Alzheimer's Disease and Developmental Disabilities - Minnesota

							     Understanding
 Alzheimer’s Disease and
Developmental Disabilities



               Alzheimer’s Association
               Minnesota – North Dakota
                                             Objectives
        At the end of this session participants will be
        able to:
       Describe Alzheimer’s disease and the disease
        process.
       Explain how Alzheimer’s disease impacts
        people with developmental disabilities.
       Work effectively with people with Alzheimer’s
        disease and developmental disabilities

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      Minnesota-North Dakota 2005
                    What is Alzheimer’s Disease
        A progressive, degenerative, neurological
         disease of the brain

        A steady decline in memory and
         intellectual functioning severe enough to
         interfere with everyday life

        It is not reversible

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      Minnesota-North Dakota 2005
                     Alzheimer’s Disease Rate of
                            Occurrence
       Adults  with developmental
        disabilities, other than Down
        syndrome, similar to the general
        adult population (6% of persons
        age 60 and older)
       Adults with Down syndrome - 25%
        age 40 and older, 65% for adults
        age 60 and older

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      Minnesota-North Dakota 2005
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      Minnesota-North Dakota 2005
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                Causes of Alzheimer’s Disease


             Researchers believe the cause may be
                  the interaction of multiple factors—
                             genetic and environmental




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      Minnesota-North Dakota 2005
                        Risk Factors for Dementia
           Age
           Genes
           Atherosclerosis
           High cholesterol
           Diabetes
           Down syndrome


          Mayo Clinic Guide to Alzheimer’s Disease, Ronald Petersen, MD, PhD, 2006



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      Minnesota-North Dakota 2005
                The Relationship of Alzheimer’s
                 Disease and Down Syndrome

        Consequence of accelerated aging
         process
        Amyloid precursor protein gene on
         chromosome21
        Acetylcholine production is decreased
        Degeneration of the hippocampus


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                                             Warning Signs
      Short term memory loss                           Misplacing things
      Difficulty performing                            Change in mood and
       familiar tasks                                    behavior
      Problems with language                           Change in
                                                         personality
      Disorientation to time
       and place                                        Problems with
                                                         abstract thinking
      Poor and decreased
       judgment                                         Loss of initiative


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      Minnesota-North Dakota 2005
                   Warning Signs for Adults with
                        Down Syndrome

          Changes in activities of daily living
           skills are noted most often
          Seizures may occur in individuals
           who have not had them in the past
          Cognitive changes may be present
           although they may not be apparent



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      Minnesota-North Dakota 2005
                   Warning Signs for Adults with
                        Down Syndrome
      Development of                           Visual retention deficits
       seizures                                 Loss of speech
      Changes in                               Disorientation
       personality
                                                Increase in stereotyped
      Long periods of
       inactivity or apathy                      behavior
                                                Abnormal neurological
      Hyperactive reflexes                      signs
      Loss of activity of
       daily living skills


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      Minnesota-North Dakota 2005
          How is Alzheimer’s Disease Diagnosed?
          There is no single test for the diagnosis
                   of Alzheimer’s Disease
        Complete history and physical
        Mental status exam
        Neurological exam
        Lab work
        CAT scan, MRI, PET scan
        Psychological exams

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           Diagnosing Alzheimer’s Disease in
             Adults with Down Syndrome

         Observe a well-documented progression of
          symptoms.


         Evaluate to determine a baseline level of
          function and repeat assessments to
          establish decline



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      Minnesota-North Dakota 2005
                    Aging Issues that May Mask
                 Alzheimer’s Disease in Adults with
                         Down Syndrome
         Visual and hearing impairments
         Thyroid disorders
         Depression
         Physical health problems
         Medication effects



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                                             Early Stage
             Loss of activity of daily living skills
             Personality changes
             Development of seizures
             Disorientation to time and place
             Easily frustrated
             Apathy or inactivity
             Preference for familiar things
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                                             Middle Stage

             Wandering begins
             Sleep disturbances
             Changes in appetite
             Recognition of self and others
              begins to decline
             Behavioral changes


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                                             Late Stage
    Severe disorientation                           No longer
     to time and place                                recognizes family
                                                      members
    No short term
     memory                                          Inability to survive
                                                      without total care
    Loss of speech
                                                     Death occurs most
    Difficulty walking                               commonly from
    Incontinent                                      pneumonia and
                                                      kidney failure
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                                 Skills Retained with
                                 Alzheimer’s Disease
          Music


          Sense of humor


          Ability to read non-verbal
           language


          Social graces
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         Medications for Cognitive Symptoms
         FDA –approved cholinesterase inhibitors to
         treat mild to moderate Alzheimer’s disease
        Donepezil (Aricept), approved 1996
        Rivastigmine (Exelon), approved in 2000
        Galantamine (Razadyne), approved in 2005




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         Medications for Cognitive Symptoms
         FDA –approved cholinesterase inhibitor to
         treat severe Alzheimer’s disease
        Donepezil (Aricept), approved 2006




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      Minnesota-North Dakota 2005
        Medications for Cognitive Symptoms
         FDA-approved glutamate receptor
         antagonist to treat moderate to severe
         Alzheimer’s disease
        Memantine (Namenda), approved in 2003




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                                Edinburgh Principles
         1. Adopt an operational philosophy that
            promotes quality of life.
         2. Affirm that individual strengths guide
            decision-making
         3. Involve the individual and family in all
            planning and service
         4. Ensure availability of appropriate
            diagnostic and service resources



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                                 Edinburgh Principles
         5.      Plan and provide supports to optimize
                 remaining in the community
         6.      Ensure that people with developmental
                 disabilities have access to the same
                 dementia services provided to others in
                 the population
         7.      Ensure that community planning involves
                 focus on adults with developmental
                 disabilities


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                  Care Management for Adults with
                   Alzheimer’s Disease and Down
                             Syndrome
        Support the individual to feel safe and
         secure
        Emphasize maintaining abilities rather
         than teaching new skills
        Simplify routines and reduce choices
        Use patience and redirection and offer
         supportive care


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      Minnesota-North Dakota 2005
          Alzheimer’s Association Resources

              24/7 Information Helpline: 1-800-272-3900
              Website: www.alz.org/mnnd
              Care Consultation
              Support Groups
              MedicAlert + Safe Return®
              Family and Professional Education
              Advocacy
              Research
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      Minnesota-North Dakota 2005
                                             References
            ―Alzheimer’s Disease and People with Mental Retardation‖
           2001*. The Arc of the United States www.thearc.org
           (accessed September, 2005)

           Dr. Ira Lott, ―Alzheimer’s Disease and Down Syndrome‖
           National Down Syndrome Society www.ndss.org (accessed
           September, 2005)

           PS Kishnani, et al ―Cholinergic therapy for Down’s
           Syndrome‖ Abstract of the Month: April 1999 Lancet 353:
           1064, 1999 (accessed September, 2005)


      *The terminology used to describe people with developmental disabilities has changed over time. While
          DHS supports the use of ―people first‖ language within its documents, certain outdated terms may be
          found within historical and official documents, such as statutes and reports.


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      Minnesota-North Dakota 2005
                                             References
      ―Dementia and Intellectual Disabilities‖ 2003.
       Alzheimer’s Disease International
       www.alz.co.uk (accessed June, 2007)

        ―Alzheimer Disease in Individuals with Down
        Syndrome‖ 2005. emedicine
        www.emedicine.com/neuro/topic552.htm (accessed
        July, 2007)

       ―Edinburgh Principles‖ 2002. Journal of Intellectual
        Disability Research
        www.uic.edu (accessed July, 2007)


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      Minnesota-North Dakota 2005
         952-920-0855
         info@arcgreatertwincities.org

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      Minnesota-North Dakota 2005
                                  Contact Information


         Marsha Berry, M.A., CAEd
         Alzheimer’s Association Minnesota-North
           Dakota
         952.857.0541
         marsha.berry@alz.org




Copyrighted by the Alzheimer’s Association
      Minnesota-North Dakota 2005