ACETYLCHOLINE: Ach. A chemical in neurons that acts as a neurotransmitter.
ACUTE CONDITION: A disease or symptom that appears very suddenly with marked intensity and subsides in a relatively short period of time following treatment.
ADLs: ACTIVITIES OF DAILY LIVING The basic personal care tasks that must be performed to maintain some degree of independence, such as eating, transferring (e.g. moving from bed to chair) walking inside and outdoors, dressing, grooming, bathing and toileting.
ADVANCE DIRECTIVE: Also called LIVING WILLS. Written documents completed and signed, when a person has the cognitive ability (legally) to explain their medical wishes in advance. Advanced directives allow someone else to make treatment decisions on behalf of the person with dementia as they become more disabled by their dementia. There is no Irish legislation to deal with this matter.
AGNOSIA: Loss of the ability to recognize familiar people or objects by sight, touch, taste, smell, or sound. Family members often find it emotionally difficult to cope with the loss of personal recognition.
ALZHEIMER’S: DISEASE: A disability characterised by impaired memory & ability to learn new material, accompanied by a high level of stress and an acute sensitivity to the social & built environment.
ANOMIA: The inability to recall or recognise names of objects. As dementia progresses this problem intensifies and word substitutions are common. E.g. All 4 legged animals may be called a ‘dog’.
APATHY: Lack of interest, concern or emotion.
APP: Amyloid Precursor Protein. A large protein from which beta-amyloid is formed.
APRAXIA: The loss of the ability to carry out complex learned and familiar purposive movements. e.g. A dressing apraxia, difficulty in remembering the sequence associated with putting on clothes. e.g. putting a shirt on over a sweater.
ASSESSMENT: An evaluation of a person’s condition or personal needs to enable them to live as independently as is possible. Assessment is a process that is ongoing and is vital to therapeutic care & support of people with dementia.
AUTOPSY: A postmortem examination performed to determine the cause of death. Plaques & tangles, markers of Alzheimer’s disease are only visible following autopsy.
BRAIN: The centre of thought & emotion, responsible for the coordination & control of bodily activities & the interpretation of information from the senses. The brain has a number of lobes. Frontal, Temporal, Parietal, Orbito-Basal, related to different behavioural functions.
C.J.D.: Creutzfeldt Jacob Disease. CJD is an extremely rare disease. It is a human form of a transmissable dementia. It has a long incubation period but progresses rapidly once symptoms develop. Concern about transmission from beef infected with BSE, the bovine form of the disease, has led to the introduction of strict controls.
CADASIL: Cerebral Autosomal Dominant Arteriopathy with Sub cortical Infarcts and Leukoencephalopathy: An inherited form of vascular dementia which affects young adults. Characterised by a series of strokes, psychiatric problems and dementia.
CARE PLAN: A document specifying long-term care goals for residents/patients and the time frame within which the goals should be achieved. Goals are determined through careful assessment of the person’s physical and psychosocial abilities and difficulties. Care planning should involve the person with dementia, their family and if in a medical setting, the multi disciplinary team. Plans should be regularly reviewed to take account of changing abilities.
CEREBELLUM: The part of the brain which controls the body’s balance and coordination.
CHALLENGING BEHAVIOUR: Any type of behaviour deemed difficult to manage, harmful, potentially harmful, or disturbing to the person performing the action or to others. Such behaviour should be viewed as an attempt to communicate by the person with dementia.
CLINICAL TRIAL: A research study involving humans that intensively tests safety, side effects, and how well a medication or behavioral treatment works.
COGNITION: All the components of the mental process. These include awareness and comprehension of ideas, things, and events; retention of the experience; retrieval of it; sequencing ideas, forming concepts, and learning from them; reasoning and forming judgments and opinions.
CUEING: The provision of prompts or hints, often verbal and/or visual to assist the person with dementia with orientation, to initiate or complete a task or stage of a task. Objective is to maintain independence of person with dementia.
DELIRIUM: A sudden onset of severe confusion and changes in brain function, sometimes characterized by hallucinations and hyperactivity.
DELUSION: A persistent belief that an event or situation is true even though it may be illogical. It is often based on fact or a distortion of facts.
DEMENTIA: An umbrella term for a range of symptoms which manifest a decline in intellectual functioning caused by a disease or other injury to the brain. The most common symptom involves loss of memory. From a psychosocial perspective dementia is a disability characterised by impaired memory & ability to remember, learn new material, a high level of stress & sensitivity to the social & built environment.
DEPRESSION: An abnormal emotional state characterized by feelings of worthlessness, sadness, emptiness, and hopelessness. When the primary diagnosis of the mental disorder is depression, it is potentially reversible but it may be extremely difficult to treat. It may be so severe that physical symptoms and symptoms of mental impairment (including short-term and long-term memory loss, confusion, delusions, and hallucinations) occur. When the symptoms of dementia appear but do not have an organic base, it is a pseudo-dementia. Depression is the most common pseudo-dementia. Alzheimer’s Disease and related disabilities, therapeutic drug use, and illegal drug use may all cause depression as a symptom of the primary condition.
DIAGNOSIS: The identification of a disease or condition by scientific examination of physical signs and symptoms, history, laboratory tests, and other procedures.
DRUGS: Aricept & Exelon are on the market since 1998 for use by people who have a mild /moderate level of dementia. Both work in a similar fashion, having an effect on one of the chemical pathways in the brain that is involved in storing memories. As dementia progresses, other pathways in the brain become involved so the effectiveness of the drugs becomes limited. The limitations of the drugs also relate to the fact that they do not directly affect the disease process; they are expensive and are not appropriate for everyone.
DYSARTHRIA: Relates to changes in speech production as a result impaired control and flexibility of the speech apparatus. Word usage may be correct but to the listener, speech may sound blurred or indistinct as a result of poor articulation or lack of volume control.
DYSPHASIA: The person has difficulty understand what is being said.
EEG: Electroencephalography. Study of electrical currents in the brain.
ENDURING POWER OF ATTORNEY: Unlike the more general power of attorney, remains in place should the person become mentally incapacitated as with dementia. This power must meet other requirements. Advisable to contact a solicitor.
EXCESS DISABILITY: When the level of disability displayed goes beyond what should be present in the context of that person’s level of impairment. An un-supportive environment may increase a person’s level of disability.
EXECUTIVE FUNCTION: Ability to set a goal; make decisions and implement appropriate activities to meet those goals.
FRONTAL LOBE: Located behind the forehead in both hemispheres of the brain. Controls cognition, personality and emotions.
FTD: Frontotemporal dementia is a rare degenerative condition caused by damage to the frontal lobe and/or the temporal parts of the brain. In the early stages of the disease it differs from Alzheimer’s in as much as memory may not be badly affected.
GAIT: Person’s manner of walking. People with Parkinson’s disease or Lewy Body dementia may have a “shuffling” gait. While people with Alzheimer’s disease have a reduced gait, because as they become more disabled they lose the ability to lift their feet.
HALLUCINATION: A persistent belief that something is seen, heard, or smelled, when nothing is really there. It is not based on fact, or even misinterpretation of fact. Visual hallucinations are more common in Alzheimer’s Disease.
HIPPOCAMPUS: Area in the forebrain while controls emotion and memory, particularly short-term memory.
HISTORY: A document recording all relevant medical (the medical history), psycho-social (the social history) information about a person or resident to enable the caregiver to care for & support the person with dementia.
HUNTINGTON’S DISEASE: A rare, abnormal hereditary condition characterized by involuntary, purposeless movements and a progressive dementia. Those with the condition usually begin to have symptoms between 30-45 years and have a life expectancy of approximately fifteen more years.
HYDROCEPALUS: A build up of cerebrospinal fluid (CSF) in the brain. Person may experience dementia like symptoms.
IADLs INSTRUMENTAL ACTIVITIES OF DAILY LIVING: The tasks of home management (such as money management, shopping, housekeeping, preparing meals, and answering the telephone) that are necessary but not as crucial to independent living as the ADLs.
INCONTINENCE: Loss of bowel (faecal) and/or bladder (urinary) control due to physical problems or to an inability to perceive signals correctly, which is common in Alzheimer’s disease. Some people may become doubly incontinent. When incontinence first becomes obvious a medical examination should be carried out to exclude a treatable physical problem.
KORSAKOFF’S: A condition sometimes seen in chronic alcoholism and caused by degenerative changes in the brain. It is characterized in part by short-term memory loss and an inability to learn new skills.
LEVEL OF CARE: The amount of physical care, psycho-social stimulation, Support and supervision a person with dementia requires; measured by the staff-to-patient/resident ratio and type of care needed to provide good quality care for that person.
LEWY BODY: A type of dementia, with a range of features including symptoms similar to Parkinson’s Disease such as tremor, shuffling gait & rigidity & hallucinations both visual & auditory. Of note people with this type of dementia are sensitive to neuroleptics (anti -psychotic medications)
LIVING WILLS: Also called ADVANCED DIRECTIVES. Written documents completed and signed, when a person has the cognitive ability (legally) to explain their medical wishes in advance. Advanced directives allow someone else to make treatment decisions on behalf of the person with dementia as they become more disabled by their dementia. There is no Irish legislation to deal with this matter.
LONG TERM MEMORY: A permanent storage place for memory and information.
MCI MINI-MENTAL STATE EXAMINATION: A mental status exam used to measure a person’s basic cognitive abilities, such as short-term memory, long-term memory, orientation, writing and language. Marked out of 30 points. A score of less than 24 is usually suggestive of some form of cognitive impairment.
MRI MAGNETIC RESONANCE IMAGING: A special radiology technique which is designed to image internal structures of the body using magnetism, and a computer to produce the images of body structures. MRIs are very clear and are particularly good for imaging the brain and soft tissues.
MULTI-INFARCT DEMENTIA (Vascular Dementia): A dementia caused by small or mini strokes that may be so small that they go undetected, but eventually they result in a stepwise deterioration of cognitive functioning. Similar risk factors to those of cardiac disease, more common in men than in women and less common after age 75 years. May co-exist with Alzheimer’s disease.
NEURODEGENERATIVE: Disease characterised by a progressive decline in the structure, activity, and function of brain tissue. These diseases include AD, Parkinson’s disease, and dementia with Lewy bodies. These are usually more common in older people.
NEUROLOGICAL: Having to do with the nerves or the nervous system.
NEUROLOGY: The field of medicine dealing with the nervous system, composed of the brain and spinal cord with their cranial and spinal nerves.
NEURONS: Every single nerve contains bundles of nerve cells or neurons, i.e. the messengers of the nervous system. Each neuron consists of a control centre and fibres of varying lengths.
OXIDATIVE DAMAGE: OXIDATION damage that can occur to cells when they are exposed to many free radicals.
PARANOIA: Suspicion of others not based on fact.
PARKINSON’S DISEASE: A slowly progressive neurological disorder usually occurring in the early sixties characterized by tremor, impassive facial features, shuffling gait, and other muscular disturbances. Symptoms of dementia can occur, or occur as a result of medication for other symptoms of the disease.
PATHOLOGY: The study of the characteristics, causes, and effects of disease by examining the structural and functional changes in the body.
PERCEPTION: The conscious recognition and interpretation of external stimuli using any of the senses. Correct interpretation is based on unconscious association with memory and is the basis for correct understanding and learning of new information.
PERSEVERATION: The compulsive repetition of a simple one or two-step action or phrase over and over again. Once the person has grasped the ability to perform a simple action, it is often done repeatedly and is difficult to stop. Longstanding preservations are very difficult to eradicate.
PERSON CENTRED CARE: An approach to dementia care which takes a holistic view of the person & their needs based on knowledge of the person & their story. The person with dementia is placed at the centre of every intervention.
PICK’S DISEASE: A disease affecting the frontal and temporal lobes of the brain. Onset is usually between 40 and 65 years of age. There is gradual dissolution of language in first 2 years. People are usually aware of this deficit and are adept at covering it up. Later memory deficits, personality change and disinhibited behaviours become evident. Neglect of personal hygiene, loss of insight, apathy or obsessional traits may also develop.
PLAQUES & TANGLES: With Alzheimer’s Disease, plaques and tangles develop which interfere with the transmission of the signal from one neuron to another or from neuron to brain, muscle etc. These plaques & tangles are visible only on autopsy following death
POWER OF ATTORNEY: A power of attorney is a document whereby one person (the donor) authorises another (the attorney) to act for them in certain matters on their behalf and in their name. E.G. power to sell property. It may be limited or general. It is always written.
PRAXIS: The performance of an action or task.
PROGRESSIVE SUPRANUCLEAR PALSY (PSP): Is a rare brain disorder that causes serious and permanent problems with control of gait. The most obvious sign of the disease is an inability to aim the eyes properly, which occurs because of lesions in the area of the brain that coordinates and controls eye movements.
PROGRESSIVE: Increasing in severity.
PSYCHOSOCIAL: Relates to the psychological emotional and social aspect of a person’s history in relation to their needs and abilities.
PSYCHOTROPIC DRUGS: are drugs primarily designed to affect the brain. They control emotions and behavior. Psychotropic drugs are not only tranquilizers, some act as antidepressants, others may reduce anxiety.
REMINISCENCE: An activity to promote a “sense of wellbeing” by getting in touch with long held memories & experiences and using these recollections to trigger & stimulate communication both verbal & non verbal.
SUNDOWNING SYNDROME: Confusion and irritation may occur in people with dementia at the end of the day. The cause of sundowning is not really known, but it may be due to general tiredness and an inability to process any more information or to interpret the environment correctly. A reduced level of activity consisting of familiar, undemanding tasks is best at this time.
VASCULAR DEMENTIA: Multi Infarct Dementia. A dementia caused by small or mini strokes that may be so small that they go undetected, but eventually results in a stepwise deterioration of cognitive functioning. Similar risk factors to those of cardiac disease, more common in men than in women and less common after age 75 years. May co-exist with Alzheimer’s disease.
WANDERING: A tendency to keep on the move, either in an aimless or confused fashion, or in pursuit of an indefinable or unattainable goal (Stokes’86). It may be indicative of a person’s need for exercise or their feeling of boredom. Two associated risks (1) possibility person may become exhausted or (2) their safety and security in some environments may be threatened if they wander. The capacity of a person with dementia to wander underlines the need to have appropriate space or an area such as a garden to allow them to wander/pace safely.
WARD of COURT: If a person becomes incapable of managing their affairs, due to having significant cognitive impairment as with a dementia, a committee (one or more people) is appointed by the court to manage their affairs. The person then becomes a ward of court. The application is made without the person involved having any say in the Courts determination. All applications are processed through The Wards of Court Office (Tel 01 8725555). The Office publishes an explanatory booklet and approximately 30% of all applications involve people with dementia.