Pay Attention!: The Critical Importance of Assessing Attention in Older Adults with Dementia

Abstract

Attention is an important cognitive domain that is affected in Alzheimer’s disease and other dementias. It influences performance in most other cognitive domains, as well as activities of daily living. Nurses are often unaware of the critical importance of assessing attention as part of the overall mental status examination. This article addresses an important gap in nurses’ knowledge. The authors present a brief overview of attention as a critical cognitive domain in dementia; review instruments/methods for standardizing and enhancing the assessment of attention; and offer ways to help ensure that best practices in the assessment, recognition, and documentation of inattention are implemented in the clinical area. Clinical resources that practicing nurses may find helpful are included.

A Novel Assessment and Profiling of Multidimensional Apathy in Alzheimer’s Disease

“…As one of the most prominent behavioral symptoms in AD, cognitive impairment is also associated with apathy [45][46][47]. While memory impairment is common in AD, attention [48] and executive dysfunction [49], such as planning, spatial navigation attention [50][51][52] and verbal fluency [53] are also particularly noted to be impaired as the disease progresses to later stages, which is particularly relevant to our sample which is more impaired. However, it is important to differentiate between the DAS Executive apathy items and executive functioning assessments, wherein the overt, observational assessments of the former and the performance-based assessment of the latter, are unlikely to fully overlap but are more likely to measure similar elements relating to demotivation towards planning, organization and attention.…”

Attention! A good bedside test for delirium?

“…As mentioned earlier, deficits in sustained attention occur in the late stages of AD, but performance on more complex attentional functions is impaired earlier in the disease 27. Some studies have used the MOTYB to distinguish stages of AD,53 54 including one small study which showed that the predictive value of the MMSE for dementia could be augmented by the addition of the MOTYB 53.…”

Barriers and Facilitators to Implementing Delirium Rounds in a Clinical Trial Across Three Diverse Hospital Settings

“…Increasing nurse tasks or responsibilities for delirium care means that they must be given the time, resources, and support from institutional leadership, including unit and executive leadership. Another solution to the time barrier is to integrate the work of detection and management as closely as possible into the current context of care and break it into manageable chunks, for instance having a nurse assess attention as part of the initial shift assessment can take as little as 30 seconds (Kolanowski et al, 2012). These solutions must be part of the usual workflow and may be more easily accepted if it does not become an additional workload issue.…”