Alzheimer s Disease Neurological Bases and Informed Behavioral Interventions Peter T. Keenan Clinical Neuropsychologist Marshfield Clinic Minocqua Center What is Neuropsychology? Science of the relationship between brain health and behavior/functioning Includes examination of: Cognitive Abilities (e.g., memory) Psychological functioning (e.g., anxiety or depression) Daily functioning (e.g., managing finances) Presentation Goals By the end of this presentation you should be able to: Identify what characterizes the Alzheimer s disease process Anticipate key features and associated symptoms of Alzheimer s disease State three or more strategies for helping to support patients with Alzheimer s disease 1
Alzheimer s Disease Overview Cause: Two disease processes impact brain cells ability to function: Amyloid Plaques Neurofibrillary Tangles No clear onset of symptoms Neurons 1. Need to be able to communicate to connecting cells in order to help the brain think. 2. Need to stay healthy in order to survive and function. Overview Course: Progresses gradually over months and years as more and more brain cells are lost and brain circuits are increasingly disrupted New symptoms emerge as the disease process spreads to additional areas of the brain Source: www.alz.org 2
Why Memory? Disease starts in area of brain that is critical for forming new memories: the hippocampus Integrates information from other parts of the brain Routes signals to other areas of the brain to integrate emotional and associative content Healthy Memory Profile Attention Retention Recall Alzheimer s Disease Profile Attention Retention Recall 3
Prodromal Stage Disease Process: Changes gradually occurring in hippocampus Symptoms: Mild cognitive difficulties emerge in latter portion of this stage Increased forgetfulness Less benefit from reminders Early Alzheimer s Disease Disease Process: Expands from hippocampus to neighboring areas in brain. Symptoms: Memory difficulties increase Repeated statements and questions Limited benefit from cueing Difficulty with word finding and naming Mod. Alzheimer s Disease Disease Process: Moves to include frontal cortex and associative areas. Symptoms: Profound forgetting of new information Loss of recent memories Reduced organization and problem solving Behavioral Changes: Increased frustration/impatience More passive. Withdrawing. 4
Severe Alzheimer s Disease Disease Process: Now affecting most of the brain Symptoms: Continued loss of more recent memories May have difficulty recognizing people Increased confusion Possible hallucinations or delusions Dementia vs. Alzheimer s Dementia = Changes to the brain s health that affect functioning to the extent that a person can not function independently. Alzheimer s disease = Progressive disease of the brain. Alzheimer s disease will eventually result in dementia. Major Neurocognitive Disorder Other Conditions! Examples of other conditions that can cause cognitive issues later in life: Small vessel ischemic disease from chronic vascular conditions Stroke Parkinson s disease Lewy bodies Frontotemporal dementia Depression & Anxiety 5
Behavioral Intervention Reminders & Cues Use visible reminders that they will bump into. Consolidate information and items to one place Be patient Redirection Help person shift to another activity or topic Works better if change its something that they like to do or talk about 6
Change Environment & Access Remove cues that remind them of problematic activities Limit access to unsafe items Medications Firearms Cars! Partial Truths Limit upsetting information that they will not benefit from. Present information in a way that is reassuring at their level. Accept their reality Gently steer them to other topics. Be Calm. Reassure. We retain our ability to recognize emotions long after other abilities fade Individuals who are confused struggle to put emotions in context 7
Summary Alzheimer s is a progressive neurodegenerative disease Individuals with Alzheimer s disease do better when they are provided with support that: Takes the disease process into account. Evolves with their symptom progression Questions 8