#3: Affect & Cognitive Interventions & Environmental Modifications

Question 1

Depression in patients with Alzheimer’s disease (AD) is common in ….

Answer 1

15%-63% of dementia population

Question 2

When is depression more common in AD?

Answer 2

early to mid-stages

Question 3

What does depression in AD possibly reflect…

Answer 3

• lack of control,
• sense of helplessness,
• insufficient reinforcing activities, -loneliness.

Question 4

Depression in AD is can often lead to…

1. increased
2. reduced
3. more impaired
4. earlier
5. greater
6. larger

Answer 4

• increased mortality
• reduced quality of life
• impairments in activities of daily living
• earlier admission to long-term care facilities
• greater likelihood of behavioural disturbances
• larger caregiver burden

Question 5

What makes the diagnosis of depression in dementia so challenging?

Answer 5

• reduced communication abilities
• difficulty distinguishing depressive symptoms from those common in dementia such as emotional dysregulation, apathy, cognitive changes).

Question 6

What is the first step of AD depression diagnosis

Answer 6

professional evaluation

Question 7

What other factors can produce symptoms of depression in AD

Answer 7

Side effects of medications or an unrecognized medical condition

Question 8

What are the 8 sub-symptoms of depression and how many must be present for how long?

Answer 8

• Social isolation or withdrawal
• Disruption in appetite
• Disruption in sleep
• Agitation or slowed behavior
• Irritability
• Fatigue or loss of energy
• Feelings of worthlessness, hopelessness, or guilt
• Recurrent thoughts of death, suicide plans or a suicide attempt (less common in AD)

Two or more symptoms over 2 weeks**

Question 9

What are the 2 main symptoms of depression

Answer 9

• Depressed mood (sad, hopeless, discouraged or tearful)

- decreased pleasure in usual activities

Question 10

treatment of depression in AD improves?

Answer 10

• sense of well-being
• quality of life
• function.

Question 11

What are 5 non pharmachological therapies for depression in AD?
BRVSC

Answer 11

Behaviour therapy (positive reinforcement)
Reminiscience Therapy
Validation Therapy
Simulated presence therapy
Cognitive Therapy

Question 12

What 3 approaches are often combined in treating depression in AD patients?

Answer 12

pharmacological & non pharmacological approaches

ECT

Question 13

What are the 8 physician prescribed antidepressants for people with AD
CDE PP RW

Answer 13

(Wellbutrin®) 
(Celexa®) 
(Prozac®) 
(Remeron®) 
(Paxil®) 
(Zoloft®) 
(Desyrel®) 
(Effexor®)

Question 14

What is the defining early feature of AD

Answer 14

Memory decline

Question 15

Which aspect of memory shows early and rapid decline

Answer 15

Episodic

Question 16

What are 3 distinct approaches to cognitive interventions

RST (rest)

Answer 16

1) Cognitive Rehabilitation
2) Cognitive Stimulation
3) Cognitive Training

Question 17

What is cognitive stimulation

Answer 17

global stimulation and reality orientation

Question 18

What level of AD decline is cognitive stimulation used for

Answer 18

moderate AD severity

Question 19

With cognitive stimulation it is unclear which are beneficial or the impact of…

Answer 19

…social interaction in creating a more stimulating environment

Question 20

What is cognitive training

ex:

Answer 20

guided practice on a set of standard tasks

example: setting the table

Question 21

What is the focus of cognitive training

Answer 21

specific cognitive functions (memory, attention, language etc.)

Question 22

Cognitive training is based on the idea that…

Answer 22

practice can maintain or improve functioning in a given domain and will generalize to other similar tasks

Question 23

Cognitive or neuropsychological tests like the _____________ are typically used to cognitive: training/simulation or rehabilitation?
Usually involves a control group? T/F
How significant?

Answer 23

TRAINING
(e,g, MMSE)
usually with comparison to a control group
with few significant findings

Question 24

What is cognitive rehabilitation

Answer 24

individualized approach to helping those with cognitive impairments

Question 25

Who conducts a cognitive rehabilitation

Answer 25

individuals with AD, families, and health care professionals work together to identify personally relevant goals and strategies for addressing them

Question 26

Goals of cognitive rehabilitation

Answer 26

enhance/maintain everyday functioning and well being, reduce caregiver burden

Question 27

-significant benefits identified, but a lack of randomized controlled trials - more research needed IS related to…

Answer 27

Outcome of cognitive rehabilitation research

Question 28

What is the focus of cognitive rehabilitation?
2

EX:

Answer 28

1. building on strengths (aspects of preserved memory)
2. strategies for compensating for weaknesses

EX:

Question 29

Episodic memory is the memory of ___________________ that can be explicitly stated.

ex:

Answer 29

Episodic memory is the memory of autobiographical events that can be explicitly stated.

ex:(times, places, associated emotions, and other contextual who, what, when, where, why knowledge)

Question 30

Semantic memory refers to a portion of ____________ that processes _____________. Semantic memory includes things that are ______________.

Examples:

Answer 30

Semantic memory refers to a portion of long-term memory that processes ideas and concepts that are not drawn from personal experience.

Ex: names of colors,
the sounds of letters,
the capitals of countries
and other basic facts acquired over a lifetime

Question 31

Implicit memory is a type of ______________ memory that doesn’t require ____________ ____________ It allows you to do things by _______.

ex:

Answer 31

Implicit memory is a type of long-term memory doesn’t require conscious thought. It allows you to do things by rote.

ex: sing a song you have known forever