Alzheimer’s disease & Dementias

1. Alzheimer’s disease & Dementias by Robin Fenley, CSW Director Alzheimer’s and Long-term Care Unit NYC Department for the Aging

2. What is Dementia? • The term given to changes experienced in cognition, behavior and self-care • Reversible • Metabolic • Physiologic • Irreversible • Alzheimer’s disease ~75% of all dementias

3. Alzheimer’s Disease (AD) • Not a normal part of aging • Progressive decline in executive functioning • Memory loss • Inability to learn new tasks • Behavioral changes • Deterioration in self-care abilities

4. Ten Warning Signs(Alzheimer’s Assoc.) • Recent memory loss that effects job performance • Difficulty performing familiar tasks • Problems with language • Disorientation of time and place • Impaired judgment • Problems with abstract thinking • Misplacing things • Changes in mood or behavior • Personality changes • Loss of initiative

5. Medical Work-up • Neurological and physical examination • Lab tests, EKG, chest X-ray • Brain scans CT, MRI, PET • EEG • Psychiatric evaluation • Neuropsychological tests for mental status and cognitive functioning

6. Disease Course of AD • Prognosis • Insidious onset • Avg 8-10 years after diagnosis • Up to 20 years • Retrogenesis • Barry Reisberg, MD, NYU Silberstein Dementia Research Center • 20 year reversal in abilities

7. Risk factors • Age • Family history • < 10% • Before age 60 • High cholesterol • High blood pressure • Head injury • Speculative: • Exposure to aluminum • Aspartame (artificial sweetner)

8. Treatments • Medication • Early stage • Aricept, Exelon, Reminyl • Moderate to late stage • Namenda • Antipsychotics • Antidepressants • Vaccine • Elan Pharmaceutical, 2002 and 2004

9. Alternative Treatments • Vitamin E • 400 IU 2x day • 1200 IU 2x day in 1997 study • Ginkgo biloba • 1997 study showed ~improved cognition, ADLs, social behavior • Current study with 3000 participants • Exercise • NYU’s study

10. Facts & Figures • 4 million persons with AD nationally • Estimated 200,000 in NYC • Projected to grow to 14-16 million by 2050 • 1 in 10 people 65+ • Almost 50% for those 85+ (Source: Alzheimer’s Association)

11. Facts & Figures cont’d • 4th leading cause of death in the elderly (heart disease, cancer, diabetes) • 75% of individuals with AD are cared for at home (Source: Alzheimer’s Association; National Institute on Aging)

12. The Price of AD • Nationally • $100 billion/year • Direct and indirect care • $61 billion/year to business • Lost productivity, absenteeism, replacement (Source: Alz Assoc., Nat’l Institute on Aging) • Average lifetime costs per person • $174,000 (Source: Ernst,RL & Hay,JW. The U.S. economic & social costs of Alzheimer’s disease revisited. American Journal of Public Health. 1994. Cited in Nat’l Institute of Health, 2003.)

13. Challenging Behaviors • Psychosis • 50-70% incidence rate • Theft • Intruders • Misidentification • Infidelity (Source: J.Cummings, MD, UCLA Alzheimer’s Disease Research Center)

14. Depression • 25% incidence rate • Decreased appetite • Decreased interest in life activities • Lethargy • Apathy (Source: J.Cummings, MD, UCLA Alzheimer’s Disease Research Center)

15. Agitation • 60-80% incidence rate • Resistance to care • Aggression, striking out • Shouting ٠Disinhibition ٠Irritability ٠Anxiety (Source: J.Cummings, MD, UCLA Alzheimer’s Disease Research Center)

16. Impact of Behavioral Changes • Distressing to caregivers • Distressing to person with AD • Can precipitate abuse • Can lead to earlier institutionalization BUT • Can respond to medical intervention

17. Engaging the Person with Dementia • Respect the dignity of the individual • Approach the individual in their direct line of vision • Identify yourself in reassuring tone • If appropriate, use touch to get their attention • Avoid sudden movements that may startle

18. Be Aware of the Environment • Reduce background noise and distraction • Sundowning

19. Simplify Verbal Communication • Convey ideas one step at a time • Select concrete words when possible • Avoid abstractions or generalizations • Use yes/no questions • Repeat as necessary • Person may ‘mask’ responses

20. Active Listening • Be patient. Allow time for the individual to find the words • Do not interrupt or finish the sentence • Understand what the person is saying before responding

21. Nonverbal Communication • Communication skills deteriorate from verbal to nonverbal • Watch body language and facial expression for signs of agitation, discomfort or pain

22. Communicating with the Caregiver • Allow time to vent • Listen for veiled or overt expressions of exhaustion, frustration, anger • Be sensitive to caregiver/care receiver confidentiality • If possible, interview separately

23. Resistance in Alzheimer’s • If the person becomes agitated, stop the activity • Schedule enough time • Do not force the issue unless there is an immediate threat to health and safety

24. Service Options • Diagnostic centers • Safe Return Program • Clinical trials • NYC Caregiver Program

25. Community Care Options • Home care • Home delivered meals • Transportation • Adult day service • Social model • Medical model

26. Taking a Break • Respite • In-home • Congregate • Overnight respite

27. Residential Continuum • Adult home • Assisted living • Nursing home

28. Considerations • Available social supports • Awareness of community services • Utilization of services • Financial resources • Involvement of APS where appropriate

29. The Multidisciplinary Team • Family members • Social workers • Geriatricians, psychiatrists • Elder law attorneys • Law enforcement • Geriatric care managers • Faith-based community

30. Useful Contacts • 311 for all city services in NYC • NYC Dept for the Aging • (212) 442-1000 • www.nyc.gov/aging • www.nyccaregiver.org • Alzheimer’s Association, NYC Chapter • (212) 973-0700 • www.alznyc.org

31. Useful Contacts, cont’d • U.S. Administration on Aging • www.aoa.gov • Fisher Foundation • www.alzinfo.org