Dementia: Dementia: From Diagnosis to Management - A Functional Approach

by Bourgeois, Michelle S.; Hickey, Ellen M.

• ISBN13: 9780805856064
• ISBN10: 0805856064
• Edition: 1st
• Format: Hardcover
• Copyright: 2009-02-04
• Publisher: Psychology Pres

Summary

Dementia: From Diagnosis to Management-A Functional Approach is a comprehensive description of a functional and behavioral approach to assessing and treating persons with dementia. While very practical, the information is embedded in a scientific context of the causes, neuropsychological manifestations, and complications of dementia. The management of the impairments of dementia is centered on its functional consequences and impact on daily living. The chapters describe behavioral interventions and environmental strategies that aim to improve daily activities and quality of life from a proactive communication and memory basis. Specific suggestions are provided to enhance family involvement and staff relationships, interdisciplinary cooperation, reimbursement, and documentation across various home and institutional settings.

Table of Contents

Foreword	p. xiii
Acknowledgments	p. xv
Introduction	p. 1
Diagnosis of Dementia	p. 9
The Clinical Presentation	p. 12
Community Memory Screenings	p. 12
Medical Assessment	p. 13
Neuropsychological Assessment	p. 17
The Pathophysiology and Genetics of Dementia	p. 17
Differential Diagnosis	p. 18
Reversible Conditions	p. 18
Age-Related Memory Decline	p. 19
Mild Cognitive Impairment (MCI)	p. 20
Dementias	p. 20
Pseudodementia	p. 31
Conclusion	p. 31
Cognitive, Language, and Behavioral Characteristics Across the Stages of Dementia	p. 41
Cognitive Skills and Deficits	p. 42
Memory	p. 42
Executive Function	p. 49
Attention and Concentration	p. 50
Perception and Visuospatial Functions	p. 51
Language Skills and Deficits	p. 53
Spoken Language Production	p. 55
Written Language Production	p. 58
Auditory Comprehension	p. 59
Reading Comprehension	p. 60
Summary	p. 61
Behavior Problems	p. 61
Characteristics of Behavior Problems	p. 61
Relationships Among Language, Memory, and Behavior in Dementia	p. 63
Assessment	p. 79
Factors to Consider in Planning for Assessment	p. 79
Types of Assessment	p. 80
Assessment Procedures	p. 82
Assessment of Body Structures and Functions (Impairment)	p. 85
Sensory Screening	p. 86
Global Dementia Rating Scales	p. 86
Comprehensive Dementia Assessment Batteries	p. 90
Domain-Specific Assessment Tools	p. 93
Assessment of Activities and Participation	p. 94
Dementia-Specific Measures	p. 95
General Measures	p. 96
Rating Scales	p. 99
Discourse Assessment	p. 99
Problem Behavior Assessment	p. 102
Assessment of Treatment Potential	p. 106
Assessment of Functional Outcomes	p. 109
Treatment	p. 133
Some Guiding Principles for Functional Intervention	p. 134
Maintain Independent Functioning as Long as Possible	p. 134
Maintain Quality of Life via Supported Participation and Engagement	p. 134
Emphasize Personal Relevance and Contextual Training	p. 135
Cognitive and Communicative Intervention: Pharmacological Versus Nonpharmacological Approaches	p. 136
Pharmacological Approaches	p. 136
Nonpharmacological Behavioral Treatment Approaches	p. 138
Memory and Cognitive Stimulation Approaches	p. 139
External Memory Aids and Graphic Cueing Strategies	p. 146
Training Considerations	p. 158
Spaced Retrieval	p. 159
Vanishing Cues	p. 163
Cueing Hierarchies	p. 163
Prospective Memory Training	p. 164
Critical Variables	p. 164
Conclusion	p. 165
Management	p. 177
The Interdisciplinary Team	p. 178
Barriers to Activities, Participation, and Engagement	p. 179
Environmental Interventions	p. 180
Building Designs and Structure	p. 181
Visual Barriers and Cues	p. 182
Object Arrangement	p. 183
Outdoor Environments and Therapeutic Gardens	p. 184
Sensory-Enhancing Adaptations	p. 185
Problems and Future Research Needs	p. 188
Individualized and Group Activities Interventions	p. 189
Importance of Pleasurable Activities and Engagement	p. 189
Social and Participation Barriers	p. 190
Maintaining Self-Identity Through Social Roles and Adapted Work	p. 191
Maintaining Participation in Social Groups	p. 192
Maintaining Lifelong Interests Through Modified Activities	p. 193
Maintaining Connections and Interactions	p. 199
Maintaining Spirituality and Religious Practices	p. 200
Intergenerational Programming	p. 203
Combined Activity-Based and Environmental Interventions	p. 204
Music Therapy	p. 204
Pet Therapy	p. 206
Cotreatment and Consultation: "Playing Well With Others"	p. 207
What if I Do Not Get Referrals for Clients With Dementia?	p. 208
Management of Eating and Swallowing Challenges	p. 219
Description of Eating and Swallowing Challenges	p. 220
Appetite Regulation	p. 220
Weight Loss	p. 221
Types of Eating Challenges	p. 223
Types of Swallowing Challenges	p. 225
Assessment of Eating and Swallowing Challenges	p. 226
Chart Review and Case History	p. 227
Positioning	p. 228
Structural-Functional Examination of the Swallowing Mechanism	p. 228
Clinical ("Bedside") Evaluation of Eating and Swallowing Behaviors	p. 229
Instrumental Assessments	p. 231
Treatment of Eating and Swallowing Challenges	p. 232
Food Selection and Environmental Factors	p. 233
Caregiver Interventions	p. 242
Multicomponent Interventions	p. 245
Eating Issues in End-Stage Dementia	p. 246
Quality of Life Issues	p. 255
Assessing Quality of Life in Persons With Dementia	p. 255
Defining Quality of Life	p. 255
Measurement Issues	p. 261
QoL Instruments for Persons With Dementia	p. 266
Interventions Designed to Improve Quality of Life	p. 270
Policy and Staff Approaches	p. 270
Sensory Stimulation Approaches	p. 272
Caregiver and Family Issues	p. 285
Caregiver Characteristics	p. 287
Factors Related to the Caregiving Experience	p. 288
Risks and Benefits of Caregiving	p. 295
Barriers to Obtaining Assistance With Caregiving	p. 296
Interventions for Family Caregivers	p. 298
Communications-Focused Dementia Caregiver Interventions	p. 305
Impact on Staff	p. 329
Staff Characteristics	p. 330
Staff Training Needs and Models	p. 331
Communication-Based Models	p. 332
Behavior Management and Skills Training Approaches	p. 337
Person-Centered Staff Training Approaches	p. 339
Technology-Delivered Training Programs: Video Versus CD Versus Internet	p. 341
Post training: The Challenge of Supervision	p. 344
The Role of the SLP in Training Nursing Home Staff	p. 346
Treatment Settings, Goals, and Documentation Issues	p. 353
Treatment Considerations in a Variety of Settings	p. 354
Implementing Memory and Communication Supports Across Settings	p. 354
Pain Management	p. 361
Advance Directives	p. 364
Obtaining Referrals	p. 365
Reimbursement and Documentation Issues	p. 366
Navigating the Maze of Third-Party Payers	p. 366
Goal Writing for Reimbursement	p. 369
Reasonable Expectation for Progress	p. 372
Coding for Documentation and Billing	p. 373
Documenting Progress	p. 375
Functional Maintenance Programs	p. 376
The Appeals Process	p. 376
Reporting Results to Family Caregivers	p. 377
Resources for Family Caregivers and Clinicians	p. 377
Resources for Advance Directives	p. 377
General Information on Medicare, Regulations and Plans	p. 377
Information on Best Practices, Treatment Efficacy, and Reimbursement Issues	p. 378
Information on Coding Systems	p. 378
Subject Index	p. 387
Author Index	p. 407
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