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). 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).
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.
Reference: The information presented above on frontal, temporal, and parietal
lobe damage was compiled from:
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, p.215).
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).
Resource: This streamed segment is taken with permission from:
Rural Health Education Foundation (2003) Dementia: The importance of early diagnosis
and the role of GPs (Program 314a - streamed media broadcast: 80 mins) [Available at
http://www.rhef.com.au/programs/314a/314a.html
Accessed Jan 2008]
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
Brooker (2004)
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.
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.
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.
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.
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 by
Nolan, McCarron,
McCallion and Murphy-Lawless (2006). 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.
Resource:
Nolan, L.; McCarron, M.; McCallion, P.; and Murphy-Lawless, J. (2006) Perceptions of
stigma in dementia: an exploratory study Dublin: The Alzheimer Society of Ireland
[Available at http://www.alzheimer.ie/pdf/StigmaRepot.pdf
Accessed Jan 2008]
Module 2: Recognising Dementia
