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Dementia

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Gina Diaz

on 5 March 2015

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Transcript of Dementia

Types of Dementia
Alzheimer's Disease
Categories Of Alzheimer's Disease
Gina B Diaz MA RN ANP GNP
DEMENTIA
DEMENTIA
What does Alzheimer's look like?
Symptoms of Alzheimer’s Disease
Aging Quiz (True/False)
Old People are...
Normal Aging
Cont: Normal Aging
DEMENTIA
Aging
The majority of old people (past 65 years) have Alzheimer's disease.
Memory loss is a normal part of aging.
As people grow older, their intelligence declines significantly.
It is very difficult for older adults to learn new things.
Research has shown that old age truly begins at 65.
Intelligence remains intact
Principal changes in “normal” aging:
1. General slowing of cognitive performance

2. Decrease in mental flexibility
Solving new problems with old solutions

3. Mild word-finding difficulties
Names of places, objects, people

4. Mild decrease in working memory
Manipulating information mentally (working a math problem in your head)
“Senior moments”
Independence in daily activities preserved

Complains about memory but provides considerable detail re: instances of forgetfulness

Patient often more concerned than close family

Recent memory intact for important events

Normal performance on mental status exam
A chronic and persistent disorder caused by a brain disease or injury that produces a decline in memory and intellect from some previously higher level of functioning severe enough to interfere with everyday life.
Dementia is NOT a normal part
of aging
Mild Cognitive Impairment
(MCI)
Alzheimer's Disease
Other Dementia
Vascular dementia
Lewy Body dementia
Parkinson's disease
Fronto-temporal lobar dementia
Mixed dementia
A progressive, degenerative, neurological disease of the brain

A steady decline in memory and cognitive functioning severe enough to interfere with everyday life

Related to specific chemical and structural changes in the brain

NOT reversible




Neurofibrillary tangles

Beta-Amyloid plaques

Decrease in chemicals (ACh) that facilitate memory

Cell death
Memory loss that disrupts daily life
Challenges in planning or solving problems
Difficulty completing familiar tasks
Confusion with time or place
Trouble understanding visual images or spatial relationships
New problems with words in speaking or writing
Misplacing things or losing the ability to retrace steps
Decreased or poor judgment
Withdrawal from work or social activities
Changes in mood and personality
Mild cognitive decline

Moderate cognitive decline

Severe cognitive decline
Prevalence
2/3 of Americans with Alzheimer’s disease are women
Prevalence and incidence studies show that fewer years of education is associated with greater likelihood of developing dementia

Some researchers believe that additional education provides a “cognitive reserve” that allows people to compensate for changes in the brain

Other researchers believe that higher risk of dementia for those with less education can be explained by the higher risks found in people in lower socioeconomic groups such as higher risk of disease and less medical care
Facts and Figures
By 2025, the number of people 65 and older with Alzheimer’s disease will grow to 6.7 million people, a 30% increase from 2012

By 2050, the number of people 65 and older with Alzheimer’s disease may triple from 2012 levels

By 2050, the number of people 85 and older with Alzheimer’s disease may quadruple from 2012 levels
By 2030, the US population over the age of 65 is expected to double
As the number of older Americans continues to grow, the number of Alzheimer’s cases will continue to increase
Mild cognitive decline includes three stages:

Stage 1: no impairment, normal function

Stage 2: very mild cognitive decline, occasional memory lapses; may be normal aging or the earliest signs of Alzheimer’s Disease

Stage 3: mild cognitive decline, early-stage Alzheimer’s may be diagnosed at this stage; family and friends may begin to notice changes
Moderate cognitive decline includes two stages:

Stage 4: moderate cognitive decline (mild or early-stage Alzheimer’s disease); careful medical interview should discover clear-cut symptoms

Stage 5: moderately severe cognitive decline (moderate or mid-stage Alzheimer’s disease); individuals begin to need help with day-to-day activities
Severe cognitive decline includes two stages:

Stage 6: Severe cognitive decline (moderately-severe or mid-stage Alzheimer’s disease), memory loss worsens, changes in personality and individuals may need help with daily activities

Stage 7: Very severe cognitive decline (severe or late-stage Alzheimer’s disease), individuals lose the ability to respond to their environment and need help with much of daily personal care
Early Detection
The following observations may indicate to a healthcare provider the presence of an undiagnosed cognitive disorder:

Forgetting medications

Repeated phone calls to provider

Reported unusual sleeping habits

Inappropriate clothing, behaviors or speech

Personal hygiene issues

Excessive weight gain or loss
The Medicare Wellness Visit
Cognitive Assessment


3 word verbal recall

Clock draw
Mini-Cog
The severity of Alzheimer’s Disease can be broken down into three categories:
Risk Factors for Alzheimer's
Most people with Alzheimer’s are over the age of 65. In addition to advancing age, other risk factors include:

Family history

Apolipoprotein E-4 (APOE-4)

Mild Cognitive Impairment (MCI)

Cardiovascular disease risk factors

Social engagement and diet

Head trauma and traumatic brain injury (TBI)

Lack of education
Disease Diagnosis
Diagnostic Evaluation
Geriatric Depression Scale
CBC
Serum electrolytes, BUN, Cr, Glucose
Vitamin B12 levels
Folate levels
Thyroid and liver function tests
Serologic test for syphyllis
Toxicity screening test; heavy metal screen
Alcohol screening test
Genetic testing (apolipoprotein E4)
Amyloid beta protein precursor
CT
PET scan
MRI
EEG
Quality Interventions
Intervention Goals:

The treatment for Alzheimer’s disease is symptomatic as there is no cure

All available FDA-approved drugs for Alzheimer’s disease target cognitive and behavioral symptoms

There are many interventions that can improve the quality of and extend life
Categories of Interventions:

Non-pharmacological
Pharmacological
Pharmacological Intervention
Medications for cognitive symptoms
Medications for behavioral and neuropsychiatric symptoms
Contraindicated medications
Vitamins and supplements
Cholinesterase Inhibitors:
Donepezil (Aricept)
Namenda (Memantine)
Rivastigmine (Exelon)
Galantamine( Razadyne)

NMDA: N-methyl-D-aspartate


Medications for Behavioral and Neuropsychiatric symptoms:
Citalopram (Celexa), Sertraline (Zoloft), Paroxitine (Paxil) Selective serotonin reuptake inhibitor (SSRI)

Venlafaxine (Effexor), Duloxetine (Cymbalta)Serotonin norepinephrine reuptake inhibitor (SNRI)
Neuroleptics:
Quetiapine (Seroquel)
Risperidone (Risperdal)
Olanzapine (Zyprexa)
As a general rule, providers should avoid anticholinergics, benzodiazepines, hypnotics, and narcotics in geriatric population
Beers Criteria has been developed to guide pharmacological care in populations aged 65 and older
Vitamins and Supplements:
Vitamin E
Gingko biloba
Estrogen supplementation
Omega 3 fatty acids
Vitamin B
Caregiving For People With Dementia
Physical risks: caregiving increases the risk of health problems

Social risks: caregivers frequently suffer from feelings of social isolation

Psychological risks: caregivers are at increased risk of depression

Financial risks: caregiving places significant financial burdens on caregivers due to lost wages and cost of care
Strategies in Reducing Caregiver Stress:
Expectations
Positive outlook
Humor
Self Care
Information and assistance
Respite
Counseling
Support groups and education
Personal care
Homemaker/chore services
Legal or financial services
Care consultation
Health Promotion and Maintenance
Eating a balance diet
Eating dark colored fruits and vegetables
Using soy products
Folate, Vitamins B12, C, and E
Exercise
Crossword puzzles
Learning new hobby
Socialization
Research Studies: alz.org

Immunization strategies
Production blockers
Preventing Tau from forming tangles
Research on Insulin nasal spray
Heart-Head connection
A Minnesota collaboration known as ACT on Alzheimer's has developed a diagnosis provider checklist which consists of four steps:
Obtain patient history and perform a neurological examination

Gather further diagnostics to address other potential causes of dementia

Review objective and subjective data to establish a diagnosis

Organize a meeting with the patient and family to discuss diagnosis, prognosis and treatment strategy
Began January 1, 2011

Prior to this time, Medicare did not pay for an annual check-up/physical

Medicare will now pay for an annual wellness visit

Included in the wellness visit is screening for possible cognitive impairment

Wellness visit may be performed by doctor, nurse practitioner, physician assistant, clinical nurse specialist, or other health professional
Priority problems for clients with AD:
Chronic confusion
Risk for Injury
Caregiver role strain
SAFETY-is priority of care
Nonpharmacologic Mgt: Managing Chronic Confusion

1) cognitive stimulation and memory training

2) structuring the environment

3) orientation and validation therapy

4) promoting self management

5) promoting bladder and bowel continence

6) promoting communication

7) collaboration of care with PT and OT
Preventing Injury

wandering
safe return program
structured activities
agitation
driving
safe environment
risk for neglect/abuse
http://www.alz.org/braintour/3_main_parts.asp
Core Mental Function
memory
communication and language
ability to focus and pay attention
reasoning and judgment
visual perception
http://video.pbs.org/video/2365432117/
Full transcript