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:
A. Impairment in recent and long-term memory.
B. One or more of the following:
1. Aphasia (language disturbance)
2. Apraxia (impaired ability to carry out motor activities despite intact motor function)
3. Agnosia (failure to recognize or name objects despite intact sensory function)
4. Impairment in executive functioning, including planning, organizing, sequencing, or using abstract reasoning.
C. 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.
Some information provided by Psychosocial Intervention in Long-Term Care by Gary W. Hartz, Ph.D. and D. Michael Splain, LCSW
Additional information and web page by Paul Susic Ph.D. Licensed Psychologist (Health Psychology)