Professional Documents
Culture Documents
Dementia Management
Dementia Management
Management
EVALUATION AND STAGING
TONYA DEDERA
Objectives
Colleagues will be able to:
What is Dementia?
https://accessgenesishoc.com/site/rehabcentral/Cli
nical/ResourceGuides/Pages/.DanaInfo=central.ge
nesishoc.com+Dementia.aspx
Utilization: Once at pretreatment, at least one posttreatment rating, and additional ratings at the discretion of
the investigator
Evaluation-Global Deterioration
Scale (GDS)
7 stages
Global
Deterioration
Scale
Allen Level
1-Normal
(No Cog. Deficits)
6-Planned Activities
30
5-Exploratory Actions
20
Mini Mental
Developmental
Age
18 - 21
yrs.
(Allen
Level)
5.4-5.6
14 -17
yrs.
5-Exploratory Actions
(Allen
Level)
5.0-5.2
7-13
yrs.
4-Moderate Cog.
Decline
(Late Confusional)
4-Goal Directed
Activity
11-17
(Allen
Level)
4.0-4.4
4-6
yrs.
5- Moderately Severe
Cog. Decline
3-Manual Actions
(Allen
Level)
3.0-3.6
18 mos.3 years
MIDDLE STAGE
DEMENTIA
2-Postural Actions
(Allen
Level)
2.0-2.6
9 23
mos.
LATE/END STAGE
DEMENTIA
(Allen
Level)
1.0-1.8
0 12
mos.
EARLY STAGE
DEMENTIA
1-Automatic Actions
Memory
Unable to
recall major
relevant
aspects of
their lives
Frequent
disorientation
to time (date,
day of week,
season) or to
place
Behavior
Impatient
Paranoid
Unaware of
safety
hazards
ADL
Assistance
with higherlevel ADLs
Requires
moderate
cueing
Capable of
routine task
Unable to
problem
solve
Communicati
on
Motor/Mobilit
y
Repetitive
speech
Difficulty with
higher-level
executive
functioning
Fine-motor
and grossmotor intact
Control of
voluntary
movement
Environmental Considerations
Sample Intervention
Occupational Therapy:
Routine Task Inventory
Cognitive Level
Observable
Behaviors
3.2
Spontaneously
initiates brushing
and combing
when objects
are in close
proximity
May attempt to
squeeze
toothpaste, turn
on water, pick
up bottles
Assistance
Needed
Caregiver places
objects in visible
close proximity
Cues patient to
start and stop
actions with verbal
commands
Does task requiring
sequencing of
actions for precise
results
Special
Considerations
Restrict access to
harmful objects
Focus of
Performanc
e Skills
Priority
Assessment
Areas
Activities of Determine
Daily Living task abilities
for self care
and leisure
tasks and
how to
segment
tasks for
success
Treatment
Interventions
Adapt
activities for
poor
attention
span
Provide
cues to
initiate,
sustain, and
discontinue
task
Sit patient at
table with
stage 5 or 6
Sample
Documentation
/
Outcomes
Patient will
name comb
when
presented to
him and use
appropriately
100 % of the
time
Patient will
initiate use of
toothbrush
once placed in
hand and
complete task
with Min A and
50 % verbal
cues
Universal
Approaches
Limit
choices to 2
items
Allow
additional
time to
perform task
(2-3 times
longer)
References
Einterz, S. F., Gilliam, R., Chang Lin, F., McBride, J. M., & Hanson, L. C. (2014).
Development and Testing of a Decision Aid on Goals of Care for Advanced Dementia. Journal
of the American Medical Directors Association, 15 (4), 251-255. doi:
10.1016/j.jamda.2013.11.020
Gitlin, L. N., Winter, L., Vause Earland, T., Adel Herge, E., Chernett, N. L., Piersol, C. V., &
Burke, J. P. (2009). The tailored activity program to reduce behavioral symptoms in
individuals with dementia: Feasibility, acceptability, and replication potential. The
Gerontologist, 28 (3-4), 55-60. doi: 10.1093/geront/gnp087