Alzheimer

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Alzheimers disease Dementias

• by Robin Fenley, CSW
• Director
• Alzheimers and Long-term Care Unit
• NYC Department for the Aging

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What is Dementia?

• The term given to changes experienced in
  cognition, behavior and self-care
• Reversible
• Metabolic
• Physiologic
• Irreversible
• Alzheimers disease 75 of all dementias

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Alzheimers 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

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Ten Warning Signs(Alzheimers Assoc.)

1. Recent memory loss that effects job performance
2. Difficulty performing familiar tasks
3. Problems with language
4. Disorientation of time and place
5. Impaired judgment
6. Problems with abstract thinking
7. Misplacing things
8. Changes in mood or behavior
9. Personality changes
10. Loss of initiative

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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

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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

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Risk factors

• Age
• Family history
• lt 10
• Before age 60
• High cholesterol
• High blood pressure
• Head injury
• Speculative
• Exposure to aluminum
• Aspartame (artificial sweetner)

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Treatments

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

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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
• NYUs study

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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 Alzheimers Association)

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Facts Figures contd

• 4th leading cause of death in the elderly (heart
  disease, cancer, diabetes)
• 75 of individuals with AD are cared for at home
• (Source Alzheimers Association National
  Institute on Aging)

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The Price of AD

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

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Challenging Behaviors

• Psychosis
• 50-70 incidence rate
• Theft
• Intruders
• Misidentification
• Infidelity
• (Source J.Cummings, MD, UCLA Alzheimers Disease
  Research Center)

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Depression

• 25 incidence rate
• Decreased appetite
• Decreased interest in life activities
• Lethargy
• Apathy
• (Source J.Cummings, MD, UCLA Alzheimers Disease
  Research Center)

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Agitation

• 60-80 incidence rate
• Resistance to care
• Aggression, striking out
• Shouting
• ?Disinhibition ?Irritability
• ?Anxiety
• (Source J.Cummings, MD, UCLA Alzheimers Disease
  Research Center)

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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

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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

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Be Aware of the Environment

• Reduce background noise and distraction
• Sundowning

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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

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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

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Nonverbal Communication

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

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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

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Resistance in Alzheimers

• 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

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Service Options

• Diagnostic centers
• Safe Return Program
• Clinical trials
• NYC Caregiver Program

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Community Care Options

• Home care
• Home delivered meals
• Transportation
• Adult day service
• Social model
• Medical model

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Taking a Break

• Respite
• In-home
• Congregate
• Overnight respite

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Residential Continuum

• Adult home
• Assisted living
• Nursing home

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Considerations

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

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The Multidisciplinary Team

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

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Useful Contacts

• 311 for all city services in NYC
• NYC Dept for the Aging
• [phone]
• www.nyc.gov/aging
• www.nyccaregiver.org
• Alzheimers Association, NYC Chapter
• [phone]
• www.alznyc.org

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Useful Contacts, contd

• U.S. Administration on Aging
• www.aoa.gov
• Fisher Foundation
• www.alzinfo.org