12.1 Dementia and Alzheimer's Disease Care
Key Takeaways
- Dementia is a group of symptoms (not one disease) — Alzheimer's is the most common type (60-80%)
- Use simple, one-step directions; avoid arguing, correcting, or saying "don't you remember"
- Redirect rather than confront — validate feelings and offer pleasant alternatives
- Sundowning: increase lighting, maintain routine, reduce stimulation in the evening
- Agitation triggers: pain, overstimulation, unmet needs — identify and address the underlying cause
- Safety: wandering alarms, secured units, remove hazards, bed alarms, consistent routines
Last updated: March 2026
Dementia and Alzheimer's Disease Care
Caring for residents with dementia and Alzheimer's disease is a major component of CNA practice and is tested as part of Duty Area 5 (Providing Mental Health and Social Services) on the INACE. Dementia affects a large percentage of long-term care residents, and Illinois facilities are required to provide specialized dementia care training for all staff.
Understanding Dementia
Dementia is not a single disease but a group of symptoms affecting memory, thinking, and social abilities severely enough to interfere with daily life.
| Type | Characteristics | Progression |
|---|---|---|
| Alzheimer's Disease | Most common (60-80%); plaques and tangles in brain | Progressive, irreversible; 4-20 years |
| Vascular Dementia | Caused by strokes or blood vessel disease | May be stepwise or gradual |
| Lewy Body Dementia | Protein deposits in brain; visual hallucinations | Progressive; fluctuating cognition |
| Frontotemporal Dementia | Affects personality, behavior, and language first | Progressive; younger onset (40-65) |
| Mixed Dementia | Combination of two or more types | Varies |
Stages of Alzheimer's Disease
| Stage | Symptoms | CNA Impact |
|---|---|---|
| Early (Mild) | Short-term memory loss, word-finding difficulty, poor judgment, personality changes | Supervision with ADLs; safety monitoring; orientation cues |
| Middle (Moderate) | Increased confusion, wandering, sundowning, incontinence, difficulty with ADLs, may not recognize family | Hands-on assistance with all ADLs; behavioral management; structured routine |
| Late (Severe) | Total dependence, inability to communicate, bed-bound, difficulty swallowing, weight loss | Total care; comfort measures; aspiration precautions; family support |
Communication Strategies for Dementia Residents
| Strategy | Application |
|---|---|
| Use simple sentences | One-step directions: "Please sit down" not "Could you please sit down in the chair so we can start your bath?" |
| Speak slowly and calmly | Allow processing time; do not rush |
| Use positive language | "Walk with me" instead of "Don't run" |
| Avoid arguing or correcting | Do not say "Don't you remember?" or "I just told you that" |
| Use visual cues | Show the toothbrush while asking "Time to brush your teeth" |
| Maintain eye contact | Approach from the front; get their attention before speaking |
| Validate feelings | "You seem worried. How can I help?" |
| Redirect, don't confront | If upset about going home, redirect to a pleasant activity |
| Be patient | Allow extra time for responses and processing |
Behavioral Symptoms and Management
| Behavior | Possible Causes | CNA Response |
|---|---|---|
| Wandering | Restlessness, looking for something familiar, boredom | Safe walking areas; monitoring; redirection; activity programs |
| Sundowning | Increased confusion in late afternoon/evening | Adequate lighting; calm routine; reduce stimulation; reassurance |
| Agitation/Aggression | Pain, overstimulation, unmet needs, frustration | Identify trigger; remain calm; reduce stimulation; report to nurse |
| Repetitive questions/behaviors | Memory loss; anxiety | Answer patiently each time; redirect to activity |
| Refusal of care | Confusion, fear, not understanding | Approach calmly; try again later; use a different approach; do not force |
| Hoarding/rummaging | Need for security; old habits | Provide a safe area to rummage; do not take items without replacing |
| Inappropriate behavior | Loss of social awareness; brain damage | Calmly redirect; do not embarrass; report to nurse |
| Catastrophic reaction | Overwhelming frustration or stimulation | Stay calm; reduce stimulation; do not restrain; allow to de-escalate |
Sundowning: Special Considerations
Sundowning is increased confusion, agitation, and anxiety that occurs in the late afternoon and evening:
Strategies to reduce sundowning:
- Maintain a consistent daily routine
- Increase lighting in the afternoon/evening
- Reduce stimulation (noise, activity) as evening approaches
- Encourage physical activity during the day to promote restful sleep
- Limit caffeine after noon
- Provide a calm, reassuring environment
- Offer a light snack in the late afternoon
- Close curtains before it gets dark outside
Safety Considerations for Dementia Residents
| Safety Measure | Purpose |
|---|---|
| ID bracelet/wandering alarm | Locate resident if they wander |
| Secured unit | Prevent elopement from the facility |
| Remove hazards | Chemicals, sharp objects, medications out of reach |
| Supervision during meals | Prevent choking and ensure adequate intake |
| Bed alarm | Alert staff when resident gets out of bed |
| Consistent routine | Reduces confusion and agitation |
| Familiar objects | Photos, blankets from home provide comfort |
| Adequate lighting | Reduces confusion, especially at night |
Test Your Knowledge
A resident with Alzheimer's asks you the same question for the fifth time in 10 minutes. What is the best response?
A
B
C
D
Test Your Knowledge
What is "sundowning" and when does it typically occur?
A
B
C
D
Test Your Knowledge
A dementia resident becomes agitated and starts yelling when you try to help them get dressed. What should you do FIRST?
A
B
C
D