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Managing behavioural disturbances in dementia

Whilst some problems emerge directly out of the neurological damage caused by the underlying pathology (e.g. hallucinations in Lewy body dementia), often it is not clear why people with identical degrees of cognitive impairment might present in radically different ways. In addition to neurological damage it is important to think about the person who has the illness: what are their life experiences, what are their experiences of illness, and how are they being treated now they have dementia?

Malignant social pathology

Kitwood delineated the role of social processes and procedures in damaging the self-esteem of the dementia sufferer. These set up a self-fulfi lling spiral of decline, often resulting in the behavioural disturbances exhibited by the patient (Box 16.8). The major processes are:

Routines and practices that tend to depersonalise the person with dementia Failure to meet the individual patient’s needs Focus on management, containment and control.

Assessing behavioural disturbance

When a person with dementia presents with behavioural disturbance, a number of questions should be asked before any intervention is commenced:

What is the ‘problem’? (i.e. an operational defi nition is required) To whom is it a problem? What is known about the people who are experiencing the problem? What is being communicated by the problem? How do we fi nd out what is being communicated by the problem?

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