Is Dementia A Cognitive Disability

If You Have Some Form Of Dementia It Is Likely You Have Poor Memory And Attention Skills And Are Unable To Perform Any Type Of Work

The Social Security Administration recognizes dementia as an impairment in two different sections of its Blue Book. Section 12. Mental Disorders evaluates dementia of the Alzheimer type, vascular dementia, and dementia due to a metabolic disease. Section 11. Neurological Disorders evaluates cases of early onset Alzheimers disease .

Clinical Vs Functional Classifications

Cognitive disabilities can be thought of in functional or clinical terms. Clinical diagnoses include autism, Down syndrome, traumatic brain injury , and dementia. Less severe cognitive conditions include attention deficit disorder , dyslexia , dyscalculia , and learning disabilities in general. Clinical diagnoses may be useful from a medical perspective for treatment, but for the purposes of web accessibility, classifying by functional disability is more useful.

Functional classification focuses on the user’s abilities and challenges, irrespective of their medical or behavioral causes. Multiple functional disabilities can stem from one clinical diagnosis: A person with memory deficits may also have difficulty with attention or problem-solving.Functional categories of cognitive disabilities include difficulties with:

Functional classifications are useful in web accessibility because they align to concerns of web designers and developers. Telling a developer that some people have autism is only meaningful if the developer knows what kinds of barriers a person with autism might face with web content. On the other hand, telling a developer that some people have difficulties comprehending math gives the developer a meaningful context. Developers simply need to understand and consider the user’s range of abilities.

Reasoning And Executive Functioning

• Mood fluctuations, including agitation and crying
• Negative reaction to questioning
• Loss of initiative and motivation

Behavioral and psychosocial symptoms are common in dementia . Responsive behaviorsa subset of these symptomsare thought to be expressions of unmet needs , responses to the environment , expressions of psychosocial needs , and responses to caregivers and other individuals.

Behavioral and psychosocial changes can lead to frustration and misunderstanding between the individual with dementia and his or her caregiver. Since these reactions are often forms of communication, it is important for caregivers to consider why the behavior is occurring and to explore ways to facilitate better communication .

See Behaviors: How To Respond When Dementia Causes Unpredictable Behaviors from the Alzheimer’s Association for more information.

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What Is The Difference Between Mild Cognitive Impairment And Dementia

The term Mild Cognitive Impairment can be explained as a decline in brain function. It can also be thought of as an early stage of a dementia such as Alzheimers disease.

A person with dementia will experience more serious cognitive performance symptoms than Mild Cognitive Impairment . Noticeable cognitive changes in people may affect their memory, language, thinking, behaviour, and problem-solving and multitasking abilities. In MCI, these symptoms do not significantly impact daily living. In contrast, dementia patients will show more severe forms of these symptoms and everyday activities will become more of a challenge.

Talk to a doctor if you or someone close to you is experiencing any of these symptoms:

Psychological And Psychosocial Therapies

Psychological therapies for dementia include some limited evidence for reminiscence therapy , some benefit for cognitive reframing for caretakers, unclear evidence for validation therapy and tentative evidence for mental exercises, such as cognitive stimulation programs for people with mild to moderate dementia. A 2020 Cochrane review found that offering personally tailored activities could help reduce challenging behavior and may improve quality of life. The reviewed studies were unable to draw any conclusions about impact on individual affect or on improvements for the quality of life for the caregiver.

Adult daycare centers as well as special care units in nursing homes often provide specialized care for dementia patients. Daycare centers offer supervision, recreation, meals, and limited health care to participants, as well as providing respite for caregivers. In addition, home care can provide one-to-one support and care in the home allowing for more individualized attention that is needed as the disorder progresses. Psychiatric nurses can make a distinctive contribution to people’s mental health.

Some London hospitals found that using color, designs, pictures and lights helped people with dementia adjust to being at the hospital. These adjustments to the layout of the dementia wings at these hospitals helped patients by preventing confusion.

Cognitive Training

Personally Tailored Activities

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What Is Alzheimer’s Disease

Alzheimer’s is a progressive disease that destroys memory and other important mental functions. In its early stages, memory loss is mild, but with late-stage Alzheimer’s, individuals lose the ability to carry on a conversation and respond to their environment.

Alzheimer’s is not a normal part of aging, although the greatest known risk factor is increasing age, and the majority of people with Alzheimer’s are 65 and older. But Alzheimer’s is not just a disease of old age. Up to 5 percent of people with the disease have early onset Alzheimer’s , which often appears when someone is in their 40s or 50s.

Alzheimers is the sixth leading cause of death in the United States. Those with Alzheimer’s live an average of eight years after their symptoms become noticeable to others, but survival can range from four to 20 years, depending on age and other health conditions.

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Risk And Protective Factors

Risk factors are factors associated with an elevated incidence rate ofdisease, higher odds of developing disease, or earlier onset of disease,depending on the type of statistical analysis that is performed. Protectivefactors represent the converse. An observed risk factor does not necessarilycause disease a protective factor does not necessarily prevent disease andalmost certainly will not treat the disease. The observed effects canpotentially reflect selection or survival bias or confounding, or sometimesreverse causality. They may also depend on the timing and duration of exposureto the factor, with mid-life often being the critical period.

What Can I Do To Help My Brain Health If I Have Been Diagnosed With Mild Cognitive Impairment

According to the American Academy of Neurologys practice guideline for patients with mild cognitive impairment, the best thing you can do to maintain your brain health is to exercise twice a week.

Although there is no clear-cut proven link that doing any of the following will help slow memory and thinking skill decline, these are general recommendations for maintaining good health.

• Maintain good blood pressure, cholesterol levels, and blood glucose levels
• Stop smoking and avoid excess drinking
• Eat a healthy diet
• Reduce stress
• Get an adequate amount of sleep
• Exercise the brain
• Engage in social activities

Most important, see your doctor every 6 to 12 months so that he or she can check for changes in your memory or thinking skills over time.

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Evaluation Of Cognitive Symptoms

Cognitive symptoms can be due to many conditions and dementia is only one of them. Delineation of the syndrome of dementia and differentiating it from other cognitive disorders is the first task. Other assessments can then follow. The suggested assessments are best carried out as part of the initial evaluation though it might take a few sessions to complete. See .

Memory Loss Has Long Been Accepted As A Normal Part Of Ageing

Recently there has been increasing recognition that some people experience a level of memory loss greater than that usually experienced with ageing, but without other signs of dementia. This has been termed Mild Cognitive Impairment . As MCI has only recently been defined, there is limited research on it and there is much that we do not yet understand.

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Additional Support For Cognitive Accessibility

Some cognitive accessibility user needs are not addressed in existing W3C standards.

W3C is actively working to provide additional guidance on cognitive accessibility, including:

• updating supplemental guidance beyond what fits into accessibility standards now
• developing additional requirements to be included in future versions of WCAG
• developing standards for personalization, which is a key aspect of cognitive accessibility

Dementia Bathroom And Personal Care

The bathroom is one of the most important areas of the home, when it comes to maintaining independence and dignity for someone who is cognitively impaired.

Some of the considerations are just the same as when adapting a bathroom for any type of disability or age-related frailty: ease of access providing support where necessary eliminating trip hazards providing easy-to-use taps, flush levers, etc. You can read more about all aspects of an accessible bathroom here.There are some additional points to bear in mind, when planning a dementia-friendly bathroom:

Someone with dementia is much more likely to fall, so a completely level access wetroom is the way to go, if possible, without anything distracting about the floor covering: no colour changes or small patterns, nor high shine, which might look as if the floor is wet.

Less ability to recognise danger is another factor, so anti-scald taps are important, and any radiator in the room should have a low surface temperature, or be covered, to prevent accidental burns.

While short-term memory goes, longer term recall can be excellent, so a person with dementia is likely to be happier with familiar rooms and traditional-style bathroom fittings.

Overhead waterfall-style showerheads can be distressing, as the person cant see where the water is coming from.

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Eating And Swallowing Difficulties

Swallowing function changes as we age. These changes may be more pronounced in individuals with dementia, and swallowing difficulties may appear sooner . Overall, 13%57% of individuals with dementia have swallowing impairment . Rates of swallowing impairment for individuals with dementia in long-term care may be as high as 53%60% .

Difficulties are not limited to swallowing dysfunctioncognitive and behavioral changes associated with dementia can also have an impact on eating. Early on, individuals may have difficulty shopping for groceries and planning and preparing meals independently . They may forget to eat, initiate eating less often, or have difficulty determining the need to eat . As the disease progresses, they may become more distracted during mealtime or have difficulty self-feeding, recognizing foods, or using various eating utensils .

Eating and swallowing difficulties may place an individual at greater risk for choking and aspiration pneumonia and may eventually result in malnutrition, dehydration, and weight loss .

Causes

Alzheimer’s disease is the most common cause of dementia, accounting for approximately 70% of all cases .

The remaining cases are accounted for by vascular dementia, Lewy body dementia, Parkinson’s disease, frontotemporal dementia, and mixed dementia types . See ASHA’s resource on common dementias.

Interacting With A Dementia Sufferer

Regardless of what other social interactions your patient or loved one engages in, remember that you are their first point of contact. As such, its vital that you are treating them with dignity and respect. There are several ways to do this. Here are just a few:

• Maintain a peaceful environment and demeanour.4 For instance, when discussing dementia with your patient or loved one, be honest and direct, but stay calm so as not to cause them undue worry or distress.
• Speak slowly and simply, at a moderate volume and pace, using short words that your patient or loved one will understand. This will make it easier for them to participate in the conversation and will help them feel included.
• Ask one question at a time, avoiding those that require your patient or loved one to recall past details or events. This will keep them from feeling disoriented or rushed and will give them time to process your questions and respond appropriately.
• Use cues to remind your patient or loved one of the important details. For instance, you might help them set an alarm clock to remind them of things they need to do throughout the day, such as taking their medications, eating, napping, and going to the bathroom. A calendar may also help them keep track of important dates.

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Demanding A Better Deal

While researchers and clinicians are actively moving towards promoting a more timely diagnosis for dementia, it is also becoming clearer that the medical model of care is no longer appropriate for early stage dementia.

There is much work to do, and while people with dementia cannot do it alone, they and their families are now speaking up all around the world demanding a better deal. The growing group of people with dementia who are self-advocating and/or speaking up publicly, individually and collectively, believe the best way to ensure people with dementia can live with a high quality of life and dignity, without the isolation, stigma and discrimination they currently face, is through a human-rights based approach to dementia.

Collectively, we are demanding support to live with dementia, not only to die from it. There is a basic human right. And yet, as I wrote in 2015: There is a systemic and gross underestimation of the capacity of all people with dementia, even in the later stages of the disease.

Presenting at a side event at the WHA, co-hosted by DAI, ADI, Global Alzheimers and Dementia Action Alliance and the Swiss Government, I was asked why the Global Dementia Action Plan has been so important to me. In my speech I replied, We need this plan because care is failing, and research for a cure is failing. .

Clinical Diagnosis Of Mci And Mild Dementia

A medical history and a mental status examination are the principal tools for making a diagnosis of MCI or mild dementia. The medical history is the principal means by which the clinician establishes whether or not the patient has impairment in daily functioning. The mental status examination is the means by which the clinician establishes whether there is objective evidence of cognitive impairment. Clinical judgment is required to integrate information from the two sources. The general neurological examination should also be performed, but its role in the diagnostic process is largely in contributing to an understanding of the etiology of the cognitive disorder.

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How Is Mild Cognitive Impairment Diagnosed

First, your doctor will perform a thorough medical history including asking about current and previous diseases and illnesses, current and previous medications, and family history of memory problems and dementia. He or she will also ask you if there have been noticeable changes in your ability to function in your usual day-to-day living and activities.

Your doctor will also look for other causes of the symptoms of mild cognitive impairment . Ruling out other causes usually involves blood tests and possibly brain scans, such as magnetic resonance imaging scan.

Short mental status tests may be given to assess memory, attention, short-term recall, and other brain functions. Sometimes more in-depth thinking skills testing, called neuropsychological testing, is ordered. These tests assess memory, planning, decision-making, ability to understand information, language and other complicated thinking tasks.

No single test should be used to make a diagnosis of mild cognitive impairment or dementia. Your doctors clinical judgment is also necessary. He or she will likely be able to confirm a diagnosis of mild cognitive impairment if you show impairment on the kinds of tests mentioned above but are otherwise functioning well.

Does Mci Lead To Dementia

Recent studies indicate that people with MCI are more likely to develop dementia, especially Alzheimers disease. It is currently estimated that people with MCI have a 3 to 5 times increased risk of developing dementia than others their age.

A large treatment trial with selected people with more severe diagnosis of MCI found that about 15% of subjects progressed to dementia each year.

However, MCI does not always lead to dementia and can take many years to do so. In tests conducted regularly over a number of years, a substantial proportion of people with MCI have remained stable or even improved. Various studies show differing results in their estimates of how many people with MCI will progress to dementia.

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Functional Diagnosis Of Cognitive Disability

Sometimes it is more useful to avoid the medical perspective of cognitive disability and view them from a functional perspective instead.

A Functional disability perspective ignores the medical and behavioral causes of cognitive disability and focuses on the abilities and challenges the person with a cognitive disability faces. Functional cognitive disabilities may involve difficulties or deficits involving problem-solving, attention, memory, math comprehension, visual comprehension, reading, linguistic, and verbal comprehension.

Neurocognitive Disorders Due To Parkinsons Disease

These disorders are diagnosed when there is gradual cognitive decline in thepresence of a well-established diagnosis of Parkinsons disease. Over thecourse of their disease, approximately 75% of individuals withParkinsons disease will develop a major neurocognitive disorder. The pattern of cognitive deficits isvariable but often affects the executive, memory, and visuospatial domains, with aslowing of information processing that suggests a subcorticalpicture. Associated features include psychiatric symptoms such as depressed oranxious mood, apathy, hallucinations, delusions, or personality change, as well asrapid eye movement sleep behavior disorder and excessive daytimesleepiness.

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