Model of Psychological Intervention in Dementia Care Polly Shepard, Psy.D. Corby Bubp, Ph.D. Clinical Neuropsychology/Psychology

Learning Disability Assessment Individual Therapy Career Counseling Custody Evaluation Competency Evaluation Parent Coordination Biofeedback Therapy Neuropsychological Assessment Marital/Family Therapy Psychiatric Assessment PPS

The Memory Clinic of Indianapolis Provide compensatory strategies and recommendations for home and school Identify potential barriers for decision making in daily living (e.g. independent living, driving, financial decision making, etc.) Provide assessment, consultation, and testimony for issues related to competency and brain-related impairments.

The Memory Clinic of Indianapolis Pediatric and Adult Neuropsychological Evaluations Psychoeducational Evaluations To determine Learning Disorders and AD/HD Evaluate cognitive strengths and weaknesses in chronic medical diagnoses Pre-and post-concussion/TBI evaluations School readiness/private school admission evaluations Distinguish neurological vs. emotional/psychiatric syndromes

What is a Neuropsychologist? Neuropsychology = study of brain-behavior relationships Educational requirements 1. Ph.D./Psy.D. in Psychology with emphasis in neuropsychology 2. Doctoral level internship with 50% devotion to neuropsychology 3. 2 year fellowship/residency in neuropsychology 4. Board certification in Clinical Neuropsychology by the American Board of Professional Psychology (ABPP)

Overview Treatment/Interventions ConsultationDiagnostics

Referral Process Medical MD Director of Nursing Family Social Worker

Referral Triggers 1. Prior Psych Diagnosis 2. Psychotropic/Sedative use 3. Behavioral Issues 4. MDS Trigger 5. Staff-patient interaction 6. Non-compliance with Treatment 7. Substance/Medication abuse 8. Cognitive/Behavioral change

Treatment and Interventions Counseling/therapy Supportive/emotional Cognitive behavioral

Treatment and Interventions Behavioral-based Interventions Wandering Sleep management Hallucinations Physical/Verbal abusive behaviors

Treatment and Interventions Cognitive Rehabilitation ACTIVE Impact Tailored intervention Cogmed

Diagnostics Screen/Full Neuropsych Assessment Testing instruments designed to evaluate: Cognitive (IQ, Memory, Attention, Problem Solving, Insight, Executive Functioning, Language, Motor Skills, Judgment, Speed of Thought, etc.) Emotional (Depression, Anxiety, Post Traumatic Stress Disorder, Manic episodes, etc.) Personality (Impulsivity, Recklessness, Lack of Motivation, Apathy, Withdrawal, etc.)

Diagnostics Diagnostics guide recommendations for: Differential diagnosis (Dementia/Delirium/Depression) Treatment planning Ability to handle finances (bills, checkbook, plan, vulnerable to scam artists) Ability to make medical/legal/financial decisions Ability to drive (Poor reaction time, spatial neglect, mentally plan for driving in high traffic conditions) Medication effectiveness (tracking cognitive/emotional/behavioral)

Memory: Word List Learning 1. Butter 2. Arm 10. Engine Trial 1 1. Butter 2. Arm 10. Engine Trial 2Trial 3 Recognition Recall Delayed Recall Target 20. Distractor

Memory Performance in Normals and Patients with Mild Dementia

Consultation Environmental/Physical design of facility Behavioral management strategies for staff Stress management Prevention of staff burnout Research-based program design

Limitations Medical culture Environmental logistics Insurance/reimbursement Communication/Language Training opportunities

Questions 1. What do facilities want from us 2. How can we better address limitations 3. What is the best way to educate facilities about psych/neuropsych services