Alzheimer

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Alzheimers DiseaseSupporting the
PersonSupporting their Caregivers

• Shelly Zylstra
• zylstra_at_dshs.wa.gov
• 360-676-6749

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A Few Facts

• Once considered a rare disorder, Alzheimers
  disease is now seen as a major public health
  problem that is seriously affecting millions of
  older Americans and their families.
• In 2050, 70 million people will be over the age
  of 65 20 million over the age of 85.
• An estimated 14 million Americans will have
  Alzheimers disease if a cure is not found.
• Alzheimers disease will be the leading cause of
  death among adults by the middle of this century.

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What Is It?

• Alzheimers disease is an irreversible,
  progressive brain disease that slowly destroys
  memory and thinking skills.
• Not Normal Aging!
• Alzheimers disease destroys brain cells and
  causes abnormal structural changes in the brain

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Dementia is Not Normal Aging

20 year old brain 80 year old
brain
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The Brain

• Adult weight about 3 pounds
• Adult size a medium
  cauliflower
• Different parts of the brain do different things

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Cerebral Hemispheres

• Where sensory information received from the
  outside world is processed this part of the
  brain controls voluntary movement and regulates
  conscious thought and mental activity
• accounts for 85 of brains weight

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Cerebellum

• In charge of balance and coordination
• takes up about 10 of brain
• consists of two hemispheres
• Receives information from eyes, ears, and muscles
  and joints about bodys movements and position

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Brain Stem

• Connects the spinal cord with the brain
• Relays and receives messages to and from muscles,
  skin, and other organs
• Controls automatic functions such as heart rate,
  blood pressure, and breathing

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Different Parts-Different Roles

• Even though the activities are similar, a
  different part of the brain is involved
• Walking-Kicking
• Talking-Swearing
• Chewing-Swallowing

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Scans Show the Loss of Activity

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Reversible Dementias

• Intoxications
• Infections
• Metabolic disorders
• Depression
• Medication Problems

• Brain tumors
• Head injuries
• Normal pressure hydrocephalus
• Dehydration

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Irreversible Dementias

• Alzheimers disease
• Multi-Infarct Dementia
• Parkinsons disease
• Lewy Body disease

• Creutzfeldt-Jakob disease
• Picks disease
• Huntingtons disease
• AIDS dementia complex
• Progressive aphasia

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Prevalence of Alzheimers Disease by Age
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Stages of Alzheimers disease
Function Early Stage
Memory Routine loss of recent memory
Orientation Seeks familiar and avoids unfamiliar
Language Mild aphasia (word finding difficulty)
Motor Some difficulty writing and using objects
Mood Apathy depression
ADLs Needs reminders with some ADLs
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Stages of Alzheimers disease
Function Middle Stage
Memory Chronic, recent memory loss
Orientation May get lost at times, even in home
Language Moderate aphasia (word finding difficulty)
Motor Repetitive actions apraxia (unable to start an action)
Mood Some mood and behavior disturbances
ADLs Needs reminders and help with most ADLs
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Stages of Alzheimers disease
Function Late Stage
Memory Mixes up past and present
Orientation Misidentifies familiar places
Language Expressive and receptive aphasia often does not understand
Motor Bradykinesia (very slow walking) fall risk
Mood Increased mood and behavior disturbances
ADLs Needs reminders and help with all ADLs
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Stages of Alzheimers disease
Function Terminal Stage
Memory No link to past or present
Orientation Oblivious to surroundings
Language Mute or a few incoherent words
Motor Little voluntary movement dysphasia, myoclonus, seizures
Mood Completely passive
ADLs Total Care
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Alzheimers Symptoms

• Very gradual onset
• Picture may differ from person to person
• Gradual withdrawal from active engagement with
  life
• Narrowing social activities and interests
• Lessening of mental alertness and adaptability
• Lowering of tolerance to new ideas and changes in
  routine
• Thoughts and activities may be selfish or
  childlike

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Alzheimers Symptoms

• Progressive memory loss
• Difficulty remembering familiar things
• Difficulty performing familiar tasks
• Problems finding the right words
• Misplacing things/ Messiness
• Confusion and agitation
• Poor judgment and poor decision making skills
• Changes in personality mood swings
• Loss of initiative

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Might Even Involve the Law!

• Wandering/Lost
• Auto Accidents
• Indecent Exposure
• Homicide/Suicide/Domestic Violence
• Suspicion of DUI/Intoxication
• Abuse/Neglect
• Trespassing
• Shoplifting

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Behaviors

• Alzheimers disease often causes a person to
  exhibit unusual and unpredictable behaviors.
• This can easily lead to frustration and tension
  in the person with Alzheimers as well as the
  person responsible for them.

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Challenging Behaviors

• Agitation, anger, depression, aggression
• Combativeness
• Psychosis
• Wandering
• Sleeplessness
• Sundowning
• Unpredictable situations

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Agitation, Anger, Depression

• Agitated behavior can be disruptive to the elders
  daily life.
• Anxiety may not be put into words but instead
  manifest physical symptoms such as a racing
  heart, nausea, or pain.
• Agitation may increase the risk of harm to the
  affected individual and to others.

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Agitation

• Irritability, frustration, excessive anger
• Constant demands for attention reassurance
• Repetitive questions or demands
• Stubborn refusal to do things or go places
• Constant pacing, searching, rummaging
• Yelling, screaming, cursing, threats
• Hitting, biting, kicking

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Depression

• Extreme tearfulness
• Hand-wringing
• An excessive need for reassurance
• Other signs of extreme unhappiness
• Loss of interest in things they used to love
• Excessive sleep
• Personality changes

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Aggression

• Verbal accusations and insults
• Aimless screaming
• Refusal to cooperate with simple requests
• Physical assaults
• Self-injury such as head banging or biting oneself

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Delusions

• When the person believes things that are not
  true.
• Common examples of delusions would be
• Believing that one is in danger from others and
  that others have stolen items or money.
• A spouse is unfaithful
• Unwelcome guests are in the house
• A relative or friend is an imposter and not who
  they claim to be.

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Hallucinations

• This is a false perception of objects or events
  involving the senses.
• The person may see, hear, smell, taste or feel
  something that is not there.
• If it doesnt cause a problem it might be best to
  ignore it.
• If it becomes continuous then look for a possible
  underlying physical cause.

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Look for The Why

• Physical discomfort caused by an illness or
  medications.
• Over-stimulation from or overactive environment
• Inability to recognize familiar places, faces, or
  things
• Difficulty completing simple tasks or activities.
• Inability to communicate effectively.

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There is usually a Cause

• Physical factors
• Is the person tired because of inadequate rest or
  sleep?
• Are medications causing side effects?
• Is the person unable to let you know he or she is
  experiencing pain?
• Environmental factors
• Is the person over stimulated by loud noises, an
  overactive environment, or physical clutter?
• Does the person feel lost or abandoned?

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Sleeplessness and Sundowning

• About 20 experience periods of increased
  confusion, anxiety, agitation, and disorientation
  from dusk to dawn.
• End-of-day exhaustion (mental physical)
• An upset in the internal clock causing a
  biological mix-up between night day
• Reduced lighting and increased shadows
• Disorientation due to the inability to separate
  dreams from reality when sleeping
• Less need for sleep, which is common among older
  adults

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Responding to Challenging Behaviors

• Stay calm and be understanding
• Be patient and flexible
• Dont argue or try to convince the person
• Acknowledge requests and respond to them.
• Try not to take behaviors personally
• Accept the behavior as a reality of the disease
  and try to work through it.

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Try to Determine the Cause

• Often the trigger is some change in the persons
  environment.
• Clutter, new person in the room
• Change in routine
• Pain
• Hunger
• Thirst/dehydration
• Full bladder/UTI
• Fatigue/pending illness
• Infections
• Skin irritation
• Constipation

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Hints to Manage Behavior

• Dont
• Argue or disagree
• Confront
• Raise your voice
• Take offense
• Corner, crowd
• Try to reason

• Do
• Simplify the environment, tasks and routines
• Allow adequate rest between stimulating events
• Use labels or clues to remind

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• Do
• Back off
• Use calm, positive statements
• Reassure
• Slow down
• Offer guided choices between two options
• Limit stimulation and offer simple exercises

• Dont
• Restrain,
• Shame, criticize
• Demand or try to force
• Talk down, ignore
• Explain, teach
• Rush
• Show alarm
• Make sudden movements

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Communication

• Communication is critical and can be the basis
  for poor behavior
• Are you asking too many questions or making too
  many statements at once?
• Are your instructions simple and easy to
  understand?
• Is the person picking up on your own stress and
  irritability?
• Are you being negative or critical?

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Communication

• Remember people with Alzheimers Disease often
  find it hard to remember the meaning of words
  that you are using or to think of the words they
  want to say.
• Identify yourself by name and call the person by
  name. Dont ask, Do you know who I am?
• Approach the person slowly from the front and
  give them time to get used to your presence.
  Maintain eye contact.

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Communication

• Try to talk away from other distractions such as
  a loud TV or others trying to join the
  conversation.
• Speak slowly and distinctly. Use familiar words
  and short sentences
• You may feel angry but dont show it. If you are
  about to lose it try counting to ten. REMEMBER
  that this person has a disease and is not
  deliberately trying to make things difficult for
  you.

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• Keep things positive.
• Offer positive choices with no wrong answers
• If the person seems frustrated and you dont know
  what he or she wants, try to ask simple questions
  that can be answered with yes or no or one-word
  answers.
• Use gestures, visual cues, and verbal prompts to
  help.
• If conversation causes agitation drop the issue
  rather than try to clear it up.

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• Use memory aids such as calendars lists.
• Explore various solutions.
• Accept the behavior as a reality of the disease
  and try to work through it.
• Acknowledge requests and respond to them.
• Respond to the emotion and not the behavior.
• Offer corrections as a suggestion. Avoid
  explanations that sound like scolding. Try I
  thought that was a spoon.

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Caregiver Support

• Provide Information
• Provide Assistance
• Respite Care
• Adult Day Care
• Counseling or Support Groups
• Training
• Supportive Services
• Caregiver Consultants
• Loan Closet

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Resources

• http//www.ahaf.org/alzdis/about/adabout.htm
• http//www.mayoclinic.com/health/alzheimers-caregi
  ver/AZ00018
• http//www.agis.com/
• http//www.nia.nih.gov/Alzheimers/Publications/car
  egiverguide.htm
• Or Call your local Alzheimer Association Chapter