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Dementia – Depression - Delirium Understand the relationship

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					   Dementia – Depression -
          Delirium
Understand the relationship, Recognize the signs and
                     symptoms



       Dementia Care Training Centre - 2007
     No More Business as Usual
1.   Dementia Care Training Centre
2.   Guiding principles
3.   Sharing our story
4.   Outcomes
5.   Lessons learned
Dementia Care Training Centre
 A core business of Alzheimer Society of
 Calgary
 Includes staff training and family education

Guiding Principles
Person-centred
Outcomes driven
Supporting Excellence in Dementia Care
What was happening in Calgary

More than 10,000 people diagnosed with
Alzheimer’s disease
Limited recognition of delirium among
direct care providers
Cognitive Impairment Strategy
National Guidelines for Seniors Mental
Health
Alzheimer Society Responsibility

 “No one in a better position than the Alzheimer
  Society to educate staff and families about the
              importance of delirium”



“Staff need to recognize the symptoms, who and
           how to report what they see”
            Sharing Our Story
Workshop Learning Objectives

  To understand the terms dementia, depression & delirium

  To recognize the signs and symptoms of dementia,
  depression and delirium

  To appreciate the difficulty of co-existence and
  interrelations of the dementia, depression, delirium

  To understand the diagnostic process

  To appreciate a person-centred approach to care
         Workshop Outline
The Marvellous Healthy Brain
Causes of Cognitive Impairment
Functions & Damages of the Brain
Irreversible Types of Dementia
Reversible Causes of Dementia
Depression & Delirium
Understanding the Distinctions
The Diagnostic Process
Person-Centered Care
 The Healthy Brain - Introduction
The brain weighs approx. 3 lbs. – 7 cups
 Structural & Functional Organization

 The brain consists of brain cells
 (neurons) that connect to each other
 through their axons, dendrites and
 synaptic connections.
 Neural networks: 1012 (100 billion)
 neurons has on average 7k-10k
 connections (total 1000 trillion).

      another SENSATIONal fact:
  “the little man”        Homunculus
Causes of Cognitive Impairment

     developmental disabilities
            brain injury
     mild cognitive impairment
             dementia


     What is Dementia?
Areas of the Brain
      Structure & Functions




Limbic System
Non-Reversible Types of Dementia

                          Others:
    Alzheimer’s disease    Parkinson’s Disease
                           Huntington’s
                           Disease
    Vascular Dementia
                           Creutzfeldt Jakob
                           Disease
    Dementia with Lewy
                           Progressive
    bodies                 Supranuclear Palsy
                           Korsakoff’s
    Fronto-Temporal        Syndrome
    Dementia               Infection-Related
                           Dementia (HIV,
                           Syphilis)
Reversible Causes of Dementia

Malnutrition
Dehydration
Metabolic Dysfunction
Vitamin B12 Deficiency
Depression
Delirium
             Depression
                     Signs & Symptoms:
Sad or depressed most of the time (mood)
“emptiness”
Feelings of anxiety (various forms) and
psychomotor agitation
Changing appetite and weight loss/gain
Sleep Disturbances
Loss of interest/Lack of motivation
Concentration or Memory problems
Social Withdrawal
Thoughts of death/Suicidal Risk
Depression in the Elder Population
 Common atypical features :
 Psychotic features (paranoid
 delusions)
 Somatization
 The “dwindles” (*)
 Potential Issues:
 Suicide risk is high              Vincent van Gogh, who himself
                                   suffered from depression and
                                   committed suicide, painted this
 Depression is an unusual sole     picture in 1890 of a man that can
                                   symbolize the desperation and
 cause of cognitive impairment     hopelessness felt in depression.


 Depression often co-exists with
 dementia
Delirium – Core Features (DSM-IV)
Disturbance in consciousness (i.e., reduced
clarity of awareness of the environment) with
reduced ability to focus, sustain, or shift attention;
A change in cognition (i.e., memory deficit,
disorientation, language disturbance) or the
development of a perceptual disturbance that is not
better accounted for by a preexisting, established,
or evolving dementia; and
The disturbance develops over a short period of
time (usually hours to days) and tends to fluctuate
during the course of the day.
Delirium can occur as a consequence of

A general medical condition
Substance intoxication
Substance withdrawal
Multiple causes

Often arises as an interplay of predisposing and
precipitating factors.

  Furthermore:
  In general, the greater the vulnerability of the
  person, the higher the likelihood of delirium
  occurring.
  It is not always possible to firmly establish the
  specific etiology of the delirium in an older person.
   Comparison of the Clinical Features
 Dementia             Depression                Delirium

 Insidious/slow and   Coincides with major      Sudden/abrupt;
often unrecognized;    life changes; often   depends on cause;
 depends on cause      abrupt, but can be    often at twilight or in
                              gradual              darkness


                Clinical Features:   ONSET

   COURSE, PROGRESSION, ATTENTION,
          MEMORY, THINKING
Principles of Person Centred Care

Uniqueness

Complexity

Enabling

Personhood

Value of others
             Outcomes
 40 people trained
 3 workshops to date
 Participants: acute care, long-term care,
developmental disabilities, adult day
support, independent seniors residences,
seniors community resources, Calgary and
Edmonton health region
                           I have an understanding of the term dementia…
                                               (N=15)

100%


90%



80%


                                                               69%
70%                                                                                67%


60%


                                                                                            PRIOR
50%
                                                                                            AFTER


40%
                                                                     33%

30%
                                                                             25%


20%



10%                          6%

           0%   0%                0%         0%    0%
 0%
       Strongly Disagree     Disagree   No Opinion - Neutral    Agree      Strongly Agree

                                           Agreement
                           I understand the various consequences of dementia…
                                                  (N=15)

100%


90%



80%


70%
                                                                  63%
                                                                                      60%
60%


                                                                                               PRIOR
50%
                                                                                               AFTER
                                                                        40%
40%



30%


                                                                                19%
20%
                                               13%

10%                             6%

           0%   0%                   0%               0%
 0%
       Strongly Disagree        Disagree   No Opinion - Neutral    Agree      Strongly Agree

                                             Agreement
           I understand the relationship between dementia, depression and dleirium…
                                             (N=15)

100%


90%



80%


70%

                                                                   60%
60%


                                                                                          PRIOR
50%
                                                                                          AFTER
                                                             40%                 40%
40%



30%                        27%


20%
                                          13%                              13%

10%        7%

                0%               0%              0%
 0%
       Strongly Disagree   Disagree   No Opinion - Neutral    Agree      Strongly Agree

                                        Agreement
         Lessons Learned
 Direct care providers across the care continuum
recognize their need to learn more about
dementia, depression and delirium and reporting
requirements
 Family members are beginning to recognize the
importance of understanding the relationship
between dementia, depression and delirium
The Alzheimer Society plays a key role in
educating and supporting staff and families
about delirium
         Thank you!
If you have any questions or comments,
          please contact us at

         Telephone: 290-0110
  Email: info@alzheimercalgary.com

         or have a look at our website:
     www. AlzheimerCalgary.com

				
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