21 COGNITIVEDISORDERS 535
of caring for a family member with dementia (Fung
& Chien, 2002). The client’s physician can provide in-
formation about support groups and the local chap-
ter of the National Alzheimer’s Disease Association
is listed in the phone book. Area hospitals and public
health agencies also can help caregivers to locate
community resources.
Caregivers should be able to seek and accept as-
sistance from other people or agencies. Often care-
givers think that others may not be able to provide
care as well as they do or say they will seek help
when they “really need it.” Caregivers must maintain
their own well-being and not wait until they are ex-
hausted before seeking relief. Sometimes family mem-
bers disagree about care for the client. The primary
caregiver may feel as if other family members should
volunteer to help without being asked, but other
family members feel that the primary caregiver
chose to take on the responsibility and do not feel ob-
ligated to help out regularly. Whatever the feelings
are among family members, it is important for them
all to express their feelings and ideas and participate
in caregiving according to their own expectations.
Many families need assistance to reach this type of
compromise.
Finally caregivers need support to maintain a
personal life. They need to continue to socialize with
friends and to engage in leisure activities or hobbies
rather than focus solely on the client’s care. Care-
givers who are rested, happy, and have met their
own needs are better prepared to manage the rigor-
ous demands of the caregiver role. Most caregivers
need to be reminded to take care of themselves; this
act is not selfish but really in the client’s best long-
term interests.
RELATED DISORDERS
Amnestic disordersare characterized by a distur-
bance in memory that results directly from the physi-
ologic effects of a general medical condition or the per-
sisting effects of a substance such as alcohol or other
drugs (APA, 2000). The memory disturbance is suffi-
ciently severe to cause marked impairment in social
or occupational functioning and represents a signifi-
cant decline from previous functioning. Confusion,
disorientation, and attentional deficits are common.
Clients with amnestic disorders are similar to those
with dementia in terms of memory deficits, confusion,
and problems with attention. They do not, however,
have the multiple cognitive deficits seen in dementia
such as aphasia, apraxia, agnosia, and impaired exec-
utive functions.
Several medical conditions can cause brain dam-
age and result in an amnestic disorder—for example,
stroke or other cerebrovascular events, head injury,
and neurotoxic exposures such as carbon monoxide
poisoning, chronic alcohol ingestion, and vitamin B 12
or thiamine deficiency. Alcohol-induced amnestic dis-
order results from a chronic thiamine or vitamin B
deficiency called Korsakoff’s syndrome.
The main difference between dementia and
amnestic disorders is that once the underlying med-
ical cause is treated or removed, the client’s condition
no longer deteriorates. Treatment of amnestic dis-
orders focuses on eliminating the underlying cause
and rehabilitating the client and includes prevent-
ing further medical problems. Some amnestic dis-
orders improve over time when the underlying cause
is stabilized. Other clients have persistent impairment
of memory and attention with minimal improvement;
this can occur in cases of chronic alcohol ingestion or
malnutrition. Nursing diagnoses and interventions
are similar to those used when dealing with the mem-
ory loss, confusion, and impaired attention abilities
of clients with dementia or delirium (see the display
on nursing interventions for dementia).SELF-AWARENESS ISSUES
Working with and caring for clients with
dementia can be exhausting and frustrating for both
nurse and caregiver. Teaching is a fundamental role
for nurses, but teaching clients who have dementia
can be especially challenging and frustrating. These
clients do not retain explanations or instructions, so
the nurse must repeat the same things continually.
The nurse must be careful not to lose patience and
not to give up on these clients. The nurse may begin
to feel that repeating instructions or explanations
does no good because clients do not understand or
remember them. Discussing these frustrations with
others can help the nurse to avoid conveying negative
feelings to clients and families or experiencing pro-
fessional and personal burnout.
The nurse may get little or no positive response
or feedback from clients with dementia. It can be dif-
ficult to deal with feelings about caring for people
who will never “get better and go home.” As dementia
progresses, clients may seem not to hear or respond
to anything the nurse does. It is sad and frustrating
for the nurse to see clients decline and eventually lose
their abilities to manage basic self-care activities and
interaction with others. Remaining positive and sup-
portive to clients and family can be difficult when the
outcome is so bleak. In addition, the progressive de-
cline may last months or years, which adds to the
frustration and sadness. The nurse may need to deal
with personal feelings of depression and grief as the