All of his mental functions are affected due to dementia including higher-level cognitive, attention, memory, perception, thought, mental functions of sequencing, emotional, and experience of self and time. Due to these client factors, he is no longer independent in occupational performance.

Global mental functions are also affected as indicated by his aggressive temperament.

Roles: Our client's role as a brother/uncle are affected because he is now depending on his sister as a caregiver. He no longer has the ability to be a supportive family member because of his dementia.

Physical environment: He lives with his sister who is also caring for her grandchildren and cannot watch over him 24/7.

Mini Mental State Evaluation (MMSE): The MMSE is an appropriate screening for our client because the screening consists of 11 subtests that measure "orientation, attention and calculation, language, and immediate and delayed recall" (Schmitt, Livingston, Goette, & Galusha-Glasscock, 2016, p. 607). Our client's biggest deficit in safety and independence is due to his lack of cognition from his progressive dementia. The MMSE will allow us to target the most significant themes within the subsets that are causing these occupational barriers and greater caregiver stress. The MMSE will also be helpful in tracking any changes in his cognition.

Allen Cognitive Level Screen (ACLS): Since his disease is progressive, continue to use ACLS to screen his cognitive levels (Wesson, Clemson, Crawford, Kochan, Brodaty, & Reppermund, 2017).

Patient/Family Self-Report: Subjective report that will allow patient and/or family to express personal experience of the condition and its effects. This will also allow us to see what goals the caregiver has and how we can address all needs holistically. We will also be able to ask questions directly related to how the caregiver is doing with the burden of taking care of her brother.

Informal Observation: Unstructured method that will allow OT to formulate a hypothesis regarding the client's cognitive strengths and weaknesses in his everyday life.

Person-Environment-Occupation-Performance Model: This model focuses on occupation and performance by examining the environment (contexts, cultural/societal norms, social interactions, and social/economic systems) and client factors (physiological, psychological, neurobehavioral, cognitive, and spiritual) (Cole & Tufano, 2008).

Allen's Cognitive Levels Frame of Reference: Addresses all occupational performance areas, including ADLs, IADLs, education, work, play, leisure, and social participation, as relevant to the client by examining the client's cognition, habits and routines, physical and social contexts, as well as performing analyses of activity demands (Cole & Tufano, 2008).

LTG: Within 60 days, client will stay engaged in activities within the home to prevent anxiety and restlessness with minimal verbal cuing to limit wandering and increase safety during functional mobility.

Examples: Improvement in communication management with decreased aggression, bowel and bladder control

LTG: Within 60 days, client will independently use a visual schedule to facilitate effective communication management during daily routine.

LTG: Within 60 days, client will demonstrate increased awareness of surroundings with minimal assistance to decrease risk of harm to self and others during functional mobility.

LTG: Within 60 days, client will demonstrate effective bowel and bladder control with minimal verbal cuing and less than 3 episodes of incontinence per week to improve participation in toileting and toilet hygiene.

LTG: Within 60 days, client will initiate engagement with family with minimal assistance and no signs of aggressive behavior to enhance social participation.

Examples: Decreased risk of falls during functional mobility, minimal risk of harming self or others by increasing awareness of surroundings, limited wandering, and lowered sense of caregiver burden

Examples: Effective bowel and bladder control, increased communication, non-aggressive social participation, safe and monitored functional mobility/community mobility (decreased wandering)

Examples: Contentment with health (dementia and bowel/bladder control), sense of belonging to family (sister and her grandchildren), security within the home and safety during functional/community mobility, meaningful participation in occupations (positive social participation with family)

Examples: Increased life-satisfaction as a result of progressing toward goals, hope, self-concept (improved occupational performance leading to increased self-confidence), and health and functioning (decreased wandering, increased safety, ability to perform self-care)

Examples: Improvement in familial and societal expectations as a brother and uncle

LTG: Within 60 days, client will attend a public outing with minimal assistance and 2 or fewer signs of aggressive behavior at least 1 hr 1x/wk with sister to meet role demands as a brother through social participation with family.

Functional Independence Measure: The FIM can be used to determine how functionally independent our client is in his daily occupations. To alleviate some caregiver stress, we can work on goals that promote some independence. The FIM will address areas of occupations that are affected due to his affected cognition and memory including ADLs, IADLs, performance, etc. These will specifically address his toileting hygiene, bowel and bladder management, grooming tasks, etc. (Tanaka, Nakatsuka, Ishii, Nakayama, Hosaka, & Meguro, 2013).