Mary Guerriero Austrom PhD Wesley P Martin Professor of AD Education Associate Dean for Diversity and Inclusion IUSM Director Outreach and Recruitment Core Indiana Alzheimer Disease Center ID: 697450
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Understanding Aging, Cognitive Impairment and Dementia
Mary
Guerriero
Austrom, PhD
Wesley P Martin Professor of AD Education
Associate Dean for Diversity and Inclusion, IUSM
Director Outreach and Recruitment Core
Indiana Alzheimer Disease CenterSlide2
5/11/2017
All men would live long but no man would be old.Slide3
What is Normal Aging?We all slow down as we age
Reaction time slows
Natural and individual preferenceTakes us longer to remember our phone numberTip of the tongue phenomenonSenses become less acuteWe should still remember what keys are for, who our children and grandchildren areSlide4
5/11/2017
Aging is
not for sissies
Age is the biggest risk factor associated with dementia and Alzheimer’s disease:
65 - 70 years 2 - 5%
70 - 75 years 5 - 10%
75 - 80 years 10 - 20%
80-85% 20 - 40%
85 years+ 40 - 80%Slide5
Alzheimer’s Disease & Age
Figure from the Alzheimer’s Disease Facts and Figures.
Alzheimer’s & Dementia 2016;12(4). Hebert et al. Alzheimer Dis Assoc Disord 2001;15(4):169–73..Slide6
5/11/2017
What can be done?
Better treatments and prevention strategies
Delaying onset of AD by 5 years could reduce prevalence by 50
% over 50 years
Many clinical drug studies are going on now
> 100 AD studies seeking participants:
www.clinicaltrials.gov
;
http://www.alz.org/trialmatch
There is a shortage of study volunteers
Slows down researchSlide7
Alzheimer Centennial 2006
Alois
Alzheimer presented first case at small medical meeting in Germany51-year-old Auguste D. had profound memory loss, confusion, difficulty expressing herself, unfounded suspicions about husband and hospital staffOn autopsy, saw plaques and tangles, cortical shrinkage, vascular changesSlide8
Dementia
Impaired Function in Activities
Decline from Prior FunctionCognitive and Behavioral Problems (at least in Domains)Recall/MemoryReasoning, Handling complex tasks, and JudgmentVisuospatial Abilities
Language Functions (speaking, reading, writing)
Changes in Personality and Behavior
McKhann
et al.
Alzheimers
Dementia. 2011;7(3):263–9
.Slide9
Brain Atrophy in ADSlide10
5/11/2017
9Slide11
5/11/2017
Mild Cognitive
Impairment
Self-reported impairment, preferably corroborated by informant
Problems in one or more core cognitive domains on mental status exam or neuropsychological testing (e.g., paragraph recall)
Primary memory complaint =
“
amnestic SCC
”
Generally intact cognition and daily function
Increased risk, but
not certainty
,
of progressing to AD or another dementia, especially with amnesticSlide12
10 Warning Signs of Alzheimer’s disease
Memory loss that disrupts daily life
Challenges in planning or solving problemsDifficulty completing familiar tasksConfusion with time or placeTrouble understanding visual images and spatial relationshipsNew problems with words in speaking and writingMisplacing things and losing the ability to retrace stepsDecreased or poor judgmentWithdrawal from work or social activitiesChanges in mood and personalitySlide13
5/11/2017
0
5
10
15
20
25
30
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
5.5
6
6.5
7
7.5
8
8.5
9
Years
MMSE score
Early Diagnosis Mild-Moderate Severe
Cognitive Symptoms
Loss of ADLs
Behavioral Problems
Nursing Home Placement
Death
Feldman H,
Gracon
S. In: Clinical Diagnosis and Management of Alzheimer
’
s Disease. 1996, 239-253
.
Progression of ADSlide14
5/11/2017
Progression of the Disease
Mild Moderate Severe
Memory loss
Language
problems
Mood swings
Personality
changes
Diminished
judgment
Behavioral, personality
changes
Unable to learn/recall
new info
Long-term memory affected
Wandering, agitation,
aggression,
confusion
Require assistance w/ADL
Gait, incontinence,
motor
disturbances
Bedridden
Unable to perform
ADL
Placement in
long-term care
needed
Dementia/Alzheimer’s disease
Stage
Symptoms
SCC
DepressionSlide15
Common Ethical Issues in Working with Older Adults
Preservation of autonomy
Decision making capacitySurrogate decision makingIntensity of treatment/trial Quality of lifeSlide16
Mental Incapacity
= Clinical Judgment
Mental Incompetence
= Judicial DeterminationSlide17
Capacity
The ability to understand information relevant to a decision and appreciate the consequences of a particular decision or lack of decision.Slide18
Assessment of Decision Making Capacity
No set protocol
No diagnosis is automatically exclusionaryNeeds to be decision specificSlide19
Decision Making Capacity
Increased risk of unfairly being considered mentally incapacitated due to sensory impairments, slow cognition and diminished memory
Increasing numbers of older adults will consider the possibility of refusing life sustaining treatmentsPearlman RA Geriatric Medicine, 3rd Ed. p201Slide20
Default Surrogate Status—IC 16-35-1-15
Spouse
Adult childParentAdult siblingIn IN this is not a hierarchy but a committeeSlide21
Decision Making Capacity
Capacity should be based on the
specific decision rather than an all-or-nothing determinationPerson may be able to rationally make some decisions but not othersRecognize that there may be subjective interpretation involved
High DM
Clinics in Geriatric Medicine,10(3)
p448
.Slide22
State of IndianaSecurities Division
Effective July 1, 2016, Broker-Dealers will have additional tools to fight the growing and troubling trend of the financial exploitation of seniors.
A new section added to the Indiana Uniform Securities Act at Ind. Code § 23-19-4.1 provides mechanism for Broker-Dealers to not only report suspected financial exploitation, but also to temporarily hold a disbursement if there is a reasonable belief of exploitation.Slide23
How to Report
If a qualified individual at a Broker-Dealer has reason to believe that financial exploitation of a
financially endangered adult has occurred, has been attempted, or is being attempted, the qualified individual shall:A. Contact the Indiana Securities Division [317.232.6681]B. Contact Indiana Adult Protective Services [800.992.6978]Slide24
Cure versus Treatment
A distinction must be made between
curable and treatable. While AD is not yet curable, its symptoms are treatable.Slide25
Recognize when person’s stress levels are rising
Identify and avoid triggers of distress
Tell the person what is happening and why?
Identify worry that triggers underlying repetitive question.
Address worry
Caregiver “Do’s” for Persons with Dementia
O’Connor,
Rabins
,
Swanick
et al. “Module -5 Non-Pharmacologic Treatments for BPSD” 2011 International Psychogeriatric Association. Slide26
Do avoid arguments
Do attempt to redirect patient to a different topic.
Do diffuse situation by changing activity, topic, or tempo when episode of distress occurs
Do tell a little white lie, if all else fails, e.g., “Your car is in the shop.”
O’Connor,
Rabins
,
Swanick
et al. “Module -5 Non-Pharmacologic Treatments for BPSD” 2011 International Psychogeriatric Association.
Caregiver “Do’s” for Persons with DementiaSlide27
Do not:
Nag
Repeat demands of resident (when not capable).
Ignore the resident
Use punishment
Engage in power struggles
Withhold privileges
Show annoyance, frustration or anger
Be disrespectful of resident.
Caregiver “Don’ts” for Persons with Dementia
O’Connor,
Rabins
,
Swanick
et al. “Module -5 Non-Pharmacologic Treatments for BPSD” 2011 International Psychogeriatric Association. Slide28
Any questions?
Thank you for listening and for helping others.