2. Agenda
What is Alzheimer’s and Dementia?
Types of Dementia
Stages of the Disease
Tips for Communication
Managing Severe Behaviors
3. What is Alzheimer’s
Disease? Alzheimer’s is a disease of the brain that causes problems
with memory, thinking and behavior.
◦ It is not a normal part of aging.
Alzheimer’s gets worse over time.
◦ Although symptoms can vary widely, the first problem many
people notice is forgetfulness severe enough to affect their
ability to function at home or at work, or to enjoy lifelong
hobbies.
The disease may cause a person to become confused,
get lost in familiar places, misplace things or have trouble
with language.
It can be easy to explain away unusual behavior as part of
normal aging, especially for someone who seems
physically healthy.
Any concerns about memory loss should be discussed
with a doctor.
4. What is Dementia?
Dementia is a general
term for the loss of
memory and other
cognitive abilities serious
enough to interfere with
daily life.
Dementia is often
incorrectly referred to as
"senility" which reflects the
formerly widespread, but
incorrect, belief that
serious mental decline is a
normal part of aging.
5. Types of Dementia
Vascular Dementia is a decline in thinking
skills caused by conditions that block or
reduce blood flow to the brain, depriving
brain cells of vital oxygen and nutrients.
These changes in thinking skills
sometimes occur suddenly following
strokes that block major brain blood
vessels.
It is widely considered the second most
common cause of dementia after
Alzheimer’s disease.
6. Types of Dementia
Parkinson’s Disease
Dementia is an impairment in
thinking and reasoning that
eventually affects many people
with Parkinson’s disease.
As brain changes gradually
spread, they often begin to
affect mental functions,
including memory and the ability
to pay attention, make sound
judgments and plan the steps
needed to complete a task.
7. Types of Dementia
Lewy Body Dementia is a type of
progressive dementia that leads to a
decline in thinking, reasoning and
independent function due to abnormal
microscopic deposits that damage brain
cells.
8. Types of Dementia
Huntington’s Disease Dementia is a
progressive brain disorder caused by a
defective gene.
It causes changes in the central area of
the brain, which affect movement, mood
and thinking skills.
9. Types of Dementia
Frontotemporal Dementia (FTD) is a
group of disorders caused by
progressive cell degeneration in the
brain’s frontal lobes (the areas behind
the forehead) or its temporal lobes (the
regions behind the ears).
10. Types of Dementia
Down Syndrome
Dementia -As
individuals with Down
Syndrome age, they
have a greatly
increased risk of
developing a type of
dementia that’s either
the same as or very
similar to Alzheimer’s
disease.
11. Who can be affected?
Research shows that older Latinos are
about 1 ½ times as likely as older
Caucasians to have Alzheimer’s and other
dementias.
Older African-Americans are about twice
as likely to have Alzheimer’s and other
dementias as older Caucasians. The reason for these
differences is not well
understood, but
researchers believe that
higher rates of vascular
disease in these groups
may also put them at
greater risk for
developing Alzheimer’s.
12. Stages of Alzheimer’s
Stage 1: No cognitive impairment-
◦ Unimpaired individuals experience no
memory problems and none are evident to
a health care professional during a medical
interview.
13. Stages of Alzheimer’s
Stage 2: Very mild decline-
◦ Individuals at this stage feel as if they have
memory lapses, especially in forgetting
familiar words or names or the location of
keys, eyeglasses, or other everyday
objects.
◦ But these problems are not evident during a
medical examination or apparent to friends,
family, or co-workers.
14. Stages of Alzheimer’s
Stage 3: Mild cognitive decline-
◦ Early-stage Alzheimer's can be diagnosed in some, but
not all, individuals with these symptoms.
◦ Friends, family or co-workers begin to notice
deficiencies.
◦ Problems with memory or concentration may be
measurable in clinical testing or discernible during a
detailed medical interview. Common difficulties include:
Word- or name-finding problems noticeable to family or close
associates
Decreased ability to remember names when introduced to new
people
Performance issues in social or work settings noticeable to
family, friends or co-workers
Reading a passage and retaining little material
Losing or misplacing a valuable object
Decline in ability to plan or organize
15. Stages of Alzheimer’s
Stage 4: Moderate cognitive decline
(Mild or early-stage Alzheimer's disease)
◦ At this stage, a careful medical interview
detects clear-cut deficiencies in the following
areas:
Decreased knowledge of recent occasions or current
events
Impaired ability to perform challenging mental math
For example, to count backward from 100 by 7s
Decreased capacity to perform complex tasks, such
as grocery shopping, planning dinner for guests, or
paying bills
Reduced memory of personal history
The affected individual may seem subdued and
withdrawn, especially in socially or mentally
16. Stages of Alzheimer’s
Stage 5: Moderately severe cognitive decline
(Moderate or mid-stage Alzheimer's disease)
◦ Major gaps in memory and deficits in cognitive function
emerge.
◦ Some assistance with day-to-day activities becomes
essential.
◦ At this stage, individuals may:
Be unable during a medical interview to recall such important
details as their current address, their telephone number, or the
name of the college or high school they graduated from
Become confused about where they are or about the date, day
of the week or season
Have trouble with less challenging mental math
For example, counting backward from 40 by 4s or from 20 by 2s
Need help choosing proper clothing for the season or the
occasion
Usually retain substantial knowledge about themselves and
know their own name and the names of their spouse or
children
17. Stages of Alzheimer’s
Stage 6: Severe cognitive decline (Moderately severe or mid-
stage Alzheimer's disease)
◦ Memory difficulties continue to worsen, significant personality changes
may emerge, and affected individuals need extensive help with daily
activities.
◦ At this stage, individuals may:
Lose most awareness of recent experiences and events as well as of their
surroundings
Recollect their personal history imperfectly, although they generally recall their
own name
Occasionally forget the name of their spouse or primary caregiver but generally
can distinguish familiar from unfamiliar faces
Need help getting dressed properly; without supervision, may make such errors
as putting pajamas over daytime clothes or shoes on wrong feet
Experience disruption of their normal sleep/waking cycle
Need help with handling details of toileting (flushing toilet, wiping and disposing
of tissue properly)
Have increasing episodes of urinary or fecal incontinence
Experience significant personality changes and behavioral symptoms, including
suspiciousness and delusions
For example, believing that their caregiver is an impostor
hallucinations (seeing or hearing things that are not really there)
compulsive, repetitive behaviors such as handwringing or tissue shredding
Tend to wander and become lost
18. Stages of Alzheimer’s
Stage 7: Very severe cognitive decline (Severe
or late-stage Alzheimer's disease)
◦ This is the final stage of the disease when individuals
lose the ability to respond to their environment, the
ability to speak, and, ultimately, the ability to control
movement.
◦ Frequently individuals lose their capacity for
recognizable speech, although words or phrases may
occasionally be uttered
◦ Individuals need help with eating and toileting and there
is general incontinence
◦ Individuals lose the ability to walk without assistance,
then the ability to sit without support, the ability to smile,
and the ability to hold their head up.
◦ Reflexes become abnormal and muscles grow rigid.
◦ Swallowing is impaired.
19. Tips for communicating with a
confused client
Treat the client with dignity and respect.
◦ Respond to feelings, display empathy, interest.
Know the client as an individual (his past, likes, and
dislikes).
Always introduce yourself, call the client by name,
and explain what you are doing as you approach the
client.
◦ Speak softly, in a low-pitched voice.
Approach the client from the front, moving slowly and
gently and without startling him.
◦ Establish and sustain eye contact with the client.
Speak in short, direct statements and repeat key words to
help promote understanding.
Always get the client's attention before commenting or
asking a question.
◦ As soon as eye contact is made, begin speaking because the
client with Alzheimer's disease has an attention span that may
last only a few seconds.
20. Tips for communicating with a
confused client (cont.)
Explain each task by providing short, one-step directions.
◦ Ensure that all tasks are simple and manageable.
◦ Show the client how to begin a specific task (e.g., brushing hair).
Ask questions that are short and to the point.
◦ Only ask one question at a time.
◦ When repeating a question, ask it exactly the same way as you did
the first time.
Use nods, pats, gestures, and smiles, and other means of
nonverbal communication.
◦ Be consistent with gestures.
It only adds to the client's confusion if you use a gesture to mean one thing one
time and something else at a different time.
Provide sensory stimulation if appropriate
using music or touch.
◦ Encourage clients to talk about their families and
past experiences if they desire.
21. Managing Severe Behaviors
(Catastrophic Reactions)
Resulting from Confusion
Catastrophic reactions occur when
confused clients cannot cope with the
stress around them.
Unable to understand what is
happening and respond appropriately,
the client becomes distressed and may
strike out in anger or fear.
During a catastrophic reaction, the client
cannot control his behavior.
22. Managing Severe Behaviors
(Catastrophic Reactions)
Resulting from Confusion
The best way to deal with a catastrophic
reaction is to try to prevent it from happening.
Look for signs that the client is getting upset.
Ensure that the client is comfortable and has
rest periods throughout the day.
A client that is tired is more likely to become
upset.
Speak to the client calmly and quietly, never
argue with them.
Always treat the client with courtesy and
respect.
If the client had a previous catastrophic
reaction, try to determine its cause.
23. If a catastrophic reaction occurs,
you can help to calm the client by:
Trying to determine the cause of the behavior.
◦ Ask a nurse to check for physical causes, (e.g., swollen
gums, sore teeth, infection, and pain).
Remaining calm and quiet
Trying to soothe the client
If the client allows it, touch them and hold their
hand
Do not ask the client questions at this time
Speak in simple, short sentences
Slowly move the client to a quiet private place
Using simple distractions, such as, "Let's go get a
drink"
Feeding the client.
◦ Food was used in many homes as a sign of nurturing.
24. Catastrophic Reactions-
Most Important to Remember
Clients usually calm down as quickly as
they flare up and typically do not
remember what just happened.
Do not take the catastrophic reaction
personally; it is a reaction to the
situation, not the caregiver.
25. Conclusion
First and foremost, treat
people with respect and
dignity.
Do not argue with the client.
Keep calm.
Be patient.
Always introduce yourself,
call the client by name, and
explain what you are doing
as you approach the client.
Explain each task by
providing short, one-step
directions.
