9/8/2017. Dementia Symptoms. Judi Kelly Cleary, CDP, ALFA Executive Director, Branchlands

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1 Judi Kelly Cleary, CDP, ALFA Executive Director, Branchlands What Dementia is, and the types of Dementia The stages of an Alzheimer s Disease Type of Dementia Effective Support Strategies at the Various Stages Objectives: You will be able to implement one or more practical techniques to interact with a person with dementia to lower stress and improve quality of life. Dementia Symptoms Problems with memory Problems with thinking, attention, planning and problem solving Difficulty with communication Changes in personality/behaviors Problems with spatial awareness (visual perceptions, depth perception, etc.) 1

2 Main Types of Dementia Up to 70 80% of dementia cases are caused by Alzheimer s Disease Another 20 30% are caused by Lewy Body Dementia, Vascular Dementia or Mixed Dementia Other types or causes of Dementia: Frontal Temporal Dementia, Normal Pressure Hydrocephelus, Parkinson s Disease, Syphilis, Creutzfeldt Jakob Disease, Pick s Disease, Multiple Sclerosis, Celiac Disease, Lupus, Lyme Disease, Hypothyroidism, Vitamin B12 deficiency, Dehydration, Malnutrition, Excessive alcohol use, Infections, chronic stress, and more Alzheimer s type Dementia and the Brain Brain failure causes the symptoms of dementia The hippocampus, which is the part of the brain that creates MEMORIES out of EXPERIENCES, is one of the most severely affected by Alzheimer s disease. As brain cells die, the brain actually shrinks and ceases to operate effectively Dementia Progression in Stages Early Stages (MILD) Begins to show symptoms that are noticeable to others Something is wrong, but we aren t talking about it Middle Stages (MODERATE) Behaviors and personality begin to change Will need help with daily tasks I don t know what I don t know Late Stages (SEVERE) Basic functions are difficult or impossible to complete Final stages, will not survive without assistance from others 2

3 as developed by Dr. Barry Reisberg, M.D. Stage 1: No Impairment ~ Cell damage is occurring Stage 2: Very Mild Decline ~ Difficult to tell from normal aging Stage 3: Mild Decline ~ Difficulty with complicated tasks; uses coping mechanisms (lists, excuses) Stage 4: Moderate Decline ~ Help from others is needed, but can still perform many activities independently, can do personal care, becomes more rigid about routines and time, likes to keep same patterns Stage 5: Moderately Severe Decline ~ Gaps in memory and thinking, needs help with daily tasks, difficulty following steps to complete tasks, likes to be busy but unsure what to do, embarrassed Stage 6: Severe Decline ~ Notable personality and behavior changes, inability to perform self care activities, Like to touch things, gather things, trouble finding right words, trouble using devices, unable to control impulses, Difficulty with verbal communications, not able to relate to others, losing weight, but may still be able to walk Stage 7: Very Severe Decline Final stage, loss of verbal abilities, loss of continence, eating abilities, and responsiveness to environments. Reflexive behavior, rocking, flexion, and making noises. Stage 1: No Impairment Cell damage is occurring Stage 2: Very Mild Decline Difficult to tell from normal aging Stage 3: Mild Decline Difficulty with complicated tasks Uses coping mechanisms such as lists, talking to self, making excuses. Mild Dementia Mild Decline Assist with reminders Accept excuses as valid Celebrate abilities to use coping mechanisms Cognitive Impairment will worsen when tired, in pain, stressed, hungry, etc. Needs extra time to process and make decisions (Be Patient!) Stage 4: Moderate Decline Help from others is needed, but can still perform many activities independently Can still do personal care tasks, becomes more rigid about routines and time, likes to keep same patterns Stage 5: Moderately Severe Decline Gaps in memory and thinking, needs help with daily tasks and activities Difficulty with following all of the steps to complete tasks, likes to be busy but not sure what to do, embarrassed about cognitive losses Moderate Dementia Moderate Decline Behavior can shift dramatically Personal preferences, likes/dislikes will become more intense Respects authority figures Celebrate individuality Respect choices and routines Honor irritability as a symptom of being aware of cognitive decline Do not quiz Offer information, needs repetition 3

4 Tips: Moderate Stages The person is aware that she is SUPPOSED to understand, but doesn t To be socially appropriate will pretend to understand The person will pretend to remember by confabulating (making things up that make sense, or giving vague answers) Do not quiz the person by asking questions such as do you remember such and such? or what is my name? Stage 4: Moderate Decline Help from others is needed, but can still perform many activities independently Can still do personal care tasks, becomes more rigid about routines and time, likes to keep same patterns Stage 5: Moderately Severe Decline Gaps in memory and thinking, needs help with daily tasks and activities Difficulty with following all of the steps to complete tasks, likes to be busy but not sure what to do, embarrassed about cognitive losses Moderate Dementia Moderately Severe Needs structured routine, step by step cuing Cannot make new short term memories Limited awareness of decreased abilities Uses vague words as communication skills are diminishing, language skills are being lost Emotionally, very difficult stage for the person with dementia; strong emotional reactions are normal Be aware of signs of depression and/or anxiety Celebrate long term memories Join the reality of the person, apologize and allow blame, help solve her problems (in her reality) Tips: Moderate Stages Do not ask the person questions that require detailed answers Offer (simple) choices. Show rather than using words or at the same time, because the person may answer yes or no but is really not sure what you were asking 4

5 Alternatives: Moderate Stages Call the person by the name he or she relates to Approach from the front, provide facial expressions and use a direct, friendly tone of voice Make eye contact before communicating Stage 6: Severe Decline Notable personality and behavior changes, physical changes and inability to perform self care activities Like to touch things, gather things, trouble finding right words, trouble using devices, unable to control impulses Difficulty with verbal communications, not able to relate to others, losing weight, but may still be able to walk Stage 7: Very Severe Decline Final stage, loss of verbal abilities, loss of continence, eating abilities, and responsiveness to environments Reflexive behavior, rocking, flexion, and making noises Severe Dementia Severe Decline Many changes will be made in abilities during this stage Seeks to satisfy desires, limited social skills so crosses boundaries, avoids what is disliked Very limited ability to communicate or understand communication or cues in the environment Can copy gestures, large motions, struggles to understand gestures as a form of communication Use music, rhythm, singing Provide moments of joy Limit expectations Alternatives: Moderate and Severe Stages Give TIME for the person to receive your message and communicate a response If no response is given, try the same phrase again If this does not help, try to use different words to send the same message 5

6 Alternatives: Moderate Stages Use the sound of your voice (volume, inflection, tone, rhythm) to communicate feelings and be aware that the words are secondary Do not ask someone a yes or no question if you don t want the answer to be no Keep it very simple, such as come with me or Let s stand up Stage 6: Severe Decline Notable personality and behavior changes, physical changes and inability to perform selfcare activities Like to touch things, gather things, trouble finding right words, trouble using devices, unable to control impulses Difficulty with verbal communications, not able to relate to others, losing weight, but may still be able to walk Stage 7: Very Severe Decline Final stage, loss of verbal abilities, loss of continence, eating abilities, and responsiveness to environments Reflexive behavior, rocking, flexion, and making noises Severe Dementia Very Severe Decline Comfort Care Use gentle, soothing touch End of life choices will need to be made Alternatives: Severe Stages Go Slow! Get the person s attention before beginning any communication Use gestures and facial expressions more than words 6

7 Behavior Interventions Accuse someone Dress inappropriately Want to leave Go to the bathroom Refuse to bathe Refuse to take medications Touch others or self Say inappropriate things So What? About Dementia Behaviors Dementia behaviors are coping behaviors Analyze the behavior and try to become a detective in figuring out what the reason for the behavior Then help the person with dementia to solve the problem The person with dementia cannot learn new things or use judgment and reasoning to change the behavior 7

8 Reflect on Changes to the Brain Remember the Symptoms: Problems with memory, thinking/attention, planning/problem solving, Difficulty with communication, changes in personality/behaviors and problems with spatial awareness The person cannot try harder The person cannot purposefully change behaviors The person is doing the best she can We must make accommodations for the brain deterioration It s not easy! Take care of YOURSELF 8

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