Dementia – Depression - Delirium Understand the relationship, Recognize the signs and symptoms

1. Dementia – Depression - DeliriumUnderstand the relationship, Recognize the signs and symptoms Dementia Care Training Centre - 2007

2. No More Business as Usual • Dementia Care Training Centre • Guiding principles • Sharing our story • Outcomes • Lessons learned

3. Dementia Care Training Centre • A core business of Alzheimer Society of Calgary • Includes staff training and family education Guiding Principles Person-centred Outcomes driven Supporting Excellence in Dementia Care

4. What was happening in Calgary • More than 10,000 people diagnosed with Alzheimer’s disease • Limited recognition of delirium among direct care providers • Cognitive Impairment Strategy • National Guidelines for Seniors Mental Health

5. AlzheimerSociety Responsibility “No one in a better position than the Alzheimer Society to educate staff and families about the importance of delirium” “Staff need to recognize the symptoms, who and how to report what they see”

6. Sharing Our Story Workshop Learning Objectives • To understand the terms dementia, depression & delirium • To recognize the signs and symptoms of dementia, depression and delirium • To appreciate the difficulty of co-existence and interrelations of the dementia, depression, delirium • To understand the diagnostic process • To appreciate a person-centred approach to care

7. Workshop Outline • The Marvellous Healthy Brain • Causes of Cognitive Impairment • Functions & Damages of the Brain • Irreversible Types of Dementia • Reversible Causes of Dementia Depression & Delirium • Understanding the Distinctions • The Diagnostic Process • Person-Centered Care

8. The Healthy Brain - Introduction The brain weighs approx. 3 lbs. – 7 cups Structural & Functional Organization The brain consists of brain cells (neurons) that connect to each other through their axons, dendrites and synaptic connections. Neural networks: 1012 (100 billion) neurons has on average 7k-10k connections (total 1000 trillion). another SENSATIONal fact: “the little man” Homunculus

9. Causes of Cognitive Impairmentdevelopmental disabilitiesbrain injurymild cognitive impairmentdementia What is Dementia?

10. Limbic System Areas of the BrainStructure &Functions

12. Non-Reversible Types of Dementia

13. Reversible Causes of Dementia • Malnutrition • Dehydration • Metabolic Dysfunction • Vitamin B12 Deficiency • Depression • Delirium

14. Signs & Symptoms: Sad or depressed most of the time (mood) “emptiness” Feelings of anxiety (various forms) and psychomotor agitation Changing appetite and weight loss/gain Sleep Disturbances Loss of interest/Lack of motivation Concentration or Memory problems Social Withdrawal Thoughts of death/Suicidal Risk Depression

15. Vincent van Gogh, who himself suffered from depression and committed suicide, painted this picture in 1890 of a man that can symbolize the desperation and hopelessness felt in depression. Depression in the Elder Population Common atypical features : • Psychotic features (paranoid delusions) • Somatization • The “dwindles” (*) Potential Issues: • Suicide risk is high • Depression is an unusual sole cause of cognitive impairment • Depression often co-exists with dementia

16. Delirium – Core Features (DSM-IV) • Disturbance in consciousness (i.e., reduced clarity of awareness of the environment) with reduced ability to focus, sustain, or shift attention; • A change in cognition (i.e., memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance that is not better accounted for by a preexisting, established, or evolving dementia; and • The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day.

17. A general medical condition Substance intoxication Substance withdrawal Multiple causes Often arises as an interplay of predisposing and precipitating factors. Furthermore: In general, the greater the vulnerability of the person, the higher the likelihood of delirium occurring. It is not always possible to firmly establish the specific etiology of the delirium in an older person. Delirium can occur as a consequence of

18. Comparison of the Clinical Features COURSE, PROGRESSION, ATTENTION, MEMORY, THINKING

19. Principles of Person Centred Care • Uniqueness • Complexity • Enabling • Personhood • Value of others

20. Outcomes • 40 people trained • 3 workshops to date • Participants: acute care, long-term care, developmental disabilities, adult day support, independent seniors residences, seniors community resources, Calgary and Edmonton health region

24. Lessons Learned • Direct care providers across the care continuum recognize their need to learn more about dementia, depression and delirium and reporting requirements • Family members are beginning to recognize the importance of understanding the relationship between dementia, depression and delirium • The Alzheimer Society plays a key role in educating and supporting staff and families about delirium

25. Thank you! If you have any questions or comments, please contact us at Telephone: 290-0110 Email: info@alzheimercalgary.com or have a look at our website: www. AlzheimerCalgary.com