Page 1
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
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
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5/6/2018
© 2018 Dr. Govind Bharwani. All Rights Reserved. 2
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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5/6/2018
© 2018 Dr. Govind Bharwani. All Rights Reserved. 3
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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5/6/2018
© 2018 Dr. Govind Bharwani. All Rights Reserved. 4
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
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5/6/2018
© 2018 Dr. Govind Bharwani. All Rights Reserved. 5
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
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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5/6/2018
© 2018 Dr. Govind Bharwani. All Rights Reserved. 6
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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© 2018 Dr. Govind Bharwani. All Rights Reserved. 7
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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5/6/2018
© 2018 Dr. Govind Bharwani. All Rights Reserved. 8
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
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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© 2018 Dr. Govind Bharwani. All Rights Reserved. 9
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?