8As of Dementia

What are the “8A’s of Dementia”?

The “8A’s of Dementia” are a group of signs and symptoms that may appear in someone with
Dementia. “Each “A” represents damage to a particular part of the brain. Please keep in mind
that someone with Dementia may not experience all of the A’s” (Alzheimer’s Society, 2018).

1. Anosognosia

A person experiencing Anosognosia can no longer recognize that something has changed and
that there is something wrong. They might not understand that they have any cognitive
problems or are experiencing any problems at all. The part of the brain that helps with
reasoning is damaged therefore the person does not see the changes in their abilities that
others might see.

An example of Anosognosia could be with a person not recognizing that they are capable of
driving anymore. They might be looking for the keys to their car that they no longer drive when
in fact the keys and car have been moved to another place for safety factors.

2. Agnosia

A person experiencing Agnosia can no longer recognize things through their senses (sight,
sound, taste, touch and smell). Safety could be a factor if someone confuses objects for
something other than what they are purposed for. Sorting out sights or sounds can be
troublesome as well as recognizing familiar people. Later on in the dementia journey, a person
might not even be able to recognize themselves.

An example of Agnosia could be that a person might be sitting at a dinner table, pick up a fork
and then use it to comb their hair.

3. Aphasia

A person experiencing Aphasia loses the ability to use and/or properly decode language. This
can include the ability to speak, understand, read and write. Although the person may retain
the ability to speak for some time, the ability to understand what others are saying might be
affected early on in the dementia journey. Frustration and misunderstandings can occur and a
person might start to withdraw from social interactions because they are concerned that others
might not understand them or they might not understand what others are saying.

An example of Aphasia could be when multiple task-driven instructions are quickly relayed to a
person and they are unable to process everything at once, such as, “Go to the fridge, take out
the milk, cheese, tomatoes, lettuce, and mayonnaise and put them on two slices of bread that
are on the counter and make a sandwich for yourself.” The part of the brain processing
language is affected and the person has trouble following through with all the instructions.
4. Apraxia

A person experiencing Apraxia has lost the ability to carry out purposeful movement. The
person knows exactly what they want to do however the motor processing area in their brain is
affected and therefore they have difficulties carrying out what it is they would like to do.
Coordinating movement according to a certain pattern such as hand and leg movement can
affect certain activities such as the ability to drive.

An example of Apraxia could be when a person is trying to do up the zipper on their sweater.
They know that this is what they want to do however there is a disconnect in the brain such
that they are unable to coordinate the movement to do up the zipper. Additional examples
include doing up buttons and tying shoelaces.

5. Altered Perception

A person experiencing Altered Perception has lost the ability to interpret information that their
senses are giving them. This can occur in the late afternoon or evening when the light changes.
It can also occur with the loss of their depth perception and therefore the loss of judgment
regarding how high, deep, long, wide, near or far things can be.

An example of Altered Perception could be when a person wishes to sit down on a couch that is
the same colour as the floor and cushions. They might perceive everything to be one space
therefore making it difficult to judge when they are close enough to sit down on the couch
safely. Another example could include a black mat sitting on a contrasting floor colour. The
person might judge this as being a black hole and become afraid they might fall in and therefore
refuse to go over it. Consideration in environmental design could be helpful in minimizing
these altered perceptions.

6. Amnesia

A person experiencing Amnesia has loss of memory. Most things people do are dependent on
the ability to remember. Short-term memory loss can be displayed when a person loses their
ability to remember what was just said or just occurred. Earlier on in the dementia journey, it is
the short-term memory that is affected first. Later on in the dementia journey, long-term
memories become harder to retrieve.

An example of Amnesia is when a person with short-term memory loss repeatedly asks to see a
person with whom they have just had a visit. They are not able to recall that the person was
just there with them.
7. Apathy

A person experiencing Apathy has lost the ability to initiate an activity or conversation. It can
be helpful for another person to use cueing techniques or hints to assist the person in starting a
task or discussion.

An example of Apathy is when a person who enjoys playing cards now sits staring at a wall until
someone cues them by handing them their cards to begin playing the game.

8. Attention Deficits

A person experiencing Attention Deficits has lost the ability to maintain a complex attention
span. Paying attention or being able to focus forms part of the ability to accomplish a task.
When having a conversation or performing a task the person could become easily distracted
and not finish the dialogue or activity.

An example of Attention Deficits is when a person is sitting and having a conversation with
their friend about a specific topic and then they suddenly become distracted by something they
see or hear. They then stop engaging in the conversation to get up and leave without
completing the discussion.

References:

Source: Adapted from The Ontario Centres for Learning, Research and Innovation in Long-Term
Care at Baycrest. Dementia Simulation Toolkit Version 2.0 Summer 2018

Alzheimer Society of York Region (2018). Seven A’s of dementia. Retrieved on June 8th, 2018
from http://alzheimer.ca/en/york/About-dementia/What-is-dementia/Seven-A-s-of-dementia