Dr Graham Stokes 2

We don't know why dementia starts. It is striking at random. It is a disability. It is a person with a disability. They have rights. The person is still there, it is just that they are disabled. The new always stays strange, so it is good to keep people in their own place. Layers and layers of intellectual devastation. In the beginning it is subtle, changes in concentration. It could be depression, thyroid problems, but needs to be checked out.

Concentration deficits: Capture successes by putting their house number on their door (for Health and Safety, put actual room numbers on the frame of the door). Activities need to be meaningful to the person.

Incidental and intentional learning deficits: Incidental learning is no longer possible. Intentional learning cannot occur. What they know is all that they know now. They become like Teflon, nothing sticks.

Loss of established memories: Forgetting personal history. What they learn last, they forget first.

Disorientation: New place, new room, new toileting place. Don't know where you are, or what time of the day it is.

Language impairment - speech and comprehension: What the person with language impairment suffers from is that they are not able to communicate. People can sing when they cannot speak. Sing directions to them, and they may respond.

Executive dysfunction: inability to make decisions for self. It starts right at the beginning. People make very bad decisions. It is an indicator of problems ahead

Apraxia: loss or impairment of the ability to execute complex coordinated movements without muscular or sensory impairment. Loss of coordination, related to dressing themselves, ido-motor apraxia is unable to make a deliberate movement, like pick up a cup, to drink the tea.

Agnosia: loss or diminution of the ability to recognize familiar objects or stimuli usually as a result of brain damage. Loss of meaning, nothing makes any sense whatsoever. Proso-agnosia, means faces all look the same. Babies have agnosia, until they make sense of the world.

                                                                               - evolving dependency