Dementia & Alzheimer's Disease

Sporadic CJD

- over 60 years of age

Vascular dementia

-A deficit in cognitive fx that is often linked with cerebrovascular disease -vascular cognitive impairment -multi-infarct dementia -subcortical dementia -post-stroke dementia

Stage 7: Very Severe Decline

-ACL: 2.8 -Vocab limited to single words or grunt -need help with all ADLs -can't sit up -not able to smile -swallowing is impaired (aspiration/pneumonia is the #1 resons clients with dementia die)

Stage 4: Moderate Decline

-ACL: 4.8 -forgetfulness of recent events -impaired ability to perform challenging mental arithmetic -greater difficulty performing complex tasks, such as planning dinner for guests and paying bills -forgetfulness about one's owen personal history -a lot of people in this stage have depression -FAMILY DILEMMA: most families do not realize something is wrong until this stage -OT's need to document function -VALIDATION- use it in every aspect of care

Stage 3: Mild Decline

-ACL: 5.2 -BREAKDOWN BEGINS 1. cant multi task 2. noticeable problems coming up with the right word or name 3. losing or misplacing a valuable object 4. increasing trouble with planning or organizing 4. having noticeably greater difficulty performing tasks in social or work settings. Forgetting material that they just read

Stage 2: Very Mild decline

-ACL: 5.6 -NOBODY KNOWS -COMPENSATORY STRATEGIES -May be normal age-related changes or earliest signs of alzheimer's

Stage 6: Severe Decline

-ACL:3.6 -will see some components of stage 5 in this stage -A TIME OF CHANGE -lose of awareness of recent experiences as well as of surroundings -remember their own name but have difficulty with their personal history -distinguish familiar and unfamiliar faces but have trouble remembering the name of a spouse or caregiver -need help dressing properly and may make mistakes -experience major changes in sleep patterns -need help handling details of toileting -trouble controlling bladder and bowels -exp major personality and behavioral changes, including suspiciousness and delusions or compulsive, repetitive behavior -tend to wander or become lost

Stage 5: Moderately severe decline

-ACL:4.2 -be unable to recall their own address or telephone number or high school they went to -become confused about where they are and what day it is -have trouble with less challenging arithmetic -need help choosing proper clothing for the season or occasion -still remember significant details about themselves and family -still require no assist with eating or using the toilet -Escape preperation: helps with wandering

Korsakoffs Syndrome

-Abnormal memory function usually following Wernikce encephalopathy, with memory and learning affected disproportionately to other cognitive functions in an alert and responsive individual

Lewy Body Dementia

-Abnormal protein deposits in the brain referred to as lewy bodies -Lewy body proteirn deteriorate areas of cognitive functioning and motor control -Umbrella term for "Parkinson's disease dementia" and " dementia with lewy bodies" -A degenerative dementia associated with cognitive impairment, visual hallucinations and parkinsonian like symptoms

Wernicke Encephalopathy

-An acute reaction to severe loss of thiamine -Life threatening brain disruption -confusion - staggering and stumbling - lack of coordination - abnormal involuntary eye movements

Treatment for FTD

-Behavioral counseling -meds -caregiver support

Creutzfeldt-Jakob Disorder

-CJD belongs to a family of human and animal diseases known as transmissible spongiform encephalopathies -Spongiform refers to the characteristic appearance of infected brains, which become filled with holes until they resemble sponges under a microscope (mad cow) -CNS -Rare -degenerative -invariable -fatal brain disorder -can happen in animals and humans

Stages of Alzheimer's

-Early -Middle -Late

Causes of dementia

-Normal pressure hydrocephalus -TIA's (Transient Ischemic attacks) -Strokes -Other circulatory and neurological disorders -malnutrition -infection -drug and alcohol use -alzheimer's

Interventions for FTD

-Target behavioral: changes in environment, rewards, hearing aids, bright light therapy -Target diet: oral feeding to improve weight

Familial CJD (genetics)

autosomal dominant -memory lapses -fatigue and visual disturbances -gait ataxia -lack of coordination -difficulty with speech/swalloing -sudden jerky movements -rigid limbs

Alzheimer's disease

-Type of dementia that causes problems with memory, thinking and behavior -Most common form of dementia (50-80%) -Not a normal part of aging -Worsen's over time (6th leading cause of death) -A progressive neurological disorder and is classified as a mental disorder -Exact etiology is unknown and there is not current cure -Damage is done to the brain resulting in: 1. impaired higher mental processes 2. altered behavior 3. mood disturbance -Only diagnosed by autopsy (tau) -Ach has been found to be decreased by up to 90% in people with alzheimer's

Behaviors seen in dementia

-anxiety, wandering, stealing, inability to remain quiet, demand for attention, repetative speech or ax's, inappropraite toileting, undressing, sadness, resisting care -inn sexual behavior, emotional outbursts, combativeness, screaming/cursing, easily frustrated, hiting/kicking, paranoid ideas, hallucinations and mood swings

Early Symptoms of sporadic CJD

-depression, mood swings, memory lapses, social withdrawal and lack of interest

Signs and Symptoms

-general confusion, disorientation to date, time or place -apathy, irritability, depression, anxiety -problems with language, math, abstract thinking and judgement -personality changes with strange quirks or innapropriate behaviors -wandering, hiding objects, problems with eating and sleeping -toward the end, total loss of self, and inability to control bodily function

Iatrogenic CJD (exposure to contaminated tissue)

-human growth hormone -dura mater grafts -eating contaminated beed -symptoms life sporadic -peripherally-kuru-prion disease caused by consumption of human tissue members -mostly ataxia -dementia-rare

Symptoms of WE

-inability to form new memories -loss of memory, can be severe -making up stories (confabulation) -seeing or hearing things that aren't there -problems learning new info -inability to remember recent events or long term memory gaps

Later symptoms of Sporadic CJD

-lack of coordination-clumsy -cerebellar ataxia- damage to cerebellum-controls movement -blurred vision -hallucinations -blindness -slurred speech -swallowing difficulty

Causes of aggressive behavior

-medical condition -response to pain -environmental changes -not knowing how to express feelings -chemical imbalances

Causes of WE

-unrecognized or goes untreated -85% who survive this develop Korsakoff -alcohol abuse -lack of thiamine -stroke

Stage 6 cont'd

-wearing bifocals distorts their vision -clients usually wont make eye contact -will no have side vision by the end of this stage and no depth perception -when going from 5 to 6 look for a stiff neck -up to 90 second processing delay -CREATIVE INTERVENTIONS (gold club 4 cane)

People's responses to Alzheimer's

1. Denial (early stage) 2. blame others for making them "look ridic" 3. complete self-awareness 4. frustration, agitation, rage 5. vacant despair, with no apparent recognition that they were once a different person

Dementia

"Any group of symptoms characterized by a decline in intellectual functioning severe enough to interfere with a person's normal daily activities and social relationships" -Dementia is part of 120 diseases -Different than cognitive slowing -problems with new learning -the first thing to go is the last thing learned (retrogenesis)

Stage 1

Allen cognitive level (ACL-6) No symptoms

Meds for FTD

Antidepressants

Frontotemporal degeneration

Overall name for the disease group and clinical subgroup other names: pick's, lobar sclerosis, lobar atrophy, primary progressive aphasia and semantic dementia -Neurodegenerative condition that affects behavioral and cognitive areas in the brain. degenerative cond of the frontal and temporal lobes -3 types: 1. frontal-variant or behavioral-variant 2. progressive non-affluent aphasia 3. semantic dementia

Cognitive slowing

normal process of aging and does not normally interfere with function. Dementia is more severe and normally does cause a decrease in function and has identifiable causes