Understanding Alzheimer’s Disease and Dementias

AgendaWhat is Alzheimer’s and

Dementia?Types of DementiaStages of the DiseaseTips for CommunicationManaging Severe Behaviors

What is Alzheimer’s Disease? Alzheimer’s is a disease of the brain that causes problems

with memory, thinking and behavior. ◦ It is not a normal part of aging.

Alzheimer’s gets worse over time. ◦ Although symptoms can vary widely, the first problem many

people notice is forgetfulness severe enough to affect their ability to function at home or at work, or to enjoy lifelong hobbies.

The disease may cause a person to become confused, get lost in familiar places, misplace things or have trouble with language.

It can be easy to explain away unusual behavior as part of normal aging, especially for someone who seems physically healthy.

Any concerns about memory loss should be discussed with a doctor.

What is Dementia?Dementia is a general term

for the loss of memory and other cognitive abilities serious enough to interfere with daily life.

Dementia is often incorrectly referred to as "senility" which reflects the formerly widespread, but incorrect, belief that serious mental decline is a normal part of aging.

Types of DementiaVascular Dementia is a decline in

thinking skills caused by conditions that block or reduce blood flow to the brain, depriving brain cells of vital oxygen and nutrients.

These changes in thinking skills sometimes occur suddenly following strokes that block major brain blood vessels.

It is widely considered the second most common cause of dementia after Alzheimer’s disease.

Types of DementiaParkinson’s Disease

Dementia is an impairment in thinking and reasoning that eventually affects many people with Parkinson’s disease.

As brain changes gradually spread, they often begin to affect mental functions, including memory and the ability to pay attention, make sound judgments and plan the steps needed to complete a task.

Types of DementiaLewy Body Dementia is a type of

progressive dementia that leads to a decline in thinking, reasoning and independent function due to abnormal microscopic deposits that damage brain cells.

Types of DementiaHuntington’s Disease

Dementia is a progressive brain disorder caused by a defective gene.

It causes changes in the central area of the brain, which affect movement, mood and thinking skills.

Types of DementiaFrontotemporal Dementia

(FTD) is a group of disorders caused by progressive cell degeneration in the brain’s frontal lobes (the areas behind the forehead) or its temporal lobes (the regions behind the ears).

Types of DementiaDown Syndrome

Dementia -As individuals with Down Syndrome age, they have a greatly increased risk of developing a type of dementia that’s either the same as or very similar to Alzheimer’s disease.

Who can be affected?Research shows that older Latinos are about

1 ½ times as likely as older Caucasians to have Alzheimer’s and other dementias.

Older African-Americans are about twice as likely to have Alzheimer’s and other dementias as older Caucasians.

The reason for these differences is not well understood, but researchers believe that higher rates of vascular disease in these groups may also put them at greater risk for developing Alzheimer’s.

Stages of Alzheimer’sStage 1: No cognitive

impairment-◦Unimpaired individuals experience no

memory problems and none are evident to a health care professional during a medical interview.

Stages of Alzheimer’sStage 2: Very mild decline-

◦Individuals at this stage feel as if they have memory lapses, especially in forgetting familiar words or names or the location of keys, eyeglasses, or other everyday objects.

◦But these problems are not evident during a medical examination or apparent to friends, family, or co-workers.

Stages of Alzheimer’sStage 3: Mild cognitive decline-

◦ Early-stage Alzheimer's can be diagnosed in some, but not all, individuals with these symptoms.

◦ Friends, family or co-workers begin to notice deficiencies.

◦ Problems with memory or concentration may be measurable in clinical testing or discernible during a detailed medical interview. Common difficulties include: Word- or name-finding problems noticeable to family or close

associates Decreased ability to remember names when introduced to new

people Performance issues in social or work settings noticeable to

family, friends or co-workers Reading a passage and retaining little material Losing or misplacing a valuable object Decline in ability to plan or organize

Stages of Alzheimer’sStage 4: Moderate cognitive decline (Mild

or early-stage Alzheimer's disease)◦At this stage, a careful medical interview detects

clear-cut deficiencies in the following areas: Decreased knowledge of recent occasions or current

events Impaired ability to perform challenging mental math

For example, to count backward from 100 by 7s Decreased capacity to perform complex tasks, such as

grocery shopping, planning dinner for guests, or paying bills

Reduced memory of personal history The affected individual may seem subdued and withdrawn,

especially in socially or mentally challenging situations

Stages of Alzheimer’sStage 5: Moderately severe cognitive decline

(Moderate or mid-stage Alzheimer's disease)◦ Major gaps in memory and deficits in cognitive function

emerge. ◦ Some assistance with day-to-day activities becomes

essential. ◦ At this stage, individuals may:

Be unable during a medical interview to recall such important details as their current address, their telephone number, or the name of the college or high school they graduated from

Become confused about where they are or about the date, day of the week or season

Have trouble with less challenging mental math For example, counting backward from 40 by 4s or from 20 by 2s

Need help choosing proper clothing for the season or the occasion Usually retain substantial knowledge about themselves and know

their own name and the names of their spouse or children Usually require no assistance with eating or using the toilet

Stages of Alzheimer’s Stage 6: Severe cognitive decline (Moderately severe or mid-

stage Alzheimer's disease)◦ Memory difficulties continue to worsen, significant personality changes may

emerge, and affected individuals need extensive help with daily activities. ◦ At this stage, individuals may:

Lose most awareness of recent experiences and events as well as of their surroundings

Recollect their personal history imperfectly, although they generally recall their own name

Occasionally forget the name of their spouse or primary caregiver but generally can distinguish familiar from unfamiliar faces

Need help getting dressed properly; without supervision, may make such errors as putting pajamas over daytime clothes or shoes on wrong feet

Experience disruption of their normal sleep/waking cycle Need help with handling details of toileting (flushing toilet, wiping and disposing of

tissue properly) Have increasing episodes of urinary or fecal incontinence Experience significant personality changes and behavioral symptoms, including

suspiciousness and delusions For example, believing that their caregiver is an impostor hallucinations (seeing or hearing things that are not really there) compulsive, repetitive behaviors such as handwringing or tissue shredding

Tend to wander and become lost

Stages of Alzheimer’s

Stage 7: Very severe cognitive decline (Severe or late-stage Alzheimer's disease)◦ This is the final stage of the disease when individuals lose

the ability to respond to their environment, the ability to speak, and, ultimately, the ability to control movement.

◦ Frequently individuals lose their capacity for recognizable speech, although words or phrases may occasionally be uttered

◦ Individuals need help with eating and toileting and there is general incontinence

◦ Individuals lose the ability to walk without assistance, then the ability to sit without support, the ability to smile, and the ability to hold their head up.

◦ Reflexes become abnormal and muscles grow rigid. ◦ Swallowing is impaired.

Tips for communicating with a confused client Treat the client with dignity and respect.

◦ Respond to feelings, display empathy, interest. Know the client as an individual (his past, likes, and dislikes). Always introduce yourself, call the client by name, and

explain what you are doing as you approach the client. ◦ Speak softly, in a low-pitched voice.

Approach the client from the front, moving slowly and gently and without startling him. ◦ Establish and sustain eye contact with the client.

Speak in short, direct statements and repeat key words to help promote understanding.

Always get the client's attention before commenting or asking a question. ◦ As soon as eye contact is made, begin speaking because the client

with Alzheimer's disease has an attention span that may last only a few seconds.

Tips for communicating with a confused client (cont.) Explain each task by providing short, one-step directions.

◦ Ensure that all tasks are simple and manageable. ◦ Show the client how to begin a specific task (e.g., brushing hair).

Ask questions that are short and to the point. ◦ Only ask one question at a time. ◦ When repeating a question, ask it exactly the same way as you did the

first time. Use nods, pats, gestures, and smiles, and other means of

nonverbal communication. ◦ Be consistent with gestures.

It only adds to the client's confusion if you use a gesture to mean one thing one time and something else at a different time.

Provide sensory stimulation if appropriate using music or touch. ◦ Encourage clients to talk about their families

and past experiences if they desire.

Managing Severe Behaviors (Catastrophic Reactions) Resulting from Confusion Catastrophic reactions occur when

confused clients cannot cope with the stress around them.

Unable to understand what is happening and respond appropriately, the client becomes distressed and may strike out in anger or fear.

During a catastrophic reaction, the client cannot control his behavior.

Managing Severe Behaviors (Catastrophic Reactions) Resulting from Confusion The best way to deal with a catastrophic reaction

is to try to prevent it from happening. Look for signs that the client is getting upset. Ensure that the client is comfortable and has rest

periods throughout the day. A client that is tired is more likely to become

upset. Speak to the client calmly and quietly, never

argue with them. Always treat the client with courtesy and respect. If the client had a previous catastrophic reaction,

try to determine its cause.

If a catastrophic reaction occurs, you can help to calm the client by: Trying to determine the cause of the behavior.

◦ Ask a nurse to check for physical causes, (e.g., swollen gums, sore teeth, infection, and pain).

Remaining calm and quietTrying to soothe the client If the client allows it, touch them and hold their handDo not ask the client questions at this timeSpeak in simple, short sentencesSlowly move the client to a quiet private placeUsing simple distractions, such as, "Let's go get a

drink"Feeding the client.

◦ Food was used in many homes as a sign of nurturing.

Catastrophic Reactions-Most Important to RememberClients usually calm down as

quickly as they flare up and typically do not remember what just happened.

Do not take the catastrophic reaction personally; it is a reaction to the situation, not the caregiver.

ConclusionFirst and foremost, treat

people with respect and dignity.

Do not argue with the client.Keep calm.Be patient.Always introduce yourself, call

the client by name, and explain what you are doing as you approach the client.

Explain each task by providing short, one-step directions.