Approaching Alzheimer’s: Making your first response the right response Tim Harrington Development Coordinator Business Relations and Advocacy

What do you think of when you hear the term “Alzheimer’s” or “dementia”? What has your experience been with those with Alzheimer’s and dementia in the community?

What’s going on? Keep your copy short. Suggested uses for this page: a mission statement, a goal, a summarizing statement, an Alzheimer’s fact.

The “Real Work” of the Brain Nerve cell (neurons) Branches Signals traveling The brain has 100 billion neurons, brain cells that are constantly communicating. We are born with a full set of brain cells. Neurons are the chief type of cell destroyed by AD. Image credit: Jannis Productions. Rebekah Fredenburg, computer animation; Stacy Jannis, illustration/art direction.

You are a brain cell ACTIVITY Cell Signaling Synapses Signals that form memories and thoughts move through an individual nerve cell as a tiny electrical charge. Nerve cells connect to one another at synapses. When a charge reaches a synapse, it may trigger a release of tiny bursts of chemicals called neurotransmitters. The neurotransmitters travel across the synapse, carrying signals to other cells. AD disrupts both the way electrcial charges travel within cells and the activity of neurotransmitters. You are a brain cell ACTIVITY Assign a time keeper Everyone join hands. Designate a starting point and give directions. Everyone squeeze the hand of the person next to you so it is a chain reaction. The last person in the chain yells DONE when they feel the squeeze from their neighbor. Try two more times to improve time. The squeeze was the communication between brain cells. When you learn something new, you make connections between brain cells. The more we used our brain, the better we got at it. The more you use your brain the stronger it will get. Tiny electrical charge Neurotransmitters Image credit: Alzheimer's Disease Education and Referral Center, a service of the National Institute on Aging.

Under the Microscope: Hallmarks of Alzheimer’s Disease Tangles Plaques Scientists can also see the terrible effects of Alzheimer's disease when they look at brain tissue under the microscope: Alzheimer tissue has many fewer nerve cells and synapses than a healthy brain. Plaques, abnormal clusters of protein fragments, build up between nerve cells. Dead and dying nerve cells contain tangles, which are made up of twisted strands of another protein. Scientists are not absolutely sure what causes cell death and tissue loss in the Alzheimer brain, but plaques and tangles are prime suspects. Plaques form when protein pieces called beta-amyloid (BAY-tuh AM-uh-loyd) clump together. Beta-amyloid comes from a larger protein found in the fatty membrane surrounding nerve cells. Beta-amyloid is chemically "sticky" and gradually builds up into plaques. The most damaging form of beta-amyloid may be groups of a few pieces rather than the plaques themselves. The small clumps may block cell-to-cell signaling at synapses. They may also activate immune system cells that trigger inflammation and devour disabled cells Tangles destroy a vital cell transport system made of proteins. This electron microscope picture shows a cell with some healthy areas and other areas where tangles are forming. In healthy areas: The transport system is organized in orderly parallel strands somewhat like railroad tracks. Food molecules, cell parts and other key materials travel along the “tracks.” A protein called tau (rhymes with wow) helps the tracks stay straight. In areas where tangles are forming: Tau collapses into twisted strands called tangles. The tracks can no longer stay straight. They fall apart and disintegrate. Nutrients and other essential supplies can no longer move through the cells, which eventually die. Image credit: Jannis Productions. Rebekah Fredenburg, computer animation; Stacy Jannis, illustration/art direction.

What’s going on? Keep your copy short. Suggested uses for this page: a mission statement, a goal, a summarizing statement, an Alzheimer’s fact.

What’s the Difference? Alzheimer’s Disease Dementia Symptoms of Dementia include: Confusion, disorientation, memory loss and behavior changes. Symptoms and Stress As the disease progresses, the stress threshold decreases

Recognizing a person with dementia Age Facial expression Attire Balance/gait Actions

Communication Tips Approach from the front. 18 inch window Introduce yourself, multiple times if necessary. Speak slowly. Use simple language. Be mindful of body language, yours and theirs. Be mindful of voice tone, volume and intonation, yours and theirs.

Communication Tips Excess tension radiates and exacerbates. Minimize distractions when possible. Don’t talk down to the person. Work one-on-one whenever possible. Don’t gang up. They may be able to hear you, but not understand. Face the person when speaking to them.

Communication Tips Get information from the family about the person. Is there a diagnosis? Other underlying physical problems? The life story is the best communication tool. Learn relationship to law enforcement. Find out a few tidbits to use to make a connection to the person. In Alzheimer’s disease, all behavior is communication.

Communication Tips Lots of questions to the person with dementia can lead to a catastrophic response. Direct questions to family. In the case of a catastrophic response, back off and allow the person to calm down.

Wandering Six out of ten people with Alzheimer’s will wander. If not found within 24 hours, up to 50% risk serious injury or death. Wandering can take place in multiple ways: on foot, by wheelchair, in a car and by public transportation. Wandering can be triggered by stressful situations.

Medic Alert + Safe Return Nationwide identification and medical information program for people with dementia. 24/7/365 call center Fee to join but scholarships available through the Chapter.

Firearms Extreme reactions to common events. Misinterpretation of surroundings. TV shows, Trick or Treaters Over-reactions to surrounding events.

TALK Tactics Take it slow Ask short, simple questions Limit reality checks Keep eye contact

Dementia and Individual Response Sensitive to trauma. Limited ability to understand directions or explanations. May forget directions. Easily agitated, frustrated or overwhelmed. Prone to wander or hide.

Dementia and Individual Response Each reaction to your actions will be different. Reactions are as different as the people themselves. Be flexible and switch off to find the “fit” for communicating. Your response: Let them know they are ok, they are in the right place, they are being helpful. Use “me” and “I” instead of “us” and “we.

Dementia and the Individual Response Use reflective listening… It sounds like… You shared that… What I hear you saying is that….

Thank you!