Webinar Why Do They Do That?

1. WebinarWhy Do They Do That? Presented by: Jennifer A. Scott, B.S.R.A., C.A.L.M. VP Facility Development and Operations Tree of Life Care Group Management Company For Arveda Alzheimer’s Assisted Living Residences 512-828-8151 Office jscott@tlcaregroup.com www.arvedacare.com and www.tlcaregroup.com

2. Presentation Goals • The participants will be able to identify the different types of the most common forms of dementia • The participants will be able to identify how the different dementia disease processes impact the patient • The participants will be able to identify the medications available to treat Alzheimer’s disease and how they benefit the patient. • The participants will be able to identify the leading problem behaviors associated with Alzheimer’s disease.

3. Disease Diagnoses • Alzheimer’s Disease • Vascular Dementia – Multi Infarct Dementia • Parkinson’s Dementia • Lewy Body Dementia • Pick’s Disease • Alcohol Dementia-Wernicke-Korsakoff Syndrome • CreutzfeldtJakob Disease

4. Alzheimer’s Dementia Slow progression Short Term Memory Loss first Loss of executive functioning Skills Long Term Memory Loss Loss of motor skills Vascular Dementia Stair Step Decline Incontinent of bladder sooner than Alz. Loss of language sooner than Alz. Loss of ambulation sooner than Alz. How do you know the difference?

5. Parkinson’s Dementia Irregular Body Movements Stiffness in joints and limbs Loss of motor skills 40%-50% also get Alzheimer’s Lewy Body Dementia Hallucinations Loss of motor skills Pseudo-Parkinson’s symptoms Rapid cognitive changes Syncope Episodes Intolerance of psychotropic medications How do you know the difference?

6. Pick’s Disease Frontal Temporal Involvement Only 1-5% of people diagnosed with this Diagnosis early in life – 40’s and 50’s Extreme hyperactivity or very lethargic Short Term Memory Stays intact longer May put everything in mouth Gluttonous eating Extreme loss of language in late stages Hyperactivity turns into non-responsiveness in late stage Wernicke-Korsakoff Syndrome Thiamine deficiency; Vitamin B1 deficiency Most often caused by excessive alcohol consumption Confabulation Psychosis Motor Skill Losses Neuropathy of extremities Muscle Wasting Brain damage affecting language and thinking Heart Failure is common Behaviorally very difficult to care for How do you know the difference?

7. How do you know the difference? • Creutzfeldt Jakob Disease • Two different types “classic” and “variant” forms • Variant seems to be linked to “mad cow disease” but not always and it’s very rare • Classic is not linked to “mad cow” • Both forms have long gestation periods but once diagnosed the person deteriorates very rapidly, a few months to a year • Signs and symptoms in both forms are similar – personality changes, loss of thinking ability, behavioral symptoms, loss of motor control

8. 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.

9. 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.

10. 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.

11. Frontal Lobe – What does this do?

12. Frontal Lobe – What does this do?

13. 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.

14. Looking for a deceased relative Borrowing items from others (some people call this stealing, which is incorrect) Yelling Striking out at others Refusals to bathe and non-compliant with ADL’s Disrobing in public Medication Refusals Pushing/pulling furniture Wandering High Anxiety Hoarding Rummaging Catastrophic Reactions Types of Disease Behaviors

15. Causes for Behavioral Disruptions • Changes in the brain • Health and Medical Problems • Environmental Factors • Problems with Communication

16. Alzheimer’s Medications • Aricept®(donepezil) • Exelon® (Rivastigmine) • Razadyne ® (galantamine) • Namenda ®(Memantine)

18. The Tragic Difference

19. We need to Love them and be Patient at all times.

20. Thank You • I want to thank the Star Chapter of the Alzheimer’s Association’s Regional Office in San Antonio for the wealth of information and resources that helped in formulation of this program. • Late Stage Dementia Care – book resource available through the Alzheimer’s Association networks.