Table 5.

Behavior dementia care pathway vignette

How the Behavioral Deficits are Affecting Sam's Daily Life	Sam's Identified Strengths	Corresponding Recommendations for Sam
Fixating on topics for long periods of time	Enjoys wood working	Communication strategies were provided for Sam's wife; for example, using distraction when Sam fixates on topics. During the appointment, Sam's wife and a therapist role-played this strategy using the example of refocusing Sam's attention to an enjoyable activity, such as woodworking. Written cues in a memory wallet were also introduced to decrease perseveration on topics and to increase initiation of meaningful questions during conversations with family members.
Taking an extended time dressing and getting ready in the morning due to changes in initiation	Can follow simple written instructions	Step-by-step instructions with images to help Sam get ready in the morning were designed to assist Sam with brushing his teeth and hair. A referral was made to speech-language therapy in the home to help formulate these visual memory aids.
Problems with motivation and making decisions	Performs well with structured routine and participates in some household work	A daily schedule of activities was created so that Sam was not faced with decisions and was offered structure. Activities were written on a dry-erase schedule board to increase recall of past/upcoming activities. Activities focused on his interests in a modified and simplified way. For example, instead of using the woodworking equipment, Sam spent time sanding various pieces of wood for a project that his friend later helped him put together.
Makes inappropriate comments to strangers that are embarrassing to his wife		Sam's wife was counseled on strategies to help her cope with Sam's disinhibition. These included disclosing the diagnosis to close friends and family to increase their awareness and, as much as possible, avoiding public situations where Sam's behavior could be particularly troubling to her. Sam's wife was also given a card that she could show to strangers briefly explaining Sam's diagnosis and asking for their patience and understanding. Sam was referred to a behavioral home health program and a psychiatrist to assist with managing behavior changes. Sam's wife was referred to a frontotemporal dementia caregiver support group to help her cope with Sam's changes as well as help guide her with long-term planning.
Frequent irritability		The social worker explored and identified triggers for Sam's irritability and counseled family on interventions that may help to avoid these symptoms, such as playing calming music and remaining nonconfrontational.