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Improving Functioning i Alzheimer’s Disease Exploring the Influence of Music Elena Kronmiller Psychopathology

Psychopathology virtual project

Feb 19, 2017


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Improving Functioning in Alzheimers Disease

Exploring the Influence of MusicElena KronmillerPsychopathology

First, take a look at how Alzheimer's affects the brain:

Three Stage Model:

Stage 1: Mild/Early (2-4 years)

Stage 2: Moderate/Middle (2-10 years)

Stage 3: Severe/Late (1-3+ years)

Healthy Brain vs Severe Alzheimers Disease v=yJXTXN4xrI8

Quick overview on how brain changes happen:

Lets take a look at the three stage model.

Stage 1 (lasts 2-4 yrs):Frequent short-term memory lossRepeated questionsSome problems expressing and understanding languageMild coordination problems: writing and using objects becomes difficultDepression and apathy can occur, accompanied by mood swingsNeed reminders for daily activities, and may have difficulty driving

Stage 2 (lasts 2-10 yrs):Can no longer cover up problemsPervasive and persistent memory loss, including forgetfulness about personal history and inability to recognize friends and familyRambling speech, unusual reasoning, and confusion about current events, time, and placeMore likely to become lost in familiar settingsSleep disturbances and changes in mood and behavior, which may become aggravated by stress and changeDelusions, aggression and uninhibited behaviorMobility and coordination is affected by slowness, rigidity, and tremorsNeeds structure, reminders, and assistance with activities of daily living

Stage 3 (lasts 1-3+ yrs):Confused about past and presentLoss of ability to remember, communicate, or process informationGenerally incapacitated with severe to total loss of verbal skillsUnable to care for selfFalls possible and immobility likelyProblems with swallowing, incontinence, and illnessExtreme problems with mood, behavior, hallucinations, and deliriumWill need round the clock intensive support and careMore information about the three stage model:

Visual Representation

Current TreatmentFocus on slowing the diseaseMedications treatment (Which tends to focus on avoiding triggers) to manage sleep changes treatment (none of which is FDA approved)

Alzheimers in the CommunityAlzheimers is frequently confused for normal aging and frequently goes undiagnosed When it is diagnosed, the disease is often misunderstoodFamilies and communities dont recognize the severity of the persons brain death so the person is frequently blamed for their symptomsWhy cant he/she just remember my name?I think he/she sometimes does ___ on purposeThe elderly in Western society experience a loss of respect in the communityThis loss of respect is magnified if the person is also suffering from AlzheimersPerson with Alzheimers tends to lose both their support systems and physicality at the same time, which can be devastating. Support systems: Friends, family, sense of selfPhysical systems: Vision, hearing, balance, cognition How Im preparing for Alzheimers

Family DynamicTypically, families/loved ones will attempt to care for the person with Alzheimers during the beginning phases of the diseaseBegin to be viewed by caregivers as hopeless, frustrating, extremely difficult to manage and useless as their disease progressesCan be frustrating because the person with Alzheimers will come in and out of episodes and timing can be unpredictableThis sometimes leads to blaming and I know he/she can do that kind of thinking when the person with Alzheimers has trouble with usual tasksFamilies often make the decision to send their loved one into assisted care once their needs become too difficult to manage (often because of incontinence)As person begins to progress into the later phases of the disease, families may stop visitingEither because their loved one has stopped recognizing their face and name and they dont see the value in visiting (perhaps too busy)Or because it has become too painful to be around a loved one who doesnt know who they are (sometimes this is taken very personally by family members and loved ones)

The following video is a good representation of a few things:How difficult it can be for caregivers. How little we know about the disease. The loss of connection and understanding that often happens between the person suffering from dementia and their caregivers. Take note of the I know he/she can do that kind of thinking.

PseudodementiaThe syndrome in which dementia is mimicked or caricatured by functional psychiatric disorders For more information about pseudodementia: in the elderly can look very similar to AlzheimersShort-term memory lossIrritabilityForgetfulness Once depression is cured, if the symptoms were due to the depression and not a form of dementia, symptoms will go away and person will return to normal functioning. Alzheimers and depression are often comorbid. Consider the implications of a person suffering from both.Work towards diminishing depression symptoms and there should be some improvement in overall symptoms

As you can see, it can be difficult to parse out what symptoms are due to depression and which are due to Alzheimers and other forms of Dementia.

What about music?

Musical Therapy in Alzheimers can:Aid in memory recallCause positive changes in moods and emotional statesProvide a sense of control over lifeManage pain and discomfort without medicationStimulate interest even when other approaches are ineffectivePromote rhythmic and continuous movement or vocal fluency as an adjunct to physical rehabilitationProvide opportunities to interact sociallyRecollection through sound article:

Effect of Music on DepressionSiedliecki and Good: Found that groups given music experienced more power and less pain, depression and disability than the control groupAlso found that there were no differences between giving a person a researcher provided music vs subject-chosen musicSo, allowing those with Alzheimers to listen to music may diminish depression symptoms and therefore diminish pseudodementia symptoms for Memory Recall, Henrys Story:

Social InteractionListening to, playing instruments, and singing can all provide socialization opportunities to those with AlzheimersWith each other With care giversFamily is more inclined to visit if they have a way of connecting with a loved onePlaying music from the individuals past may spark memory recallMusic can often improve moodLess of a need for heavy drugs= easier interactionSomething for the family to focus on

Implications for Reduction in Medication:

Why does it work?Thought to offer a back door to memory retrievalPeople with Alzheimers do not lose things like rhythm or automatic responsesHearing and speech components are located in specific places of the brain, and thus DO get lostThis is why people with Alzheimers can often still swear at you, perform quick small talk (Hi, how are you? Im good, how are you?) but cant remember your name or how to brush their teeth.This is also why they can enjoy and remember music

Integrating Musical Therapy into Nursing HomesMusical group therapyFlexible! Can be singing, live music, or recorded audioEncourages socializing with other residentsCare givers can encourage residents to move along to music as a form of exercise This is much more effective than other forms of exerciseIssue: Residents in final stages may not be mobile enough to get thereCustomized iPods that works to provide people with personalized iPods Insurance companies still unwilling to cover this

Research SupportGutin et al: Effect of Music Therapy on Anxiety and Depression in Patients with Alzheimers Type Dementia: Randomized, Controlled Study. These results confirm the valuable effect of music therapy on anxiety and depression in patients with mild to moderate Alzheimers disease. Aldridge: Alzheimers Disease: rhythm, timing and music as therapy. Mood improvement, self-expression, the stimulation of speech and organization of mental processes; and sensory stimulation and motor integration are promoted.

Informative Links clinics tips for choosing and using music and Memory website- where you can donate iPods to nursing homes activities for a loved one with Alzheimers information on how to incorporate music in each stage of the illness

Explicit Question-Answering SlidesAKA: Blatant butt-covering

1. How is mental health and illness depicted in society?

People who live with Alzheimers are depicted slightly differently than people who live with other mental illnesses. The word Alzheimers isnt attached to the same level of stigma as words like depression or anorexia, for example. Even though these words can be quite taboo and fetch negative reactions from the public, they do come along with a sense of hope. Those with Alzheimers arent so lucky. I believe that this happens for 2 reasons. Firstly: there is no out for those with Alzheimers. Unlike other mental illnesses, Alzheimers is always terminal. Secondly: ageism. The elderly in our society are not viewed with the same respect as they are in other cultures. This leads to helpless attitudes and thousands of poorly run nursing home and assisted living facilities. Misunderstandings about the nature of the disease also contribute to these negative depictions- instead of being viewed as sick, people are viewed as being crazy, weak, helpless, and are viewed with pity.

2. What messages about mental health and illness are displayed through these depictions?

The hopelessness associated with having Alzheimers plays out very negatively for those living with the disease. The messages about mental health displayed through these depictions show a general attitude of giving up on those with Alzheimers. This is especially clear during the later stages of the disease when most families stop visiting and most nursing homes dont show these people the respect they deserve. People are frequently overmedicated to manage mood swings, left in their rooms by themselves, and not cleaned up properly. The message is clear- people with Alzheimers are not worth our time of effort.

3. What does this mean to me?/ How does this affect me?

As someone who is planning on working with older adults, this topic is incredibly important to me. Dementia affects 25 million people worldwide, most of whom suffer from Alzheimers. It hardly seems fair that such a devastating and common disease has received so little research support and is so badly misunderstood by the public. Ive done a lot of work in assisted living and am passionate about being better able to care for those with Alzheimers and educate their families. Partly what drives me so crazy about this is that including musical therapy in nursing homes is an easy and cheap way to better engage residents without weighing them down with heavy medications. However, there has still been push back, partly due to insurance companies making so much money from nursing homes, and partly due the aforementioned lack of respect for those with Alzheimers. It is just easier to feed them a benzo.

4. What implications does this have for therapists and psychologists working with individuals with mental health problems?

Therapists working with a person suffering with Alzheimers might want to consider a few different things. First of all, one of the most helpful things may be to involve family members in therapy. There is likely to be a lot of hurt and confusion (and a lack of understanding around the illness) and in order to ensure that the client receives the best care later in life, involving the family could be essential. Group therapy has also been shown to be helpful. Therapists should keep in mind that often the individual is not as bothered by their diagnosis as those around them. Therapists should also keep in mind that if they suspect an individual is in the beginning stages of the illness, it might be a good idea to have them evaluated by a professional. If their symptoms are caught early certain medications (e.g. Namenda) can be used to significantly slow the illness.