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4. Understanding the Different Dementias

5. PET and Aging: PET Scan of 80-Year-Old Brain
ADEAR, 2003

6. Something Goes Wrong with Our Brains
As we age, our processing speed may slow, but we do not lose function in our brains, unless:
Something Goes Wrong with Our Brains

7. Ten Early Warning Signs for Alzheimers and Some Other Dementias:
-Memory loss for recent or new information, repeats self frequently
-Difficulty doing familiar but difficult tasks: managing money, medications, driving
-Problems with word finding, mis-naming, or mis- understanding
-Getting confused about time or place, getting lost while driving, missing several appointments
-Worsening judgment: not thinking thing through like before
-Difficulty problem-solving or reasoning
-Misplacing things, putting them in odd places
-Changes in mood or behavior
-Changes in typical personality
-Loss of initiation, withdraws from normal patterns of activities and interests

8. Normal versus Not Normal:
Normal Aging:
Not Normal Aging:
Slower to think Slower to do Hesitates more More likely to ‘look before you leap’ Know the person but not the name Pause to find words Reminded of the past For you, it’s harder
Can’t think the same Can’t do like before Can’t get started Can’t seem to move on Doesn’t think it out at all Can’t place the person Words won’t come – even later Confused about past versus now For you, it’s very different!

9. How Common is Dementia?
The risk goes up dramatically with increasing age
America is aging
Various dementia will increase by 300% over the next 50 years without medical advances and lifestyle changes

10. What Else Could It Be? Another chronic medical condition developing
Depression or other mental health issue
Delirium: acute/rapid onset
Medication: toxicity, interaction, side effects
Undetected hearing loss or vision loss
Severe but unrecognized pain or central acting pain medication
Other things

11. But Couldn’t it Just Be Forgetfulness or Getting Old?
There is a difference
At first it may be hard to tell, but then you start to notice patterns
One of these things start to show changes:
Memory - Problem solving
Word finding - Behavior

12. Cognitive Changes with Aging:
Normal changes: more forgetful and slower to learn
MCI: Mild Cognitive Impairment: Immediate recall, word finding, or complex problem-solving problems
-Half these folks will develop dementia in 5 years
Dementia: Chronic thinking problems in > 2 areas
Delirium: Rapid changes in thinking and alertness, seek medical help immediately
Depression: Chronic unless treated, poor quality of life, “I don’t know” or “I just can’t” responses, no pleasure, can look like agitation and confusion

13. Dementia: What Changes?
Structural changes: permanent
Cells are shrinking and dying
Chemical changes - variable
Cells are producing and sending less chemicals
Can ‘shine’ when least expected due to a chemical rush

14. Dementia does not equal Alzheimers does not equal Memory problems

15. Having dementia does not equal and is more than just Alzheimers does not equal and is more than just memory problems

18. Alzheimers: New info lost Recent memory worse Problems finding words
Mis-speaks
More impulsive or indecisive
Gets lost
Notice changes over 6 months – 1 year
Lasts 8-12 years

19. Normal Brain
Alzheimers Brain

20. Positron Emission Tomography (PET) Alzheimers Disease Progression vs
Positron Emission Tomography (PET) Alzheimers Disease Progression vs. Normal Brains:
Early Alzheimers
Late Alzheimers
Normal
Child
G. Small, UCLA School of Medicine.

21. Young/Early Onset Late Life Onset
Alzheimers: Two Forms
Young/Early Onset
Late Life Onset

22. Young Onset: Groups: genetic, Down, head injury, lifestyle
Young family: kids often involved
Mis-diagnosis and non–diagnosis is common
Work may be first place to notice
Relationships are strained early, misunderstood
Services are usually a problem
Finances are often problematic
Executive decision making and sequencing diminished

23. -Secondary -Old term is MID -Many variations -CADASIL: genetic
Vascular Dementias:
-Secondary
-Old term is MID
-Many variations
-CADASIL: genetic

24. Vascular Dementia: Sudden changes: stepwise progression
Other conditions: DB, HTN, heart disease
So, damage is related to blood supply/not primary brain disease: treatment can plateau
Picture varies by person: blood/swelling/recovery
Can have bounce back and bad days
Judgment and behavior ‘not the same’
Spotty loss in memory, mobility
Emotional and energy shifts

25. CT Scan The white spots indicate dead cell areas: mini-strokes
Vascular Dementia:
CT Scan
The white spots indicate dead cell areas: mini-strokes

27. Latest Thinking About Vascular Treatment?
Lots of similarity with Alzheimer’s
Manage blood flow issues CAREFULLY!
Watch for and manage depression
Visual field changes can be ½ of field
Delays or impulsivity can be extreme

28. Lewy Body Dementia: Movement problems, falls
Visual Hallucinations: animals, children, people
Fine motor problems: hands, swallowing
Episodes of rigidity, syncopy
Nightmares or insomnia
Delusional thinking
Fluctuations in abilities
Drug responses can be extreme and strange
Can become toxic, can die, can become unable to move
Can have an OPPOSITE reactions

29. Latest Thinking about Lewy Body Treatment:
Try AChIs: Start Low and Go Slow
Then try Namenda early: Start Low and Go Slow
Be VERY careful about anti-psychotic meds: not Haldol
Balancing movement losses and aid to function: not working?
Parkinson’s meds may/may not help movement BUT may make hallucinations and delusions worse
Anti-depressants may be used to help anxiety, sleep, and depression but can increase confusion, movement drowsing
Sleep aids or anti-anxiety meds can cause paradoxical reactions

30. Frontotemporal Dementias:
Many types, typically Younger Onset
Frontal: impulse and behavior control loss (not memory issues)
Says unexpected, rude, mean, odd things to others
Disinhibited: food, drink, sex, emotions, actions
OCD type behaviors
Hyperorality
Temporal: language loss
Can’t speak or get words out
Can’t understand what is said, sound fluent: nonsense words

31. FTDs: FvFTD: frontal variant of FTD FTD: frontotemporal lobe dementia
TLD: non-fluent aphasia
TLD: fluent aphasia
CTE: chronic traumatic encephalopathy

32. FvFTD:
Mis-behavior Impulsivity Dis-inhibition Inertia Obsessive compulsive behaviors Inattention Lack of social awareness Lack of social sensitivity Lack of personal hygiene
Becomes sexually over- active or aggressive Becomes rigid in thinking Stereotypical behaviors Manipulative Hyper-orality Language may be impulsive but unaffected OR may be reduced or repetitive

33. FTD (Pick’s Disease): Frontal Issues: Temporal Issues:
Poor decision making Problems sequencing Reduced social skills Lack of self-awareness Hyper-orality Ego-centric Dis-inhibited – food, drink, words, actions OCD behaviors early Excessive emotions
Reduced attempts to talk Reduced content in speech Poor volume control Public use of ‘forbidden words’ Sing-song speech Can’t understand others’ words

34. Temporal Lobe Non-Fluent Aphasia:
Can’t NAME items Hesitant speech Not speaking Worsening of speech production over time Echolalia Mis-speaking Word salad
Receptive inability Other skills intact early 25% never develop global dementia

35. Temporal Lobe Fluent Aphasia:
Has smooth delivery More nonsense words Word salad May think they make sense Expect rhythm back Fixates on a few phrases Chit-chats if enjoying company
Volume control varies: limited awareness of others’ needs There are frequently 1-2 ‘value words’ mixed in to speech Picks up on ‘value words’ they hear – they then connect and want to talk more

36. Chronic Traumatic Encephalopathy:
Caused by repeated head injuries or concussions – doesn’t happen to all
Symptoms
Frontal lobe issues
Temporal lobe issues
Sometimes rapid progression into ‘Alzheimers’ patterns
Sometimes rapid progression into FTD patterns

37. Other Dementias: Genetic syndromes: Huntington’s Chorea
Alcohol-related: Wernickes or Korsakoffs
Drugs/toxin exposure: heavy metals, pesticides
White matter diseases: MS
Mass effects: tumors, NPH
Depression and other psychological conditions
Infections that cross the blood-brain barrier: C-J, HIV/Aids, Lyme?
Posterior Cortical Atrophy
Progressive Supranuclear Palsy
Or, could be a mixture of two or more types

38. Alcohol-Drug Related Dementia: May be called Wernicke’s and Korsakoffs syndrome
Possibly caused by neurotoxicity and/or Vitamin B1 and thiamine deficiency
Common Symptoms
Decreased ability to learn ‘new’
Decreased interest in valued activities, people, life
Impaired judgment and decision making
Emotional lability or apathy
Problems with balance and coordination
Problems with social control and behaviors
Problems with initiation and termination

39. Why Bother Getting a Good/Complete Diagnosis?
Future plans
Progression and prognosis
Finances
Health
Being in control
Medications can make a difference in quality of life

40. Building Care Partner Skills and Knowledge:
Understand dementia and its progression
Know how symptoms affect behavior
Describe needs connected to behavior
Optimize interaction skills

41. How Can We Become Better Care Partners?
Be willing to try something new
Be willing to learn something different
Be willing to see it through another’s eyes
Be willing to fail and try again

42. Realize:
It Takes Two to Tango …or Tangle! Learn how to dance with your partner!

43. Being ‘right’ doesn’t necessarily translate into a good outcome for both of you

44. It’s the relationship that is most critical Not the outcome of one encounter

45. Final Suggestions: Back off, change something and try again
Remember the ‘So What’ mentality
Accept yourself, and the person with dementia
Look for the joy!!!

46. DISCLAIMER
The content contained in this presentation is strictly for informational purposes. Therefore, if you wish to apply concepts or ideas contained from this presentation you are taking full responsibility for your actions. Neither the creators, nor the copyright holder shall in any event be held liable to any party for any direct, indirect, implied, punitive, special, incidental or other consequential damages arising directly or indirectly from any use of this material, which is provided as is, and without warranties.
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This presentation is copyrighted by Positive Approach to Care and is protected under the US Copyright Act of and all other applicable international, federal, state and local laws, with ALL rights reserved. No part of this may be copied, or changed in any format, sold, or used in any way other than what is outlined within this under any circumstances without express permission from Positive Approach to Care.
Copyright 2017, All Rights Reserved
Teepa Snow and Positive Approach to Care

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