Model of Psychological Intervention in Dementia Care Polly Shepard, Psy.D. Corby Bubp, Ph.D. Clinical Neuropsychology/Psychology.

Model of Psychological Intervention in Dementia Care

Polly Shepard, Psy.D. Corby Bubp, Ph.D.Clinical Neuropsychology/Psychology

LearningDisability

Assessment

IndividualTherapy

CareerCounseling

CustodyEvaluation

CompetencyEvaluation

ParentCoordination

BiofeedbackTherapy

Neuropsychological Assessment

Marital/FamilyTherapy

PsychiatricAssessment

PPS

The Memory Clinic of IndianapolisProvide compensatory strategies and

recommendations for home and schoolIdentify potential barriers for decision

making in daily living (e.g. independent living, driving, financial decision making, etc.)

Provide assessment, consultation, and testimony for issues related to competency and brain-related impairments.

The Memory Clinic of Indianapolis

Pediatric and Adult Neuropsychological EvaluationsPsychoeducational EvaluationsTo determine Learning Disorders and AD/HD

Evaluate cognitive strengths and weaknesses in chronic medical diagnosesPre-and post-concussion/TBI evaluationsSchool readiness/private school admission evaluationsDistinguish neurological vs. emotional/psychiatric syndromes

What is a Neuropsychologist?Neuropsychology =

study of brain-behavior relationshipsEducational requirements

1. Ph.D./Psy.D. in Psychology with emphasis in neuropsychology

2. Doctoral level internship with 50% devotion to neuropsychology

3. 2 year fellowship/residency in neuropsychology

4. Board certification in Clinical Neuropsychology by the American Board of Professional Psychology (ABPP)

Overview

Treatment/Interventions

ConsultationDiagnostics

Referral ProcessMedical

MD

Director of

Nursing

Family

Social Worker

Referral Triggers1. Prior Psych Diagnosis2. Psychotropic/Sedative

use3. Behavioral Issues4. MDS Trigger5. Staff-patient interaction6. Non-compliance with

Treatment7. Substance/Medication

abuse8. Cognitive/Behavioral

change

Treatment and InterventionsCounseling/therapySupportive/

emotionalCognitive behavioral

Treatment and InterventionsBehavioral-based Interventions

WanderingSleep managementHallucinationsPhysical/Verbal abusive behaviors

Treatment and Interventions

Cognitive RehabilitationACTIVEImpactTailored

intervention

Cogmed

DiagnosticsScreen/Full Neuropsych AssessmentTesting instruments designed to evaluate:

Cognitive (IQ, Memory, Attention, Problem Solving, Insight, Executive Functioning, Language, Motor Skills, Judgment, Speed of Thought, etc.)Emotional (Depression, Anxiety, Post Traumatic Stress Disorder, Manic episodes, etc.)Personality (Impulsivity, Recklessness, Lack of Motivation, Apathy, Withdrawal, etc.)

Diagnostics

Diagnostics guide recommendations for:Differential diagnosis (Dementia/Delirium/Depression)Treatment planningAbility to handle finances (bills, checkbook, plan, vulnerable to scam artists) Ability to make medical/legal/financial decisionsAbility to drive (Poor reaction time, spatial neglect, mentally plan for driving in high traffic conditions)Medication effectiveness (tracking cognitive/emotional/behavioral)

Memory: Word List Learning

1. Butter

2. Arm

10. Engine

Trial 1

1. Butter 1. Butter

2. Arm 2. Arm

10. Engine 10. Engine

Trial 2 Trial 3

Recognition Recall

Delayed Recall

1.

2.

10.

1. Target

20. Distractor

Memory Performance in Normals and Patients with Mild Dementia

0123456789

10

WLL R

aw

Score

Trial 1 Trial 2 Trial 3 Delay

Normal

Demented

ConsultationEnvironmental/

Physical design of facility

Behavioral management strategies for staff

Stress managementPrevention of staff

burnoutResearch-based

program design

LimitationsMedical cultureEnvironmental logisticsInsurance/reimbursementCommunication/LanguageTraining opportunities

Questions1. What do facilities want from us2. How can we better address limitations3. What is the best way to educate facilities

about psych/neuropsych services