The document discusses a training program provided by the Alzheimer Society of Calgary to educate direct care providers and families about dementia, depression, and delirium. The program consisted of workshops that helped participants understand the relationship between these conditions, recognize their signs and symptoms, and appreciate a person-centered approach to care. An evaluation found the training increased participants' knowledge and understanding. Lessons learned include the need for continued education on these topics and recognizing the Alzheimer Society's role in supporting staff and families.

1. Dementia – Depression -Dementia – Depression -
DeliriumDelirium
Understand the relationship, Recognize the signs andUnderstand the relationship, Recognize the signs and
symptomssymptoms
Dementia Care Training Centre - 2007Dementia Care Training Centre - 2007

2. 1.1. Dementia Care Training CentreDementia Care Training Centre
2.2. Guiding principlesGuiding principles
3.3. Sharing our storySharing our story
4.4. OutcomesOutcomes
5.5. Lessons learnedLessons learned
No More Business as UsualNo More Business as Usual

3. A core business of Alzheimer Society ofA core business of Alzheimer Society of
CalgaryCalgary
Includes staff training and family educationIncludes staff training and family education
Guiding PrinciplesGuiding Principles
Person-centredPerson-centred
Outcomes drivenOutcomes driven
Supporting Excellence in Dementia CareSupporting Excellence in Dementia Care
Dementia Care Training CentreDementia Care Training Centre

4. More than 10,000 people diagnosed withMore than 10,000 people diagnosed with
Alzheimer’s diseaseAlzheimer’s disease
Limited recognition of delirium amongLimited recognition of delirium among
direct care providersdirect care providers
Cognitive Impairment StrategyCognitive Impairment Strategy
National Guidelines for Seniors MentalNational Guidelines for Seniors Mental
HealthHealth
What was happening in CalgaryWhat was happening in Calgary

5. ““No one in a better position than the AlzheimerNo one in a better position than the Alzheimer
Society to educate staff and families about theSociety to educate staff and families about the
importance of delirium”importance of delirium”
““Staff need to recognize the symptoms, who andStaff need to recognize the symptoms, who and
how to report what they see”how to report what they see”
AlzheimerAlzheimer Society ResponsibilitySociety Responsibility

6. Sharing Our StorySharing Our Story
Workshop Learning ObjectivesWorkshop Learning Objectives
To understand the termsTo understand the terms dementiadementia,, depressiondepression && deliriumdelirium
To recognize the signs and symptoms of dementia,To recognize the signs and symptoms of dementia,
depression and deliriumdepression and delirium
To appreciate the difficulty of co-existence andTo appreciate the difficulty of co-existence and
interrelations of the dementia, depression, deliriuminterrelations of the dementia, depression, delirium
To understand the diagnostic processTo understand the diagnostic process
To appreciate a person-centred approach to careTo appreciate a person-centred approach to care

7. Workshop OutlineWorkshop Outline
The Marvellous Healthy BrainThe Marvellous Healthy Brain
Causes of Cognitive ImpairmentCauses of Cognitive Impairment
Functions & Damages of the BrainFunctions & Damages of the Brain
Irreversible Types of DementiaIrreversible Types of Dementia
Reversible Causes of DementiaReversible Causes of Dementia
Depression & DeliriumDepression & Delirium
Understanding the DistinctionsUnderstanding the Distinctions
The Diagnostic ProcessThe Diagnostic Process
Person-Centered CarePerson-Centered Care

8. The Healthy Brain - IntroductionThe Healthy Brain - Introduction
The brain weighs approx. 3 lbs. – 7 cups
Structural & Functional Organization
The brain consists of brain cells
(neurons) that connect to each other
through their axons, dendrites and
synaptic connections.
Neural networks: 1012
(100 billion)
neurons has on average 7k-10k
connections (total 1000 trillion).
another SENSATIONal fact:
“the little man” Homunculus

9. Causes of Cognitive ImpairmentCauses of Cognitive Impairment
developmental disabilitiesdevelopmental disabilities
brain injurybrain injury
mild cognitive impairmentmild cognitive impairment
dementiadementia
What is Dementia?What is Dementia?

10. Areas of the BrainAreas of the Brain
Structure &Structure & FunctionsFunctions
Limbic System

12. Non-Reversible Types of DementiaNon-Reversible Types of Dementia
Alzheimer’s diseaseAlzheimer’s disease
Vascular DementiaVascular Dementia
Dementia with LewyDementia with Lewy
bodiesbodies
FrontoFronto
-Temporal Dementia-Temporal Dementia
Others:Others:
Parkinson’s DiseaseParkinson’s Disease
Huntington’sHuntington’s
DiseaseDisease
Creutzfeldt JakobCreutzfeldt Jakob
DiseaseDisease
ProgressiveProgressive
Supranuclear PalsySupranuclear Palsy
Korsakoff’sKorsakoff’s
SyndromeSyndrome
Infection-RelatedInfection-Related
Dementia (HIV,Dementia (HIV,
Syphilis)Syphilis)

13. Reversible Causes of DementiaReversible Causes of Dementia
MalnutritionMalnutrition
DehydrationDehydration
Metabolic DysfunctionMetabolic Dysfunction
Vitamin B12 DeficiencyVitamin B12 Deficiency
DepressionDepression
DeliriumDelirium

14. DepressionDepression
Signs & Symptoms:Signs & Symptoms:
Sad or depressed most of the time (mood)Sad or depressed most of the time (mood)
“emptiness”“emptiness”
Feelings of anxiety (various forms) andFeelings of anxiety (various forms) and
psychomotor agitationpsychomotor agitation
Changing appetite and weight loss/gainChanging appetite and weight loss/gain
Sleep DisturbancesSleep Disturbances
Loss of interest/Lack of motivationLoss of interest/Lack of motivation
Concentration or Memory problemsConcentration or Memory problems
Social WithdrawalSocial Withdrawal
Thoughts of death/Suicidal RiskThoughts of death/Suicidal Risk

15. Depression in the Elder PopulationDepression in the Elder Population
Common atypical features :Common atypical features :
Psychotic features (paranoidPsychotic features (paranoid
delusions)delusions)
SomatizationSomatization
The “dwindles” (*)The “dwindles” (*)
Potential Issues:Potential Issues:
Suicide risk is highSuicide risk is high
Depression is an unusual soleDepression is an unusual sole
cause of cognitive impairmentcause of cognitive impairment
Depression often co-exists withDepression often co-exists with
dementiadementia
Vincent van Gogh, who himself
suffered from depression and
committed suicide, painted this
picture in 1890 of a man that can
symbolize the desperation and
hopelessness felt in depression.

16. DeliriumDelirium –– Core Features (DSM-IV)Core Features (DSM-IV)
Disturbance in consciousnessDisturbance in consciousness (i.e., reduced(i.e., reduced
clarity of awareness of the environment) withclarity of awareness of the environment) with
reduced ability to focus, sustain, or shift attention;reduced ability to focus, sustain, or shift attention;
A change in cognitionA change in cognition (i.e., memory deficit,(i.e., memory deficit,
disorientation, language disturbance) or thedisorientation, language disturbance) or the
development of a perceptual disturbance that is notdevelopment of a perceptual disturbance that is not
better accounted for by a preexisting, established,better accounted for by a preexisting, established,
or evolving dementia; andor evolving dementia; and
The disturbance develops over a short period ofThe disturbance develops over a short period of
timetime (usually hours to days) and tends to fluctuate(usually hours to days) and tends to fluctuate
during the course of the day.during the course of the day.

17. Delirium can occur as a consequence ofDelirium can occur as a consequence of
A general medical conditionA general medical condition
Substance intoxicationSubstance intoxication
Substance withdrawalSubstance withdrawal
Multiple causesMultiple causes
Often arises as an interplay of predisposing andOften arises as an interplay of predisposing and
precipitating factors.precipitating factors.
Furthermore:Furthermore:
In general, the greater the vulnerability of theIn general, the greater the vulnerability of the
person, the higher the likelihood of deliriumperson, the higher the likelihood of delirium
occurring.occurring.
It is not always possible to firmly establish theIt is not always possible to firmly establish the
specific etiology of the delirium in an older person.specific etiology of the delirium in an older person.

18. Comparison of the Clinical FeaturesComparison of the Clinical Features
DementiaDementia DepressionDepression DeliriumDelirium
Insidious/slow andInsidious/slow and
often unrecognized;often unrecognized;
depends on causedepends on cause
Coincides with majorCoincides with major
life changes; oftenlife changes; often
abrupt, but can beabrupt, but can be
gradualgradual
Sudden/abrupt;Sudden/abrupt;
depends on cause;depends on cause;
often at twilight or inoften at twilight or in
darknessdarkness
Clinical Features:Clinical Features: ONSETONSET
COURSE, PROGRESSION, ATTENTION,
MEMORY, THINKING

19. Principles of Person Centred CarePrinciples of Person Centred Care
UniquenessUniqueness
ComplexityComplexity
EnablingEnabling
PersonhoodPersonhood
Value of othersValue of others

20. OutcomesOutcomes
40 people trained40 people trained
3 workshops to date3 workshops to date
Participants: acute care, long-term care,Participants: acute care, long-term care,
developmental disabilities, adult daydevelopmental disabilities, adult day
support, independent seniors residences,support, independent seniors residences,
seniors community resources, Calgaryseniors community resources, Calgary
and Edmonton health regionand Edmonton health region

21. I have an understanding of the term dementia…
(N=15)
0%
6%
0%
69%
25%
0% 0% 0%
33%
67%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Strongly Disagree Disagree No Opinion - Neutral Agree Strongly Agree
Agreement
PRIOR
AFTER

22. I understand the various consequences of dementia…
(N=15)
0%
6%
13%
63%
19%
0% 0% 0%
40%
60%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Strongly Disagree Disagree No Opinion - Neutral Agree Strongly Agree
Agreement
PRIOR
AFTER

23. I understand the relationship between dementia, depression and dleirium…
(N=15)
7%
27%
13%
40%
13%
0% 0% 0%
60%
40%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Strongly Disagree Disagree No Opinion - Neutral Agree Strongly Agree
Agreement
PRIOR
AFTER

24. Lessons LearnedLessons Learned
Direct care providers across the care continuumDirect care providers across the care continuum
recognize their need to learn more aboutrecognize their need to learn more about
dementia, depression and delirium and reportingdementia, depression and delirium and reporting
requirementsrequirements
Family members are beginning to recognize theFamily members are beginning to recognize the
importance of understanding the relationshipimportance of understanding the relationship
between dementia, depression and deliriumbetween dementia, depression and delirium
The Alzheimer Society plays a key role inThe Alzheimer Society plays a key role in
educating and supporting staff and familieseducating and supporting staff and families
about deliriumabout delirium

25. Thank you!Thank you!
If you have any questions or comments,If you have any questions or comments,
please contact us atplease contact us at
Telephone: 290-0110Telephone: 290-0110
Email: info@alzheimercalgary.comEmail: info@alzheimercalgary.com
or have a look at our website:or have a look at our website:
www. AlzheimerCalgary.comwww. AlzheimerCalgary.com