Age-Related Brain Changes Changes in the brain and nervous system occur with aging. Confusion, delirium, and dementia cause cognitive impairment but are NOT normal parts of aging. Certain diseases can cause changes in the brain. See Box 38.1: A Comparison of Normal and Abnormal Nervous System Changes (p. 893)
Disorientation (1 of 6) Also called confusion. Refers to an impaired ability to recall people, time or places. In most cases, there is an underlying medical condition (e.g., depression, brain tumour, electrolyte imbalance) causing the disorientation.
Disorientation (2 of 6) Disorientation can occur suddenly or gradually over a long period of time. It is more common in older people. Sometimes it is reversible. Whether or not it is reversible depends on the cause.
Disorientation (3 of 6) Signs and symptoms of disorientation: People often exhibit behaviour changes and may be angry, restless, depressed, or irritable. Other symptoms: • Anxiety • Tremors • Hallucinations • Delusions • Decline in level of consciousness (LOC) • Disorganized thinking and speech • Attention problems
Disorientation (4 of 6) Causes of disorientation: Urinary tract infections (UTIs)—one of the main causes Alcohol intoxication Low blood sugar Head trauma and injury; concussion Nutritional deficiencies Fever
Disorientation (6 of 6) Ways to minimize or prevent disorientation: Get regular hours of sleep. Eat a balanced diet that has plenty of vitamins and minerals. Do not drink alcohol in excess. Maintain careful control of blood sugar if diabetes is present. Don’t smoke. Sudden onset of disorientation without a known cause requires immediate medical attention within hours, or it could result in permanent cognitive, mental, or physical disorders, or even death.
Slide 8 Delirium (1 of 5) Disorientation that occurs suddenly. A state of temporary, but acute, mental confusion. Onset is sudden. • It is common in older persons with acute or chronic illnesses. Delirium is an emergency. • The cause must be found and treated immediately before symptoms become permanent.
Delirium (2 of 5) Common causes include: Reaction to medications Infection or other illnesses Poor nutrition Food poisoning Dehydration Emotional trauma Major life changes (e.g., death of a loved one)
Delirium (3 of 5) Signs and symptoms of delirium: Attention disturbances, difficulty concentrating Incoherent speech Disorientation to time or place Changes in sensation and perception Signs of illusions and hallucinations
Delirium (4 of 5) Signs and symptoms of delirium: Altered level consciousness or awareness Altered sleep patterns; drowsiness Level of alertness may vary Decrease in short-term memory and recall Changes in motor activities, movement Emotional or personality changes
Dementia (2 of 19) Dementia is more common after 65 years of age but can also affect people in their 40s and 50s. When diagnosed, it is either categorized as a mild or major neurocognitive disorder. Categorization is based on decline in attention, function, learning, memory, language, deliberate motor movement, and social functioning.
Dementia (3 of 19) See tables: Textbook Table 38.1: Typical Symptoms and Support Strategies for Early Stage of Dementia Textbook Table 38.2: Typical Symptoms and Support Strategies for Middle Stage of Dementia Textbook Table 38.3: Typical Symptoms and Support Strategies for Late Stage of Dementia
Dementia (4 of 19) Some early warning signs include: Recent memory loss that affects job skills Problems with common tasks Problems with language; forgetting simple words Getting lost in familiar places Misplacing things and putting things in odd places Personality changes Poor or decreased judgement Loss of interest in life
Dementia (5 of 19) Untreatable (irreversible) forms of dementia: Also known as primary dementia. Brain function will decline over time. Types include: • Alzheimer’s disease (AD) • Vascular dementia • Dementia with Lewy bodies • Frontotemporal dementia
Slide 20 Dementia (8 of 19) Alzheimer’s disease and related dementias (ADRD): A primary disorder of the brain Categorized as either a major or minor neurocognitive disorder. First identified by Dr. Alois Alzheimer in 1906. Has two distinguishing characteristics: • Plaques: deposits in brain that become toxic • Tangles: interfere with vital processes
Dementia (11 of 19) Warning signs of ADRD (according to Alzheimer’s Society of Canada): Misplacing things Changes in mood and behaviour Changes in personality Loss of initiative
Dementia (12 of 19) Vascular dementia (multi-infarct dementia) One of the most common types of dementia, second to Alzheimer’s disease. Caused by small strokes resulting in brain tissue death. • The cortex of the brain is associated with learning, memory, and language. • These strokes do not necessarily lead to hemiplegia but may instead cause changes in personality or memory. • These strokes are known as “silent strokes” or transient ischemic attacks (TIAs)
Dementia (13 of 19) Vascular dementia (multi-infarct dementia): Behavioural or physical symptoms can come on gradually or suddenly. There is no cure. Disease progresses in a stepwise fashion: • Starts with lapses in memory, followed by periods of stability, then further decline.
Dementia Dementia (14 of 19) Common mental and emotional signs and symptoms of vascular dementia include: Slowed thinking Memory impairment Unusual mood changes (e.g., irritability, depression) Hallucinations and delusions Disorientation, may get worse at night (sundowning) Personality changes and loss of social skills
Dementia (15 of 19) Dementia with Lewy bodies (DLB): One of the most common types of progressive dementia. Involves progressive decline combined with three additional defining features: • Severe fluctuations in alertness and attention • Recurrent visual hallucinations • Parkinson-like motor symptoms
Dementia (16 of 19) Dementia with Lewy bodies (DLB) (cont.): People with DLB may also suffer from depression: • Symptoms are caused by build-up of Lewy bodies • Accumulated bits of protein in area of the brain regulating aspects of memory and motor control There is no known familial connection, but there are some rare cases.
Dementia (19 of 19) Types of FTD: Pick’s disease • Marked by presence of abnormalities in brain cells (Pick’s bodies) • Behavioural changes are very subtle at first. • Dementia is recognized when behaviour becomes more bizarre. Mixed dementia • Has characteristics of both Alzheimer’s disease and vascular dementia • Now believed to be more common than previously thought.
Secondary Dementias (1 of 9) Dementia that results from the physical effects of a disease process (e.g., ingestion of damaging substance or from injury) Types include the following: Parkinson’s disease dementia Creutzfeldt-Jakob disease Normal-pressure hydrocephalus Substance-induced persisting dementias Wernicke-Korsakoff syndrome
Slide 33 Secondary Dementias (2 of 9) Parkinson’s Disease Dementia Parkinson’s disease affects the brain’s ability to control movement. Involves tremors, stiffness, slowness, difficulty walking, loss of balance In later stage of the disease, some people may also develop dementia. May also develop depression
Slide 34 Secondary Dementias (3 of 9) Creutzfeldt-Jakob Disease (CJD) A very rare disease that causes dementia A rapid progressive neurological disease—it is rapidly fatal. There is a genetic link or susceptibility. Occurs between ages of 50-70 years. Affects both people and animals.
Secondary Dementias (5 of 9) Normal-Pressure Hydrocephalus: People with a history of brain hemorrhage or meningitis are at increased risk for this type of dementia. Symptoms: • Difficulty walking • Memory loss • Inability to control urination Can sometimes be corrected with a shunt in the brain.
Secondary Dementias (6 of 9) Substance-Induced Persisting Dementias Result from persisting effects of an abused substance, medication, toxic substance exposure, or alcohol. Caused by: Toxic effects of the substance on brain cells Substance-related effects on internal organs Acquired brain injuries (ABI) related to falls sustained while impaired or disoriented • Remember DIPPS principles and act professionally when providing care to clients.
Slide 38 Secondary Dementias (7 of 9) Wernicke-Korsakoff Syndrome (WKS): A brain disorder caused by lack of thiamine (vitamin B) Associated with alcohol use disorder over a long period of time: • Many heavy drinkers have severe malnutrition, poor eating habits. • Alcohol can inflame stomach lining and impede body’s ability to absorb the key vitamins it receives.
Slide 41 Depression and Dementia (1 of 6) The causes of major depression and dementia may be totally unrelated. Sometimes depression in some clients can be mistaken for dementia. Depression is sometimes called pseudo-dementia. People showing signs of early ADRD might be mistaken as being depressed.
Depression and Dementia (4 of 6) People with ADRD may be less likely to talk about or attempt suicide Proper diagnosis and treatment is important Treatment: • Involves a combination medication, counselling, and encouraged socialization and activities
Depression and Dementia (5 of 6) Supporting a Client Living with Dementia Who is Depressed Support groups are helpful and should be encouraged. Schedule predictable routines, high-energy activities (e.g., bathing during client’s best time of the day). Frequently schedule activities, food, people or places that client enjoys.
Depression and Dementia (6 of 6) Supporting a Client Living with Dementia Who is Depressed: Assist client with regular exercises. Validate clients’ feelings of sadness and frustration. Celebrate small successes. Reassure client that they are loved, respected, and appreciated. Reassure the client that they will not be abandoned.
Stages of Dementia (1 of 5) Staging systems: Most dementias are classified using these 3 stages: • (1) early stage • (2) middle stage • (3) late stage Another staging system is the Global Deterioration Scale (Reisberg Scale) • Divides the disease process into 7 stages
Stages of Dementia (2 of 5) Staging (cont): Dementia affects each client differently, depending on which part of the brain is affected. The length of each stage varies. Stages will overlap. Some clients will experience several symptoms, others only a few symptoms.
Stages of Dementia (3 of 5) Stage 1: Mild (early stage) Client is usually aware of diagnosis and will be able to participate in decisions affecting future care. Experiences mild forgetfulness, difficulty learning new things, problems with orientation, communication difficulties.
Stages of Dementia (4 of 5) Stage 2: Moderate (middle stage) Further decline occurs in client’s mental and physical abilities. Memory continues to deteriorate—client may forget personal history; may not recognize friends and family. Some clients become restless and pace constantly or may wander off. • Register such clients with MedicAlert Safely Home program (which can assist with locating client if they should become lost).
Stages of Dementia (5 of 5) Stage 3: Severe (late stage) Client is incapable of remembering, communicating, or carrying out self-care. Care is required 24 hours a day.
Supporting Clients Who Are Living With Dementia (1 of 2) Each client living with dementia has unique care needs, depending on the form and stage of dementia they have, and the care setting they are in. See textbook box: Providing Compassionate Care: The Client Living with Dementia
Supporting Clients Who Are Living With Dementia (2 of 2) Guidelines for caring for clients include: • Meeting basic needs • Safety (protect from wandering, falls) • Hygiene, grooming, and dressing • Elimination needs • Nutrition and fluids • Exercise • Health issues • Comfort • Sleep • Therapy and activities
Validation Therapy Focuses on empathy and advocates accepting the affected person’s perception of reality. The purpose is to make client feel supported and respected. Caregiver focuses on descriptive clues that the client provides See textbook Box 38.3: Principles of Validation Therapy See textbook box: Supporting Mrs. Yi: Using Validation Therapy
Slide 58 Gentle Persuasive Approaches Gentle Persuasive Approaches (GPA) is a program initially designed for use by long- term care home staff. Teaches workers to be self-protective, respectful, and nonviolent and to prevent workplace injury. Designed to train direct care providers on how best respond to clients with responsive behaviours (e.g., grabbing, hitting, biting) that are associated with Alzheimer’s disease.
Caregiver Needs (3 of 4) The family: Caregivers need much support and encouragement. • Many join support groups sponsored by Alzheimer’s Society of Canada, hospitals. or long-term care facilities. The family often feels helpless, guilty The family is an important part of the health team. • They need support and understanding from the health team.
Caregiver Needs (4 of 4) Caregiver Relief: As a support worker, you may assist the primary caregiver, or care for the client and provide respite for the caregiver. Follow the care plan. Observe signs of caregiver stress and signs of depression and abuse. Report all observations immediately to your supervisor • See textbook box: Case Study: Supporting Caregivers of Clients Living with Dementia