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Basics of Dementia and Alzheimer

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Title: Dementia Basics Author: Shelly Created Date: 5/12/1997 8:51:04 AM Document presentation format: Custom Other titles: Times New Roman Arial Wingdings Monotype ... – PowerPoint PPT presentation

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Title: Basics of Dementia and Alzheimer


1
Basics of Dementia and Alzheimers Disease
  • Shelly Zylstra
  • Northwest Regional Council
  • zylstra_at_dshs.wa.gov

2
Definition of Dementia
  • An acquired intellectual deterioration which
    affects at least two areas of cognitive function.
  • In the past, commonly referred to as senility or
    hardening of the arteries

3
Cognitive Functions
  • Memory
  • Orientation
  • Language
  • Judgement
  • Perception
  • Attention
  • Ability to perform tasks in sequence

4
Dementia is Not Normal Aging

20 year old brain 80
year old brain
5
Causes of Dementia
  • Causes of dementia
  • 47.7 Alzheimers
  • 10.0 Alcoholic dementia
  • 9.4 Vascular dementia
  • 6.0 Normal pressure hydrocephalus
  • 4.8 Intracranial masses (tumors)
  • 2.9 Huntingtons disease
  • 2.4 Drug toxicity
  • 1.7 Post-traumatic
  • 6.7 Pseudo-dementia

6
Scans Show the Loss of Activity

7
Reversible Dementias
  • Intoxications
  • Infections
  • Metabolic disorders
  • Depression
  • Medication Problems
  • Brain tumors
  • Head injuries
  • Normal pressure hydrocephalus
  • Dehydration

8
Irreversible Dementias
  • Alzheimers disease
  • Multi-Infarct Dementia
  • Parkinsons disease
  • Lewy Body disease
  • Creutzfeldt-Jakob disease
  • Picks disease
  • Huntingtons disease
  • AIDS dementia complex
  • Progressive aphasia

9
Dementia of the Alzheimers-type (DAT)
  • Diagnosing DAT
  • Usually diagnosed by process of elimination
  • MRI shows enlarged ventricles and widening in
    folds of the cerebral cortex

10
DAT Clinical features
  • 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

11
DAT Clinical features
  • Messiness
  • Impaired judgment
  • Agitation
  • Periods of confusion
  • Terminal stages person is in a vegetative state
  • Psychopathological symptoms are transitory and
    inconsistent
  • Sometimes paranoia

12
Vascular dementia
  • Clinical picture looks like DAT (increasing
    incidence with age)
  • Multiple small strokes cumulatively destroy
    neurons over an ever expanding brain area
  • Defective areas get soft over time
  • Less common than DAT, but may be more common in
    Indian Elders
  • May be associated with more severe behavioral
    complications such as violence
  • Increasingly vulnerable to sudden death

13
Prevalence of Alzheimers Disease
  • Over 4 million Americans plus their families
  • Number doubles every 5 years after age 65
  • Numbers may triple by 2050
  • 1/10 people over age 65 in USA
  • 5/10 people over age 85 in USA
  • 30-40 of nursing home patients have DAT

14
Prevalence of Alzheimers Disease by Age
15
Stages of Alzheimers disease
  • Function Early Stage
  • Memory Routine loss of recent memory
  • Language Mild aphasia (word finding
    difficulty)
  • Orientation Seeks familiar and avoids
    unfamiliar
  • Motor Some difficulty writing and using
    objects
  • Mood Apathy depression
  • ADLs Needs reminders with some ADLs

16
Stages of Alzheimers disease
Function Middle Stage Memory Chronic, recent
memory loss Language Moderate
aphasia Orientation May get lost at times, even
inside the home Motor Repetitive actions,
apraxia Mood Possible mood and
behavioral disturbances ADLs Needs
reminders and help with most ADLs
17
Stages of Alzheimers disease
Function Late Stage Memory Mixes up past and
present Language Expressive and receptive
aphasia Orientation Misidentifies familiar
persons and places Motor Bradykinesia, at
risk for falls Mood Greater incidence of mood
and behavioral problems ADLs Needs
reminders with all ADLs
18
Stages of Alzheimers disease
Function Terminal Stage Memory No apparent link
to past or present Language Mute or few
incoherent words Orientation Oblivious to
surroundings Motor Little spontaneous
movement, dysphagia, myoclonus,
seizures Mood Completely passive ADLs
Requires total care
19
Loss of Brain Tissue with DAT
20
Treatment of Alzheimers Disease
  • Delay onset
  • Slow rate of progression
  • Treat primary symptoms (cognitive)
  • Treat secondary symptoms (behavioral)

21
Care of Persons with Alzheimers disease
  • Create a supportive atmosphere
  • Structure appropriate activities routine
  • Design dementia friendly environments
  • Facilitate peer groups (for emotional support
    shared activities)

22
Help for Family Caregivers
  • Offer education, training and consultation
  • Promote respite services e.g.- adult day care,
    companion
  • Offer individual and family counseling
  • Encourage participation in support groups

23
The Basics of Good Communication with DAT
  • Rules of communication between two cognitively
    intact persons ( a 2-way street)
  • When one person has AD there is no longer an even
    exchange
  • Setting the right tone

24
Communication Changes
  • Early stage Difficulty finding the right word,
    repetitiveness keeping pace with others
  • Middle stage Increased difficulty with speaking
    correctly comprehending language of others
  • Late stage Vocabulary reduced to a few words or
    phrases increased need for nonverbal cues
  • Terminal stage Mute or occasional word/phrase

25
Similar Functions Different Locations
Speaking Words
Hearing Words
Seeing Words
  • Seeing Words

Thinking Words
26
How is the person with dementia understanding
the world?
27
Approaches of Others
  • Unrealistic expectations
  • Communication is key
  • - verbal means
  • - non-verbal means

28
Emotional Stressors
  • Diminished self-esteem
  • Fear related to the disease
  • Low frustration tolerance

29
Medical Stressors
  • Medications
  • Pain
  • Insomnia/fatigue
  • Infections/illness
  • Dehydration and malnutrition
  • Constipation
  • Poor vision
  • and hearing

30
Environmental Stressors
  • Stimulation - too much or too little
  • Physical design - helps and hindrances
  • Familiarity- cues labels

31
When You Speak
  • Make the setting free of distractions
  • Gain attention, make eye contact, be aware of
    body language
  • Provide orienting information

32
Language that Works
  • Use short, simple sentences
  • Use familiar and concrete words
  • Break down tasks into steps
  • Avoid open-ended questions
  • Help reduce choices

33
Trouble Understanding
  • Active listening
  • Focus on word or phrase that may have meaning
  • Respond to the emotional tone
  • Try to stay calm and be patient
  • Ask family members for clues

34
Trouble Being Understood
  • Allow enough time
  • Give a visual demonstration
  • Evaluate complexity of task
  • Change the subject if necessary

35
Things to Avoid
  • Dont argue
  • Dont give strict orders
  • Dont be condescending
  • Dont ask questions requiring detailed responses
  • Dont talk about people in front of them
  • Dont bother asking, Do you remember? in regard
    to recent events

36
Validate their Goodness!
  • Give them the gift of a one-way conversation.
  • Eat lunch with them. Dont feed them.
  • Discuss your day.
  • Ask about their life when they were 10.
  • Dont try to orient. Their reality is different
    from the present.

37
  • While the majority of the attention to
    nutrition and Alzheimers Disease and dementia is
    related to cause and effect of specific nutrients
    or environmental concerns, the most time-tested
    nutritional aspect is what people with
    Alzheimers Disease are eating for dinner.
  • Zylstra, 1998

38
Goals of Nutrition in Alzheimers
  • Maintain weight
  • Individual more important than weight
  • Protect muscles to promote independence
  • Enhance immune function
  • Promote good bowel health
  • Good hydration
  • Medication management--prevent interactions,
    manage side-effects

39
Barriers to Good Nutrition
  • Early Illness
  • Memory loss can lead to over- or under-eating.
  • Inability to prepare appropriate meals.
  • Food-born illness from improper food handling.
  • Depression/medications affect appetite.
  • Eating out can be embarrassing for family.
  • Begin to make changes for later illness now.

40
Solutions to Early Problems Forget to eat
  • Look for signs that food is not eatenfood taken
    to room from dining room and forgotten, scraps in
    garbage, food containers in refrigerator.
  • Provide snacks with activities and cue using
    smells--bread, cookies.
  • Watch for weight changes.

41
Solutions to Early Problems Food Handling
  • Food born illness can be an early warning sign of
    dementia. Food needs to be kept cold or hot and
    food-contact surfaces sanitized.
  • Microwave ovens are a mystery to many with
    dementia.
  • Breadbox? Pie Safe? Cake Keeper?
  • Automatic turn-off appliances can be useful.
  • Look into bad odors! Watch food supplies closely
    for old food which is unsafe to eat.

42
Solutions to Early Problems Other Issues
  • Depression can be associated with dementia at
    every stage of the disease.
  • Eating out can be embarrassing.
  • Medications used with dementia and depression can
    affect appetite and cause dry mouth which makes
    eating and swallowing difficult.
  • Educate family members about Companion Cards
    to prevent isolation.

43
Barriers to Good Nutrition
  • Middle-stage illness
  • Prevent dehydration.
  • Respond to appetite changes.
  • Watch for poisons.
  • Visual perception can change.
  • Choice can be overwhelming.
  • Watch oral condition and care.
  • Watch for agitation and confusion.
  • Motor planning skills decrease (apraxia).

44
Solutions to Middle Problems Dehydration
  • Thirst perception may be seriously impaired.
  • Fluids should be offered every two hours.
  • Broth Ice Cream Juice Popsicle's
    Jell-O Flavored water
  • Never restrict fluids to eliminate incontinence.
    Dehydration can cause incontinence by increasing
    confusion and causing urinary tract infection
    which increases urinary urgency.
  • Make tea time a regular social occasion.

45
Solutions to Middle Problems Appetite Changes
  • Appetite sensors can be impaired.
  • May not realize hunger and not eat regularly.
  • May not be able to feel satiety and may eat
    continuously (hyperphagia).
  • Offer snacks which are nutrient dense and easy to
    fix and eat--cheese and crackers, supplements.
  • Keep low calorie snacks around if weight gain is
    a problem.
  • Use other activities to distract attention from
    food...

46
Solutions to Middle Problems Poisons and
Inedibles
  • Take precautions so that a confused person does
    not have access to everyday items which could be
    poisonous.
  • Common items which are eaten include soap,
    potting soil, paper napkins or Styrofoam cups,
    toothpaste and mouthwash or medications including
    vitamin pills.
  • It is important to document non-food items which
    are preferred and get this information from
    Respite clients.

47
Solutions to Middle Problems Perception Changes
  • It is sometimes difficult to discern food on
    plates.
  • Simple, unpatterned plates are best.
  • Table linens can be disturbing, if busy. Get
    plain non-skid placemats which contrast with
    dishes.
  • Playing with food is usually a sign of agitation
    or frustration or can mean physical problem.
  • Offer one utensil or one food at a time (tell
    families).
  • Watch mixtures! Component parts can prevent
    choking, and improve intake!

48
Solutions to Middle Problems Dental Health
  • Buy SOFT toothbrushes!
  • Be certain to have regular dental checkups to be
    certain that teeth or dentures are in good
    repair.
  • Supervise dental hygiene to assure quality
    brushing and be certain that products are not
    swallowed.
  • Dental problems can cause agitation, catastrophic
    behavior, and failure to thrive. Catch it early!!

49
Solutions to Middle Problems Agitation/Confusion
  • Minimize distractions at mealtime--no TV, sit
    with person, quiet conversation only, limit
    people at the table, pull shades, arrange
    mealtimes properly.
  • Eliminate emotional agitation by accepting people
    where they are.
  • Reality orientation doesnt work in
    mid-/late-stage.

50
Solutions to Middle Problems
Agitation/Confusion
  • Many difficult behaviors are the result of
    response to the perceived environment chair seat
    color, floral rugs, patterns
  • Agnosia is the inability to recognize an object
    with the senses--visual, auditory, tactile.
  • Having someone to mimic can help eating behavior.
  • Be certain that all distracting physical needs
    are taken care of before eating (toilet, wet
    clothes)

51
Solutions to Middle Problems Apraxia
  • Apraxia means a person is unable to begin a task
    because they cannot remember how.
  • Allow plenty of time for meals. Watch for
    individual schedules! Try finger foods!
  • Aides or family may demonstrate by eating with
    clients using the same utensils and foods.
  • Hand over hand assistance may be needed.
  • Adaptive equipment encourages independence!

52
Barriers to Good Nutrition
  • Later-stage illness
  • Prevent dehydration.
  • Worsening motor planning skills
  • Choking and aspiration danger
  • Difficulty nourishing because of feeding problems
  • End of life decisions
  • Tube feeding
  • Withholding food and water

53
Solutions to Later Problems Ataxia
  • Ataxia is a condition where intentional movement
    becomes nearly impossible.
  • People with end-stage dementia my forget to chew,
    swallow, or may swallow food whole.
  • May need to switch to cut-up food, pureed food,
    or liquids.
  • If nutritional intake is insufficient, consider
    supplements (decubitis ulcer, UTI, pneumonia)
  • Dont try to feed a person who is sleepy.

54
Solutions to Later Problems Choking
  • Most people with end stage dementia choke on
    food liquids can be especially difficult.
  • When first chokes, doesnt mean Puree!, but could
    indicate the need for a swallowing evaluation.
  • Be certain that foods are prepared to proper
    consistency--nectar, honey, pudding thick.
  • Be certain that foods are properly handled
    because food born illness can be devastating.
  • Mixing textures can cause choking.

55
Signs of a Swallowing Problem
  • Weight loss.
  • Exaggerated swallowing actions.
  • Big eyes.
  • Agitation or fear spitting, throwing food.
  • No Adams Apple movement.
  • Slow eating prolonged chewing.
  • Drooling, pocketing, choking, bolting.
  • Slight fever after eating

56
Dysphagia Diets will be more Successful IF They
are
  • Proper consistency and good flavor.
  • Identifiable as food.
  • Well-sauced and fortified with calories and
    protein.
  • Messed with as little as possible.
  • Not all the same shape and color.
  • Well-garnished and not presented like the dogs
    dinner.
  • Flavor enhanced--watch for new technology!

57
Sundowning
  • Some folks begin at lunch! Serve the big meal
    early in the day!
  • May affect ability to sit at table--plan for food
    on the go!
  • Turn lights on before it gets dark.
  • Have naps in chairs rather than bed or they will
    have lots more than 7 days in a week!
  • Outdoor activities can enhance eating.

58
Food Dos and Donts
  • Plate to mouth foods only--no pits, bones, peels,
    wrappers, toothpicks.
  • Watch for inedible packaging materials--eggshells,
    cupcake papers, plastic ties
  • Chicken bones are confusing!
  • No chunks for bolters!
  • Watch the garnish!
  • Mix peanut butter with butter or applesauce!

59
Food Dos and Donts
  • Families must be involved and informed about food
    limitations.
  • Snacks are important--cheese cubes, fortified
    puddings, ice cream, leftover desserts
  • Some foods are difficult for everyone and more so
    for persons with dementia--pizza, open-faced
    sandwiches, artichokes
  • Tastes can drastically change from one day to
    anotherhates can become likes!
  • Olden days foods can be a real comfort to us
    all.

60
Food Dos and Donts
  • Add extra calories--cream and whole milk, extra
    butter and sauces, nice desserts
  • Add extra protein--chopped egg, NFD milk, cheese,
    chopped meat on salads, peanut butter
  • Add extra fiber--bran muffins, applesauce, pears,
    legumes
  • Fortify beverages--milkshakes, meds with juice or
    milk,
  • Cue with smells!
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