26 Questions
What is the estimated percentage of people with mild to moderate dementia who may experience sleep disturbance?
25%
What is the primary reason to prioritize non-pharmacological interventions in NCSD?
Pharmacological approaches have limited effectiveness and can have harmful side-effects
What is the main goal of indirect interventions in NCSD?
To decrease NCSD through working with caregivers or adapting the environment
Why is Lewy body dementia unlikely to be the cause of Lauren's worsening symptoms?
She is not experiencing hallucinations and does not show signs of Parkinsonism
What is the primary purpose of 'watchful waiting' in NCSD?
To consider approaches to treatment and symptom management
What is the main difference between direct and indirect interventions in NCSD?
Direct interventions target individuals with dementia, while indirect interventions target caregivers or adapt the environment
What is the primary goal of a well thought-out wayfinding system in a person-centered approach?
To help people in their navigation efforts and reduce stress and anxiety
What is a key principle of a person-centered approach?
To understand the human value of people living with dementia and their individuality
What is an indication for antipsychotics in a person with dementia?
Agitation, psychosis, and aggression
What should be done before considering any psychotropic medication in a person with dementia?
A comprehensive assessment by a qualified healthcare professional
What is a potential risk of antipsychotic medication in older people with NCSD?
Increased risk of stroke, cardiovascular events, and mortality
What percentage of late-onset psychosis is secondary and has an underlying cause?
Sixty percent
What is a characteristic of late-onset psychosis?
Delusions or hallucinations
Why should non-pharmacological approaches be prioritized in managing NCSD?
Because pharmacological approaches should only be considered if there is severe distress or an identifiable risk of harm
What is an example of providing support in a tactful way?
Saying 'You were telling me about…'
Why is it important to introduce yourself and address the person with dementia by name?
To help the person feel more at ease and build trust
What is the purpose of Cognitive Stimulation Therapy (CST)?
To improve quality of life and maximize available cognition in people with mild to moderate dementia
What is the focus of person-centered care (PCC)?
The whole person and requires care givers to have an in-depth knowledge of the individual
What is the recommended approach to communication with people with dementia?
Creating a calm environment and speaking clearly and respectfully
What is the role of family carers in caring for people with dementia?
Playing a central role in caring for people with dementia
What is the benefit of training staff in person-centered care?
Improving agitation and quality of life for people with dementia
What is the goal of the bio-psycho-social-physical perspective?
To recognize the influence and interplay between biological, psychological, social, and physical factors
What is the recommended approach to supporting carers of people with dementia?
Offering the opportunity to attend dementia-specific training sessions
What is the importance of getting to know the person living with dementia?
To recognize and accept the person's reality
What is the benefit of providing education and training on specific non-pharmacological interventions?
Reducing the need for antipsychotic and other medications
What is the recommended approach to meaningful activity for people with dementia?
Identifying and supporting ongoing opportunities for meaningful engagement
Study Notes
Sleep Disturbance in Dementia
- Up to 25% of people with mild to moderate dementia and 50% of people with severe dementia experience sleep disturbances.
- Lauren, a person with dementia, exhibits agitated behavior during the day and wanders around the house at night, but does not show signs of hallucinations or Parkinsonism.
NCSD (Non-Cognitive Symptoms of Dementia)
- NCSDs affect people with dementia and include agitation, aggression, disinhibition, delusions, hallucinations, anxiety, apathy, wandering, and repetitive actions.
- Most NCSDs will resolve themselves within a 4-week period, so "watchful waiting" is recommended.
- Pharmacological approaches have limited effectiveness and can have harmful side-effects, so non-pharmacological interventions should be prioritized.
Interventions for NCSD
- Indirect interventions target caregivers and the environment, including caregiver training, multidisciplinary team approaches, individualized treatment plans, and modifying environmental factors.
- Direct interventions target individuals with dementia, such as art, music, physical exercise, meaningful activities, life story discussion groups, and Cognitive Stimulation Therapy (CST).
- CST is a talking therapy that improves quality of life and maximizes available cognition in people with mild to moderate dementia.
Bio-Psycho-Social-Physical Perspective
- An integrated approach considers biological, psychological, social, physical, and environmental factors for effective management of NCSD.
Person-Centered Care
- Focus on the whole person, not just the disease.
- Get to know the person with dementia, recognize and accept their reality, and support ongoing opportunities for meaningful engagement.
- Build and nurture authentic, caring relationships and create a supportive community.
Caregiver Support
- Family carers play a central role in caring for people with dementia and need support to develop their skills and address their own emotional and practical needs.
- Recommendations include dementia-specific training, carer support, and address the risk of depression among carers.
Communication
- Good communication skills are essential in supporting people with dementia.
- Techniques include creating a calm environment, speaking clearly, and respecting the person's perspective.
Environmental Design
- A well-designed environment can reduce NCSD, improve orientation, and reduce behavioral disturbance.
- Key principles include reducing crowding and noise, using clear signage, and providing easy-to-use toilets.
Pharmacological Intervention
- Prior to considering psychotropic medication, a comprehensive assessment must be performed.
- Antipsychotics may be indicated for agitation, psychosis, and aggression, but risks and benefits must be fully explained to the patient and/or caregivers.
Lauren, a dementia patient, experiences sleep disturbance, agitation, and wandering at night. What could be the cause of her worsening symptoms?
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