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Different Strokes for Different Strokes for Different Folks: Different Folks: Variable Approaches to Variable Approaches to Different Forms of Different Forms of DementiaDementia
Julie Feil, MSW, LCSWJulie Feil, MSW, LCSW
The Memory Center The Memory Center
Affinity Health SystemAffinity Health System
The Goals of The The Goals of The Memory CenterMemory Center We see individuals of all ages We see individuals of all ages
with all forms of memory loss in with all forms of memory loss in various stages.various stages.
To identify and provide treatment To identify and provide treatment options for those with memory options for those with memory disordersdisorders
To advocate for early detection!To advocate for early detection!
Why is the Diagnosis Why is the Diagnosis Important?Important?
It allows us to identify what form of memory It allows us to identify what form of memory problem we are dealing with. This results problem we are dealing with. This results in:in:
More focused education and support- More focused education and support- appropriate to family and individualappropriate to family and individual
More accurate and effective More accurate and effective pharmaceutical treatment modality choicepharmaceutical treatment modality choice
Increased awareness for families and Increased awareness for families and individualindividual
Rule out treatable causes of dementiaRule out treatable causes of dementia
It is like Stopping a It is like Stopping a Rolling Truck!Rolling Truck!
Barriers to Obtaining a Barriers to Obtaining a DiagnosisDiagnosis
Belief that it is “Just normal aging”Belief that it is “Just normal aging” Stigma attached to “Alzheimer’s Stigma attached to “Alzheimer’s
Disease”Disease” FearFear Lack of Insight into ProblemLack of Insight into Problem DenialDenial EmbarrassmentEmbarrassment
Determining the Determining the DiagnosisDiagnosis
Appointment includes:Appointment includes: The Neurological or Medical The Neurological or Medical
ExaminationExamination The Neuropsychological The Neuropsychological
TestingTesting The Psychosocial EvaluationThe Psychosocial Evaluation
Possible Diagnosis’Possible Diagnosis’
Alzheimer’s Disease Alzheimer’s Disease Mild Cognitive ImpairmentMild Cognitive Impairment Probable Lewy Body DementiaProbable Lewy Body Dementia Vascular DementiaVascular Dementia Frontotemporal DementiaFrontotemporal Dementia Normal Pressure HydrocephelusNormal Pressure Hydrocephelus Sleep ApneaSleep Apnea Pseudodementia- DepressionPseudodementia- Depression EpilepsyEpilepsy Parkinson’s Disease PlusParkinson’s Disease Plus Alcohol Related DementiaAlcohol Related Dementia
Imaging StudiesImaging Studies
Extremely helpful tool in diagnosing which Extremely helpful tool in diagnosing which particular type of memory disorder is likely particular type of memory disorder is likely present. A trained physician can now identify present. A trained physician can now identify classic Alzheimer’s Disease with 98% classic Alzheimer’s Disease with 98% certainty.certainty.
Alzheimer’s Disease Alzheimer’s Disease
What is Alzheimer’s What is Alzheimer’s Disease?Disease? The most common cause of dementiaThe most common cause of dementia Irreversible, progressive diseaseIrreversible, progressive disease Affects the brain by destroying neurons – Affects the brain by destroying neurons –
first in the hippocampus (memory area of first in the hippocampus (memory area of the brain) then spreading to other areasthe brain) then spreading to other areas
Neuron degeneration is felt to be from Neuron degeneration is felt to be from plaques consisting of beta amyloid plaques consisting of beta amyloid proteins that are deposited and tangles proteins that are deposited and tangles in nerve cellsin nerve cells
Is it in the Water?Is it in the Water?
““Why are so many Why are so many people ‘getting it’ “ is people ‘getting it’ “ is a common question.a common question.
We do not know the We do not know the exact cause nor do we exact cause nor do we have a cure. Latest have a cure. Latest research is focusing research is focusing on diet and lipids.on diet and lipids.
This is a disease that, This is a disease that, predominantly affects predominantly affects those > 65. those > 65.
As we are living As we are living longer, the prevalence longer, the prevalence is thus higher.is thus higher.
Neuropsychological Neuropsychological TestingTesting Following testing, individuals with Following testing, individuals with
MCI show an isolated memory MCI show an isolated memory loss. Those with Alzheimer’s loss. Those with Alzheimer’s Disease show a pattern of Disease show a pattern of increased difficulty with memory, increased difficulty with memory, categorical fluency, orientation, categorical fluency, orientation, and emerging problems in and emerging problems in construction and calculations.construction and calculations.
ExerciseExercise
Name as many animals as you can in 1 Name as many animals as you can in 1 minuteminute
Measures catagorical fluencyMeasures catagorical fluency Individuals with some form of progressive Individuals with some form of progressive
memory disorder will score less than 12 memory disorder will score less than 12 and should be evaluated. and should be evaluated.
A better predictor of Alzheimer’s disease A better predictor of Alzheimer’s disease or MCI than the Mini Mental and can easily or MCI than the Mini Mental and can easily be used quickly as a screen in doctor’s be used quickly as a screen in doctor’s officesoffices
Mild Cognitive Mild Cognitive ImpairmentImpairment Being researched as a likely “pre-Being researched as a likely “pre-
cursor” to Alzheimer’s Disease- cursor” to Alzheimer’s Disease- consists of mild memory loss that consists of mild memory loss that appears progressive in natureappears progressive in nature
It is crucial that these individuals are It is crucial that these individuals are assessed as early preventative assessed as early preventative interventions are showing promise in interventions are showing promise in delaying the onset or “conversion” delaying the onset or “conversion” to Alzheimer’s Disease!to Alzheimer’s Disease!
Assessment QuestionsAssessment Questions
Short term memory loss?Short term memory loss? Financial managementFinancial management Repetitive questions?Repetitive questions? Depression? Anxiety?Depression? Anxiety? Misplacing items or Misplacing items or
hiding items?hiding items? Orientation to person, Orientation to person,
place and timeplace and time Change in ability to Change in ability to
perform hobbies or perform hobbies or household tasks?household tasks?
Occupational issues?Occupational issues?
Depression ScreenDepression Screen
It is also important to address depression It is also important to address depression using a depression screening tool such using a depression screening tool such as the Geriatric Depression Scale or as the Geriatric Depression Scale or Beck Depression Inventory. Beck Depression Inventory.
Why?Why? Studies suggest between 20 and Studies suggest between 20 and 30% of dementia patients in early 30% of dementia patients in early stages develop Major Depressive stages develop Major Depressive Disorder and between 30-40% in Disorder and between 30-40% in middle stages. Not uncommon, middle stages. Not uncommon, depressive symptoms need to be depressive symptoms need to be monitored closely on a frequent basis monitored closely on a frequent basis and treated appropriately.and treated appropriately.
Characteristics - EarlyCharacteristics - Early
Short term memory loss Short term memory loss and asking questions and asking questions repeatedly are often the repeatedly are often the first signsfirst signs
Inability to complete Inability to complete familiar tasks familiar tasks
Difficulty learning and Difficulty learning and retaining new retaining new informationinformation
Misplacing items, often Misplacing items, often in inappropriate placesin inappropriate places
A growing awareness of A growing awareness of subtle changes may subtle changes may cause depression and cause depression and frustration.frustration.
ModerateModerate
Forgetting to turn off Forgetting to turn off stoves, appliancesstoves, appliances
Emerging safety Emerging safety concernsconcerns
Problems with Problems with calculations and calculations and financial managementfinancial management
Inappropriate in publicInappropriate in public More problems More problems
communicating, communicating, reading, writingreading, writing
SevereSevere
Severe loss of memorySevere loss of memory May be unable to recognize loved May be unable to recognize loved
onesones More hallucinations or delusionsMore hallucinations or delusions Void of emotionVoid of emotion Needs assistance with all personal Needs assistance with all personal
carescares Difficulty chewing or swallowing.Difficulty chewing or swallowing.
TreatmentsTreatments
Cholinesterase Inhibitors are being used Cholinesterase Inhibitors are being used to slow the progression with good to slow the progression with good success:success:– AriceptAricept– RazadyneRazadyne– ExelonExelon
Other medication often used in conjunction Other medication often used in conjunction with cholinesterase inhibitors (NMDA with cholinesterase inhibitors (NMDA receptor antagonist)receptor antagonist)
– NamendaNamenda
Key Psychosocial Key Psychosocial IssuesIssuesIndividuals and families Individuals and families
coping with Alzheimer’s coping with Alzheimer’s Disease require ongoing Disease require ongoing support as the disease support as the disease progresses.progresses.
A referral to the local A referral to the local Alzheimer’s Association is Alzheimer’s Association is recommended for recommended for ongoing needsongoing needs
Although there is “staging” Although there is “staging” documented and many documented and many follow the pattern loosely, follow the pattern loosely, everyone has a unique, everyone has a unique, individual experience.individual experience.
Supportive Supportive ApproachesApproaches
Care partners have various Care partners have various thresholds in terms of their thresholds in terms of their ability to manage the care ability to manage the care of someone with progressive of someone with progressive Alzheimer’s Disease.Alzheimer’s Disease.
Goal is to tackle each Goal is to tackle each symptom as it emerges and symptom as it emerges and seek manageable solutionsseek manageable solutions
Behavior issues are often Behavior issues are often signs of unmet, signs of unmet, unexpressed needs.unexpressed needs.
Important to increase Important to increase activity level and provide activity level and provide cognitive “exercise” as well cognitive “exercise” as well as physical and social as physical and social activity.activity.
The Alzheimer’s The Alzheimer’s AssociationAssociation Excellent organization for all Excellent organization for all
types of memory disorderstypes of memory disorders Provide support, education, Provide support, education,
advocacy and programming advocacy and programming encompassing all aspects of the encompassing all aspects of the disease to individuals and their disease to individuals and their care partners.care partners.
Other Resources for Other Resources for Individuals and Care Individuals and Care Partners Partners Adult Day CentersAdult Day Centers Home health agenciesHome health agencies Respite careRespite care Transportation resourcesTransportation resources Care consultantsCare consultants Assisted living optionsAssisted living options County Departments on Aging / Benefit County Departments on Aging / Benefit
SpecialistsSpecialists Aging and Disability Resource CentersAging and Disability Resource Centers Elder Law AttorneyElder Law Attorney
Support Groups Support Groups
Support groups are very valuable Support groups are very valuable and take many forms. Groups exist and take many forms. Groups exist for:for:– MCI patientsMCI patients– Early onset Alzheimer’s diseaseEarly onset Alzheimer’s disease– Care partners (spouses, family, etc)Care partners (spouses, family, etc)– Adult Children of people with Adult Children of people with
Alzheimer’s DiseaseAlzheimer’s Disease– Early stage Alzheimer’s DiseaseEarly stage Alzheimer’s Disease
Key ResourcesKey Resources
Books and Magazines:Books and Magazines:– The 36 Hour DayThe 36 Hour Day – Mace and Rabins – Mace and Rabins– A Dignified Life: The Best Friend’s A Dignified Life: The Best Friend’s
Approach to Alzheimer’s CareApproach to Alzheimer’s Care – Bell and – Bell and TroxelTroxel
– ReminiscenceReminiscence magazine (Reiman Public.) magazine (Reiman Public.)– Aging with GraceAging with Grace - Snowdon - Snowdon– Learning to Speak Alzheimer’sLearning to Speak Alzheimer’s - Coste - Coste– Mayo Clinic on Alzheimer’s DiseaseMayo Clinic on Alzheimer’s Disease - -
PetersonPeterson
Resources continued:Resources continued:
Websites:Websites:– www.alz.orgwww.alz.org – The Alzheimer’s Assoc. – The Alzheimer’s Assoc.– www.alzheimers.orgwww.alzheimers.org - Alzheimer’s Disease - Alzheimer’s Disease
Education and Referral CenterEducation and Referral Center– www.alzstore.comwww.alzstore.com – The Alzheimer’s Store – The Alzheimer’s Store– www.cwag.orgwww.cwag.org – Coalition of WI Aging Groups – Coalition of WI Aging Groups– www.dhfs.state.wi.us/aging/dementiawww.dhfs.state.wi.us/aging/dementia - WI - WI
Bureau of Aging & Long Term Care ResourcesBureau of Aging & Long Term Care Resources– www.mayoclinic.comwww.mayoclinic.com – Mayo Clinic Health Info – Mayo Clinic Health Info
Lewy Body DementiaLewy Body Dementia
Lewy Body DementiaLewy Body Dementia
A progressive brain disease and second A progressive brain disease and second leading cause of dementia in elderly. (20% of leading cause of dementia in elderly. (20% of all dementia cases)all dementia cases)
Appears to affect men more than womenAppears to affect men more than women Consists of protein deposits or “lewy bodies” Consists of protein deposits or “lewy bodies”
that are widespread throughout the brain. that are widespread throughout the brain. Often the memory area looks fine on Often the memory area looks fine on imaging.imaging.
Cognitive decline occurs prior to or Cognitive decline occurs prior to or concurrent with parkinsonian featuresconcurrent with parkinsonian features
Earlier age of onset than Alzheimer’sEarlier age of onset than Alzheimer’s
CharacteristicsCharacteristics
A probable Lewy Body Disease is A probable Lewy Body Disease is defined when one meets 2 out of defined when one meets 2 out of the 3 symptoms:the 3 symptoms:– Fluctuating Cognition with clear Fluctuating Cognition with clear
variations in alertness.variations in alertness.– Recurrent visual hallucinations that Recurrent visual hallucinations that
are very detailedare very detailed– Parkinsonism – muscle stiffness and Parkinsonism – muscle stiffness and
rigid, slowed movementsrigid, slowed movements
Other Suggestive Other Suggestive FeaturesFeatures
REM sleep disorders – vivid dreams, REM sleep disorders – vivid dreams, purposeful and sometimes violent purposeful and sometimes violent movementsmovements
Severe sensitivity to neuroleptics Severe sensitivity to neuroleptics (medications for psychiatric (medications for psychiatric symptoms)symptoms)
Abnormal depth perception – problems Abnormal depth perception – problems in visuospatial skillsin visuospatial skills
Mood lability, depression, aggressionMood lability, depression, aggression
Neuropsychological Neuropsychological TestingTesting Individuals with LBD have Individuals with LBD have
difficulty in the following areas of difficulty in the following areas of cognitive thinking:cognitive thinking:– OrientationOrientation– ConstructionConstruction– PerceptionPerception– MemoryMemory
Hooper Visual Hooper Visual Organization TestOrganization Test
30 “puzzle” pictures30 “puzzle” pictures Indicator of visuospatial skills and Indicator of visuospatial skills and
posterior functioning.posterior functioning. Shows how we perceive and make Shows how we perceive and make
sense of the world around us.sense of the world around us. Often a good predictor of whether or Often a good predictor of whether or
not someone should be retested for not someone should be retested for driving abilities.driving abilities.
Hooper Visual Hooper Visual Organization ExampleOrganization Example
Answer:Answer:
LIGHTHOUSELIGHTHOUSE
Clock Draw ExampleClock Draw Example
Goal- To draw the face of a clock, put Goal- To draw the face of a clock, put the numbers in the correct positions, the numbers in the correct positions, and indicate the time at 11:10.and indicate the time at 11:10.
Key Psychosocial Key Psychosocial IssuesIssuesFamilies and affected person Families and affected person
may be dealing early on with may be dealing early on with safety issues involving the safety issues involving the physical issues, physical issues, hallucinations, and hallucinations, and misperceptions (often leading misperceptions (often leading to trouble with driving).to trouble with driving).
Also, the inconsistency of Also, the inconsistency of symptoms and confusion, symptoms and confusion, creates stress as the family creates stress as the family never quite knows what is never quite knows what is coming next.coming next.
Loved one may not recognize Loved one may not recognize family or home at an earlier family or home at an earlier stage.stage.
Assessment QuestionsAssessment Questions
Sleep disturbance?Sleep disturbance? Gait disturbance / Falls?Gait disturbance / Falls? Appears socially withdrawn at Appears socially withdrawn at
timestimes Variable symptoms?Variable symptoms? Hallucinations?Hallucinations? Disorientation?Disorientation? Suspiciousness?Suspiciousness? Wandering?Wandering? Apparent slowed processing Apparent slowed processing
verbally and physicallyverbally and physically Other behavior problems or Other behavior problems or
aggression?aggression?
Supportive Supportive ApproachesApproaches Families struggle with Families struggle with
misperceptions- benefit misperceptions- benefit from support of others in from support of others in same situation (support same situation (support groups). Care partners groups). Care partners need respite!need respite!
Often occurs at a younger Often occurs at a younger age- grieve loss of age- grieve loss of retirement plans, etc.retirement plans, etc.
Individual often very Individual often very insecure without loved oneinsecure without loved one
More rapid course than ADMore rapid course than AD Physical and Physical and
communication issues in communication issues in addition to cognitiveaddition to cognitive
Common InterventionsCommon Interventions
Due to Parkinsonism, individual is at a higher Due to Parkinsonism, individual is at a higher fall risk. Need to adapt environment and fall risk. Need to adapt environment and consider a Physical therapy evaluation consider a Physical therapy evaluation
Misperceptions! Eg. May perceive that a black Misperceptions! Eg. May perceive that a black rug is a hole, or texture change represents a rug is a hole, or texture change represents a different height/level. Occupational therapist different height/level. Occupational therapist evaluation, adjusting home environment, evaluation, adjusting home environment, adjusting lighting and visual cuesadjusting lighting and visual cues
Wandering Risk – easily disorientated- Obtain Wandering Risk – easily disorientated- Obtain Safe ReturnSafe Return
Driving Issues – becomes lost or does not Driving Issues – becomes lost or does not recognize once familiar landmarks. Driver recognize once familiar landmarks. Driver evaluation and subsequent referral to evaluation and subsequent referral to transportation resources suggestedtransportation resources suggested
Treatments for LBDTreatments for LBD
Cholinesterase inhibitors (medications Cholinesterase inhibitors (medications approved for Alzheimer’s Disease) tend to approved for Alzheimer’s Disease) tend to work even better for people with LBDwork even better for people with LBD
Parkinson’s Disease medications often Parkinson’s Disease medications often help with the symptoms related to help with the symptoms related to movementmovement
It is important to diagnose LBD as some It is important to diagnose LBD as some antipsychotic medications given for antipsychotic medications given for hallucinations can cause severe reactions hallucinations can cause severe reactions in patients with this disease. (eg. Haldol)in patients with this disease. (eg. Haldol)
Key ResourcesKey Resources
The Alzheimer’s AssociationThe Alzheimer’s Association The Lewy Body Dementia The Lewy Body Dementia
AssociationAssociation Websites:Websites:
– www.lewybodydementia.orgwww.lewybodydementia.org LBD LBD Assoc.Assoc.
– www.zarcrom.com/users/alzheimers/owww.zarcrom.com/users/alzheimers/odem/od-d.htmldem/od-d.html Directory of other Dementias Directory of other Dementias
– www.alz.orgwww.alz.org – The Alzheimer’s Assoc. – The Alzheimer’s Assoc.
The Frontotemporal The Frontotemporal DementiasDementias
Frontotemporal Frontotemporal DementiasDementias Neurodegenerative changes in the Neurodegenerative changes in the
frontal and temporal lobes of the brainfrontal and temporal lobes of the brain Several types depending on which areas Several types depending on which areas
show damage – eg. Picks disease show damage – eg. Picks disease (involves only frontal lobes)(involves only frontal lobes)
Occurs between the ages of 35 and 75 Occurs between the ages of 35 and 75 years (younger than AD and LBD) Some years (younger than AD and LBD) Some forms are genetic.forms are genetic.
Many early research programs are Many early research programs are focusing on the frontotemporal focusing on the frontotemporal dementias and “possible” reversible dementias and “possible” reversible causes causes
CharacteristicsCharacteristics
There is generally an early loss of personal There is generally an early loss of personal awareness and sometimes an increase in awareness and sometimes an increase in social disinhibition and mood swings.social disinhibition and mood swings.
Depression is commonDepression is commonOften diagnosed at an earlier age, therefore Often diagnosed at an earlier age, therefore
occupational problems may exist.occupational problems may exist. Family members are usually quite Family members are usually quite
frustrated and require special counseling frustrated and require special counseling or supportor support
More rapid progressionMore rapid progression
The Frontal Lobe - the The Frontal Lobe - the GatekeeperGatekeeper People who suffer People who suffer
from the FTDs may from the FTDs may exhibit inappropriate exhibit inappropriate behaviors in public, behaviors in public, be less inhibited, may be less inhibited, may show mood swings, show mood swings, or may become quite or may become quite the opposite- more the opposite- more depressed, apathetic depressed, apathetic and socially and socially withdrawn.withdrawn.
Neuropsychological Neuropsychological TestingTesting Frontal area involves the “doing” Frontal area involves the “doing”
part of the brain- executive part of the brain- executive functioning thus testing shows functioning thus testing shows difficulties in the areas of:difficulties in the areas of:– BehaviorBehavior– Reasoning and JudgmentReasoning and Judgment– Planning Planning – InitiationInitiation
Neuropsychological Neuropsychological testing continued…testing continued… Temporal Area involves speech Temporal Area involves speech
and language thus testing reveals and language thus testing reveals difficulty withdifficulty with– NamingNaming– ComprehensionComprehension– Word findingWord finding– Speech (aphasia often noted)Speech (aphasia often noted)
Example – Boston Example – Boston Naming TestNaming Test
Key Psychosocial Key Psychosocial IssuesIssues Loss of Insight: Often people Loss of Insight: Often people
with frontotemporal with frontotemporal dementias do not have dementias do not have insight into their difficulties. insight into their difficulties. This makes it more This makes it more challenging for families to challenging for families to provide care and that care is provide care and that care is occasionally met with occasionally met with resistanceresistance
Compulsive behaviorsCompulsive behaviors Lack of empathy for others- Lack of empathy for others-
Often the care partner Often the care partner desires an acknowledgement desires an acknowledgement for their hard work that never for their hard work that never comes.comes.
Assessment QuestionsAssessment Questions
Judgment and InsightJudgment and Insight Decision making, impulsivityDecision making, impulsivity Mood changes – depression, Mood changes – depression,
apathyapathy Alteration in planning and Alteration in planning and
initiationinitiation Susceptible to sweepstakesSusceptible to sweepstakes Compulsive behaviorsCompulsive behaviors Speech and language issuesSpeech and language issues Socially or sexually Socially or sexually
inappropriatenessinappropriateness Work related problemsWork related problems
Supportive Supportive ApproachesApproaches Often the disinhibition and behavior changes Often the disinhibition and behavior changes
combined with the lack of insight put care combined with the lack of insight put care partners in very difficult situations. Families partners in very difficult situations. Families benefit greatly by connecting with others.benefit greatly by connecting with others.
Examine behaviors and look at underlying Examine behaviors and look at underlying needs that are unexpressed or the emotions needs that are unexpressed or the emotions behind the behaviors. Document approaches behind the behaviors. Document approaches and redirections that work.and redirections that work.
Compulsive behaviors can be draining on Compulsive behaviors can be draining on loved ones. loved ones.
Need to choose battles wisely!Need to choose battles wisely!
CommunicationCommunication
As the temporal lobes As the temporal lobes become damaged, become damaged, one will often will see one will often will see changes in ability to changes in ability to express self and express self and converse with others. converse with others.
A referral to a speech A referral to a speech therapist and therapist and communication books communication books may be helpfulmay be helpful
TreatmentsTreatments
The cholinesterase inhibitors The cholinesterase inhibitors (Alzheimer’s medications) work in (Alzheimer’s medications) work in approximately 1 in 3 patients with approximately 1 in 3 patients with FTD. We are not sure why.FTD. We are not sure why.
SSRIs or specific anti-depressants are SSRIs or specific anti-depressants are being investigated as chemically being investigated as chemically beneficial and also help control beneficial and also help control behavior symptoms and behavior symptoms and accompanying depressionaccompanying depression
Key ResourcesKey Resources
Books:Books:– The 36 Hour DayThe 36 Hour Day – Mace and Rabins – Mace and Rabins– What if it’s Not Alzheimer’s? A What if it’s Not Alzheimer’s? A
Caregiver’s Guide to DementiaCaregiver’s Guide to Dementia – – Radin and RadinRadin and Radin
– Websites:Websites: www.alz.orgwww.alz.org – The Alzheimer’s Assoc. – The Alzheimer’s Assoc. www.ftd-picks.orgwww.ftd-picks.org – The Assoc. for – The Assoc. for
Frontotemporal DementiasFrontotemporal Dementias
Vascular DementiaVascular Dementia
Vascular DementiaVascular Dementiaor Multi Infarct or Multi Infarct DementiaDementia Caused by “hardening of the arteries” or Caused by “hardening of the arteries” or
mini silent strokes in the brainmini silent strokes in the brain The blockages of the small arteries of the The blockages of the small arteries of the
brain caused by poor blood flow. Can be brain caused by poor blood flow. Can be prevented by a heart healthy diet and prevented by a heart healthy diet and other stroke prevention techniques other stroke prevention techniques (controlled blood pressure and (controlled blood pressure and cholesterol)cholesterol)
More common in those with Alzheimer’s More common in those with Alzheimer’s Disease as a co-existing problem.Disease as a co-existing problem.
CharacteristicsCharacteristics
Early on there may be changes in:Early on there may be changes in:
Memory and cognitionMemory and cognition
Decision-makingDecision-making
Sleep disturbanceSleep disturbance
ApathyApathy
Sensory LossSensory Loss
More physical limitationsMore physical limitations
Language problemsLanguage problems
Assessment and Assessment and ApproachesApproaches Any or all of the above symptoms Any or all of the above symptoms
or approaches mentioned may or approaches mentioned may apply dependent on where the apply dependent on where the damage has occurred in the damage has occurred in the brain.brain.
A clear differentiation of diagnosis A clear differentiation of diagnosis is thus important.is thus important.
TreatmentsTreatments
Goal is to prevent further strokes Goal is to prevent further strokes through diet and exercise.through diet and exercise.
Generally speaking, what is good for Generally speaking, what is good for the heart is good for the brainthe heart is good for the brain
Anticoagulants such as Aspirin, Anticoagulants such as Aspirin, Aggrenox, Plavix, or Vit. E are often Aggrenox, Plavix, or Vit. E are often used.used.
Cholinesterase inhibitors are utilized – Cholinesterase inhibitors are utilized – Razadyne has been approved for use Razadyne has been approved for use and has shown benefit in those with and has shown benefit in those with Vascular DementiaVascular Dementia
SummarySummary
There are many kinds of dementia – it is There are many kinds of dementia – it is inaccurate to assume “Alzheimer’s inaccurate to assume “Alzheimer’s Disease” prior to a complete diagnostic Disease” prior to a complete diagnostic assessment.assessment.
It is important to determine which type of It is important to determine which type of memory loss one has as there are various memory loss one has as there are various treatments, prognosis, and expectations treatments, prognosis, and expectations related to each. Some are also related to each. Some are also preventable!preventable!
Each form has its own unique effects on Each form has its own unique effects on family and care partners. It is important to family and care partners. It is important to tailor our approach to that individual’s tailor our approach to that individual’s needs.needs.
What Comes First?What Comes First?
Alzheimer’s DiseaseAlzheimer’s Disease Memory, repetition, Memory, repetition, confusionconfusion
Lewy Body Lewy Body DementiaDementia
Hallucinations, Hallucinations, variability, variability, movement movement problemsproblems
Frontotemporal Frontotemporal DementiasDementias
Behavior changes, Behavior changes, apathy, language apathy, language problemsproblems
Vascular DementiaVascular Dementia Depends on area of Depends on area of damage damage
QUESTIONS?QUESTIONS?
FOR YOUR REFERENCEFOR YOUR REFERENCE
Comprehensive Comprehensive Psychosocial Psychosocial Interventions Interventions Should include:Should include: Assessment of psychosocial needs of the Assessment of psychosocial needs of the
individual with the memory loss and their individual with the memory loss and their family.family.
Ruling out other possible contributing causes of Ruling out other possible contributing causes of dementia such as depression and alcoholismdementia such as depression and alcoholism
Providing support and counseling as they Providing support and counseling as they journey through the various stages of the journey through the various stages of the diseasedisease
Providing education and resources to meet Providing education and resources to meet ongoing needs.ongoing needs.
Advocating for the individual and family.Advocating for the individual and family. Promotion of healthy lifestyle and non- Promotion of healthy lifestyle and non-
pharmaceutical interventions if possiblepharmaceutical interventions if possible
Continued…Continued…
Assessments of:Assessments of: Family History of Memory LossFamily History of Memory Loss Family Dynamics and Support Family Dynamics and Support
SystemsSystems Social and Occupational Social and Occupational
implicationsimplications Safety and Potential Environmental Safety and Potential Environmental
BarriersBarriers Communication IssuesCommunication Issues
Continued…Continued…
Mental health historyMental health history Activities of Daily Living – Activities of Daily Living –
grooming, dressing, and bathing grooming, dressing, and bathing (The Functional Activity (The Functional Activity Questionnaire is often given)Questionnaire is often given)
IADLs- meal preparation, cleaning, IADLs- meal preparation, cleaning, shopping, money managementshopping, money management
Medication complianceMedication compliance
Continued…Continued…
DrivingDriving Financial PlanningFinancial Planning Emerging Behavioral IssuesEmerging Behavioral Issues Advanced Directives and Advanced Directives and
Financial PlanningFinancial Planning End of Life CareEnd of Life Care