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Behavioural Challenges in Dementia
Trevor Janz MD
Residential Care Medical Director for Interior Health East
Dementia: Definition
A progressive neurologic
impairment of thinking and
memory that affects a person’s
ability to perform activities of daily
living.
Prevalence increases with age
Age 65 to 74
• 37%
Age 75 to 84
• 20%
Over 85 years
• 50%
Types of dementia
Alzheimer’s
Vascular
50 to 70%
25 to 40%
• Short-term memory
loss
• Gradual progression
• Abrupt on-set
• Stepwise
progression
• Gait & balance issues
• Difficulty speaking &
swallowing
• Poor judgement
• Depression
Types of dementia
Lewy
bodies/Parkinson’s
•
•
•
•
•
•
15%
Slowed movement
Gait problems
Visual hallucinations
Fluctuations in ability
Sensitivity to
medications
Frontotemporal
• Changes in:
• Personality
• Behaviour
• Speech & language
• Often younger
(onset in 60’s)
• Intact memory &
some thinking
Dementia imposters





Delirium
Depression
Drugs
Drinking alcohol
Deficiencies (thyroid, B12, Thiamine)
Dementia affects

Thinking


Feeling


Memory and problem
solving
Our emotional life
Willing

Our behaviours & abilities
in the world
Thinking
Memory loss
Hallucinations
& delusions
Orientation
(time, place,
person)
Language
Organizing &
planning
Problem
solving
Feeling
Frustration
(simple tasks)
Paranoia
Depression
Fear of loss
of control
Anxiety
Willing
Difficulty with
simple tasks
Loss of interests
in hobbies &
projects
Apathy & loss of
motivation
Social withdrawal
& isolation
Behavioural Changes







Repetitive questions/comments
Head turning sign
Indecision or impulsiveness
Restlessness or agitation
Verbal or physical outbursts
Inappropriate behaviour
Sexual disinhibition
Stages of dementia: Early


Early memory loss
Problems





Driving
Shopping
Cooking
Managing money
Requires caregiver to
manage at home
Stages of dementia: Middle

Increasing support required to manage:




Dressing & grooming
Bowel & bladder
Feeding
Admit to residential care
Stages of dementia: Late





Swallowing difficulties
Weight loss
Increasing contractures & rigidity
Infections (bladder, pneumonia)
Forget how to:



Walk
Talk
Recognize loved ones
Behavioural challenges
All behaviour is communication
Agitation
Aggression
unmet needs
self-protecting from danger
Resident centered care
Know resident, seek to understand
behaviours, anticipate needs
Relationship centered care

If resident senses they are:




Safe
Respected
Understood
Liked & loved
Then quality of life for
both resident and care
giver will be better
Use short term memory
to your advantage:

Divert

Distract

Re-direct

Use creative “non-fiction”

Start with the facts and
create a compelling story
trevor.janz@interiorhealth.ca
trevorjanz@hotmail.com
(250) 352-1208
Thank you
Slides by Deanne Taylor