Alzheimer's Disease/Dementia

What is Alzheimer's Disease?

- a form of dementia and accounts for 60-80% of dementia cases - progressive brain disorder that damages and eventually destroys brain cells leading to memory loss and changes in thinking as well as other brain functions - a serious mental decline that is associated with dementia is not part of the normal aging process - greatest risk factor is age but up to 5% of people with Alzheimer's have early onset

Alzheimer's Disease Cont.

- a type of dementia that causes problems with memory, thinking and behavior - in early stage memory loss is mild but progresses to the point of being unable to carry on a conversation or respond to their environment

Mixed Dementia

- abnormalities associated with more than one type of dementia occur simultaneously

Parkinson's Disease

- as the disease progresses, pts present with progressive dementia similar to AD or dementia with Lewy Bodies

10. Changes in mood and personality

- can become confused, suspicious, anxious, fearful, depressed - upset easily, especially when out of comfort zone Typical age related change: developing a very specific way of doing something and becoming irritated when routine is disrupted

3. Difficulty completing familiar tasks at home, work, or leisure

- daily tasks hard to complete - trouble driving to familiar place - not remembering rules of an often played game Typical age related changes: occasionally needing help to operate household item such as the microwave

2. Changes in planning or solving problems

- difficulty developing and following a plan - difficulty working with numbers - take longer to complete tasks Typical age related changes: making occasional errors when balancing the checkbook

5. Trouble understanding visual images and spatial relationships

- difficulty reading, judging distance, determining colors - pass a mirror and think someone else is in the room Typical age related changes: visual changes due to cataracts

1. Memory loss that disrupts daily life

- forgetting recently learned info - forgetting important dates and events - asking the same thing over and over - relying on memory aids Typical age related change: sometimes forgetting names or appointments but remembering them later

5. moderately severe cognitive decline

- gaps in memory and thinking noticeable - start needing help with day to day activities but typically still be able to toilet self and feed self

Frontotemporal Dementia

- includes dementias such as progressive aphasia, pick's disease, and progressive supranuclear palsy - symptoms include changes in personality and behavior, difficulty with language

7. very severe cognitive decline

- lose ability to respond to environment, carry on conversation and ultimately control movement - may still say words or phrases - need help with all ADL's - reflexes become more abnormal, muscles rigid, swallowing impaired

4. Confusion with time or place

- lose track of dates, seasons, and time - sometimes forget how they go somewhere or where they are at Typical age related changes: getting confused on day of week but being able to figure out later

4. moderate cognitive decline

- medical interview will detect clear cut symptoms in several areas

Dementia with Lewy Bodies (DLB)

- memory loss and thinking problems similar to AD - more likely than people with AD to have initial or early symptoms such as sleep disturbances, hallucinations, muscle rigidity or other parkinsonian movement problems

6. severe cognitive decline

- memory worsens - personality changes occur - extensive help needed with ADL's - major changes in sleep patterns - need help handling details of toileting (wiping, disposing of TP)

1. No impairment (normal function)

- no memory problems - may have memory issues but it does not cause a problem

Normal Pressure Hydrocephalus (NPH)

- presents with difficulty walking, memory loss, and inability to control urination - can be corrected with a shunt

7. Misplacing things and losing the ability to retrace steps

- put things away in unusual places - lose items and be unable to retrace steps - may accuse others of stealing items they've misplaced Typical age related changes: misplacing things on occasion

9. Withdrawal from work or social activities

- start to lose interest in hobbies, social activities, projects, or sports - avoid being social Typical age related changes: sometimes feeling weary at work, family, and social obligations

Diagnosis

- there is no single test that can show whether a person has AD - diagnosed with a comprehensive medical assessment

6. New problems with words in speaking or writing

- trouble following or joining a conversation - repeat themselves - struggle with vocabulary Typical age related changes: sometimes having difficulty finding the right word

8. Decreased or poor judgment

- use poor judgment with finances - decrease in personal hygiene Typical age related changes: making a bad decision once in a while

Vascular dementia

- 2nd most common cause of dementia (AD is the first) - previously called multi-infarct or post stroke dementia -initial symptoms related to impaired judgment, planning steps to complete a task rather than memory loss as in AD

Alzheimer's statistics

- 6th leading cause of death in the US - survival age 4-20 yrs but most survive 8 yrs after symptoms become noticeable to others - no cure but treatment can slow down the worsening of symptoms

Wernicke-Korsakoff Syndrome

- Chronic memory disorder caused by severe thiamine deficiency - Most common cause is alcohol misuse - Severe memory problems but other thinking and social skills relatively unaffected

Huntington's Disease

- Progressive brain disorder caused by chromosome 4 defective gene - Abnormal involuntary movements - Severe decline in thinking and reasoning

What is dementia?

-It's not a specific disease but rather a wide range of symptoms - a term used to describe various diseases and conditions that damage brain cells

Creutzfeldt-Jakob Disease

-Mad Cow Disease - human form of a group of rare, fatal brain disorders affecting people and certain other mammals - rapidly fatal disease that impairs memory and coordination, causes behavioral changes

2. very mild cognitive decline

-may be normal age related changes or earliest signs of AD - the person starts noticing memory lapses but not evident to others

3. mild cognitive decline

-others start noticing difficulties

Communication Techniques

1. Establish eye contact before talking to a person to get their attention 2. Short, grammatically simple, and concrete input, avoid pronouns 3. One topic at a time. Repeat and rephrase important info 4. Multisensory input, both visual and tactile (pics, key words, gestures) 5. Yes-no or either-or Q's 6. External orientation and memory aids, name bracelets, reminder signs, calendars 7. Share successful techniques with caregivers

Other conditions with dementia like symptoms:

1. depression 2. drug interactions 3. thyroid problems (hormonal imbalance can cause memory problems) 4. excess alcohol 5. vitamin deficiencies

10 Warning Signs of Alzheimer's

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. decreased or poor judgment 9. withdrawal from work or social activities 10. changes in mood and personality

Stages of Alzheimer's Disease

1. no impairment (normal function) 2. very mild cognitive decline 3. mild cognitive decline 4. moderate cognitive decline 5. moderately severe cognitive decline 6. severe cognitive decline 7. very severe cognitive decline

Brain abnormalities associated with AD

1. plaques- microscopic clumps of protein called beta-amyloid peptide 2. tangles- twisted microscopic strands of protein called tau 3. loss of synapses among brain cells- lose transmission of info from cell to cell 4. inflammation- results from the brain trying to fend off lethal effects of changes 5. death of brain cells with severe tissue shrinkage

Assessment should include

1. thorough medical history 2. mental status testing 3. physical and neurological exam 4. tests to rule out other causes of dementia like symptoms