Dementia – Depression - Delirium Understand the relationship, Recognize the signs and symptoms Dementia Care Training Centre

1.Dementia Care Training Centre 2.Guiding principles 3.Sharing our story 4.Outcomes 5.Lessons learned No More Business as Usual

A core business of Alzheimer Society of Calgary Includes staff training and family education Guiding Principles Person-centred Outcomes driven Supporting Excellence in Dementia Care Dementia Care Training Centre

More than 10,000 people diagnosed with Alzheimer’s disease Limited recognition of delirium among direct care providers Cognitive Impairment Strategy National Guidelines for Seniors Mental Health What was happening in Calgary

“No one in a better position than the Alzheimer Society to educate staff and families about the importance of delirium” “Staff need to recognize the symptoms, who and how to report what they see” Alzheimer Society Responsibility

Sharing Our Story Workshop Learning Objectives To understand the terms dementia, depression & delirium To recognize the signs and symptoms of dementia, depression and delirium To appreciate the difficulty of co-existence and interrelations of the dementia, depression, delirium To understand the diagnostic process To appreciate a person-centred approach to care

Workshop Outline The Marvellous Healthy Brain Causes of Cognitive Impairment Functions & Damages of the Brain Irreversible Types of Dementia Reversible Causes of Dementia Depression & Delirium Understanding the Distinctions The Diagnostic Process Person-Centered Care

The Healthy Brain - Introduction The brain weighs approx. 3 lbs. – 7 cups Structural & Functional Organization The brain consists of brain cells (neurons) that connect to each other through their axons, dendrites and synaptic connections. Neural networks: (100 billion) neurons has on average 7k-10k connections (total 1000 trillion). another SENSATIONal fact: “the little man” Homunculus

Causes of Cognitive Impairment developmental disabilities brain injury mild cognitive impairment dementia What is Dementia?

Areas of the Brain Structure & Functions Limbic System

Non-Reversible Types of Dementia Alzheimer’s disease Alzheimer’s disease Vascular Dementia Vascular Dementia Dementia with Lewy bodies Fronto-Temporal Dementia Fronto-Temporal Dementia Others: Parkinson’s Disease Parkinson’s Disease Huntington’s Disease Creutzfeldt Jakob Disease Progressive Supranuclear Palsy Korsakoff’s Syndrome Infection-Related Dementia (HIV, Syphilis)

Reversible Causes of Dementia MalnutritionDehydration Metabolic Dysfunction Vitamin B12 Deficiency DepressionDelirium

Depression Signs & Symptoms: Sad or depressed most of the time (mood) “emptiness” Feelings of anxiety (various forms) and psychomotor agitation Changing appetite and weight loss/gain Sleep Disturbances Loss of interest/Lack of motivation Concentration or Memory problems Social Withdrawal Thoughts of death/Suicidal Risk

Depression in the Elder Population Common atypical features : Psychotic features (paranoid delusions) Somatization The “dwindles” (*) Potential Issues: Suicide risk is high Depression is an unusual sole cause of cognitive impairment Depression often co-exists with dementia Vincent van Gogh, who himself suffered from depression and committed suicide, painted this picture in 1890 of a man that can symbolize the desperation and hopelessness felt in depression.

Delirium – Core Features (DSM-IV) Disturbance in consciousness (i.e., reduced clarity of awareness of the environment) with reduced ability to focus, sustain, or shift attention; A change in cognition (i.e., memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance that is not better accounted for by a preexisting, established, or evolving dementia; and The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day.

Delirium can occur as a consequence of A general medical condition Substance intoxication Substance withdrawal Multiple causes Often arises as an interplay of predisposing and precipitating factors. Furthermore: In general, the greater the vulnerability of the person, the higher the likelihood of delirium occurring. It is not always possible to firmly establish the specific etiology of the delirium in an older person.

Comparison of the Clinical Features DementiaDepressionDelirium Insidious/slow and often unrecognized; depends on cause Coincides with major life changes; often abrupt, but can be gradual Sudden/abrupt; depends on cause; often at twilight or in darkness Clinical Features: ONSET COURSE, PROGRESSION, ATTENTION, MEMORY, THINKING

Principles of Person Centred Care UniquenessComplexityEnablingPersonhood Value of others

Outcomes 40 people trained 40 people trained 3 workshops to date 3 workshops to date Participants: acute care, long-term care, developmental disabilities, adult day support, independent seniors residences, seniors community resources, Calgary and Edmonton health region Participants: acute care, long-term care, developmental disabilities, adult day support, independent seniors residences, seniors community resources, Calgary and Edmonton health region

Lessons Learned Direct care providers across the care continuum recognize their need to learn more about dementia, depression and delirium and reporting requirements Direct care providers across the care continuum recognize their need to learn more about dementia, depression and delirium and reporting requirements Family members are beginning to recognize the importance of understanding the relationship between dementia, depression and delirium Family members are beginning to recognize the importance of understanding the relationship between dementia, depression and delirium The Alzheimer Society plays a key role in educating and supporting staff and families about delirium

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