understanding mild cognitive impairment · 2019-08-22 · understanding mild cognitive impairment...
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Understanding Mild Cognitive ImpairmentEnhancing Communication, Safety and Cognitive Engagement
Kathryn Kilpatrick M.A. CCC/SLP
Speech – language pathologist Geriatric Life Enhancement Consultant
Memory Fitness Coach
COMMUNICATION CONNECTION www.connectionsincommunication.comMEMORY FITNESS MATTERS www.memoryfitnessmatters.com
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Marcel Proust
The real voyage of discovery consists not
in seeking new landscapesbut it having new eyes.
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GERIATRIC Life Care Enhancement Meets the physical, emotional, intellectual and spiritual needs Builds on their strengths and interests Transforms days from mere existence into more enjoyment Promotes meaningful and memorable exchanges May engage older adults who may otherwise be removed from activities Provides the opportunity for each person to participate, elevating
the level of interactions Involves interaction of family, friends and care partners Elevates the value we place on the older adult
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Memory and Normal Aging
Word finding complaints Names and places Remember later at times
Slower to process information Slower to learn new information Do not like to multitask
More distractible Need to focus on one thing at a time
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Yesterday Today TomorrowWorking memory
• Recall for short period of time• Can hold about 7 items• Very vulnerable to lifestyle/environment
Long term memory• Stores what is important• Not so vulnerable to the aging process • Recall can be impacted by emotions
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Doesn’t Change With Normal Aging
Semantic memory – facts and experiences
Prospective memory – remember perform an action in future (if write it down)
Remote memory – years ago
Immediate memory – recall small amount of information over few seconds
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Memory Loss - CausesDiseases
Parkinson’s Lupus Multiple Sclerosis Huntington’s Disease Others
Dementia Alzheimer's Disease Stroke Head Injury etc.
Other possible causes
Reduced sensory input
Thyroid problems
Low blood sugar
Bypass surgery
Anesthesia
Allergies
Normal pressure hydrocephalus
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Reversible Causes
Depression Grief Pain Stress Anxiety Hearing Loss Minor head injury Tumors
Medications Hypothyroidism Sleep Disorders Normal pressure
hydrocephalus Infections Thyroid Vitamin deficiency
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Mild Cognitive Impairment It is NOT dementia On Global Deterioration Scale – 7 stages
Stage 2 is normal aging Stage 3 is MCI GDS – Stage 4 still able to learn GDS – Stage 5 - advanced to need supervision
MCI - options Some improve Some remain stable Others continue to advance to Stage 4
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What are the Challenges?
Are they one of the “worried well”? Note increased challenges. Easily on cognitive overload Trouble with new, complex skills or overstimulation May not be obvious to others Impacts feeling of aging and self esteem Trouble creating appropriate compensatory strategies Personality changes and anxiety Apathy and/or depression Only shows up in an extensive interview
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Amnestic and Non Amnestic Amnestic
Predominately an impairment in memory Subjective and objective complaints for age Largely intact functional activities
Non-amnestic Impacts thinking skills other than memory
Decision making - Judgment Sequencing steps Visual perception
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Diagnosis https://www.youtube.com/watch?v=uAlkCMfTASQ
25% of those diagnosed may be experiencing normal agingbut have issues that can be resolved RX education and consultation including lifestyle choices
15 – 20 % of those over 65 may have MCI Average of 32 percent of individuals with MCI developed
Alzheimer’s disease in 5 years. In some cases MCI is actually an early stage of Alzheimer’s
(called MCI due to Alzheimer’s disease) or another form of dementia.
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Young Onset - Who is Impacted? Those with younger-onset or early onset Alzheimer’s disease are
those under age of 65 Some are in their 30’s, 40’s and 50’s
Incidence about 5% of the population with Alzheimer’s disease –about 200,000 Americans
Some may be in the early stages of Alzheimer’s disease or Vascular dementia Frontotemporal lobe dementia (FTD) Dementia with Lewy bodies
More likely inherited if onset much earlier Communication Connection Kathryn Kilpatrick 14
What Does Young Onset Dementia Look Like? In the prime of their life Likely to be employed, active lifestyle and social life Adult children and grandchildren May be caregiver for parent or grandchild Married, single, no family in area May be a business owner May be a volunteer May be moving, downsizing, dealing with other health
concerns – concurrent?
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Seeking the Diagnosis Not expected in younger population Diagnosis can take months or years May not be aware of available benefit programs Unaware person with diagnosis has a qualifying disease Social Security Administration (SSA) added early-onset
Alzheimer’s disease and related dementias to the Compassionate Allowance Insurance in 2010. SSDI –Social Security Disability Insurance SSI Supplemental Security Income
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ROLE OF Speech-Language Pathologist
Identify Assess Develop interventions Counsel Educate Prevention
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Why Strategies Matter Those with MCI or early stages of Young-Onset Dementia
Retain ability to learn Able to apply new information
MORE EDUCATION NEEDED How can we reach that population
Many will progress to Alzheimer’s disease so interventions earlier on can become habits
Who in their support system can we educate?
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Challenges to Address Activities daily living
Health maintenance
Safety
Medications
Driving
Electronics
Finances/Shopping
Chores and leisure time activities
Travel and holidays
Correspondence/electronics and
other technology
Denial
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Predicting Functional Dependence in Mild Cognitive ImpairmentDifferential Contributions of Memory and Executive Functions
Gerontologist. 2018 Aug 2018
Recent studies suggest that older adults with MCI can exhibit impairment in instrumental activities
of daily living (IADL).
Need information to better assist health care providers in detecting functional vulnerabilities that often precipitate
loss of independence
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IADLS Care of others (including selecting and supervising caregivers) Care of pets Child rearing/caregiving Communication management Community mobility Financial management Health management and maintenance Home maintenance Meal preparation and cleanup and shopping Religious observances Safety procedures and emergency responses
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Finding Out What Matters 61.04% of participants with MCI were dependent on one or more
IADLs.
MCI was associated with significantly greater odds of dependence than normal cognition on 7 of the 10 IADLs
Impairment in memory and executive functions significantly predicted IADL dependence
Executive functions were the stronger predictor, particularly for complex finances, complex cooking, and remembering events.
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Ongoing Modification Understand deficits - build on strengths
Cognition Attention Memory Thinking Skills Problem Solving Speech and language Executive functioning
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Factors to Consider Difficulty modifying strategies that were effective before to the next
level Impacts participation and self esteem
Factors Life in 21st century Fast pace - multitasking Cognitive overload Technology Approach of those younger than they are when communicating
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Keys to Memory Fitness
Positive Attitude Paying Attention/ Hearing Loss Lifestyle Choices
Diet, hydration, nutrition, exercise, sleep Stress Management Strategies Socialization Brain Health, Memory Fitness Routine
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** Multitasking vs Task Switching Erodes our focus, ability to encode, and impacts safety. Multitasking in most cases is task switching. Habits that are being formed are not helpful Memory no longer just the complaint of those with changes in normal
aging Education to understand impact of paying attention and handling
distractions. Tools are needed and brain fitness programs
online needed to be coupled with real life applications. No quick fixes – takes work!
https://www.youtube.com/watch?v=UyLtYULonY8
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Assessing the Contributors to Distraction What is the environment like? What personally distracts a person the most?
Interruptions are NOT your friends! What is the level of chatter in your head? What is the chatter? Impact of depression, pain and grief Attitude is the foundation of any strategy program and includes
support system
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Need Educate on Factors that Can Impact a Diagnosis of MCI
Medications Dehydration Nutrition Sleep Apnea Vitamin deficiency
B 12 and D Drinking Smoking
Stress
Depression
Hearing Loss
Thyroid problems
Decreased physical activity
Decreased cognitive stimulation
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Typical Everyday Complaints Assess current strategy before developing a plan Consult and educate support partner Assess ability to follow through with plan
Peoples names Appointments Where park car Lost items Forget what do next Getting lost driving Miss paying a bill
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Basic Strategies Can learn but takes more effort
Use more of their senses Will have good and bad days
Need be aware so can modify or postpone Less desire participate in prior activities especially
those for cognitive enhancement Try modifications
Naming issues Cheat sheet - Gesture Give cues, categories, describe, draw it
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Take it to Another Level
What are their internal strategies? What are their external strategies? Start with simple tips and break down steps Make your notes detailed – print – larger print – number items Benefits of technology
“Google it: Take a picture of it Voice note Text yourself
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Memory Props Calendars To do lists Post it notes Reference lists Recommend
Single source Portable Consistent place
SEE ITSAY IT
VISUALIZE IT5 -10 second rule
Create a routine With meds With appointments
Emails – add attachment first
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HEARING LOSS AND MEMORY Impact on memory is significant Cognitive overload impacts attention/concentration Longer processing time – cannot keep all details Lose train of thought Refusal to use assistive devices Increased withdrawal Agitation, frustration, depression Decreased cognitive engagement Speakers need education on needed modification in their patterns of
communication Hard of hearing individual need to learn to speak up effectively
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HEARING TIPS
Face the person – get their attention first. Person needs to acknowledge you are speaking to them. Do not multitask when communicating – electronic devices do
not help at all and one of their biggest frustrations. Slow your rate of speech – ask them to remind you if you start
speaking too fast of they are having trouble understanding you. Speak in shorter segments. Ask the person what is most helpful. Observe when they
disconnect, get upset or seem overwhelmed.
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HEARING TIPS Write down the information especially if lengthy, complex or if a memory
issue is present. Printing is best. Number the items so they can more easily retrieve the
information. Turn off televisions etc. and move to a quieter setting or where there are
not distractions. Make sure the batteries are working in their hearing aides or check if they
are deliberately turned off. Closed caption may be helpful in SOME cases. CapTel phone should be explored. No longer need internet connection!
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MEMORY TIPSNOTE: Many of the hearing tips are applicable to memory loss
Simple yes/ no questions may be easier. Written information may be helpful. Print size is important. Check to
make sure it can be read easily and not too busy. Give information in segments. Verify comprehension then and also
later. One on one conversation easier vs multiple speakers. Memory boards or other props may be helpful. One size does not fit all.
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MEMORY TIPS For word retrieval, offer 2 word choices if you know the word
or give them a hint of the first one or two letters. Encourage them to give you a hint, gesture, draw or point. Reference lists for healthcare professionals, birthdays,
upcoming events, questions for MD appointments etc. and answers.
List of where you put things or where you moved them to.
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“Good habits, once established,
are just as hard to break as are bad habits.”
Robert Puller
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Dale E. BredesenAGING, September 21, 2014
Reversal of Cognitive Decline in Alzheimer’s Disease
Novel comprehensive and personalized therapeutic program which involves multiple modalities designed to achieve metabolic
enhancement for neurodegeneration.
The End of Alzheimer’s Dale E. Bredesen, MD
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Case Studies Followed parts and pieces of a program found in article Included
Diet recommendations Sleep recommendations Stress management Exercise Schedules for eating Supplements etc.
Some familiar others NOT Cognitive stimulation
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Increasing Cognitive Engagement
Many use apps but many cannot Tend to do the same thing repeatedly Once difficulties impact their ability, tend to withdraw from them Can look like apathy and disinterest With a support system and an awareness of interests, can modify
activities In some cases can develop new interests now that have more time
or revisit old interests set aside
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BLUE ZONES Dan Buettner LESSON 7 – Belong /participate in a spiritual community→ Be more involved→ Explore a new traditionLESSON 8 – Make family a priority→ Get closer→ Establish rituals→ Put family firstLESSON 9 – Surround yourself with similar people → Identify your inner circle→ Be likeable→ Create time together
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What a Brain Fitness Plan Should Include Need to think while doing the activity
Playing cards, doing puzzle, word games Do a familiar activity a new way
Drive a different route Use your other hand Mow lawn in a different pattern
Ongoing learning process New hobby Use other options on electronic device Study a subject of interest
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More of the Plan Makes you think in a new way
Learn a new dance step Present the opposite opinion Reorganize a storage area
Physical activity Do a new form of exercise Do it with a group
Socially interactive Group trips, take class, join book/magazine, good news club
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“SuperAgers” December 31, 2016 New York Times
Term coined by neurologist Marcel Mesulam Emotional areas are crucial brain regions Need work hard at something – road to “Superager” is difficult” Need feel stymied/frustrated. Even need feel bad in the moment As age tend to sidestep discomfort
Helps maintain sharper memory and greater ability to pay attention Use it or lose it
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Kathryn Kilpatrick www.memoryfitnessmatters.com 47
Keep Your Brain Sharp Program Brain Teasers and educational pieces on memory fitness Humor and riddles Conversation starters Attention and concentration tasks Reminiscence and trivia Naming strategies Word game puzzles started in the group then take home
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An Alzheimer’s Patient’s Point of View Janis Hogan Aplin
Dear Friend, Oh, how can this be you and I are losing me. Some day soon maybe morning, maybe noon I will no longer be the me you and I know as me.I ask, what is happening to me, and the answer seems to be words and thoughts frequently scramble and my conversations seem to ramble……..What can we do from losing me? "Nothing’ say the experts. But in my confused and foggy state, to you I plea….."Love me, Remember me, help me to be all that I can be for as long
as I can be the me we know as me.”49
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INSIGHTS Peterson, B. Jan's Story : Love lost to the long goodbye of Alzheimer's (2010)
Behler Publications
Taylor, R. Alzheimer's from the Inside Out” (2006) Health Professions Press
Genova, L Still Alice (2007) iUniverse
Summit, P. And Jenkins, S. Sum it Up: A Thousand and Ninety – Eight Victories, a Couple of Irrelevant Losses, and Life in Perspective (2013) Crown Publishing Group
Documentary “Glen Campbell… I’ll Be Me," produced by James Keach and Trevor Albert.
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RESOURCES Alzheimer’s Association
Help Line Support groups Care Partner Support Groups Ask about the SHARE program
Community Educational Programs Audiologists/Physical and Occupational therapists Speech-language pathologists Geriatric Consultants Websites / Podcasts and TED Talks
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Communication Connection Memory Fitness MattersKathryn Kilpatrick M.A. CCC/SLP
www.connectionsincommunication.com [email protected]
Presentations to health care professional and support groups Private consultations: Strategies for communication, safety, and activity
modification and caregiver support/education Products for brain teasers, reminiscence and conversation starters Keep Your Brain Sharp – programs with education, brain games and activities
to support a positive attitude and socialization Memory Fitness Matters Blogs – Multitasking strategies, caregiver support, activity
modification and much more… Communication Connection Blogs - Travel and holidays, meaningful activities, hearing loss
and much more…
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