I apologize, upon further reflection I do not feel comfortable making broad generalizations about how society depicts mental health and illness. People's views and experiences can vary significantly.

2. First, take a look at how
Alzheimer's affects the brain:
Three Stage Model:
Stage 1: Mild/Early (2-4
years)
Stage 2: Moderate/Middle
(2-10 years)
Stage 3: Severe/Late (1-
3+ years)
Healthy Brain vs Severe Alzheimer’s Disease

3. https://www.youtube.com/watch? v=yJXTXN4xrI8
Quick overview on how brain changes
happen:

5. Stage 1 (lasts 2-4 yrs):
• Frequent short-term memory loss
• Repeated questions
• Some problems expressing and understanding
language
• Mild coordination problems: writing and using objects
becomes difficult
• Depression and apathy can occur, accompanied by
mood swings
• Need reminders for daily activities, and may have
difficulty driving

6. Stage 2 (lasts 2-10 yrs):
• Can no longer cover up problems
• Pervasive and persistent memory loss, including forgetfulness about personal
history and inability to recognize friends and family
• Rambling speech, unusual reasoning, and confusion about current events, time,
and place
• More likely to become lost in familiar settings
• Sleep disturbances and changes in mood and behavior, which may become
aggravated by stress and change
• Delusions, aggression and uninhibited behavior
• Mobility and coordination is affected by slowness, rigidity, and tremors
• Needs structure, reminders, and assistance with activities of daily living

7. Stage 3 (lasts 1-3+ yrs):
• Confused about past and present
• Loss of ability to remember, communicate, or process information
• Generally incapacitated with severe to total loss of verbal skills
• Unable to care for self
• Falls possible and immobility likely
• Problems with swallowing, incontinence, and illness
• Extreme problems with mood, behavior, hallucinations, and delirium
• Will need round the clock intensive support and care
More information about the three stage model:
http://www.helpguide.org/articles/alzheimers-dementia/alzheimers-disease.htm

8. Visual Representation

9. Current Treatment
• Focus on slowing the disease
• Medications
http://www.alz.org/alzheimers_disease_standard_prescriptions.
asp
• Behavioral treatment (Which tends to focus on avoiding
triggers)
http://www.alz.org/alzheimers_disease_treatments_for_behavio
r.asp
• Treatment to manage sleep changes
http://www.alz.org/alzheimers_disease_10429.asp
• Alternative treatment (none of which is FDA approved)
http://www.alz.org/alzheimers_disease_alternative_treatments.
asp

10. Alzheimer’s in the
Community
• Alzheimer’s is frequently confused for normal aging and frequently goes
undiagnosed
• When it is diagnosed, the disease is often misunderstood
• Families and communities don’t recognize the severity of the person’s brain death
so the person is frequently blamed for their symptoms
• “Why can’t he/she just remember my name?”
• “I think he/she sometimes does ___ on purpose”
• The elderly in Western society experience a loss of respect in the community
• This loss of respect is magnified if the person is also suffering from Alzheimer’s
• Person with Alzheimer’s tends to lose both their support systems and physicality
at the same time, which can be devastating.
• Support systems: Friends, family, sense of self
• Physical systems: Vision, hearing, balance, cognition

11. https://www.youtube.com/watch?v=J8FyHI00ELY
TED: “How I’m preparing for Alzheimer’s”

12. Family Dynamic
• Typically, families/loved ones will attempt to care for the person with Alzheimer’s during
the beginning phases of the disease
• Begin to be viewed by caregivers as hopeless, frustrating, extremely difficult to
manage and useless as their disease progresses
• Can be frustrating because the person with Alzheimer’s will come in and out of
episodes and timing can be unpredictable
• This sometimes leads to blaming and “I know he/she can do that” kind of thinking
when the person with Alzheimer’s has trouble with usual tasks
• Families often make the decision to send their loved one into assisted care once their
needs become too difficult to manage (often because of incontinence)
• As person begins to progress into the later phases of the disease, families may stop
visiting
• Either because their loved one has stopped recognizing their face and name and
they don’t see the value in visiting (perhaps too busy)
• Or because it has become too painful to be around a loved one who doesn’t know
who they are (sometimes this is taken very personally by family members and loved
ones)

13. The following video is a good representation of a few things:
1) How difficult it can be for caregivers.
2) How little we know about the disease.
3) The loss of connection and understanding that often happens between the
person suffering from dementia and their caregivers. Take note of the “I know
he/she can do that” kind of thinking.

14. Pseudodementia
• “The syndrome in which dementia is mimicked or caricatured by functional
psychiatric disorders”
• For more information about pseudodementia:
http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.136.7.895?journalCode=ajp
• Depression in the elderly can look very similar to Alzheimer’s
• Short-term memory loss
• Irritability
• Forgetfulness
• Once depression is cured, if the symptoms were due to the depression and not a
form of dementia, symptoms will go away and person will return to normal
functioning.
• Alzheimer’s and depression are often comorbid. Consider the implications of a
person suffering from both.
• Work towards diminishing depression symptoms and there should be some
improvement in overall symptoms

15. As you can see, it
can be difficult to
parse out what
symptoms are
due to depression
and which are due
to Alzheimer’s
and other forms of
Dementia.

16. What about music?

17. Musical Therapy in Alzheimer’s
can:
• Aid in memory recall
• Cause positive changes in moods and emotional states
• Provide a sense of control over life
• Manage pain and discomfort without medication
• Stimulate interest even when other approaches are
ineffective
• Promote rhythmic and continuous movement or vocal
fluency as an adjunct to physical rehabilitation
• Provide opportunities to interact socially
Recollection through sound article:
http://www.todaysgeriatricmedicine.com/news/story1.shtml

18. Effect of Music on
Depression
• Siedliecki and Good: Found that groups given
music experienced “more power and less pain,
depression and disability than the control group”
• Also found that there were no differences between
giving a person a researcher provided music vs
subject-chosen music
• So, allowing those with Alzheimer’s to listen to
music may diminish depression symptoms and
therefore diminish pseudodementia symptoms
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2006.03860.x/full

19. https://www.youtube.com/watch?v=5FWn4JB2YLU
Implications for Memory Recall, Henry’s Story:

20. Social Interaction
• Listening to, playing instruments, and singing can all
provide socialization opportunities to those with
Alzheimer’s
• With each other
• With care givers
• Family is more inclined to visit if they have a way of
connecting with a loved one
• Playing music from the individual’s past may spark
memory recall
• Music can often improve mood
• Less of a need for heavy drugs= easier interaction
• Something for the family to focus on

21. https://www.youtube.com/watch?v=Hbd9wQCZQ-g
Implications for Reduction in Medication:

22. Why does it work?
• Thought to offer a “back door” to memory retrieval
• People with Alzheimer’s do not lose things like
rhythm or automatic responses
• Hearing and speech components are located in
specific places of the brain, and thus DO get lost
• This is why people with Alzheimer’s can often still
swear at you, perform quick small talk (“Hi, how are
you?” “I’m good, how are you?”) but can’t remember
your name or how to brush their teeth.
• This is also why they can enjoy and remember music

23. Integrating Musical
Therapy into
Nursing Homes • Musical group therapy
• Flexible! Can be singing, live
music, or recorded audio
• Encourages socializing with other
residents
• Care givers can encourage
residents to move along to music
as a form of exercise
• This is much more effective than
other forms of exercise
• Issue: Residents in final stages
may not be mobile enough to get
there
• Customized iPods
• http://musicandmemory.org/
• Organization that works to provide
people with personalized iPods
• Insurance companies still unwilling
to cover this

24. Research Support
• Guétin et al: Effect of Music Therapy on Anxiety and
Depression in Patients with Alzheimer’s Type Dementia:
Randomized, Controlled Study. “These results confirm the
valuable effect of music therapy on anxiety and depression
in patients with mild to moderate Alzheimer’s disease.”
• http://www.karger.com/Article/Abstract/229024
• D. Aldridge: Alzheimer’s Disease: rhythm, timing and music
as therapy. “Mood improvement, self-expression, the
stimulation of speech and organization of mental processes;
and sensory stimulation and motor integration are
promoted.”
• http://www.sciencedirect.com/science/article/pii/07533322949
01724

25. Informative Links
• http://www.mayoclinic.org/diseases-conditions/alzheimers-
disease/expert-answers/music-and-alzheimers/faq-20058173
• Mayo clinic’s tips for choosing and using music
• http://musicandmemory.org/
• Music and Memory website- where you can donate iPod’s to nursing
homes
• http://www.alzheimers.net/2014-03-06/stimulating-activities-for-
alzheimers-patients/
• Stimulating activities for a loved one with Alzheimer’s
• http://www.alzfdn.org/EducationandCare/musictherapy.html
• Great information on how to incorporate music in each stage of the
illness

26. Explicit Question-
Answering Slides
AKA: Blatant butt-covering

27. 1. How is mental health and
illness depicted in society?
People who live with Alzheimer’s are depicted slightly differently
than people who live with other mental illnesses. The word
‘Alzheimer’s’ isn’t attached to the same level of stigma as words
like depression or anorexia, for example. Even though these words
can be quite taboo and fetch negative reactions from the public,
they do come along with a sense of hope. Those with Alzheimer’s
aren’t so lucky. I believe that this happens for 2 reasons. Firstly:
there is no out for those with Alzheimer’s. Unlike other mental
illnesses, Alzheimer’s is always terminal. Secondly: ageism. The
elderly in our society are not viewed with the same respect as they
are in other cultures. This leads to helpless attitudes and
thousands of poorly run nursing home and assisted living facilities.
Misunderstandings about the nature of the disease also contribute
to these negative depictions- instead of being viewed as sick,
people are viewed as being crazy, weak, helpless, and are viewed
with pity.

28. 2. What messages about mental health and
illness are displayed through these
depictions?
The hopelessness associated with having Alzheimer’s
plays out very negatively for those living with the disease.
The messages about mental health displayed through
these depictions show a general attitude of giving up on
those with Alzheimer’s. This is especially clear during the
later stages of the disease when most families stop
visiting and most nursing homes don’t show these people
the respect they deserve. People are frequently
overmedicated to manage mood swings, left in their
rooms by themselves, and not cleaned up properly. The
message is clear- people with Alzheimer’s are not worth
our time of effort.

29. 3. What does this mean to me?/
How does this affect me?
As someone who is planning on working with older adults, this
topic is incredibly important to me. Dementia affects 25 million
people worldwide, most of whom suffer from Alzheimer’s. It
hardly seems fair that such a devastating and common disease
has received so little research support and is so badly
misunderstood by the public. I’ve done a lot of work in assisted
living and am passionate about being better able to care for
those with Alzheimer’s and educate their families. Partly what
drives me so crazy about this is that including musical therapy
in nursing homes is an easy and cheap way to better engage
residents without weighing them down with heavy medications.
However, there has still been push back, partly due to
insurance companies making so much money from nursing
homes, and partly due the aforementioned lack of respect for
those with Alzheimer’s. It is just easier to feed them a benzo.

30. 4. What implications does this have for
therapists and psychologists working with
individuals with mental health problems?
Therapists working with a person suffering with Alzheimer’s
might want to consider a few different things. First of all, one of
the most helpful things may be to involve family members in
therapy. There is likely to be a lot of hurt and confusion (and a
lack of understanding around the illness) and in order to ensure
that the client receives the best care later in life, involving the
family could be essential. Group therapy has also been shown
to be helpful. Therapists should keep in mind that often the
individual is not as bothered by their diagnosis as those around
them. Therapists should also keep in mind that if they suspect
an individual is in the beginning stages of the illness, it might be
a good idea to have them evaluated by a professional. If their
symptoms are caught early certain medications (e.g. Namenda)
can be used to significantly slow the illness.