Rosemary Lewis Disclosures Financial: None Non-Financial: None
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Rosemary Lewis
Disclosures
Financial: None
Non-Financial: None
ROSEMARY BROWN LEWIS, MS CC-SLP
BEAUFORT MEMORIAL HOSPITAL, BEAUFORT, SC
I’m just a PRN clocking in and out whenever needed!
I get paid every other Friday
Slide 1
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Slide 3
What is “Normal” Memory Loss?
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Slide 4
You Are Not Alone Self-Reported Increased Confusion or Memory
Loss in Adults 60 & Older is Common
12.7% Over the Past Year
35.2% Reported Increased Functional Difficulties
Non-Institutionalized Older Adults
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Slide 5
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Slide 6
Age: The Biggest Risk for Declining Memory 85 & Older: 15.6%
65-74: 11.9%
60-64: 12.0%
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Slide 7
Risk Factors for Memory Decline Race: Hispanic/Latino (16.9%) vs. White (12.1%) vs.
African-American (11.8%)
Education: Less than High School (16.9%) vs. College Graduate (10.9%)
Disabled (20.2%) vs. Non-disabled (7.5%)
Unable to Work (28.3%) vs. Employed (7.8%) vs. Unemployed (16.4%) vs. Homemakers (11.8%) vs. Students (3.9%) vs. Retirees (12.3%)
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Slide 8
Is It In The Water?
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Slide 9
Memory Loss & Confusion By Location
Lowest (6.4%) in Tennessee
Highest (20.0%) in Arkansas
13.7% in South Carolina
Functional Difficulty Lowest (21.3%) in Wisconsin
Functional Difficulty Highest (52.2%) in West Virginia
39.7% in South Carolina
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Slide 10
Impact of Confusion & Memory Loss Functional Disability (FD) Determines the Need for Help
81% Need Help Compared to 38.2% without Functional Disability
46.5% Get Help From Family/Friend vs. 6% Without FD
32.6% Discuss Confusion & Memory Loss with Healthcare Provider vs. 12.1% Without FD
32.8% Unable to Work vs. 9.6% Without FD
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Slide 11
Time: Memory’s Worst Enemy
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Slide 12
Memory Loss & Aging: What’s Normal? Shortly after taking in new information, memory starts
to deteriorate.
Some things fade quickly, others more slowly.
Importance of the information to you determines retention.
Stress & other factors can impact memory.
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Slide 13
Benign Memory Loss “Tip of the Tongue”
Syndrome
Often Starts in the 20s & 30s
Names, Dates & Facts that are Just Beyond Retrieval
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Slide 14
Benign Memory Loss Memory Distortion
You Think Your Memory is Vivid For An Event
Passage of Time Causes You to Remember Facts Differently or Not at All
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Slide 15
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Slide 16
Memory Loss & Dementia Dementia is not one disease.
Dementia is a decline in memory and at least one other area of thinking that affects the ability to perform everyday activities.
Dementia significantly impairs a person’s abilities in work, social interactions & relationships.
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Slide 17
Core Mental Functions & Dementia Memory
Communication & Language
Ability to Focus & Pay Attention
Reasoning & Judgment
Visual Perception
Praxis
Personality
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Slide 18
Signs of Dementia Asking the Same Questions Repeatedly
Forgetting Common Words When Speaking
Mixing Words Up – Saying “Bed” for “Table”
Taking Longer to Complete Familiar Tasks (e.g. recipes, checkbook)
Misplacing Items in Inappropriate Places
Getting Lost in Familiar Neighborhoods
Sudden Changes in Mood or Behavior for No Reason
Less Able to Follow Directions
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Slide 19
SEEK MEDICAL ATTENTION EARLY!!!
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Slide 20
Dementia: Causes Alzheimer’s Dementia (60-80%)
Vascular Dementia
Lewy Body Dementia
Frontotemporal Dementia
Normal Pressure Hydrocephalus
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Slide 21
Dementia: Causes Stress & Anxiety (Dementia of Depression)
Metabolic Diseases (Thyroid, Kidney, Liver)
Alcoholism
Attention Deficit Disorder
Drugs (Prescription & OTC)
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Slide 22
Testing For Dementia Neurological Examination
Montreal Cognitive Assessment (MOCA)
Mini-Mental Status Examination (MMSE)
Computerized Cognitive Testing
Memory, Attention, Executive Function, Language, Information Processing Speed, Visual Spatial Skills
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Slide 23
Testing for DementiaNeuroimaging NeuroQuant
MRI of the Brain
Measure Atrophy of Brain Areas Involved in Short-Term Memory
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Slide 24
Testing for DementiaNeuroimaging
AMYViD PET Scans PET Scan
Functional Image of the Brain
AMYViD allows us to visualize Alzheimer plaque.
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Slide 25
Testing for Dementia Comprehensive Metabolic Panel
Complete Blood Count
Thyroid Studies
Vitamin B12, Homocysteine
Vitamin D
Apo E Genotype
CSF Biomarkers
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Slide 26
Diagnosis Achieved: Now What?
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Slide 27
Staying Sharp: Treating Memory Loss & Dementia Mediterranean Diet
More Fresh Fruit, Raw Olive Oil, Oily Fish (Salmon); Less Red Meat, Fried Foods
Slows Cognitive Decline with Age
Reduces Risk of Transitioning from MCI to AD
Odds Ratio of Developing AD 0.60
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Slide 28
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Slide 29
Staying Sharp: Treating Memory Loss & Dementia
Exercise Has A Protective Effect on the Brain
Memory & Aging Project at Rush University
700 Cognitively Unimpaired Participants
Bottom 10% of Physically Active Developed Alzheimer’s Twice as Often as Top 10%
• Adding Physical Activity to Mediterranean Diet Lowers Alzheimer’s Risk as Much as 2/3
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Slide 30
Staying Sharp: Treating Memory Loss & Dementia Choose to snooze!
Sleep is important for allowing the brain to organize the events of the day.
Fatigue can affect memory.
Snoring and pauses in breathing may indicate obstructive sleep apnea.
A recent study demonstrated that cognitive normal people with disrupted sleep deposit more amyloid (plaque).
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Slide 31
Staying Sharp: Treating Memory Loss & Dementia Reduce stress.
Emotional stress affects brain areas involving with memory processing and impairs attention.
Consider meditation, counseling, psychotherapy and/or pharmacotherapy when needed.
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Slide 32
Staying Sharp: Treating Memory Loss & Dementia Focus on the task at hand.
Multitasking may lead to inattention and forgetfulness.
Use memory tricks (e.g. same PIN for all your accounts, repeating a person’s name several times after being introduced).
Maintain social connections.
Continue to learn.
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Slide 33
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Slide 34
Staying Sharp: Treating Memory Loss & Dementia – The Role of Medication
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Slide 35
Rationale for Medication to Treat Memory Loss & Dementia Cognitive Decline Linked to Reduced Levels of Brain
Neurotransmitters
Acetylcholine
Phosphatidylserine
Vitamin D
B Complex Vitamins
Excess Levels of Neurotransmitters Can Damage the Brain
Glutamate
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Slide 36
Acetylcholine Boosters Aricept (Donepezil)
Exelon Patch & Capsules (Rivastigmine)
Razadyne, Razdyne ER (Galantamine)
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Slide 37
Glutmate Blockers Namenda (Memantine HCl)
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Slide 38
Vitamin D Supplementation
Low Vitamin D Levels Linked to Poor Cognitive Performance & Higher Risk of Developing Alzheimer’s Dementia
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Slide 39
B-Complex Vitamin Supplementation Oxford University Study
156 People with MCI
All had Elevated Homocysteine Levels
Took B6 (20 mg), B12 (0.5 mg) and Folic Acid (0.8 mg) Supplements for 2 Years
Pre and Post MRI Scans Show Supplement Group Had Reduced Brain Atrophy by as Much as 7-Fold
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Slide 40
Brain Atrophy with Alzheimer’s Dementia
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Slide 41
Phosphatidylserine Phospholipids – The Building Blocks of Cells
494 Subjects in Northeastern Italy with Moderate to Severe Mental Decline took PS (300 mg) or Placebo for 6 Months
PS Group Did Better in Behavior & Mental Function
Depression Improved in PS Group
Several Studies Show Cognitive Benefits of PS in Mild Cognitive Impairment (MCI)
Marketed in U.S. as Vayacog
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Slide 42
Beaufort Memorial Memory Center
At Bluffton Medical Services
(843) 707-8833
www.bmhsc.org
www.coastalneurology.com
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Slide 43
Beaufort Memorial Memory CenterOur Mission: To Provide Comprehensive, Local Diagnostic, Treatment, Research & Support Services For People Experiencing Memory Disorders & Their Caregivers.
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Slide 44
Beaufort Memorial Memory Center Paul Mazzeo, M.D.
Board Certified, Neurology, Behavioral Neurology & Neuropsychiatry
Peggy Hitchcox, LMSW Memory Center Navigator
Rosemary Lewis, SLP Speech, Language & Cognitive Therapies
Richard Craner, OTR/L, Senior Occupational Therapist ADLs, Driving Assessment
Roxanne Davis-Cote, MPH, RD, LD Dietary Evaluation & Modification
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Slide 45
Beaufort Memorial Memory Center Clinical Research Trials
Harmony – AD
Moderate Alzheimer’s with Agitation or Aggression
Exelon Patch
Health Care Utilization & Quality of Life
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Slide 46
Memory Center Navigator Determination of Insurance Benefits
Transition to Assisted Living, Home Health Services or Hospice Care
Assistance with Disability Application
Advanced Directives Durable Power of Attorney, Healthcare Power of
Attorney
Liaison with Remote Family Members
Referrals to Local Support Services Memory Matters, Alzheimer’s Family Services of Greater
Beaufort
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Slide 47
Speech & Language Pathology Memory Strategies
Naming Strategies
Functional Ideas for Organizing Daily Activities
Medicine Charts
Visual Reminders
Goal is to Maximize Functional Memory via Compensation Techniques
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Slide 48
Occupational Therapy Enhance Independence with ADLs
Money Management
Cooking
Housekeeping
Using Appliances
Assistance in Maintaining Hobbies
Formal Driving Assessment Vision
Cognition
Sensory & Motor Skills
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Slide 49
Nutrition Diet Analysis
Caloric Intake Relative to Physical Exercise
Modification of Diet to Align with Mediterranean Style
Assessment of Special Needs (DM, HTN)
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Slide 50
Beaufort Memorial Memory CenterOur Ideal Outcome is to Maintain Functional Independence in the Home with a Good Quality of Life for as Long as Possible.
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Slide 52
ROSEMARY BROWN LEWIS, MS CC-SLP
BEAUFORT MEMORIAL HOSPITAL, BEAUFORT, SC
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Slide 54
THE EVALUATION PROCESS
Case history
Medical History – Medication Who is in Charge
Family History of Memory Loss
Vision
Hearing
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Slide 55
PATIENT/CAREGIVER CONCERNSStatement of the problem
Onset
Strengths/Weaknesses
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Slide 56
PRIMARY RESIDENCE Profession – Retired
Education
Volunteer Work
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Slide 57
ACTIVITIES OF DAILY LIVING
Daily Schedule – Get Up/Go to Bed
Driving – Yes/No Gotten Lost?
Chores – Cleaning, Cooking, Pets
Bills – Method of Payment
Hobbies, Exercise, Clubs
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Slide 58
SOCIAL INTERACTIONS
Friends – Dining Out
Children, Grandchildren
Church
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Slide 59
TECHNOLOGY USAGE Reading
TV Viewing
Computer – Email, Social Media
Cell Phone, Texting
Any Additional Information
Likes or Dislikes
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Slide 60
FORMAL ASSESSMENT ABCD
Arizona Battery for Communication Disorders of Dementia
Kathryn Bayles & Cheryl Tomoeda
11 Subtests
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Slide 61
Selected Subtests1. Mental Status
2. Story Retelling – Immediate, Delayed
3. Following Commands
4. Comparative Questions
5. Word Learning – Controlled, Cued
6. Reading Comprehension – Sentence Level
7. Confrontation Naming
You Could Also Use – Repeatable Battery of the Assessment of Neuropsychological Status- (RBANS)
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Slide 62
RESULTS OF TESTING First Steps
Meds Charting
Community Resources - Memory Matters
Compensatory Strategies
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Slide 63
TREATMENT 2-3 SESSIONS Functional Goals that relate to patient’s daily schedule
HEP to reinforce compensatory strategies
KEEP IT REAL!
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Slide 64
NAMING STRATEGIES – NEW LEARNING IN AN OLD LEARNING BRAIN
1. A-B-C-D - I M D B
2. Talk About It
3. Visualize It
4. All About Me
5. Write It Down
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Slide 65
HOW TO DEAL!!
1. Meds check-off list
2. Daily Schedule check off list
3. Calendars / reminders / post-it-notes / preserved reading
4. Daily Journal
5. Put the name to the face
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Slide 66
KEEP IT MOVING !
Exercise – Walking, Biking, Golf
Don’t Move – Sleep Schedule
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Slide 67
KEEP DOING1. Reading – Headlines Only
2. TV – News highlights / Favorite shows
3. Computer
4. Cards and Games
5. Church, Social groups, Activities – A MUST !
6. Rehearsal and scripting techniques
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Slide 68
PROBLEM SOLVING Step-by-Step progression
NO Multitasking Allowed
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Slide 69
OTHER ISSUES FOR THE SLP DRIVING
What to look for
1. Getting lost on familiar roads
2. Reliance on a co-pilot of directions and info
3. Going the wrong way
4. Not noticing signs, pedestrians, signal
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Slide 70
ANY QUESTIONS
???????
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Slide 71
THANK YOU FOR YOUR ATTENTION!
Preserve Your Memories; Keep Them Well:
What You Forget You Can Never Retell
Louisa May Alcott
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