REVERSIBLE DEMENTIAS. Drug/alcohol interactions Thyroid disease Tumors Malnutrition/dehydration Infections Anemia Mental Illness

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2 DEMENTIA Dementia describes a group of symptoms that are caused by changes in brain function. People with dementia lose their abilities at different rates depending on the disease causing the symptoms. Symptoms may include: Asking the same questions repeatedly Becoming lost in familiar places Being unable to follow directions Getting disoriented about time, people, and places Neglecting personal safety, hygiene, and nutrition

3 REVERSIBLE DEMENTIAS Drug/alcohol interactions Thyroid disease Tumors Malnutrition/dehydration Infections Anemia Mental Illness

4 IRREVERSIBLE DEMENTIAS Alzheimer s Disease Vascular dementia Parkinson s disease Lewy Body disease Huntington s disease Frontaltemporal Dementia/Picks Disease Creutzfeldt-Jakob disease Wernicke-Korsakoff Syndrome Traumatic brain injury 50 + more

5 VASCULAR DEMENTIA A decline in thinking skills caused by blocked or reduced blood flow to the brain. Symptoms can vary widely, depending on the severity of the blood vessel damage and the part of the brain affected. Memory loss may or may not be a significant symptom depending on the specific brain areas where blood flow is reduced. Vascular dementia symptoms may be most obvious when they happen soon after a major stroke. Sudden post-stroke changes in thinking and perception may include: Confusion Disorientation Trouble speaking or understanding speech Vision loss

6 PARKINSON'S DISEASE DEMENTIA An impairment in thinking and reasoning that eventually affects many people with Parkinson's disease. It is estimated that 50 to 80 percent of those with Parkinson's disease eventually experience Parkinson's disease dementia. Common symptoms include: Changes in memory, concentration and judgement Trouble interpreting visual information Muffled speech Visual hallucinations Delusions, especially paranoid ideas Depression Irritability and anxiety Sleep disturbances, including excessive daytime drowsiness

7 DEMENTIA WITH LEWY BODIES (DLB) A progressive dementia that leads to a decline in thinking, reasoning and independent function because of abnormal microscopic deposits that damage brain cells over time. Symptoms include: Changes in thinking and reasoning Confusion and alertness that varies significantly from time to time Parkinson's symptoms (hunched posture, balance problems and rigid muscles) Visual hallucinations Delusions Trouble interpreting visual information Acting out dreams, sometimes violently Malfunctions of the involuntary nervous system Memory loss that may be significant but less prominent than in Alzheimer's

8 HUNTINGTON'S DISEASE (HD) A progressive brain disorder caused by a defective gene which affect movement, mood and thinking skills. Some symptoms include: Uncontrolled movement of the arms, legs, head, face and upper body. Decline in thinking and reasoning skills, including memory, concentration, judgment and ability to plan and organize. Alterations in mood, especially depression, anxiety, and uncharacteristic anger and irritability. Obsessive-compulsive behavior, leading a person to repeat the same question or activity over and over.

9 FRONTOTEMPORAL DEMENTIA (FTD) A group of disorders caused by progressive cell degeneration in the brain's frontal or temporal lobes. FTD includes a range of specific disorders with different core symptoms in three main categories. Behavioral variant frontotemporal dementia (bvftd) takes its greatest toll on personality and behavior. It may begin with subtle changes that may be mistaken for depression. As bvftd progresses people often develop disinhibition, a striking loss of restraint in personal relations and social life. Primary progressive aphasia (PPA) affects language skills in early stages, but often also affects behavior as it advances. People may speak easily, but their words convey less and less meaning. For others, they may lose their ability to generate words easily, and their speech becomes halting, "tongue-tied" and ungrammatical. Ability to read and write also may be impaired. FTD movement disorders affect certain involuntary, automatic muscle functions. These disorders also may impair language and behavior.

10 CREUTZFELDT-JAKOB DISEASE (CJD) A group of rare, fatal brain disorders known as prion diseases. CJD is rare, occurring in about one in 1 million people annually worldwide. Types include: Sporadic CJD develops spontaneously for no known reason. (85% of cases) Familial CJD is a hereditary form caused by certain changes in the prion protein gene. (10% to 15% of cases) Infectious CJD is an especially rare form of CJD from exposure to an external source of abnormal prion protein. (1% of cases) Some common symptoms are: Depression Agitation, apathy and mood swings Rapidly worsening confusion, disorientation Problems with memory, thinking, planning and judgment Difficulty walking Muscle stiffness, twitches and involuntary jerky movements

11 KORSAKOFF SYNDROME A chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1). Korsakoff syndrome is most commonly caused by alcohol misuse, but can also be associated with AIDS, chronic infections, poor nutrition and certain other conditions. Korsakoff syndrome is often preceded by an episode of Wernicke encephalopathy, which is an acute brain reaction to severe lack of thiamine. The disorder is sometimes known as Wernicke-Korsakoff syndrome, but Korsakoff syndrome can also develop in individuals who have not had a prior episode of Wernicke encephalopathy. Korsakoff syndrome causes problems learning new information, inability to remember recent events and long-term memory gaps. Memory problems may be strikingly severe while other thinking and social skills are relatively unaffected. Those with Korsakoff syndrome may make up, information they can't remember. They are not "lying" but actually believe their invented explanations.

12 ALZHEIMER S DISEASE Alzheimer s is a type of dementia that effects memory, thinking and behavior. It is the most common form of dementia and accounts for 50 to 80 percent of dementia cases. The 7 Stages of Alzheimer s from provide a general idea of mental and physical changes during the course of the disease. Not everyone will experience the same symptoms or progress at the same rate.

13 7 STAGES OF ALZHEIMER'S Stage 1: No Impairment Shows no signs or symptoms. Stage 2: Very Mild Cognitive Decline Memory lapses, forgetting familiar words or location of everyday objects. No symptoms may be detected medically. Stage 3: Mild Cognitive Decline Noticeable problems with name recognition, difficulty performing tasks, trouble with planning or organizing. Trouble finding the right word.

14 7 STAGES OF ALZHEIMER'S Stage 4: Moderate Cognitive Decline Forgetting recent events, greater difficulty performing complex tasks like paying bills, forgetting one s own personal history. Mood changes. Stage 5: Moderate Severe Cognitive Decline Gaps in memory that are noticeable, becoming confused with day and time, forgetting personal information like their own address or phone number. Need assistance choosing proper clothing for the weather or occasion. Need assistance with day to day activities.

15 7 STAGES OF ALZHEIMER'S Stage 6: Severe Cognitive Decline Lose awareness of their surroundings and recent experiences, changes in sleep patterns, need assistance with toileting. Major personality and behavior changes - suspiciousness, delusions, compulsive and repetitive behavior (wringing hands, shredding tissues). Wanders and becomes lost.

16 7 STAGES OF ALZHEIMER'S Stage 7: Very Severe Cognitive Decline Need help with most daily activities including personal care, eating, and toileting. Reflexes become abnormal, swallowing can become impaired, muscles become rigid. Lose ability to sit or hold head up without support. Lose ability to hold conversations.

17 HEALTHY BRAIN VS ALZHEIMER'S BRAIN

18 SOCIAL WITHDRAWAL Dementia patients can still have an awareness that they are not thinking or behaving normal. The awareness that they are not themselves can cause them to withdraw from others to avoid embarrassment. They may start to remove themselves from hobbies or social activities and may be easily upset in places where they are out of their comfort zone.

19 UNDERSTANDING BEHAVIORS People with dementia typically cannot tell us what they want or need. Dementia patients are often found very agitated crying, yelling, begging for help and asking for directions. These behaviors can be extremely persistent. If you try to control or change their behavior, you ll most likely be unsuccessful or be met with resistance. Consider what needs the person might be trying to meet with their behaviors and try to accommodate them. In late stages of this disease, behavior may be the only sign that something is wrong.

20 UNDERSTANDING BEHAVIORS Causes of behavior changes: Pain Sleep deprivation Urgent need of bowel movement Headache Weather Barometric pressure Sundowning

21 UNDERSTANDING BEHAVIORS Sundowning is the onset or exacerbation of delirium during the evening or night with improvement or disappearance during the day. Ease confusion by: Turning on more lights Closing blinds and curtains Reassure the patient they are safe Offer an activity for distraction Offer snacks or finger food

22 UNDERSTANDING BEHAVIORS Memory impairment and disorientation can cause people to forget where they are. Patients may be very upset and state repeatedly I want to go home. When they want to go home, it signals a desire for a sense of safety and familiarity. Bring the patient home by reuniting her with her favorite memories of what home represents.

23 UNDERSTANDING BEHAVIORS People with dementia commonly affiliate with important roles they have taken on in the past. A past job may still be very meaningful to them. Patients may believe they are still at work. They might treat you like an employee & tell you they need the paperwork finished by the end of the day. Use this moment to create an activity that can contribute to a sense of purpose.

24 UNDERSTANDING BEHAVIORS Dementia patients can lose the ability to determine if something is food. They might be found putting all sorts of things in their mouth. Activity supplies (beads, pen caps) Toothpaste Food wrapper

25 COMBATIVE BEHAVIORS Dementia patients can be combative. Deter combative behavior by: Always avoid startling a dementia patient. Position your approach so they see and hear you coming. Avoid looming over a dementia patient. Avoid large or sudden gestures. Dementia patients can be very suspicious so make sure they can always see what you are doing in their space.

26 PERCEPTION Refusal to walk in a certain area may indicate they are having trouble viewing the spatial relationships. Different floor textures might be perceived as a step up, a step down, a hole, bump or ridge. Refusal to lower their legs off of the bed could suggest they think something is under the bed. Don t reason that the floor is smooth. Don t insist there is no monster under the bed. Help them step over the false step or remove the monster for them using a garbage bag.

27 ACTIVITIES Meaningful activities that reflect the dementia patient s interests or are enjoyable to them serve to provide a sense of purpose and belonging. Find activities that are based upon the individual s strengths, rather than on the individual s problems, weaknesses or losses. Concentrate on the process, not the result Break activities into simple, easy-to-follow steps Assist with difficult parts of the task Let the individual know he or she is needed Encourage self-expression Create a routine

28 ACTIVITIES Structure activities to provide an opportunity for the dementia patient to be in control. Allow them to direct how the flow of the activity. The more choices the person with dementia can make, the more in control they feel about their life. The more in control they feel, the greater their sense of independence and self-esteem resulting in fewer behavior problems. Offer simple choices when ever possible. Would you like carrots or celery? Would you like to take a walk?

29 DEMENTIA BEHAVIORS EXAMPLE #1 Mrs. Smith is usually cooperative and pleasant. One day you find her wandering through a hallway far from her room, opening doors and trying to get out an exit door. When you try to steer her back to her room she becomes resistant, plants her feet firmly and begins shouting that she won t go with you. When you take her hand to guide her along, she swings at you with her other hand. Assumed Reason Mrs. Smith must be progressing in her disease and should now be classified as aggressive. She may need additional medication or an evaluation in a hospital.

30 DEMENTIA BEHAVIORS EXAMPLE #1 Actual Behavior Cause Mrs. Smith is thirsty. She knows something is wrong and that she needs something, but she doesn t know how to meet the need, or what she should do to find water. So she is wandering the halls, looking for some clue that will help her know what she needs to do. When you try to prevent this activity, she naturally becomes angry at your efforts to keep her from meeting an important need. She feels she is defending herself from someone who is trying to harm her.

31 DEMENTIA BEHAVIORS EXAMPLE #2 Mr. Jones is not normally incontinent. Recently, however, he has begun walking outside to relieve himself. Sometimes the workers find he has urinated in wastebasket. Occasionally he wets himself. He has started to wander and he often seems anxious and agitated. Assumed Reason Mr. Jones has lost the ability to control his bladder and should be placed in adult incontinent briefs.

32 DEMENTIA BEHAVIORS EXAMPLE #2 Actual Behavior Cause Mr. Jones cannot find the toilet. In this facility the white toilets blend in with the creamcolored tiles and walls, and his dementia has begun causing visual loss. Mr. Jones simply cannot see the toilets. He spends much of the day looking for a place to urinate, but when he can t find one he relieves himself outside or in a wastebasket, most of which are brightly colored and easy to see.

33 DEMENTIA BEHAVIORS EXAMPLE #2 Resolution Place a brightly colored toilet seat or toilet cover on the commode to help him locate it. When you see Mr. Jones wandering anxiously in the halls or acting agitated, ask if you can help him find a bathroom and then guide him to one.