Model of Psychological Intervention in Dementia Care

1. Model of Psychological Intervention in Dementia Care Polly Shepard, Psy.D. Corby Bubp, Ph.D. Clinical Neuropsychology/Psychology

2. Psychiatric Assessment Marital/Family Therapy Learning Disability Assessment Individual Therapy Neuropsychological Assessment PPS Career Counseling Biofeedback Therapy Parent Coordination Custody Evaluation Competency Evaluation

3. The Memory Clinic of Indianapolis • Provide compensatory strategies and recommendations for home and school • Identify potential barriers for decision making in daily living (e.g. independent living, driving, financial decision making, etc.) • Provide assessment, consultation, and testimony for issues related to competency and brain-related impairments.

4. The Memory Clinic of Indianapolis • Pediatric and Adult Neuropsychological Evaluations • Psychoeducational Evaluations • To determine Learning Disorders and AD/HD • Evaluate cognitive strengths and weaknesses in chronic medical diagnoses • Pre-and post-concussion/TBI evaluations • School readiness/private school admission evaluations • Distinguish neurological vs. emotional/psychiatric syndromes

5. What is a Neuropsychologist? • Neuropsychology = study of brain-behavior relationships • Educational requirements • Ph.D./Psy.D. in Psychology with emphasis in neuropsychology • Doctoral level internship with 50% devotion to neuropsychology • 2 year fellowship/residency in neuropsychology • Board certification in Clinical Neuropsychology by the American Board of Professional Psychology (ABPP)

6. Overview

7. Referral Process

8. Referral Triggers • Prior Psych Diagnosis • Psychotropic/Sedative use • Behavioral Issues • MDS Trigger • Staff-patient interaction • Non-compliance with Treatment • Substance/Medication abuse • Cognitive/Behavioral change

9. Treatment and Interventions • Counseling/therapy • Supportive/emotional • Cognitive behavioral

10. Treatment and Interventions • Behavioral-based Interventions • Wandering • Sleep management • Hallucinations • Physical/Verbal abusive behaviors

11. Treatment and Interventions • Cognitive Rehabilitation • ACTIVE • Impact • Tailored intervention • Cogmed

12. Diagnostics • Screen/Full Neuropsych Assessment • Testing instruments designed to evaluate: • Cognitive (IQ, Memory, Attention, Problem Solving, Insight, Executive Functioning, Language, Motor Skills, Judgment, Speed of Thought, etc.) • Emotional (Depression, Anxiety, Post Traumatic Stress Disorder, Manic episodes, etc.) • Personality (Impulsivity, Recklessness, Lack of Motivation, Apathy, Withdrawal, etc.)

13. Diagnostics • Diagnostics guide recommendations for: • Differential diagnosis (Dementia/Delirium/Depression) • Treatment planning • Ability to handle finances (bills, checkbook, plan, vulnerable to scam artists) • Ability to make medical/legal/financial decisions • Ability to drive (Poor reaction time, spatial neglect, mentally plan for driving in high traffic conditions) • Medication effectiveness (tracking cognitive/emotional/behavioral)

14. Memory: Word List Learning Delayed Recall Trial 1 Trial 2 Trial 3 1. Butter 1. Butter 1. Butter 1. 2. Arm 2. Arm 2. Arm 2. 10. Engine 10. Engine 10. Engine 10. Recognition Recall 1. Target 20. Distractor

15. Memory Performance in Normals and Patients with Mild Dementia

16. Consultation • Environmental/Physical design of facility • Behavioral management strategies for staff • Stress management • Prevention of staff burnout • Research-based program design

17. Limitations • Medical culture • Environmental logistics • Insurance/reimbursement • Communication/Language • Training opportunities

18. Questions • What do facilities want from us • How can we better address limitations • What is the best way to educate facilities about psych/neuropsych services