Master’s Advanced Curriculum (MAC) Teaching Module: Advanced Practice in Mental Health Settings Acknowledgement: The development of this PowerPoint was made possible through a Gero Innovations Grant from the CSWE Gero- Ed Center’s Master’s Advanced Curriculum (MAC) Project and the John A. Hartford Foundation.

Dementia DEFINITION: Group of symptoms that can be caused by many disorders. Syndrome which refers to progressive decline in intellectual functioning severe enough to interfere with person’s normal daily activities and social relationships. (National Institute on Aging, 1995 No. 95-3782)

Dementia Progressive and irreversible declines in memory visual-spatial relationships performance of routine tasks language and communication skills abstract thinking Mathematical ability

Dementia Two Types: Reversible Irreversible

Dementia Reversible: D= Drugs, Delirium E= Emotions (such as depression) and Endocrine Disorders M= Metabolic Disturbances E= Eye and Ear Impairments N= Nutritional Disorders T= Tumors, Toxicity, Trauma to Head I= Infectious Disorders A Alcohol, Arteriosclerosis (Dick-Mulheke- Overview of Alzheimer's Disease)

Dementia Irreversible: Alzheimer’s Lewy Body Dementia Pick’s Disease (Frontotemperal Dementia) Parkinson’s Heady Injury Huntington’s Disease Jacob-Cruzefeldt Disease

Dementia Irreversible: Alzheimer's most common type of irreversible dementia Multi-Infarct dementia second most common type of irreversible dementia Death of cerebral cells Blockages of larger cerebral vessels, arteries Abrupt in onset Associated with previous strokes, hypertension Can be determined through diagnostic procedures

Changes Caused by Alzheimer's Diminished blood flow Neurofibrillary Tangles Neuritic Plaques Degeneration of hippocampus, cerebral cortex, hypothalamus, and brain stem

Theories Regarding Causes of Alzheimer's Changes in Protein Synthesis Changes in Neurotransmitters Genetic Theories

Theories Regarding Causes of Alzheimer's Genetic Theories Metabolic Theories Calcium Theories

Theories Regarding Causes of Alzheimer's Environmental Aluminum--Traces of metal found in brain. Zinc--found in brains on autopsies. Food borne poisons--amino acids found in legumes in Africa and India my cause neurological damage. Viral May be hidden in body and attack brain cells years later. (NIH-1995)

Theories Regarding Causes of Alzheimer's Head Trauma Head trauma increase the concentration of B-amyloid protein Low Level of Education Individuals with low level of education less able to compensate for cognitive deficits Estrogen Deficiency

Diagnosis of Dementia Due to Alzheimer’s Memory Impairment Multiple cognitive deficits with at least one disturbance in the following areas: Aphasia—loss of the ability to use symbols to communicate orally or in writing Apraxia—inability to initiate complex learned motor movement or unable to perform activity on command Agnosia---inability to recognize familiar objects by sight, touch, taste, smell or sound

Diagnostic Tests Neurological Exam Brain Imaging—shrinkage, atrophy of brain (CT or MRI) Blood Work

Stages of Alzheimer’s Disease Mild Stage Memory Loss Symptoms: Confusion Loss of Spontaneity Loss of Initiative Mood/Personality Changes Poor Judgment Takes Longer to Perform Routine chores

Stages of Alzheimer’s Disease Moderate Stage Impairments in: language motor ability recognition of objects increasing memory loss and confusion

Stages of Alzheimer’s Disease Moderate Stage Symptoms: Problems recognizing family members, close friends. Repetitive statements and/or movements. Restless, especially in late afternoon and at night.. Problems organizing thoughts, thinking logically. Can’t find right words; confabulation. Reading and writing difficulties May be suspicious, irritable, fidgety, teary or silly.

Stages of Alzheimer’s Disease Severe Stage Symptoms: Weight loss, even with good diet. Deterioration in self-care. Difficulties in verbal - May put everything in mouth or touch everything. Loss of bladder and/or bowel May have difficult with seizures, swallowing, skin breakdown, infections.

Stages of Alzheimer’s Disease Terminal Stage Symptoms: Loss of ability to ambulate. Loss of ability to sit. Loss of ability to smile. Loss of ability to hold up head. Loss of ability to swallow.