記憶奪寶 應用工作坊. Outline. Prevalence. Dementia 記憶力 記憶奪寶 詳盡版 評估工具 示範及練習 正常老化 早期記憶衰退 輕度認知缺損 老年痴呆症. Progressive deterioration in intellectual area

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1 Outline 記憶奪寶 應用工作坊 記憶力 記憶奪寶 詳盡版 評估工具 記憶奪寶 1-8 課 示範及練習 Rebecca SHIU 蕭婉容職業治療師 6&16/7/2010 正常老化 Normal Ageing 早期記憶衰退 Early Memory Loss 輕度認知缺損 Mild Cognitive Impairment 老年痴呆症 Dementia (in stages of mild, moderate, & severe) 8-15% MCI to be AD each year Successful aging Normal aging Prevalence Study shown that 8-15% of people with MCI to be Alzheimer s Disease 8.5% MCI at aged 70 or above 9.3% dementia at aged 70 or above Dementia Progressive deterioration in intellectual area interfere social & occupational functioning Statistics Data by DH 2006 In lack of golden standard in diagnosis of older people with Mild Cognitive Impairment (MCI) 6 1

2 Types of Dementia DSM IV classification Senile Dementia of the Alzheimer s Type Vascular Dementia (multi-infarct Dementia) Dementia due to other General Medical conditions : Lewy Body Dementia Alzheimer s Disease Progression nerve cell networks damaged plaques & tangles 7 8 Vascular Dementia Progression Disease Progression in Stages Infarction : obstruction of blood circulation Ischaemic condition of brain due to embolismhypertension /CVA Mild / Early Stage Moderate / Middle Stage Severe / Late Stage 9 10 Symptoms of Dementia Memory impairment Short term memory impaired (cannot learn new things) Disorientation to Time/ Place/ Persons Long term memory impaired (cannot retrieve past information) Symptoms of Dementia Aphasia (difficulty in finding words) Expressive Receptive Agnosia (failure to recognize objects despite intact sensory function) Apraxia (motor planning) ADL deterioration Loss of co-ordination

3 Behavior & Psychological Symptoms of Dementia Wandering Agitation Hitting Hoarding Disinhibition Hallucination Paranoid Early stage of Dementia Recent memory loss affecting normal function Confusion/ anxiety Loss of interest/ initiative/depression may be present Suspicious Mood/personality changes Poor judgment Take longer with routine chores Moderate Stage of Dementia Severe Stage of Dementia Increasing memory loss & confusion, shorter attention span Problems recognizing close friends/family Repetitive statements/ movements Restlessness, especially in late afternoon or night (sundowning) Catastrophic reaction Can t find right words; make up stories to fill in the blanks Perceptual-motor problems affecting ADL tasks Loss of impulse control; won t bathe, trouble dressing, wears 2-3 layers of clothing Can t recognize family or self Dependency on ADL Can t communicate verbally Double incontinence Difficulty in swallowing May put everything in mouth or touch everything MCI Memory complaints Normal activities of daily living, interfere complex tasks only Normal general cognitive function Abnormal memory for age but no dementia With memory inefficiencies corroborated by an informant 2 types of MCI Age-related cognitive decline with lower fringe of performance Definite cognitive decline but without dementia (pathological) 3

4 Sensory systems Target 海馬體 As no consent definition of MCI in Hong Kong, we search older people with Early Memory Loss always subjective memory complaint objective memory loss intact in IADL function Early Memory Loss *Early detection and early treatment is important Memory The process of Memory (Petersen 1995) Memory: the retention of knowledge over time Learning: the process of acquiring new knowledge Information presented quickly and verbally is forgotten sooner New information is more difficult to remember because it is not processed as efficiently visual auditory Somatosensory TEMPORARY STORE Short-term memory Primary memory Working memory Digit span 3 or 4 word lists Consolidation Learning Aquisition PERMANENT STORE Long term memory Secondary memory Recent, remote memory Episodic, semantic memory Word list>7 items Delayed recall Complex figure The term cognitive refers to processes or operations involved in processing of all kinds of information. Cognitive control processes are those processes that are used by the mind and brain to regulate the storage, retrieval and usage of information (thinking). 4

5 Long Term and Short Term Memory Memory Semantic Memory Memory losses occur primarily to episodic memory Semantic memories and implicit memories are largely unaffected by age Short-term memory declines gradually until age 70 5

6 Procedural Memory Factors affecting memory function Emotional difficulties Anger, anxiety, depression interference Factors affecting memory function Behavioral difficulties Impulsivity, frustration, inappropriateness Factors affecting memory function Physical dysfunction Motor impairments, eg, Parkinsonism Sensory changes, 請講出之前記住的數字 / 圖畫? headache, musculoskeletal pain 6

7 Memory Training Program Research Period: July to October 2006 Twice sessions a week 60 minutes per session Total 8 sessions Staff ratio 1:8 Design Pretest posttest design aged 65 or above elderly with self-complaint memory loss, living in community willing to learn for memory enhancement CMMSE 23 Interactive Cued cards CD ROM Brain game Homework assignment Outcome measure Mini Mental Status Examination in Chinese (CMMSE) Abbreviated Memory Inventory for Chinese sampling: 16 all are female mean aged: 77 education level: illiteracy to primary school Mattis Dementia Rating Scale Personal Wellbeing Index (PWI-ID) 7

8 Result Assessment tool Pre Post MMSE ** DRS-overall Attention ** Initiation/Perseveration Construction Conceptualization * Memory **PWI **p<0.01 ASSESSMENT Abbreviated Memory Inventory for Chinese Quick screening memory questionnaire It is derived from Memory Inventory for Chinese (MIC) Five questions 3 out of 5 is positive 3 mins administered 記憶奪寶教材套 : 附錄二 training is needed Lam et al Subjective memory complaints in Chinese subjects with mild cognitive impairment and early Alzheimer s disease. International Journal of Geriatric Psychiatry, 20,(9), pp Mini-Mental Status Examination 簡短智能測驗 In Cantonese version 6 areas Orientation Registration Attention and calculation Recall Language Visuo-construction Score range: Geriatric Depression Scale- 15 GDS- 30 (Yesavage et al., 1983) is one of the most widely used instruments for the screening of depression in later life Self-report scale with yes/no format GDS-15 ( Sheikh &Yesavage 1986) Chinese GDS ( Chiu et al 1994) Chinese GDS-15 (Lee et al 1994) 8

9 實習 記憶奪寶 課程 Five memory elements 記憶五大元素 Attention 專注力 Problem Solving 解難能力 Perception 感知能力 Registration & Recall 註冊及記錄 Verbal Fluency 口述流暢 Attention 專注力 Attention is prerequisite for learning and memory, for information needs to be attended to before it can be remembered Attention is a central executive that controls cognitive activities Attention 專注力 Alertness Focused attention Sustained attention Selective attention Alternating attention Divided attention Focused attention the ability to respond discretely to specific visual, auditory, olfactory, tactile, and gustatory stimuli 9

10 Sustained attention Sustain attention over time is dependent on maintaining levels of tonic alertness Routine tasks, e.g. shaving, watching TV, driving Selective attention the ability to focus selectively on relevant stimuli in the environment while simultaneously inhibiting irrelevant stimuli e.g. prepare a meal with children playing in the background Alternating attention involves the ability to shift one s focus from one set of stimuli to another e.g. a mother who needs to switch between attending to the needs of her child and cooking Divided attention the ability to attend to several pieces of information simultaneously e.g., listening to the news report while driving, or listening to lecture and taking notes 10

11 Registration & Recall 註冊及記錄 Registration : Encoding is a major memory process, defined as a mental activity or a type of strategy that the learner employs when studying material to be remembered Registration Recall (Immediate recall Delayed recall) Recall : require search and retrieval of information from storage without the use of any externally provided, orienting cues Verbal Fluency 口述流暢 speak out items under specific category as many as possible within 1 minutes it related to working memory 請你講出於 港鐡站名, 愈多愈好 請你講出於 補腦 的食品 Perception 感知能力 ability to perceive information and is regarded as the first step and prerequisite to higher function relied on perceiver s experience and previous knowledge relied on sensory areas: visual, spatial, auditory and tactile 11

12 Problem Solving 解難能力 Problem solving is a behavior directed toward achieving a goal Involves breaking the goal down into hierarchical tasks that achieving the goal Reasoning Logical thinking Judgment Execution 當你搭小巴, 要付款時才發現八達通卡的金額已不敷應用, 你會怎樣處理呢? 訓練內容 時段 : 一周二節, 每節一小時 課程有 8 節 訓練員 :1 學員 :10 * 學員需要完成長者手冊的習作 單元主題物資課題長者練習 1 互相認識, 認識普通善忘 輕度認知缺損 CD 1.1, ,3-4 2 考定力, 畫中畫 CD, 圖卡 ,6,10,11 3 講故佬, 先後有序圖卡 3.5,3.6 12,13 4 分 功 合作, 區區有別 記憶奪寶 訓練 自備道具 1-8 課 左思右想, 沿途購物樂圖卡 5.6,5.8, 熱門話題, 聲相記憶 CD 6.2, 路路暢通, 社區地標考考你, 購物樂逍遙圖卡 介紹記憶輔助工具, 如何使用記事簿, 補腦食療, 自備道減壓技巧, 相識滿天下具 8.1,

13 圖卡示範 畫中畫 先後有序 講故佬 聯想咭 社區地標 / 路路暢通 水火既濟功示範 13