Presentation by: Vladislava Synenko

1. Presentation by: Vladislava Synenko

3. Dementia A general term for loss of intellectual or “cognitive” functions such as • Memory • Thinking • Reasoning • Judgment • Attention • Concentration • Language • Perception

4. Types of dementia • Reversible • Caused by drugs, depression, infection, brain tumors etc. • Irreversible - Alzheimer’s disease, Multi-Infarct or Vascular Dementia, Lewy Body Disease, Parkinson’s Disease • Alzheimer's disease accounts for about 70-80% of all dementia.

5. Alzheimer’s Disease • Most common form of dementia • Progressive, degenerative disease • No known cause or cure • Affects 1 in 10 people over age 65 • Affects 1 in 3 people over age 85

6. What is AD? Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills. Although the risk of developing AD increases with age – in most people with AD, symptoms first appear after age 60 – AD is not a part of normal aging. It is caused by a fatal disease that affects the brain.

7. The Impact of AD Once considered a rare disorder, Alzheimer’s disease is now seen as a major public health problem that is seriously affecting millions of older Americans and their families. • AD Statistics…. • Scientists estimate that around 4.5 million people now have AD. • For every 5-year age group beyond 65, the percentage of people with AD doubles. • The national cost of caring for people with AD is about $100 billion every year.

8. What changes occur in the brain? • Loss of brain cells • Brain shrinks • Nerve fibers become tangled • Abnormal protein deposits form • Production of chemical messengers reduced • Signals can not pass from one nerve cell to another • Nerve cells eventually die

9. Inside the Human Brain • Neurons • The brain has billions of neurons, each with an axon and many dendrites. • To stay healthy, neurons must communicate with each other, carry out metabolism, and repair themselves. • AD disrupts all three of these essential jobs.

10. Inside the Human Brain To understand Alzheimer’s disease, it’s important to know a bit about the brain… • The Brain’s Vital Statistics • Adult weight: about 3 pounds • Adult size: a medium cauliflower • Number of neurons: 100,000,000,000 (100 billion) • Number of synapses (the gap between neurons): 100,000,000,000,000 (100 trillion)

11. Inside the Human Brain The Brain in Action Hearing Words Speaking Words Seeing Words Thinking about Words Different mental activities take place in different parts of the brain. Positron emission tomography (PET) scans can measure this activity. Chemicals tagged with a tracer “light up” activated regions shown in red and yellow.

12. AD and the Brain Plaques and Tangles: The Hallmarks of AD The brains of people with AD have an abundance of two abnormal structures: • beta-amyloid plaques, which are dense deposits of protein and cellular material that accumulate outside and around nerve cells • neurofibrillary tangles, which are twisted fibers that build up inside the nerve cell An actual AD plaque An actual AD tangle

13. AD and the Brain Beta-amyloid Plaques Amyloid precursor protein (APP) is the precursor to amyloid plaque. 1.APP sticks through the neuron membrane. 2.Enzymes cut the APP into fragments of protein, including beta-amyloid. 3.Beta-amyloid fragments come together in clumps to form plaques. 1. 2. In AD, many of these clumps form, disrupting the work of neurons. This affects the hippocampus and other areas of the cerebral cortex. 3.

14. Neurons have an internal support structure partly made up of microtubules. A protein called tau helps stabilize microtubules. In AD, tau changes, causing microtubules to collapse, and tau proteins clump together to form neurofibrillary tangles. AD and the Brain • Neurofibrillary Tangles

15. Under the microscope, there were widespread fatty deposits in small blood vessels, dead and dying brain cells, and abnormal protein amyloid deposits in and around cells.

16. AD and the Brain Preclinical AD • Signs of AD are first noticed in the entorhinal cortex, then proceed to the hippocampus. • Affected regions begin to shrink as nerve cells die. • Changes can begin 10-20 years before symptoms appear. • Memory loss is the first sign of AD.

17. AD and the Brain • AD spreads through the brain. The cerebral cortex begins to shrink as more and more neurons stop working and die. • Mild AD signs can include memory loss, confusion, trouble handling money, poor judgment, mood changes, and increased anxiety. • Moderate AD signs can include increased memory loss and confusion, problems recognizing people, difficulty with language and thoughts, restlessness, agitation, wandering, and repetitive statements. Mild to Moderate AD

18. AD and the Brain Severe AD • In severe AD, extreme shrinkage occurs in the brain. Patients are completely dependent on others for care. • Symptoms can include weight loss, seizures, skin infections, groaning, moaning, or grunting, increased sleeping, loss of bladder and bowel control. • Death usually occurs from aspiration pneumonia or other infections. Caregivers can turn to a hospice for help and palliative care.

19. Diagnosing Alzheimer’s Disease • A complete evaluation by a team of health professionals is best: • Medical evaluation • Mental status examination • Psychological examinations • Family interviews

20. Stages of Alzheimer’s Disease Stage 1 (Early Stage): • Short term memory problems • May be unable to find the right words • Forgets familiar names and telephone numbers • Begins to write reminders but loses notes • Shows preference for familiar things (Wears the same clothes, Avoids going out) • Judgment may be impaired (May dress inappropriately for the weather)

21. Stages of Alzheimer’s Disease • Stage 2 (Middle Stage): • Deterioration of ability to initiate and sequence purposeful activities like bathing and driving • Sleep disturbance with restlessness at night • Begins to neglect health and hygiene • Needs directions to function in familiar surroundings • Needs help with ADL • Confusion and agitation

22. Stages of Alzheimer’s Disease Stage 3 (Advanced Stage): • May lose ability to perform daily skills (like buttoning a shirt or using a knife & fork) • May need to be told each step of a former routine act (like brushing teeth or getting dressed) • May walk with a shuffling gait or may seem “glued to the floor” due to a physical inability to walk • Often needs physical assistance with activities of daily living (dressing, bathing, eating) • Needs protection and supervision

23. Stages of Alzheimer’s Disease Stage 4 (Late Stage): • Can’t walk • May discontinue talking or be unable to talk • Trouble swallowing • May have seizures • Incontinence • May make loud unintelligible negative noises or sounds • Complete withdrawal or apathy • May lose control of outer extremities • Unable to survive without total care

24. AD Research: Managing Symptoms Between 70 to 90% of people with AD eventually develop behavioral symptoms, including sleeplessness, wandering and pacing, aggression, agitation, anger, depression, and hallucinations and delusions. Experts suggest these general coping strategies for managing difficult behaviors: • Stay calm and be understanding. • Be patient and flexible. Don’t argue or try to convince. • Acknowledge requests and respond to them. • Try not to take behaviors personally. Remember: it’s the disease talking, not your loved one. Experts encourage caregivers to try non-medical coping strategies first. However, medical treatment is often available if the behavior has become too difficult to handle. Researchers continue to look at both non-medical and medical ways to help caregivers.

25. AD Research: the Search for Treatments Drugs used to treat mild to moderate AD symptoms include: • Aricept • Exelon • Reminyl An additional drug, Namenda, has been approved to treat symptoms of moderate to severe AD. These drugs can help improve some patients’ abilities to carry out activities up to a year or so, but they do not stop or reverse AD. Scientists are also studying agents that someday may be useful in preventing AD. For example, they have experimented with a vaccine against AD. Although the first clinical trial was stopped due to side effects in some participants, valuable information was gathered.

26. Nasal spray vaccine to fight Alzheimer's Tel Aviv University researchers are working on a nasally delivered vaccine that promises to protect against Alzheimer's as well as stroke. The new vaccine repairs vascular damage in the brain by using the body's own immune system and, in addition to its prophylactic effect, it can work even when Alzheimer's symptoms are already present.

27. Communication

28. How Alzheimer’s affects Communication • Alzheimer's disease damages the part of the brain that controls communication • Each person is unique, but all experience some type of communication problems • Amount of damage to the language area of the brain influences how communication is impaired

29. Successful Communication • Maintain a calm, pleasant approach • Approach person from the front and establish eye contact • Speak slowly and use short, simple sentences • Speak to the person as an adult and do not be disrespectful or “talk down” to him/her • Do not ask questions that rely on memory as this can be humiliating if the person cannot remember the answer

30. Successful Communication (cont) • Do not argue - the person can no longer reason and he/she may become angry • Use reality orientation such as reminding them of current day, time, and place • Use validation to help reduce stress and establish a bond • Be non-judgmental, provide reassurance and comfort

31. Support for Caregivers Who are the AD Caregivers? • Spouses – the largest group. Most are older with their own health problems. • Daughters – the second largest group. Called the “sandwich generation,” many are married and raising children of their own. Children may need extra support if a parent’s attention is focused on caregiving. • Grandchildren – may become major helpers. • Daughters-in-law – the third largest group. • Sons – often focus on the financial, legal, and business aspects of caregiving. • Brothers and Sisters – many are older with their own health problems. • Other – friends, neighbors, members of the faith community.

32. Unpaid caregivers and stress There are nearly 15 million Alzheimer’s and dementia caregivers providing 17 billion hours of unpaid care valued at $202 billion. Facts and Figures finds that caregivers not only suffer emotionally but also physically. Because of the toll of caregiving on their own health, Alzheimer’s and dementia caregivers had $7.9 billion in additional health care costs in 2010. More than 60 percent of family caregivers report high levels of stress because of the prolonged duration of caregiving and 33 percent report symptoms of depression. Helping Families • Educate them • Listen to them • Involve them

33. Activities

34. Planning Activities • Get to know individual’s life story • Learn their likes, dislikes and preferences • Individuals past habits and experiences should influence activities planned

35. Learn What Individual is Capable of Doing • Each individual w/Alzheimer’s disease is different • Look at what individual “can do” rather than what they “can’t do.”

36. Types of Dementia Specific Activities • These are “can’t fail” activities. • Reminiscence • Give back pleasure of old memories. • Music • Give back the joy of music • Dance • Give back the joy of dancing • Art • Give back the role of artist

37. Types of Dementia Specific Activities (cont) • Work or profession • Give back the role of worker • Teacher • Give back the role of teacher • Helper • Give back the role of helper • Homemaker • Give back the role of homemaker • Holidays and special occasions • Give back the joy of holidays and special occasions

38. Adapt and Modify Activities • To ensure safety, individual’s enjoyment and ability • Brake down tasks into simple • Share your skills and talents with them • Use your sense of humor

39. Nonverbal communication strategies • Maintain a calm, pleasant approach – the person with dementia will “mirror” your mood • Approach person from the front and establish eye contact to avoid startling him/her • Use gentle touch to calm and reassure the person

40. Common Behavior Problems Common behaviors -Repetitive actions -Wandering Challenging behaviors -aggressiveness -shouting -angry outburst Harmful behaviors -hitting -screaming

41. Common Behavior Problems Hallucinations and paranoia Catastrophic Reactions • rapid mood changes • uncontrolled crying • anger • increased restlessness

42. Responding to Challenging Behaviors Basic Principles • All behavior has meaning • Do not take it personally • Be calm, understanding, patient • Intervene before a behavior or situation becomes a problem • Seek suggestions from the family • Be creative and flexible • Acknowledge the persons’ request and respond to it

43. Responding to challenging behavior

44. Points to remember • We cannot modify the behavior of the person with Alzheimer's disease-we can manage it through creative intervention • All behavior has meaning • Tailor your approach to the individual • Be creative, calm, flexible, patient, and understanding • Behavioral interventions are the preferred way to manage problem behaviors • Medication is last resort

45. For more information on Alzheimer’s disease and a list of the NIA-funded Alzheimer’s Disease Centers, contact the Alzheimer’s Disease Education and Referral (ADEAR) Center at: 1-800-438-4380 www.alzheimers.org The ADEAR Center is a service of: National Institute on Aging, part of the National Institutes of Health (NIH), part of the Department of Health and Human Services This PowerPoint slideshow is based on the publication Alzheimer’s Disease: Unraveling the Mystery.