Module One: Dementia – Overview and Impact
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Hand-Feeding Techniques for Nursing Facility Residents Module One: Dementia – Overview and Impact Participant’s Manual Module One: Dementia – Overview and Impact Module One: Dementia – Overview and Impact 1. Overview of Dementia 2. Types of Dementia 3. Normal brain development vs. brain changes with Dementia 4. Communication impairments with dementia 5. Sensory Changes 6. Fight, Flight, Fright (Freeze) Response 7. Use of C3P to problem solve residents with Dementia Objectives: Upon completion of the course, the participant will be able to: 1. Define cognition and discuss the role of cognition in daily life. 2. Discuss how dementia causes brain changes that impact the resident’s ability to think, reason, and remember. 3. Discuss the term dementia and the term Alzheimer’s and why they are sometimes used interchangeably. 4. Describe sensory changes (taste, smell, vision, hearing, and touch) that occur in Residents with dementia 5. Define how a resident with dementia may respond when a fight, flight or fright response is stimulated. 6. Provide an example of how the C3P problem solving method can be used when caring for a resident with dementia. On a daily basis we perform multiple tasks that require cognitive functioning. In most instances we are not consciously aware of the intricacies required of such everyday tasks as tying a shoe, recalling the name of your first grade teacher, recognizing colors, or balancing your checkbook. And yet some area of our brain has been very actively involved in ensuring our ability to perform thousands of various tasks and skills on a daily basis. The Oxford Dictionary defines “cognition” as the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses. We recognize the maturation of the brain as we observe infants transform into toddlers, children, teenagers, and finally adults. Each stage adds to the building blocks of knowledge, reasoning, decision making, and judgement required for successful advancement to the next life stage. Every day at home, work, and in life, we come into contact with many sources of information. This information is provided to us through our senses…….what we see, hear, taste, and smell. Our senses do not work alone. Once the “sense” picks up a signal (stimuli), it has to send it to the brain. The brain then has many jobs to do. The brain will receive the information, break it down and make sense of it, store it into our memory banks, and give it back to us when we need it. If our brain is able to handle all of this in a useful way, we have the tools we need to do a good job at home, work, school and in life. This ability comes from the brain’s “cognitive skills”. Page 1 of 16 Hand-feeding Techniques for Nursing Facility Residents March 2018 The brain’s cognitive skills include long- and short-term memory. This is what we learned or experienced either a long time ago……..or what we learned just recently. Cognitive skills also include auditory processing and visual processing……..what we hear and what we see. Importantly, our brain controls logic & reasoning. These help us to make sense of the world we live in. Working together, all of these cognitive skills play important roles in processing new information. That means if even one of these skills is weak, no matter what kind of information is coming your way, being able to hold on to the information, process the information or understand the information will be damaged.1 Additionally, we have learned that changes occur in the aging brain. These changes vary from individual to individual but are not generally severe enough to interfere with activities of daily living. Cognitive changes in the normal aging process can be subtle. As we age, we may notice we are mentally less flexible, requiring more time for the processing of information. The ability to multitask declines as a result of a decrease in the aging brain’s difficulty paying attention. Memory may also be affected and names, faces, places, etc. may become harder to recall. Many cognitive abilities are relatively unchanged in the normal aging brain. For example, Howieson (2015) notes that language and vocabulary are retained during the normal aging process. General knowledge recall remains close to normal as does the ability to perform well- honed skills such as addition and subtraction. Judgement can be negatively affected in the normal aging brain when both the cognitive and emotional aspects of the brain’s functions are required. Reflexes, or response time to situations may slow. Additional study of the normal aging brain on cognition is more important than ever due to the increase in the number of persons living beyond the age of 80 years.2 Dementia Dementia is a syndrome, or an umbrella term, that results from an acquired brain disease. Dementia is characterized by progressive deterioration, beyond the scope of “normal aging”, in memory and other cognitive functions including, language, judgement, abstract thinking, and executive functioning. Social and occupational functioning is also negatively affected. As the individual’s cognition declines, the ability to comprehend and produce linguistic (verbal) information is impaired. Behavioral problems are common as a result of abnormal changes at the cellular level of the brain. These problems may be manifested by paranoia, hallucinations, 1 American Speech-Language-Hearing Association. Dementia: An Overview. Retrieved from: https://www.asha.org 2 Howieson, D. (2015). Cognitive Skills and the aging brain: What to expect. Cerebrum, December, 2015 Page 2 of 16 Hand-feeding Techniques for Nursing Facility Residents March 2018 and repetitiousness. These behaviors, in turn, can impair communication.3 As the disease progresses, the declines in the brain become more severe. A number of diseases fall under the umbrella term, “dementia”. The 4 most common causes include: . Alzheimer’s disease: Alzheimer’s progresses gradually. As the brain cells become more damaged, the symptoms associated with this disease become more severe. Alzheimer’s generally affects memory first and increasing forgetfulness may be the first sign that something is wrong. Other symptoms include changes in mood, the inability to perform more than one task at a time (multi-task), confusion, repeating things, difficulty voicing their thoughts, not recognizing familiar places.4 Alzheimer’s disease includes about 60% or more of individuals with dementia. Vascular Dementia: About 20% of the individuals with dementia are diagnosed with Vascular Dementia, an impairment caused by a blockage in the brain’s blood vessel system. When a clot forms in a blood vessel in the brain, the blood flow is blocked and brain cells in the area of the clot are unable to receive oxygen and nutrients resulting in cellular death. The area of the brain can vary depending on the location of the clot. Individuals with vascular dementia can present with a variety of symptoms including: memory loss, confusion, and inability to maintain attention. Many cases of vascular dementia occurs suddenly (i.e., CVA or stroke). In other cases, the onset is gradual and is related to recurring blockages of small brain vessels.4 3 American Speech-Language-Hearing Association. Dementia: An Overview. Retrieved from: https://www.asha.org 4 Alzheimer’s Association. Common causes of dementia. Retrieved from www.alz.org/mnnd Page 3 of 16 Hand-feeding Techniques for Nursing Facility Residents March 2018 . Lewy Body (DLB): This type of dementia is caused by the abnormal collections of proteins (Lewy Bodies) that have formed inside of the nerve cells of the brain. Lewy Body proteins have also been noted in individuals with Parkinson’s disease. This type of dementia causes: fluctuations between lucidity and confusion, problems with memory, visual hallucinations, muscle rigidity, slow movements, involuntary tremors.5 . Frontotemporal Dementia (FTD): Rare occurrence. This dementia affects the front and sides of the brain and negatively impacts the functions of the areas that are damaged. This form of dementia occurs at a younger age, generally, and will progress more rapidly. Symptoms can include: changes in personality, judgement, and social skills. This disease can also cause an inability to control appetite and a weight gain can result.5 Clinical Criteria for diagnosing Dementia (of all causes):6 Dementia is diagnosed when there are cognitive or behavioral symptoms that: 1. Interfere with the ability to function at work or at usual activities 2. Include a decline in levels of functioning and performing 3. Are not caused by delirium or a major psychiatric disorder 4. Cognitive impairment is detected and diagnosed 5. The cognitive or behavioral impairment involves a minimum of two or more of the following:7 a. Impaired ability to acquire and retain new information (AEB repetitive questions, repetitive conversations, misplacing personal belongings, forgetting events or appointment, getting lost on a familiar route) 5 Ibid 6 McKhann, G., Knopman, D., Chertkow, H., Hyman, B, Jack, C., Kawas, C., Klunk, W., Koroshetz, W., Manly, J., Mayeux, R., Mohs, R., Morris, J., Rossor, M., Scheltens, P., Carrillo, M., Thies, B., Weintraub, Phelps, C. (2011). The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s and Dementia, 7, 263-269. 7 Cunningham, E., McGuiness, B., Herron, B., & Passmore, A. (2015). Dementia. Ulster Medical Journal, 84(2), 79-87. Page 4 of 16 Hand-feeding Techniques for Nursing Facility Residents March 2018 b. Impaired reasoning and handling of complex tasks, poor judgement (AEB poor understanding of safety risks, inability to handle finances, poor ability to make decisions, inability to plan complex or sequential activities, difficulty with multitasking c. Impaired visuospatial abilities (AEB inability to recognize faces or common objects, inability to operate simple equipment or implements, inability to orient clothing to body.