Understanding Dementia

Presented by Susie Zeigler, MA, CF-SLP October 28, 2014

What is Dementia? Condition in which there is a gradual loss of brain function, particularly with cognitive and intellectual function. ◦ Loss of memory

◦ Confusion

◦ Problems with speech and understanding

◦ Changes in behavior and personality

◦ Increased reliance on others

◦ Alzheimer’s disease is a type of Dementia

Theory of Retro-genesis •Suggests that people reverse develop due to Alzheimer’s disease

•Compares stages of dementia to functional/developmental ages

•Helps explain why a person with AD is acting in a certain way and provides caregivers with a better way to respond

•Does not mean treating the person like a child—always give them the dignity and respect they deserve

Staging Dementia • Helps in understanding a better way to approach

your loved one

• Staging is fluid and changing—can change from day to day.

Allen Cognitive Scale Level 6: Independent; Normal Cognition

Level 5: Mild Cognitive Impairment

Level 4: Early Stage

Level 3: Middle Stage

Level 2: Late Stage

Level 1: End Stage

Aging in Place •Focusing on a person’s remaining ABILITIES and doing as much as possible to sustain independence

•Goal is to keep person with AD at the stage they are in for as long as possible and prevent further decline

How do we do this?

Changing the Paradigm Negative Perspective Positive Perspective

Sad/unengaged Excited about interests

Wanders off Has ability to walk

Can’t feed self Eats finger foods

Rummages Has ability to use hands

Focus on what a person CAN DO; their Best Ability to Function

Focus on Remaining Abilities Allen Level 5: Mild Cognitive Impairment

◦ Retro-genesis suggests: teens-early 20s

Observed Abilities Caregiver Approaches

Follow simple written instructions

May need assistance with finances

Possibly employed May need assistance with planning, appointment-making

Driving

Child care

Laundry

Focus on Remaining Abilities Allen Level 4—Early Stage

◦ Retro genesis suggests: 4-12 years

Observed Abilities Caregiver Approaches

Follow routines well Set out or make supplies visible

Goal directed in familiar activities Provide assistance in simple problem-solving

Can solve simple problems Establish and maintain a daily routine

Some new learning ability

Focus on Remaining Abilities Allen Level 3—Middle Stage

◦ Retro genesis suggests: 18 months-3 years

Observed Abilities Caregiver Approaches

Grasp and release objects Use verbal, visual, and touch cues to gain attention

Hand-eye coordination Break activity down into parts

Notice effects of actions Use familiar objects to access procedural memory

Follow one-step directions with cues

Examples: painting, drawing, photo albums, magazines

Focus on Remaining Abilities Allen Level 2—Late Stage

◦ Retro genesis suggests: 12-18 months

Observed Abilities Caregiver Approaches

Movement—some range of motion

Wait for a response (up to 30 seconds or more)

Some ability to feed self Finger foods, cups with lids

Possibility of walking Provide meaningful sensory stimulation

Speak some words Use verbal, visual, and touch cues to gain attention and trust

Focus on Remaining Abilities Allen Level 1—End Stage

◦ Retro-genesis suggests: infant

Observed Abilities Caregiver Approaches

Vocalize Wait for a response

Respond to stimulus (voice, touch, sound)

Provide meaningful sensory stimulation

Swallow Use verbal, visual, and tactile cues to gain attention

Turn head in response to stimulation

Provide stimuli directly in front of the person

Make facial expressions Keep a calm, soothing energy

Behavior is Communication •Behavior will typically stem from an unmet need

•Need to figure out what is trying to be communicated

•Use theory of retro-genesis to guide you in determining what may be the issue ◦ Hot, cold, hungry, lonely, uncomfortable, dislikes

a food, dislikes activity, bored, etc.

Questions?

Thank you!