Domain 2 – Cognition
The domain of cognition is all about the person’s understanding of their world. It links very much with communication, as when understanding goes, communication usually goes too. It is about their ability to understand who they are, where they are, when time/date it is. Cognition can also be linked to psychological needs, as someone stressed will not process their thinking in the same way as when they are unstressed. I have met clients who are very conflict / stress averse and this really does affect them badly, so they lose sleep and don’t eat and a downward spiral commences.
Dis/orientation is often described as “to time, place and/or person”. When someone is confused they can become disorientated to one or more of these things. Disorientation to time is about the person understanding not just what hour of the day it is, but what year it is. Although an over generalisation, with dementia short term memory tends to go first and the longer the person has had that memory, the longer it will take them to lose the memory, so it appears as though they are retreating in time and living ever further into the past. Emotional memory works like long term memory and people with dementia remember feelings better than facts.
Disorientation to place is about the person knowing where they are, if they have just moved into a new care home, then they may not be able to remember where they are very well. After a while they may be able to remember their room, but not the way to the loo, dining room or lounge. If their room has their own furniture in it, then they may be able to recognise that and feel comfort from having familiar things around them.
There can be an issue with small things of value, such as watches and rings. The various residents may know that they own a watch, but don’t recognise which watch is theirs, so if a resident sees a watch, they put it on, thinking “I’ve got a watch, this must be mine”. I would advise that any precious items are removed from the care home or there is a risk they will go missing.
Disorientation to person can be varied. Every one has a visual appearance, a relationship and a name, it is possible for the person to recognise your face, but not know your name or the relationship. Things can become tricky when son or daughter look like their parents and the spouse of the parent has memory issues. They father/mother then see their daughter/son believing them to be their spouse and behave in a way that is inappropriate for a parent/child relationship, but would be acceptable between spouses. This can happen in particular if the person’s memory is retreating so they think they are the age of their children. If they see themselves in the mirror, they would think that was their parent or even grandparent.
Cognition, since it is about their understanding, is about their ability to function in their world. What assistance do they need? What can they do for themselves? What do they need reminding about? What do they need support for? Very importantly, what is their understanding of risk? What risks do they understand?
It is also about their condition, do they know what is wrong with them, how bad it is and how it affects them? Do they ask for things to be done for them or are all their needs anticipated?
In my experience, if in doubt, try to find out if it will not be too distressing to the person to test them. It is not worth putting them through any embarrassment or distress, but if you can ask a question to gauge their answer, it is usually worth doing so.