In reading articles about dementia (or major neurocognitive disorder, as it is also called), reference is often made to “cognitive domains”. In fact, in order for a diagnosis of dementia to be made (as per the American Psychiatric Association 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders), there must be evidence of a significant cognitive decline from the previous level of function in at least one cognitive domain. The decline must be severe enough to interfere with the person’s activities of daily living. Preferably the decline will be documented by standardized neuropsychological testing or another quantified clinical assessment. So what are these “cognitive domains”?

In short, they are

  • Complex attention
  • Executive function
  • Learning and Memory
  • Language
  • Perceptual-motor
  • Social cognition

Below is a brief description of the abilities that are included in each of the domains, as well as an example of the type of dementia that typically has losses in the domain. It is important to be aware of which cognitive domains are affected because we want to support the losses and capitalize on the areas that are less affected, or not affected at all. When choosing activities for the person, it is important to be aware of the abilities affected by the type of dementia and choose accordingly. In Alzheimer's disease, for example, the learning and memory domain is affected, so an activity that requires the person to remember something that was just presented to them would not be appropriate (a game such as "Concentration", for example).

Complex Attention

Abilities Affected:

Maintain attention, divide attention across multiple stimuli and the speed that information is processed

Losses prevalent in:

Vascular Dementia

Executive Function

Abilities Affected:

Plan, organize and complete tasks and projects, make decisions, respond to feedback

Losses prevalent in:

Vascular Dementia

Learning and Memory

Abilities Affected:

Acquiring, manipulating and remembering items, facts, events, people, procedures, skills

Losses prevalent in:

Alzheimer’s Disease

Language

Abilities Affected:

Naming objects, word finding, fluency, grammar and syntax, and receptive language (the ability to understand language heard or read)

Losses prevalent in:

Frontotemporal – Language Variant, Vascular Dementia

Perceptual-Motor

Abilities Affected:

Identification and manipulation of figures, maps and items; motor tasks and gestures, recognition of faces and hand-eye coordination

Losses prevalent in:

Lewy Body Dementia

Social Cognition

Abilities Affected:

Socially appropriate behaviours and decision making, empathy and recognition of emotions

Losses prevalent in:

Frontotemporal – Behavioral Variant