Table 1.

Four care pathways for dementia: common neuropsychological profiles, deficits in daily living activities, and strategies and interventions

Common Neurocognitive Findings	Common Symptoms in Daily Living Reflecting Primary Deficit	Common Strategies/Interventions
Memory Dementia Care Pathway
Poor orientation to time and place Acquisition deficits: scores are low on tests of learning words, stories, and designs, and, despite repeated trials, cannot increase the amount of information recalled immediately after presentation Retention and retrieval deficits: after a delay even as brief as 3 min, cannot recall the information initially learned Performance does not improve with multiple-choice recognition and the patient may also “recognize” information that was not previously presented (ie, make false-positive identifications)	Mixes up appointments; takes medications at the wrong times or completely forgets them; does not know the day, date, and, when more advanced, time of day Despite repeated information/instructions, cannot retain information; may ask the same question over and over again within a short interval of time Information evaporates and patients may argue that they were never told the information Cannot use cues to remember; seeing a familiar landmark does not remind the patient of location or direction to move in	Spaced retrieval training (ie, gradually increasing recall intervals to promote learning)37,38 Errorless learning: learning that occurs in a facilitated environment that eliminates errors39 Vanishing cues hierarchy: the systematic reduction of cue information across learning trials40 Use of memory wallets/books to promote recall of orientation facts, important names, past and recent events, and other functional facts, such as safety precautions41 External or electronic memory aids, such as schedule boards42,43 Environmental modifications to improve participation in activities of daily living and safety (eg, lighting, flooring, color schemes, wall hangings, furniture, and noise/sound) Ongoing training of caregivers/family members on the use of positive communication strategies and the importance of avoiding questions that rely on short-term memory also contributes to a reduction in difficult behaviors44 Safety devices, such as GPS personal locator devices, home monitor device, adaptive telephones, identification bracelets
Language Dementia Care Pathway
Low scores on tests of object naming; makes errors (may say “microscope” instead of “stethoscope”) May not understand single words even when they are common (eg, asking “What is salt?”) or sentences that are grammatically complex (eg, “Who is the boy that John kicked?”) Low scores on tests of reading comprehension and writing	Gropes for words so that speech is interrupted by long pauses for word-finding Cannot carry out instructions; may misunderstand what is being said, despite normal hearing, and misinterpret messages, which can lead to anger and even paranoia Cannot understand written communications (newspapers, books); cannot write normally; makes errors in spelling and/or grammar	Self-cueing strategies (eg, semantic circumlocution) Home exercise program targeting the rehearsal of personally relevant words Oral reading tasks, including strategies to increase motor sequencing for multisyllabic words (eg, syllabic segmentation, Melodic Intonation Therapy)45 Personal picture description tasks Script rehearsal for telephone conversations and in social contexts Communication tools to supplement spoken language as the disease progresses include use of a communication wallet, communication boards/book, and possibly an augmentative and alternate communication device29,46 Strategies to help an individual compensate for dyslexia and dysgraphia, including technology that provides auditory and visual cues to promote reading comprehension; for dysgraphia, speech recognition apps and word prediction features can help facilitate functional writing tasks
Visuospatial Dementia Care Pathway
Low scores on tests requiring spatial perception, such as deciding if 2 lines are at the same angle as a model Difficulty finding specific targets on a sheet containing many different types of letters or shapes; search strategy is unsystematic and patient may miss many targets despite normal visual acuity Difficulty drawing a clock or copying a simple geometric figure; difficulty putting blocks together to make a visual pattern Facial discrimination problems and inability to decide if 2 faces seen from different perspectives are the same person or not	Misjudging distance and relationship of body to external space, which can result in car accidents or scrapes when trying to park or pass between fences Difficulty searching for household items; items may be in plain view and, especially if surrounded by other items (as an item in a drawer or in a refrigerator), are “invisible” to the patient Inability to place objects on a table surface; difficulty assembling kitchen utensils; difficulty orienting clothing to one's body or working knobs and accessories in the car Misrecognizing people; not able to easily recognize facial differences Larger letters can be more difficult to recognize due to “simultanagnosia”	Environmental modifications: increasing organization around the home, decreasing clutter, using proper lighting, controlling glare, and increasing contrast Use of technology for compensation: talking watches/alarm clocks, a large numbered phone, a reading machine, a magnifier with a light feature, and a variety of voice-activated enabled smartphones Reduce the size of print for individuals with simultanagnosia
Behavior Dementia Care Pathway
Has difficulty reasoning and performing cognitive shifting tasks Loses knowledge about what is socially acceptable in different settings Cannot inhibit automatic responses May incorporate stimuli irrelevant to the task at hand because they are accessible, known as stimulus-bound behavior	Makes poor decisions, which may jeopardize financial or personal safety or the safety of others; thinking is rigid; cannot come up with or understand alternative solutions to problems Engages in embarrassing behaviors (eg, talking loud or laughing during a funeral service); makes insulting remarks; sloppy eating habits May unintentionally engage in criminal behavior (eg, “shoplifting”); touches objects; may dial the phone just because it is there	Communication tips or visual cue strategies to best respond to behavioral changes, such as agitation disinhibition, poor judgment, etc.47 Emotional support and respite care for the primary caregiver Safety devices, such as GPS personal locator devices, home monitor device, adaptive telephones, identification bracelets