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Differentiating depression and dementia gendron and heck

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Live webinar recorded June 26, 2012 featuring Tracey L. Gendron and Dr. Andrew L. Heck - discussion moderated by Dr. E. Ayn Welleford. View details at www.alzpossible.org
  • 1. Community Training onDepression and DementiaTracey Gendron, MSGAndrew L. Heck, Psy.D., ABPPGerontologistLicensed Clinical PsychologistAssistant ProfessorClinical DirectorVirginia Commonwealth University Piedmont Geriatric Hospital

2. Why is it important for YOUto know the differences betweendepression dementia 3. A CASE STUDYGeorge is a 70-year-old physically healthy retiree Hobbies: working in the shop, target shooting Recently began having memory problems Family history of Alzheimers disease (sister) Family physician diagnosed George with Alzheimers too THEN: Son and grandsons removed ammunition from house Nursing home admission months later Occasional passes to visit home Wife hears screen door slamFatal suicide attempt with handgun Note revealed George had hidden one bullet back from family, was afraid of becoming a burden 4. QUICK FACTSMajor depressive disorder affects 1-2% of olderadults 65+ in the communitySignificant depressive symptoms affectup to 20% of older adultsDementia affects 5% of people 65+ andabout 40% of adults over 85 5. OUR RESEARCH SHOWSType of job influences knowledgeabout depression anddifferentiation of depression anddementia symptoms However, it did not influence knowledge of dementia 6. WHAT PERCENTAGE OF RESIDENTS IN YOURFACILITY HAVE DEMENTIA AND DEPRESSION?PROFESSIONAL PARAPROFESSIONAL 74 66 37 33DementiaDepression 7. DEMENTIA: AN OVERVIEW 8. Short-term memory loss that disruptsdaily life Word-finding difficultySYMPTOMS of AD Get lost in familiar places Following a plan or recipe Challenges with planning or solving problemsPaying bills Misplacing things and losing ability to retrace steps Trouble understanding visual images and spatial relationshipsWithdrawal from work or social ADLsactivitiesBegin to be unable to care for selfMeals Changes in mood or personalitySafety May begin to lose track of place and time (orientation) 9. 10% of medically hospitalized and 12-20% of Long Term Care (LTC) residents have a full diagnosis of major depression Between 20-25% of older adults in LTC have clinically significant signs andDEPRESSIONsymptoms of depression10-15% of older adults in the community have signs and symptoms ofdepression Rates of diagnosed major depression in older adults are lower than rates foryounger adultsOlder adults report that they would be most likely to tell their primary caredoctors about emotional difficulties Depression can be treated as successfully in older adults as it can be in younger persons! 10. DEPRESSION DSM IV*depressedmoodloss of interest orfeelings of pleasure in worthlessnessactivitiesFive (5) or more of the following signs/symptomssignificant fatigueweight lossor gainpsychomotor agitation or sleep disturbance retardation*Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition 11. DEPRESSION NON-DSM Hypochondriasis IrritabilitySleep difficulties Depression (Non- DSM) Reduced ApathyappetiteA lack of positivefeelings (rather than Fatigue active negativefeelings) 12. DID YOU KNOW??Patients diagnosed with depression actually developdementia at As many as 10-30% of patients 2.5 - 6presenting with times dementia alsothe rate of theHAVE depressiongeneral population 13. SO, HOW DO YOU KNOW IF IT IS DEPRESSION or DEMENTIA? 14. What type of What do wecomplaints ariseknow about thefrom the persons history? individual? Fromthe family? How didWhat does thesymptomsbehavior lookdevelop?TAKING like? ACLOSER LOOK 15. THE FAMILY PERSPECTIVE1. The symptoms progressed very quickly after they first appeared.2. The onset of symptoms are dated with accuracy MIGHT THIS BE DEPRESSION OR DEMENTIA?? 16. Answer:Depression 17. SIDE BY SIDE COMPARISON DEPRESSION DEMENTIA Symptoms develop Symptoms developQUICKLY after onsetSLOWLY after onset and The onset of symptoms is throughout the course ofDATED WITH ACCURACYthe illness Family is AWARE of a The onset of symptoms isproblem and that it is only KNOWN WITHINsevere BROAD LIMITS Medical help is sought Family is often UNAWARESHORTLY after symptoms that there is a problem andbeginof its severity Medical help is usually sought a LONG TIME after symptoms develop 18. COMPLAINTS1. The individual isnt complaining much about their cognitive problems.2. They actually try to hide their disability. IS THIS DEPRESSION OR DEMENTIA?? 19. Answer:Dementia 20. SIDE BY SIDE COMPARISONDEPRESSIONDEMENTIA Person usually Person usuallycomplains MUCHcomplains LITTLEabout cognitive lossabout cognitive loss Complaints about Complaints aboutcognitive dysfunction cognitive problemsis usually DETAILED are usually VAGUE Person Person CONCEALSEMPHASIZESdisabilitydisability 21. BEHAVIOR1. The individual makes very little effort to perform even simple tasks2. They usually communicate a strong level of distress IS THIS DEPRESSION OR DEMENTIA?? 22. Answer:Depression 23. SIDE BY SIDE COMPARISONDEPRESSIONDEMENTIA Person makes very Person STRUGGLESLITTLE effort toto perform tasksperform even simple Person often appearstasks UNCONCERNED Person usually Person delights incommunicates a strong ACCOMPLISHMENTSsense of DISTRESS Person highlightsFAILURES 24. BEHAVIOR1. The individual still behaves appropriately in social situations2. Behavioral problems are clearly worse at nighttime DEPRESSION OR DEMENTIA?? 25. Answer:Dementia 26. SIDE BY SIDE COMPARISONDEPRESSIONDEMENTIA LOSS of social skills Social skills are oftenoften early and RETAINEDprominent Mood is LABILE and Change in mood is shallowPERVASIVE TYPICAL to NOT TYPICAL toexperienceexperienceaccentuatedaccentuated problems at nightproblems at night 27. WHAT DOES ALL OF THIS MEAN FOR YOU?? Watch the individuals behavior In making a good diagnosis carefully, especially for anything out of (which is crucial), treatment the ordinary;providers are truly counting on Ask about how he or she is feeling now and how theyve been feelinggood information fromlately, and ask their family orcaregivers;caregivers the same thing about them; Listen for increased complaints about health, pain, memory/cognition, or anything else; Look closely for changes in eating habits, sleep patterns, level of activity; Report your observations to someone from the treatment team immediately;Realize that your observationsmay lead to life-changingtreatment!! 28. PRE-EVENT SURVEYIt is normal to become depressed as individuals get older and live in long-term care FALSEfacilities.Depressed residents should be able to "snap out of it" (i.e. use their willpower to get FALSEbetter).Family members can be helpful when working with depressed residents. TRUEOlder adults do not change; therefore, there is no need to treat their depression. FALSEWeight loss, difficulties falling asleep and concentration problems can be signs ofTRUEdepression in older adults.If a resident reports guilt about the past he or she might be depressed. TRUEAgitation can be a sign of depression. TRUEConfusion and memory lapses in older people can sometimes be due to physical TRUEconditions that doctors can treat so that these symptoms go away over time.Becoming disoriented (such as getting lost or losing track of what day it is) happens to FALSEpersons with Alzheimers disease, but only in the later stages of the disease. TRUEMemory loss that disrupts daily life can be a symptom of dementia. TRUEConfusion with time or place can be a symptom of dementia.Alzheimers disease is the only illness that leads to confusion and memory problems in FALSEolder adults. 29. PRE-EVENT SURVEYSymptoms develop slowly after onset and throughout the course of the illness in a person DEMENTIAwithSocial skills are often maintained in a person with DEMENTIADifficulties with behavior and symptoms at night are typically of patients with DEMENTIAA person with ________ makes very little effort to perform basic tasks.DEPRESSIONA person with _______ complains very little about cognitive loss.DEMENTIA 30. QUESTIONS? COMMENTS? For additional information about this trainingplease contact: Tracey Gendron [email protected] Commonwealth University (804) 828-1565Or Dr. Andrew [email protected] Geriatric Hospital (434) 767-4582

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