Lecture 3 - Dementia

Question 1

What are 2 common cognitive screens?

Answer 1

Mini Mental Status Exam

Montreal Cognitive Assessment (MOCA)

Question 2

when working with patients w/ dementia, In your selected preformance measure, there should be a max of ___ commands/instructions, but likely less

Answer 2

3

Note: you’ll always want to demo and during the actual test provide as little cueing as possible

Question 3

You’ll want a ____ duration preformance test to prevent cognitive/physical fatigue when working with patients w/ dementia

Answer 3

short

Question 4

In preformnace measures, ________________ scores can occur with lower cognitive levels

Answer 4

less reliable

(because their cognition might impact their preformance)

Question 5

What is an effective treatment that can slow cogntive decline, enhance neurogenesis and has minimal side effects?

Answer 5

Exercise

Question 5

Test administration tips for pt with dementia

Answer 5

Clear speech

friendly face

eye contact

instructions repeated during demo

ask person if they understand

remove distractions

Question 6

T or F: Aerobic exercise is shown to lessen cogntiive impairment and decrease dementia risk

Answer 6

T

Question 7

What intensity exercise is best in frail older adults?

Answer 7

High intensity is better than low/moderate

Question 8

Exercise ____________ appears to be neuroprotective for dementia, and these patients have similar amounts of exercise recommendations as other adults

Answer 8

Volume

Question 9

When strength training dementia patients, how many days a week and what intensity?

Answer 9

Atleast 2 times a week

mod/high intensity

emphasis on good form

Question 10

When balance training adults w/ dementia, how many times a week is recommended?

Answer 10

3 times a week

Essential to prevent falls

Question 11

When giving a home exericse program to adults w/ dementia, they need lots of _______________ first

Answer 11

Lots of reps/practice first to make the movements routine

“errorless learning” - make it to where they don’t get frusterated with too much corrections, build the enviroment to where they can succeed

Question 12

Keys to exercising adults w/ dementia

Answer 12

• Work in their reality
• Note pain behaviors
• Vary exercise w/ a lot of reps
• make it fun (focus on what they like)
• Be flexible
• Know when to increase cognitive load and when not to
• Blend social interaction and physical activity

Question 13

According to medicare, is maintence therapy covered for adults w/ dementia?

Answer 13

Yes if it is deemed that they cannot safely/effectively preform it by themselves

Question 14

What are 2 common ways adults w/ dementia cope with the impairment

Answer 14

Frustration/lashing out

or withdrawing/shutting down

Note: Anxiety and depression is common

Question 15

Care for adults w/ dementia should focus on ____ and _____

Answer 15

Quality of life and independence

Person-centered care is vital, care providers must relate to the person, not just react to the disease

Question 16

When working w/ patients that have dementia, should you focus on their strengths or weaknesses?

Answer 16

You should use a strength-based approach

note: Bypass traditional learning methods, and capitalze on remaining long term memory, language, and reading

Question 17

What are the remaining cognitive strengths in a person w/ dementia

Answer 17

Reading simple words

emotional memory (remembering if something is favorable or unfavorable)

Procedural memory of well-practiced habits

long-term memory

focused attention for simple tasks

production and comprehension of language until late in disease

L/R orientaton

Question 18

Strategies to use for communication w/ adults that have dementia

Answer 18

approach from front

come to their eye level

remove distraction

eye contact

smile

introduce yourself

simply explain why youre there

invite to participate

Question 19

What is the patience/acceptance component of communicating w/ adults who have dementia

Answer 19

Allow enough time for them to understand and form a response/action (dont rush them)

Question 20

What does KISS stand for?

Answer 20

Keep it short and simple

referring to removing unessicary details from your directions

Note: also do not provide them with too many choices

Question 21

Avoid asking questions based on ______ memory, instead focus on now

Answer 21

Short-term

Ex: Are you having pain now? vs Have you had pain in the last few days?

Question 22

3 aspects of multi-modal cueing for patients w/ dementia

Answer 22

1. Use signs/pictures
2. repeat information for them
3. physically guide them

Question 23

T or F, adults w/ dementia should use trial and error learning

Answer 23

F

Adults w/ dementia need errorless learning

Ensure theres only 1 solution for each problem, and use feedback from task/enviroment to ensure they learn the correct information/procedure

Question 24

What is "learning by modeling"

Answer 24

Utilizing **procedural memory/nondeclarative longterm** memory Cargiver provides **demo** and the person **watches**, then they **preform** it themselves works good for learning any motor task or habit, good for language deficits

Question 25

What is spaced retrieval learning

Answer 25

building upon maintenance of **implicit procedural** memory (instead of using explicit memory processing) **Learning without intention/awareness** "The method of retaining information by recalling that information over increasingly longer periods of time"

Question 26

What does ABLED stand for, in reference to "Exernal memory aids"

Answer 26

Accessible (easily seen) Bright (good contrast) Legible (Large and easy to read) Explicit (simple but adequate explanation) Done (Lists to cross off)

Question 27

What are examples of external memory aids

Answer 27

Memory books (Ex: biography, photos) Day planners Signs or labels on doors

Question 28

What is cognitive task analysis and what is it used for?

Answer 28

**Breaking down** a task into the simplest cognitive **components** so that each step can be completed easily and **decrease cognitive load** used to simplify activities / routines -

Question 29

What are coping strategies helpful for dealing with patient's w/ dementia

Answer 29

**reframing**- helpful when a situation cannot be fixed **re-evaluating expectations** - develop reasonable goals based on their current strengths/abilities **substituting behaviors**- replacing undesirable behaviors with more desirable ones **adjusting enviroment** - making sure it's not too over or understimulating

Question 30

What is the primary barrier that PTs have for patients w/ dementia

Answer 30

Lack of knowledge of their strengths/abilities and their potential for improvement PTs must see the situation and barriers from the other person's perspective

Question 31

PT for dementia clinical pearls

Answer 31

-Patient-centered care -match patient w/ appropriate clinican -have backup plan -verbal and non-verbal communication -be creative