WebinarWebinarWhy Do They Do That?Why Do They Do That?

Presented by:Presented by:Jennifer A. Scott, B.S.R.A., C.A.L.M.Jennifer A. Scott, B.S.R.A., C.A.L.M.

VP Facility Development and OperationsVP Facility Development and Operations

Tree of Life Care Group Tree of Life Care Group Management CompanyManagement Company

For Arveda Alzheimer’s Assisted Living ResidencesFor Arveda Alzheimer’s Assisted Living Residences

512-828-8151 Office512-828-8151 Officejscott@tlcaregroup.com

www.arvedacare.com and and www.tlcaregroup.com

Presentation GoalsPresentation Goalso The participants will be able to identify the different The participants will be able to identify the different

types of the most common forms of dementiatypes of the most common forms of dementia

o The participants will be able to identify how the The participants will be able to identify how the different dementia disease processes impact the different dementia disease processes impact the patientpatient

o The participants will be able to identify the medications The participants will be able to identify the medications available to treat Alzheimer’s disease and how they available to treat Alzheimer’s disease and how they benefit the patient.benefit the patient.

o The participants will be able to identify the leading The participants will be able to identify the leading problem behaviors associated with Alzheimer’s disease.problem behaviors associated with Alzheimer’s disease.

Disease DiagnosesDisease Diagnoses

Alzheimer’s DiseaseAlzheimer’s Disease Vascular Dementia – Multi Infarct DementiaVascular Dementia – Multi Infarct Dementia Parkinson’s DementiaParkinson’s Dementia Lewy Body DementiaLewy Body Dementia Pick’s DiseasePick’s Disease Alcohol Dementia-Wernicke-Korsakoff Alcohol Dementia-Wernicke-Korsakoff

Syndrome Syndrome Creutzfeldt Jakob Disease Creutzfeldt Jakob Disease

How do you know the How do you know the difference?difference?

Alzheimer’s Alzheimer’s DementiaDementia

Slow progressionSlow progression Short Term Memory Short Term Memory

Loss firstLoss first Loss of executive Loss of executive

functioning Skillsfunctioning Skills Long Term Memory Long Term Memory

LossLoss Loss of motor skillsLoss of motor skills

Vascular DementiaVascular Dementia Stair Step DeclineStair Step Decline Incontinent of Incontinent of

bladder sooner bladder sooner than Alz.than Alz.

Loss of language Loss of language sooner than Alz.sooner than Alz.

Loss of ambulation Loss of ambulation sooner than Alz.sooner than Alz.

How do you know the How do you know the difference?difference?

Parkinson’s DementiaParkinson’s Dementia Irregular Body Irregular Body

MovementsMovements Stiffness in joints and Stiffness in joints and

limbslimbs Loss of motor skillsLoss of motor skills 40%-50% also get 40%-50% also get

Alzheimer’sAlzheimer’s

Lewy Body DementiaLewy Body Dementia HallucinationsHallucinations Loss of motor skillsLoss of motor skills Pseudo-Parkinson’s Pseudo-Parkinson’s

symptomssymptoms Rapid cognitive Rapid cognitive

changeschanges Syncope EpisodesSyncope Episodes Intolerance of Intolerance of

psychotropic psychotropic medicationsmedications

How do you know the How do you know the difference?difference?

Pick’s DiseasePick’s Disease Frontal Temporal Frontal Temporal

InvolvementInvolvement Only 1-5% of people Only 1-5% of people

diagnosed with thisdiagnosed with this Diagnosis early in life – 40’s Diagnosis early in life – 40’s

and 50’sand 50’s Extreme hyperactivity or Extreme hyperactivity or

very lethargicvery lethargic Short Term Memory Stays Short Term Memory Stays

intact longerintact longer May put everything in May put everything in

mouthmouth Gluttonous eatingGluttonous eating Extreme loss of language in Extreme loss of language in

late stageslate stages Hyperactivity turns into Hyperactivity turns into

non-responsiveness in late non-responsiveness in late stagestage

Wernicke-Korsakoff Wernicke-Korsakoff SyndromeSyndromeThiamine deficiency; Thiamine deficiency; Vitamin B1 deficiencyVitamin B1 deficiency

Most often caused by Most often caused by excessive alcohol excessive alcohol consumptionconsumption

ConfabulationConfabulation PsychosisPsychosis Motor Skill LossesMotor Skill Losses Neuropathy of extremitiesNeuropathy of extremities Muscle WastingMuscle Wasting Brain damage affecting Brain damage affecting

language and thinkinglanguage and thinking Heart Failure is commonHeart Failure is common Behaviorally very difficult Behaviorally very difficult

to care forto care for

How do you know the How do you know the difference?difference?

Creutzfeldt Jakob DiseaseCreutzfeldt Jakob Disease Two different types “classic” and “variant” Two different types “classic” and “variant”

formsforms Variant seems to be linked to “mad cow Variant seems to be linked to “mad cow

disease” but not always and it’s very raredisease” but not always and it’s very rare Classic is not linked to “mad cow”Classic is not linked to “mad cow” Both forms have long gestation periods but Both forms have long gestation periods but

once diagnosed the person deteriorates very once diagnosed the person deteriorates very rapidly, a few months to a yearrapidly, a few months to a year

Signs and symptoms in both forms are similar Signs and symptoms in both forms are similar – personality changes, loss of thinking ability, – personality changes, loss of thinking ability, behavioral symptoms, loss of motor controlbehavioral symptoms, loss of motor control

What Happens in the Brain?Hypothalamus (Hippocampus)

Alzheimer's begins in the part of the brain that is called the Hypothalamus. (Hippocampus) This part of the brain contains our short-term memory center.

This is the first part of the brain to be affected by Alzheimer's. However the disease is not localized here. It will travel to all parts of the brain.

That is what makes Alzheimer's disease different from other diseases.

What Happens in the Brain?Hypothalamus (Hippocampus)

All information has to travel through our Hypothalamus before it can reach the part of our brain where information is stored.

This part of our brain is called the Cerebral Cortex. It is responsible for long-term memories and conscious thought.

The Cerebral Cortex is one of the last parts of the brain to be affected by Alzheimer's disease.

What Happens in the Brain?Hypothalamus (Hippocampus)

Alzheimer's disease causes all new information to no longer be able to pass through the Hypothalamus. You can think of it as if a "Dam" is being built in that part of the brain. Therefore, the person can no longer tell you the conversations they just had with someone, or tell you what they had for lunch, or if they took their medicines. They lose the ability to tell you what happened moments before in time, or what happened last week, two weeks ago, etc.

Frontal Lobe – What does this Frontal Lobe – What does this do?do?

Abstract ConceptsAbstract ConceptsClothing – clean/dirtyClothing – clean/dirty

Natural ConsequencesNatural Consequences

TelevisionTelevision

Left from RightLeft from Right

Safety IssuesSafety Issues

Rationalizing/Rationalizing/ReasoningReasoningUsing good judgmentUsing good judgment

Knowing if something is Knowing if something is true or untruetrue or untrue

Seeing someone else’s Seeing someone else’s point of viewpoint of view

Not arguing with realityNot arguing with reality

Multi-Step TasksMulti-Step TasksTooth brushingTooth brushing

EatingEating

BathingBathing

DressingDressing

PersonalityPersonalityEmotional ControlEmotional Control

Happy/Sad/AngerHappy/Sad/Anger

Dealing with ChangesDealing with Changes

Personality ChangesPersonality Changes

Frontal Lobe – What does this Frontal Lobe – What does this do?do?

Impulse ControlImpulse ControlYellingYelling

Aggressive type Aggressive type behaviorsbehaviors

Saying the first thing on Saying the first thing on their mindstheir minds

Eating off some else’s Eating off some else’s plateplate

Taking/Borrowing ItemsTaking/Borrowing Items

EmpathyEmpathyUnderstanding how their Understanding how their actions affect othersactions affect others

To put themselves in To put themselves in someone else’s shoessomeone else’s shoes

Knowing what others are Knowing what others are doing for themdoing for them

InitiationInitiationStarting TasksStarting Tasks

Changing clothes when Changing clothes when dirtydirty

Fixing something to eatFixing something to eat

Participating in activitiesParticipating in activities

Attention To TaskAttention To TaskTo finish tasks and stay To finish tasks and stay seatedseated

To watch whole moviesTo watch whole movies

To participate in long To participate in long activitiesactivities

Understanding Disease Related Behaviors

Behavioral issues are hard to manage. They upset the resident, they upset the other

people living in the community, they upset the staff, and they upset the families.

In other words, behavioral issues really upset the apple cart and decrease customer

satisfaction all the way around. Therefore, the following information lists the things that

might cause behavioral issues to occur.

Types of Disease BehaviorsTypes of Disease Behaviors

Looking for a deceased Looking for a deceased relativerelative

Borrowing items from Borrowing items from others (some people others (some people call this stealing, which call this stealing, which is incorrect)is incorrect)

YellingYelling Striking out at othersStriking out at others Refusals to bathe and Refusals to bathe and

non-compliant with non-compliant with ADL’sADL’s

Disrobing in publicDisrobing in public Medication RefusalsMedication Refusals Pushing/pulling Pushing/pulling

furniturefurniture WanderingWandering High AnxietyHigh Anxiety HoardingHoarding RummagingRummaging Catastrophic ReactionsCatastrophic Reactions

Causes for Behavioral Causes for Behavioral DisruptionsDisruptions

o Changes in the brainChanges in the brain

o Health and Medical ProblemsHealth and Medical Problems

o Environmental FactorsEnvironmental Factors

o Problems with CommunicationProblems with Communication

Alzheimer’s MedicationsAlzheimer’s Medications

o Aricept®(donepezil)Aricept®(donepezil)

o Exelon® (Rivastigmine)Exelon® (Rivastigmine)

o Razadyne ® (galantamine)Razadyne ® (galantamine)

o Namenda ®(Memantine)Namenda ®(Memantine)

The Tragic DifferenceThe Tragic Difference

We need to We need to Love them Love them

and be and be Patient at all Patient at all

times.times.

Thank YouThank You I want to thank the Star Chapter of I want to thank the Star Chapter of

the Alzheimer’s Association’s the Alzheimer’s Association’s Regional Office in San Antonio for the Regional Office in San Antonio for the wealth of information and resources wealth of information and resources that helped in formulation of this that helped in formulation of this program.program.

Late Stage Dementia Care – book Late Stage Dementia Care – book resource available through the resource available through the Alzheimer’s Association networks.Alzheimer’s Association networks.