A change in mental status can refer to any changes in brain function resulting in...

• Confusion
• Memory Loss
• Loss of alertness
• Unusual thinking
• Poor judgement
• Emotional changes
• Behavioral changes
• Personality changes

Possible Reasons for a Change in Mental Status

There are many possible reasons a person experiences a change in mental status - some examples include:

• Infection
• Fever
• Medications
• Low blood sugar
• Stroke
• Liver failure
• Alcohol or drug use
• Consuming toxic substances
• Dementia
• Lack of oxygen (Anoxia)
• Brain injury / Concussion

What's important is recognizing that a change has occurred and seeking medical assessment and care as soon as possible.

What You Might Notice

You might notice some changes in how a person speaks or acts that may be an indication of a medical issue (Acute Change in Status) or a change in ability (Progressive Change in Status).

Examples of changes to look for:

• Is the person talking differently?
• Is the person walking differently?
• Is the person doing something that is out of character?

Common Signs of Acute Change in Status (Medical Emergency)

Look for a sudden, unexpected change in:

• Speech (slurred, difficulty finding words, nonsense words)
• Gait (walking funny, stumbling, difficulty walking)
• Movement (sudden paralysis or weakness of one side of the body or face)
• Behavior (confusion, agitation, sudden withdrawal)
• Level of consciousness (unresponsive, excessive sleepiness)

Acute Change in Status - Action Plan

If you notice a sudden, unexpected, and significant change in the person's mental status:

• Call 911 immediately
• Stay with the person
• Follow the 911 operator's instructions
• Contact your supervisor/manager immediately

Progressive Change in Status - Dementia

Dementia is a progressive and chronic condition which affects a person's ability to remember, think, and make decisions that interferes with daily life.

Dementia is not a normal part of aging.

A sudden change in a person with dementia should be treated as a medical emergency (Acute Change in Status) and may not be related to the dementia itself.

Dementia in Adults with Developmental Disabilities

People with Intellectual and Developmental Disabilities (IDD) are more likely to develop dementia and at an earlier age than the general population.

People with Down Syndrome are at an especially high risk of developing Alzheimer's disease.

Dementia in Adults with IDD - Signs

Dementia may appear differently in people with IDD. Look for changes in the person's baseline abilities, such as:

• Loss of existing skills (e.g., losing the ability to read, count, or tie shoes).
• Personality changes (e.g., more agitated or withdrawn).
• Change in communication style.
• Physical changes (e.g., shuffling gait, increased falling).
• New onset of seizures or a change in a seizure pattern.

Dementia: Supporting the Person with IDD

When providing supports, remember that the person with dementia is still the same person with the same life history.

• Be patient and reassuring.
• Maintain established routines.
• Simplify tasks and activities (step-by-step instructions).
• Focus on what the person can still do.
• Connect with the person's history and memories (reminiscence).

Dementia: Supporting the Person

Simplify communication:

• Use simple language and short sentences.
• Ask one question at a time.
• Repeat important information.
• Allow plenty of time for response.
• Use gestures and visual cues.
• Be calm and reassuring.

Dementia: Supporting the Person

Simplify activities:

• Break down tasks into simple steps.
• Use visual aids (pictures, lists, sequencing cards).
• Provide a quiet, uncluttered environment.
• Avoid rushing or overwhelming the person.
• Focus on enjoyment, not accomplishment.

Dementia: Ways to support - Reminiscence

Reminiscence is talking about past events or experiences and can be a meaningful way to connect with the person.

• Use photo albums, favorite objects, or music to spark memories.
• Encourage the person to share stories.
• Focus on positive memories.
• Do not correct the person if they confuse details; focus on the feeling.

Dementia: Ways to support - Dealing with Agitation

Agitation can be a sign of discomfort, unmet needs, or confusion. Try to:

• Identify the cause (e.g., pain, hunger, fatigue, overstimulation).
• Maintain a calm, quiet environment.
• Speak in a soft, reassuring voice.
• Distract the person with a favorite activity or object.
• Avoid arguing or trying to force compliance.
• Ensure basic needs (e.g., toileting, food, drink) are met.

Dementia: Ways to support - The Role of Music

Music can be a powerful tool for connection and comfort:

• The brain often holds on to musical memories longer than other memories.
• Familiar music can prompt reminiscence related to a person's past.
• Music can promote interconnection with caregivers and others with dementia.
• Musical training appears to delay cognitive decline and promote brain plasticity in the elderly brain.
• Music therapy can help agitation, as well as other recreational activities.
• People with dementia respond better with individualized activities including personally preferred music.

Create a “life story” with the person.

Resources

• The National Task Group on Intellectual Disabilities and Dementia Practices
• The Eunice Kennedy Shriver Center - Aging IDD Education
• The Alzheimer's Association
• The Social Care Institute for Excellence (SCIE) - Dementia
• Practical Neurology: Music and Dementia: an Overview by Ronald Devere, MD

For more information, visit Provider Development online at

http://www.dbhds.virginia.gov/developmental-services/provider-development