Changing Perception in Alzheimer's: An Experiential View

Changing Perception in Alzheimer's: An Experiential View

G. Allen Power (University of Rochester, USA)
DOI: 10.4018/978-1-4666-8478-2.ch012
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Abstract

In this chapter, the author will explain how the predominant models for viewing Alzheimer's and other forms of dementia fail to provide an adequate understanding of the changing perceptions of people who live with these conditions and consequently limit our ability to provide effective support. An alternative “experiential” model will be presented and used to reframe several concepts regarding the changing mind. New insights from this model inform an innovative approach to understanding and supporting people whose perceptual mechanisms and communication abilities differ from those of their care partners, and suggest a strength-based framework for enhancing several aspects of well-being, regardless of one's diagnosis or cognitive ability.
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Background

The dominant biomedical model of dementia that has emerged over the past several decades focuses heavily on dementia as a progressive, incurable, and ultimately fatal disease. We explore the various structural and chemical changes in the brain in exquisite detail and compile assessments that are primarily concerned with deficits—what the person has lost or can no longer do. While these deficits undoubtedly exist, our focus on them creates a one-dimensional view of the person, which explains why many of our responses to her personal expressions are also very one-dimensional.

There are many ways in which a narrow deficit-based view of dementia fails to provide a full picture. One fundamental example is the array of tests that are employed to evaluate cognition. Each assessment tool is comprised of a number of discrete tasks to be performed, relating to various aspects of cognition, such as orientation, short-term word retrieval, clock drawing, calculation, or sentence construction. Each tool reports a score based on the number of such tasks that are performed correctly.

Many such tests have good sensitivity for identifying discrete deficits in cognitive function. However, much of one’s daily actions and interactions involve more complex and integrative thinking than these tests can identify. While deficits in certain areas may lead to impairment in some complex tasks (e.g., memory loss or math impairment affecting timely and accurate bill paying), there are many other integrative skills that are not measured (or often cannot be measured in a quantitative manner), even though they may be well preserved far into one’s life with dementia. Examples of such skills include dispensing advice, teaching an activity (such as knitting or cooking), engaging in art or music, reading to a small child, or providing comfort and consolation to a person in distress. (Representative examples of these abilities can be found in Dijkstra, Bourgeois, Youmans, & Hancock, 2006; DuPuis, et al., 2012; Rosebrook, 2007; Sabat, 2001.)

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