BOX 31-1

FOUR As OF ALZHEIMERS DISEASE* AND ADAPTIVE ACTIONS

Agnosia: Impaired ability to recognize or identify familiar objects and people in the absence of a visual or hearing impairment. Assess and adapt for visual impairment. Do not expect the patient to remember you; introduce yourself. Cover mirrors or pictures if they cause distress. Name objects and demonstrate their use. Keep area free of ingestible hazards (toiletries, chemical cleaning supplies, checkers, buttons, unmonitored medicine). Aphasia: Language disturbances are exhibited in both expressing and understanding spoken words. Expressive aphasia is the inability to express thoughts in words; receptive aphasia is the inability to understand what is said. Assess and adapt for hearing loss. Observe and use gestures, tone, and facial expressions. Provide help with word nding. Restate your understanding of behaviors and word fragments. Acknowledge feelings expressed verbally and nonverbally. Use simple words and phrases; be concise and organized. Allow time for response. Listen carefully and encourage with nonverbal praise. Use pictures, symbols, and signs. Amnesia: Inability to learn new information or to recall previously learned information. Do not expect the patient to remember you; introduce yourself. Do not test the patients memory unnecessarily. Operate in the here and now. Provide orientation cues. Remember, you must adapt when the patient cannot change. Compensate for patients lost judgment or reasoning. Apraxia: Inability to carry out motor activities despite intact motor function. Assess and adapt for motor weakness and swallowing difculties. Simplify tasks; give step-by-step instructions and time for response. Initiate motion for patient with gentle guidance or touch.
*May also be present in other cognitive disorders.