Long term care:
Dementia and cognitive impairment
Long-term care
residents experience various forms of dementia and cognitive
impairment. Before discussing dementia among long-term care
residents, it is important to distinguish between cognitive impairment
and dementia. Cognitive impairment may or may not be severe enough to
be referred to as dementia. It all depends upon which cognitive areas
have been affected. Some long-term care residents who have mild head
injuries or focal strokes may have cognitive impairment restricted to
very specific areas of the brain. These residents may be unable to
recognize familiar objects (agnosia) or may not be able to name
familiar objects (aphasia), yet their memory is often intact. As long
as their memory is
normal, we would not usually consider these
long-term care residents to have dementia.
According to the
Diagnostic and Statistical Manual of Mental Disorders-IV (DSM- IV)
which is used by mental health clinicians to diagnose psychological
disorders, memory and one of four or more other areas of cognitive
functioning must be impaired before an individual will be considered
for a diagnosis of dementia.
Dementia used to
be considered to be a strictly progressive, irreversible disease
process for both long-term care residents as well as community-based
elderly. Now, dementia is recognized as having a much more variable
course which may mean being progressive, static, or remitting. The
course that it takes or the way symptoms may be manifested usually
depends on its cause. Long-term care residents exhibit all of the many
forms of cognitive impairment. Alzheimer’s disease is progressive and
irreversible, and worsens over a period of many years. Strokes are
also irreversible, but not necessarily progressive. Cognitive
impairment due to depression is very common among long-term care
residents, and is very reversible when appropriately treated with
antidepressants and/or psychotherapy. Complete remissions are common
when cognitive impairment is caused by problems such as depression,
medications, hydrocephalus, infections, toxic conditions or metabolic
disorders among long-term care residents.
The DSM-IV
criteria for cognitive impairment in various types dementia include:
-
Impairment in
recent and long-term memory.
-
One or more of
the following:
-
Aphasia
(language disturbance)
-
Apraxia
(impaired ability to carry out motor activities despite intact
motor function)
-
Agnosia
(failure to recognize or name objects despite intact sensory
function)
-
Impairment in
executive functioning, including planning, organizing, sequencing,
or using abstract reasoning.
-
These cognitive
deficits must cause significant impairment in social or occupational
functioning and represent a significant decline from a previous
level of functioning.
Some researchers
have found that as many as 50% to 75% of residents in long-term care
facilities have dementia. Of these, approximately half have
Alzheimer’s disease and a quarter has multi-infarct dementia (caused
by multiple strokes). The remaining one quarter of demented long-term
care residents, have other types of dementia such as those due to head
trauma, Parkinson’s disease, Huntington’s disease, Pick’s disease, as
well as other diseases.
