23.A tables.docx

+-----------------------+-----------------------+-----------------------+ | Stages | | | +=======================+=======================+=======================+ | Stage I | - Reduced | - Patient/caregiver | |...

+-----------------------+-----------------------+-----------------------+ | Stages | | | +=======================+=======================+=======================+ | Stage I | - Reduced | - Patient/caregiver | | | concentration and | education and | | Mild cognitive | memory lapses | training | | impairment | noticeable by | | | | others | - Environmental | | | | modifications to | | | - Difficulty | promote safety | | | learning new | | | | information | - Encourage | | | | planning for | | | - Problems | advanced stages | | | functioning in | of the disease | | | work or social | while patients | | | settings | are still able to | | | | participate in | | | - Frequently losing | decision making | | | or misplacing | | | | important objects | - Use of cuing | | | | devices such as | | | - Difficulties with | to-do lists, | | | planning and | calendars, | | | organization | written | | | | schedules, and | | | - Forgetting | verbal reminders | | | familiar words or | | | | the locations of | - Cognitive | | | various objects | activity kits | | | | | | | | - Deliberate | | | | establishment of | | | | and adherence to | | | | daily routines | | | | | | | | - Referral to | | | | community | | | | resources, | | | | support groups, | | | | and/or counseling | | | | services | | | | | | | | - Nonpharmacologic | | | | therapies such as | | | | validation | | | | therapy, reality | | | | orientation, and | | | | reminiscence | | | | therapy | | | | | | | | - Counseling | | | | regarding | | | | possible | | | | retirement or | | | | withdrawal from | | | | the more | | | | challenging | | | | aspects of one's | | | | job | +-----------------------+-----------------------+-----------------------+ | Stage II | - Inability to | - Behavioral | | | carry out ADLs, | interventions | | Moderate AD | such as preparing | such as | | | meals for oneself | distraction, | | | and choosing | provision of | | | appropriate | meaningful | | | clothing | activities | | | | | | | - Loss of ability | - Continued use of | | | to live | cuing devices and | | | independently | established | | | | routines | | | - Difficulty | | | | recalling one's | - Assistance with | | | address or phone | ADLs | | | number | | | | | - Administration of | | | - Increased | anti-AD | | | problems finding | acetylcholinester | | | words and | ase | | | communicating | inhibitors, | | | clearly | including | | | | rivastigmine | | | - Inability to | (Exelon), | | | recall | galantamine | | | information from | (Razadyne), and | | | recent memory | donepezil | | | | (Aricept); an | | | - Increasing | NMDA inhibitor | | | difficulty | may be added, | | | remembering | including | | | details from | memantine | | | remote memory | (Namenda) | | | | | | | - Disorientation to | - Administration of | | | time and place | SSRIs and/or | | | | anxiolytics to | | | - Increased | address | | | tendency to | mood-related | | | become lost | symptoms of | | | | depression and | | | - Changes in | anxiety | | | ability to | | | | control | - Occupational, | | | bladder/bowels | physical, and | | | | speech therapy | | | - Changes in sleep | | | | patterns | - Nonpharmacologic | | | | therapies such as | | | - Withdrawal from | validation | | | social situations | therapy and | | | and challenging | reminiscence | | | mental activity | therapy | | | | | | | - Increased | - Consultation with | | | moodiness, flat | a dietitian or | | | affect, or signs | nutritionist | | | of depression | | | | and/or anxiety, | - Respite care for | | | paranoia | family members | | | | and other | | | | caregivers | | | | | | | | - May require | | | | around-the-clock | | | | care or | | | | transition to a | | | | skilled nursing | | | | facility | +-----------------------+-----------------------+-----------------------+ | Stage III | - Gradual inability | - Assistance with | | | to perform any | all ADLs | | Severe AD | ADLs, including | | | | bathing and | - Continuation of | | | toileting | earlier | | | | behavioral and | | | - Eventual urinary | pharmacologic | | | and fecal | therapies | | | incontinence | | | | | - Round-the-clock | | | - Inability to | care and/or | | | identify family | admittance to a | | | members and | skilled nursing | | | caregivers | facility | | | | | | | - Extreme confusion | - Frequent | | | and lack of | repositioning | | | awareness of | | | | one's | - Hand feeding | | | surroundings | and/or liquid | | | | nutrition as | | | - Gradual loss of | appropriate | | | remote memory and | | | | ability to speak | - Respite care for | | | | family members | | | - Inability to | and other | | | perform simple | caregivers | | | mental | | | | calculations | - End of life care | | | | | | | - Dramatic | | | | personality | | | | changes, | | | | including extreme | | | | suspiciousness | | | | and fearfulness | | | | | | | | - Sundowning, | | | | delusions, | | | | compulsions, | | | | agitation, and | | | | violent outbursts | | | | | | | | - Gradual loss of | | | | ability to walk, | | | | sit unaided, and | | | | hold one's head | | | | up | | | | | | | | - Development of | | | | abnormal reflexes | | | | | | | | - Physical rigidity | | | | | | | | - Loss of | | | | swallowing | | | | ability | | +-----------------------+-----------------------+-----------------------+