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Dementia Therapy Essentials for the Speech Pathologist

Speaker: Peggy Watson M.S., CCC-SLP

www.consultantsindementiatherapy.com

JOIN THE CONVERSATION onfacebook.com/consultantsindementiatherapy

DisclosureRelevant financial relationship

I have relevant relationships in the products or services described, reviewed, evaluated or compared in this

presentation.

Presentation based on book titledDementia Therapy & Program Development

Owned by Consultants in Dementia Therapy PLLC (CDT)CDT is co-owned by

Peggy Watson M.S., CCC-SLP Owners receive royalties from sale of said book.

Dementia diagnosis requirements:

- Impairment of memory and at least one other cognitive domain

- Represent a decline from previous level of functioning

INTRODUCTION

Types and Causes of

Dementia

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ALZHEIMER’S DEMENTIA

Hallmark Presentation:

-Gradual onset and continuing

decline of memory and

cognition.

-Frontal and temporal lobes

as well as the hippocampus

(memory) are characteristically

most affected.

BRAIN TOURhttp://www.alz.org/brain/01.asp

VASCULAR DEMENTIA

Hallmark Presentation:

-Step-wise decline pattern -

sudden cognitive deficits after

an event, then a plateau with

no changes until the next

ischemic event.

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Also called ‘Picks Disease’

Three Main Presentation Types:

1. Personality

2. Behavior

3. Language

4. Memory later

FRONTOTEMPORAL DEMENTIA LEWY BODY DEMENTIA

Hallmark Presentation:- Visual hallucinations - Memory loss- Cognitive dysfunction/dementia

typically at initial phase of disease- Parkinsonism (rigidity, gait disorder...)typically after dementia

A progressive degenerative

disease classically affecting

motor control first causing:

tremors

balance

gait problems

rigidity

Dementia typically later

PARKINSON’S DISEASE PSEUDODEMENTIASILLNESSES THAT MIMIC DEMENTIA

SOME EXAMPLES TO CONSIDER

-Chronic Malnutrition

-Chronic Dehydration-Alcohol Abuse (Wernike-Korsakoff)-Infectious Diseases-HIV-Depression-Brain Tumors-Thyroid Dysfunction-Medications

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Medication related dementia:

*Anti-depressants

*Anti-epileptics

*Antihistamines (e.g., Benadryl,

cold and flu medications with

antihistamine component)

* Antihypertensives

*Pain medications

*Sleep aids

Short-Term Memory

- Immediate Memory

- Working Memory

LONG TERM MEMORY

- Episodic Memory

- Semantic Memory

- Procedural Memory

Global Deterioration Scale for Dementia(outline)

Dr. Barry Reisberg, et. al. 1982

Stage 1: No Cognitive Decline

Stage 2: Minimal Cognitive Decline• forgetting where one has placed a

familiar object• forgetting names one formerly knew well

Stage 3: Mild Cognitive Decline

• word and name finding deficit evident on clinical interview

• patient may have gotten lost when traveling to unfamiliar location

• co-workers may become aware of patient’s relatively poor performance

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Stage 4: Moderate Cognitive Decline

• decreased knowledge of current and recent events

• may exhibit some deficit in memory of one’s personal history

• concentration deficit elicited on serial subtractions

Stage 5: Moderately Severe Cognitive Decline

• patient can no longer survive without some assistance

• patient is unable during interview to

recall a major relevant aspect of their

current lives

• frequently disoriented about time (date, day of week, season, etc)

Stage 6: Severe Cognitive Decline

• may occasionally forget the name of the spouse upon whom they are entirely dependent

• diurnal rhythm frequently disturbed

(diurnal=active during the daytime)

• frequently continue to be able to distinguish familiar from unfamiliar persons in environment

Stage 7: Profound Cognitive Decline

• verbal abilities lost

• incontinent, requires assistance toileting and feeding

• loses basic psychomotor skills (ex:

ability to walk)

• the brain appears to no longer tell the body what to do

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Suggested Evaluation/Staging Tools

• FLCI: Functional Linguistic Communication Inventory

• ABCD: Arizona Battery for Communication Disorders of Dementia

• FROMAJE: Function, Reason, Orientation, Memory, Arithmetic, Judgment & Emotional Status

• FAST: Functional Assessment Staging Test

• GDS: Global Deterioration Scale

Establishing Medical Necessity

#1: Identify Functional Change

Represents a change in the person’s ability to perform an ADL.

ST examples of functional change

-Increasingly confused, disoriented

-Change in memory-Impaired safety and judgment-Change in swallowing safety-Difficulty chewing-Change in orientation-Increased confusion-New or increased wandering without purpose

*Chart notes reflect

functional change in status.

*Chart notes reflect an ‘event’.

*Functional change should be accompanied by an ‘event’.

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Potential Events:

-Illnesses

-Exacerbation of chronic conditions

-Other

Developing Goals

Always relate goals to functional outcomes

All goals should be:

a) functional for the patient’s capabilities according to staging

b) Skilled, Measurable, Attainable, Reasonable and Necessary. (S M A R N)

• Mobility

• Communication

• Socialization

• Behavior

MobilityLTG: Utilize pts spared skills for ambulation safety, reduced risk of falls and max mobility independence by mastery of the objectives.

STG: Decrease demands on working memory related to ambulation with rolling walker to ensure safety and decrease fall risk over 50 ft using min verbal and 3 visual cues 5/7 sessions.

Daily Note: Intervention/Modality Statement

Utilized procedural memory along with ongoing

development of AAC. SLP provided 2 visual cues along with max verbal instruction to achieve ambulation safety for 10 ft with rollingwalker.

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CommunicationLTG: Pt will utilize a communication system compatible with spared skills to ensure adequate expression of basic & medical needs by mastery of the objectives.

STG: Pt. will participate when episodic memory is cued to increase appropriate communication exchanges 10/10 times in a session and decrease verbal preservations to 2 over 5 sessions.

Daily Note: Intervention/Modality Statement Augmentative alternative communication (AAC)e.g., memory book, was used to increase the patients communication to 5 of 20 opportunities within a session and reduced perseverations to 8.

Socialization

LTG: Pt. will utilize spared skills to decrease isolation through activity attendance and improve quality of life by mastery of objectives.

STG: Pt. will attend 1 meaningful activity with others utilizing mod prompts and cues for 30 minutes to decrease isolation 5 of 5 sessions.

Daily Note: Intervention/Modality Statement Validation and reminisce were evidence-based interventions utilized to increase socialization to 2 activities for 10 mins each.

BehaviorLTG: The patient will decrease affective behaviors for improved quality of life and safety within the environment by mastery of the objectives.

STG: Pt. will participate in 1 activity within a social setting and decrease verbal outbursts to 1 per session, 5/5 sessions for improving behavior and quality of life.

Daily Note: Intervention/Modality Statement Montessori evidence-based intervention along with calm environment, choices and one step commands decreased verbal outbursts to 3 per session.

Developing Interventions

Sensory

Reminiscence

Validation

Spaced Retrieval

Montessori Therapy

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Sensory Intervention (Burns, Byrne, Ballard, Holmes, 2002)

Sensory interventions involve the

patient’s sense of touch, taste,

hearing, smell or sight, or some

combination of these.

Alive InsideDramatic Effects of Music!

www.musicandmemory.org

www.youtube.com/watch?v=QG7X-cy9iqA

Reminiscence Therapy(Chiang, Chu, Chang, et al., 2010)

Refers to a collection of memories

from the past.

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Think Back When Questions

1. Did you have a favorite pet?

2. What were you doing when you

were 21 years old?

3. What was your first car?

4. Which parent had the most

influence on you?

5. Who was your favorite comedian?

Spaced RetrievalCameron Camp PhD et al.

Gradually increases the interval

between correct recall of target items.

Montessori for Dementia Montessori Based Programming for Dementia®

Developed by Cameron Camp, PhD

Guided by the principles of Dr. Maria Montessori who claimed that children who were engaged and interested in what they were doing did not exhibit problematic behaviors such as pushing, screaming or acting out in inappropriate ways.

Connecting past interests and skills with the present spared skills and needs of the patient

Montessori

Evidence-Based Interventionvideo

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Examples of

Montessori Treatment Activities

1. Sorting buttons

2. Rolling balls of yarn

3. Sorting sugars

4. Sorting nuts and bolts

5. Sorting fabrics

6. Flower arrangements

7. Sorting socks

8. Clipping coupons

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Validation TherapyNaomi Feil 1980

Communicating with a person with dementia by validating and respecting their feelings.

Thank You!Your CDT Team:

Peggy Watson M.S., CCC-SLP

Nancy Shadowens M.S., CCC-SLP

Consultants In Dementia Therapy PLLC

www.consultantsindementiatherapy.com

JOIN THE CONVERSATION ON FACEBOOK

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