2016‐05‐13 ADUL ULT C T COGNITION & GNITION & DEMENTIAS NTIAS D R S D R S A R A H G R G R E E R , R . P S Y C H P R A P R A C T I C E I N C E I N C L I N I C A L A N D C L I N I C A L A N D N E U R N E U R O P S O P S Y C H O L C H O L O G O G Y N O R T H S H O R E N O R H S H O R E S T R E S S & R E S S & A N X I E T A N X I E T Y C L I N I C Y C L I N I C COGNITIVE CHANGES AND DEMENTIAS What would you like to know? What questions do you have about aging & the brain? About dementia? AIMS OF TODAY’S SESSION To thin think about about what what kin kinds of of cogn cognitive change changes we can can expe perience ce as as we gr grow older older, bo both with without and with and with a a deme dementi ntia. . To tal talk about the cau about the causes of of dement dementia ia and ho and how w deme dementi ntia can af can affect ct the the bra brain, and ho and how w psy psycho hologists are are in involved in the diagnos in the diagnostic ic pr process. To under derstand ho nd how ha having ving de dementia mentia ca can a affect a a person’s b on’s beha haviour viour. Thin Think abou about ho how w peop people with with deme dementia can can best best be be supp supported. North Shore Stress & Anxiety Clinic (nssac.ca) 1
2016‐05‐13 HO HOW DOES THE DOES THE BRAIN CHANGE BRAIN CHANGE AS AS WE WE GROW OLDER GR OLDER? Some s small I ll IQ c changes, b s, but ov overall m all minimal d mal decline. ine. Some Some chang changes are are norm normal al! F For e r exam ample: We are relatively slower in our thinking. We are relatively more forgetful. Changes can occur in both our visual and verbal memory. Changes can occur in several areas of cognition: executive skills (planning, organising, prioritising), visuo-spatial skills, and language fluency. CHANGING BRAINS CHANG NG BRAINS IN IN OLDE OLDER ADUL R ADULTS TS Some d me degree o gree of ch change is ange is acceptable! acceptable! However, some c me changes anges a are cons nsidered be idered beyond nd the “ “normal” ra ormal” range f e for t r the g general p neral population. pulation. “Signi “Si nifi ficant cha change ges” s” are are thos those that that are are measured as bein mea as being g statistically tically differen erent f t from th om the normal nor al pop popula lation. WHAT IS A DEMENTIA? Gr Group e exer ercise: Turn to the people around you and think about what you think dementia is/definition of dementia. How does it affect people? North Shore Stress & Anxiety Clinic (nssac.ca) 2
2016‐05‐13 WHA WHAT IS DEMENT IS DEMENTIA? Dement mentia i ia is an umbrel brella t la term. I rm. It d describes scribes t the symptoms c caused w used when th en the bra brain i n is a affect cted b ed by specif ecific d ic diseases a seases and condit nditio ions. ns. The f The follo llowing area areas can be can be af affected: •Memo Memory • Cognition ition • Lang Langua uage ge • Beha Behavi viour our • Emoti Emotions ns TYPES O TY OF DEMENTIA There a ere are m many d different ty erent types o of d dementia, mentia, incl including: Alzhe Alzheimer’ r’s Dise Disease Vascular d scular disease sease Dem Dement ntia of the mix of the mixed d type type Dem Dement ntia with le with lewy wy bodi bodies Fronto-t -tem empo pora ral d l dementia mentia A FEW FACTS… • Dementi ntia is is most comm most common in older in older adults adults; ; ho however it r it can affect can af ct indivi individual als of of an any age (McLe y age (McLennon, n, 1 1999) 999). • Alzhe Alzheimer’s Dis Disease is is the most the most commo common n type type of of de dementia mentia (W (Wilson ilson et et al., 20 2011). ). • 747,00 000 C 0 Canadians a ans are living w ng with A Alzheimer's eimer's Disease a ase and d dement ntia, , with t this n number mber expected t ed to in incre crease t to 1.4 milli 4 million on in in less less than 20 than 20 year ars (Alzheimer’s S heimer’s Society o ety of Canada). ). • Gr Growing e evide idence ce sugg suggests that that brai brain chang changes resulting i sulting in d dementia c ntia can b begin 2 n 25 years s before symptoms appe sym appear. North Shore Stress & Anxiety Clinic (nssac.ca) 3
2016‐05‐13 THE BRAIN THE BRAIN & & DEMENT DEMENTIA IA • A lo lot t of the of the b brain is in is involved in the in the re retention n and d retrie re trieval of l of memorie memories. • The hipp The hippocampus regi region is is sign significant in in proces essin sing a and enabling u ng us to s store e memori ries es (the (the “sa “save butt button”) ”). • Brai Brain scans (e.g. CT n scans (e.g. CT, fMR , fMRI or or PET PET) f for r peop people le dia diagno nosed w with th Alz Alzheimer's d mer's disease sease usually lly shows e sho evid idence of of da damage in/ in/deterioration in in thi this region region, as as well as as possible possible o overa erall shrin ll shrinkag age (atr (atrop ophy). Cerebral Lobes Occipital —visual information (visual cortex) Parietal —information about touch (sensory cortex), Temporal —hearing (auditory cortex), language (Wernicke’s area), Frontal —planning, judgment, memory, reasoning, abstract thinking, movement (motor cortex) North Shore Stress & Anxiety Clinic (nssac.ca) 4
2016‐05‐13 In the Alzheimer's brain: • The cortex shrinks, leading to damage in areas involved in thinking, planning and remembering. • Shrinkage is especially severe in the hippocampus, an area of the cortex that plays a key role in formation of new memories. • Ventricles (fluid-filled spaces within the brain) grow larger. UNDERST DERSTAND NDING THE ING THE TYPES O PES OF DEMENT DEMENTIA IA Alzheimer’s D eimer’s Disease ase – chemistry and structure of the brain changes leading to the death of brain cells. Plaques & tangles (amyloid plaques and neurofibrillary tangles) accumulate; impairs communication between cells. Vascu scular Disea Disease – – associated with problems of circulation of oxygenated blood to the brain leading to death of brain cells. Dem Dementia wi with Lewy wy Bod Bodies – – deposits of protein cause brain cells to die. Fr Fronto-temporal D Dementia – damage to brain cells is usually focused on the front side of the brain. 14 ALZHEIMER’S DISEASE (HIPPOCAMPAL ATROPHY) North Shore Stress & Anxiety Clinic (nssac.ca) 5
2016‐05‐13 ALZHEIMER’S DISEASE (GLOBAL ATROPHY) PLAQUES & TANGLES CT SCAN OF VASCULAR DEMENTIA North Shore Stress & Anxiety Clinic (nssac.ca) 6
2016‐05‐13 MRI SCAN OF FRONTO-TEMPORAL DEMENTIA THOUG THOUGHT EXER T EXERCI CISE SE You have gone on holiday with a group of friends to a foreign country. You go on a coach trip the morning of the day you are due to fly home. Whilst you are there, you lose your friends and miss the coach back to the hotel. You cannot remember the name of the hotel. You realize that your passport is at the hotel. You realize that you do not have any money. You don’t know the language, and you can’t find anyone who speaks English. You look at y u look at your w ur watc tch and y h and you real u realize that that y you u are going ar e going t to miss miss y your flig flight home. ht home. • Wh What do do y you thin think? • How How do do you f you feel? eel? • What do Wh do you do you do? HOW ARE HO W ARE MEMOR MEMORY CHANGES CHANGES EXPERIENCED? EXPERIENCED? Easier to remember things from a long time ago Harder to grasp new ideas Feeling uneasy in new surroundings Forgetting things you have either said or done Difficulties finding words or using the right words (expressive dysphasia) Struggling to make sense of what people have said (receptive dysphasia) Difficulties reading Struggling to make plans, decisions or solve problems Poor concentration/distractible And many more… North Shore Stress & Anxiety Clinic (nssac.ca) 7
2016‐05‐13 EMO EMOTIONA IONAL CHANG L CHANGES Some or Some or all of all of these can these can be be expe perienced: d: • Anxiety • Tearfulness • Frustration and irritation • Anger • Happiness • Feeling “blank” • Difficulty in understanding others’ emotions and expressing own emotions BEHAVIOU BEHA VIOURAL CHANGES WITH DEMENT RAL CHANGES WITH DEMENTIA IA Hiding & Losing Hallucinations Incontinence Agitation /Apathy Noisy Walking Repetition Angry Behaviour Disorientation Delusions DISPELLING MYTHS Vi Vitami tamins ns s supplements a pplements and m memo mory bo boos osters rs can p prevent d ent dement mentia? ia? Sudo Sudoku or or brai brain n traini training (e. (e.g. L Lumosity) can can prevent dem pre dement ntia? Taki king a ng aspirin m rin might h ght help? Heal alth thy l lifestyle? style? E Exer ercise? cise? Fami mily hist history mean y means s I’ll de I’ll develop p Alzhe Alzheimers? rs? North Shore Stress & Anxiety Clinic (nssac.ca) 8
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