Renee: Thank you to everyone for joining us this afternoon. Our discussion topic for today is the use of abilities-based approaches to the assessment of persons with dementia. This course will provide guidance on best practice for assessment of persons with dementia, including methods for evaluation of cognitive function, and the environment. Additionally, this course will describe methods for assessing functional abilities present in order to develop those person-centered plans of care. What I hope you take away from today's course is the fact that dementia, in the majority of cases, is a progressive neurological condition. However, there are residual abilities present at every stage of the disease process, and we can tap into those abilities, beginning with the assessment, in order to develop that well-rounded, person-centered plan of care.
Assessing the Whole Person
As we begin, it is key to understand the need to assess the entire person. Depending on your facility or the location where you are providing care, you may see a patient whose primary diagnosis is dementia. However, it is also important to have an adequate understanding of how we treat other individuals that may come to us. For example, they may have a traumatic brain injury or an exacerbation of their COPD, but they have an underlying diagnosis of dementia as well. How do we treat all of those diagnostic categories as they interplay with one another? All of that begins at assessment.
We know that many of the individuals that we treat present with these multiple complexities, including diagnoses which affect cognitive and language functions. In order to promote carry-over into the real world with interventions, we need to assess all areas of functional impairment. For example, let's say Mrs. Smith has diagnoses of COPD, traumatic brain injury, and moderate Alzheimer's disease. Her prior level of function was living at an assisted living facility. In order to treat her as a whole, we would need to address energy conservation, recall of safety needs, and improving balance.
Different Aspects of Cognitive Function
Before we get into talking about various assessment tools, I wanted to break down for everyone the different aspects of cognitive function and language that impacts the ability to process information in an individual with dementia. If you think of language and cognition as a hierarchy, we learn language and cognition as children across a hierarchy, and individuals lose it across a similar hierarchy with the progression of dementia. The foundational areas are language-based, and the higher-level areas will be your cognitive-based areas (Figure 1).
Figure 1. Definitions of language and cogntive function.
The foundation needed for language is the person's ability to understand you and for them to be able to express themselves. Language is a two-fold process. It includes expressive and receptive language.
Expressive Language
Expressive language includes the ability to express wants, needs, and ideas. It affects the ability to complete automatic speech tasks, which include counting, singing, stating the days of the week and the months of the year, and the ability to verbalize across language domains. For example, you may see someone that used to be able to express at a sentence level, and now they are only able to express in words. They are losing language across that language continuum.
Receptive Language
The other area of language is receptive language. This affects the ability to understand others. It also affects the ability to discriminate. You could see how this would directly interplay with interventions and assessments that occupational therapists are providing. It affects the ability to discriminate body parts, objects, and pictures; the ability to follow a one step, a two step, a multi-step direction; the ability to respond to yes/no and open-ended questions; and the ability to comprehend conversational interactions. Perhaps you receive a referral because someone is having difficulty with a dressing task and you determine that they have issues with receptive language. They are not able to discriminate their body parts nor understand the caregiver when they are giving them various directions. Perhaps six months ago, Mrs. Adams could understand her ADL directives when given three steps, and now she is only able to understand one step at a time, because she is losing this receptive language ability.
Cognitive and Executive Function
Cognitive and executive function are higher-level tasks. Language is lower level, while cognition is at a higher level.
