Dementia – Depression - Dementia – Depression - DeliriumDelirium

Understand the relationship, Recognize the signs and Understand the relationship, Recognize the signs and symptomssymptoms

Dementia Care Training Centre - 2007Dementia Care Training Centre - 2007

1.1. Dementia Care Training CentreDementia Care Training Centre

2.2. Guiding principlesGuiding principles

3.3. Sharing our storySharing our story

4.4. OutcomesOutcomes

5.5. Lessons learnedLessons learned

No More Business as UsualNo More Business as Usual

A core business of Alzheimer Society of A core business of Alzheimer Society of CalgaryCalgary

Includes staff training and family educationIncludes staff training and family education

Guiding PrinciplesGuiding Principles

Person-centred Person-centred

Outcomes driven Outcomes driven

Supporting Excellence in Dementia CareSupporting Excellence in Dementia Care

Dementia Care Training CentreDementia Care Training Centre

More than 10,000 people diagnosed with More than 10,000 people diagnosed with Alzheimer’s disease Alzheimer’s disease

Limited recognition of delirium among Limited recognition of delirium among direct care providers direct care providers

Cognitive Impairment StrategyCognitive Impairment Strategy

National Guidelines for Seniors Mental National Guidelines for Seniors Mental HealthHealth

What was happening in CalgaryWhat was happening in Calgary

““No one in a better position than the Alzheimer No one in a better position than the Alzheimer Society to educate staff and families about the Society to educate staff and families about the

importance of delirium”importance of delirium”

““Staff need to recognize the symptoms, who and Staff need to recognize the symptoms, who and how to report what they see”how to report what they see”

AlzheimerAlzheimer Society ResponsibilitySociety Responsibility

Sharing Our StorySharing Our Story

Workshop Learning ObjectivesWorkshop Learning Objectives

To understand the terms To understand the terms dementiadementia, , depression depression && delirium delirium

To recognize the signs and symptoms of dementia, To recognize the signs and symptoms of dementia, depression and deliriumdepression and delirium

To appreciate the difficulty of co-existence and To appreciate the difficulty of co-existence and interrelations of the dementia, depression, deliriuminterrelations of the dementia, depression, delirium

To understand the diagnostic processTo understand the diagnostic process

To appreciate a person-centred approach to careTo appreciate a person-centred approach to care

Workshop OutlineWorkshop Outline

The Marvellous Healthy BrainThe Marvellous Healthy Brain

Causes of Cognitive ImpairmentCauses of Cognitive Impairment

Functions & Damages of the BrainFunctions & Damages of the Brain

Irreversible Types of DementiaIrreversible Types of Dementia

Reversible Causes of DementiaReversible Causes of Dementia

Depression & DeliriumDepression & Delirium

Understanding the DistinctionsUnderstanding the Distinctions

The Diagnostic ProcessThe Diagnostic Process

Person-Centered CarePerson-Centered Care

The Healthy Brain - IntroductionThe Healthy Brain - Introduction

The brain weighs approx. 3 lbs. – 7 cups

Structural & Functional Organization

The brain consists of brain cells (neurons) that connect to each other through their axons, dendrites and synaptic connections.

Neural networks: 1012 (100 billion) neurons has on average 7k-10k connections (total 1000 trillion).

another SENSATIONal fact:

“the little man” Homunculus

Causes of Cognitive ImpairmentCauses of Cognitive Impairment

developmental disabilitiesdevelopmental disabilitiesbrain injurybrain injury

mild cognitive impairmentmild cognitive impairmentdementiadementia

What is Dementia?What is Dementia?

Areas of the BrainAreas of the BrainStructure &Structure & FunctionsFunctions

Limbic System

Non-Reversible Types of DementiaNon-Reversible Types of Dementia

Alzheimer’s diseaseAlzheimer’s disease

Vascular DementiaVascular Dementia

Dementia with Lewy Dementia with Lewy bodiesbodies

FrontoFronto-Temporal Dementia-Temporal Dementia

Others:Others:

Parkinson’s DiseaseParkinson’s Disease

Huntington’s Huntington’s DiseaseDisease

Creutzfeldt Jakob Creutzfeldt Jakob DiseaseDisease

Progressive Progressive Supranuclear PalsySupranuclear Palsy

Korsakoff’s Korsakoff’s SyndromeSyndrome

Infection-Related Infection-Related Dementia (HIV, Dementia (HIV, Syphilis)Syphilis)

Reversible Causes of DementiaReversible Causes of Dementia

MalnutritionMalnutrition

DehydrationDehydration

Metabolic DysfunctionMetabolic Dysfunction

Vitamin B12 DeficiencyVitamin B12 Deficiency

DepressionDepression

DeliriumDelirium

DepressionDepressionSigns & Symptoms:Signs & Symptoms:

Sad or depressed most of the time (mood) Sad or depressed most of the time (mood) “emptiness”“emptiness”

Feelings of anxiety (various forms) and Feelings of anxiety (various forms) and psychomotor agitationpsychomotor agitation

Changing appetite and weight loss/gainChanging appetite and weight loss/gain

Sleep DisturbancesSleep Disturbances

Loss of interest/Lack of motivationLoss of interest/Lack of motivation

Concentration or Memory problemsConcentration or Memory problems

Social WithdrawalSocial Withdrawal

Thoughts of death/Suicidal RiskThoughts of death/Suicidal Risk

Depression in the Elder PopulationDepression in the Elder PopulationCommon atypical features :Common atypical features :

Psychotic features (paranoid Psychotic features (paranoid delusions)delusions)

SomatizationSomatization

The “dwindles” (*)The “dwindles” (*)

Potential Issues:Potential Issues:

Suicide risk is highSuicide risk is high

Depression is an unusual sole Depression is an unusual sole cause of cognitive impairmentcause of cognitive impairment

Depression often co-exists with Depression often co-exists with dementiadementia

Vincent van Gogh, who himself suffered from depression and committed suicide, painted this picture in 1890 of a man that can symbolize the desperation and hopelessness felt in depression.

Delirium Delirium – – Core Features (DSM-IV)Core Features (DSM-IV)

Disturbance in consciousnessDisturbance in consciousness (i.e., reduced (i.e., reduced clarity of awareness of the environment) with clarity of awareness of the environment) with reduced ability to focus, sustain, or shift attention;reduced ability to focus, sustain, or shift attention;

A change in cognitionA change in cognition (i.e., memory deficit, (i.e., memory deficit, disorientation, language disturbance) or the disorientation, language disturbance) or the development of a perceptual disturbance that is not development of a perceptual disturbance that is not better accounted for by a preexisting, established, better accounted for by a preexisting, established, or evolving dementia; andor evolving dementia; and

The disturbance develops over a short period of The disturbance develops over a short period of timetime (usually hours to days) and tends to fluctuate (usually hours to days) and tends to fluctuate during the course of the day.during the course of the day.

Delirium can occur as a consequence ofDelirium can occur as a consequence of

A general medical conditionA general medical conditionSubstance intoxicationSubstance intoxicationSubstance withdrawalSubstance withdrawalMultiple causesMultiple causes

Often arises as an interplay of predisposing and Often arises as an interplay of predisposing and precipitating factors.precipitating factors.

Furthermore:Furthermore:

In general, the greater the vulnerability of the person, the In general, the greater the vulnerability of the person, the higher the likelihood of delirium occurring.higher the likelihood of delirium occurring.

It is not always possible to firmly establish the specific It is not always possible to firmly establish the specific etiology of the delirium in an older person.etiology of the delirium in an older person.

Comparison of the Clinical FeaturesComparison of the Clinical Features

DementiaDementia DepressionDepression DeliriumDelirium

Insidious/slow and Insidious/slow and often unrecognized; often unrecognized; depends on causedepends on cause

Coincides with major Coincides with major life changes; often life changes; often abrupt, but can be abrupt, but can be

gradualgradual

Sudden/abrupt; Sudden/abrupt; depends on cause; depends on cause; often at twilight or in often at twilight or in

darknessdarkness

Clinical Features:Clinical Features: ONSET ONSET

COURSE, PROGRESSION, ATTENTION, MEMORY, THINKING

Principles of Person Centred CarePrinciples of Person Centred Care

UniquenessUniqueness

ComplexityComplexity

EnablingEnabling

PersonhoodPersonhood

Value of othersValue of others

OutcomesOutcomes

40 people trained 40 people trained

3 workshops to date3 workshops to date

Participants: acute care, long-term care, Participants: acute care, long-term care, developmental disabilities, adult day developmental disabilities, adult day support, independent seniors residences, support, independent seniors residences, seniors community resources, Calgary and seniors community resources, Calgary and Edmonton health region Edmonton health region

I have an understanding of the term dementia…(N=15)

0%

6%

0%

69%

25%

0% 0% 0%

33%

67%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Strongly Disagree Disagree No Opinion - Neutral Agree Strongly Agree

Agreement

PRIOR

AFTER

I understand the various consequences of dementia…(N=15)

0%

6%

13%

63%

19%

0% 0% 0%

40%

60%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Strongly Disagree Disagree No Opinion - Neutral Agree Strongly Agree

Agreement

PRIOR

AFTER

I understand the relationship between dementia, depression and dleirium…(N=15)

7%

27%

13%

40%

13%

0% 0% 0%

60%

40%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Strongly Disagree Disagree No Opinion - Neutral Agree Strongly Agree

Agreement

PRIOR

AFTER

Lessons LearnedLessons Learned

Direct care providers across the care continuum Direct care providers across the care continuum recognize their need to learn more about recognize their need to learn more about dementia, depression and delirium and reporting dementia, depression and delirium and reporting requirementsrequirements

Family members are beginning to recognize the Family members are beginning to recognize the importance of understanding the relationship importance of understanding the relationship between dementia, depression and deliriumbetween dementia, depression and delirium

The Alzheimer Society plays a key role in The Alzheimer Society plays a key role in educating and supporting staff and families educating and supporting staff and families about deliriumabout delirium

Thank you!Thank you!

If you have any questions or comments,If you have any questions or comments,

please contact us atplease contact us at

Telephone: 290-0110Telephone: 290-0110

Email: info@alzheimercalgary.comEmail: info@alzheimercalgary.com

or have a look at our website:or have a look at our website:

www. AlzheimerCalgary.comwww. AlzheimerCalgary.com