different strokes for different folks: variable approaches to different forms of dementia

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Different Strokes for Different Strokes for Different Folks: Different Folks: Variable Approaches to Variable Approaches to Different Forms of Different Forms of Dementia Dementia Julie Feil, MSW, LCSW Julie Feil, MSW, LCSW The Memory Center The Memory Center Affinity Health System Affinity Health System

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Different Strokes for Different Folks: Variable Approaches to Different Forms of Dementia. Julie Feil, MSW, LCSW The Memory Center Affinity Health System. The Goals of The Memory Center. We see individuals of all ages with all forms of memory loss in various stages. - PowerPoint PPT Presentation

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Different Strokes for Different Strokes for Different Folks: Different Folks: Variable Approaches to Variable Approaches to Different Forms of Different Forms of DementiaDementia

Julie Feil, MSW, LCSWJulie Feil, MSW, LCSW

The Memory Center The Memory Center

Affinity Health SystemAffinity Health System

The Goals of The The Goals of The Memory CenterMemory Center We see individuals of all ages We see individuals of all ages

with all forms of memory loss in with all forms of memory loss in various stages.various stages.

To identify and provide treatment To identify and provide treatment options for those with memory options for those with memory disordersdisorders

To advocate for early detection!To advocate for early detection!

Why is the Diagnosis Why is the Diagnosis Important?Important?

It allows us to identify what form of memory It allows us to identify what form of memory problem we are dealing with. This results problem we are dealing with. This results in:in:

More focused education and support- More focused education and support- appropriate to family and individualappropriate to family and individual

More accurate and effective More accurate and effective pharmaceutical treatment modality choicepharmaceutical treatment modality choice

Increased awareness for families and Increased awareness for families and individualindividual

Rule out treatable causes of dementiaRule out treatable causes of dementia

It is like Stopping a It is like Stopping a Rolling Truck!Rolling Truck!

Barriers to Obtaining a Barriers to Obtaining a DiagnosisDiagnosis

Belief that it is “Just normal aging”Belief that it is “Just normal aging” Stigma attached to “Alzheimer’s Stigma attached to “Alzheimer’s

Disease”Disease” FearFear Lack of Insight into ProblemLack of Insight into Problem DenialDenial EmbarrassmentEmbarrassment

Determining the Determining the DiagnosisDiagnosis

Appointment includes:Appointment includes: The Neurological or Medical The Neurological or Medical

ExaminationExamination The Neuropsychological The Neuropsychological

TestingTesting The Psychosocial EvaluationThe Psychosocial Evaluation

Possible Diagnosis’Possible Diagnosis’

Alzheimer’s Disease Alzheimer’s Disease Mild Cognitive ImpairmentMild Cognitive Impairment Probable Lewy Body DementiaProbable Lewy Body Dementia Vascular DementiaVascular Dementia Frontotemporal DementiaFrontotemporal Dementia Normal Pressure HydrocephelusNormal Pressure Hydrocephelus Sleep ApneaSleep Apnea Pseudodementia- DepressionPseudodementia- Depression EpilepsyEpilepsy Parkinson’s Disease PlusParkinson’s Disease Plus Alcohol Related DementiaAlcohol Related Dementia

Imaging StudiesImaging Studies

Extremely helpful tool in diagnosing which Extremely helpful tool in diagnosing which particular type of memory disorder is likely particular type of memory disorder is likely present. A trained physician can now identify present. A trained physician can now identify classic Alzheimer’s Disease with 98% classic Alzheimer’s Disease with 98% certainty.certainty.

Alzheimer’s Disease Alzheimer’s Disease

What is Alzheimer’s What is Alzheimer’s Disease?Disease? The most common cause of dementiaThe most common cause of dementia Irreversible, progressive diseaseIrreversible, progressive disease Affects the brain by destroying neurons – Affects the brain by destroying neurons –

first in the hippocampus (memory area of first in the hippocampus (memory area of the brain) then spreading to other areasthe brain) then spreading to other areas

Neuron degeneration is felt to be from Neuron degeneration is felt to be from plaques consisting of beta amyloid plaques consisting of beta amyloid proteins that are deposited and tangles proteins that are deposited and tangles in nerve cellsin nerve cells

Is it in the Water?Is it in the Water?

““Why are so many Why are so many people ‘getting it’ “ is people ‘getting it’ “ is a common question.a common question.

We do not know the We do not know the exact cause nor do we exact cause nor do we have a cure. Latest have a cure. Latest research is focusing research is focusing on diet and lipids.on diet and lipids.

This is a disease that, This is a disease that, predominantly affects predominantly affects those > 65. those > 65.

As we are living As we are living longer, the prevalence longer, the prevalence is thus higher.is thus higher.

Neuropsychological Neuropsychological TestingTesting Following testing, individuals with Following testing, individuals with

MCI show an isolated memory MCI show an isolated memory loss. Those with Alzheimer’s loss. Those with Alzheimer’s Disease show a pattern of Disease show a pattern of increased difficulty with memory, increased difficulty with memory, categorical fluency, orientation, categorical fluency, orientation, and emerging problems in and emerging problems in construction and calculations.construction and calculations.

ExerciseExercise

Name as many animals as you can in 1 Name as many animals as you can in 1 minuteminute

Measures catagorical fluencyMeasures catagorical fluency Individuals with some form of progressive Individuals with some form of progressive

memory disorder will score less than 12 memory disorder will score less than 12 and should be evaluated. and should be evaluated.

A better predictor of Alzheimer’s disease A better predictor of Alzheimer’s disease or MCI than the Mini Mental and can easily or MCI than the Mini Mental and can easily be used quickly as a screen in doctor’s be used quickly as a screen in doctor’s officesoffices

Mild Cognitive Mild Cognitive ImpairmentImpairment Being researched as a likely “pre-Being researched as a likely “pre-

cursor” to Alzheimer’s Disease- cursor” to Alzheimer’s Disease- consists of mild memory loss that consists of mild memory loss that appears progressive in natureappears progressive in nature

It is crucial that these individuals are It is crucial that these individuals are assessed as early preventative assessed as early preventative interventions are showing promise in interventions are showing promise in delaying the onset or “conversion” delaying the onset or “conversion” to Alzheimer’s Disease!to Alzheimer’s Disease!

Assessment QuestionsAssessment Questions

Short term memory loss?Short term memory loss? Financial managementFinancial management Repetitive questions?Repetitive questions? Depression? Anxiety?Depression? Anxiety? Misplacing items or Misplacing items or

hiding items?hiding items? Orientation to person, Orientation to person,

place and timeplace and time Change in ability to Change in ability to

perform hobbies or perform hobbies or household tasks?household tasks?

Occupational issues?Occupational issues?

Depression ScreenDepression Screen

It is also important to address depression It is also important to address depression using a depression screening tool such using a depression screening tool such as the Geriatric Depression Scale or as the Geriatric Depression Scale or Beck Depression Inventory. Beck Depression Inventory.

Why?Why? Studies suggest between 20 and Studies suggest between 20 and 30% of dementia patients in early 30% of dementia patients in early stages develop Major Depressive stages develop Major Depressive Disorder and between 30-40% in Disorder and between 30-40% in middle stages. Not uncommon, middle stages. Not uncommon, depressive symptoms need to be depressive symptoms need to be monitored closely on a frequent basis monitored closely on a frequent basis and treated appropriately.and treated appropriately.

Characteristics - EarlyCharacteristics - Early

Short term memory loss Short term memory loss and asking questions and asking questions repeatedly are often the repeatedly are often the first signsfirst signs

Inability to complete Inability to complete familiar tasks familiar tasks

Difficulty learning and Difficulty learning and retaining new retaining new informationinformation

Misplacing items, often Misplacing items, often in inappropriate placesin inappropriate places

A growing awareness of A growing awareness of subtle changes may subtle changes may cause depression and cause depression and frustration.frustration.

ModerateModerate

Forgetting to turn off Forgetting to turn off stoves, appliancesstoves, appliances

Emerging safety Emerging safety concernsconcerns

Problems with Problems with calculations and calculations and financial managementfinancial management

Inappropriate in publicInappropriate in public More problems More problems

communicating, communicating, reading, writingreading, writing

SevereSevere

Severe loss of memorySevere loss of memory May be unable to recognize loved May be unable to recognize loved

onesones More hallucinations or delusionsMore hallucinations or delusions Void of emotionVoid of emotion Needs assistance with all personal Needs assistance with all personal

carescares Difficulty chewing or swallowing.Difficulty chewing or swallowing.

TreatmentsTreatments

Cholinesterase Inhibitors are being used Cholinesterase Inhibitors are being used to slow the progression with good to slow the progression with good success:success:– AriceptAricept– RazadyneRazadyne– ExelonExelon

Other medication often used in conjunction Other medication often used in conjunction with cholinesterase inhibitors (NMDA with cholinesterase inhibitors (NMDA receptor antagonist)receptor antagonist)

– NamendaNamenda

Key Psychosocial Key Psychosocial IssuesIssuesIndividuals and families Individuals and families

coping with Alzheimer’s coping with Alzheimer’s Disease require ongoing Disease require ongoing support as the disease support as the disease progresses.progresses.

A referral to the local A referral to the local Alzheimer’s Association is Alzheimer’s Association is recommended for recommended for ongoing needsongoing needs

Although there is “staging” Although there is “staging” documented and many documented and many follow the pattern loosely, follow the pattern loosely, everyone has a unique, everyone has a unique, individual experience.individual experience.

Supportive Supportive ApproachesApproaches

Care partners have various Care partners have various thresholds in terms of their thresholds in terms of their ability to manage the care ability to manage the care of someone with progressive of someone with progressive Alzheimer’s Disease.Alzheimer’s Disease.

Goal is to tackle each Goal is to tackle each symptom as it emerges and symptom as it emerges and seek manageable solutionsseek manageable solutions

Behavior issues are often Behavior issues are often signs of unmet, signs of unmet, unexpressed needs.unexpressed needs.

Important to increase Important to increase activity level and provide activity level and provide cognitive “exercise” as well cognitive “exercise” as well as physical and social as physical and social activity.activity.

The Alzheimer’s The Alzheimer’s AssociationAssociation Excellent organization for all Excellent organization for all

types of memory disorderstypes of memory disorders Provide support, education, Provide support, education,

advocacy and programming advocacy and programming encompassing all aspects of the encompassing all aspects of the disease to individuals and their disease to individuals and their care partners.care partners.

Other Resources for Other Resources for Individuals and Care Individuals and Care Partners Partners Adult Day CentersAdult Day Centers Home health agenciesHome health agencies Respite careRespite care Transportation resourcesTransportation resources Care consultantsCare consultants Assisted living optionsAssisted living options County Departments on Aging / Benefit County Departments on Aging / Benefit

SpecialistsSpecialists Aging and Disability Resource CentersAging and Disability Resource Centers Elder Law AttorneyElder Law Attorney

Support Groups Support Groups

Support groups are very valuable Support groups are very valuable and take many forms. Groups exist and take many forms. Groups exist for:for:– MCI patientsMCI patients– Early onset Alzheimer’s diseaseEarly onset Alzheimer’s disease– Care partners (spouses, family, etc)Care partners (spouses, family, etc)– Adult Children of people with Adult Children of people with

Alzheimer’s DiseaseAlzheimer’s Disease– Early stage Alzheimer’s DiseaseEarly stage Alzheimer’s Disease

Key ResourcesKey Resources

Books and Magazines:Books and Magazines:– The 36 Hour DayThe 36 Hour Day – Mace and Rabins – Mace and Rabins– A Dignified Life: The Best Friend’s A Dignified Life: The Best Friend’s

Approach to Alzheimer’s CareApproach to Alzheimer’s Care – Bell and – Bell and TroxelTroxel

– ReminiscenceReminiscence magazine (Reiman Public.) magazine (Reiman Public.)– Aging with GraceAging with Grace - Snowdon - Snowdon– Learning to Speak Alzheimer’sLearning to Speak Alzheimer’s - Coste - Coste– Mayo Clinic on Alzheimer’s DiseaseMayo Clinic on Alzheimer’s Disease - -

PetersonPeterson

Resources continued:Resources continued:

Websites:Websites:– www.alz.orgwww.alz.org – The Alzheimer’s Assoc. – The Alzheimer’s Assoc.– www.alzheimers.orgwww.alzheimers.org - Alzheimer’s Disease - Alzheimer’s Disease

Education and Referral CenterEducation and Referral Center– www.alzstore.comwww.alzstore.com – The Alzheimer’s Store – The Alzheimer’s Store– www.cwag.orgwww.cwag.org – Coalition of WI Aging Groups – Coalition of WI Aging Groups– www.dhfs.state.wi.us/aging/dementiawww.dhfs.state.wi.us/aging/dementia - WI - WI

Bureau of Aging & Long Term Care ResourcesBureau of Aging & Long Term Care Resources– www.mayoclinic.comwww.mayoclinic.com – Mayo Clinic Health Info – Mayo Clinic Health Info

Lewy Body DementiaLewy Body Dementia

Lewy Body DementiaLewy Body Dementia

A progressive brain disease and second A progressive brain disease and second leading cause of dementia in elderly. (20% of leading cause of dementia in elderly. (20% of all dementia cases)all dementia cases)

Appears to affect men more than womenAppears to affect men more than women Consists of protein deposits or “lewy bodies” Consists of protein deposits or “lewy bodies”

that are widespread throughout the brain. that are widespread throughout the brain. Often the memory area looks fine on Often the memory area looks fine on imaging.imaging.

Cognitive decline occurs prior to or Cognitive decline occurs prior to or concurrent with parkinsonian featuresconcurrent with parkinsonian features

Earlier age of onset than Alzheimer’sEarlier age of onset than Alzheimer’s

CharacteristicsCharacteristics

A probable Lewy Body Disease is A probable Lewy Body Disease is defined when one meets 2 out of defined when one meets 2 out of the 3 symptoms:the 3 symptoms:– Fluctuating Cognition with clear Fluctuating Cognition with clear

variations in alertness.variations in alertness.– Recurrent visual hallucinations that Recurrent visual hallucinations that

are very detailedare very detailed– Parkinsonism – muscle stiffness and Parkinsonism – muscle stiffness and

rigid, slowed movementsrigid, slowed movements

Other Suggestive Other Suggestive FeaturesFeatures

REM sleep disorders – vivid dreams, REM sleep disorders – vivid dreams, purposeful and sometimes violent purposeful and sometimes violent movementsmovements

Severe sensitivity to neuroleptics Severe sensitivity to neuroleptics (medications for psychiatric (medications for psychiatric symptoms)symptoms)

Abnormal depth perception – problems Abnormal depth perception – problems in visuospatial skillsin visuospatial skills

Mood lability, depression, aggressionMood lability, depression, aggression

Neuropsychological Neuropsychological TestingTesting Individuals with LBD have Individuals with LBD have

difficulty in the following areas of difficulty in the following areas of cognitive thinking:cognitive thinking:– OrientationOrientation– ConstructionConstruction– PerceptionPerception– MemoryMemory

Hooper Visual Hooper Visual Organization TestOrganization Test

30 “puzzle” pictures30 “puzzle” pictures Indicator of visuospatial skills and Indicator of visuospatial skills and

posterior functioning.posterior functioning. Shows how we perceive and make Shows how we perceive and make

sense of the world around us.sense of the world around us. Often a good predictor of whether or Often a good predictor of whether or

not someone should be retested for not someone should be retested for driving abilities.driving abilities.

Hooper Visual Hooper Visual Organization ExampleOrganization Example

Answer:Answer:

LIGHTHOUSELIGHTHOUSE

Clock Draw ExampleClock Draw Example

Goal- To draw the face of a clock, put Goal- To draw the face of a clock, put the numbers in the correct positions, the numbers in the correct positions, and indicate the time at 11:10.and indicate the time at 11:10.

Key Psychosocial Key Psychosocial IssuesIssuesFamilies and affected person Families and affected person

may be dealing early on with may be dealing early on with safety issues involving the safety issues involving the physical issues, physical issues, hallucinations, and hallucinations, and misperceptions (often leading misperceptions (often leading to trouble with driving).to trouble with driving).

Also, the inconsistency of Also, the inconsistency of symptoms and confusion, symptoms and confusion, creates stress as the family creates stress as the family never quite knows what is never quite knows what is coming next.coming next.

Loved one may not recognize Loved one may not recognize family or home at an earlier family or home at an earlier stage.stage.

Assessment QuestionsAssessment Questions

Sleep disturbance?Sleep disturbance? Gait disturbance / Falls?Gait disturbance / Falls? Appears socially withdrawn at Appears socially withdrawn at

timestimes Variable symptoms?Variable symptoms? Hallucinations?Hallucinations? Disorientation?Disorientation? Suspiciousness?Suspiciousness? Wandering?Wandering? Apparent slowed processing Apparent slowed processing

verbally and physicallyverbally and physically Other behavior problems or Other behavior problems or

aggression?aggression?

Supportive Supportive ApproachesApproaches Families struggle with Families struggle with

misperceptions- benefit misperceptions- benefit from support of others in from support of others in same situation (support same situation (support groups). Care partners groups). Care partners need respite!need respite!

Often occurs at a younger Often occurs at a younger age- grieve loss of age- grieve loss of retirement plans, etc.retirement plans, etc.

Individual often very Individual often very insecure without loved oneinsecure without loved one

More rapid course than ADMore rapid course than AD Physical and Physical and

communication issues in communication issues in addition to cognitiveaddition to cognitive

Common InterventionsCommon Interventions

Due to Parkinsonism, individual is at a higher Due to Parkinsonism, individual is at a higher fall risk. Need to adapt environment and fall risk. Need to adapt environment and consider a Physical therapy evaluation consider a Physical therapy evaluation

Misperceptions! Eg. May perceive that a black Misperceptions! Eg. May perceive that a black rug is a hole, or texture change represents a rug is a hole, or texture change represents a different height/level. Occupational therapist different height/level. Occupational therapist evaluation, adjusting home environment, evaluation, adjusting home environment, adjusting lighting and visual cuesadjusting lighting and visual cues

Wandering Risk – easily disorientated- Obtain Wandering Risk – easily disorientated- Obtain Safe ReturnSafe Return

Driving Issues – becomes lost or does not Driving Issues – becomes lost or does not recognize once familiar landmarks. Driver recognize once familiar landmarks. Driver evaluation and subsequent referral to evaluation and subsequent referral to transportation resources suggestedtransportation resources suggested

Treatments for LBDTreatments for LBD

Cholinesterase inhibitors (medications Cholinesterase inhibitors (medications approved for Alzheimer’s Disease) tend to approved for Alzheimer’s Disease) tend to work even better for people with LBDwork even better for people with LBD

Parkinson’s Disease medications often Parkinson’s Disease medications often help with the symptoms related to help with the symptoms related to movementmovement

It is important to diagnose LBD as some It is important to diagnose LBD as some antipsychotic medications given for antipsychotic medications given for hallucinations can cause severe reactions hallucinations can cause severe reactions in patients with this disease. (eg. Haldol)in patients with this disease. (eg. Haldol)

Key ResourcesKey Resources

The Alzheimer’s AssociationThe Alzheimer’s Association The Lewy Body Dementia The Lewy Body Dementia

AssociationAssociation Websites:Websites:

– www.lewybodydementia.orgwww.lewybodydementia.org LBD LBD Assoc.Assoc.

– www.zarcrom.com/users/alzheimers/owww.zarcrom.com/users/alzheimers/odem/od-d.htmldem/od-d.html Directory of other Dementias Directory of other Dementias

– www.alz.orgwww.alz.org – The Alzheimer’s Assoc. – The Alzheimer’s Assoc.

The Frontotemporal The Frontotemporal DementiasDementias

Frontotemporal Frontotemporal DementiasDementias Neurodegenerative changes in the Neurodegenerative changes in the

frontal and temporal lobes of the brainfrontal and temporal lobes of the brain Several types depending on which areas Several types depending on which areas

show damage – eg. Picks disease show damage – eg. Picks disease (involves only frontal lobes)(involves only frontal lobes)

Occurs between the ages of 35 and 75 Occurs between the ages of 35 and 75 years (younger than AD and LBD) Some years (younger than AD and LBD) Some forms are genetic.forms are genetic.

Many early research programs are Many early research programs are focusing on the frontotemporal focusing on the frontotemporal dementias and “possible” reversible dementias and “possible” reversible causes causes

CharacteristicsCharacteristics

There is generally an early loss of personal There is generally an early loss of personal awareness and sometimes an increase in awareness and sometimes an increase in social disinhibition and mood swings.social disinhibition and mood swings.

Depression is commonDepression is commonOften diagnosed at an earlier age, therefore Often diagnosed at an earlier age, therefore

occupational problems may exist.occupational problems may exist. Family members are usually quite Family members are usually quite

frustrated and require special counseling frustrated and require special counseling or supportor support

More rapid progressionMore rapid progression

The Frontal Lobe - the The Frontal Lobe - the GatekeeperGatekeeper People who suffer People who suffer

from the FTDs may from the FTDs may exhibit inappropriate exhibit inappropriate behaviors in public, behaviors in public, be less inhibited, may be less inhibited, may show mood swings, show mood swings, or may become quite or may become quite the opposite- more the opposite- more depressed, apathetic depressed, apathetic and socially and socially withdrawn.withdrawn.

Neuropsychological Neuropsychological TestingTesting Frontal area involves the “doing” Frontal area involves the “doing”

part of the brain- executive part of the brain- executive functioning thus testing shows functioning thus testing shows difficulties in the areas of:difficulties in the areas of:– BehaviorBehavior– Reasoning and JudgmentReasoning and Judgment– Planning Planning – InitiationInitiation

Neuropsychological Neuropsychological testing continued…testing continued… Temporal Area involves speech Temporal Area involves speech

and language thus testing reveals and language thus testing reveals difficulty withdifficulty with– NamingNaming– ComprehensionComprehension– Word findingWord finding– Speech (aphasia often noted)Speech (aphasia often noted)

Example – Boston Example – Boston Naming TestNaming Test

Key Psychosocial Key Psychosocial IssuesIssues Loss of Insight: Often people Loss of Insight: Often people

with frontotemporal with frontotemporal dementias do not have dementias do not have insight into their difficulties. insight into their difficulties. This makes it more This makes it more challenging for families to challenging for families to provide care and that care is provide care and that care is occasionally met with occasionally met with resistanceresistance

Compulsive behaviorsCompulsive behaviors Lack of empathy for others- Lack of empathy for others-

Often the care partner Often the care partner desires an acknowledgement desires an acknowledgement for their hard work that never for their hard work that never comes.comes.

Assessment QuestionsAssessment Questions

Judgment and InsightJudgment and Insight Decision making, impulsivityDecision making, impulsivity Mood changes – depression, Mood changes – depression,

apathyapathy Alteration in planning and Alteration in planning and

initiationinitiation Susceptible to sweepstakesSusceptible to sweepstakes Compulsive behaviorsCompulsive behaviors Speech and language issuesSpeech and language issues Socially or sexually Socially or sexually

inappropriatenessinappropriateness Work related problemsWork related problems

Supportive Supportive ApproachesApproaches Often the disinhibition and behavior changes Often the disinhibition and behavior changes

combined with the lack of insight put care combined with the lack of insight put care partners in very difficult situations. Families partners in very difficult situations. Families benefit greatly by connecting with others.benefit greatly by connecting with others.

Examine behaviors and look at underlying Examine behaviors and look at underlying needs that are unexpressed or the emotions needs that are unexpressed or the emotions behind the behaviors. Document approaches behind the behaviors. Document approaches and redirections that work.and redirections that work.

Compulsive behaviors can be draining on Compulsive behaviors can be draining on loved ones. loved ones.

Need to choose battles wisely!Need to choose battles wisely!

CommunicationCommunication

As the temporal lobes As the temporal lobes become damaged, become damaged, one will often will see one will often will see changes in ability to changes in ability to express self and express self and converse with others. converse with others.

A referral to a speech A referral to a speech therapist and therapist and communication books communication books may be helpfulmay be helpful

TreatmentsTreatments

The cholinesterase inhibitors The cholinesterase inhibitors (Alzheimer’s medications) work in (Alzheimer’s medications) work in approximately 1 in 3 patients with approximately 1 in 3 patients with FTD. We are not sure why.FTD. We are not sure why.

SSRIs or specific anti-depressants are SSRIs or specific anti-depressants are being investigated as chemically being investigated as chemically beneficial and also help control beneficial and also help control behavior symptoms and behavior symptoms and accompanying depressionaccompanying depression

Key ResourcesKey Resources

Books:Books:– The 36 Hour DayThe 36 Hour Day – Mace and Rabins – Mace and Rabins– What if it’s Not Alzheimer’s? A What if it’s Not Alzheimer’s? A

Caregiver’s Guide to DementiaCaregiver’s Guide to Dementia – – Radin and RadinRadin and Radin

– Websites:Websites: www.alz.orgwww.alz.org – The Alzheimer’s Assoc. – The Alzheimer’s Assoc. www.ftd-picks.orgwww.ftd-picks.org – The Assoc. for – The Assoc. for

Frontotemporal DementiasFrontotemporal Dementias

Vascular DementiaVascular Dementia

Vascular DementiaVascular Dementiaor Multi Infarct or Multi Infarct DementiaDementia Caused by “hardening of the arteries” or Caused by “hardening of the arteries” or

mini silent strokes in the brainmini silent strokes in the brain The blockages of the small arteries of the The blockages of the small arteries of the

brain caused by poor blood flow. Can be brain caused by poor blood flow. Can be prevented by a heart healthy diet and prevented by a heart healthy diet and other stroke prevention techniques other stroke prevention techniques (controlled blood pressure and (controlled blood pressure and cholesterol)cholesterol)

More common in those with Alzheimer’s More common in those with Alzheimer’s Disease as a co-existing problem.Disease as a co-existing problem.

CharacteristicsCharacteristics

Early on there may be changes in:Early on there may be changes in:

Memory and cognitionMemory and cognition

Decision-makingDecision-making

Sleep disturbanceSleep disturbance

ApathyApathy

Sensory LossSensory Loss

More physical limitationsMore physical limitations

Language problemsLanguage problems

Assessment and Assessment and ApproachesApproaches Any or all of the above symptoms Any or all of the above symptoms

or approaches mentioned may or approaches mentioned may apply dependent on where the apply dependent on where the damage has occurred in the damage has occurred in the brain.brain.

A clear differentiation of diagnosis A clear differentiation of diagnosis is thus important.is thus important.

TreatmentsTreatments

Goal is to prevent further strokes Goal is to prevent further strokes through diet and exercise.through diet and exercise.

Generally speaking, what is good for Generally speaking, what is good for the heart is good for the brainthe heart is good for the brain

Anticoagulants such as Aspirin, Anticoagulants such as Aspirin, Aggrenox, Plavix, or Vit. E are often Aggrenox, Plavix, or Vit. E are often used.used.

Cholinesterase inhibitors are utilized – Cholinesterase inhibitors are utilized – Razadyne has been approved for use Razadyne has been approved for use and has shown benefit in those with and has shown benefit in those with Vascular DementiaVascular Dementia

SummarySummary

There are many kinds of dementia – it is There are many kinds of dementia – it is inaccurate to assume “Alzheimer’s inaccurate to assume “Alzheimer’s Disease” prior to a complete diagnostic Disease” prior to a complete diagnostic assessment.assessment.

It is important to determine which type of It is important to determine which type of memory loss one has as there are various memory loss one has as there are various treatments, prognosis, and expectations treatments, prognosis, and expectations related to each. Some are also related to each. Some are also preventable!preventable!

Each form has its own unique effects on Each form has its own unique effects on family and care partners. It is important to family and care partners. It is important to tailor our approach to that individual’s tailor our approach to that individual’s needs.needs.

What Comes First?What Comes First?

Alzheimer’s DiseaseAlzheimer’s Disease Memory, repetition, Memory, repetition, confusionconfusion

Lewy Body Lewy Body DementiaDementia

Hallucinations, Hallucinations, variability, variability, movement movement problemsproblems

Frontotemporal Frontotemporal DementiasDementias

Behavior changes, Behavior changes, apathy, language apathy, language problemsproblems

Vascular DementiaVascular Dementia Depends on area of Depends on area of damage damage

QUESTIONS?QUESTIONS?

FOR YOUR REFERENCEFOR YOUR REFERENCE

Comprehensive Comprehensive Psychosocial Psychosocial Interventions Interventions Should include:Should include: Assessment of psychosocial needs of the Assessment of psychosocial needs of the

individual with the memory loss and their individual with the memory loss and their family.family.

Ruling out other possible contributing causes of Ruling out other possible contributing causes of dementia such as depression and alcoholismdementia such as depression and alcoholism

Providing support and counseling as they Providing support and counseling as they journey through the various stages of the journey through the various stages of the diseasedisease

Providing education and resources to meet Providing education and resources to meet ongoing needs.ongoing needs.

Advocating for the individual and family.Advocating for the individual and family. Promotion of healthy lifestyle and non- Promotion of healthy lifestyle and non-

pharmaceutical interventions if possiblepharmaceutical interventions if possible

Continued…Continued…

Assessments of:Assessments of: Family History of Memory LossFamily History of Memory Loss Family Dynamics and Support Family Dynamics and Support

SystemsSystems Social and Occupational Social and Occupational

implicationsimplications Safety and Potential Environmental Safety and Potential Environmental

BarriersBarriers Communication IssuesCommunication Issues

Continued…Continued…

Mental health historyMental health history Activities of Daily Living – Activities of Daily Living –

grooming, dressing, and bathing grooming, dressing, and bathing (The Functional Activity (The Functional Activity Questionnaire is often given)Questionnaire is often given)

IADLs- meal preparation, cleaning, IADLs- meal preparation, cleaning, shopping, money managementshopping, money management

Medication complianceMedication compliance

Continued…Continued…

DrivingDriving Financial PlanningFinancial Planning Emerging Behavioral IssuesEmerging Behavioral Issues Advanced Directives and Advanced Directives and

Financial PlanningFinancial Planning End of Life CareEnd of Life Care