3/9/2019. For the slides from this presentation, visit: Slides will be available for 2 weeks

Transcription

1 1 For the slides from this presentation, visit: Slides will be available for 2 weeks 2 Handouts are intended for personal use only. Any copyrighted materials or DVD content from Positive Approach, LLC (Teepa Snow) may be used for personal educational purposes only. This material may not be copied, sold or commercially exploited, and shall be used solely by the requesting individual. Copyright 2017, All Rights Reserved Teepa Snow and Positive Approach to Care Any redistribution or duplication, in whole or in part, is strictly prohibited, without the expressed written consent of Teepa Snow and Positive Approach, LLC 3 1

2 Brain Changes in Dementia 4 PET and Aging: PET Scan of 20-Year-Old Brain PET Scan of 80-Year-Old Brain ADEAR, As we age, we do not lose function in our brains, unless Something Goes Wrong with Our Brains 6 2

3 Normal vs. Not Normal Normal Aging: Slower to think Slower to do Hesitates more More likely to look before leaping Know the person but not the name Pause to find words Reminded of the past Harder Not Normal Aging: Can t think the same Can t do like before Can t get started Can t seem to move on Doesn t think it out at all Can t place the person Words won t come even later Confused about past versus now Very different 7 Cognitive Changes with Aging: - Normal changes: more forgetful and slower to learn - MCI: Mild Cognitive Impairment: Immediate recall, word finding, or complex problem-solving problems -Half these folks will develop dementia in 5 years - Dementia: Chronic thinking problems in > 2 areas - Delirium: Rapid changes in thinking and alertness, seek medical help immediately - Depression/anxiety: Chronic unless treated, poor quality of life, I don t know or I just can t responses, no pleasure, can look like agitation and confusion 8 Ten Early Warning Signs: 1. Memory loss for recent or new information, repeats self frequently 2. Difficulty doing familiar but difficult tasks: managing money, medications, driving 3. Problems with word finding, mis-naming, or misunderstanding 4. Getting confused about time or place, getting lost while driving, missing several appointments 5. Worsening judgment, not thinking thing through like before 6. Difficulty problemsolving or reasoning 7. Misplacing things or putting them in odd places 8. Changes in mood or behavior 9. Changes in typical personality 10. Loss of initiation: withdraws from normal patterns of activities and interests 9 3

4 What Could It Be? - Another medical condition symptom - Medication side effect - Hearing loss or vision loss - Depression/anxiety - Acute illness, delirium - Pain or medication for pain - Other things Drugs That Can Affect Cognition in Elders: Anti-arrhythmic agents Antibiotics Antihistamines - decongestants Tricyclic antidepressants Anti-hypertensives Anti-cholinergic agents Anti-convulsants Anti-emetics Histamine receptor blockers Immunosuppressant agents Muscle relaxants Narcotic analgesics Sedative hypnotics Anti-Parkinsonian agents Washington Manual Geriatrics Subspecialty Consults edited by Kyle C. Moylan (pg 15) published by Lippencott, Wilkins & Williams, 2003 Old: - MMSE New: Dementia Screening Options: -SLUMS: 7 minute screen -Animal fluency: 1 minute # of animals -Clock Drawing: 2 step - Full Neuropsychological testing panel 12 4

5 What Should the Doctor Do? - A thorough physical and medical history - Blood work - A neurological exam - A good history from the person and the family - A complete medication review - A CAT scan or MRI or PET scan - Neuropsychological testing: screening for cognitive changes - Follow-up and counseling, or at least a referral 13 So, What is Dementia? - It is not part of normal aging! It is a disease! - It is more than just forgetfulness, which is part of normal aging - It makes independent life impossible, eventually - It changes everything over time - It is not something the person can control - It is not always the same for every person - It is not a mental illness - It is real - It is hard at times 14 What is Dementia? It is both a chemical change in the brain and a structural change in the brain So Sometimes they can and sometimes they can t 15 5

6 Four Truths About Dementia: 1. At least 2 parts of the brain are dyingone related to memory and another part 2. It is chronic can t be fixed 3. It is progressive it gets worse 4. It is terminal it will kill, eventually 16 The person s brain is dying 17 Normal Brain Alzheimers Brain Used with permission from Alzheimers:The Broken Brain, 1999 University of Alabama 18 6

7 Storage units - data Executive Control Center: Emotions Behavior Judgment Reasoning Wiring connecting, bringing data in and sending data out 19 Hippocampus Big Changes: Learn and remember Way-finding Passage of time 20 Changes in Language Skills Vocabulary Comprehension Speech Production 21 Understanding Language Big Change 7

8 Hearing Sound Not Changed 22 Sensory Strip Motor Strip White Matter Connections: Big Changes Automatic Speech Rhythm Music Expletives: Preserved Formal Speech and Language Center: Huge Changes 23 Executive Control Center Changes: Being logical, reasonable, rational Controlling impulses Making decisions Initiatingsequencingterminatingtransitioning Being self-aware Seeing other perspectives 24 8

9 Vision Center Big Changes 25 Dementia does not equal Alzheimers does not equal Memory Problems

10 28 Alzheimers: - New information lost - Recent memory worse - Problems finding words - Misspeaks - More impulsive or indecisive - Gets lost - Notice changes over 6 months 1 year 29 Positron Emission Tomography (PET) Alzheimers Disease Progression vs. Normal Brains Normal Early Alzheimers Late Alzheimers Child 30 G. Small, UCLA School of Medicine. 10

11 Vascular Dementia: CT Scan: The white spots indicate dead cell areas caused by mini-strokes Latest Thinking About Vascular Dementia? - Lots of similarity with Alzheimer s - Manage blood flow issues carefully! - Watch for and manage depression 33 11

12 Latest Thinking about Lewy Body Treatment: - Use AChIs - Add Namenda early - Be very careful about anti-psychotic meds - Parkinson s meds may help movement but may make hallucinations and delusions worse - Anti-depressants and anti-convulsants may be used to help anxiety, sleep, and depression but can increase confusion, movement, and drowsing 34 Pick s Disease: PET Scan

13 Latest Thinking About FTD Treatments: - Consider Namenda earlier - Look at SSRI medications - May use medications used to treat OCD - May not use AChI Medications 37 Brain Atrophy: -The brain actually shrinks -Cells wither, then die -Abilities are lost -With Alzheimers, areas of loss are fairly predictable, as is the progression, but the experience is individual -With other dementias. Look for your clues. 38 Memory Loss: Losses: Immediate recall Attention to selected info Recent events Relationships Preserved Abilities: Long ago memories Confabulation Emotional memories Motor memories 39 13

14 Understanding: Losses: Can t interpret words Misses some words Gets off target Preserved Abilities: Can get facial expression Hears tone of voice Can get some non-verbals Learns how to cover 40 Sensory Changes: Losses: - Awareness of body and position -Ability to locate and express pain -Awareness of feeling in most of body Preserved Abilities: -4 areas can be sensitive -Any of these areas can be hypersensitive - Need for sensation can become extreme 41 Self-Care Changes: Losses: - Initiation and termination - Tool manipulation - Sequencing Preserved Abilities: - Motions and actions -The doing part - Cued activity 42 14

15 Language: Losses: Can t find the right words/vague language Word salad Single phrases Sounds and vocalizing Can t make needs known Preserved Abilities: Singing Automatic speech Swearing/sex words/forbidden words 43 Impulse and Emotional Control: Losses: Becomes labile and extreme Think it - say it Want it - do it See it - use it Preserved: Desire to be respected Desire to be in control Regret after action 44 Sensory Processing and Dementia: With dementia or brain change, it matters 45 15

16 Five Ways Humans Get Information: What we: - See - Hear - Feel - Smell - Taste 46 Two Major Categories of Sensory Information: - Protective - Discriminatory 47 Two Categories: Protective: Fast Reflexive Try to keep you safe Autonomic reflexive Big! Strong Emotions!!! Spinal and primitive Flight-Fight-Flight Discriminatory: Slower Brain driven Exploring and figuring out Details and differences Focused Ignore big world to experience immediate Want more or want less 48 16

17 With Dementia: Protective: -Less able to pick up on danger signals/cues -More likely to over-react to normal range -To non-demented seems unpredictable -But, it s the new predictable set point -May move toward dangerous versus away from it Discriminatory: -Either hyper-focused or unobservant -From multi-modal awareness to single characteristic attention -Shortened task attention span -Variable sensory attention -Atypical focus on a characteristic: edges of the frame versus the picture 49 With Dementia All Senses Are Affected: - Miss information - Misunderstand information - Over-react to information - Under-react to information - Get stuck on a sensation - Can t stand a sensation - Variable abilities - Can t adjust or adapt to sensation 50 Vision Changes: Protective: Peripheral awareness Visual field Depth perception Light-dark accommodation Tracking Blink Discriminatory: Organized scanning Saccadic eye movements Color discrimination Figure ground perception Near-far accommodation Near acuity Night vision Object recognition Facial recognition 51 17

18 Hearing-Comprehension Changes: Protective: Discriminatory: Direction Localization Emergency signals Comprehension Alerting communication Sound recognition Voice recognition Foreground-background Tracking Following a conversation Interpreting meaning Multi-step information 52 Touch and Movement Changes: - This one is both complicated and important! - Sensation, Processing, Reactions and Responses happen fast! Almost automatic due to habits and procedural memories: looping once started - Active versus passive: different 53 Touch: Movement: Sensations: Balance Pressure Coordination Temperature Speed Moving touch Accuracy Texture Strength Shapes Bilateral and unilateral Gross motor Fine motor Reflexes 54 18

19 Touch: Protective: Extreme Temperature Sharp, cutting High velocity impact Sustained pressure Friction Discriminatory: Variation in temperature Variable textures Massage Wet/dry Manipulation Grasp 55 Movement: Protective: Balance against gravity Block incoming Avoid contact Catch balance Maintain upright Discriminatory: Voluntary movements to meet goals Tool use Object manipulation Construction 56 Olfactory-Smell Changes: Protective (becomes limited): Smoke Chemicals or gas Spoiled food Body odor Urine or feces Discriminatory: Emotional memories Emotional reaction Pleasant-unpleasant Smell identification Stimulate hunger or thirst Stimulate nausea Localization and tracking 57 19

20 Gustatory-Taste Changes: - Less able to pick up on sweet and salty, so they want more! - Still keep bitter and sour, so they may not like things they used to - Things may taste wrong, so may order something then refuse to eat it 58 Truths About Dementia? - It changes everything over time - It is not something the person can control - It is not always the same for every person - It is not a mental illness - It is real - It is hard at times 59 Believe: People with dementia are doing the best they can! 60 20

21 Dementia is not curable, but it can be treated: - With knowledge - With skill building - With commitment - With flexibility - With practice - With support - With compassion 61 DISCLAIMER The content contained in this presentation is strictly for informational purposes. Therefore, if you wish to apply concepts or ideas contained from this presentation you are taking full responsibility for your actions. Neither the creators, nor the copyright holder shall in any event be held liable to any party for any direct, indirect, implied, punitive, special, incidental or other consequential damages arising directly or indirectly from any use of this material, which is provided as is, and without warranties. Any links are for information purposes only and are not warranted for content, accuracy or any other implied or explicit purpose. This presentation is copyrighted by Positive Approach to Care and is protected under the US Copyright Act of 1976 and all other applicable international, federal, state and local laws, with ALL rights reserved. No part of this may be copied, or changed in any format, sold, or used in any way other than what is outlined within this under any circumstances without express permission from Positive Approach to Care. Copyright 2017, All Rights Reserved Teepa Snow and Positive Approach to Care 62 To learn more about the information covered in this educational presentation, join our list. Text TEEPA to Resources are provided free of charge. Message and data rates may apply to text