• Dementia
– Memory impairment (decline)
– Other cognitive decline
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Aphasia (language impairment)
Apraxia (impaired motor functioning)
Agnosia (failure to recognize/identify objects)
Executive functioning (planning, organization,
abstract thinking)
– Will impact social, occupational functioning
– Can include delirium, delusions, depressed mood
– Early onset prior to age 65, late onset > 65
Causes of Dementia
• Alzheimer’s (more details to follow)
• Vascular: loss of blood supply & nutrients to the brain
due to blockage or bleed
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Single large stroke
Multiple small strokes (multi-infarct)
Aneurysm
Course can be sudden or “patchy”
• Late-stage HIV
• Head Trauma
• Creutzfeldt-Jacob Disease (virus lies dormant then rapid
progression/deterioration; similar to “mad-cow” disease)
• Parkinson’s Disease
• Huntington’s Disease
Velma & Alzheimer’s
• Multiple cognitive deficits manifested by:
• Memory impairment
– She is unlearning things, in roughly the same order that she
learned them as a toddler
– Mary Velma Connolly Buchanan is losing herself
– Dolores Bordelon thinks that this is all about memory loss, and
it’s not. It’s about personhood loss
– Each new day was already a scary adventure for Velma. She
already felt like a new kid at school, even in her own home,
where you don’t know if you’ll be able to locate your classroom
– Jeanne? Is anything wrong? Where are the babies?
– My given name Jeanne might no longer come to her, but at such
moments she could distinguish me from my father.
– Velma no longer had any name for Rocky’s wife.
• Deficits in one (or more):
– Aphasia
• I’d try to wake up, sit up, and explain things to her in simple
and positive language.
• Alzheimer’s prevented her from … making sense of what she
heard. Her misinterpretation could lead to paranoia.
• I knew that I should limit myself to short, declarative, positive
sentences.
• She had needs to satisfy, yet could not articulate them.
• Right words would not come, and wrong ones would just pop
up to take their places. She was embarrassed by this, and
terribly frustrated.
• Damn fick thapper, she muttered, floo thing!
• VROOO! Mecklin barson! Saliva sprayed from the coral
mouth.
– Apraxia
– Agnosia
– Executive functioning
• Deficits in one (or more):
– Aphasia
– Apraxia
• She no longer knows how to button clothing. Brassieres are
deep mysteries.
• Mama no longer knew how to dial or even answer a
telephone.
• And then I’d hear it, that uncoordinated shuffling
• Mama tried to feed herself ice cream with her spoon upside
down
• She once diapered me, now it’s my turn to diaper her.
• She stopped bathing. Her clothes didn’t match.
• Mama was folding towels … or trying to. She could not line
up the corners.
– Agnosia
– Executive functioning
• Deficits in one (or more):
– Aphasia
– Apraxia
– Agnosia
• Mama no longer understood what toilet tissue was
for. She had stopped using it.
• Mistakes a lipstick tube for her disposable lighter,
and keeps trying to light her cigarette with it.
• She asks you if the dirt white sock on the bathroom
floor is a fried egg.
• She was taking bites out of the kleenex.
– Executive functioning
• Deficits in one (or more):
– Aphasia
– Apraxia
– Agnosia
– Executive functioning
• She could no longer follow her own train of thought
• Mama did things that made no sense. She would turn on the
electric burners of the stove for no reason
• Now she’s starting to say somebody’s embezzling from us …
You know, all that trash saying ‘You may have already won
five million dollars ’
• She did things for no reason, prompted by nothing more than
the misfiring of damaged neurons.
• Velma wept frequently, not knowing why.
Progression
• Stage 1 (2-4 yrs):
– Memory loss for: new information, recent events, routine tasks
– Other Symptoms: occasional disorientation and impaired
decision making abilities
– Anxiety about symptoms, more reluctant to deal with others.
• Stage 2 (2-10 yrs):
– Memory loss for: words, friends or relatives; past events, very
routine tasks (bathing or dressing).
– No longer think logically.
• Stage 3 (until death):
– Memory loss for: day or month; familiar settings; spouse or
children; how to feed or dress himself or herself.
– Other symptoms: Wandering off, no longer be able to speak
logical sentences.
Complicating factors
• Delirium: Impaired alertness & awareness
(disorientation) along with cognitive deficits (e.g.,
memory, language)
– Medical conditions (e.g.,hypoxia, hypoglycemia,
electrolyte imbalance, liver or kidney disease, postseizure, head trauma)
– Substance-Induced
• Medications such as anesthetics, anticonvulsants,
antihistamines, sedatives, etc.
• Illegal drug use such as cocaine, cannabis, opioids
Topics for Research
• Resources in the area for caregivers
• Compare symptoms with other types of
dementia
• Suspected biological causes of Alzheimer’s
• Biological causes of other types of dementia
• Treatments of Alzheimer’s and other dementias
(could be combined with one of the above)
• Famous people who developed Alzheimer’s (or
other type of dementia)