Persons with Down Syndrome and the Alzheimers Connection

Memory Just a line to say I’m living, that I’m not among the dead; though I’m getting more forgetful and mixed up in my head. For sometimes I can’t remember when I stand at the foot of the stairs if I must go up for something or I’ve just come down from there. And before the refrigerator, so often my poor mind is filled with doubt, have I just put food away or have I come to take some out? I’ve got used to my arthritis, to my dentures I’m resigned, I can manage by bifocals, but, Oh God, I miss my mind!

What is Alzheimers?

Definition Progressive, degenerative disease of the neurological system Irreversible deterioration of the intellect and emotions It affects over 4 million American adults It is the fourth leading cause of death in adults after heart disease, cancer, and stroke Pre-senile and senile dementia are used to describe any diminished capacity to think and to understand

Symptoms Cells of the brain are affected, causing severe intellectual impairment and changes in mental and neurological functioning Changes occur in the cerebral cortex – the outer layer of the brain An accumulation of protein called “tangles” occur in the area of the brain that control recent short-term memory. This area of the brain is the “hippocampus”. This protein is located in the skin and intestines as well as the brain.

Synapse Axon Nucleus Cell Body Bendrites Healthy Neuron

Plaques Granulovacuolar Degeneration

DISINTEGRATION

Stages stages for the generic population There areStages for persons with Down Syndrome There are Each stage can last up toyears

Stage One Anxiety or depression over memory loss Decreased efficiency in performance Defensiveness

Stage Two Marked disorientation Reduced capacity for speech Decreased motor dexterity

Stage Three Loss of self-help skills Incontinence Seizures develop Delusional, persectory and hallucinatory behavior is exhibited

Causes The cause is unknown Suspected causes are: A gene in the 21 st gene Slow virus or other infectious agent Accumulation of aluminum or other toxins Changes in immune system relating to aging

Diagnosis There is no single clinical test to identify Alzheimers Other conditions must be ruled out: Depression Head injuries or brain tumor Adverse drug reaction Nutrition deficiencies Menopause

Diagnosis A diagnosis of Alzheimers can be confirmed only after death by performing an autopsy

Alzheimers Losses Short Term Memory New learning ability Reasoning and abstracting Judgment, planning and foresight Language skills Inhibition/impulse control Sense of intimacy

Behavioral Changes Pacing Rummaging Hand wringing Agitation Insistence Public Masturbation Fearfulness Sexual comments Hallucinations/Delusions Withdrawal Repeating questions

Physical Factors Urinary tract infections Bowel impaction Dehydration Seizures Pain/discomfort Mood swings

Strategies Provide quiet time Alleviate boredom Avoid many changes Keep choices simple keep consistent schedule Reduce stimuli Provide decaf beverages Limit length of conversation

Communication Techniques Identify yourself Use calm, clear voice Eliminate background noise Use short, simple sentences Use one-step commands Ask yes/no questions Use word cues Make direct eye contact

Written Communication Label the environment Keep a schedule of the day Use notes as reminders Non-Verbal Communications Use an open, gentle approach Hold out items Wave goodbye Use expression of concern Nod your head

Increasing Quality of Life

Use the R’s Remain calm Respond to feelings Reassure the person Remove yourself Return later

And Also: Be aware of client needs, information and resources available Identify aspects of disease and screen their problems Provide treatment through program development Advocate and refer for further treatment

Programming Reality Orientation: Brings information regarding time, place, person, and things Sensory Stimulation: Activities are presented to accentuate a particular sense Re-socialization: Uses group techniques to stress interpersonal relationships

Attitude!