Working with People with Dementia and Other Cognitive Impairments

Working with People with
Dementia and Other Cognitive
Impairments

Terry R. Barclay, Ph.D.
Clinical Neuropsychologist
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Background
 Neuropsychologist
– Training: UCLA School of Medicine
– Specialist: Aging/Dementia
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HealthPartners Neurology
Alzheimer’s Research Center
Independent practice, Edina

– Practice:
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Cognitive/Psychological evaluations
Medical/Legal cases
Geriatric consultation
Psychotherapy

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Objectives
Signs,

symptoms, and stages of common
forms of dementia
Strategies for early recognition and
assessment
Effective interview and communication
techniques
Tips for intervention and referral

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Normal (Healthy) Aging
Characteristic

pattern:

– Sensory declines (i.e., hearing, vision)
– General slowing of information processing
– Intelligence remains stable
– Mild decrease in:
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Ability to recall names of people, places, objects

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Mental flexibility

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Memory

Independence

preserved

in daily activities
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What is Dementia?

A disease of the brain that causes a

decline in memory and intellectual
functioning from some previously higher
level of functioning severe enough to
interfere with everyday life.
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Dementia is NOT normal aging


Common Signs of Dementia

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Memory loss
– Newly learned information vs. old memories

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Disorientation to time, place, and people
Language problems
Diminished concentration
Visual-spatial and perception problems
– Sense of direction

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Difficulty with complex tasks and learning new concepts
Problems with abstract reasoning, problem-solving,
judgment
Changes in personality / mood / behavior
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How is Dementia Diagnosed?
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Complete medical history
Physical exam
Neurological exam
Lab tests
Neuroimaging (CT, MRI)
Mental Status exam
–

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Neuropsychological testing

Functional assessment of ADLs and IADLs
–

OT/PT evaluation

No single test can diagnose Dementia

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Dementia vs. Alzheimer’s
What is the difference between
dementia and Alzheimer’s

disease?
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Flowers
Pansies

Mums

Tulips

Daisies
Roses
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Dementia
Frontotemporal
dementia
Vascular dementia

Parkinson’s
dementia
Lewy body dementia

Alzheimer’s dementia
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Many Causes of Dementia

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Alzheimer’s disease
CVA/Stroke
Parkinson’s disease
Traumatic brain injury
HIV/AIDS
Multiple Sclerosis
Huntington’s disease
Lewy Body dementia
Frontotemporal dementia
Creutzfeldt-Jakob disease

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Toxic exposures (industrial
strength
solvents/chemicals)
Chronic hypoxia
Lyme disease
Syphilis
Brain tumors
Normal pressure
hydrocephalus
Wernicke-Korsakoff’s
Syndrome

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Alzheimer’s Disease is
One Type of Dementia

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Alzheimer’s Disease Is:
 A progressive,

degenerative, neurological disease

of the brain
 A steady decline in memory and cognitive
functioning severe enough to interfere with

everyday life
 Related to specific chemical and structural
changes in the brain
 NOT reversible

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Alzheimer’s Disease:
What does it look like?
 Neurofibrillary
 Amyloid

tangles

plaques

 Decrease

in chemicals that
facilitate memory

 Cell

death
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Video Clip

What

is Alzheimer's D
isease?

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Progression of Alzheimer’s
Disease
Early

Stage:
2 - 4 years in duration
Middle Stage:
2 - 10 years in duration
Late Stage:
1 - 3 years in duration

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Early Stage AD
Forgetfulness

Trouble

multi-tasking
Writes reminders, but loses them
Personality changes
Shows up at the wrong time or day
Changes in appearance
Preference for familiar things

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Middle Stage AD
 Fluctuating

disorientation
 Diminished insight
 Learning new things becomes difficult
 Declining recognition of acquaintances,
distant relatives, then more sig. relationships
 Mood and behavioral changes
 Functional declines
 Alterations in sleep and appetite
 Wandering

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Late Stage AD
Severe

disorientation to time and place
No short term memory
Loss of speech
Difficulty walking
Loss of bladder/bowel control
No longer recognizes family members
Inability to survive without total care

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Video Clip

Frontotemporal

Demen

tia

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Why is Recognition Important?
 5.1

million Americans have Alzheimer’s
disease (AD)
– New case every 72 seconds
– 1 in 8 people over 65

– 1 in 2 people over 85

 Approximately

50% are never diagnosed
 Almost 10 million people in U.S. caring for a
person with AD or related dementia
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(Alzheimer’s Disease Facts and Figures 2007 published by the Alzheimer’s Association

www.alz.org)


Why is Recognition Important?
 Crisis-driven

utilization of healthcare services

– 1/3 of people with dementia require hospitalization

each year

 Support
–
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and interventions ARE available:

Medication
Environmental/safety adaptations
Community programs
Family education and support
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(Silverstein & Maslow, 2006; U.S. Centers for Medicare and Medicaid, 2000)


What Makes Recognition Difficult?
Poor

understanding of healthy aging
Baseline variability in education,
intelligence, personality factors
Lack of insight = not seeking help
Clinician fear of damaging relationship
Erroneous belief that “nothing can be
done”, “no good medication treatment”

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