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BOX 31-1

FOUR As OF ALZHEIMER’S DISEASE* AND ADAPTIVE ACTIONS

Agnosia: Impaired ability to recognize or identify familiar objects and people in the absence of a visual or hearing impairment. • Assess and adapt for visual impairment. • Do not expect the patient to remember you; introduce yourself. • Cover mirrors or pictures if they cause distress. • Name objects and demonstrate their use. • Keep area free of ingestible hazards (toiletries, chemical cleaning supplies, checkers, buttons, unmonitored medicine). Aphasia: Language disturbances are exhibited in both expressing and understanding spoken words. Expressive aphasia is the inability to express thoughts in words; receptive aphasia is the inability to understand what is said. • Assess and adapt for hearing loss. • Observe and use gestures, tone, and facial expressions. • Provide help with word finding. • Restate your understanding of behaviors and word fragments. • Acknowledge feelings expressed verbally and nonverbally. • Use simple words and phrases; be concise and organized. • Allow time for response. • Listen carefully and encourage with nonverbal praise. • Use pictures, symbols, and signs. Amnesia: Inability to learn new information or to recall previously learned information. • Do not expect the patient to remember you; introduce yourself. • Do not test the patient’s memory unnecessarily. • Operate in the here and now. • Provide orientation cues. • Remember, you must adapt when the patient cannot change. • Compensate for patient’s lost judgment or reasoning. Apraxia: Inability to carry out motor activities despite intact motor function. • Assess and adapt for motor weakness and swallowing difficulties. • Simplify tasks; give step-by-step instructions and time for response. • Initiate motion for patient with gentle guidance or touch.
*May also be present in other cognitive disorders.