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Dementia Education Online
 
 

Module 2: Recognising Dementia

 

iii. Memory, Behaviour and Personality Changes in Dementia

Aims

The aims of this content focus area are to:

  • Facilitate a beginning understanding of changes associated with dementia.
  • Foster skills for providing appropriate support for a person with a cognitive impairment, and their family, when assessment and investigations are required.

Outcomes

By the end of this content focus area, participants should be able to:

  • Identify memory, behaviour and personality changes that are triggers for concern about cognitive impairment.
  • Compare memory, behaviour and personality changes associated with frontal, temporal and parietal lobe damage to the brain.

Memory, Behaviour and Personality Changes in Dementia

People with damage to different parts of the brain will often demonstrate quite different types of behaviour. For example, as previously explained, if the frontal lobe is primarily affected by brain damage, then personality changes may be most prominent (Alzheimer's Australia, 2005b, [1]). However, in the most common form of dementia, Alzheimer's disease, the parts of the brain that influence memory are most affected (Alzheimer's Australia, 2005c, [2]).

Here is a short summary of how damage to different parts of the brain may lead to different functional and behavioural outcomes. Knowledge of the different outcomes associated with damage to different parts of the brain provides a strong basis for clinical assessment.


(A) Frontal Lobe

If the frontal lobe is affected by disease, changes can occur in the following:

  • ability to plan and then follow through with body movements;
  • ability to concentrate;
  • ability to make decisions and plans, as well as engaging in higher level thinking activities;
  • ability to control impulses;
  • self-awareness, personality and emotional control;
  • language expression (speech); and
  • judgment.

(B) Temporal Lobe

If the temporal lobe is affected by disease, changes can occur in the following:

  • interpreting and processing sound (hearing);
  • memory;
  • understanding speech;
  • hearing; and
  • ability to sequence and organise.

(C) Parietal Lobe

If the parietal lobe is affected by disease, changes can occur in the following:

  • ability to perceive sensory input such as pressure and touch;
  • ability with spatial perception; and
  • ability with processing information.

References and Resources

  1. Alzheimer’s Australia 2005, Fronto temporal lobar degeneration, http://www.alzheimers.org.au/understanding-dementia/fronto-temporal-lobar-degeneration.aspx .

  2. Mathers, C, Leonardi, M 2006, Global burden of dementia in the year 2000: summary of methods and data sources, Report to the World Health Organisation, Geneva, http://www.who.int/healthinfo/statistics/bod_dementia.pdf.

  3. Brooker, D 2003, ‘What is person-centred care in dementia?’, Cambridge University Press, Vol.13, Issue. 3, pp 215-222.

Activity 3: Reflections on Diagnosis and Person hood

Although a person with a particular type of dementia may exhibit a range of behaviours that are considered "common or typical" for that form of dementia—it is critical for health care workers to understand the concept and importance of "personhood". In particular, this refers to seeing the person with dementia as "an individual with rights and a need for sensitive interaction" (Brooker, 2004, [3]).

The following steps guide you through a reflective activity designed to reinforce the importance of "personhood" and the need for health care practitioners to show great sensitivity when revealing a diagnosis of dementia.

Step 1: Reading
Access and read the following article from the link provided.

Step 2: View the video segment
Watch the following short streamed video segment from the Rural Health Education Foundation where a man with early dementia (Geoff) and his wife (Maria) are interviewed about how the disease was diagnosed. This video segment illustrates that it is sometimes difficult to make a diagnosis of dementia, especially for people with early onset dementia such as Geoff. When watching the segment, pay particular attention to changes in Geoff's abilities and behaviour as described first hand by him and from the perspective of a close family member (Maria his wife).

CLICK HERE TO VIEW STREAMED VIDEO SEGMENT

Question 1: How did you feel when you or a family member required screening or assessment for a medical condition? Decide if you/they were supported adequately by the health care staff involved. Write down reasons for your response.


Step 3: Reflection
Now that you have read the article by 'What is person-centered care in dementia' and seen the video segment, think about the situation for a person with dementia and their family during the screening and assessment stage. Consider, for example, the experience of Geoff and his family or a person from a minority cultural group.




Question 2: Propose ways in which optimal physical, psychological and cultural care could be provided during screening and this potentially stressful time.

Answer


Submit

Answer:

This question is very complex. Optimal strategies may depend on age, gender, socioeconomic variables (e.g., income, education, and occupation), culture, and other factors impacting on the person with dementia and their family. In addition, to answer this question you could think back to the principles outlined in Activity 2 of this module, as well as those presented by Brooker in the resource provided above. Recall that Brooker's (2004) paper emphasises concepts such as person-centred care.

With these comments in mind, your answer could include:

  • Ensuring that the person with dementia is always acknowledged and spoken to, not about, when discussing issues relating to them and their future.
  • Providing both the person with dementia and the carer with information about their local Alzheimer's support group and the National Dementia Helpline (1800 100 500).
  • Ensuring that the person with dementia and their carer receive information in a language that they understand.
  • Ensuring that there is discussion of likely events in the near and more distant future, and that both the person with dementia and their carer have as much understanding as possible.
  • By individualising care for every person with dementia.

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Question 3: Geoff is relatively young and in an early stage of dementia. Take some time now to think about your feelings toward older people who have a cognitive impairment. Establish if you feel comfortable or uncomfortable when interacting with an older person who has a cognitive impairment. Jot down reasons for why you feel this way and strategies to assist when uncomfortable.

Answer:


Submit

Answer:

This answer is a very personal one but gives you the opportunity to reflect on important issues. We all hold individual values, beliefs and attitudes that stem from our ongoing interactions with family, friends and the wider society. In answering Question 3, think about factors in your social and cultural environment that have influenced your feelings about older people in general-and older people with a cognitive impairment in particular.


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Optional Activity:

If you are interested in learning more about how stigma and discrimination can impact on people with dementia and their families, browse through the report 'Perceptions of Stigma in Dementia: An Exploratory Study'. This is an Irish report and, as is the case for any publication, is framed within a particular social and cultural context. With this is mind, think about the issues raised in the report with respect to your own country and specific social and cultural influences.

Your Progress
         


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