20160513 ADUL ULT C T COGNITION & GNITION & DEMENTIAS - - PDF document

2016‐05‐13 North Shore Stress & Anxiety Clinic (nssac.ca) 1

ADUL ULT C T COGNITION & GNITION & DEMENTIAS NTIAS

D R D R S S A R A H G R G R E E R , R . P S Y C H P R A P R A C T I C E I N C E I N C L I N I C A L A N D C L I N I C A L A N D N E U R N E U R O P S O P S Y C H O L C H O L O G O G Y N O R N O R T H S H O R E H S H O R E S T R E S S & R E S S & A N X I E T A N X I E T Y C L I N I C Y C L I N I C

COGNITIVE CHANGES AND DEMENTIAS

• What would you like to know?
• What questions do you have about aging & the

brain? About dementia?

AIMS OF TODAY’S SESSION

To thin think about about what what kin kinds of

• f cogn

cognitive change changes we can can expe perience ce as as we gr grow older

• lder, bo

both with without and with and with a a deme dementi ntia. . To tal talk about the cau about the causes of

• f dement

dementia ia and ho and how w deme dementi ntia can af can affect ct the the bra brain, and ho and how w psy psycho hologists are are in involved in the diagnos in the diagnostic ic pr process. To under derstand ho nd how ha having ving de dementia mentia ca can a affect a a person’s b

• n’s beha

haviour viour. Thin Think abou about ho how w peop people with with deme dementia can can best best be be supp supported.

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HO HOW DOES THE DOES THE BRAIN CHANGE BRAIN CHANGE AS AS WE WE GR GROW OLDER OLDER?

Some s small I ll IQ c changes, b s, but ov

• verall m

all minimal d mal decline. ine. Some Some chang changes are are norm normal al! F For e r exam ample:

• We are relatively slower in our thinking.
• We are relatively more forgetful. Changes can occur in

both our visual and verbal memory.

• Changes can occur in several areas of cognition:

executive skills (planning, organising, prioritising), visuo-spatial skills, and language fluency.

• Some d

me degree o gree of ch change is ange is acceptable! acceptable!

• However, some c

me changes anges a are cons nsidered be idered beyond nd the “ “normal” ra

• rmal” range f

e for t r the g general p neral population. pulation.

• “Si

“Signi nifi ficant cha change ges” s” are are thos those that that are are mea measured as bein as being g statistically tically differen erent f t from th

• m the

nor normal al pop popula lation.

CHANG CHANGING BRAINS NG BRAINS IN IN OLDE OLDER ADUL R ADULTS TS

WHAT IS A DEMENTIA?

Gr Group e exer ercise:

• Turn to the people around you and think

about what you think dementia is/definition

• f dementia.
• How does it affect people?

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Dement mentia i ia is an umbrel brella t la term. I

• rm. It d

describes scribes t the symptoms c caused w used when th en the bra brain i n is a affect cted b ed by specif ecific d ic diseases a seases and condit nditio ions. ns.

The f The follo llowing area areas can be can be af affected:

• Memo

Memory

• Cognition

ition

• Lang

Langua uage ge

• Beha

Behavi viour

• ur
• Emoti

Emotions ns

WHA WHAT IS DEMENT IS DEMENTIA? TY TYPES O OF DEMENTIA

There a ere are m many d different ty erent types o

• f d

dementia, mentia, incl including: Alzhe Alzheimer’ r’s Dise Disease Vascular d scular disease sease Dem Dement ntia of the mix

• f the mixed

d type type Dem Dement ntia with le with lewy wy bodi bodies Fronto-t

• tem

empo pora ral d l dementia mentia A FEW FACTS…

• Dementi

ntia is is most comm most common in older in older adults adults; ; ho however it r it can af can affect ct indivi individual als of

• f an

any age (McLe y age (McLennon, n, 1 1999) 999).

• Alzhe

Alzheimer’s Dis Disease is is the most the most commo common n type type of

• f

de dementia mentia (W (Wilson ilson et et al., 20 2011). ).

• 747,00

000 C 0 Canadians a ans are living w ng with A Alzheimer's eimer's Disease a ase and d dement ntia, , with t this n number mber expected t ed to in incre crease t to 1.4 milli 4 million

• n in

in less less than 20 than 20 year ars (Alzheimer’s S heimer’s Society o ety of Canada). ).

• Gr

Growing e evide idence ce sugg suggests that that brai brain chang changes resulting i sulting in d dementia c ntia can b begin 2 n 25 years s before sym symptoms appe appear.

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THE BRAIN THE BRAIN & & DEMENT DEMENTIA IA

• A lo

lot t of the

• f the b

brain is in is involved in the in the re retention n and d re retrie trieval of l of memorie memories.

• The hipp

The hippocampus regi region is is sign significant in in proces essin sing a and enabling u ng us to s store e memori ries es (the (the “sa “save butt button”) ”).

• Brai

Brain scans (e.g. CT n scans (e.g. CT, fMR , fMRI or

• r PET

PET) f for r peop people le dia diagno nosed w with th Alz Alzheimer's d mer's disease sease usually lly sho shows e evid idence of

• f da

damage in/ in/deterioration in in thi this region region, as as well as as possible possible o

• vera

erall shrin ll shrinkag age (atr (atrop

• phy).
• Occipital—visual

information (visual cortex)

• Parietal—information

about touch (sensory cortex),

• Temporal—hearing

(auditory cortex), language (Wernicke’s area),

• Frontal—planning,

judgment, memory, reasoning, abstract thinking, movement (motor cortex)

Cerebral Lobes

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In the Alzheimer's brain:

• The cortex shrinks, leading to

damage in areas involved in thinking, planning and remembering.

• Shrinkage is especially

severe in the hippocampus, an area of the cortex that plays a key role in formation

• f new memories.
• Ventricles (fluid-filled spaces

within the brain) grow larger.

14

UNDERST DERSTAND NDING THE ING THE TYPES O PES OF DEMENT DEMENTIA IA

Alzheimer’s D eimer’s Disease ase – chemistry and structure of the brain changes leading to the death of brain cells. Plaques & tangles (amyloid plaques and neurofibrillary tangles) accumulate; impairs communication between cells. Vascu scular Disea Disease – – associated with problems of circulation of

• xygenated blood to the brain leading to death of brain cells.

Dem Dementia wi with Lewy wy Bod Bodies – – deposits of protein cause brain cells to die. Fr Fronto-temporal D Dementia – damage to brain cells is usually focused on the front side of the brain.

ALZHEIMER’S DISEASE (HIPPOCAMPAL ATROPHY)

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ALZHEIMER’S DISEASE (GLOBAL ATROPHY)

PLAQUES & TANGLES CT SCAN OF VASCULAR DEMENTIA

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MRI SCAN OF FRONTO-TEMPORAL DEMENTIA

THOUG THOUGHT EXER T EXERCI CISE SE

You have gone on holiday with a group of friends to a foreign

• country. You go on a coach trip the morning of the day you are

due to fly home. Whilst you are there, you lose your friends and miss the coach back to the hotel. You cannot remember the name of the hotel. You realize that your passport is at the hotel. You realize that you do not have any money. You don’t know the language, and you can’t find anyone who speaks English. You look at y u look at your w ur watc tch and y h and you real u realize that that y you u ar are going e going t to miss miss y your flig flight home. ht home.

• Wh

What do do y you thin think?

• How

How do do you f you feel? eel?

• Wh

What do do you do you do?

Easier to remember things from a long time ago Harder to grasp new ideas Feeling uneasy in new surroundings Forgetting things you have either said or done Difficulties finding words or using the right words (expressive dysphasia) Struggling to make sense of what people have said (receptive dysphasia) Difficulties reading Struggling to make plans, decisions or solve problems Poor concentration/distractible And many more…

HO HOW ARE W ARE MEMOR MEMORY CHANGES CHANGES EXPERIENCED? EXPERIENCED?

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Some or Some or all of all of these can these can be be expe perienced: d:

• Anxiety
• Tearfulness
• Frustration and irritation
• Anger
• Happiness
• Feeling “blank”
• Difficulty in understanding others’ emotions and

expressing own emotions

EMO EMOTIONA IONAL CHANG L CHANGES

Angry Behaviour Walking Incontinence Disorientation Noisy Repetition Agitation /Apathy Hallucinations Delusions Hiding & Losing

BEHA BEHAVIOU VIOURAL CHANGES WITH DEMENT RAL CHANGES WITH DEMENTIA IA

DISPELLING MYTHS

Vi Vitami tamins ns s supplements a pplements and m memo mory bo boos

• sters

rs can p prevent d ent dement mentia? ia? Sudo Sudoku or

• r brai

brain n traini training (e. (e.g. L Lumosity) can can pre prevent dem dement ntia? Taki king a ng aspirin m rin might h ght help? Heal alth thy l lifestyle? style? E Exer ercise? cise? Fami mily hist history mean y means s I’ll de I’ll develop p Alzhe Alzheimers? rs?

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RISKS FOR DEVELOPING DEMENTIA

Definit nite r risks: sks:

• Smo

Smoking

• Excessiv

ssive d drinking king

• Histor
• ry o

y of card rdio iovascular r vascular risks sks

• Mild c

cognitiv itive i e impair irment ment Ov Over erall mess messag age: Sta Staying g healt healthy and activ and active lat later in in lif life can help t can help to red reduce ce your ur ris risks s of

• f demen

dementia ia, but the but there are also are also gene genetic c contributions. ributions.

MEMORY: 3 BASIC STAGES

• Encoding: New information coming in
• Storage: Storing new information
• Retrieval: Finding stored information

THE PROCESS OF REMEMBERING

Bef Before re the pr the process can e can even en star start, we need t need to pa pay y att attention (t (to what

• what w

we see, see, hear hear, read read) RECEIVIN RECEIVING Information coming in

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THE PROCESS OF REMEMBERING

St Step ep 1: 1: ENC ENCODING NG

Short term memory Information coming in

THE PROCESS OF REMEMBERING

St Step ep 2: 2: STORAGE

Long term memory (encoded) Forgotten

Information coming in

Short term memory

THE PROCESS OF REMEMBERING

Step 3: 3: RETRIEV TRIEVAL

Long term memory (coded)

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Hundreds of new memories enter the brain every day & form new ideas:

 Places you’ve put things, e.g. keys, cell phone, etc!  Facts you’ve learned  New names/face of people you’ve met  Things that happen

TYPES OF MEMORY

Semantic Memory

Facts and figures learnt through education

TYPES OF MEMORY

Personal experiences Holidays Internal Diary - Keeping track of life events

Episodic Memory

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Memories for skills such as riding a bike or swimming

Procedural Memory

TYPE PES OF MEMOR S OF MEMORY TYPES OF MEMORY

Prospective Memory

For things to be done Appointments, switching oven off THE MEMORY: HOW CAN WE TEST IT?

• Psycho

holog logists are sts are o

• ften e

n emplo ployed t ed to p perform

• rm

neurops

• psych

cholo

• logical as

ical assessm sessments t ents to ai aid i in th the e diagno nostic p stic process

• cess.
• Memo

mory t testing i sting is a key c y component w ent within a in a neurops

• psycholo

chological a ical assessm sessment ent for d r dementia. mentia.

• Nor

Norms are base s are based on age d on age, gen gender, le level of

• f

education, a ucation, and s d some metimes o times occupation i ccupation is also so

• considered. (i
• nsidered. (i.e. “

. “demo emographic I raphic IQ)

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HOW DO PSYCHOLOGISTS IDENTIFY A DEMENTIA?

Full b ll back ckgr grou

• und

nd hi histor

• ry:

y:

• Age, gender, alcohol intake, smoking, hobbies,

employment (previous career), level of education, languages, cultural background, medical history, etc!

• History and nature of identified problems; can include

patient and/or family and/or caregivers Neur uropsy

• psychologic
• logical

al a assessment/t ssment/test sting ing

• Possible f

ible follo llow-up up testing ing ( (e.g .g. in . in 1 year’s t ’s time to com compare again against basel baseline) HOW CAN WE CARE AND SUPPORT INDIVIDUALS WITH DEMENTIA? Dementia m mentia medication: e tion: e.g. A Aric icept, ept, may impr prove e sym sympt ptom

• ms bu

but cu t curre rrent ntly ly n no cu cure Other her medica medicati tions

• ns: help

help w with th sleepi sleeping ng / / an anxi xiety / / blood blood pressure / essure / cholest esterol l Diag agno nosis & & edu education n for indi indivi vidua dual, f , fami mily and/o and/or care rers rs Information, e rmation, education ation and suppor pport Socia Social supp support in the commun in the community Practical s actical suppor pport (e.g. ca . care in in the ho home, “lif , “lifeline”, et eline”, etc.) c.) Psychologic logical s l suppor

• rt (

t (e.g. . adjustment stment t to diagnosis, nosis, coping ng skills, i indivi vidual, c dual, couple & le & fa family t ly therap apy) y)

MEMORY TIPS!

Thi Things y you can do can do

• Diari

Diaries/ s/agendas

• Post-it n

Post-it notes

• Calend

Calendars ars

• No

Notebooks

• Ro

Routines  very ry i import rtant

Ex Extern rnal Ai al Aids ds

Pill bo box re x reminder f inder for m r medicat dication Time Timer/al alarm clo clock

Getting help from

• thers!

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IMPACT VARIES BY INDIVIDUAL

Can depe Can depend on: nd on: Chang Changes t to the the br brain Heal Health and ph and phys ysic ical al f fitness Lif Life st story Pe Personalit ity Ho How lif w life is is for that r that indiv individual and ho and how w othe hers rs tre treat them them To really ly u unde ders rstand some nd someone

• ne, w

we need eed to con consider all all these these f fact ctors.

ALZHEIMER’S SOCIETY OF BC

• Fir

First Link D t Link Dementia H mentia Helpline lpline

• Re

Refe ferrals fo for p post-diagnosis s support

• Re

Regional Re Resource C Centres

• Dementia E

mentia Education W ion Worksh rkshops

• ps
• Suppor

pport G Groups

• ups
• “Minds

“Minds in in Mo Moti tion”: f fitne tness and socia and social pr prog

• gram

in involving light e light exerci cise an and socia d socializing

And d more re! Vi ! Visit h sit http:// ttp://www.a .alzh lzheim imer.ca .ca/en en/b /bc

THA THANK Y YOU! ANY QUES ANY QUESTI TIONS?

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REFERENCES REFERENCES

Alzheimer’s r’s S Soci ciet ety o y of C Canada. . Re Retrieved from http:/ ://www /www.a .alzhe heimer er.ca .ca/en en/A /About- de dement ntia/ ia/Dement ementias/What- as/What-is- s-dement dementia/ ia/Facts- acts-about ut-dementia. ementia. American P Psych ychologi gica cal A Associ ciation ( (1998) 1998). G . Guidelines es for t the ev evaluation

• n o
• f dementia and

age-re relat lated c d cognitiv gnitive de decline

• ine. Am

America ican P Psycho holo logis gist, 5 53(2), 1 1298-1 98-1303. 303. Lezak, M

• M. D. (1995)

1995). . Neur Neurop

• psychol
• logical as

assessment (3 (3rd

rd Ed.). O

. Oxford: O : Oxford U University Press Press. McLennan, , J. (1999) 1999). A . Assessmen ent a and s service r e respon

• nses f

for yo younger ger p people w with deme mentia: A me medical overview. In S.

• S. Co

Cox & & J.

• J. K

Kead ady (Ed.) Yo Younger p people w with deme dementia: Pl Plan anni ning, pract , practice ce and and de development (pp.

• pp. 1

17-3

• 36). L

London: J : Jessica Ki Kingsley Publ Publishers rs. Memory ry A Assessment S Serv rvice, 2 2gether NHS F Foundation T Trust ( (n.d.), The brai brain and and beh behaviour [P [PowerPoint slid slides]. Myer ers, D.

• D. G.
• G. (20

(2013). Psy

• Psychology. M

. Mich chigan: Worth. h. Wilson, R , R.S., W , Weir, D , D.R., , Leurgans, , S.E., E ., Evans, D.A., H , Hebert, L , L.E., L , Langa, K K.M., P , Plassman, , B.L., S ., Small, B B.J., ., & Bennett, D D.A. ( (2011). S . Sources ces o

• f variability i

y in estimates o

• f the

prev evalence alence o

• f Alzhei

eimer’s d r’s disease ase i in the U e United ed S Stat ates.

• es. Alzheimer’s

eimer’s & & Dementia, 7 mentia, 7, 7 , 74- 79. 79.