Dementia:Why Do They Do That?

How Can I Help? When Do I Need Help?

TeepaSnow.com

1© 2010 Teepa Snow. All rights reserved. Use only with permission. Presentation at Home Instead Senior Care of Sonoma County sponsored Dementia and Alzheimer’s event, March 22, 2010, at the Scottish Rite Masonic Center in Santa Rosa, CA.

REALIZE …

• It Takes TWO to Tango …

or two to tangle…

2

Being ‘right’ doesn’t necessarily translate into a good outcome for both of you

3

It’s the relationship that is MOST critical

NOT the outcome of any one encounter

4

As part of the disease people with dementia ‘tend to’ develop typical patterns of speech, behavior, and routines. These people will also have skills and abilities that are lost while others are retained or preserved. 5

What is it NOT…

NORMAL Aging• Slower to think• Slower to do• Hesitates more• More likely to ‘look

before you leap’• Know the person but

not the name• Pause to find words• Reminded of the past

NOT Normal Aging• Can’t think the same• Can’t do like before• Can’t get started• Can’t seem to move on• Doesn’t think it out at all• Can’t place the person• Words won’t come –

even later• Confused about past

versus now

6

What Could It Be?

• Another medical condition• Medication side-effect• Hearing loss or vision loss• Depression• Acute illness • Severe but unrecognized pain• Other things…

7

Alzheimer’sDisease

•Early - Young Onset•Normal Onset

VascularDementias(Multi-infarct)

Lewy Body Dementia

DEMENTIA

Other Dementias•Genetic syndromes•Metabolic pxs•ETOH related•Drugs/toxin exposure•White matter diseases•Mass effects•Depression(?) or Other Mental conditions•Infections – BBB cross•Parkinson’s

Fronto-Temporal Lobe Dementias

8

Alzheimer’s

• New info lost• Recent memory worse• Problems finding words• Mis-speaks• More impulsive or indecisive• Gets lost• Notice changes over 6 months – 1

year9

Vascular Dementia

• Sudden changes• Picture varies by person• Can have bounce back & bad days• Judgment and behavior ‘not the

same’• Spotty losses• Emotional & energy shifts

10

Lewy Body Dementia

• Movement problems - Falls• Visual Hallucinations• Fine motor problems – hands &

swallowing• Episodes of rigidity & syncopy• Nightmares• Fluctuations in abilities• Drug responses can be extreme &

strange11

Fronto-Temporal Dementias

• Many types• Frontal – impulse and behavior

control loss– Says unexpected, rude, mean, odd things to

others– Dis-inhibited – food, drink, sex, emotions,

actions

• Temporal – language loss– Can’t speak or get words out– Can’t understand what is said, sound fluent

– nonsense words12

What is Dementia?...

It is BOTH • a chemical change in the brain AND• a structural change in the brain

• So…Sometimes they can & sometimes they

can’t

13

PET Scan of 20-Year-Old BrainPET Scan of 80-Year-Old Brain

PET and Aging

ADEAR, 200314

15

Learning & Memory Center

HippocampusBIG CHANGE

16

Understanding Language – BIG CHANGE 17

Hearing Sound – Not Changed 18

Sensory StripMotor Strip

White Matter Connections

BIG CHANGES

Formal Speech & Language

CenterHUGE CHANGES

Automatic SpeechRhythm – Music

ExpletivesPRESERVED

19

Executive Control Center

Emotions Behavior JudgmentReasoning

20

Vision Center – BIG CHANGES21

Positron Emission Tomography (PET) Alzheimer’s Disease Progression vs. Normal Brains

G. Small, UCLA School of Medicine.G. Small, UCLA School of Medicine.

NormalNormalEarly Early Alzheimer’sAlzheimer’s

Late Late Alzheimer’sAlzheimer’s ChildChild

22

So… What is Dementia?

• It changes everything over time• It is NOT something the person can

control• It is NOT always the same for every

person• It is NOT a mental illness• It is real • It is hard at times

23

Dementia can be treated

• With knowledge• With skill building• With commitment• With flexibility• With practice• With support• With compassion

24

How to Get Started…

• Be Honest …• What is Going on NOW?• Get someone to help you look at it• Talk about ‘what is’ …– The GOOD– The BAD– The UGLY!

25

Take Some Time To…

• Figure out WHO you are And• WHO your partner is…

• Similarities & Differences And • Respect Both Partners’ Needs

26

Who Are You?... Your Partner?

• Introvert

• Logical & Reasoning

• Big Picture

• Plan it Out

• Extrovert

• Emotional & Feeling

• Lots of Details

• Just Do It

27

Four Key Building Blocks

• Activities to Relax & Re-energize

• Activities to Feel Productive & Valued

• Activities for Fun & ‘Just Because’

• Activities to Take Care of Yourself28

Its all about BALANCE

• Some of each

• Not too much of any

• Get into a routine & stick to it

• With a little changing up

• And time in between to chill

• Some old, some new

• Some for me, some for you

29

Things that will HELP…

• Build activities• Get active• Socialize• De-Stress• Get enough sleep• Get sleep apnea & depression treated• Control blood pressure & diabetes• Take meds CAREFULLY

30

Some Specifics…

• Help to make new friends – form partnerships• Help keep the old – familiar contacts• Explore & create volunteer opportunities• Use old skills and routines in new ways• ‘Give it a try’ – offer more than once• Start low, go slow… build a little at a time• Consider a support group for talking about

changes• Get away from your partners… some• Build a WHOLE day – 24/7

31

Care Partners…

• Be a partner, not a boss• Be an advocate, build a team• Do with me, not for me or to me…• Learn the ‘SO WHAT?’ philosophy…• Learn to let go not give up• Learn what you are good at, & what

not…• These ideas are for you TOO!

32

Some Key Beliefs & Principles:

• All people need to be needed – nurturing is a critical part of life worth living

• Dementia Steals Away Roles and Responsibilities that Make Us WHO We Are

• Activities can make a critical difference in the health and well-being of people with dementia

IF• Used Appropriately for the degree of

involvement – the ‘Just Right’ Challenge33© 2010 Teepa Snow. All rights reserved. Use only with permission. Presentation at Home Instead Senior Care of Sonoma County

sponsored Dementia and Alzheimer’s event, March 22, 2010, at the Scottish Rite Masonic Center in Santa Rosa, CA.