This course has been approved by the Department of Consumer Affairs Professional Fiduciaries Bureau for one and half (1.5) hours of CE credit. To receive a certificate of completion for this class, please watch the complete video and complete the form below.
My name is Lee-anne Godfrey and thank you for joining me early this morning. It's hard to find a time where everybody can make it, so sometimes we do these early in the morning and I think the next one will do will be at lunchtime so hopefully it will work for a few more people but. Thank you for showing up today. It's a really important topic and I'm sure that in your roles, whatever position you have out there, you've taken a course or two or very many possibly. Classes on dementia, cognitive decline for seniors, etc. So hopefully today we're going to get down to the basics of dementia and I chose this topic to do a CE4 because when I work out in the senior community, I notice that there is some confusion about what is dementia. What is Alzheimer's disease? Alzheimer's disease a type of dementia or is dementia type of Alzheimer's disease? There seems to be a lot of confusion, so I thought that it would be good just to have a basic understanding of dementia. So today we're going to go over some terminology so that we're all talking about the same terms when we talk about dementia, Alzheimer's disease, or Lewy body disease. Whatever, we're talking about that we have that common language of understanding. So we're getting down to the basics for sure today. My name is Leanne Godfrey. As I mentioned, I'm a nurse care manager. I've been doing care management for almost 10 years now and I started the company in health management back in 24. 13 and some of you I do know I can see who's on. This is a repeat class. Actually we did it last month as well. So it's good to see some people that I know and welcome to the people that I. Haven't met yet. But we're a. Care management company. We're a team of nurses that do care management trying to help people to live their best life for as long as possible. The setting that they've chosen for themselves, so we've been doing that for a little while now, and certainly a lot of our clients have a dementia of some sort. So that's why this is such an important topic. So in terms of today just a couple of nuts and bolts before we get going. If you registered before about 6:00 o'clock last night, you should have received a copy of the PowerPoint as well as three handouts. You have the full PowerPoint plus you have a handout sheet that you can make your notes on. So you should have both. I'm going to be sending out your certificate within the next seven days. It probably will be sooner than that, but just to make sure in case I have every anything come up that takes me away from doing this, you're going to have your certificate of CE completion as long as you stay the entire time, then you'll be able to get your CE credit for 1.5 hours. And along with that certificate I'm going. To also send you. Uh, link to this presentation so you can forward that link to people you can forward it to family members. Or maybe you have a client and you think that the family members of that client would benefit from knowing some of the basics of dementia. Feel free to forward that so you will get that within seven days as well. I don't have a formal. Survey or a way to give feedback formally, but I welcome an email. To say this was. Great or we could have used more of that. Or next time could you? So I really am open to feedback as feedback from today's presentation so. Feel free to do that. And if you have any questions, if you find that after a week you don't have your CE certificate, please make sure that you contact me. You've got my contact information, so please feel free. To reach out for that. I think we did OK last time. I don't think we missed anybody, but sometimes people don't make it. Maybe they come on for 45 minutes or whatever so we will send you an email if on our side we don't see that you've attended the whole time, so you will get. That heads up. If that's your situation. So let's dive. In we do have an hour and a half to cover a lot of information. This is just putting our tippy toe into the water of dementia care. Of course there is so much to be learned. Everybody expresses their disease a little bit differently. People respond to medications differently. They respond to. Non pharmacological interventions differently. The diseases just express themselves in different ways, and sometimes we also have the complication of not just one form of dementia in a client. They may have two or three different types of dementia going on at the same time and. That's really hard to tweeze out. Plus we have aging individuals who may also have other chronic diseases, so they may have. Congestive heart failure. They may have copd. They may have osteoarthritis and all these different things complicate the picture of dementia. So this is. It's not all cut and dried, and I know that by working in the senior industry. Sending a fiduciary or whatever role you're in. We have more than fiduciaries here today. Whatever role you're in, you realize that this is a complicated picture. It's not easy to sort through. So the reasons why we're talking about this topic is a few things, and I'm just going to quote a couple of different statistics here. Not that I'm a statistic statistics pro, but we're just going to talk a little bit about prevalence. Most of the information that I'm sharing with you today I have obtained through Alzheimer's, Orange County. In the Alzheimer's Association. So if you have some questions about this, I would really recommend those two organizations as wonderful resources. If you haven't tapped into them already. I've got their email. I'm sorry their websites at the end of the presentation. If you haven't been. There already, but. Certainly they are a wealth of information on dementia and all the different, all the different types of dementia. It's a bit of a misnomer when you talk about Alzheimer's, Orange County, or Alzheimer's Association because they deal with all the different dimensions, not just Alzheimer's disease. I've never understood why they don't change their names, but they didn't ask me, so some of the stats I'm going to give you right now are taken from the 2021 Alzheimer's disease. Facts and figures report, and this comes out on a yearly basis from the Alzheimer's Association. The topic is important because our prevalence of dementia in our population is increasing and of course you see this with your population as. Well, we're all getting older. The baby boomers are going through the age group of 85 plus is the fastest growing demographic that we have in in our country. So certainly. The longer we Live the increased chance that we have of developing a form of dementia. Age is a huge risk factor, probably the number one risk factor I should say for developing a dementia. So just aging is our biggest risk factor. So we have about. Six million Americans, according to the 2021 report, 6 million Americans right now are living with Alzheimer's disease. That is only Alzheimer's disease. There are many other forms of dementia. Many, many other forms of dementia, so. Just with Alzheimer's disease alone, 6 million people are living with that right now. That number isn't is projected to increase to about 13 million people just with Alzheimer's disease. Again by the year 2050. So that's less than 30 years away, so it's closing in on us very quickly, actually. And for many of us, we may still be living when that 2050 hits, so. It's projected to be a huge number again 13 million just with Alzheimer's disease. Worldwide, they say that 50 million people are living with Alzheimer's disease and other dementias. It is a huge money pit for people. It's not just the personal tragedy, the family tragedy that happens when this disease comes. It's also the financial hit to the health care system. We know that people with Alzheimer's or Alzheimer's disease or another dementia they are twice as likely. I'm sorry two times they have two times as many hospitalizations per year as other older people within their age group. So two times as many hospitalizations per year. They're more likely to have chronic conditions. Such as heart. Disease, diabetes, kidney disease, and you know this, they have more skilled nursing days. They have more health home health visits. They have more visits to places like adult day services, adult day health programs and nursing related. Here at home and also I will throw in their home care our wonderful care. Members through these homecare organizations that are caring for these folks day. Today they are more likely to use resources over time and we see that all the time and one in three seniors dies with Alzheimer's disease or another form of dementia. So at least 33 percentage. The people seniors die with a diagnosis of Alzheimer's disease or other dementia. The other thing to consider is that sometimes these folks do not get diagnosed properly, so these numbers I'm sure are a little bit higher actually than what they're quoting, because many times we don't really know what that person exactly has died from. They haven't been diagnosed formally and we're going to talk a little bit about the need to have a formal diagnosis. It's also a. Really important topic because of the work that you do, I think everybody on this from what I can see is involved in senior care. You're a fiduciary. You are a nurse. You are working with this population, so the more you know, especially with what we're doing. Today with the basics, have that. Basic understanding and a really good. A place to come from in terms of learning other things very, very important so. Your work is. Definitely one reason why you're here today. I'm sure also your personal life. You may have someone in your life, whether it's a parent, whether it's a sibling, a cut. And maybe you have a friend, husband that's been recently diagnosed with dementia. So in your personal life, you probably have run up against this. Both of my parents died from vascular dementia when they were in their early 90s, so I think it touches all of us in not just it's beyond work. It's also personal. Speaking personally, in terms of your own cognitive health, your own brain health, I think this is really important information to kind of tuck in the back of your brain. To determine what kinds of things can you be doing on a day to day basis to maximize the health of your brain, we know now that lifestyle, lifestyle choices, how we live, our day to day life has great impact on. Our brain health. So we're going to talk a little. Bit about that, but you've heard this before. You know that exercising you know that. Cognitively stimulating your brain. You know that your nutrition stress management. All of those things really impact your own brain health. So I encourage you if you're not doing it already. Or maybe you are. Maybe you want to add a couple little items after our today's presentation. On this, I really encourage you to do that. You see day to day, the impact of dementia on your clients and their families and we sure want to avoid that. If we can by making some different choices in our life, it's not all tide up with that. We know that there's a little bit of genetics, a little bit of genetics, there's environmental impacts, and of course the aging process itself. So it's not like changing your lifestyle is going to prevent absolutely prevent a dementia from occurring in your brain, but minimizing that risk is certainly worth the. So now objectives. We do have a CD being offered here today, so we need to get through our objectives. We're going to talk about what is normal brain aging and what how. Is that different? From a brain that is actually not aging in a healthy way. It has a dementia, possibly of some sort, So what can we expect as we age from our brain and what is not normal? We're going to define dementia and believe it or not, I think this is where we need to start in this conversation here today, in a way, because, as I mentioned at the at the front end of this presentation, many people are confused or maybe are not clear on what exactly is dementia. If you were to try and define that and how is it different from the types? Of dementia that are out there. So we'll get into that. We're going to describe the process of Alzheimer's disease and how it progresses through the brain over time. I have some cool pictures of the brain. Which will walk. Through and you can sort of see what happens over time. When someone has Alzheimer's disease, we're going to focus on Alzheimer's because it is the most prevalent. The most common form of dementia that we tend to see out there, and you've probably. Seen that in your practice. And we're also going to talk about the impact of dementia on the client. And how can we? We as people who have oversight over some of these clients. How can we best address their needs as an individual? This really is a disease that expresses itself very individually, even though there's common things between different clients with a dementia diagnosis, everybody progresses in their own way through this disease process. So how can we? Best address that for our clients. So let's talk about what is. Normal aging and what? Is a disease process. I know that for myself there are many days, many moments that I think that perhaps my brain is heading in this direction and I think that all of us kind of joke about it. But some days I'm not joking, so I really wonder about my brain. Sometimes when I forget things etc. So there when we are, it wasn't. Very long ago even I think when I was in. Nursing school they talked. About when you're born. You were born with all the brain cells you're ever going to have, and that was sort of just the way we thought about the brain. And we now know that that is not true. We know that our brains. Can constantly learn. They can constantly add brain cells and brain connections. You've probably heard the term neuroplasticity. We have cognitive reserve where we can build as much muscle in our brain as possible by learning as much as challenging our brains as often as we can. That goes back to. Stimulating our brain, learning new things. A new hobby. Going home from work a different way, actually. I'm in my Home Office so I don't get that opportunity. Much these days. But even when. You go to the grocery store. If you go into the grocery store and go a different direction than you normally do, or you park in a different place, I think we all get into these habits, right? So even little things like changing those things up can have an impact. On your brain. So we have opportunities. Almost every moment of our day to shake up our brains. A little bit to. Challenge our brains in a different way. So what is normal aging? What can we expect and what is maybe not such a good thing? Well, we do know that dementia is not a normal part of aging, just as having kidney disease or developing diabetes over time. It is not a. Normal part of aging. It is a disease Prof. Success if we don't have a dementia, we will have a brain that can consistently learn right up until the very last day. Of our lives. We can. We can continually challenge ourselves. That being said, we also need to remember that people with dementia can also challenge their brains. They may need assistance to do that, but it's never too late to challenge someone. Frame and to try and encourage a growth of brain cells and brain connections. When we do trainings we talk about. So focusing not on the weaknesses, not on what the client can't do anymore, but what can the client do and adding to that overtime and stimulating their brain in that area if they're not able to feed themselves anymore. Or I'm sorry if they're not able to maybe make something in the kitchen anymore. Is there a? Part of that that they can do. They're not independent. They can't cook at the stove etc anymore, but can they sit and can they, you know, put the salad together. Maybe someone cuts up the salad pieces and they put that salad together so it's focusing on. The strengths and not just saying you know what they can't cook anymore. I'm just going to have them wait in the living room or at the kitchen table while I do everything in here. So constantly looking for opportunities to stimulate the brain of someone who even does have a dementia diagnosis. Thankfully for many of us, a certain degree of forgetfulness is common as we age, so I'm hopeful with that statement right there. We compensate for our forgetfulness in a big way, and we have a lot going on these days. We're constantly being torn between different demands. We have our devices around us all day long. We have a lot of distraction. So what we tend to do is we have sticky notes and if I was to turn this camera around you would see a lot of different sticky notes. On my monitor, and maybe that's the same for you. Too, or maybe you have lists beside. You, or maybe you have on your phone. You have a lot of. Your lists on there, but we compensate for our brains, right? We know that we're going to forget this and that, so I'm going to write that down so I don't forget I'm going to. Slap it on my monitor so I make sure I do that today. So a certain degree of forgetfulness is OK. We adapt to forgetfulness through all these different means. We usually remember things later, so if I'm trying to think of a movie that I watched last weekend and I want to tell you about it and I can't quite grab that that movie name, I'll maybe remember it later. It might be at three in the morning when I'm. Laying there trying. To sleep, or we compensate. So maybe I'm trying to tell you a story and there's a certain word. That I'm trying to grab. I can't grab that word, but I'll substitute a different word that is almost just as good so we can compensate for those kinds of things. That is normal aging in terms of carbs. And as I've mentioned, the normal aging human brain without dementia does not stop functioning with age, so that is very good news. If we can keep our brains cognitively intact for all the time that we age, some typical age related changes involved making a bad decision now and again. I think all of us. Or a little bit guilty of maybe. Making a bad decision, that's OK. Maybe we make. An error in paying something, maybe we don't have all of our bills. Probably you, as fiduciaries have all of your bills on autopay, you're very organized, probably in that department. But some of us will miss a monthly payment. That's OK, that happens. That's normal. We forget things sometimes I've, you know, people think what day is it. What's the date? And we are not quite sure we have to think about it right? Doesn't come to top of mind, that's OK. Sometimes forgetting which word to use as I just mentioned in the last slide, we can substitute maybe another word that works just as well. Now we lose things from time to time, but we tend to remember or we backtrack. On our steps, right? Where did I leave my phone? We backtrack where was I? Oh, I was over in the kitchen I went I was washing my hands. There it is. So we compensate and we find things. So let's take. A look we probably won't go through. All of these different examples. But this is a chart here that talks about normal aging on the left hand column and then compare to the disease process within the brain on the right hand column and comparing what is normal aging versus what it is a disease process of the brain. So let's just take the top one, temporarily forgetting a colleague's name, so maybe this is someone that you'd know pretty. Well, but for. Whatever reason it's gone and you may have had this happen to you, I know that I have. That's normal aging to maybe temporarily forget and then you're like, Oh yeah, Kathy, and it comes to you on the other side of that. The disease process is not being able to remember that name later, so the colleague that you've been working with for a while you still can't remember their name after some time goes by. Let's do. Forgetting carrots on the stove until the meal is over. How many times have you gone into the oven the next morning and found there's the buns or there's something else that you forgot in the oven or on the stove and it just you know you got carried away and you had other food and there were people over and you were visiting with them, et cetera. You just forgot that you had something else. An example of a. Disease process were would be that forgetting that the meal was ever prepared. You may hear stories of a client who says what's for breakfast and you know that they just had breakfast 35 minutes ago. But they've forgotten that. So that's an example of the disease process. Let's do maybe the 4th one down, forgetting for a moment where you are going and I'm. I'm thinking this happens to all of us that we're driving along and all of a sudden we know maybe we're listening to the news, or we're doing a phone call while we're in the car and we forget that momentary lapse of where am I going here and. Have to get reoriented. For a second, getting lost on one's own street is certainly an example. Of a disease process. Yes, we do get into trouble where people wander. You hurt you hear that term where people wander when they have a dementia of some sort and this is one of those things and I used to work with the Alzheimer's Association and we would get calls of people being lost and some never did make it home. But these were folks. Who would walk every day? I remember 1 gentleman in Laguna Beach had two dogs and he would go up and hike the same area every single day. It was part of his routine in the morning. One day he didn't come back from that. And they found him a couple of days later. The dogs came home without him and they did find him just off the trail. So sometimes there's just a disorientation and it's hard to know whether something else happened to him as well, but this is not an unusual story and we hear people who drive. And they keep driving until they have no more gas in the car and they're not quite sure how they got there or. Why they are? Where they are so it can have some really serious implications. I have one more slide that gives a few. I thought I had one more slide on that. Hang on, I did. Let's see, let's do. A couple more here, so having trouble balancing a checkbook can be a normal. I don't know how many people balance a. Checkbook these days, but. Getting into the numbers and trying to balance things and getting a little. Bit befuddled with all. Of that normal aging, you figure it out eventually, or you call your accountant whatever. But another example of a disease process related to this is not knowing what those numbers mean, and if someone lives with the dementia for long enough. Those kinds of things will happen where letters don't make sense where numbers don't make sense anymore. One more, a gradual change in personality. You know people over time do change a little bit with their personality. An example of a disease process would be drastic personality changes. Some of the dementias have more of a personality related aspect to them. Frontal temporal lobe dementia can involve. With some personality disorder, you may have heard. Of picks disease. Is sort of an older term for that, but. Some pretty drastic personality changes. The person is just not the same person that they used to be in terms of that, and that can be kind of a shocking transition for family members for loved ones. All right, so let's move on to what I call. The good news. Dementia if there is such a. Thing you have. A handout on this that should have come with your packet last evening. It's from the Alzheimer's, Orange County group treatable causes of memory loss. There are certainly more than 13. That's how many they have on that that document, but certainly there's more than that. We'll just pick through a few as we go through here today, but certainly if. We can address. These causes of a temporary form of cognitive change. Usually it's related. To memory, is this, uh, the thing that we tend to observe in people that their memory has been changing, especially short term, but it can be due to dietary changes to nutritional deficiencies vitamins. Or that are not being taken in in the proper amounts and we know going back to that old term, I haven't heard it for a long time, but the tea and toast syndrome of our seniors where they're barely getting enough calories and the calories that they do get, are pretty devoid of nutrition. So this is a really important aspect for our seniors or anybody with dementia. I'm going to go off on a tangent here because I don't think I address it anywhere else. In the presentation but. There's also dementias, early onset dementia, and these are dimensions that can come in when people are in their 30s, Forties, 50s and even into the 60s, but early onset usually progresses faster than the later. In life, dementias that are dying. Diagnosed so when we talk about older people I think I'm also throwing in some people who may have an earlier onset as well with their dementia, early onset folks and this of course is such a devastating thing to happen to younger people. Some of them are in the prime of their professional life. They have a young family. They have plans for the future, so this can be a devastating, devastating diagnosis for early on. Except, but again, if we can identify some of these issues here, these causes and treat them. Then we can usually clear up the issues that are going on with the cognition. So someone who has poor nutrition, vitamin deficiencies, they're deficient in many nutrients. We can fix that we can get a dietary console. We can start working on who is making the food. Do they need to have food delivered to them? That kind of thing, dehydration? Everybody has heard this before that. Someone who is dehydrated can change cognitive cognitively very significantly, and we know many times seniors do not hydrate enough. They don't want to go to the bathroom very often. They don't want to get up at night to go to the bathroom, so they often will self restrict the amount of fluid that they're taking in every day. Trends in blood sugar can certainly affect someone cognition. Many side effects from medications. Our seniors are taking handfuls. Many times we go into reconcile medications. Very often for clients and there's a lot of meds being taken. A lot of different physicians are prescribing nurse practitioners PA's. All these people are prescribing. Sometimes the cardiologist doesn't know what the endocrinologist has ordered, who doesn't know what the primary care physician has ordered, who doesn't know what the neurologists just order. Word so a really important thing to do with our seniors is to reconcile their meds on a regular basis. What we do is we send out the Med sheets to all the physicians and we have them literally sign off. They see the whole Med sheet the recently put together Med sheet that has everything on it so that they can see what. Other providers have been ordering and we literally have them initial and say, you know this is OK to continue or no. I had no idea they were supposed to be off that Plavix that blood thinner months ago. We actually had a client who had his blood thinner discount. Then you'd somehow it made it back to a home between you know, the time between hospital to skilled nursing and back to home. Those times of transitions, a lot of things happen, right? You've probably seen this where things fall through the cracks, the meds I can pretty much say the 100% of the time there are Med issues when they come. Out to go home. So this gentleman, somehow it had been discontinued when he was in the skilled nursing facility, the blood thinner because he had had strokes. He came out with a prescription for a blood thinner and he did have another stroke and a severe stroke, one that knocked out his occipital lobe, which meant that he is legally blind now. So medications huge risk, toxicity related to medications. We know that some meds interact together, but we also know that some meds, like digitalis for the heart, digoxin, that can become toxic over time. So we need to make sure that we're getting regular blood work seizure medication. Can also be problematic, so making sure that we're following up on our medication levels, making sure they're being checked as needed. That's a really in this whole medication thing. People often too, they have different pharmacies filling their meds. So again, one pharmacy. Is the best. Way to go. If you have someone that has multiple pharmacies, maybe they got a mail order. They've got two local pharmacies that they're pulling from for different things. They need to have it as much as possible. Sometimes there's a specialty Med that has to come out. You know, maybe from a, maybe it's not on formulary at most pharmacies. That's OK, that's sort of an outlier, but for the most part bring everything to one pharmacy so that that's another layer of. Tracking that a pharmacist will say oh they shouldn't be on this and this at the same time, let's call that doctor and find out what else we can do instead. Of that medication, it's not safe. Depression can often lead to confusion, so that is another reason for cognitive changes. Sensory loss, so things like the loss of hearing the loss of vision, those types of losses, loss of sensation with neuro neurological changes that really interferes with our orientation and also it contributes to confusion. So that can affect our cognitive status as well. Cancers and of course the most obvious one is brain tumors. They can lead to memory loss and other cognitive changes. Sleep apnea the brain. Needs a lot of oxygen, a lot of oxygen. It needs a lot of blood supply going up there, and so when you don't sleep well when you are deprived of proper. Oxygenation, especially overnight, that can have serious complications for your brain. Of course, drug use alcoholism. We have a client now who is an alcoholic and there are certain types of dementia related to that encephalitis and things like that can be very problematic for someone who is abusing a substance like this. I've underlined and put. In bold, not bold, but caps infection. You have all seen this out there. When someone develops a really quick onset, you know yesterday they seemed to be fine or the day before they were really good, and today they're confused. They're combative, what's going on? And probably there's been an infection of some sort. Their white count is probably up a little bit to fight. The infection and that is a common cause and we all tend to think about the. Urinary tract infection. Right, so one of the first things that we see when in effect when a change in personality change in cognition happens very quickly. They usually draw blood just in case there's anything with that, but they also take that your analysis and see if there's anything growing in that you're in. So that's a really good thing to check out. And this is for you. This is for all of us keeping your brain healthy. I mentioned towards the beginning that one of the reasons we need to talk about dementia is because of our own health and well being over time. So the kinds of things that we want to be doing are, you know, we can't control the aging. Process I wish I could say we could. Do that. We can't really control our genetics and that plays a little bit of a role, especially with the early onset of dementia. But lifestyle can also reduce our risk of cognitive decline, so keeping our brains active mentally active, that really encourages blood flow to our brain. The more we use that brain, the more blood flow. That is going up there and that's what you want. I mentioned just a moment ago that the brain takes up a lot of oxygen. It really sucks up a lot. It wants a lot of blood up there. You have vessels, miles of vessels in this brain of yours up here. So we need to make sure that we're encouraging through using our brain. Encouraging that blood flow up there really important, we want to every time you learn something new IT modifies your brain and it creates more connections between brain cells. So you have in your brain billions and billions of brain cells you also have. Trillions and trillions of connections between those brain cells and that's. How thinking wow? Works the connections between those brain cells. That's how we actually have our thinking process occurring. If there is a breakdown and maybe those connections are broken over time, we're not growing new connections over time. Then we have cognitive changes so anything you can do to stimulate. That brain is a. Good thing exercise and physical health. We know that now research is telling us that exercise can stimulate the brain. 's ability to maintain its network the network. That I just. Talked about those connections between the brain cells, exercise and physical health can contribute to those connections. And it also promotes. The blood. Flow, it's not just going to your arms and legs as you're physically active. It's also going up to your brain. So again, a really. Good thing what I've heard most recently and I think that having been stuck in inside for almost well over a year now for us sitting is the new smoking and that I think has been a real awakening over the last year that we're all sitting more. Many of us don't. I have a gym membership anymore and I know that I'm not going back anytime soon. But it has changed how we workout and how physically active we are. The research now says that physical inactivity is a number one modifiable risk factor for cognitive impairment. I'm going to say that again, physical inactivity is a number one modifiable risk factor for cognitive impairment so. We're all going to get outside after we finished this webinar this morning and walk for three miles. Diet and nutrition. So things like Whole Foods. We want to make sure we have foods that are, you know, not high in fat. We want to avoid trans fats. We want to. Avoid a lot. Of added sugar. We want to take it down to Whole Foods like the veggies of fruits. We've all heard this a million times, right? So staying away from the saturated fats. The processed foods and what do our seniors quite. Often eat not all of them. But for many clients. I will go in and take a little look in the refrigerator and the freezer and I'll see. Stove fridge. No frozen dinners packed to the gills in the free. These are just full of processed foods, right? And you look below to see what kind of veggies there are and there's minimal veggies. There might be an orange and apple, maybe for fruit, a couple of carrots sticking around, so this is an area I think that we can really make a difference with our seniors educating them. And if they're not able to manage this themselves, put some things in place. You know, help them with meal delivery. Help them with grocery delivery. Maybe they've got a caregiver that comes in three times a week for four hours each time. Maybe they can as one of their activities make some healthy foods, freeze those or put them in Tupperware for the next couple of days. 2-3 days, that kind of thing. And last but not least is social engagement, and they found that that can delay the onset of dementia with people really trying to connect and having a purpose. To the day. You have seen this with your clients that if there's no reason to get out of bed in the morning, why bother? So having a reason to get up? I think that people, even when they're quite compromised, maybe they physically can't even get out of the house anymore, especially right now with the COVID restrictions that we're still dealing with. Volunteering can happen on different levels, right? So we have one client who she does it by zoom now, but before COVID she would go and she would help children in classrooms and do reading with them. That was her reason to get up. She was not. She was a nurse. Actually she wasn't a teacher, but that was her reason to get up. And stay healthy and keep going and be positive and give back to the community and. Love those kids. So something like that and what is really good is if you can combine all four at once. Now I don't play golf, but I'll bet that some of you out there do and that is an activity that combines all four of these things. So hopefully as you learn. More about your swing. I'm going to. Say the wrong. Terms here, but. As you learn more about the game. How to recover? From certain shots I'm making an embarrassing thing out of. Myself here, but that combines cognitive activity, exercise right? Don't take the. Cart do the walk and Oh well. I guess it doesn't work on the. Diet does it. But social engagement, so you're there with friends, you're talking, you're engaging. There's a lot of blood flow to the brain, something that combines all of these together. And maybe afterwards you. Go to the. You go to the little cafe there and you have a wonderful spinach salad with eggs on top or something. So anyways, something that combines all of these things is ideal. It's a wonderful way to go. So that is for all of us that slide there. All right. So let's get. To the nuts and bolts here. I gotta keep an eye on my time here so with dementia. This is a term that does get a lot of confusion out there, so I'm going to start with the very basics here and I've got a picture of an umbrella. As you can see. Dementia is an umbrella term and I'm using that as a general term for a decline in mental ability cognitive ability. That is severe enough to interfere with daily life. If so, it's a very general term. It's like saying that someone has cardiovascular disease, and if I tell you I have cardiovascular disease, well that's a really big term. That's an umbrella term. A very big general term, so I could have coronary artery disease. I could have hypertension. I could have arrhythmia congestive heart failure I could have. Peripheral vascular disease. All of those things right can be dumped underneath cardiovascular disease. Same thing with dementia. It's a big umbrella term in underneath that term that can be very there, can be different disease processes similar to my cardiovascular with the CHF and all of those kinds of things. This general term, this umbrella term describes a group of symptoms, and we're going to talk about some of those symptoms as we go through here today. But they share a lot of symptoms in common, so the one we tend to think about most often again is the memory issue, right? But it also has some other symptoms, and we're going to look at those as I mentioned, but things like judgment, things like planning. Those are areas that with dementia they start to break down. It becomes more difficult for people to manage those kinds of things, so dementia is not a specific disease. I will hear people. Say, as I mentioned at the beginning. Oh, he doesn't have Alzheimer's disease. He is dead. Or the opposite, he doesn't have dementia as Alzheimer's disease, so dementia is not a specific disease, just as cardiovascular disease is not a specific disease, it describes the overall term Alzheimer's disease is most definitely a specific disease, so there is a difference between the term dementia. And Alzheimer's disease. In general, no matter what kind of dementia one has, dementia develops when the nerve cells, when those neurons are also known as brain cells no longer function normally and many times it's related to plaques and tangles as it is in Alzheimer's disease and where you apply her plaques and tangles. As a term before our terms previously and we're going to take a look at what that looks like shortly here. Now the changes that happen because of the brain cell changes lead to changes in one's memory, their thought processes, their behavior and their reasoning, et cetera. All the other symptoms that tend to come with dementia is because of those changes in the brain cells and also the connections between those. Brain cells that we talked about before. It's like remember that game broken telephone everybody would you know you you'd share the message so one person here. Would give you. The message whispered into your ear and you'd send it to the next person beside. You so it's kind of like the. People in that circle or like brain cells and the message gets passed around right? But if there's a breakdown. Between those brain cells, the message doesn't get through. If the person over here. Tells me the incorrect message I'm going to pass on the incorrect message here. There is breakdown and the communication breaks down and that's what happens with dementia. This is a little image that I've grabbed from the Alzheimer's Association because it does nicely show the umbrella term. The general term of dementia. But it also talks about here. It has a five. I guess it's supposed to be raindrops here, but you can see that the Alzheimer's accounts for 60 to 80% of all dementias. So it is by. Far the most common form of dementia, and that's why we talk about it more than any other. Form vascular dementia and Lewy body dementia account for about 5 to 10% of all dementias. I see much more vascular dementia than I do Lewy body, but they say that the numbers are very similar. Same with frontotemporal dementia, 5 to 10%, and then we have sort of the last drop is a bucket full of all the others, so we have honey. Sentence dementia we have Parkinson's dementia. There are many other ones, and the puddle on the bottom is the mixed dementia that I mentioned earlier. Sometimes people have. Two different forms of dementia at the same time, or they can even have more than that. I'm not very common to have more, but certainly you can have a mixed form of dementia. So that person is going to be. Coping with a. Lot of cognitive changes for sure. One thing I want to point out here with our definition before I give. You a little cookie description. Dementia, as I've mentioned, is an overall term that describes a wide range, a wide variety of symptoms that are in common, and all of this leads to a decline in memory and also other thinking skills and what I've underlined here is that that decline is severe enough. To reduce a person's ability to function on a day to day basis to function on a. Day to day. Basis and just get through their day. We talk about activities of daily living, right? Someone who has a dementia as they progress will have more and more difficulty managing those activities of daily living. Someone who has a decline in memory but is still able to get through the day. OK, they're still able to get bathed and dressed and make themselves a meal. Are they forgetful? Yeah, they've got some memory issues going on there, but they're able to get through their day in their activities of daily. Living that indicates someone who may have mild cognitive. Impairment, and probably a lot of you have heard this term before. MCI, so they do have some of the symptoms, but they're still able to get through data. So that's the difference there. So the cookie description. I love this because I think it makes sense of how to make sense of dementia versus the specific diseases that fall under the umbrella term of dementia. So I call this the cookie description if I was to come to you today and I was to say I have some. Cookies for you. You wouldn't know what kind of cookies I have. You wouldn't know whether they were chocolate chip, chocolate chip, M&M, sugar. Caramel, you don't know what they are. I mean there's hundreds of different kinds of. Cookies right snickerdoodle. Uhm, there's lemon. Drop whatever. There's hundreds of different kinds of cookies. You have no idea. So Cookie is our umbrella term. And then we have all these different types of cookies. I'm going to compare. That to dementia. If I tell. You I have dementia you don't know what kind I. Have I could have Alzheimer's disease? I could have vascular dementia. I could have Parkinson's dementia. I could have Lewy body related dementia, I could have huntingtins. I could have Cruz felt Jakob. There's all different kinds that I could have. And you don't know which one because all I've done. Is given. You a big. Term I've given you the umbrella term of dementia. You need more information to know what kind. Of disease. What kind of specific dementia that person has? So I find when we explain this to anybody that this cookie example has compared to what dementia is to cookies, I think can be helpful for people to kind of figure out what is dementia and what is a specific disease of dementia. So I hope that that's helpful for you and even with family members, many times they know that that dad has dementia. They know he has vascular dementia, but they don't really know how this all fits together and this is a really nice little simple explanation so. I hope that that's helpful too. You all right, so we know that a couple of things happen with dementia. Well, actually many things happen in dementia, but again, we're talking about the overall term, right? Some of these things are shared by all forms of dementia. Some things in common, but we know that dementia is caused by damage to those brain cells. Those neurons up there, and our craniums there. So when the brain cells can't communicate normally, our thinking changes, our behavior changes. Our feelings change in our even our feel. Our interpretation of the world changes as our brain cells are changed. So this is not a full list. It would be a bigger list to go through all of this, but let's take a look at the most common intellectual abilities that are affected by the deterioration of the brain cells memory. We all hear about that. Right especially short term, and then eventually over time we may even see it progress into the long term memory. You may have someone that no longer recognizes their spouse of 71 years. My own parents didn't reckon that my mom didn't recognize me at the end of her. Life, so eventually it gets to that point where they're forgetting things that have been very consistent. Presences in their life, their ability to concentrate is decreased judgment and reasoning, making decisions, planning. People we hear a lot about. Elder abuse right so? People who take advantage of the person who, when they call to the house at 7:00 o'clock at night. Asking for money. This is your grandson grandma. I really need some money right now. Can you send it to me? So those kinds of scams are prevalent. I heard a lot during the first and it was quite still going on, but the COVID scams that were coming out, people calling elderly people and saying if you send in a you know $500. You'll get sure your shot and we'll schedule. Schedule for. That language is changed as well. You may have someone that starts to substitute words that don't make any sense. We talk about word salad as a disease progresses where people are just putting words together and they don't really have any they make. They don't make sense together. Problem solving becomes more difficult for people when they have a dementia of some sort. Behavioral changes there's a lot of discussion these days about behavior management, challenging behaviors, managing behaviors because what people are saying is, you know, this is this is one of the symptoms of dementia. Is changes in our behavior, but what they're trying? They're trying to change the view of this to avoid it being a problematic thing. This is a language I'm seeing change where people are acting in a way that makes sense to them. So if the behavior changes because their perception of the world is modified so much so. As an example. If I was to come into your room tomorrow morning and it is oh dark 100 at 6:00 o'clock. The sun is even up at this hour 6:00 o'clock. And I say to you, Joe. Time to get. Up and I start to take off the sheets of your bed and I lean over and grab your legs and kind of swing your legs to the side of the bed so that you can sit up if somebody did. That tomorrow. What would you do? So I would think that most people would take a swing at me, push me, yell at me, tell me. To get out. Of your house, something like that, right? This can happen with someone with dementia where they think that they're just life as usual right? And all of a sudden there's a caregiver who's in the room waking them up, taking the sheets off, taking their gown off, or whatever it is they're wearing so they can get the bathing thing going on. And should we be surprised if someone takes a swing at us? If they truly don't understand why there is someone in their room, a stranger in their room, and how many times do we have new caregivers come in? To see our. Client, or if they're in a facility, how many times would there be a new person that came in that day? Different shift, different. Person an in there all of a sudden opening blinds and saying it's time to get going and it's time to get washed up so we can go have breakfast and there's all this activity happening. Should we be surprised if someone yells? Should we be surprised if someone pushes away that caregiver? If we were to go into the mind of that person and understand the world from their view, we wouldn't be surprised we would do the same thing. So I think we're trying to I. I see the change that we're trying to say. Let's figure out what's behind that behavior. What emotion is driving that behavior? Is it fear, is it? Anger is it, sadness. What's behind it? So I think that's really fascinating, and I think we need to change how we talk about behavior as opposed to he has challenging behaviors. He is. He is violent. He is all these different terms we use that are very negative, where really what we should be doing perhaps is taking a. Step back and saying. How is it to be in their shoes right now? You know what? What is their perception of their reality? I think that that would be very helpful for all of us. To take a step back and look at. All right, so personality changes, emotional disturbances, the whole brain is affected by dementia over time and we'll take a look at that too. As we progress. Let's hop into Alzheimer's disease because it is the most common form of dementia. It's the one that you're going to bump up against most in the community. Brain cells are not communicating well with each other. This is where the plaques and tangles communication comes in. Plaques and tangles are made up of protein, sticky icky protein, and because that protein is there, the brain cells can't communicate with one another. We know that Alzheimer's disease is progressive. We know that it gets worse over time, it's degenerative, it's irreversible. We know that there are some medications that can help with some of the symptoms, and we're going to have one slide on that, but it is irreversible. It's sort of a one way degenerative decline over time. And people can live a long time right with Alzheimer's disease, but plaques and tangles I'm going to show you a really quick picture here, but plaques and tangles you and I have plaques and tangles in our brain right now. It's a matter of degree, right? So as we age we get more and more of this sticky, icky protein. Are that the protein is around the brain cell? The tangles are inside of the brain cell, so between those two different things the brain cells cannot function normally and they die off. I thought I had a picture. What happened to? My picture I had a beautiful picture I thought. Hmm, I think I moved it so other forms of dementia. Uhm, we've talked about vascular dementia is the second most prevalent form of dementia, and that occurs because of microscopic bleeding and blood vessel blockages in the brain. That is a very good thing to think about in terms of lifestyle, right? So managing hypertension, managing cholesterol and all the different levels that your doctor checks on you because that does have huge implications for all the vessels in your brain. Not to mention two strokes, right? That's related to that microscopic bleeding. Other forms of dementia, dementia with Lewy bodies. This is actually named after Doctor Lewis, not Doctor Lewy body, but Doctor Lewis. He back in the early 1900s was working in the same lab as Doctor Alzheimer, and he found a different protein, so Tao and amyloid was found by Alzheimer Dr. Alzheimer, but doctor Lui. He came up with another protein that is problematic in our brains. Alpha synuclein protein. You don't say that very often. But he found that in the brain it's in the brain. I think normally, just as the Tau and the pots and the tangles are. But it's a matter again of degree. Sometimes you have someone who has the alpha synuclein proteins as well as the. Tau and the amyloid all together. So again you have mixtures of these issues going on. You have mixed dementia as I mentioned before frontotemporal dementia, and this is 1 where the frontal part of your brain, the temporal along the sides, has changes as well. Our frontal lobe is where we do a lot of our language kinds of things are planning our higher thinking like our executive functioning's. I'm going to plan. For retirement in five years that a lot of that brainpower comes from your frontal lobe. We also have some emotional processes going on in our frontal lobe. Also motor abilities. Our ability to walk to move those kinds of things can come from the frontal lobe. So when you think about the implications of having dementia up in this area, right, our emotions are going. To be affected. Our abilities. To plan and have higher executive function through our frontal lobe is going to be affected. Language is going to be affected so it just depends on where these changes are happening in the brain as to how those symptoms are expressed. There's also. Parkinson's disease dementia. I've seen this. Unfortunately, we have had a lot of clients with Parkinson's and it is a very tragic disease because it's not just the physical, it's also the changes in the brain that occur and they have symptoms that are pretty problematic. And it's not just for Parkinson's disease. Dementia, but they can have hallucinations. They can have severe changes with their emotional status delusions. They also had changes with their autonomic systems, so that means the things that you never think about your blood pressure, your breathing, your respiratory rate, your heart rate, your digestive system. We don't tend to think about those things because they occur on a level autonomically with our nervous system. But they have. Challenges in that area as well, so it's not just The Walking or the ability to do smooth movement. It's not just the posture changes with that, it's also all these other cognitive changes as well. And they lose their ability to communicate well, so. It really is a severe. When they live with this disease long enough, it can have some pretty serious implications. And there's more. There's more different forms of dementia. They're not as common, but they're definitely out their top ten warning signs of Alzheimer's disease. You should have this as a handout as well. Memory loss again number one thing that we tend to see right off the top and that is because we'll get into this a little bit, but with the memory loss, especially with Alzheimer's disease, as we're talking about here, this disease process starts in the hippocampus. And this is where short term memory. How is housed is in the hippocampus on either side. Of our brains here, and that's where Alzheimer's disease begins its process. So that's why it's usually the first symptom that we see. So we might forget people's names. We might forget, just sort of a more general things about our day. What we did this morning, what we did yesterday. So it starts with the very immediate kind of short term memory and then it progresses from there. Another warning sign of Alzheimer's. Disease challenges in planning or solving problems. Difficulty completing familiar tasks. This is a really big red flag, right? So if someone is able to normally do all other activities of daily living and now they can't. That is a huge red flag. Confusion with time or place trouble. Understanding visual images or spatial relationships. Some sometimes in hallways there's shadows and so or dark areas on the carpeting. People can have misperceptions of that. They think that the dark part in the carpet. As a whole. If they step on it, they're going to fall into that or the shading, right? The shadows can cause confusion when they're walking down a hall. Maybe an assisted living or something. We're going to be developing problems with words, whether that's speaking words, writing words, reading words. I've seen many times clients progress over time, and they've gone from being a very voracious reader. And now they don't want to read at all. And it's usually related to the. Fact that the words are not making sense anymore. Visually, they're not able to take in the same information as they were before. Or I tell this story about my mom, who usually would read her paper every single morning and just a few days before she died. Actually, she asked for her paper and I've seen this play out in the weeks and months prior, but she would get the paper and either it would stay on the same page for a long time and she would never turn the page. She'd be looking at. It right but. She just nothing would change and at the very end of her life she had her paper and it she had grabbed it but it was upside down. But to her it was you know that physical action and right of reading the paper was all she really wanted, because obviously she couldn't read. It was upset. Down, but it's just that that ingrained habit that she had. So yeah, new problems with words misplacing things and losing the ability to retrace steps. And that gets. Really confusing too. When you have someone that wants to hide something of value. Maybe they're not trusting people who are coming into the house. You know the home health. People or the caregivers? So they want to hide their valuables away and they hide them and they can't remember where they put them. Or they put them in a very strange place, right? We found some very interesting things in freezers and over in the dog food area, etc. So they lose their ability to find those things decreased or poor judgment, and this again leads them right open to scans and people taking advantage of them, withdraw from work, and our social activities. Being out in a work environment. If they're still working or a social environment can be very difficult. For someone who is experiencing these cognitive changes can be overwhelming. Too much to. Handle so they tend to with. Raw and changes in mood change in personality. Again, I think it's really important to put ourselves in the shoes of our clients and to empathize with what they're going through. It goes back to understanding. If you can't make sense of your environment. If you can't make sense. Of all the clues and the cues that. Are going on in your environment. And there will be changes in mood. There will be changes in personality in addition to what is occurring because of brain cell changes. So there's a lot going on for people, and that's a very short list, right? That's just ten of them, and there's many other things that, but those are good. 10 warning signs right off the. Top So what causes Alzheimer's disease? I kind. Of talked a little. Bit about the plaques and tangles. Here, but they are still doing research and I still see things going by me that talk about different things other than plaques and tangles, right? You probably are experiencing. Same thing. So there's a lot of. Research going on there needs to be much more money put into this. The implications of our baby boomers progressing through all these elderly ages is going to be huge. We have to put more money into this. It's just not getting the same kind of money as other diseases are. So there's a lot of reasons why these diseases are occurring. Age being the number one risk factor, but we know that the plaques and tangles are part of this picture in some way, but we don't know for sure exactly why this occurs. Still, after all these years. We likely are dealing with something that is multifactorial, so of course the age process, our genetics, the environment, lifestyle factors are all contributing to the development of Alzheimer's disease. The disease, as I've mentioned, is characterized by an excessive. Buildup of that. Protein, the plaques, and the tangles in the brain. And those buildup. Of plaques and tangles are leading to the brain cells dying. When the brain. Cells die the. The brain literally shrinks and I've got a couple of pictures of that and because of that you're going to have all the symptoms that we talked about. The memory loss. The ability to take care. Of yourself on a day. To day basis etc. So these are blown up pictures. Left side is a plaque. Right side is that angle. This is the protein. That I had mentioned before. Or that causes so much destruction in the brain. The plaques, again, are between the brain cells. This icky sticky protein between the brain cells that angle the amyloid protein. I'm sorry the Tau protein in the tangle is inside the brain cell and between those two, obviously you cannot have the brain cells functioning and communicating with one another. It just can't happen. So let's take. A look just let me check my time here. Normal brain this is a slice of a brain, so if I was to slice my brain from ear to ear like this. And pop open the front of my I guess front. Of my face here. What I'm hoping you would see is a normal brain and you can see that it's the two lobes right going back to your anatomy class here and those two loads are connected and you can actually see the corpus callosum here that connects those two lobes. That is a normal brain full of tissue. There are reams. And reams and reams of connections, uh, connective tissue, right? Brain cells packed in there. There's not a lot of open. Places the next slide I will show you is a picture of a late stage Alzheimer's disease patient and you'll see the difference between. This full brain. And a brain that has a lot. Of open space. Right, so the tissue that we saw in the normal brain is a lot of it is gone. I'm going to go back here. Right, so full. Tissue everywhere brain cells, neurons, all that good stuff in there. And now we have a brain that has a lot of open spaces. A lot of destruction. I talked a moment ago about the brain shrinking, and certainly you can see the brain has shrunk considerably in this slide. I use those two slides a lot with caregivers because and this is also something that can be helpful for family members that are like. Why is Dad acting like this? Why can't he remember what we talked about 20 minutes ago? It's because Dad has a brain that looks somewhere on the continuum between normal and. Pretty severe Dad has a brain like this. If he has Alzheimer's disease right on some on some someplace on that sort of spectrum. You cannot remember what you had for breakfast. You cannot remember how to put your shoes on. You cannot remember where you left your glasses. You cannot remember words you cannot remember. You're your grandchild name. Perhaps when you have a brain that looks like this, you cannot. It's like if I showed you a picture of. Heart and I compared the beautiful young full red shiny beautiful heart right of a young person and then I showed you the heart of a 95 year old who has congestive heart failure. Who has valve leakage? Who has hypertrophy? Where one side? Their heart is large and flabby. It's like that, but because we can't really get our minds around our brain, sometimes it's harder to figure out why someone can't remember why someone can't come up with the words why someone can't. Respond appropriately why someone lashes out at a caregiver at 6:00 o'clock in the morning when the caregiver just wants to get them out of bed. And now they've been labeled as combative and the doctor is going to come in and order some. Meds for that person, right so? It's just a really good reminder. I think the visual part of these kinds of pictures are really, really helpful for anybody who's caring for someone or cares about someone with a disease like this. So again, talking about size and the shrinkage on the left hand. Side we have. A normal brain on the right hand side. We have a brain of an Alzheimer's patient. You can see definitely that there is a huge change in the size of that brain and again brain cells are dying and the connections between brain cells can't function. They're going to be destroyed. As well, the body rids itself of those kinds of things, and you end up with a brain that is shrunken. The brain cross sections here. This is on the left. Of course we have our normal brain on the right. We have an Alzheimer's brain. You see the shrinkage of as you have in the other pictures as well. But one thing I wanted to. Point out here. Is you'll see a box that says memory right? It's got one another side that is the hippocampus that I mentioned earlier. That is a place where Alzheimer's begins that is a place for our short term memory and for us to learn new things we have to have an intact short term memory. Because you have to have that in order for it to be processed and go to the long term memory to retain anything. So hopefully with this class today, you're learning facts and all these kinds of things, learning new things. Hopefully that's going into your short term memory into your hippocampal area. Hopefully you'll think about it. You'll review things. You're going to go online and take a look at a few more things, right? You're going to go to the Alzheimer's Association website and you're going to submit some of that learning. So it goes into. Long term memory. If this area of the hippocampus with short term memory is not intact, you can't make longer term memories, you can't. It won't work. The other thing I wanted to point out. The other box. Is the language center in the in the temporal lobe? There that is another area that is affected greatly towards the beginning of these disease processes. So those two areas, especially with Alzheimer's, are affected significantly even right. Off the top. I'm going to give you. A little brain tour here and just as a little reminder from anatomy class, your brain is composed of three main areas, the cerebrum, the cerebellum and the brainstem. So the cerebrum is the area that we're kind of looking at here today. The largest. Part of the brain that makes up fills up most of your skull, the cerebellum. At the back. There has to do with your balance or coordination, etc. And then your brainstem is the other main area, and that's the area that houses all those things you never think about your breathing, your pulse, your blood pressure, all those things. So we never have to think about that. Because of your brain cells in your brain stem. And this cerebrum, the biggest part of your brain. There is involved in the memory, the problem solving, the language, et cetera. The thinking, the feeling it also controls movements. So think about a. Client who you know has some dementia of some sort and they can't stand to get out of a chair anymore. Sometimes it's not necessarily a physical thing. Sometimes it's actually a cognitive thing where they're not able to process movement anymore, so. That has implications for care as well. So what I'm going to do is I'm going to show you a quick little brain tour. This can be found on the alzheimers.org website and I've used this thing for a lot of years, especially with caregiving caregiver training, et cetera. It's a wonderful website. They've changed it a little bit in terms of the brain tour. But it's still. Good, I liked it better before, but so this is something again for you to possibly if you like to share this with family members or with any caregivers that are taking care of. One of your clients perhaps? We do training with a couple of home care companies, which is wonderful cause we know that their caregivers are getting some good information here. But even if you have a caregiver you're working for suggests that they spend some time on this website. So, so just before I get into the little Tour part, it talks about how the brain is £3.00 and three major parts that we just reviewed there. And down here, if you keep scrolling it takes a look at the blood vessels that make up the brain and it says here when you're thinking hard. Like all of you are right now. Your brain may. Use up to. 50% of the fuel and oxygen that it receives up there, so half. Of all of. The nutrients that head up to your brain when you're thinking hard are being extracted and utilized by your brain that. Is very cool. Sorry I get a little bit geeky about this. So let's take a look. This is the part. I wanted to show you. I mentioned before that as the disease progresses through the brain, you're going to have different symptoms, signs and symptoms developing based on where the changes are occurring with the disease process so. We have mapped the brain so we know what areas of the brain are responsible for what. And this diagram does a really nice job of highlighting what areas of the brain are responsible for what function. So here is. The first one view the specific regions of the cortex, so if you're interpreting sensations from your body. That is being perceived by this area that's highlighted in purple. That area is responsible for interpreting sensations from your body. So let's take an example of this. We know that sometimes people quite often people with a dementia do not like to get into the shower. They don't often like to get in tub sometimes, but let's talk about the shower specifically. That they don't like standing underneath the shower. It hurts them. So for someone who used to love to have long showers, we wonder why this happens and sometimes it may be related to not interpreting sensations the same way anymore. So as opposed to enjoying the Nice sort of massage that comes down from that showerhead. They perceive it as pain because they're interpreting the sensations from the body differently. If I want to put some lotion on someone hands, they may have pain because they have some arthritis, right? Or they may be interpreting sensations differently so as opposed to a nice massage that they. Used to love. Now they want nothing to do with it. So that could be an example or two of misinterpreting sensations, or interpreting them differently. Than they used to. Processing site that comes from the back I mentioned our client who was sent home before he. Was our client. I should say he was sent home on a blood thinner, never should have been so he had a major insult to his occipital lobe. But imagine if the disease process of dementia has progressed to this area. They're not going to see things the same way they might see shadows. They might see people they might see something that causes them to be. Very scared when. Really, it's just a plant in the corner. But they perceive it differently. They physically perceive it differently because of the changes to their brain processing sounds. They're hearing things that you and I don't hear or they're misinterpreting what is normally something that is nice to listen to when they hear that now they process it differently. Our processing smells. Right, they may not smell food the same way, so their appetite changes and we see that quite often. Actually this is the. Frontal lobe where our. Higher thinking occurs, and what we're noticing here is that thoughts, problem solving and planning when the disease process ends up in this lobe. I'm sorry in this lobe in this area of the brain. They're going to have trouble with solving problems with figuring things out on a day to day basis, getting their bills paid. All those kinds of things. Kids are going to be affected. Forming and storing memories. This is the hippocampal area that we've talked about a couple of times here. Today when it progresses to that area and that is as I've said, a couple of times. That's where Alzheimer's disease begins, so we can't form memories. We can't certainly store them. And here we also have controlling of voluntary movement and I mentioned a few minutes ago that sometimes people find it hard to initiate movement or keeping the movement going or stopping movement and that may be because the disease has progressed to this area of the brain where they're no longer able to control volunteering. So that's pretty cool. And if you go further in this little brain tour, it does have some other images. It talks about the neurons that connect, it talks about in the circle. We have an image of what a brain cell would be doing and then we have all the different connection points. The branches that come out from that brain cell. Here, so there is more. It gets a little bit more technical, but certainly I think this website is really, really helpful for people to visualize what's going on. Whether you're a caregiver or a paid caregiver or a loved one. Last couple of things related to the progression of Alzheimer's disease here. Just to reiterate, this is also on the alzheimers.org website, and it shows where Alzheimer's disease begins with the blue, and that again is in the hippocampal area, and it literally spreads throughout the brain, so the one in the bottom. There where it's. Got pretty much blue throughout the whole brain you'd be talking about someone. Who has severe Alzheimer's disease? Some people call it end stage. This would be someone who would be probably Hospice appropriate by that time. Not able to care for themselves. Bedbound those kinds of things. So again, just a picture to show you. How it spreads throughout the brain. So let's talk about importance of early diagnosis and this is important for the client. The patient as well as a loved 1, right? So the earlier we can get people diagnosed, the earlier we can benefit or they can benefit from treatment education of themselves, education of their loved ones of caregivers. So we'll be with them. We want to make sure that we're getting them some support in terms of supporting the cognitive function. So just because someone has been diagnosed doesn't mean we don't do anything about that. We want to get them into. Maybe a program where they can be stimulating their brain on a regular basis. We use cognitive care solutions as an organization who helps to keep people brains active. They get homework that they have to do so. Maintaining cognitive stimulation is really important. There can be support groups and both Alzheimer's. Association Alzheimer's OC have support groups on a regular basis. You probably all have interacted with that kind of situation before preparing documents, getting their Advanced healthcare directive put in place, making sure that all those things have done the will. The trust we have a client right now who waited too long and it, well you're finished here is, you know, more than I do about this. We have to get this paperwork put together even if we have a client who does not have dementia, but they don't have their paperwork done. It's one of the first things that we tell them, or after we do our assessment. It's always in our assessment. Get your paperwork in place. If you don't have it already. Make some decisions about long term care planning, right? You know that as well more than I do. Current medications don't prevent dementia from occurring. They don't stop something like an Alzheimer's from progressing. It doesn't reverse Alzheimer's disease when you have these meds, but it can help to lessen some of the symptoms. Some of the problematic symptoms such as memory loss and function for a limited time and what they've noticed, is that when they give these folks that the medication. That it might help for a while, but then it'll the. The benefits will taper off, and then they'll be at the same level that someone else was along the same trajectory. So it can help temporarily. It can make them higher functioning for a period of time for a shorter, for a short period of time. So we still have a long way to go to get the right meds. On the. There are also non drug options for treating some of the symptoms and I'll get to that in just a minute because I think that it's really important for people quality of life. We don't have any great medications for this. Obviously, we can treat things like the depression. We can treat things like the hallucinations etc. But as we talked about the very beginning. No medication out there doesn't have side effects and when you start layering these things on top, you know that we get into trouble with all these different meds. So diagnosing Alzheimer's disease, initially we want to rule out. Is there anything else going on? Could there be maybe a disease of the brain that is not related to dementia? Maybe there is. A deficiency in the nutrition. Maybe there is a brain tumor, right? Maybe there's depression that is expressing itself as sort of a dementia related kind of thing, so rule out other reasons for what's going on with this person. Of course, running lab work, making sure they're being worked. Up by a neuron. So just many mental status tests can be helpful. PCPS do this sometimes. I am a huge fan of if we're seeing changes, let's get them into a neurologist. We use neuropsychologists a lot for testing, so we run them through brain imaging as well. Is there anything going? Are there bleeds? They're happening up in the brain. They're accounting for some of these changes that we're seeing. But this person CT scans can determine whether maybe there is a tumor there, etc. I wanted to put a plug in here for preparing for appointments. Uhm, it's really good. If you have a client that's having changes, making sure that the caregiver, or whether a paid caregiver, or maybe it's a loved one. Tracking and documenting symptoms over time can be helpful. What kinds of symptoms are we seeing? What happens when, uh? Symptom occurs what happens before right before that symptom occurs. What makes their symptoms worse? What makes their symptoms better? All those kinds of things can be helpful to take along with you to any appointment. Treatments we talked about the meds, right? So there's a few medications, cholinesterase inhibitors. Uh acetylcholine is something that we need for our brain cells to function properly, and that tends to drop. So what we need to do is possibly use something like. An Aricept is probably the most common medication. Underneath this class that we see named A is another one that is used in more moderate to severe cases as they progress. There are no drugs that are specifically approved by the FDA to treat behavioral and psychiatric symptoms. So when you're having doctors prescribing medication for dementia, symptoms like that for psychiatric, more psychiatric related meds and symptoms, they're using it. Off label there really. There are no medications that have been prescribed that have been approved. I should say for treating behavioral and psychiatric symptoms of dementia. So and sometimes it can be effective, right? Sometimes we try them and they're not effective. We tried one recently with a client, made things much worse so. That didn't last long, but you have to try some things to see what works and what doesn't. I think this is a huge issue. I feel very passionate about this that we have to treat the person UM themselves, right? So every person is going to respond differently to their dementia experience, so we have to get to know our client as best we can. Figure out what did they love to do, what gets them up out of bed every morning? What did they use to do? What are their hobbies? You know those kinds of things are really, really important. What are the remaining strengths of this person? Yes, we know that they have deficits, but what are the strengths? Who are they as a? Person and really make it client centered care so we can do meds, but even in my mind a little bit more. Important is to. Tap into who that person is in to promote the strengths. Keep the cognitive things coming. Keep the brain strengthening efforts coming. Maximize the ability of the. Brain as much as possible. Educate the family. Educate the caregivers how to communicate. I sent a form for you compassionate communication techniques for the memory impaired and that's been around for a long time, but that is just a little extra tool of how to communicate with someone with dementia. Sometimes things work, sometimes they don't. Sometimes they work yesterday, but they don't work. Today so we have to be really flexible and really tap into our client as best as possible. Let's see. So things like art therapy, music therapy. Music does wonderful things alive. Inside is a wonderful example of utilizing music with people who were so shut down and didn't communicate at all that came to life when music came to them. So getting to. Know who they are and trying these other therapies, pet therapies, whatever it takes to make that person connect with. Others and with themselves. So developing a very person centered strategy care plan for each and every client making it very personalized know about their life story. Ask them about their life story right? We know about that. I love to see people doing legacy work with their with their loved one. I encourage caregivers to do some legacy. Work doesn't matter if it's accurate all the time, but just, you know, documenting that person and going through the process if they enjoy it right, it has to be very individualized. If they enjoy doing that. The more you know about the clients, the more you can the better you can meet their needs, especially for those with dementia. Sorry, I'm kind of going through a little bit fast here because I realized I'm 5 to 9. So parting thoughts here today I'm. I'm very glad that you folks have stayed with me here. Their state they're saying and doing things. That are normal for a person with dementia. Even the person that is resisting care. I, I hear that a lot. He's resisting care. Well, let's do some. Some thinking about this. Some brainstorming about why he is resisting care. What can we do to create an environment where it's easier for that person to accept care? What's going on for them and that can be very tricky and hard to do, but it's worth doing some problem. Solving over that. We must adapt how we communicate, how we behave. We have to meet them where they are, just as we wouldn't expect someone with severe cardiovascular disease to run up and down the stairs 12 times without being short of breath, we cannot. Anticipate that someone or expect someone with dementia to be able to manage and communicate and have behavior that always makes sense to us. We just can't expect that we have to adapt ourselves. Remember that there's a lot of non pharmacological options. Drugs have their place, but I really encourage people to figure out who that person is and tap into who they are and create a quality of life. Day-to-day moment to moment, that's very special for them and preparation for the future. And again, for all you fiduciaries out there, you know this. Kindness, empathy and patience go a long way and I've heard this. I think it might be on that communication sheet that when you are just about out of your patients, go grab some more patients and a little bit. More on top of that, the patients that you already have, it takes a lot of patience to care. For these Folks, but again, putting yourself in their shoes. Knowing that a large percentage of the time that they are dealing with this disease, they are in a place of fear, and especially as the disease progresses in the world, doesn't make any sense. Them, it's a fearful place, so putting ourselves in those shoes and doing all we can to provide comfort and safety for our clients. So important. Resources as I promised, here are the couple of websites that I've taken most of the information here in this presentation from 2 wonderful organizations. They have helplines that you can call that families can call that caregivers can call. So please make use of them, they would. Love to hear from you. I have a Q&A box here, so if you have any questions. That you want to put in there. Feel free to do that, and as those questions come, I'm going to put up my contact information here for you. And thank you all. I apologize, I got very close to. The 9:00 o'clock hour. Here, but thank you all for coming. This is such an important topic, and there's always so much more to learn. I hope that even though it was a basic class, I hope that it provided you with a little bit of information that you hadn't heard before. It gave you some tips to explain to family members. To caregivers, a little bit more basically about what is dementia? What is Alzheimer's disease? How are they different? But again, you will have your certificate come within seven days, and if you and if you've been here the whole time. And you'll also have. That link to the video here. I'm taping as we go here, so you'll also receive a copy of that. Now open questions. OK well. In that case. Unless I'm not seeing questions here folks, I don't see one question. Well, you would know how to get ahold of. Me through phone. Or through an email. Thank you again for coming here today. Really appreciate your interest in learning more about dementia and how you can best care for your clients it. Means a lot. So take care out there, go for your walk. Go stimulate your brain and eat and have very healthy lunch today. OK, thank you all. Take good care. OK.