In addition to executive functioning impairments, other cognitive difficulties may have a significant impact on behaviour. Problems with attention, information processing and memory may result in the person experiencing significant levels of confusion, distress and anxiety, potentially contributing to the development of behavioural difficulties (including irritability, agitation and aggression).
Confusion and disorientation may arise in the context of significant cognitive difficulties as described above. High levels of confusion and disorientation may result in the person experiencing the following:
- Disorientation with respect to place, their circumstances, date and time.
- Poor awareness of brain injury and its consequences.
- Decreased ability to recognise and remember the people trying to provide care and treatment.
- Poor understanding and recall of the role of carers.
- Reduced understanding of the need for care and treatment.
- Difficulties tolerating and cooperating with care and treatment procedures, potentially misattributing the procedures as threatening and/or unnecessary.
- Difficulty engaging with the rehabilitation process.
- High levels of distress, anxiety and potentially, fear.
- Concern, anxiety and confusion with respect to the wellbeing of family and friends.
- Confabulation (expression of confused beliefs reflecting confusion and disorientation) with regard to their situation.
Therefore the person experiencing such challenges may present with difficulties cooperating with care interventions, medical treatment, rehabilitation and activities of daily living. The person may try to leave the care or home environment in an attempt to return home, go to work, look after children, do the shopping etc. These situations may contribute to the expression of challenging behaviours as carers attempt to provide care and ensure the person’s safety. Provision of orientation information, names, roles, care procedures and purpose etc may help reduce confusion and anxiety thus potentially preventing challenging behaviour occurring
Confusion, discomfort, distress, anxiety and fear arising in the context of significant cognitive impairment can result in the person feeling overwhelmed and experiencing overstimulation/hypersensitivity in particular circumstances (e.g. in a noisy/busy environment). The experience of overwhelm may also occur in the context of seemingly simple requests when the person is unable to cope with the cognitive or physical demands placed upon them. Therefore the discomfort arising from this may be expressed as anxiety, anger, intolerance, distress and challenging behaviour.