Dementia

Rehabilitation
What is Dementia?

Dementia is a term used to describe a large

group of conditions affecting the brain which
cause a progressive decline in a person’s
ability to function.

Dementia has an effect on thinking,

behaviour and social interaction, as well as
functional abilities.

Dementia is NOT a normal part of ageing.

Common Presentations
People with dementia can present with problems in:
• Cognitive function: Confusion, memory, problems
planning.
• Emotion control: Mood swings, personality changes.
• Behaviour: Wandering, aggression.
• Physical health: Incontinence, weight loss
• Difficulties in performing daily activities: Ability to
cook, clean dishes.

Dementia is usually progressive – it gets

worse over time.
Types of Dementia:
Alzheimer  most common
Vascular Dementia
Frontotemporal Dementia
Dementia with Lewy Body
Wernicke Korsakoff Dementia
etc
STAGE of DEMENTIA:
1. Early: Becoming forgetful, especially of things that have
just happened, shows some difficulty with communication,
becoming lost and confused in familiar places, etc.
2. Middle: Having difficulty comprehending time, date,
place and events, Need help with personal care (i.e.
toileting, dressing), Behaviour changes (e.g. wandering,
repeated questioning, calling out, clinging, disturbed
sleeping, hallucinations)., inappropriate behaviour (e.g.
disinhibition, aggression)
3. Late: Unaware of time and place, may not understand
what is happening around them, unable to recognize
relatives and friends, increasing need for assisted self-care,
may have bladder and bowel incontinence, May be unable
to walk or be confined to a wheelchair or bed.
Diagnostic Procedures

Recommend the following process for making a

diagnosis.
•Take a history including cognitive, behavioural and
psychological symptoms, and their impact on daily
life.
•A physical examination with blood and urine tests to
exclude reversible causes of cognitive decline
•Cognitive testing such as: the 10-point cognitive
screener (10-CS); the 6-item cognitive impairment test
(6CIT); the 6-item screener the Memory Impairment
Screen (MIS); the Mini-Cog Test Your Memory (TYM).
Example of Assessment
Outcome Measures
The following list is from a example of useful outcome measures
for dementia.
MOOD:
•Geriatric Depression Screening Scale
•Rating Anxiety in Dementia
QUALITY OF LIFE:
•Quality of Life in Alzheimer’s Disease
•The Dementia Quality of Life Instrument
ADL:
•Alzheimer’s Disease Cooperative Study – Activities of Daily Li
ving Inventory
•Bristol Activities of Daily Living Scale
•The disability assessment for dementia
Assessment for Caregiver

CAREGIVER MOOD:
•Hamilton Depression Rating Scale
•General Health Questionnaire
CAREGIVER BURDEN:
•Zarit Burden Interview
Management
As early as possible.
Medication AND Non medication.
Medication: antidepressant, cholinesterase inhibitor
(donepezil, rivastigmin), anticonvulsant, or
anxiolytics.
Non Medication:
- Cognitive rehabilitation or occupational therapy
(working on functional goals of the individual and/or
their carers).
- Lifestyle Modifications: regular exercise and an
active lifestyle,
- Physiotherapy: exercise program improving balance
and activity daily living.
- Support caregiver.
 Cognitive Rehabilitation
Therapy
Is interventions that:
•Focus on functioning in everyday activities;
•Address specific targeted activities chosen or
identified as important by each individual participant.
These activities will usually be expressed in terms of
personal goals that the participant wishes to achieve;
•It is based on individual formulations and not a one-
size-fits-all approach, acknowledging that each
individual has a unique set of experiences, values,
motivations, strengths, and needs
• Psychosocial interventions are the first-line
treatment options for people with dementia;
pharmacological interventions should not be routinely
considered.
• Behavioural and psychological symptoms of
dementia can be very distressing for the person and
carer; therefore, developing treatment plans that
address these symptoms are essential.
• Follow-up should be planned, at minimum, every
three months.
Thank You