Dementia
A Privilege
1
Types of Dementia
Alzheimers alteration chemistry/structure changes
Vascular Dementia/stroke oxygen lack
Dementia with Lewy Bodies in nerve cells
•
Frontal lobe dementia personality/ behaviour
•
Parkinson’s Huntington’s
•
•
Multiple Sclerosis Motor Neurone
Disease
Korsakoff (alcohol) C-J-D HIV
What is Dementia
Progressive, not just memory loss or
forgetting names, may not recognise
people or things,may get lost
Reduced attention span, ability to do
things, understand or communicate
increased agitation confusion
Caused by amyloid plaques/tau tangles
(‘rungs’ in communication ladders)
increased inflammatory response (TNF)
3
There is always a reason
Every action has a reason Every
communication has a purpose.
What sounds nonsense is showing
a need, expressing a feeling, or
wanting a response.
The meaning of words may be
disconnected from their sound; so
may not understand or may
produce a word salad.
4
Questions
Asking What time is it?,
might mean
“I have no idea what I am
meant to be doing”.
Asking Can I go home?,
perhaps means
“I do not feel comfortable ”
Listen to the meaning behind
the question
Dementia Time Travel
May think it is 1960 when
X not born
Y not married
Z still alive
Children have to learn social skills
In dementia lose social inhibitions
do not always ignore or accept
May have ‘comforter’ be aware
Actions there is always a reason
Wandering may have a purpose or be
responding to an hallucination.
Sleep patterns may get muddled
not aware difference between am & pm.
Might not recognise an item (fork)
so not know what to do with it.
Behavioural Patterns in Sundowning
(memories work/childhood late
afternoon)
7
Visual Spatial Muddle
Might not recognise self in a mirror
and think it is someone else.
May misjudge the edge of the table
or bathroom furniture unless
distinct/contrasting colours.
Pouring liquids can be dangerous.
May be frightened by carpets/floors
8
Strange behaviour
Difficult behaviour to who?
Aggression often due to frustration
misinterpretation of events such as
reflections in windows or mirrors
Incontinence can sometimes just forgetting to go
Might not be able to distinguish dreams from reality.
Don’t laugh or call them a liar, is it a fantasy?
Unwillingness to ‘cooperate’ may be due to fear eg
showers may not have been used in their childhood
9
SITUATIONS that can precipitate
agitation or confusion
Unfamiliar People
Unfamiliar Surroundings
Large Gatherings
A Task that is too complicated
Noise Lights
Travel
Illness
10
see it from their perspective
loss of blue purple green colour
strange lighting busy patterns
contrasts (puzzles, carpets,
bathroom, food)
walking, steps, feel as if falling
visual barriers
misidentification/misnaming
misinterpretation/misperception
When agitated
Simplify/calm the environment
Don’t ask questions or overwhelm with words
Reassure, show what to do, make a cup of tea
Too many people - take to a quieter place. Engage in
a familiar activity, music, a walk.
12
When caring
Introduce yourself with context
Approach from the front don’t tap on the back
Show Respect, their name, how dress, do hair, how touch
Involve...choice, (blue? not, which? jumper)
Buttonless clothes / digital time
Always leave with a smile
13
Feelings remain when facts are
forgotten
Exit strategy
SPECAL explained in
Contented Dementia
Absent people
Affirming statements
Reasons to sit
No need to tell lies
14
Memories
There are several ways to
reach the same destination
There are several ways to
enter the same house
Don’t give up when it
appears the key is lost
(neurons die)
Carers family or others
Younger family members may feel trapped,
be fearful
of their own future may even ‘run away’
Carers need a regular break to enable them to carry on
can
become exhausted /depressed / deny such / hide it well
Suffer great guilt if unable to cope or cope badly
This can add to their ‘grieving’ and they may be hypersensitive
Don’t assume you know what they are going through
16
Extra resources
Just put into google
Alzheimer’s Society
Somerset Dementia
Gloriousopportunity.org
Dementia
Always a reason
Feelings remain
Patterns continue
18