handout for leadingage mi conference 2018

5/6/2018

© 2018 Dr. Govind Bharwani. All Rights Reserved. 1

Dementia Care Using

Neuroscience Approach

Learning Objectives

Basic understanding of Neuroscience

What causes behavior problems during dementia?

Neuroscience approach to Alzheimer’s / Dementia Care

Dr. Govind Bharwani (Adjunct Professor)

Co-Director of Ergonomics and Alzheimer’s Care

Wright State University, Dayton, OH

Mixed Dementia

Alzheimer’s Disease

Lewy Body Dementia

Frontal Lobe Dementia

Vascular Dementia

Parkinson’s Disease

Huntington’s Disease

Down Syndrome

Pick’s Disease

Plus

Dementia Care Using


Learning Objectives







5/6/2018


Our Brain is divided into two Hemispheres: Left Brain and Right Brain

The left brain controls the right side of the body and the right brain controls the left side of the body.

Left and Right Brain Areas which affect ADL Function

Left Brain controls:

• Short-Term memory

• Language skill

• Analytical skill

• Talking, reading, writing etc.

• Speech comprehension

• Verbal memories

• Math skill

• Grammar skill

• Logical reasoning

Right Brain controls:

• Perception of faces

• Emotional speech

• Singing skill

• Environmental sounds

• Comprehension of music

• Emotional memories

• Visual-spatial processing

• Geometric thinking

• Creative thinking

ACTIVE BRAIN PASSIVE BRAIN

Alzheimer’s Disease affects the active cells of the brain

Alzheimer’s disease is caused by the formation of protein build-up between nerve

cells called PLAQUES and formation of twisted strands of proteins called TANGLES

Alzheimer’s

CellsHealthy

Cells

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Stages of Alzheimer’s Disease

Pe

rfo

rma

nce

Left & Right Brain Performance

1 2 3 4 5 6 7

Left

Brain

Right

Brain

Effect of Alzheimer’s Disease

– LEFT BRAIN begins to deteriorate significantly affecting short-term memory,

language skills, and analytical skills

– RIGHT BRAIN stays active for much

longer duration maintaining sensory functions, emotions, and feelings

Effect of Left Brain Decline

• Short-term memory declines

• Speech pattern deteriorates

• Logic and analytical skills deteriorate

• Space/time concept becomes confusing

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Effect of the Right Brain Bloom

• Music and art receptivity improves

• Tactile and touch sensitivity is retained

• Smell, taste, and aroma sensitivity is retained

• Feelings and emotions are retained

Brain PET Scan of PWD

Although the Alzheimer’s disease affects neurons (brain cells) in both right and left brain, the ADL functional areas in the left brain

is affected more than the right brain such as short-term memory,

language, logic, executive function, math skill, etc

Left

Brain

Right

Brain

Fear

HappinessAnger

Desire

Sadness

LOVE

Emotions & Feelings of Alzheimer’s and Dementia Residents

Remains High even at the Late Stage

5/6/2018


Dementia Care Using


Learning Objectives







Type of Behaviors• Catastrophic Reaction (anger, crying, etc.)

• Depression and Delusion

• Hallucination

• Restlessness or agitation

• Disruption of sleep/wake cycle

• Suspiciousness

• Wandering

• Disinhibition about social behavior

• Compulsive and repetitive symptoms

• Others (sexual, shadowing, hoarding, etc.)

What is PWD trying to tell you?

• Verbal/Vocal Agitated Behavior Action is associated with discomfort, pain, or medical conditions

• Physically Non-Aggressive Behavior Action is looking for stimulation as opportunities for meaningful activity. He/she is getting bored.

• Aggressive Behavior Action is associated with feeling cold or perceived threatening situation during ADL.

In summary:

The reason for behavior problems is the result of UNMET NEEDS

(physical, social, or psychological) which they are unable to fulfill

by themselves because of communication difficulties.

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Stage of Early Childhood

• During early childhood , the Right brain enjoyed

music, games, and all the fun stuff

• This stage was fearless, uninhibited without social

constraints and conditions

• It was a stage of total freedom and fun memories

• Those memories are stored in the Right Brain

• These emotional memories surface from time to

time and are constantly neutralized by the “Logic”

of the Left Brain

Stage of Growing Up• During this stage the person learned how to take

care of himself/herself (all ADL functions)

• He/she also learned how to live in society with social do’s and don’ts.

• All the above was programmed into the Left brain

which also included language

• The Right brain continued to enjoy fun stuff with limited language knowledge

• The Left brain became the Master brain and the Right brain became the Passive brain (spare tire)

Stage of Dementia

• All was fine for thousands of years, since our lifespan was

less than 60 years

• When there was a breakthrough in science and medicine, It

caused our lifespan to increase to more than 60 years.

• The human biology could not keep up with the change

• When the Alzheimer’s disease attacked the Left brain, It destroyed all the knowledge and experiences of the lifetime

• The Right brain is left to manage with very little knowledge,

language and ADL experience

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Neuroscience of Difficult Behavior

• Without Alzheimer’s & Dementia the Logic Force (Left Brain) is greater than

the Emotional Force (Right Brain) causing no behavior problem

• With Alzheimer’s and Dementia the Logic Force (Left Brain) becomes weaker than Emotional Force (Right Brain) which leads to behavior problem

Difficult behavior decision is made in the Orbito-Frontal Cortex in the Right Brain

Right

Brain

Left

Brain

Logic Force from the Left Brain

Emotional Force from the Right Brain

Primary Sensory Areas of the Brain and Emotional Memory

• The primary sensory areas of the brain remains relatively untouched by the

disease such as touch, smell, sight, sound and taste (except due to aging).

• Use the primary sensory areas to create positive emotional memory of pleasure and stimulation.

Amygdala in the Right Brain

Amygdala in the Right Brain acquires emotional memories through the past experiences

AMYGDALA

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Dementia Care Using


Learning Objectives







Root Cause of Behavior Problems

1. Boredom

2. Emotional Disengagement

Effect of Boredom and Emotional Disengagement

on People with Alzheimer’s & Dementia

Mental Stress, Agitation, and Behavior Problems

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Alzheimer’s/Dementia Resident Needs

1. Physical needs

2. Clinical needs

3. Emotional needs

There is lack of emotional care due to time, knowledge, and expertise of the staff.

Major Challenge for the Caregivers

The Caregivers are LEFT

BRAIN dominated taking care

of the residents who are RIGHT BRAIN dominated

BBET Program uses the science of Ergonomics and

Neuroscience research to train the caregivers on

how to interact with the residents

Questions?

handout for leadingage mi conference 2018

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