Care and Treatment of

Dementia and Alzheimer

Patients

By: Jessica Brauzer

2nd Year OT Student
University of Utah
 Dementia:

A group of symptoms which will affect an individual’s

memory, thinking, problem-solving and social skills
severely enough to impact every day functioning.

Alzheimer’s Disease (AD)- degenerative brain disease

and the most common cause of a progressive dementia
in older adults.

(Alzheimers Association, 2018; Mayo Clinic,

1998-2018)
 Signs & Symptoms of Dementia:

Cognitive: Psychological:
 Memory Loss  Personality Changes
 Difficulty in communicating/finding words  Depression & Anxiety
 Difficulty with reasoning/problem-solving  Inappropriate Behavior
 Difficulty handling complex tasks  Paranoia
 Difficulty with planning & organizing  Agitation
 Difficulty with coordination and motor  Hallucinations
function
 Confusion and disorientation

(Mayo Clinic, 1998-2018)

 Causes and Risk Factors of Dementia:

Causes:
Damage of nerve cells in the brain

Progressive dementias: Non-progressive dementias:

 AD  Reaction to medications or vitamin deficiencies
 Vascular Dementia
 Lewy Body dementia
 Frontotemporal dementia
 Mixed dementia
Unchangeable Risk factors: Changeable Risk factors:
 Age, Family Hx, Down Syndrome, Mild Cognitive  Heavy alcohol use, Cardiovascular risk factors,
Impairment Depression, Diabetes, Smoking, Sleep apnea

(Mayo Clinic, 1998-2018)

 Alzheimer’s and Dementia versus Typical
Age-Related Changes:
Alzheimer’s and Dementia Typical Age-Related Change
1: Decreased or poor judgment (esp. when dealing 1: Making a bad decision once in a while
with $, giving large amounts to telemarketers)

2: Missing a monthly payment

2: Inability to manage a budget

3: Forgetting which day it is and remembering it later

3: Losing track of the date or the season

4: Sometimes forgetting which word to use

4: Difficulty having a conversation

5: Losing things from time to time

5: Misplacing things and being unable to retrace steps
to find them
6: Trouble understanding visual images and spatial 6: Vision changes related to cataracts
relationships

(Alzheimer’s Association, 2018)

 Evaluations/Assessments:
 Canadian Occupational Performance Measure (COPM)

 PEO (Person-Environment-Occupation) Model

 Allen Cognitive Level Screen (ACLS) and Large Allen Cognitive Level Screen (LACLS)

 Mini Mental State Exam (MMSE) or Mini-Cog Test

 Performance Assessment of Self-Care Skills (PASS)

 In the clinic: money management through grocery shopping, medication management
 In the clinic/home: bed mobility, toilet mobility, shower/tub mobility, oral hygiene, dressing

 Global Deterioration Scale (GDS) (DiZazzo-Miller et. al, 2017; Piersol et.
al, 2018; Wong and Leland, 2018
 OT Interventions:
In a Rehabilitation Facility (Bedside and in the clinic):
 ADL Training/ Activity Modification (errorless learning!)
 Educate CG
 Activities involving error recognition
 Target morning and Evening Self-Care Skills
 Increase physical activity
 Strengthening exercises via therabands, DB’s, flex bars, etc, yoga/balance,
meditation/mindfulness
 Mental Health
 Omni VR [Pattern recognition, Word to object recognition, Bingo, picture memory,
ADL sequencing)
 BLINK cards
 Cognitive Activities such as the PASS: money management, home safety, medication
management, kitchen safety, etc.
 Animal Therapy
Padilla, 2011; Piersol et. al, 2018
 OT Interventions cont.
OT Communication to the Long Term Care In the Home: (esp. for the Caregiver)
Team:
 ADL training or Activity Modification
 Staff positioning during mealtime
 Environmental Modifications (color
contrast with plates, smaller tables to sit  Calming Activities, establish routine
at to decrease agitation/yelling)
 Dementia booklet/communication log in  Home Safety
each wing (S&S, Strategies for color
contrast)
 Environmental-based interventions  Rummage/Feely Bag
 Multisensory Stimulation Room
 External memory aids, etc  Exercise-Based Interventions
 Way-finding programs
 Monitoring devices to prevent falls

 Environmental Modifications
Letts et. al, 2011; Padilla, 2011; Piersol
et. al, 2018; Wong and Leland, 2018)
 Interdisciplinary Team Communication
(Nurses/Aides, Doctors, OT, PT, Speech,
Case Manager, Dietician)
Approaches recommended:
 1.Validate the resident’s feelings
 2. Prepare the resident for a task
 3. Speak in a gentle, but affirmative
voice, have patience, move efficiently
and match your body
 4. Position yourself in front of patient If the
resident has been in LTC at your facility
 5. Be proactive!
Not recommended:
 1. Invalidating the resident’s feelings
 2. Failure to prepare the resident for
a task
 3. Raising your voice, being
impatient, moving quickly, or
speaking to them as if they are a
baby
 4. Sitting to the side of the resident
may be confusing to him/her and
may be startling
 5. Not being person-centered
Padilla, 2011
 “ I think that primarily the
caregiver has to take
care of themselves first
”
Here are some segments of a 2 hour interview which is provided by
Wendy, a loving and devoted wife of 37 years and caregiver for 10
years.
How did your responsibilities shift at
home as you transitioned to
caregiver for Dick?
Do you have any tips or
recommendations for other
caregivers who are caring for
their loved one?
Or for any occupational
therapists, physical therapists,
nurses who would be treating
someone with dementia?
Caregiver Tips/Recommendations
 Learn how to do a transfer (take a class or ask an OT/PT or
another individual who has the training)
 Get proper ADL training
 Get an OT home evaluation (learn about safety in your
home and potential items that may be dangerous/harmful
to your loved one)
 Never leave your loved one home alone/by themselves
 Get involved with the community, friends, neighbors
 Don’t be afraid to seek help or assistance (hospice care,
etc)
 #1 priority: Take care of yourself first!
 Elder Abuse
Be Aware! The Abused The Abuser
Over age 75 Middle aged
 Elder Abuse: “the physical, Family
Female, single, widow
psychological, and sexual abuse; member/caregiver
caregiver neglect and self-neglect; Progressive physical and Experiencing stress:
and financial exploitation of people or mental impairment financial problems,
ages sixty and older”. (article 11)
medical problems,
 Psychological abuse is the most marital conflict,
common form of abuse 27.9-62.3% substance abuse,
unemployment
 Physical abuse 3.5-23.1%
 Many adults experienced multiple Socially isolated Experiencing increasing
forms of abuse simultaneously, risk of demands of care giving
mortality is higher with greater levels role
of cog. impairment
Dependent on abuser for
needs
Denies abuse
Dong et. al, 2014; U of U Elder Abuse PP, 2017
 Any questions or comments?
Thank you!

Thank you to Wendy for sharing her personal story of

caring for her husband Dick and providing me and
therapists with the necessary tools/advice to help
caregivers care for their loved one with dementia or AD
 References
 DiZazzo-Miller, R., Winston, K., Winkler, S. L., & Donovan, M. L. (2017). Family caregiver
training program (FCTP): A randomized controlled trial. American Journal of
Occupational Therapy, 71, 7105190010. https://doi.org/10. 5014/ajot.2017.022459

 Dong, X., Chen, R., & Simon, M. (2014). Elder abuse and dementia: a review of the
research and health policy. Health Affairs, 33, 642-649. doi: 10.1377/hithaff.2013.1261

 Interview with Wendy

 Letts, L., Minezes, J., Edwards, M., Berenyi, J., Moros, K., O’Neill, C., et al. (2011).
Effectiveness of interventions designed to modify and maintain perceptual abilities in
people with Alzheimer’s disease and related dementias. American Journal of
Occupational Therapy, 65, 505–513. doi: 10.5014/ajot.2011.002592

 Padilla,R.(2011). Effectiveness of interventions designed to modify the activity

demands of the occupations of self-care and leisure for people with Alzheimer’s
disease and related dementias. American Journal of Occupational Therapy, 65, 523–
531. doi: 10.5014/ajot.2011.002618
 References cont.
 Piersol, C. V., Jensen, L., Lieberman, D., & Arbesman, M. (2018). Evidence
connection—occupational therapy interventions for people with alzheimer’s disease.
American Journal of Occupational Therapy, 72, 7201390010. https://
doi.org/10.5014/ajot.2018.721001
 Wong, C., & Leland, N. (2018). Applying the person-environment-occupation model
to improve dementia care. American Occupational Therapy Association, CE 1-7.
 10 Early Signs and Symptoms of Alzheimer's. (n.d.). Retrieved from
https://www.alz.org/alzheimers-dementia/10_signs
 Symptoms and causes. (n.d.). Retrieved from https://www.mayoclinic.org/diseases-
conditions/dementia/symptoms-causes/syc-20352013?p=1