Recognising cognitive change
This short animation illustrates how a nurse may start thinking about cognition when with their patient, and what first steps they may take if a change is noticed. A general practice nurse dementia care checklist is included.
Having an understanding of a person’s cognitive status helps with assessing the impact of a cognitive impairment on health and well-being. This knowledge will help with the development of an appropriate plan of care to support a person’s independence.
A change in cognition can present as changes in one or more of the following:
- Memory
- Thinking
- Behaviour
- Planning
- Organisation
- Orientation
- Completing usual tasks
A person or family member may not volunteer information about cognition changes. Clues can be picked up if changes are noticed, for example, in a person’s usual mood, appearance, communication, social activities, health self-management or attendance at appointments.
Further detail and prompts about cognitive assessment and behaviour changes can be found below.
Cognitive assessment
It is useful to consider:
- When did the person or their support person first notice a change in cognition?
- Have they spoken with their Doctor?
- What is the concern?
- Whose concern is it?
- Is there a diagnosis?
- If yes, what is the diagnosis?
- Does the person has insight into their condition?
- What impact does this change have on a person’s life?
- What impact does this change has on the support person’s life?
The conversation about cognition can be opened up with questions such as:
- Have you noticed any changes in your memory?
- Have you noticed any changes in your thinking?
- Are there things you used to do but have trouble with now?
During a health assessment the nurse may pick up changes in previous functioning allowing further exploration of possible cognitive changes and their impact.
Always check a person’s sensory functioning and that if aids are used they are in working order and used appropriately. Ears blocked with wax could contribute to repetitive questioning!
Resources
Behaviour changes
Behaviour changes can be a result of changes in the brain or can be a result of a person’s unmet needs.
Not all changed behaviours cause concern. If a changed behaviour is not distressing to the person or others then let it be.
Consider
- Description of behaviour
- Onset of behaviour
- Pattern of behaviour
- Impact of the behaviour
Triggers
- Are there environmental causes including harsh lighting and noise?
- Is the person being asked to do something they find too difficult or do not want to do?
- Is there something the person needs?
- Is the person uncomfortable? anxious or frustrated? unhappy? lonely or bored?
- Is there pain?
- Is there a medication side-effect or interaction?
Is there a risk of harm to the person and/ or others?
What soothes the person?
Resources
Dementia Behaviour Management Advisory Service 24-hour Helpline 1800 699 799
Dementia Australia National Dementia Helpline 1800 100 500
Dementia Australia: Changed behaviours and dementia help sheets
Changed behaviours help sheet PDF
Problem solving help sheet PDF