Refers to any disorder of the brain that causes deficits in thinking, memory and judment.

Decline in mental ability severe enough to interfere with daily life.

Dementia is not a specific disease. It's an overall term that describes a wide range of symptoms.

There is no one test to determine if someone have dementia.

Before diagnosis of the disease is made other conditions must be excluded, called "Diagnosis by Exclusion".

Rule out by the : CBC (simple blood test), CAT scan, find out if it is another dimentia.

Combative behavior is any physically aggressive act that causes or intends to cause hurt or damage to a person or object. 

• Resisting care – for instance, aggressively hampering      efforts at bathing or dressing. •Verbal aggression – such as arguing, cursing, accusing, or threatening. 
• Fighting – endangering residents or caregivers with punches, kicks and other hurtful acts. 
• Catastrophic reaction – sudden mood changes with outbursts that indicate a resident is overwhelmed
• and unable to control feelings. 
• Physiological Responses – heart rate increases, central blood flow decreases by constriction of blood
• Vessels, peripheral blood flow increases by dilation, respiration increases and digestion ceases.

A catastrophic reaction is the emotional and behavioral reaction to a situation that either overwhelms or creates stress on the individual experiencing dementia because the situation (or stimulus) is beyond the person's ability to comprehend.

• Says that they are useless or worthless
• Is embarrassed to be in a social setting where other people might see that they have a problem
• Will not speak up in a conversation with others because they are worried that they might say the wrong thing
• Has given over activities (or given away things that they owned) because they feel that they will never be able to engage in those activities again (e.g. has given away woodworking tools, books, musical instruments, or has stopped taking part in a favorite activity)
• Accepts unfair criticism from other people
• Is generally withdrawn and is not engaged in the world around them
• Is easily embarrassed, sometimes even when only one other person is around
• Is visibly withdrawn, so that even someone who does not know them well can see that they are withdrawn (e.g. is hunched over, avoids eye contact, speaks only when spoken to, prefers the corner of a room to the centre)

A common Azhemeir behavior :

A. Combativenesse

B. Spitting

C. Screaming

D. Repetitive question

E. All above

Combativeness occurs MOST OFTEN when an Alzheimer’s individual is:

A. Angry at the caregiver

B. Frightened

C.Trying to be difficult

D. Depressed

E. None of the above

The MOST EFFECTIVE intervention for a resident who repetitively bangs on the table is:

A.Remove the table

B.Give the person something meaningful to hold

C.Ignore the situation

D.Tell the person to stop banging

E.None of the above

Which of the following is NOT an example of validation?

A.“Your husband is out at the store, he’ll be back later.”

B.“Your children are at school, they get out later this

afternoon.”

C.“Your husband died last year, don’t you remember?”

D.“You can’t go home, you live here with us.”

E. C and D

When dealing with an agitated resident, it is MOST helpful to

A.Redirect the individual

B.Walk away

C.Provide reassurance

D.Bring them to an activity

E.Tell them with a firm voice to calm down

Which of the following is the MOST important to consider when judging if an activity met the needs of an Alzheimer’s individual?

A.Was the activity interesting?

B.Was the activity done correctly?

C.Was the activity completed?

D.Was the activity safe and enjoyable?

E.None of the above

Professional caregivers can help family caregivers by

A.Educating them

B.Listening to them

C.Involving them

D.A and B

E.All of the above

Professional caregivers can reduce their stress by

A.Avoiding change

B.Asking for help

C.Using relaxation techniques

D. B and C

E.All of the above

Safety is a major concern in individuals with Alzheimer’s disease because the individual

A.Does not recognize familiar objects or places

B.Has changes in vision, hearing, depth perception

C.Has no sense of danger

D.All of the above

Types of wanderers :

1.Exit Seeker – has a specific goal. Examples: "Going home" or "Going to work."

2.Pacer – has excess energy and a need to move.

3.Explorer - interested in everything, likes to touch

things or exit doors just because they are there.

4.Follower – attracted by visual stimuli and/or may be

looking for personal contact.

Alzheimer's disease and related dementias can gradually diminish a person's ability to communicate. Not only do people with dementia have more difficulty expressing thoughts and emotions, they also have more trouble understanding others.The ability to exchange our ideas, wishes and feelings is a basic need.

1. Be calm and supportive.
2. Focus on feelings, not facts.
3. Pay attention to tone of voice.
4. Address the person by his or her name.
5. Speak slowly, and use short, simple words.
6. Ask one question at a time.
7. Avoid vague words and negative statements.
8. Don't talk about the person as if he or she isn't there.
9. Use nonverbal communication, like pointing or gesturing.
10. Be patient, flexible and understanding.

• Recent or short-term memory is more impaired than distant or long-term memory.
• Planning, judgment and insight become impaired, but the individual is often unaware of these problems.
• Difficulty finding words progresses to problems forming sentences, and eventually speech may not make sense.
• Disorientation for date and time of day may occur.
• The person may get lost, especially in a place not visited often.
• Decreased interest in previously important and pleasurable activities progresses to apathy.
• Depression occurs in about one-half of patients and about one-quarter become delusional with firmly fixed but false beliefs.
• Agitation may occur later as the disease progresses and often necessitates nursing home or other facility care if not successfully managed with behavioral strategies or medications. Later still, other abnormalities of brain function such as problems walking or seizures may occur.

• Avoid startling the person with loud noises or sudden movements.
• Identify yourself as you approach the person. 
• Tell the person of your intentions before
• you begin.
• Use large-print or audiotape materials, if available.
• If he or she has glasses, encourage the person to wear them. Keep them clean and have the prescription checked regularly.

• Approach the person from the front.
• Speak to him or her face to face.
• Get the person's attention by saying his or her name, and give a gentle touch.
• Speak slowly and clearly.
• Use a lower tone of voice.
• Use nonverbal communication like pointing, gesturing or touching.
• Write things down, if needed.
• If he or she has a hearing aid, encourage the person to wear it. Check the battery often.

• Difficulty finding the right words. 
• Using familiar words repeatedly. 
• Inventing new words to describe familiar things. 
• Easily losing train of thought. 
• Difficulty organizing words logically. 
• Reverting to speaking in a native language. 
• Using curse words. 
• Speaking less often. 
• Relying on gestures more than speaking.

• Monitor behavior closely
• Watch for signs of increasing agitation
• Check to see if the resident :

- is hungry
- needs to go to the bathroom
- Is too hot or too cold
- Is overtired or in pain
- Has signs of physical illness

• Check the environment for :

- Too much noise

- Too many people

- Staff anxiety

- Television program

Developed by Naomi Fe3il. Is a technique that tries to maintain the disoriented person's dignity by acknowledging the person's memories and feelings. 

• Maintain the identity and dignity of residents
• Help disoriented people with dementia feel good about themselves
• There is a reason for all behavior. What seems like confused behavior may be an acting-out of memories from long ago
• Disoriented people have the right to express feelings when they can no longer be orented to reality.
•  

To help a person communicate:

Be patient and supportive

Let the person know you're listening and trying to understand what is being said.

47Show your interest

Offer comfort and reassurance

Give the person time

Avoid criticizing or correcting

Avoid arguing

Offer a guess

Encourage unspoken communication

Limit distractions

Focus on feelings, not facts

Identify yourself

To best communicate:

Turn questions into answers

Turn questions into answers

Try providing the solution rather than the question. For example, say “The bathroom is right here,” instead of asking,“Do you need to use the bathroom?”

Avoid confusing expressions

If you tell the person to “Hop in!” he or she may take that as a literal instruction. Describe the action directly to prevent confusion.“Please come here.Your shower is ready.”

Avoid vague statements

Instead of saying “Here it is!” try saying, “Here is your hat.”

Emphasize key words

Stress the words in a sentence that you want to draw attention to, like “Here is your coffee.”

Turn negatives into positives

 Instead of saying, “Don't go there,” say, “Let's go here.”

Give visual cues

To help demonstrate the task, point or touch the item you want the individual to use. Or, begin the task for the person.

Avoid quizzing

Reminiscing may be healthy, but avoid asking, “Do you remember when ... ?” Refrain from saying things like,“You should know who that is.”

Give simple explanations

Avoid using complex logic and reasoning. Instead give clear and concise responses.

Write things down

Try using written notes as reminders, if the person is able to understand them.A written response may also help when a spoken one seems too confusing.

Treat the person with dignity and respect

Avoid talking down to the person or talking as if he or she isn't there.

Be aware of your tone of voice

• Speak slowly and distinctly.
• Use a gentle and relaxed tone — a lower pitch is more calming.
• Convey an easygoing, non-demanding manner of speaking.
• Be aware of your feelings and attitude — you may be communicating through your tone of voice, even when you don't mean to.

• May lose vitality
• May sleep less at night
• May benefit from rest periods during the day
• Store less fluid in body tissue and is pat to become dehydrated, results in  a loss of elasticity and resiliency in tissues
• fibrous tissue changes, decrease the tone mass and strength of skeletal and smooth muscle
• reduced nerve sensitivity

• constipation - difficulty in eliminating solid waste
• Flatulence - gas production
• Diverticulosis - small pockets (diverticula) of weakened intestinal wall

Reality orientation (RO)

RO may be effective in the first stage and the early part ofh the second stage of Alzheimer's disease.

Therapy was developed by Naomi Feil, a technique that tries to maintain the disorented person's dignity by acknowledging the  person's memories and feelings

Validation

Maintain the identity and dignity of residents

Help disoriented people with dementia feel good about themselves