Identifying the cognitive abilities of the person with dementia

We need to understand the cognitive abilities of the people with dementia we care for so that we can modify the activities to ensure they canDementia missing piece do them successfully.

Table 1 (p. 30) (Download pdf of Table 1 ) is intended to help you identify the current thinking abilities of the person with dementia you care for. The table focuses on abilities that will affect what activities you do with them, and how you present them. It is not intended to replace a formal cognitive or neuropsychological assessment to diagnose dementia, or to assess change in cognitive abilities. Rather it is intended to help carers figure out what the person with dementia may be able to do, and also may help show relative strengths and weaknesses of the person with dementia.

Those of us who get to know people with dementia after they have developed dementia find it easier to accept and work with the strengths and personality of the person as we find them, since we did not know them beforehand. Carers who have known the person from before the onset of dementia sometimes spend emotional energy noticing and worrying about the mental abilities that have deteriorated and remembering the person in their prime. While these memories are important, it can be more productive to focus on the person’s current strengths and on how to maximize their current abilities.

It is sometimes very difficult to judge what a person with dementia can do. As a psychologist, I’m often surprised at their abilities when I test a person — which can be much worse or much better than I expect, or can be unexpectedly good in one aspect of thinking or memory. I tend to expect that people with dementia with good social skills will also have good mental abilities, but social skills and mental abilities do not always correspond.

Alzheimer’s dementia is the most common form of the disease and so most professionals have a ‘prototype’ of dementia that is most similar to Alzheimer’s disease, with memory problems being the predominant early complaint. Other types of dementia often are quite different. For instance, someone with vascular dementia may have relatively good short-term memory but very poor judgment. Family and professional carers often underestimate or overestimate the abilities of a person with dementia. The only way to know what a person with dementia can do is to be observant, and to consider each ability individually. You may need to make these observations before completing the tables.

You may be surprised at what the person you care for can still do, and realize that you’ve been doing too much for him or her. Or you may be surprised at how little they can do, and reflect that they have been understanding less of what is going on than you thought or may need more supervision than you have been giving.

It may be useful to review the table and update your answers if the person with dementia’s condition changes.