Dementia and
Alzheimer’s Disease
Presented by:
Amanda Sandlin, MSW
Adjunct Professor for UAA School of Social Work
&
Lisa Stanley, Care Coordination Supervisor at Alzheimer’s
Resource Agency
Objectives
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Increase knowledge of Alzheimer’s disease
and related dementias/disorders (ADRD)
Learn statistics about ADRD, caregivers, and
the community
Discuss the person-centered approach to care
Review communication techniques
Become familiar with local resources
What is Alzheimer’s Disease?
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AD is a progressive, irreversible disease
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Leads to loss of function and death of nerve
cells in the brain
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AD results in impaired cognition and behavior
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Alzheimer’s disease is the most common cause
of dementia in individuals over the age of 65
What is Dementia?
Dementia
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The term dementia originates from Latin roots:
“OUT OF MIND”
 Dementia is not a disease in itself, but describes a
group of conditions including:
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Loss of intellectual function
Loss of memory
Confusion
Behavioral changes
Personality changes
Loss of cognitive function
Causes of Dementia
IRREVERSIBLE
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Alzheimer’s disease
Pick’s disease
Parkinson’s disease
Lewy Body disease
Vascular disease
Creutzfeld-Jakob
disease
POTENTIALLY REVERSIBLE
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Depression
Medication side-effects or
interactions
Thyroid disorders
Acute alcohol abuse
Anemia
Electrolyte imbalance
Alzheimer’s Disease Statistics
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Over 4.5 million people in the US have AD
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People with AD will live from 5 to 20 years*
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1 in 10 people have a family member with AD
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7 out of 10 people with AD live at home with family
caregivers
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6 out of 10 people will wander*
The Human Brain
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The brain consists of three main parts:
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The cerebrum: In control of remembering, problem
solving, thinking, and feeling. It also controls
movement.
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The cerebellum: Controls coordination and balance.
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The brain stem: Connects the brain to the spinal
cord and controls automatic functions such as
breathing, digestion, heart rate and blood pressure.
The Human Brain
Reading
Hearing
Thinking
Saying
Nerve Cells
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An adult brain contains over 100 billion nerve
cells, or neurons.
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Nerve cells are branched together and allow
the brain to send signals throughout the bodythey form the basis for memories, thoughts,
and feelings.
Neurons
Neurons and AD
The damage
done by AD
disrupts the
neuron’s ability
to send signals
through the
synapses, and
the activity of
neurotransmitters.
Plaques and Tangles: Hallmark of
AD
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Plaques form when protein pieces called betaamyloid clump together. Beta-amyloid comes from a
larger protein found in the fatty membrane
surrounding nerve cells.
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Beta-amyloid is chemically "sticky" and gradually
builds up into plaques.*
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Scientists have not determined whether AD causes
plaques and tangles, or whether plaques and tangles
cause AD? However, they can be identified in all
autopsied Alzheimer brains.
Plaques
Tangles
Healthy vs. Diseased Brain
Stages of Alzheimer’s disease
Four stages are typically associated with the
progression of AD:
Early Stage: Forgetfulness
 Middle Stage: Confusion
 Advanced Stage: Disorientation
 Final/Late Stage: Absence
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Ten Warning Signs
1.
2.
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4.
5.
6.
7.
8.
9.
10.
Memory changes that disrupt daily life.
Challenges in planning/problem-solving.
Difficulty completing familiar tasks at home, work, or at
leisure.
Confusion with time and place.
Trouble understanding visual images and spatial
relationships.
New problems with words in speaking or writing.
Misplacing things and losing the ability to retrace steps.
Decreased or poor judgment.
Withdrawal from work or social activities.
Changes in mood or personality.
Intellectual Symptoms
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Amnesia: Loss of Memory
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Aphasia: Loss of ability to speak and
understand
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Apraxia: Loss of motor skills and control
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Agnosia: Loss of ability to recognize
Behavioral Symptoms
Early/Middle Stages:
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Difficulty concentrating
Poor judgment
Irritability, anxiety, depression
Personality changes
Middle/Advanced Stages:
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Sleep disturbances
Outbursts/Catastrophic reactions
Emotional distress
Paranoia
Delusions
Hallucinations
Early Diagnosis
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Why is an early diagnosis so important?
An early diagnosis can:
Rule out other possible causes of dementia symptoms
 Treat any reversible causes
 Begin medication to treat AD
 Discuss and plan for long-term care with
family/professionals
 Complete POA/Advanced Directives
 Participate in early-stage support groups
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Long-Term Care
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70% of people with AD are cared for in the
home by a family caregiver.
The person with AD will eventually need 24/7
care.
Who will provide the care?
Who will pay for the care needed?
How will the safety and quality of life of the
individual be ensured?
Impacts of AD
Alzheimer’s disease and related disorders impact
not only the person diagnosed, but also the
family, the community, and the health care
system.
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The direct and indirect costs to Medicare,
Medicaid, and businesses is estimated to be
over $148 billion annually.
Impacts of AD
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Researchers estimate that the number of people
diagnosed with AD will double every twenty years;
by 2030 65.7 million people will have AD.
A recent report completed by the Alzheimer’s
Association concluded that currently the US needs an
additional 3.5 million professional providers to
support individuals with AD and their families.
The same report noted that there is a great need for
additional social workers: only 4% specialize in
geriatrics, compared to the needed 33%.
Unpaid Caregivers
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The majority of people with AD are cared for
by family members (70%).
In 2008 almost 10 million Americans provided
8.5 billion hours of unpaid care to individuals
with AD or a related dementia, valuing $94
billion.
In Alaska, 14,539 AD caregivers provided
12,550,265 hours of unpaid care, valued at
$139,307,943.00.
Unpaid Caregivers
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32% of caregivers provide care for over 5 years
40% of caregivers rate stress as high or very high
One-third of caregivers have symptoms of depression
Family caregivers are more likely to have increased levels of
stress hormones, reduced immune functions, slow wound
healing, New hypertension, and New coronary heart disease
AD caregivers are 31% more likely to reduce work hours or
quit work when caring for a loved one with no significant
behavioral symptoms
When caring for an individual with behavioral symptoms, AD
caregivers are 68% more likely to reduce work hours, or quit
work all together
How Can We Help?
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Although there is no argument as to the devastating
effects of AD and related disorders on the individual,
the family, and the community, addressing these
effects from a social work perspective can decrease
negative outcomes and improve the AD journey for
the family.
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We must always remember that the person with AD,
even in the most severe stage, can experience joy,
comfort, and meaning in life.
Communication
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To ensure a person-centered, strengths-based
approach, it is very important for all members
of the “care team” to communicate.
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In addition, providers must always remember
the cultural aspect and how one’s culture
impacts perspectives on functioning, disability,
long-term care, and caregiving.
Communication and AD
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The following tips help when communicating with a
person who is diagnosed with AD:
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Meet the individual where they are: if the person is living in 1945,
go there. Avoid reorienting the person.
Speak slowly and clearly. Choose simple words or phrases. Allow
at least five seconds for the response.
Be aware of your tone of voice and facial expressions; body
language is often understood when words are not.
Stand or sit directly in front of the person, and minimize other
distractions.
Present only one idea or question at a time.
Do not quiz the person or ask questions requiring explanations.
Keep the environment calm, with low stimuli.
Remember, the person may say one word but mean another; watch
for congruency in body language and other non-verbal cues.
Communicating with Family
Important topics to address at care planning meetings:
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Changes anticipated as the disease progresses
Care goals and possible adjustments over time*
Preparing for loss of decision-making capacity
Wandering risks and precautions
Harmful actions/behaviors
Altered sleep/wake cycle
Incontinence
Recognizing and managing pain
Fall risk
Alternatives to restraints
Diet and meals; signs of swallowing difficulty
Preparation of safe foods
Caregiver stress and use of respite/support groups
Safety issues including driving a car, or staying alone
Community Awareness
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An increased awareness of AD and related
disorders will encourage prevention* and
preventative behaviors* to increase positive
outcomes for the community
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Knowledge of resources and support programs
for families coping with a diagnosis of AD
allows us to appropriately refer individuals
National and Local Support
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The Division of Senior and Disabilities Services
(907) 269-3666
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Contact DSDS for listings of local in-home service agencies, assisted
living and nursing homes, and for a list of care coordinators and
personal care assistants
The Alzheimer’s Disease Resource Agency of Alaska
(ADRAA)
(907) 561-3313
www.alzalaska.org
Alzheimer’s Association
www.alz.org
References
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ADRAA Fact Sheets (available at the website
www.alzalaska.org)
Alzheimer’s Association website
(www.alz.org)
“Dementia Care Practice Recommendations
for Professionals Working in a Home Setting”.
Alzheimer’s Association; 2009.
“2009 Alzheimer’s Disease Facts and
Figures”. Alzheimer’s Association; 2009.
Spring Semester Follow-Up Training
Next semester’s Field Instructor Training will:
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Provide a more in-depth review of both
pharmacological and non-pharmacological
intervention strategies to use when working
with individuals and families impacted by
ADRD.
Please welcome Lisa Stanley, Care Coordination
Supervisor of the Alzheimer’s Resource
Agency and learn about the agency’s services.