Different Strokes for Different Folks: Variable Approaches to Different Forms of Dementia Julie Feil, MSW, LCSW The Memory...
The Goals of The Memory Center <ul><li>We see individuals of all ages with all forms of memory loss in various stages. </l...
Why is the Diagnosis Important? <ul><li>It allows us to identify what form of memory problem we are dealing with.  This re...
It is like Stopping a Rolling Truck!
Barriers to Obtaining a Diagnosis <ul><li>Belief that it is “Just normal aging” </li></ul><ul><li>Stigma attached to “Alzh...
Determining the Diagnosis <ul><li>Appointment includes: </li></ul><ul><li>The Neurological or Medical Examination </li></u...
Possible Diagnosis’ <ul><li>Alzheimer’s Disease  </li></ul><ul><li>Mild Cognitive Impairment </li></ul><ul><li>Probable Le...
Imaging Studies <ul><li>Extremely helpful tool in diagnosing which particular type of memory disorder is likely present.  ...
Alzheimer’s Disease
What is Alzheimer’s Disease? <ul><li>The most common cause of dementia </li></ul><ul><li>Irreversible, progressive disease...
Is it in the Water? <ul><li>“ Why are so many people ‘getting it’ “ is a common question. </li></ul><ul><li>We do not know...
Neuropsychological Testing <ul><li>Following testing, individuals with MCI show an isolated memory loss.  Those with Alzhe...
Exercise <ul><li>Name as many animals as you can in 1 minute </li></ul><ul><li>Measures catagorical fluency </li></ul><ul>...
Mild Cognitive Impairment <ul><li>Being researched as a likely “pre-cursor” to Alzheimer’s Disease- consists of mild memor...
Assessment Questions <ul><li>Short term memory loss? </li></ul><ul><li>Financial management </li></ul><ul><li>Repetitive q...
Depression Screen <ul><li>It is also important to address depression using a depression screening tool such as the Geriatr...
Characteristics - Early <ul><li>Short term memory loss and asking questions repeatedly are often the first signs </li></ul...
Moderate <ul><li>Forgetting to turn off stoves, appliances </li></ul><ul><li>Emerging safety concerns </li></ul><ul><li>Pr...
Severe <ul><li>Severe loss of memory </li></ul><ul><li>May be unable to recognize loved ones </li></ul><ul><li>More halluc...
Treatments <ul><li>Cholinesterase Inhibitors are being used to slow the progression with good success: </li></ul><ul><ul><...
Key Psychosocial Issues <ul><li>Individuals and families coping with Alzheimer’s Disease require ongoing support as the di...
Supportive Approaches <ul><li>Care partners have various thresholds in terms of their ability to manage the care of someon...
The Alzheimer’s Association <ul><li>Excellent organization for all types of memory disorders </li></ul><ul><li>Provide sup...
Other Resources for Individuals and Care Partners  <ul><li>Adult Day Centers </li></ul><ul><li>Home health agencies </li><...
Support Groups  <ul><li>Support groups are very valuable and take many forms.  Groups exist for: </li></ul><ul><ul><li>MCI...
Key Resources <ul><li>Books and Magazines: </li></ul><ul><ul><li>The 36 Hour Day  – Mace and Rabins </li></ul></ul><ul><ul...
Resources continued: <ul><li>Websites: </li></ul><ul><ul><li>www.alz.org  – The Alzheimer’s Assoc. </li></ul></ul><ul><ul>...
Lewy Body Dementia
Lewy Body Dementia <ul><li>A progressive brain disease and second leading cause of dementia in elderly. (20% of all dement...
Characteristics <ul><li>A probable Lewy Body Disease is defined when one meets 2 out of the 3 symptoms: </li></ul><ul><ul>...
Other Suggestive Features <ul><li>REM sleep disorders – vivid dreams, purposeful and sometimes violent movements </li></ul...
Neuropsychological Testing <ul><li>Individuals with LBD have difficulty in the following areas of cognitive thinking: </li...
Hooper Visual Organization Test <ul><li>30 “puzzle” pictures </li></ul><ul><li>Indicator of visuospatial skills and poster...
Hooper Visual Organization Example
Answer: <ul><li>LIGHTHOUSE </li></ul>
Clock Draw Example <ul><li>Goal- To draw the face of a clock, put the numbers in the correct positions, and indicate the t...
Key Psychosocial Issues <ul><li>Families and affected person may be dealing early on with safety issues involving the phys...
Assessment Questions <ul><li>Sleep disturbance? </li></ul><ul><li>Gait disturbance / Falls? </li></ul><ul><li>Appears soci...
Supportive Approaches <ul><li>Families struggle with misperceptions- benefit from support of others in same situation (sup...
Common Interventions <ul><li>Due to Parkinsonism, individual is at a higher fall risk. Need to adapt environment and consi...
Treatments for LBD <ul><li>Cholinesterase inhibitors (medications approved for Alzheimer’s Disease) tend to work even bett...
Key Resources <ul><li>The Alzheimer’s Association </li></ul><ul><li>The Lewy Body Dementia Association </li></ul><ul><li>W...
The Frontotemporal Dementias
Frontotemporal Dementias <ul><li>Neurodegenerative changes in the frontal and temporal lobes of the brain </li></ul><ul><l...
Characteristics <ul><li>There is generally an early loss of personal awareness and sometimes an increase in social disinhi...
The Frontal Lobe - the Gatekeeper <ul><li>People who suffer from the FTDs may exhibit inappropriate behaviors in public, b...
Neuropsychological Testing <ul><li>Frontal area involves the “doing” part of the brain- executive functioning thus testing...
Neuropsychological testing continued… <ul><li>Temporal Area involves speech and language thus testing reveals difficulty w...
Example – Boston Naming Test
Key Psychosocial Issues <ul><li>Loss of Insight: Often people with frontotemporal dementias do not have insight into their...
Assessment Questions <ul><li>Judgment and Insight </li></ul><ul><li>Decision making, impulsivity </li></ul><ul><li>Mood ch...
Supportive Approaches <ul><li>Often the disinhibition and behavior changes combined with the lack of insight put care part...
Communication <ul><li>As the temporal lobes become damaged, one will often will see changes in ability to express self and...
Treatments <ul><li>The cholinesterase inhibitors (Alzheimer’s medications) work in approximately 1 in 3 patients with FTD....
Key Resources <ul><li>Books: </li></ul><ul><ul><li>The 36 Hour Day  – Mace and Rabins </li></ul></ul><ul><ul><li>What if i...
Vascular Dementia
Vascular Dementia or Multi Infarct Dementia <ul><li>Caused by “hardening of the arteries” or mini silent strokes in the br...
Characteristics <ul><li>Early on there may be changes in: </li></ul><ul><li>Memory and cognition </li></ul><ul><li>Decisio...
Assessment and Approaches <ul><li>Any or all of the above symptoms or approaches mentioned may apply dependent on where th...
Treatments <ul><li>Goal is to prevent further strokes through diet and exercise. </li></ul><ul><li>Generally speaking, wha...
Summary <ul><li>There are many kinds of dementia – it is inaccurate to assume “Alzheimer’s Disease” prior to a complete di...
What Comes First? Depends on area of damage  Vascular Dementia Behavior changes, apathy, language problems Frontotemporal ...
QUESTIONS?
FOR YOUR REFERENCE
Comprehensive Psychosocial Interventions  <ul><li>Should include: </li></ul><ul><li>Assessment of psychosocial needs of th...
Continued… <ul><li>Assessments of: </li></ul><ul><li>Family History of Memory Loss </li></ul><ul><li>Family Dynamics and S...
Continued… <ul><li>Mental health history </li></ul><ul><li>Activities of Daily Living – grooming, dressing, and bathing (T...
Continued… <ul><li>Driving </li></ul><ul><li>Financial Planning </li></ul><ul><li>Emerging Behavioral Issues </li></ul><ul...
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Different Strokes for Different Folks: Variable Approaches to ...

  1. 1. Different Strokes for Different Folks: Variable Approaches to Different Forms of Dementia Julie Feil, MSW, LCSW The Memory Center Affinity Health System
  2. 2. The Goals of The Memory Center <ul><li>We see individuals of all ages with all forms of memory loss in various stages. </li></ul><ul><li>To identify and provide treatment options for those with memory disorders </li></ul><ul><li>To advocate for early detection! </li></ul>
  3. 3. Why is the Diagnosis Important? <ul><li>It allows us to identify what form of memory problem we are dealing with. This results in: </li></ul><ul><li>More focused education and support- appropriate to family and individual </li></ul><ul><li>More accurate and effective pharmaceutical treatment modality choice </li></ul><ul><li>Increased awareness for families and individual </li></ul><ul><li>Rule out treatable causes of dementia </li></ul>
  4. 4. It is like Stopping a Rolling Truck!
  5. 5. Barriers to Obtaining a Diagnosis <ul><li>Belief that it is “Just normal aging” </li></ul><ul><li>Stigma attached to “Alzheimer’s Disease” </li></ul><ul><li>Fear </li></ul><ul><li>Lack of Insight into Problem </li></ul><ul><li>Denial </li></ul><ul><li>Embarrassment </li></ul>
  6. 6. Determining the Diagnosis <ul><li>Appointment includes: </li></ul><ul><li>The Neurological or Medical Examination </li></ul><ul><li>The Neuropsychological Testing </li></ul><ul><li>The Psychosocial Evaluation </li></ul>
  7. 7. Possible Diagnosis’ <ul><li>Alzheimer’s Disease </li></ul><ul><li>Mild Cognitive Impairment </li></ul><ul><li>Probable Lewy Body Dementia </li></ul><ul><li>Vascular Dementia </li></ul><ul><li>Frontotemporal Dementia </li></ul><ul><li>Normal Pressure Hydrocephelus </li></ul><ul><li>Sleep Apnea </li></ul><ul><li>Pseudodementia- Depression </li></ul><ul><li>Epilepsy </li></ul><ul><li>Parkinson’s Disease Plus </li></ul><ul><li>Alcohol Related Dementia </li></ul>
  8. 8. Imaging Studies <ul><li>Extremely helpful tool in diagnosing which particular type of memory disorder is likely present. A trained physician can now identify classic Alzheimer’s Disease with 98% certainty. </li></ul>
  9. 9. Alzheimer’s Disease
  10. 10. What is Alzheimer’s Disease? <ul><li>The most common cause of dementia </li></ul><ul><li>Irreversible, progressive disease </li></ul><ul><li>Affects the brain by destroying neurons – first in the hippocampus (memory area of the brain) then spreading to other areas </li></ul><ul><li>Neuron degeneration is felt to be from plaques consisting of beta amyloid proteins that are deposited and tangles in nerve cells </li></ul>
  11. 11. Is it in the Water? <ul><li>“ Why are so many people ‘getting it’ “ is a common question. </li></ul><ul><li>We do not know the exact cause nor do we have a cure. Latest research is focusing on diet and lipids. </li></ul><ul><li>This is a disease that, predominantly affects those > 65. </li></ul><ul><li>As we are living longer, the prevalence is thus higher. </li></ul>
  12. 12. Neuropsychological Testing <ul><li>Following testing, individuals with MCI show an isolated memory loss. Those with Alzheimer’s Disease show a pattern of increased difficulty with memory, categorical fluency, orientation, and emerging problems in construction and calculations. </li></ul>
  13. 13. Exercise <ul><li>Name as many animals as you can in 1 minute </li></ul><ul><li>Measures catagorical fluency </li></ul><ul><li>Individuals with some form of progressive memory disorder will score less than 12 and should be evaluated. </li></ul><ul><li>A better predictor of Alzheimer’s disease or MCI than the Mini Mental and can easily be used quickly as a screen in doctor’s offices </li></ul>
  14. 14. Mild Cognitive Impairment <ul><li>Being researched as a likely “pre-cursor” to Alzheimer’s Disease- consists of mild memory loss that appears progressive in nature </li></ul><ul><li>It is crucial that these individuals are assessed as early preventative interventions are showing promise in delaying the onset or “conversion” to Alzheimer’s Disease! </li></ul>
  15. 15. Assessment Questions <ul><li>Short term memory loss? </li></ul><ul><li>Financial management </li></ul><ul><li>Repetitive questions? </li></ul><ul><li>Depression? Anxiety? </li></ul><ul><li>Misplacing items or hiding items? </li></ul><ul><li>Orientation to person, place and time </li></ul><ul><li>Change in ability to perform hobbies or household tasks? </li></ul><ul><li>Occupational issues? </li></ul>
  16. 16. Depression Screen <ul><li>It is also important to address depression using a depression screening tool such as the Geriatric Depression Scale or Beck Depression Inventory. </li></ul><ul><li>Why? Studies suggest between 20 and 30% of dementia patients in early stages develop Major Depressive Disorder and between 30-40% in middle stages. Not uncommon, depressive symptoms need to be monitored closely on a frequent basis and treated appropriately. </li></ul>
  17. 17. Characteristics - Early <ul><li>Short term memory loss and asking questions repeatedly are often the first signs </li></ul><ul><li>Inability to complete familiar tasks </li></ul><ul><li>Difficulty learning and retaining new information </li></ul><ul><li>Misplacing items, often in inappropriate places </li></ul><ul><li>A growing awareness of subtle changes may cause depression and frustration. </li></ul>
  18. 18. Moderate <ul><li>Forgetting to turn off stoves, appliances </li></ul><ul><li>Emerging safety concerns </li></ul><ul><li>Problems with calculations and financial management </li></ul><ul><li>Inappropriate in public </li></ul><ul><li>More problems communicating, reading, writing </li></ul>
  19. 19. Severe <ul><li>Severe loss of memory </li></ul><ul><li>May be unable to recognize loved ones </li></ul><ul><li>More hallucinations or delusions </li></ul><ul><li>Void of emotion </li></ul><ul><li>Needs assistance with all personal cares </li></ul><ul><li>Difficulty chewing or swallowing. </li></ul>
  20. 20. Treatments <ul><li>Cholinesterase Inhibitors are being used to slow the progression with good success: </li></ul><ul><ul><li>Aricept </li></ul></ul><ul><ul><li>Razadyne </li></ul></ul><ul><ul><li>Exelon </li></ul></ul><ul><ul><li>Other medication often used in conjunction with cholinesterase inhibitors (NMDA receptor antagonist) </li></ul></ul><ul><ul><li>Namenda </li></ul></ul>
  21. 21. Key Psychosocial Issues <ul><li>Individuals and families coping with Alzheimer’s Disease require ongoing support as the disease progresses. </li></ul><ul><li>A referral to the local Alzheimer’s Association is recommended for ongoing needs </li></ul><ul><li>Although there is “staging” documented and many follow the pattern loosely, everyone has a unique, individual experience. </li></ul>
  22. 22. Supportive Approaches <ul><li>Care partners have various thresholds in terms of their ability to manage the care of someone with progressive Alzheimer’s Disease. </li></ul><ul><li>Goal is to tackle each symptom as it emerges and seek manageable solutions </li></ul><ul><li>Behavior issues are often signs of unmet, unexpressed needs. </li></ul><ul><li>Important to increase activity level and provide cognitive “exercise” as well as physical and social activity. </li></ul>
  23. 23. The Alzheimer’s Association <ul><li>Excellent organization for all types of memory disorders </li></ul><ul><li>Provide support, education, advocacy and programming encompassing all aspects of the disease to individuals and their care partners. </li></ul>
  24. 24. Other Resources for Individuals and Care Partners <ul><li>Adult Day Centers </li></ul><ul><li>Home health agencies </li></ul><ul><li>Respite care </li></ul><ul><li>Transportation resources </li></ul><ul><li>Care consultants </li></ul><ul><li>Assisted living options </li></ul><ul><li>County Departments on Aging / Benefit Specialists </li></ul><ul><li>Aging and Disability Resource Centers </li></ul><ul><li>Elder Law Attorney </li></ul>
  25. 25. Support Groups <ul><li>Support groups are very valuable and take many forms. Groups exist for: </li></ul><ul><ul><li>MCI patients </li></ul></ul><ul><ul><li>Early onset Alzheimer’s disease </li></ul></ul><ul><ul><li>Care partners (spouses, family, etc) </li></ul></ul><ul><ul><li>Adult Children of people with Alzheimer’s Disease </li></ul></ul><ul><ul><li>Early stage Alzheimer’s Disease </li></ul></ul>
  26. 26. Key Resources <ul><li>Books and Magazines: </li></ul><ul><ul><li>The 36 Hour Day – Mace and Rabins </li></ul></ul><ul><ul><li>A Dignified Life: The Best Friend’s Approach to Alzheimer’s Care – Bell and Troxel </li></ul></ul><ul><ul><li>Reminiscence magazine (Reiman Public.) </li></ul></ul><ul><ul><li>Aging with Grace - Snowdon </li></ul></ul><ul><ul><li>Learning to Speak Alzheimer’s - Coste </li></ul></ul><ul><ul><li>Mayo Clinic on Alzheimer’s Disease - Peterson </li></ul></ul>
  27. 27. Resources continued: <ul><li>Websites: </li></ul><ul><ul><li>www.alz.org – The Alzheimer’s Assoc. </li></ul></ul><ul><ul><li>www.alzheimers.org - Alzheimer’s Disease Education and Referral Center </li></ul></ul><ul><ul><li>www.alzstore.com – The Alzheimer’s Store </li></ul></ul><ul><ul><li>www.cwag.org – Coalition of WI Aging Groups </li></ul></ul><ul><ul><li>www.dhfs.state.wi.us/aging/dementia - WI Bureau of Aging & Long Term Care Resources </li></ul></ul><ul><ul><li>www.mayoclinic.com – Mayo Clinic Health Info </li></ul></ul>
  28. 28. Lewy Body Dementia
  29. 29. Lewy Body Dementia <ul><li>A progressive brain disease and second leading cause of dementia in elderly. (20% of all dementia cases) </li></ul><ul><li>Appears to affect men more than women </li></ul><ul><li>Consists of protein deposits or “lewy bodies” that are widespread throughout the brain. Often the memory area looks fine on imaging. </li></ul><ul><li>Cognitive decline occurs prior to or concurrent with parkinsonian features </li></ul><ul><li>Earlier age of onset than Alzheimer’s </li></ul>
  30. 30. Characteristics <ul><li>A probable Lewy Body Disease is defined when one meets 2 out of the 3 symptoms: </li></ul><ul><ul><li>Fluctuating Cognition with clear variations in alertness. </li></ul></ul><ul><ul><li>Recurrent visual hallucinations that are very detailed </li></ul></ul><ul><ul><li>Parkinsonism – muscle stiffness and rigid, slowed movements </li></ul></ul>
  31. 31. Other Suggestive Features <ul><li>REM sleep disorders – vivid dreams, purposeful and sometimes violent movements </li></ul><ul><li>Severe sensitivity to neuroleptics (medications for psychiatric symptoms) </li></ul><ul><li>Abnormal depth perception – problems in visuospatial skills </li></ul><ul><li>Mood lability, depression, aggression </li></ul>
  32. 32. Neuropsychological Testing <ul><li>Individuals with LBD have difficulty in the following areas of cognitive thinking: </li></ul><ul><ul><li>Orientation </li></ul></ul><ul><ul><li>Construction </li></ul></ul><ul><ul><li>Perception </li></ul></ul><ul><ul><li>Memory </li></ul></ul>
  33. 33. Hooper Visual Organization Test <ul><li>30 “puzzle” pictures </li></ul><ul><li>Indicator of visuospatial skills and posterior functioning. </li></ul><ul><li>Shows how we perceive and make sense of the world around us. </li></ul><ul><li>Often a good predictor of whether or not someone should be retested for driving abilities. </li></ul>
  34. 34. Hooper Visual Organization Example
  35. 35. Answer: <ul><li>LIGHTHOUSE </li></ul>
  36. 36. Clock Draw Example <ul><li>Goal- To draw the face of a clock, put the numbers in the correct positions, and indicate the time at 11:10. </li></ul>
  37. 37. Key Psychosocial Issues <ul><li>Families and affected person may be dealing early on with safety issues involving the physical issues, hallucinations, and misperceptions (often leading to trouble with driving). </li></ul><ul><li>Also, the inconsistency of symptoms and confusion, creates stress as the family never quite knows what is coming next. </li></ul><ul><li>Loved one may not recognize family or home at an earlier stage. </li></ul>
  38. 38. Assessment Questions <ul><li>Sleep disturbance? </li></ul><ul><li>Gait disturbance / Falls? </li></ul><ul><li>Appears socially withdrawn at times </li></ul><ul><li>Variable symptoms? </li></ul><ul><li>Hallucinations? </li></ul><ul><li>Disorientation? </li></ul><ul><li>Suspiciousness? </li></ul><ul><li>Wandering? </li></ul><ul><li>Apparent slowed processing verbally and physically </li></ul><ul><li>Other behavior problems or aggression? </li></ul>
  39. 39. Supportive Approaches <ul><li>Families struggle with misperceptions- benefit from support of others in same situation (support groups). Care partners need respite! </li></ul><ul><li>Often occurs at a younger age- grieve loss of retirement plans, etc. </li></ul><ul><li>Individual often very insecure without loved one </li></ul><ul><li>More rapid course than AD </li></ul><ul><li>Physical and communication issues in addition to cognitive </li></ul>
  40. 40. Common Interventions <ul><li>Due to Parkinsonism, individual is at a higher fall risk. Need to adapt environment and consider a Physical therapy evaluation </li></ul><ul><li>Misperceptions! Eg. May perceive that a black rug is a hole, or texture change represents a different height/level. Occupational therapist evaluation, adjusting home environment, adjusting lighting and visual cues </li></ul><ul><li>Wandering Risk – easily disorientated- Obtain Safe Return </li></ul><ul><li>Driving Issues – becomes lost or does not recognize once familiar landmarks. Driver evaluation and subsequent referral to transportation resources suggested </li></ul>
  41. 41. Treatments for LBD <ul><li>Cholinesterase inhibitors (medications approved for Alzheimer’s Disease) tend to work even better for people with LBD </li></ul><ul><li>Parkinson’s Disease medications often help with the symptoms related to movement </li></ul><ul><li>It is important to diagnose LBD as some antipsychotic medications given for hallucinations can cause severe reactions in patients with this disease. (eg. Haldol) </li></ul>
  42. 42. Key Resources <ul><li>The Alzheimer’s Association </li></ul><ul><li>The Lewy Body Dementia Association </li></ul><ul><li>Websites: </li></ul><ul><ul><li>www.lewybodydementia.org LBD Assoc. </li></ul></ul><ul><ul><li>www.zarcrom.com/users/alzheimers/odem/od-d.html Directory of other Dementias </li></ul></ul><ul><ul><li>www.alz.org – The Alzheimer’s Assoc. </li></ul></ul>
  43. 43. The Frontotemporal Dementias
  44. 44. Frontotemporal Dementias <ul><li>Neurodegenerative changes in the frontal and temporal lobes of the brain </li></ul><ul><li>Several types depending on which areas show damage – eg. Picks disease (involves only frontal lobes) </li></ul><ul><li>Occurs between the ages of 35 and 75 years (younger than AD and LBD) Some forms are genetic. </li></ul><ul><li>Many early research programs are focusing on the frontotemporal dementias and “possible” reversible causes </li></ul>
  45. 45. Characteristics <ul><li>There is generally an early loss of personal awareness and sometimes an increase in social disinhibition and mood swings. </li></ul><ul><li>Depression is common </li></ul><ul><li>Often diagnosed at an earlier age, therefore occupational problems may exist. </li></ul><ul><li>Family members are usually quite frustrated and require special counseling or support </li></ul><ul><li>More rapid progression </li></ul>
  46. 46. The Frontal Lobe - the Gatekeeper <ul><li>People who suffer from the FTDs may exhibit inappropriate behaviors in public, be less inhibited, may show mood swings, or may become quite the opposite- more depressed, apathetic and socially withdrawn. </li></ul>
  47. 47. Neuropsychological Testing <ul><li>Frontal area involves the “doing” part of the brain- executive functioning thus testing shows difficulties in the areas of: </li></ul><ul><ul><li>Behavior </li></ul></ul><ul><ul><li>Reasoning and Judgment </li></ul></ul><ul><ul><li>Planning </li></ul></ul><ul><ul><li>Initiation </li></ul></ul>
  48. 48. Neuropsychological testing continued… <ul><li>Temporal Area involves speech and language thus testing reveals difficulty with </li></ul><ul><ul><li>Naming </li></ul></ul><ul><ul><li>Comprehension </li></ul></ul><ul><ul><li>Word finding </li></ul></ul><ul><ul><li>Speech (aphasia often noted) </li></ul></ul>
  49. 49. Example – Boston Naming Test
  50. 50. Key Psychosocial Issues <ul><li>Loss of Insight: Often people with frontotemporal dementias do not have insight into their difficulties. This makes it more challenging for families to provide care and that care is occasionally met with resistance </li></ul><ul><li>Compulsive behaviors </li></ul><ul><li>Lack of empathy for others- Often the care partner desires an acknowledgement for their hard work that never comes. </li></ul>
  51. 51. Assessment Questions <ul><li>Judgment and Insight </li></ul><ul><li>Decision making, impulsivity </li></ul><ul><li>Mood changes – depression, apathy </li></ul><ul><li>Alteration in planning and initiation </li></ul><ul><li>Susceptible to sweepstakes </li></ul><ul><li>Compulsive behaviors </li></ul><ul><li>Speech and language issues </li></ul><ul><li>Socially or sexually inappropriateness </li></ul><ul><li>Work related problems </li></ul>
  52. 52. Supportive Approaches <ul><li>Often the disinhibition and behavior changes combined with the lack of insight put care partners in very difficult situations. Families benefit greatly by connecting with others. </li></ul><ul><li>Examine behaviors and look at underlying needs that are unexpressed or the emotions behind the behaviors. Document approaches and redirections that work. </li></ul><ul><li>Compulsive behaviors can be draining on loved ones. </li></ul><ul><li>Need to choose battles wisely! </li></ul>
  53. 53. Communication <ul><li>As the temporal lobes become damaged, one will often will see changes in ability to express self and converse with others. </li></ul><ul><li>A referral to a speech therapist and communication books may be helpful </li></ul>
  54. 54. Treatments <ul><li>The cholinesterase inhibitors (Alzheimer’s medications) work in approximately 1 in 3 patients with FTD. We are not sure why. </li></ul><ul><li>SSRIs or specific anti-depressants are being investigated as chemically beneficial and also help control behavior symptoms and accompanying depression </li></ul>
  55. 55. Key Resources <ul><li>Books: </li></ul><ul><ul><li>The 36 Hour Day – Mace and Rabins </li></ul></ul><ul><ul><li>What if it’s Not Alzheimer’s? A Caregiver’s Guide to Dementia – Radin and Radin </li></ul></ul><ul><ul><li>Websites: </li></ul></ul><ul><ul><ul><li>www.alz.org – The Alzheimer’s Assoc. </li></ul></ul></ul><ul><ul><ul><li>www.ftd-picks.org – The Assoc. for Frontotemporal Dementias </li></ul></ul></ul>
  56. 56. Vascular Dementia
  57. 57. Vascular Dementia or Multi Infarct Dementia <ul><li>Caused by “hardening of the arteries” or mini silent strokes in the brain </li></ul><ul><li>The blockages of the small arteries of the brain caused by poor blood flow. Can be prevented by a heart healthy diet and other stroke prevention techniques (controlled blood pressure and cholesterol) </li></ul><ul><li>More common in those with Alzheimer’s Disease as a co-existing problem. </li></ul>
  58. 58. Characteristics <ul><li>Early on there may be changes in: </li></ul><ul><li>Memory and cognition </li></ul><ul><li>Decision-making </li></ul><ul><li>Sleep disturbance </li></ul><ul><li>Apathy </li></ul><ul><li>Sensory Loss </li></ul><ul><li>More physical limitations </li></ul><ul><li>Language problems </li></ul>
  59. 59. Assessment and Approaches <ul><li>Any or all of the above symptoms or approaches mentioned may apply dependent on where the damage has occurred in the brain. </li></ul><ul><li>A clear differentiation of diagnosis is thus important. </li></ul>
  60. 60. Treatments <ul><li>Goal is to prevent further strokes through diet and exercise. </li></ul><ul><li>Generally speaking, what is good for the heart is good for the brain </li></ul><ul><li>Anticoagulants such as Aspirin, Aggrenox, Plavix, or Vit. E are often used. </li></ul><ul><li>Cholinesterase inhibitors are utilized – Razadyne has been approved for use and has shown benefit in those with Vascular Dementia </li></ul>
  61. 61. Summary <ul><li>There are many kinds of dementia – it is inaccurate to assume “Alzheimer’s Disease” prior to a complete diagnostic assessment. </li></ul><ul><li>It is important to determine which type of memory loss one has as there are various treatments, prognosis, and expectations related to each. Some are also preventable! </li></ul><ul><li>Each form has its own unique effects on family and care partners. It is important to tailor our approach to that individual’s needs. </li></ul>
  62. 62. What Comes First? Depends on area of damage Vascular Dementia Behavior changes, apathy, language problems Frontotemporal Dementias Hallucinations, variability, movement problems Lewy Body Dementia Memory, repetition, confusion Alzheimer’s Disease
  63. 63. QUESTIONS?
  64. 64. FOR YOUR REFERENCE
  65. 65. Comprehensive Psychosocial Interventions <ul><li>Should include: </li></ul><ul><li>Assessment of psychosocial needs of the individual with the memory loss and their family. </li></ul><ul><li>Ruling out other possible contributing causes of dementia such as depression and alcoholism </li></ul><ul><li>Providing support and counseling as they journey through the various stages of the disease </li></ul><ul><li>Providing education and resources to meet ongoing needs. </li></ul><ul><li>Advocating for the individual and family. </li></ul><ul><li>Promotion of healthy lifestyle and non- pharmaceutical interventions if possible </li></ul>
  66. 66. Continued… <ul><li>Assessments of: </li></ul><ul><li>Family History of Memory Loss </li></ul><ul><li>Family Dynamics and Support Systems </li></ul><ul><li>Social and Occupational implications </li></ul><ul><li>Safety and Potential Environmental Barriers </li></ul><ul><li>Communication Issues </li></ul>
  67. 67. Continued… <ul><li>Mental health history </li></ul><ul><li>Activities of Daily Living – grooming, dressing, and bathing (The Functional Activity Questionnaire is often given) </li></ul><ul><li>IADLs- meal preparation, cleaning, shopping, money management </li></ul><ul><li>Medication compliance </li></ul>
  68. 68. Continued… <ul><li>Driving </li></ul><ul><li>Financial Planning </li></ul><ul><li>Emerging Behavioral Issues </li></ul><ul><li>Advanced Directives and Financial Planning </li></ul><ul><li>End of Life Care </li></ul>

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