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7/29/2019 WhyDoTheyDoThat Alz

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Presentation Goalso The participants will be able to identify the different

types of the most common forms of dementia

o

The participants will be able to identify how the differentdementia disease processes impact the patient

o The participants will be able to identify the medications

available to treat Alzheimers disease and how theybenefit the patient.

o The participants will be able to identify the leading

problem behaviors associated with Alzheimers disease.


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Disease Diagnoses

Alzheimers Disease

Vascular Dementia Multi Infarct Dementia

Parkinsons Dementia

Lewy Body Dementia

Picks Disease

Alcohol Dementia-Wernicke-Korsakoff Syndrome

Creutzfeldt Jakob Disease


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How do you know the difference?

Alzheimers Dementia

Slow progression

Short Term MemoryLoss first

Loss of executivefunctioning Skills

Long Term MemoryLoss

Loss of motor skills

Vascular Dementia

Stair Step Decline

Incontinent of bladdersooner than Alz.

Loss of languagesooner than Alz.

Loss of ambulationsooner than Alz.


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Parkinsons Dementia

Irregular BodyMovements

Stiffness in joints and

limbs


40%-50% also getAlzheimers

Lewy Body Dementia

Hallucinations


Pseudo-Parkinsonssymptoms

Rapid cognitive changes

Syncope Episodes

Intolerance ofpsychotropic medications


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How do you know the difference? Picks Disease

Frontal Temporal Involvement Only 1-5% of people

diagnosed with this

Diagnosis early in life40sand 50s

Extreme hyperactivity or verylethargic

Short Term Memory Staysintact longer

May put everything in mouth

Gluttonous eating Extreme loss of language in

late stages

Hyperactivity turns into non-responsiveness in late stage

Wernicke-Korsakoff Syndrome

Thiamine deficiency; VitaminB1 deficiency Most often caused by

excessive alcohol consumption Confabulation Psychosis

Motor Skill Losses Neuropathy of extremities Muscle Wasting Brain damage affecting

language and thinking

Heart Failure is common Behaviorally very difficult to

care for


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Creutzfeldt Jakob Disease Two different types classic and variant forms Variant seems to be linked to mad cow disease

but not always and its very rare Classic is not linked to mad cow Both forms have long gestation periods but once

diagnosed the person deteriorates very rapidly,a few months to a year

Signs and symptoms in both forms are similarpersonality changes, loss of thinking ability,behavioral symptoms, loss of motor control


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What Happens in the Brain?Hypothalamus (Hippocampus)

Alzheimer's begins in the part of the brain that is calledthe Hypothalamus. (Hippocampus) This part of the braincontains our short-term memory center.

This is the first part of the brain to be affected byAlzheimer's. However the disease is not localized here. Itwill travel to all parts of the brain.

That is what makes Alzheimer's disease different fromother diseases.


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All information has to travel through our Hypothalamusbefore it can reach the part of our brain whereinformation is stored.

This part of our brain is called the Cerebral Cortex. It isresponsible for long-term memories and consciousthought.

The Cerebral Cortex is one of the last parts of the brain tobe affected by Alzheimer's disease.


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Alzheimer's disease causes all new information to nolonger be able to pass through the Hypothalamus. Youcan think of it as if a "Dam" is being built in that part ofthe brain.

Therefore, the person can no longer tell you theconversations they just had with someone, or tell youwhat they had for lunch, or if they took their medicines.They lose the ability to tell you what happened momentsbefore in time, or what happened last week, two weeksago, etc.


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Frontal Lobe What does this do?

Abstract ConceptsClothing clean/dirty

Natural Consequences

Television

Left from Right

Safety Issues

Rationalizing/ReasoningUsing good judgment

Knowing if something is trueor untrue

Seeing someone elses pointof view

Not arguing with reality

Multi-Step Tasks

Tooth brushing

Eating

Bathing

Dressing

Personality

Emotional Control

Happy/Sad/Anger

Dealing with Changes

Personality Changes


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Frontal Lobe What does this do?

Impulse Control

Yelling

Aggressive type behaviors

Saying the first thing on

their mindsEating off some elses plate

Taking/Borrowing Items

Empathy

Understanding how theiractions affect others

To put themselves insomeone elses shoes

Knowing what others aredoing for them

Initiation

Starting Tasks

Changing clothes when dirty

Fixing something to eat

Participating in activities

Attention To Task

To finish tasks and stayseated

To watch whole movies

To participate in longactivities


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Understanding Disease Related Behaviors

Behavioral issues are hard to manage. They upset

the resident, they upset the other people living inthe community, they upset the staff, and they

upset the families.

In other words, behavioral issues really upset theapple cart and decrease customer satisfaction all

the way around. Therefore, the following

information lists the things that might causebehavioral issues to occur.


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Types of Disease Behaviors

Looking for a deceasedrelative

Borrowing items fromothers (some people callthis stealing, which isincorrect)

Yelling

Striking out at others

Refusals to bathe andnon-compliant with ADLs

Disrobing in public

Medication Refusals

Pushing/pulling furniture Wandering

High Anxiety

Hoarding

Rummaging Catastrophic Reactions


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Causes for Behavioral

Disruptionso Changes in the brain

o Health and Medical Problems

o Environmental Factors

o Problems with Communication


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Alzheimers Medications

o Aricept(donepezil)

o Exelon (Rivastigmine)

o Razadyne (galantamine)

o Namenda (Memantine)


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The Tragic Difference


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We need to

Love them andbe Patient at all

times.


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Thank You

I want to thank the Star Chapter of theAlzheimers Associations Regional Office inSan Antonio for the wealth of informationand resources that helped in formulationof this program.

Late Stage Dementia Care book

resource available through the AlzheimersAssociation networks.

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