediate

• Short term

• long term

Executive function impairments

“capacities that enable a person to engage successfully in independent purposeful, self-serving behavior”

Consists of four components:

• Volition

• Planning

• Purposeful action

• Effective performance

Body scheme and image impairments

Together, it is body awareness=sensory and person’s feelings about the body

Specific problems are:

• Unilateral neglect

• Anosognosia- neurological condition in which the patient is unaware of their neurological deficit or psychiatric condition

• Somatoagnosia-characterized as loss of recognition or awareness of part of the body.

• Right-left discrimination

Spatial impairments

“difficulty perceiving the relationship between the self and two or more objects”

Difficulties with:

• Figure-ground, form discrimination, spatial relations, position in space

Agnosia

“Inability to recognize incoming info despite intact sensations”

Different kinds:

• Visual

• Auditory

• Tactile (astereognosis)

Apraxia

“inability to do purposeful movements that is not due to weakness, impaired sensation, abnormal tone, etc”

Different kinds:

• Ideomotor – doing an activity over and over again when no longer needed

• Ideational – can not do a task because can not figure out the motor planning of how to do it

• Buccofacial (oral apraxia) – difficulty doing purposeful movements with the lips, tongue, cheeks, larynx, and pharynx on command

Theoretical Approaches to Cognitive and Perceptual Deficits

Retraining approach

Sensory integrative approach

• Organization of sensation for use to do a task

Rehabilitative/compensatory approach

• Two components: Compensation and adaptation

Types of dementia

VASCULAR DEMENTIA (Vascular COGNITIVE IMPAIRMENT )

• Due to multiple TIAs or Cvas caused from atherosclerosis or hemorrhage

• Progression will Plateau depending on future Tia/cva

Lewy body

• Protein deposits, called Lewy bodies, develop in nerve cells in the brain regions involved in thinking, memory and movemeNT

• VISUAL hallucinations

Alzheimer’s

• Some evidence of Deposits of amyloid plaques and tangles in the brain which block neural connections

• True dx is with autopsy

Frontotemporal dementia

• Onset is usually between 40-60 yo (younger age than Alzheimer’s)

• Occurs in 10-20% of dementia pts

• Due to deterioration and shrinkage of frontal and temporal lobes

• dramatic changes in Personality and behavioral changes (often misdiagnosed as psych problems)

• Impulsive, angry outbursts, lack of judgement

• socially inappropriate or emotionally indifferent, lack of inhibition

• Repetitive compulsive behavior, such as tapping, clapping or smacking lips

• A decline in personal hygiene

• Changes in eating habits, usually overeating or developing a preference for sweets and carbohydrates or Eating inedible objects

• Compulsively wanting to put things in the mouth

• May lose the ability to use language properly

Dementia

Not a part of normal aging

Dementia is a symptom that there is something wrong with the brain; it is NOT a disease

May be reversible depending on the cause

Dementia includes a group of symptoms:

• impaired memory

• impaired cognitive functioning (language, attention, problem solving, spatial skills, judgment, planning, or organization)

Causes of dementia could be:

• Alzheimer’s , Vascular dementia, Frontotemporal dementia, Lewy body disease, and Chronic traumatic encephalopathy

Alzheimer’s Disease

Not a part of normal aging

Could have a genetic predisposition

Alzheimer’s is a very specific form of dementia

Symptoms of Alzheimer’s include impaired thought, impaired speech, and confusion

Irreversible and incurable

Degenerative

National Institute on Aging (NIA)

Dementia is a brain disorder that affects communication and performance of daily activities

Alzheimer’s disease is a form of dementia that specifically affects parts of the brain that control thought, memory and language

Diagnosing dementia

At least two of the following must be impaired:

Memory

Communication and speech

Focus and concentration

Reasoning and judgment

Visual perception (can’t see the difference in colors or detect movement, or sees things that aren’t there)

Alzheimer’s Alliance of Smith County

Founded in 1982 as a nonprofit organization

Provides services and programs for caregivers, respite assistance, memory screenings, education, and community events

Every year:

• Annual Butterfly luncheon and butterfly release

• Mah Jong for memory

• Annual caregiver conference

• Memory maker leadership circle reception

• Educational workshops

Project Lifesaver

Alzheimer’s Alliance

Personalized wristband that emits a tracking signal

Battery operated, waterproof wrist transmitter emits an automatic tracking signal every second of every day

Can be tracked on the ground for up to one mile or in the air for several miles

When person is missing, law enforcement officials are notified and start searching with the mobile locator tracking system

Starts at $300 for the bracelet and a monthly fee of $10

Gems Levels*

Teepa Snow, OTR

Positive Approach techniques for caregiving, Alzheimer’s and other forms of dementia

It’s a system that helps identify what level a patient with dementia is in at that moment and ways to assist the patient in doing a task that maintains respect and helps the patient be successful

Helps to see what remains in the person instead of what the person has lost

Learn how to use skills to better care for the person with dementia and support the caregivers

6 Gems Levels

Sapphire

Diamond

Emerald

Amber

Ruby

Pearl

Sapphire

True Blue

Normal aging (not dementia)

Moments of depression about aging/changes

Can learn new things but takes effort (more time and practice)

May need reminders to help with forgetfulness

Tips to help Sapphires

Allow them time to process the information you are giving them

May resent someone “taking over a task” so ask if they want help

Use prompts to help memory

Make sure only one person talks at a time and ask the person to

repeat what was said to make sure that everything was understood

Diamond

Clear and sharp

Likes routines and familiar things

Becoming rigid or inflexible in that they resist change and want things done a certain way

Can do well at times and at other times can be hurtful without being aware that they’ve said something mean

Needs repetition and time to process information

May ask the same question or say the same thing over and over but they perceive it as new each time

Struggle with finding the right words

Family notices a change but not sure if it’s dementia or just forgetfulness and stubborn

Tips to help Diamonds

Modify your approach to the person

Don’t argue

Say “I’m sorry…”

Don’t say, “remember …”

Limit info you give them

Try to keep them in their routine but have a balance of activities

Emerald

Go, go, go

Unable to be independent but they think they are

Moments of clarity then moments of illogic

Doesn’t notice mistakes at times; not aware of their loss of abilities

Noticeable changes to others

Problems with language and comprehension

Repeating words or phrases; misspeaking

Orientation changes

May need assistance to go places and do ADLs

May forget to eat or eating frequently, not changing clothes or bathing

Pays more attention to what is seen than heard

Vision is binocular (limited to peripheral awareness)

Strong emotional reactions due to fear or unmet needs

Tips to help Emeralds

Decide if something the person does is really important to correct

Greet before you treat

Do activities with the person and NOT for the person

Stay calm and listen to the person to figure out what the person needs

Use visual cues first when you want someone to do something

Think before you speak

Establish a daily routine and schedule

If activity isn’t working, stop and do something else

Learn how to respond and not react to what the person does or says

Use humor

Simplify tasks

Ask if the person wants help

Amber

No safety awareness

Living in a moment of time

Focused on sensations (what does it look, sound, taste, or feel like)

Seeks to satisfy themselves

Avoid what is disliked

Visual abilities are limited

Focus on pieces and not the whole picture

Crosses boundaries (wants gratification immediately)

May be very curious or repetitive with objects or actions

Becomes difficult to connect or spend time with the person

Tips to help Ambers

Use behavior to guide your responses

Short visits

Try to figure out what the person needs or is avoiding

Time-out then re-approach person

Slow down or speed up which ever matches the person then gradually change the rhythm and pattern

Share with the team things the person likes, dislikes, music, food, smells, touch

Simplify the person’s world

Exaggerate visual responses, use automatic greetings and movements, limit instructions and verbal info, assist the person instead of doing it for them

Ruby

Slowing down

Difficulty switching from one transitional movement to another

If not moving, can’t go; if moving, can’t stop

Can do big movements but losing fine motor skills (difficulty using utensils)

Safety issues so more falls

Can grossly copy you but doesn’t understand what you want

Losing depth perception; monocular vision

Needs guidance to doing something else due to repetitive movements

Does better with rhythmic beats (singing, praying, rocking, dancing)

Can pick up something but not know what it’s purpose is

Understands big magnified facial expressions and tone of voice

Tips to help Rubies

Slow down

Use automatic responses whenever possible

Breakdown tasks into smaller pieces

Demonstrate activities

Help guide and cue for movements

Don’t push or pull

Limit talking but remember tone of voice

Pearl

Hidden in a shell

They are still and quiet

Becoming immobile

Body and brain are failing but may have times of awareness

Protective reflexes are gone

Connections must be made slowly and won’t last long

Start with a caring touch and a smile

Sometimes can recognize familiar touches, voices, faces, aromas, and tastes

You need to go slow and simplify tasks

Have to let them go

Tips to help Pearls

Observe how and where to approach person

Use voice and touch to let person know you’re there

Try to keep one hand on person’s shoulder or hand while the other hand is doing something

Remember how important touch is

Offer sips of a drink or food

Don’t talk like the person is not in the room

Hand-Under-Hand Technique

Helping technique

Promotes a physical touch connection that is friendly and comforting

Provides sensory feedback and communication

Uses the automatic connection between the eye and hand to form a closed circuit between the person and you

Used to greet someone

Guide someone in desired movements

Essential with the Amber, Ruby, and Pearl Gem stages

Offer handshake -> shift hand so that yours is under the person’s hand with thumbs locked ->lay your other hand over theirs in a “sandwich”

Encourages eye contact and attention

Positive Physical Approach Techniques

Knock on door

Stop about 6 feet from the person

Smile, make eye contact

Call the person by preferred name

Extend your hand to shake the person’s hand (move forward slowly)

Move toward the right side on the person while offering your hand

Shake the person’s hand

Shift your hand so that your hand is under the person’s hand

Give your name and greeting

Get to the person’s level

Now tell the person what you want