Dementia & Alzheimer's Disease
List the Dementia Warning Signs
- Recent Memory Loss - Confusion of Time and Place - Difficulty Performing Familiar Tasks - Problems with Language - Decreased or Poor Judgment - Problems with Abstract Thinking - Forget Where They Put Things - Changes in Mood and Personality - Loss of Initiative
Treatments for Behavioral Issues
- Stress usually triggers behaviors; determine what the pt.'s trigger is - Medications - Anticipate needs - Avoid confrontation - Redirect - Create a calm environment - Make sure they are getting adequate rest - Provide a security object
Severe Alzheimer's Disease (later stage)
- They've lost the ability to respond to their environment, carry on conversations and control movement - They may still speak but communication is very difficulty
Moderate Alzheimer's Disease (middle stage)
- Typically the longest stage - Damage to brain cells makes it difficult to express thoughts and perform routine tasks
Second most common cause of dementia (AD is the first), previously called multi-infarct or post stroke dementia caused by narrowing of arteries supplying the brain causing decreased blood flow. Those w/ obesity, diabetes and vascular disease are at risk
- Vascular Dementia - Initial symptoms are related to impaired judgement, and/or planning steps to complete a task rather than memory loss, as in AD
- Chronic memory disorder caused by severe Thiamine (vitamin B-1) deficiency - Most common cause is alcohol misuse
- Wernicke-Korsakoff Syndrome - - Severe confusion and memory problems but other thinking and social skills are relatively unaffected. Also have ataxia and nystagmus
What are some common difficulties in the early stage of AD (mild) ?
1. Problems coming up with the right word or name for something 2. Trouble remembering names 3. Increased difficulty performing social or work tasks 4. Forgetting material they just read 5. Losing or misplacing a valuable object 6. Increasing trouble with planning/organizing
How is Dementia diagnosed ?
A doctor must find the pt. to have 2-3 areas of decline to diagnose dementia. - These areas include disorientation, disorganization, language impairment and memory loss (neurologist administers several mental-skill challenges)
A form of dementia and accounts for 60%-80% of dementia cases
- Alzheimer's Disease - the greatest risk factor is age but up to 5% of people with Alzheimer's have early onset
Human form of a group of rare, fatal brain disorders that can be inherited or from getting a transplant (or from mad cow disease - caused by consuming infected beef)
- Creutzfeldt-Jakob Disease - Rapidly fatal disease caused by an infectious protein in the brain called a "prion" that impairs memory and coordination, causes behavior changes and eventually death
There is no cure for this disease but there are treatment options. Treatments can't stop the disease from progressing, but it can slow down the worsening of symptoms
- Dementia - PT treatment should focus on maximizing the pt.'s function and prove the family/caregiver information about the disease
A term that is used to describe various diseases and conditions that damage brain cells
- Dementia - not a specific disease but a term that describes a wide range of symptoms
Memory loss and thinking problems similar to AD. Protein deposits, called _____, develop in nerve cells in the brain regions involved in thinking, memory and movement (motor control)
- Dementia w/ Lewy Bodies - More likely than people w/ AD to have initial or early symptoms such as sleep disturbances, hallucinations, muscle rigidity or other parkinsonian movement problems.
Includes dementias such as progressive aphasia, Pick's disease and progressive supranuclear palsy. Onset is age 40-45
- Frontotemporal Dementia - Symptoms include changes in personality and behavior, difficulty with language, socially inappropriate behavior, abrupt mood changes, lack of inhibition and compulsive behaviors.
Alternative Treatments for AD
- Herbal remedies, dietary supplements and "medical foods." ** Very little research has been done on these treatments; The FDA does not require evidence for marketing dietary supplements so pt.'s need to be careful and research these methods.
Mild Alzheimer's Disease (early stage)
- May still function independently, drive and participate in social activities - Pt. notices memory lapses - Friends and family start to notice difficulties
Abnormalities associated with more than one type of dementia that occur simultaneously
- Mixed Dementia -
As the disease progresses, pt.'s present with progressive dementia similar to AD or dementia w/ Lewy Bodies
- Parkinson's Disease -
Brain Abnormalities associated w/ AD
- Plaques - Tangles - Loss of Synapses - Inflammation - Death of Brain Cells w/ Severe Tissue Shrinkage
Communication Techniques when Working with Dementia Patients
1. Establish eye contact prior to addressing the person to ensure their attention 2. Use short, grammatically simple, and concrete cues and input (avoid pronounds) 3. Keep to one topic at a time. Be redundant (repeat and rephrase critical info) 4. Provide multi-sensory input, both visual and tactile, to enhance comprehension (use pictures, write down key words, use gestures and demonstration) 5. Ask "yes-no" and "either-or" questions 6. Provide external orientation and memory aids, such as name bracelets, reminder signs and calendars 7. Share successful techniques with caregivers
What are some common difficulties in the middle stage of AD (moderate) ?
1. Forgetting about life events or their own personal history 2. Moody or withdrawn 3. Unable to recall their address, phone number, etc. 4. Confusion about time and place 5. Needs help choosing appropriate clothing 6. Incontinence 7. Changes in sleep patterns 8. Wandering, risk of getting lost 9. Personality
- Forgetting recently learned info - Forgetting important dates and events - Asking the same questions over and over
1. Memory Loss that Disrupts Daily Life - Typical Age Related Changes: Sometimes forgetting names or appointments but remembering them later and relying on memory aids
What are the 10 Warning Signs of AD ?
1. Memory Loss that Disrupts Daily Life 2. Changes in Planning or Solving Problems 3. Difficulty Completing Familiar Tasks at Home, Work, or Leisure 4. Confusion with Time or Place 5. Trouble Understanding Visual Images and Spatial Relationships 6. New Problems with Words in Speaking or Writing 7. Misplacing Things and Losing the Ability to Retrace Steps 8. Impaired or Poor Judgement 9. Withdrawal from Work or Social Activities 10. Changes in Mood and Personality
There are 3 Stages of AD
1. Mild (early) 2. Moderate (middle) 3. Severe (late)
What are some common difficulties in the late stage of AD (severe) ?
1. Require full-time assistance and supervision 2. No awareness of recent experiences or their surroundings 3. Loss of physical abilities including walking, sitting, and swallowing 4. Increasing difficulty communicating 5. Become vulnerable to infections, especially pneumonia
Diagnosis Assessment of Dementia should include:
1. Thorough medical hx 2. Mental status testing 3. Physical and neurological exam 4. Tests to rule out other causes of dementia-like symptoms
List the Other Types of Dementia
1. Vascular Dementia 2. Dementia w/ Lewy Bodies (DLB) 3. Mixed Dementia 4. Parkinson's Disease 5. Frontotemporal Dementia 6. Creutzfeldt-Jakob Disease 7. Normal Pressure Hydrocephalus (NPH) 8. Huntington's Disease 9. Wernicke-Korsakoff Syndrome
- Can become confused, suspicious, anxious, fearful, depressed - Gets upset easily, especially when out of comfort zone
10. Changes in mood and personality - Typical Age Related Changes: Developing a very specific way of doing something and becoming irritated when routine is disrupted
- Difficulty developing and following a plan - Difficulty working with numbers - Taking longer to complete tasks
2. Changes in Planning or Solving Problems - Typical Age Related Changes: Making occasional errors when balancing the checkbook
- Daily tasks are hard to complete - Trouble driving to familiar places - Not remembering rules of an often played game
3. Difficulty Completing Familiar Tasks at Home, Work, or Leisure - Typical Age Related Changes: Occasionally needing help to operate household items, such as the microwave or computer
- Lose track of dates, seasons, and time - Sometimes forget how they got somewhere or where they are at - Gets lost in familiar places
4. Confusion with Time or Place - Typical Age Related Changes: Confused about the day of the week, but being able to figure out later. Getting disoriented when driving to a new place.
- Difficulty reading, judging distance, and determining colors - Pass a mirror and think someone else is in the room
5. Trouble Understanding Visual Images and Spatial Relationships - Typical Age Related Changes: Visual changes due to cataracts or glaucoma
- Trouble following or joining a conversation - Repeat themselves; perseverates - Struggles with vocabulary
6. New Problems with Words in Speaking or Writing - Typical Age Related Changes: Sometimes have difficulty finding the right word
- Put things away in unusual places - Lose items and be unable to retrace steps - May accuse others of staling items they've misplaced
7. Misplacing Things and Losing the Ability to Retrace - Typical Age Related Changes: Misplacing things on occasion but retrace steps to find
- Use poor judgement with finances - Decline in personal hygiene
8. Impaired or Poor Judgement - Typical Age Related Changes: Making a bad decision once in a while and feeling bad about it
- Start to lose interest in hobbies, social activities, projects or sports - Avoid being social, going out
9. Withdrawal from Work or Social Activities - Typical Age Related Changes: Sometimes feeling weary of work, family and social obligations and want to stay home
What is Alzheimer's Disease (AD) ?
A progressive neurodegenerative disorder that damages and, eventually, destroys brain cells, leading to memory loss and changes in thinking as well as loss of other brain functions. ** The neurons involved with acetylcholine transmission deteriorate with/in the Cerebral Cortex
Dementia Warning Signs: Changes in Mood and Personality
Anyone can become sad or moody from time to time. - A person living with dementia can have quick mood changes such as from calm to anger. - Also becomes uncomfortable in social situations.
What Medications are used to help slow progression of AD temporarily ?
Aricept (treats all stages of AD), Exelon (treats mild-mod AD) , Razadyne (treats mild-mod AD) are common medications that are all cholinesterase inhibitors.
A general term for a decline in mental ability, severe enough to interfere with daily life
Dementia
Dementia Warning Signs: Forget Where They Put Things
Everyone misplaces their keys or glasses every now and then. - A person living with dementia might repeatedly put their items in places that they do not belong (ex. keys in the freezer)
True or False. There is a test that can show whether or not a person has AD
False. There are no tests available to show signs of AD.
Results from the brain trying to fend off lethal effects of changes
Inflammation
Managing Behavioral Problems of AD - Early Stages
Irritability, anxiety and depression are common - In the Later Stages: anger, agitation, aggression, outbursts, restlessness, pacing, hallucinations, delusions, and sleep disturbances are common
- Progressive brain disorder caused by chromosome 4 defective gene - Abnormal involuntary movements-chorea - Severe decline in thinking, reasoning, and behavior changes
Huntington's Disease
Alzheimer's Disease; Survival can range from 4-20 years after onset but on average, people survive about 8 years after symptoms become noticeable to others
In its early stages, memory loss is mild but progresses to the point of being unable to carry on conversation, recognize family members or respond to their environment
How is AD diagnosed ?
It is diagnosed with a comprehensive medical and cognitive assessment. - MRI, PET Scan, Cognitive testing
Dementia Warning Signs: Confusion of Time and Place
It is normal to forget where you are going once in a while. - Individuals living with dementia may be disoriented to time, place, and immediate environment (ex. not knowing where they are)
Dementia Warning Signs: Difficulty Performing Familiar Tasks
It is normal to get lost occasionally while driving. - A person living with dementia might have increased trouble while driving in familiar areas and get lost.
Dementia Warning Signs: Problems with Abstract Thinking
It is normal to have difficulty balancing a budget. - Someone who has a dementia-related illness might forget what numbers are, or how to add/subtract.
Dementia Warning Signs: Loss of Initiative
It is normal to not want to do housework or work tasks. - A person living with dementia may no longer initiate things that they once enjoyed.
Diagnosis Assessment of Alzheimer's Disease:
Just because someone has memory problems does not mean they have AD. Other, treatable, conditions can present w/ dementia-like symptoms: Depression, Drug interactions, Thyroid problems, excess alcohol, vitamin deficiencies
Loss of Synapses
Loss of connections among brain cells = lose transmission of information from cell to cell (neuron to neuron)
Alzheimer's Disease is a type of dementia that causes problems with what ?
Memory, thinking, and behavior. - Symptoms usually develop slowly and worsen over time. Ultimately, it is fatal.
Is there a cure to Alzheimer's ?
No, but there is treatment available to temporarily slow the progression of the disease, control symptoms and improve quality of life
Presents with difficulty walking, memory loss and inability to control urination. Can be corrected with a shunt
Normal Pressure Hydrocephalus (NPH)
Dementia Warning Signs: Recent Memory Loss
Occasionally forgetting names or what to buy at the store and then remembering them later is normal. - A person living with dementia will have memory loss that is frequent and will impact their ability to function in their daily life.
Microscopic clumps of a protein called "beta-amyloid peptide"
Plaques
Twisted microscopic strands of a protein called "tau"
Tangles
Dementia Warning Signs: Problems with Language
Trying to find the appropriate words while in conversation sometimes is very common. - However, someone living with dementia might have issues with following or initiating a conversation.
Dementia Warning Signs: Decreased or Poor Judgement
We can make poor decisions once in a while. - A person with dementia might make decision that negatively impact their wellbeing more frequently and start paying less attention to their daily needs.
The serious mental decline that is associated with dementia is NOT...
a normal part of the aging process