Copywrite - Eric Freitag, Psy.D., 2012

Transcription

1 Diagnosis, Intervention and Care for Patients With Cognitive Impairment Eric J. Freitag, Psy.D, FACPN Diplomate, American College of Professional Neuropsychology Mt. Diablo Memory Center Founder/Executive Director

2 The topics presented today are for informational use only. This presentation is not meant to diagnose or treat any medical condition. As always, if you have specific medical concerns, it is best to contact your physician.

3 Dementia Diagnosis Differential Diagnosis Alzheimer s, Vascular Dementia Challenging Behaviors Associated with Dementia Treatment Options and Interventions

4 Progressive decline in memory and 1 2 areas of cognitive function Must cause impairment or dysfunction in everyday life 70 + different types of dementias Alzheimer s 50 70% of all cases Differing prognosis and course

5 Age 65 = > 13% with a >2% increase per year of life Age 85 = >50% Risk Factors Age Genes Vascular Health Lifestyle (e.g. diet, exposure to toxins) Previous history of head injuries

6 Latency Period Mild Cognitive Impairment AD Latency Period Vascular Cognitive Decline VaD

7 Alois Alzheimer 1906 pt. Auguste Deter Autopsy discovered cerebral atrophy, plaques and neurofibrillary tangles First diagnosis of pre senile dementia or Alzheimer s

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9 1. Memory loss that disrupts life 2. Difficulties in planning & problem solving 3. Difficulty completing familiar tasks 4. Disorientation to time or place 5. Difficulty in visual or spatial perception

10 6. Difficulty in finding words or expression 7. Misplacing things and can t retrace steps 8. Decreased or poor judgment 9. Withdrawing from social activities 10. Changes in mood or personality

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12 History of progressive decline Clinical triad on neuropsychological testing 1. Deficits in learning new information/memory Impaired storage capacity 2. Impaired naming and semantic fluency 3. Impaired Visual spatial capacity

13 Possible Diagnosis Clinical information consistent with symptoms and history Probable Diagnosis Additional objective clinical evidence (e.g. neuropsychological testing, brain scan, lab data) Definitive Diagnosis On biopsy or autopsy

14 Decline in memory function similar to AD No other areas of decline Controversies in diagnosis and prognosis Latency Period Mild Cognitive Impairment AD

15 Hemorrhagic Stroke (20%) Thrombotic Stroke (80%) BLOOD VESSEL BRAIN CELL

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17 Know the Signs 1. Numbness or weakness of the face, arm, leg. Often unilateral 2. Sudden confusion 3. Trouble speaking or understanding 4. Dizziness 5. Loss of Balance or coordination 6. Severe Headache

18 Transient Ischemic Attack Brief occlusion of vessel by clot Neurological symptoms subside within hours Silent Strokes Chronic white matter lesions Caused by vascular health risk factors Hypertension High Cholesterol Diabetes II Heart Disease

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20 Behavioral Symptoms Memory difficulties similar to AD Storage is less effected Greater Deficits in Executive Function Slowed Speed of processing Decline is often stepwise

21 Latency Period Mild Cognitive Impairment AD Latency Period Vascular Cognitive Decline VaD

22 1. Proper Diagnosis Prognosis Determine stage of decline Provide patient and family with plan for care and support

23 Early Diagnosis = Better outcome of interventions and treatment Primary care not appropriate for differential diagnosis, especially in early stage Brain Scans provide useful info on structure but not function Most sensitive = Comprehensive neuropsychological evaluation in conjunction with medical data

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25 1. Rx Therapeutics Cholinesterace Inhibitor Mementine Psychotropics (depression, agitation) Sleep Aides 2. Dietary Supplements? Omega 3 Coenzyme Q 10 Resveratrol Curcumin Diet rich in antioxidants*

26 3. Improving Vascular Health Medical care Heart Healthy Diet* Heart Healthy lifestyle 4. Lifestyle Interventions Safety* Health * Welfare*

27 Anosognosia Clinical symptom Most common in AD Is a safety concern Intervention? Realize it is a gift Don t confront Defensiveness/Denial

28 Driving When should driving stop? How to take the keys away? Sometimes families have to be creative Resources AAA Private driver assessment DMV Hartford Insurance Handout (available here) John Muir OT Adaptive Driving Eval

29 Wandering Supervision* Door alarms Provide supervised exercise and opportunities to wander* Home Safety* Unwelcomed Visitors Stove Water Fall risk Medication Compliance*

30 Nutrition* Will affect cognitive function Physical Activity and exercise* Managing stress and depression* Updated labs to rule out other medical diagnosis that may contribute to cognitive decline

31 Family education* Manage expectations Utilizing community resources Get family on same page Learn the language of dementia Family intervention Facilitate education Understanding of impairments

32 6 R s of Dealing with Challenging Behaviors 1. Restrict 2. Reassess 3. Reconsider 4. Rechannel 5. Reassure 6. Review

33 Cause Sundowning Disruption in circadian rhythm Misperception in low light Confusion between dream and awake state Fatigue/exhaustion Intervention Increase daytime stimulation Limit daytime naps Increase daytime light

34 Sundowning Medical Intervention Stimulants during daytime Sedative at night Melatonin supplement?

35 Agitation/Aggression Recognize that it is a response to environment that has ceased to make sense Analyze the behavior ABC Antecedent Behavior Consequence Based on behavior analysis, adjust environment as needed and as possible Solution of last resort= sedative based Rx

36 At what age is our brain fully developed? At what age do we start to lose brain volume and decrease in brain capacity? What is the lesson? Because after all..

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