Alzheimer’s Flashcards
normal aging
making a bad decision once in a while
missing a monthly payment
forgetting which day it is and remembering later
sometimes forgetting which word to use
losing things from time to time
Alzheimer’s disease
making poor judgments and decisions a lot of the time
problems taking care of monthly bills
losing track of the date or time of year
trouble having a conversation
misplacing things often and being unable to find them
dementia
umbrella term used to describe a range of symptoms associated with cognitive impairment
alzheimer’s = 60-80%
vascular = 20-30%
lewy bodies = 10-25%
frontotemporal = 10-15%
mixed dementia
> 1 neuropathology
prevalence unknown
Most common form→ 60-80% of dementia is AD
Hallmark pathology is the accumulation of beta-amyloid plaques outside neurons and tau proteins (tangles) inside neurons
alzheimers clinical presentation:
Memory impairment
Lapse in judgement
Personality changes
Depression
Language difficulty
Difficulty with ADL
Visual-spatial impairment
Changes in temperamen
Loss of motor function (swallowing, B/B
Vascular Dementia
- Previously called multi-infarct or post-stroke dementia
- Accounts for approx. 10% of cases, but common in older individuals with dementia
- Impaired judgement, impaired ability to make decision, plan or organize (as opposed to memory loss)
- Risk factors similar to those for stroke/MI
- More abrupt onset, fluctuating course, emotional lability
Lewy Body Dementia
Lewy bodies: abnormal aggregations of alphasynuclein that accumulates in neurons
Symptoms of sleep disturbance
- Visual hallucinations
- Slowness, gait imbalance
- Early visuospatial impairment
Frontotemporal Dementia
Caused by a group of disorders that occur causing loss of nerve cells in the frontal and temporal lobes
Most common dementia to strike younger ages 45-60
Frontal variant. This form of FTD affects behavior and personality.
Primary progressive aphasia. Aphasia means difficulty communicating. This form has two subtypes:
Delirium
Sudden, rapid change in mental function that are associated with medical illness,recovery from surgery, hospitalization (especially longer stays/critical care)
Associated with behavioral changes
Is reversible
Delirium vs dementia
Delirium-
> Sudden onset
> Fluctuating symptoms
> Impaired attention and consciousness
> Is reversible
Dementia-
> progressive onset
> slow progression
> Memory loss
> Difficulty with abstract thoughts
As the disease progresses:
> Dependence on custodial care increases
> Judgment/executive functioning impaired
> Self-help limited
> Difficulty with communicating
> Confusion
> Elevated injury risk
A person with Alzheimer’s/dementia is ___ as likely to have ___ other chronic conditions as someone without Alzheimer’s/dementia.
5.5 times
6 or more
Implication
Alzheimer’s complicates the management of coexisting conditions – and as a consequence, increases costs.
Why is Alzheimer’s costly?
780 hospital stays for every 1,000 seniors with Alzheimer’s or dementia
243 hospital stays for every 1,000 seniors without these conditions
People with Alzheimer’s or dementia have over 3 times as many hospital stays
Living Alone
30 percent of community-dwelling older adults with dementia live alone.
1 in 3 people with dementia who live alone do not have an identifiable caregiver.
communication in the early stage
changes you may notice:
difficulty finding the right words
taking longer to speak or respond
withdrawing from conversations
struggling with decision-making or problem-solving
using familiar words repeatedly
inventing new words to describe familiar things
easily losing train of thought
speaking less frequently
things to keep in mind:
avoid making assumptions
speak directly to the person
communicate in the way that is most comfortable for the person
> phone
> email
> in person
laugh together
be honest, laugh together, stay connected with each other
to connect, approach the person gently:
approach from the front, say who you are and call the person by name
maintain eye contact and get at eye level if seated or reclining
avoid criticizing, correcting, and arguing
pay attention to your tone
take your time
The behavior of a person with dementia:
Is not random
Has a cause
Tells us something
Communicates something
Common Challenging Behaviors
Rummaging or searching
Hiding or losing things
Pacing or wandering
Repeated questions
Resisting or refusing care
Hallucinations, Paranoia, Delusions
Sundowning
INTERNAL triggers
Something happening in the mind or body of the person:
ex)
He is hungry
She has a headache
EXTERNAL triggers
Something that is happening around them or to them
ex)
Room is too hot
Nothing to do
She is being pulled
understanding and addressing the behavior
detect and connect
address physical needs first
then address emotional needs
reassess and plan for next time
detect and connect =
join person in their reality
understand the person’s reality in context before intervening
> who?
> what?
> where?
approach the person calmly and respectfully
Investigating Behavior
Is there a pattern?
Was it caused by a communication problem?
Was it caused by the environment?
Was it caused by our approach to care?
Was it caused by a lack of activity?
Could it be caused by an internal trigger?
Address physical needs first
medical issues
hunger/thirst
lack of social interaction
environmental triggers or discomfort
address emotional needs second =
focus on persons feelings not facts
use knowledge of persons preferences to provide effective interventions
redirect energy into a more soothing activity
reassess and plan for next time =
go back to detecting and connecting
join person’s reality
what went well and what didn’t?
how well can you make adjustments?
A problem behavior is a ___ risk for the person with dementia or for someone else.
health or safety
Problem/Risky Behavior?
Wearing mismatched clothes
no
Problem/Risky Behavior?
Asking repeated questions
no
Problem/Risky Behavior?
Pacing or wandering
maybe
Problem/Risky Behavior?
Refusing a bath or shower
maybe
Problem/Risky Behavior?
Tries to hit you
yes
Behavior as Communication
When we learn the cause, and make a change in our response, we’ve listened to what their behavior is telling us.
This is Behavior as Communication.
PT Strategies
Safety is number one priority
Avoid unnecessary details during directions
Offer a few choices instead of asking open-ended questions
Redirect to different topic when patient stops following commands
Use tactile cues to facilitate desired movement
Identify if a pattern of lucidity exists - Treat patient during lucid times
Include:
> Limit distractions
> Pain Management
> Focus on ambulation
> Try to do falls prevention if possible
> Educate Family
Intervention Strategies
- Approach from the front
- Get at their physical level
- Eliminate background noise and distractions
- Make eye contact
- Smile
- Introduce yourself
- Explain why/what you are doing
- Invite to participate
