Chapter 40: Confusion and Dementia

cognitive function

Involves memory, thinking, reasoning, ability to understand, judgment, and behavior

delirium

A state of sudden, severe confusion and rapid brain changes

elusion

A false belief

dementia

The loss of cognitive function that interferes with routine personal, social, and occupational activities

elopement

When a person leaves the center without staff knowledge

hallucination

Seeing, hearing, smelling, or feeling something that is not real

paranoia

A disorder (para-) of the mind (-noia); the person has false beliefs (delusions) and suspicion about a person or situation

pseudodementia

False (pseudo) dementia

sundowning

Signs, symptoms, and behaviors of AD increase during hours of darkness

ADL

Activities of daily living

GDS

Global deterioration scale

MCI

Mild cognitive impairment

NIA

National Institute on Aging

OBRA

Omnibus Budget Reconciliation Act of 1987

AD

Alzheimer disease

What does cognitive function involve?

• Memory

• Thinking

• Reasoning

• Ability to understand

• Judgment

• Behavior

Acute confusion is also called

delirium

What are the early signs of dementia?

• Recent memory loss that affects job skills

• Problems with common tasks (for example, dressing, cooking, driving)

• Problems with language; forgetting simple words

• Getting lost in familiar places

• Misplacing things and putting things in odd places (for example, putting a watch in the oven)

• Personality changes

• Poor or decreased judgment (for example, going outdoors in the snow without shoes)

• Loss of interest in life

What are the treatable causes of dementia?

• Medications and alcohol

• Delirium and depression

• Tumors

• Heart, lung, and blood vessel problems

• Head injuries

• Infection

• Vision and hearing problems

Pseudodementia

false (pseudo) dementia. The person has signs and symptoms of dementia. However, there are no changes in the brain. This can occur with delirium and depression. Both can be mistaken for dementia.

What are the causes of permanent dementia?

• AIDS-related dementia

• Alcohol-related dementia and Korsakoff syndrome

• Alzheimer disease

• Dementia with Lewy bodies

• Frontotemporal dementia

• Mixed dementia

• Creutzfeldt-Jakob disease

• Brain tumors

• Cerebrovascular disease

• Huntington disease (a nervous system disease)

• Multiinfarct dementia (MID) (many [multi] strokes leave areas of damage [infarct])

• Multiple sclerosis

• Parkinson disease

• Stroke

• Syphilis

• Trauma and head injury

What is the most common mental health disorder in an older person?

Depression

What functions are affected by Alzheimer disease?

• Memory

• Thinking

• Reasoning

• Judgment

• Language

• Behavior

• Mood

• Personality

What is the classical sign of AD?

gradual loss of short-term memory

What are the stages of AD?

No impairment

Very mild cognitive decline

Mild cognitive decline

Moderate cognitive decline

Moderately severe cognitive decline

Severe cognitive decline

Very severe cognitive decline

What are common behaviors of a resident affected by AD?

• Getting upset, worried, or angry more easily

• Acting depressed

• Losing interest in things

• Hiding things (p. 594)

• Believing other people are hiding things

• Pacing a lot of the time

• Wandering

• Sundowning (p. 591)

• Hallucinations (p. 591)

• Delusions (p. 591)

• Catastrophic reactions (p. 591)

• Agitation and restlessness (p. 591)

• Aggression and combativeness (p. 592)

• Screaming (p. 593)

• Problems with intimacy and sexuality (p. 592)

• Repetitive behaviors (p. 592)

• Communication problems (p. 593)

MedicAlert + Safe Return

a 24-hour emergency service for persons who wander or have a medical emergency. It was formed by the MedicAlert Foundation and the Alzheimer’s Association. The program is nationwide.

How should a NA react to paranoia?

• Do not react if the person blames you for something.

• Do not argue with the person.

• Assure the person of own safety.

• Use touch or gently hug the person. This shows that you care.

• Search for missing things. This helps distract the person. Talk about what you found. For example, you find a photo, so talk about the photo.

• Observe for early signs of agitation and restlessness. Such signs may help you remove the cause before the behaviors worsen.

• Do not ignore the problem. Try to find the cause.

• Allow personal choice. Let the person decide things to the extent possible.

• Try to distract the person. A snack, safe object, or activity may help.

• Reassure the person.

• Keep personal items within the person’s sight. Photos and treasures are examples.

• Reduce noise and clutter.

• Limit the number of people in the room.

• Use gentle touch.

• Provide soothing music.

• Read to the person using a gentle voice.

• Provide quiet times.

• Follow a set routine for bathing, dressing, eating, and so on.

What are some signs of AD involving intimacy and sexuality?

• Depend on and cling to a partner.

• Not remember life with a partner.

• Not remember feelings for a partner.

• Fall in love with another person.

• Have side effects from medications that affect sexual interest.

• Have memory loss, changes in the brain, or depression that affect sexual interest.

• Have abnormal sexual behaviors.

What are signs of AD when it comes to communicating?

• Struggling to find the right word

• Forgetting what one wants to say

• Problems understanding the meaning of words

• Attention problems during conversations

• Losing one’s train of thought when talking

• Problems blocking out background noises—radio, TV, phones, and so on

• Frustration with problems communicating

• Being sensitive to touch, tone, and voice volume

What is helpful measures by the NA when communicating with a resident who has AD?

• Providing a calm, quiet setting

• Playing soft music

• Having the person wear hearing aids and eyeglasses

• Having a family member or favorite caregiver comfort and calm the person

• Using touch to calm the person

When is LTCF needed for a resident who has AD?

• Family members cannot meet the person’s needs.

• The person no longer knows the caregiver.

• Family members have health problems.

• Money problems occur.

• The person’s behavior presents dangers to self and others.

What are the principles of Validation Therapy?

All behavior has meaning.

Development occurs in a sequence, order, and pattern

If a person does not successfully complete a stage of development, unresolved issues and emotions may surface later in life.

A person may return to the past to resolve such issues and emotions

Caregivers need to listen and provide empathy.

Attempts are not made to correct the person’s thoughts or bring the person back to reality