Dementia why do they do that
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Dementia : Why Do They Do That?. How Can I Help? When Do I Need Help? . Not going to the MD No F-PoA or HC-PoA ‘Losing’ Important Things Getting Lost Unsafe task performance Repeated calls & contacts Refusing ‘Bad mouthing’ you to others Making up stories Resisting care

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Dementia : Why Do They Do That?

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Dementia why do they do that

Dementia:Why Do They Do That?

How Can I Help?

When Do I Need Help?


What are the most common issues that come up

Not going to the MD

No F-PoA or HC-PoA

‘Losing’ Important Things

Getting Lost

Unsafe task performance

Repeated calls & contacts

Refusing

‘Bad mouthing’ you to others

Making up stories

Resisting care

Swearing & cursing

Making 911 calls

Mixing day & night

Shadowing

Eloping or Wandering

No solid sleep time

Getting ‘into’ things

Feeling ‘paranoid’

Undressing

Being rude

Feeling ‘sick’

Striking out at others

Falls & injuries

Infections & pneumonias

Seeing things & people

Not eating or drinking

Contractures & immobility

What Are the Most Common Issues That Come Up???


Realize

REALIZE …

  • It Takes TWO to Tango …

    or two to tangle…


Being right doesn t necessarily translate into a good outcome for both of you

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


It s the relationship that is most critical not the outcome of any one encounter

It’s the relationship that is MOST critical NOT the outcome of any one encounter


Dementia why do they do that

As part of the disease people with dementia ‘tend to’ develop typical patterns of speech, behavior, and routines. These people will also have skills and abilities that are lost while others are retained or preserved.


Cognitive changes with aging

Cognitive Changes with Aging

  • Normal changes = more forgetful & slower to learn

  • MCI – Mild Cognitive Impairment =

    • Immediate recall, word finding, or complex problem solving problems (½ of these folks will develop dementia in 5 yrs)

  • Dementia = Chronic thinking problems in > 2 areas

  • Delirium =Rapid changes in thinking & alertness

    (seek medical help immediately )

  • Depression =chronic unless treated, poor quality , I “don’t know”, “I just can’t” responses, no pleasure

    can look like agitation & confusion


Ten early warning signs

Ten Early Warning Signs

  • 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 form normal patterns of activities and interests


Dementia why do they do that

Vascular

Dementias

(Multi-infarct)

DEMENTIA

Lewy Body Dementia

  • Alzheimer’s

  • Disease

  • Early - Young Onset

  • Normal Onset

  • Other Dementias

  • Genetic syndromes

  • Metabolic pxs

  • ETOH related

  • Drugs/toxin exposure

  • White matter diseases

  • Mass effects

  • Depression(?) or Other Mental conditions

  • Infections – BBB cross

  • Parkinson’s

Fronto-

Temporal Lobe Dementias


Alzheimer s

Alzheimer’s

  • New info lost

  • Recent memory worse

  • Problems finding words

  • Mis-speaks

  • More impulsive or indecisive

  • Gets lost

  • Notice changes over 6 months – 1 year


Vascular dementia

Vascular Dementia

  • Sudden changes

  • Picture varies by person

  • Can have bounce back & bad days

  • Judgment and behavior ‘not the same’

  • Spotty losses

  • Emotional & energy shifts


Lewy body dementia

Lewy Body Dementia

  • Movement problems - Falls

  • Visual Hallucinations

  • Fine motor problems – hands & swallowing

  • Episodes of rigidity & syncopy

  • Nightmares

  • Fluctuations in abilities

  • Drug responses can be extreme & strange


Fronto temporal dementias

Fronto-Temporal Dementias

  • Many types

  • Frontal – impulse and behavior control loss

    • Says unexpected, rude, mean, odd things to others

    • Dis-inhibited – food, drink, sex, emotions, actions

  • Temporal – language loss

    • Can’t speak or get words out

    • Can’t understand what is said, sound fluent – nonsense words


What is dementia

What is Dementia?...

It is BOTH

  • a chemical change in the brain

    AND

  • a structural change in the brain

  • So…

    Sometimes they can & sometimes they can’t


Pet and aging

PET Scan of 80-Year-Old Brain

PET Scan of 20-Year-Old Brain

PET and Aging

ADEAR, 2003


Positron emission tomography pet alzheimer s disease progression vs normal brains

Positron Emission Tomography (PET) Alzheimer’s Disease Progression vs. Normal Brains

Early Alzheimer’s

Late Alzheimer’s

Normal

Child

G. Small, UCLA School of Medicine.


Dementia why do they do that

Normal Brain

Alzheimers Brain


Brain atrophy

Brain atrophy

  • the brain actually shrinks

  • cells wither then die

  • abilities are lost

  • with Alzheimer’s area of loss are fairly predictable

  • … as is the progression

  • BUT the experience is individual…


Dementia why do they do that

Learning & Memory Center

Hippocampus

BIG CHANGE


Memory loss

Memory Loss

  • Losses

    • Immediate recall

    • Attention to selected info

    • Recent events

    • Relationships

  • Preserved abilities

    • Long ago memories

    • Confabulation!

    • Emotional memories

    • Motor memories


Dementia why do they do that

Understanding Language – BIG CHANGE


Dementia why do they do that

Hearing Sound – Not Changed


Understanding

Understanding

  • Losses

    • Can’t interpret words

    • Misses some words

    • Gets off target

  • Preserved abilities

    • Can get facial expression

    • Hears tone of voice

    • Can get some non-verbals

    • Learns how to cover


Dementia why do they do that

Sensory Strip

Motor Strip

White Matter Connections

BIG CHANGES

Automatic Speech

Rhythm – Music

Expletives

PRESERVED

Formal Speech & Language

Center

HUGE CHANGES


Sensory changes

Sensory Changes

  • Losses

    • Awareness of body and position

    • Ability to locate and express pain

    • Awareness of feeling in most of body

  • Preserved Abilities

    • 4 areas can be sensitive

    • Any of these areas can be hypersensitive

    • Need for sensation can become extreme


Self care changes

Self-Care Changes

  • Losses

    • initiation & termination

    • tool manipulation

    • sequencing

  • Preserved Abilities

    • motions and actions

    • the doing part

    • cued activity


Language

Language

  • Losses

    • Can’t find the right words

    • Word Salad

    • Vague language

    • Single phrases

    • Sounds & vocalizing

    • Can’t make needs known

  • Preserved abilities

    • singing

    • automatic speech

    • Swearing/sex words/forbidden words


Dementia why do they do that

Executive Control Center

Emotions Behavior Judgment

Reasoning


Impulse emotional control

Impulse & Emotional Control

  • Losses

    • becomes labile & extreme

    • think it - say it

    • want it - do it

    • see it - use it

  • Preserved

    • desire to be respected

    • desire to be in control

    • regret after action


Dementia why do they do that

Vision Center – BIG CHANGES


Vision

Vision

  • Losses

    • Edges of vision – peripheral field

    • Depth perception

    • Object recognition linked to purpose

    • SLOWER to process – scanning & shifting focus

  • Preserved

    • ‘see’ things in middle field

    • Looking at… curious


So what is dementia

So… What is Dementia?

  • It changes everything over time

  • It is NOT something the person can control

  • It is NOT always the same for every person

  • It is NOT a mental illness

  • It is real

  • It is hard at times


Dementia can be treated

Dementia can be treated

  • With knowledge

  • With skill building

  • With commitment

  • With flexibility

  • With practice

  • With support

  • With compassion


Dementia why do they do that

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