Alzheimer’s and Related Disorders Dr. BC Farnham & Elizabeth Pugh, LBSW, CM

Important Information This education program for healthcare professionals was developed by The Consortium for Advancements in Health and Human Services, Inc. (CAHHS) and is facilitated by the presenting agency via a community education partnership agreement. CAHHS is a private corporation and is solely responsible for the development, implementation and evaluation of its educational programs. There is no fee associated with receiving contact hours for participating in this program titled, Alzheimer’s and Related Disorders. However, participants wishing to receive contact hours must offer a signature on the sign-in sheet, attend the entire program and complete a program evaluation form. The Consortium for Advancements in Health and Human Services, Inc. is an approved provider of continuing nursing education by the Alabama State Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. The Consortium for Advancements in Health & Human Services, Inc., is approved as a provider of continuing education in Social Work by the Alabama Board of Social Work Examiners, #0356, Expiration Date: 10/31/2018. In most states, boards providing oversight for nursing and social work recognize contact hours awarded by organizations who are approved by another state's board as a provider of continuing education.  If you have questions about acceptance of contact hours awarded by our organization, please contact your specific state board to determine its requirements. Provider status will be listed on your certificate. CAHHS does not offer free replacement certificates to participants. In the event that CAHHS elects to provide a replacement certificate, there will be a $20.00 administrative fee charged to the individual who requests it.

Learning Objective (s): Participants completing this educational program will be able to do the following: Understand and recognize the four types of Alzheimer’s Disease. Understand ways to communicate with a patient with Alzheimer’s Disease.

Dementia vs. Normal Aging Forgetfulness due to aging or stress is NOT dementia related. Dementia is not a disease but a group of symptoms.

Dementia Loss of intellectual functions and memory sufficient to impair activities of daily living. Occurs in Domains of… Memory Language Visuospatial Skills Complex cognition Emotion and Personality Visuospatial- pertaining to perception of the spatial relationships among objects within the field of vision.

4 Major Types Dementia: Alzheimer Type Vascular Dementia: multi-infarct Diffuse Lewy Body Dementia Pick’s Disease

Dementia: Alzheimer Type 50% of all dementias Affects 4 million people Irreversible Neurofiber tangles & senile placques destroy cerebral cortex producing atrophy Average Life expectancy 3 to 10 years The major predictor of life expectancy is age; the younger a person is at diagnosis, the longer the life expectancy.

Changes in memory and in Language centers of the brain.

Vascular Dementia 5 – 10% incidence Blockages in small arteries of the brain cause a loss of circulation beyond the blocked area…lead to brain cell death Causes: High blood pressure or heart disease Step–wise progression; periods of stability with sudden significant declines

Diffuse Lewy Body Dementia 15% incidence Caused by protein deposits in the brain Characterized by hallucinations and difficulty with motor skills Acute/Rapid onset Life expectancy similar to Alzheimer’s Dementia

Pick’s Disease 15% incidence Affects frontal and temporal lobes of the brain Causes personality changes, socially inappropriate behavior, amnesia, speech difficulties Younger onset, more commonly between age 40 and 60

Prognosis Permanent Loss of Neurons Medications, which prevent breakdown of acetylcholine, may slow progression for a period of time

Signs and Symptoms Memory Loss – short and long term Confusion Loss of reasoning and intuition Inability to learn new things Poor judgment Loss of ability to use knowledge Loss of ability to carry out motor tasks or follow directions

Signs and Symptoms Personality changes Frustration, withdrawal, suspiciousness or restlessness Disturbance of sleep cycle Inability to perform ADLs Inability to recognize friends and family Emotional instability

Behavioral Issues Anxiety Resistiveness to care due to inability to understand their environment and need for care

Causes of Death Infection Impaired immune function Immobility Incontinence Skin breakdown Impaired swallowing The patient “fades away”

Communication and Alzheimer’s Disease

Non-Verbal Communication Caregivers should learn to read the body language of people with AD Use all senses If patient is unreceptive leave them alone for a few minutes Make nonverbal messages match your words Add positive, pleasant nonverbal behaviors

Verbal Communication & Language Changes People with AD may: Not be able to keep up with conversation Not understand directions Have increased confusion with background noise

Verbal Communication Tips and Techniques Use simple, short sentences Say the person’s name Establish eye contact Speak clearly, calmly and repeat as needed Look for cues the person has heard you Act out the message Address the person by their given name

Early Stages Discuss important business in the mornings Focus on one topic at a time Use specific words, names of people and objects Do not use pronouns or general language

Middle Stages Give stimulation that can be sensed emotionally Give touch in a systematic way Stimulate smell Comb their hair Give favorite foods If the patient speaks in single words, then you should speak in single words

Late Stages Speak warmly, quietly and with eye contact Pat or stroke their hand Touch with love SMILE

Effective Reaction Skills Control your emotions Analyze the situation Be positive Acknowledge the patient’s emotions

Use Communication Cards Print a clear message Make cards personal Read it with the patient Plan ahead

References Special care of nursing home resident’s with alzheimer’s disease or related disorders. (n.d.). Retrieved August 17, 2010 from Florida Health Care Association website: http://www.fhca.org/ Stavitsky, K., Brickman, A. M., Scarmeas, N. Torgan, R. L., Tang, M. X., Albert, M., Brandt, J., Blacken, D., & Stern, Y. (2006). The progress on cognition, psychiatric symptoms and functional abilities in dementia with lewy bodies and alzheimer’s disease. Arch Neurol, 63 (10). Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17030662. Zannetti, O., Solerte, S.B., & Cantoni, F. (2009). Life expectancy in alzheimer’s disease. Arch Gerontol Geriatr, 49. Retrieved from http://www.med.umich.edu/alzheimers/ Alzheimer’s association. (2010). Retrieved from http://www.alz.org/index.asp

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