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Forget Me Not...Evaluation and Treatment of the Patient with Dementia, Part 1: Who, What and Why

Forget Me Not...Evaluation and Treatment of the Patient with Dementia, Part 1: Who, What and Why
Amber B. Heape, ClinScD, CCC-SLP, CDP
April 6, 2016

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Today, we will begin with the basics of dementia -- the who, what and why. We will classify dementia into types and look at the difference between reversible and irreversible dementia. We will distinguish the stages of dementia and outline risk factors to determine potential for cognitive decline in patients. In the upcoming three sessions of this series, we will delve into more in-depth information.

The aging population is one of the fastest growing populations in the United States. In 2013, the US Administration on Aging reported that one in every seven Americans could be classified as “elderly” (age 65 and older). At that time, they estimated that there were 45 million living Americans who could be categorized as elderly. By 2060, that number is projected to double to over 98 million.

Science and modern medicine has enabled the life span to increase. As the aging population grows, so does the number of people living with dementia and Alzheimer’s. In 2015, the Alzheimer's Association indicated that there were 5.1 million people over age 65 in the United States living with Alzheimer's Dementia. One out of nine people over 65 have Alzheimer’s disease. At age 85, that number increases to one in three (about 33%) who have Alzheimer's disease.

The World Health Organization reports that every 4 seconds, a new case of dementia is diagnosed. To illustrate, during this 90-minute course, 1350 new cases of dementia will be diagnosed; 7.7 million new cases worldwide every single year. It is the number one cause of disability and dependency in older adults. In 2010, the cost of dementia worldwide was estimated at $604 billion.

Dementia Defined

Although we often refer to dementia like it is a disease, it is important to clarify that dementia itself is not a specific disease -- it is a group of symptoms. Before we go any further, it is necessary to make that distinction between disease versus symptoms. To have a diagnosis of dementia, there needs to be a loss of function in at least two of the following five areas: language, judgment, memory, spatial ability or visual ability. There are also two primary categories of dementia that we will discuss: reversible and non-reversible.

Reversible Dementias

In many circumstances, dementia is reversible. I learned a mnemonic device during my certified dementia practitioner course to remember the different situations where dementia may be reversed, and it spells d-e-m-e-n-t-i-a. 

  • D - drug reaction, overdose, toxicity 
  • E - emotional disorders (depression) 
  • M - metabolic or endocrine (thyroid) issues 
  • E - eyes and ears (sensory loss) 
  • N - nutritional deficits 
  • T - tumors 
  • I - infection (sepsis, UTI, pneumonia) 
  • A - arteriosclerosis

Drug reactions, overdoses, or drug toxicity can cause dementia which may be reversed. Commonly, elders who are on multiple medications are at risk of poly-pharmaceutical side effects because of the number of medications they take. Emotional disorders, especially depression, can lead to symptoms of dementia which may be reversible. Metabolic and endocrine or thyroid issues can also lead to reversible dementias. Deafness, blindness or a decrease in either one of those sensory areas can cause symptoms of dementia. Nutritional deficits, and also tumors (whether cancerous or benign) can cause dementia symptoms. Infection is probably the most common cause that I witness in my practice with elderly population. Infections in the elderly (e.g., sepsis, UTI, pneumonia, gangrene) tend to cause sudden cognitive decline or sudden symptoms of dementia. Lastly, arteriosclerosis or coronary artery disease also may cause some reversible type dementias.

Non-Progressive Dementias

Traumatic brain injury can be categorized as non-progressive dementia, because it is an acute injury. It does not progress after that initial phase of TBI. Anoxia (lack of oxygen or respiratory distress) can cause non-progressive dementia that will not necessarily worsen over a long period of time. Finally, vascular dementia from a single CVA would not be considered progressive. We will discuss other types of vascular dementias a bit further along in this session.

Progressive Dementias

We refer to progressive dementias as non-reversible. However, later on in the series, I will address the fact that non-reversible does not necessarily mean non-rehabilitative. There are treatments and practices that have proven useful in patients exhibiting these dementias and symptoms. I will outline those rehabilitative practices in upcoming courses.

Non-reversible or progressive dementias include the following: 

  • Parkinson’s 
  • Multi-infarct or vascular dementias
  • Fronto-temporal 
  • Lewy Body 
  • Huntington’s Disease or Huntington’s Chorea 
  • Creutzfeldt-Jakob 
  • Korsakoff Syndrome 
  • Alzheimer's disease

Parkinson’s Disease (PD) Related Dementia

Over 50%, and as high as 80%, of people with Parkinson’s disease will experience dementia at some point during that disease process. The number one trigger for the development of PD-related dementia is stress. Typically, the timeframe between the original Parkinson’s diagnosis and the onset of Parkinson’s related dementia, is approximately a decade. Neuro-hallmarks (brain-related issues) that indicate Parkinson’s-related dementia are beta-amyloid plaques and tangles. We will discuss those in more detail later.

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amber b heape

Amber B. Heape, ClinScD, CCC-SLP, CDP

Amber is a dedicated advocate for the necessity and skilled nature of therapy services.  She is the Regional Clinical Specialist for a large healthcare company, where she works with SNFs in 3 states on documentation compliance, clinical education, and clinical programs for PT, OT, and ST. She co-authored the company Trach and Vent Program as well as the Dysphagia Program. 
 
Amber is a doctoral student at Rocky Mountain University of Health Professions, with a research focus on clinical supervision and student self-efficacy.  She is also an adjunct professor.  She has authored numerous continuing education courses and has presented at state and national conferences across the United States. Amber is a former SCSHA President and board member of the Council of State Association Presidents.  Amber’s clinical passion is serving the aging population, and making a difference in their quality of life.  She is a Certified Dementia Professional and volunteers with organizations that promote and preserve quality care in the elderly.  



Related Courses

Forget Me Not...Evaluation and Treatment of the Patient with Dementia; Part 1: Who, What, and Why
Presented by Amber B. Heape, ClinScD, CCC-SLP, CDP
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This is Part 1 of a four-part series, Forget Me Not…Evaluation and Treatment of the Patient with Dementia. Dementia involves a scope of etiologies, severities, limitations, and treatment strategies. In this series, we will discuss how to effectively evaluate and treat patients with a variety of dementia types and stages within evidence-based practice. An in-depth discussion of functional and meaningful therapy will occur. Part 1 will describe types of dementia, stages of dementia and various risk factors that can contribute to cognitive decline in patients. This course is open captioned.

Forget Me Not...Evaluation and Treatment of the Patient with Dementia; Part 2: Where and When
Presented by Amber B. Heape, ClinScD, CCC-SLP, CDP
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This is Part 2 of a four-part series, Forget Me Not...Evaluation and Treatment of the Patient with Dementia. The knowledge and ability to effectively stage patients with cognitive decline are important to SLPs and related professionals. This course will review levels of decline with characteristics and expectations of each, as well as assessments that are readily available to the therapist. This course is open captioned.

Forget Me Not...Evaluation and Treatment of the Patient with Dementia; Part 3: Evidence-based Treatments
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This is Part 3 of a four-part series, Forget Me Not…Evaluation and Treatment of the Patient with Dementia. Knowledge of dementia and stages of decline mean nothing if the therapist doesn’t know how to effectively treat the patient. This presentation will focus on evidence-based interventions recognized for use with patients in various stages of cognitive decline. Effective documentation of skilled services will be reviewed based on Global Deterioration Scale (GDS) stages. This course is open captioned.

Forget Me Not...Evaluation and Treatment of the Patient with Dementia; Part 4: Bringing it All Together - Functional Therapy and Caregiver Education
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This is Part 4 of a four-part series, Forget Me Not…Evaluation and Treatment of the Patient with Dementia. Functional and meaningful therapy is key in an effective dementia treatment program model. This course will give specific examples of therapy activities to address multiple goals. Caregiver education examples and environmental modifications appropriate for patients with dementia will complete the discussion. This course is open captioned.

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