Evaluations We deeply value your feedback, and will utilize it in the ongoing development of our courses and services

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DEMENTIA CARE UPDATE

JOSH ALLEN, RN, C-AL

• National trends and statistics

• The brain

• Disease overview

• Research update

• Care trends and best practices

• Risk Management

AGENDA

Trends and Statistics

42%of residents living in assisted living have Alzheimer’s disease or another form of dementia

Source: National Survey of Residential Care Facilities

Source: National Survey of Residential Care Facilities

Source: Alzheimer’s Association, Facts and Figures

Alzheimer's disease is the sixth leading

cause of death in the United States.

More than 5 million Americans are living

with the disease.

1 in 3 seniors dies with Alzheimer's or another dementia.

In 2012, 15.4 million caregivers provided

more than 17.5 billion hours of unpaid care valued at $216 billion.

Nearly 15% of caregivers for people with

Alzheimer's or another dementia are long-

distance caregivers.

In 2013, Alzheimer's will cost the nation $203

billion. This number is expected to rise to $1.2

trillion by 2050.

www.alz.org

• An estimated 5.2 million Americans have Alzheimer's disease

• Approximately 200,000 individuals younger than age 65 have younger-onset Alzheimer's.

• By 2025, the number of people age 65 and older with Alzheimer's disease is estimated to reach 7.1 million

• By 2050, the number of people age 65 and older with Alzheimer's disease may nearly triple to a projected 13.8 million

PREVALENCE


• 6th leading cause of death in the United States overall

• 5th leading cause of death for those aged 65 and older

• The only cause of death among the top 10 in America without a way to prevent it, cure it or even slow its progression

• Deaths from Alzheimer's increased 68 percent between 2000 and 2010, while deaths from other major diseases, including the number one cause of death (heart disease), decreased

MORTALITY



• Ambiguity about the underlying cause of death can make it difficult to determine how many people die from Alzheimer's

• There are no survivors: if you do not die from Alzheimer's disease, you die with it

• One in every three seniors dies with Alzheimer's or another dementia

MORTALITY


• In 2012, 15.4 million family and friends provided 17.5 billion hours of unpaid care

• Care valued at $216.4 billion

• 80% of care provided in the community is provided by unpaid caregivers.

• More than 60 percent of Alzheimer's and dementia caregivers rate the emotional stress of caregiving as high or very high; more than one-third report symptoms of depression

IMPACT ON CAREGIVERS


• In 2013, the direct costs will total an estimated $203 billion

• Including $142 billion in costs to Medicare and Medicaid

• Total payments for health care, long-term care and hospice for people with Alzheimer's and other dementias are projected to increase from $203 billion in 2013 to $1.2 trillion in 2050 (in current dollars)

COST TO THE NATION



The Brain

• Cerebrum: remembering, problem solving, thinking, and feeling, also controls movement

• Cerebellum: controls coordination and balance

• Brain stem: connects the brain to the spinal cord and controls automatic functions such as breathing, digestion, heart rate and blood pressure

THE BRAIN

Frontal Lobe

THE CORTEX

Parietal Lobe

Temporal Lobe

Occipital Lobe

ALZHEIMER’S DISEASE


Source: Alzheimer’s Association

NEURONS

• Fruit Fly: 100 thousand neurons

• Cockroach: One million neurons

• Mouse: 75 million neurons

• Cat: One billion neurons

• Chimpanzee: 7 billion neurons

• Elephant: 23 billion neurons

HUMANS: 85 BILLION NEURONS

• A nerve cell that is the basic building block of the nervous system

• Specialized to transmit information throughout the body

• Communicating information in both chemical and electrical forms

• Sensory neurons carry information from the sensory receptor cells throughout the body to the brain

• Motor neurons transmit information from the brain to the muscles of the body

• Interneurons are responsible for communicating information between different neurons in the body

NEURONS

Dendrite

CHEMICAL AND ELECTRICAL MESSAGES

Cell body

Axon

• The information must be transmitted across the synaptic gap to the next neuron

• Neurotransmitters

• Chemical messengers that are released from the axon terminals to cross the synaptic gap and reach the receptor sites of other neurons

SYNAPSE

• Acetylcholine: Associated with memory, muscle contractions, and learning. A lack of acetylcholine in the brain is associated with Alzheimer’s disease.

• Endorphins: Associated with emotions and pain perception. The body releases endorphins in response to fear or trauma. These chemical messengers are similar to opiate drugs such as morphine, but are significantly stronger.

• Dopamine: Associated with thought and pleasurable feelings. Parkinson’s disease is one illness associated with deficits in dopamine, while schizophrenia is strongly linked to excessive amounts of this chemical messenger.

NEUROTRANSMITTERS

Disease Overview

CHECK FOR UNDERSTANDING:

What is the difference between dementia and Alzheimer’s disease?

• Not a specific disease

• A general term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities

• Alzheimer's disease accounts for 60 to 80 percent of cases

• Vascular dementia, which occurs after a stroke, is the second most common dementia type

DEMENTIA


DEMENTIA

Alzheimer’s Disease Vascular Dementia

Lewy Body

Parkinson’s Disease

Frontotemporal

Mixed Dementia

• Symptoms of dementia can vary greatly

• At least two of the following core mental functions must be significantly impaired to be considered dementia:

• Memory

• Communication and language

• Ability to focus and pay attention

• Reasoning and judgment

• Visual perception

SYMPTOMS


• Depression

• Medication side effects

• Infection

• Excess use of alcohol

• Thyroid problems

• Vitamin deficiencies

OTHER CAUSES OF COGNITIVE CHANGES


• There is no one test to determine if someone has dementia.

• Medical history

• Physical examination

• Laboratory tests

• Characteristic changes in thinking, day-to-day function and behavior associated with each type

• Can determine dementia with a high level of certainty

• Harder to determine the exact type

DIAGNOSIS


Symptoms:

• Difficulty remembering names and recent events

• Apathy and depression

• Impaired judgment

• Disorientation

• Confusion

• Behavior changes

• Difficulty speaking, swallowing and walking



Brain changes:

• Deposits of the protein fragment beta-amyloid (plaques) that build up between brain cells

• Twisted strands of the protein tau (tangles) that build up inside cells

• Evidence of nerve cell damage and death in the brain



STAGES


Stage 1 No impairment The person does not experience any memory problems. An interview with a medical professional does not show any evidence of symptoms of dementia.

Stage 2 Very mild cognitive decline The person may feel as if he or she is having memory lapses — forgetting familiar words or the location of everyday objects. But no symptoms of dementia can be detected during a medical examination or by friends, family or co-workers.

Stage 3 Mild cognitive decline Friends, family or co-workers begin to notice difficulties. During a detailed medical interview, doctors may be able to detect problems in memory or concentration.

STAGES


Stage 4 Moderate cognitive declineAt this point, a careful medical interview should be able to detect clear-cut symptoms in several areas: forgetfulness of recent events, greater difficulty performing complex tasks, such as planning dinner.

Stage 5 Moderately severe cognitive declineGaps in memory and thinking are noticeable, and individuals begin to need help with day-to-day activities.

Stage 6 Severe cognitive declineMemory continues to worsen, personality changes may take place and individuals need extensive help with daily activities.

STAGES


Stage 7 Very severe cognitive declineIn the final stage of this disease, individuals lose the ability to respond to their environment, to carry on a conversation and, eventually, to control movement.

Symptoms:

• Impaired judgment or ability to plan steps needed to complete a task is more likely to be the initial symptom, as opposed to the memory loss often associated with the initial symptoms of Alzheimer's

• Occurs because of brain injuries such as microscopic bleeding and blood vessel blockage

• The location of the brain injury determines how the individual's thinking and physical functioning are affected

VASCULAR DEMENTIA


Brain changes:

• Brain imaging can often detect blood vessel problems implicated in vascular dementia

• In the past, evidence for vascular dementia was used to exclude a diagnosis of Alzheimer's disease (and vice versa)

• That practice is no longer considered consistent with pathologic evidence, which shows that the brain changes of several types of dementia can be present simultaneously

VASCULAR DEMENTIA


Symptoms:

• Often have memory loss and thinking problems common in Alzheimer's

• More likely than people with Alzheimer's to have initial or early symptoms such as sleep disturbances, well-formed visual hallucinations, and muscle rigidity or other parkinsonian movement features

DEMENTIA WITH LEWY BODIES


Brain changes:

• Lewy bodies are abnormal aggregations (or clumps) of the protein alpha-synuclein

• Alpha-synuclein also aggregates in the brains of people with Parkinson's disease, but the aggregates may appear in a pattern that is different from dementia with Lewy bodies

DEMENTIA WITH LEWY BODIES


Symptoms:

• As Parkinson's disease progresses, it often results in a progressive dementia similar to dementia with Lewy bodies or Alzheimer's

• Problems with movement are a common symptom early in the disease

• If dementia develops, symptoms are often similar to dementia with Lewy bodies.

PARKINSON’S DISEASE


Symptoms:

• Typical symptoms include changes in personality and behavior and difficulty with language

• Nerve cells in the front and side regions of the brain are especially affected.

• Generally develop symptoms at a younger age (at about age 60) and survive for fewer years than those with Alzheimer's

FRONTOTEMPORAL DEMENTIA


• Creutzfeldt-Jakob disease

• Normal pressure hydrocephalus

• Huntington's Disease

• Wernicke-Korsakoff Syndrome

OTHER DEMENTIAS

Depression, Delirium or Dementia?

• An acute confusional state

• Medical condition that results in confusion and other disruptions in thinking and behavior, including changes in perception, attention, mood and activity level

• Individuals living with dementia are highly susceptible to delirium

• Can easily go unrecognized

DELIRIUM

ONSET, COURSE, MOOD

Source: American Medical Association

Depression Delirium Dementia

Onset Weeks to months Hours to days Months to years

Mood Low/apathetic Fluctuates Fluctuates

Course Chronic; responds to treatment.

Acute; responds to treatment

Chronic, with deterioration over time

SELF-AWARENESS, ADLS, IADLS

Source: American Medical Association

Depression Delirium Dementia

Self-Awareness

Likely to be concerned about memory impairment

May be aware of changes in cognition; fluctuates

Likely to hide or be unaware of cognitive deficits

ADLs May neglect basic self-care

May be intact or impaired

May be intact early, impaired as disease progresses

IADLs May be intact or impaired

May be intact or impaired

May be intact early, impaired before ADLs as disease progresses

Research Updates

GREAT INFO AT WWW.ALZ.ORG

• Scientists know Alzheimer's disease involves progressive brain cell failure

• The reason cells fail isn't clear

• Experts believe that Alzheimer's develops as a complex result of multiple factors rather than any one overriding cause

CAUSES


Age and Alzheimer’s:

• Although Alzheimer's is not a normal part of growing older, the greatest risk factor for the disease is increasing age

• After age 65, the risk of Alzheimer's doubles every five years

• After age 85, the risk reaches nearly 50 percent

CAUSES


Family History and Alzheimer’s:

• Research has shown that those who have a parent, brother, sister or child with Alzheimer's are more likely to develop the disease

• The risk increases if more than one family member has the illness

• Either heredity (genetics) or environmental factors or both may play a role

CAUSES


WATCH THIS VIDEO


Instructors: Click on the link to the movie to begin.The movie will open in Media player. Double click on the playing video to make it full-screen.

When movie is complete, hit escape. Then, close Media player to return to PowerPoint.

VIDEO:THE ROLE OF GENETICS IN ALZHEIMER’S

• Amyloid precursor protein (APP), discovered in 1987, is the first gene with mutations found to cause an inherited form of Alzheimer's.

• Presenilin-1 (PS-1), identified in 1992, is the second gene with mutations found to cause inherited Alzheimer's. Variations in this gene are the most common cause of inherited Alzheimer's.

• Presenilin-2 ( PS-2), discovered 1993, is the third gene with mutations found to cause inherited Alzheimer's.

• Apolipoprotein E-e4 (APOE4), discovered in 1993, is the first gene variation found to increase risk of Alzheimer's and remains the risk gene with the greatest known impact. Having this mutation, however, does not mean that a person will develop the disease.

GENES LINKED TO ALZHEIMER’S


TREATMENTS

Drug Name Brand Name Approved For FDA Approved

donepezil Aricept All stages 1996

galantamine Razadyne Mild to moderate 2001

memantine Namenda Moderate to severe

2003

rivastigmine Exelon Mild to moderate 2000

tacrine Cognex Mild to moderate 1993


HOW ALZHEIMER’S DRUGS WORK


Cholinesterase inhibitors

• Slowing down the disease activity that breaks down a key neurotransmitter

• Donepezil, galantamine, rivastigmine and tacrine are cholinesterase inhibitors



Memantine

• NMDA (N-methyl-D-aspartate) receptor antagonist

• Works by regulating the activity of glutamate, a chemical messenger involved in learning and memory

• Protects brain cells against excess glutamate, a chemical messenger released in large amounts by cells damaged by Alzheimer's disease and other neurological disorders



DIAGNOSIS




VIDEO:ADVANCES IN BRAIN DAMAGE

• Brain Atrophy Linked With Cognitive Decline in Diabetes

• Mediterranean Diet Is Good for the Mind, Research Confirms

• Alzheimer’s risk raised by high blood sugar, even for those without diabetes

• Exercise May Be the Best Medicine for Alzheimer‘s Disease

LATEST NEWS

DIET AND EXERCISE




VIDEO:THE BENEFIT OF DIET AND EXERCISE IN ALZHEIMER’S

Care Trends and Best Practices

• Behavior management

• Communication

• Wandering and elopement

• Co-morbidities

• Changes in condition

• Tips and tricks…

CARE TRENDS AND BEST PRACTICES

Behavior Management

• Can be one of the most challenging aspects of caring for residents with dementia

• The key is to have an established management technique

• Behaviors are not resolved, they are managed.

• Caregivers will find caring for residents with dementia less stressful if they accept that difficult, and even bizarre behaviors are a normal part of the illness

BEHAVIOR MANAGEMENT

1. Try not to take behaviors personally

2. Remain patient and calm

3. Explore pain as a trigger

4. Don't argue or try to convince

5. Accept behaviors as a reality of the disease and try to work through it

TOP 5 TIPS…

• Source: Alzheimer’s Association

• Step 1: Is the behavior a problem?

• Step 2: What is the problem?

• Step 3: Who, when and where?

• Step 4: Why?

• Step 5: How will you manage the behavior?

• Step 6: Reassessment

BEHAVIOR MANAGEMENT

• A behavior is not a problem unless it negatively affects the resident with the behavior or other residents

• If a behavior does not negatively affect the resident or other residents, management of the behavior is not necessary

STEP 1: IS THE BEHAVIOR A PROBLEM?

• Specifically identify what the problem behavior is

STEP 2: WHAT IS THE PROBLEM?

• Identify with whom the problem behavior occurs, when it occurs, and where it occurs

• This can identify specific triggers that may be causing the problem behaviors

• Such as specific times of day, specific residents or staff, or specific places or situations

STEP 3: WHO, WHEN, AND WHERE?

• This step can be difficult but attempt to identify why the problem behavior occurs

• If a specific reason for the behavior cannot be identified, it can be related to a symptom of dementia

STEP 4: WHY?

• This step must be done as a team effort

• All members of the staff and caregivers in your community can contribute

• Remember, problem behaviors in dementia are managed, not resolved

STEP 5: HOW WILL YOU MANAGE THE BEHAVIOR?

• It is vital that the problem behavior is regularly reassessed

• Is it getting better?

• Has it become worse?

• Should your management solution be changed or updated?

• Establish a regular time frame for reassessments, such as; every day, every week, etc.

STEP 6: REASSESSMENT

• Pain

• Frustration

• Demoralizing or infantilizing approach

• Misunderstanding a request

• Fatigue

• Communication barriers

• Inability to perform a task

• Inability to express needs

• Rapid change in the environment

COMMON TRIGGERS

Communication

• Be patient and supportive

• Offer comfort and reassurance

• Avoid criticizing or correcting

• Avoid arguing

• Offer a guess

• Encourage unspoken communication

• Limit distractions

• Focus on feelings, not facts

COMMUNICATION


Behavior Tips…

• Try to identify the immediate cause

• Rule out pain as a source of stress

• Focus on feelings, not the facts

• Don't get upset

• Limit distractions

• Try a relaxing activity

• Shift the focus to another activity

• Decrease level of danger

• Avoid using restraint or force

AGGRESSION AND ANGER


• Keep the home well lit in the evening

• Make a comfortable and safe sleep environment

• Maintain a schedule

• Avoid stimulants and big dinners

• Plan more active days

• Try to identify triggers

SLEEP ISSUES AND SUNDOWNING


• Carry out daily activities

• Identify the most likely times of day that wandering may occur

• Reassure the person if he or he feels lost, abandoned or disoriented

• Ensure all basic needs are met

• Avoid busy places that are confusing and can cause disorientation

• Place locks out of the line of sight

• Camouflage doors and door knobs

• Use devices that signal when a door or window is opened

• Provide supervision

• Keep car keys out of sight

WANDERING


• Ensure safety of residents and staff

• Resident rights

• Ability to consent

• Communicate with family

• Relocate if needed

SEXUAL BEHAVIOR CHALLENGES

Co-Morbidities

Swallowing Disorders

• Dysphagia: Occurs when there is a problem with any part of the swallowing process.

• Aspiration: Occurs when liquids or solids are breathed into the respiratory system instead of properly being swallowed into the stomach.

SWALLOWING DISORDERS

• Choking on foods, liquids or medication

• Coughing during or after eating

• Wet sounding voice

• Extra effort to chew or swallow

• “Pocketing” food

MONITORING FOR ASPIRATION

• Have resident sit upright when eating.

• Tilt the resident’s head slightly forward when eating.

• Ensure the resident remains sitting or standing upright for at least 15-20 minutes after finishing a meal.

• Minimize distractions in dining area.

INTERVENTIONS

• Do not encourage residents to talk until he/she has swallowed his/her food.

• Cut food into small pieces.

• Encourage swallowing more than once after each bite or drink.

• Modified diets if physician ordered.

• Request a speech therapy evaluation from the physician to evaluate swallowing.

INTERVENTIONS

• Thick liquids

• Soft foods

• Pureed

• Minced, ground and chopped

MODIFIED DIETS

Skin Breakdown

• Poor nutrition

• Dehydration

• Lack of ability to ambulate or move about easily

• Inability to turn in bed or from side to side in chair

• Decreased sensation

• Poor circulation

• Shearing

• Loss of bladder and/or bowel control

• Decreased activity

• Poor cognitive function

RISK FACTORS

• Meticulous incontinence care

• Adequate hydration and nutrition

• Turn and reposition minimally every 2 hours

• Hydrate skin with topical application of lotions/creams

• Utilization of a barrier cream/ointment for incontinence

KEEPING SKIN HEALTHY

Falls

• More than 1/3 of adults 65 and older fall each year in the US.

• Men are more likely to die from a fall. However, women are 67% more likely than men to have a nonfatal fall injury.

• When an older adult falls, the effects go beyond physical injury.

FALLS

Resident

• Effects of medications

• Eyesight problems

• Hip, leg and foot disorders

• Disease and illness

RISK FACTORS

Environment

• Elevated Bed Heights

• Low-seated chairs

• Poor lighting

• Slippery floors or non-secured rugs

• Clutter

• Poorly maintained ambulatory aides

• Condition of resident

• Medications

• History of falls

• Gait and balance

• Ambulatory aide assessment

• Medical history

• Evaluation by physical therapist

FALL RISK ASSESSMENT

• Remind resident to request assistance as needed.

• Ensure all pathways are free from obstacles.

• Provide adequate lighting.

• Provide appropriate chairs with arms that are solid and secure.

GENERAL STRATEGIES

• Remind resident to request assistance as needed.

• Ensure all pathways are free from obstacles.

• Provide adequate lighting.

• Provide appropriate chairs with arms that are solid and secure.

• Observe environment for potentially unsafe conditions.

• Identify residents who are “at risk” for falling and implement specific fall risk reduction strategies for that resident

FALL RISK REDUCTION

RESPONDING TO A FALL

Changes in Condition

STOP AND WATCH

• Physical aggression

• Physical symptoms, non-aggressive

• Verbal aggression

• Verbal symptoms, non-aggressive

• Social withdrawal

• Depression

CHANGES IN BEHAVIOR

• Source: www.interact2.net

• New symptoms or signs of increased confusion (e.g. disorientation, change in speech)

• Decreased level of consciousness

• Inability to perform usual activities (due to mental status change)

• New or worsened physical and/or verbal agitation

• New or worsened delusions or hallucinations

MENTAL STATUS CHANGE

• Source: www.interact2.net

• Physician

• Family

• Licensing agency

• Your staff

COMMUNICATION IS KEY!

Reducing Off-Label Use of Antipsychotics

• Indicated for persons with mental illness (e.g. schizophrenia, bipolar, etc.)

• Primarily used to manage psychosis

• Delusions

• Hallucinations

ANTIPSYCHOTICS

Traditional

• Haldol

• Thorazine

• Mellaril

• Serentil

ANTIPSYCHOTICS

Atypical

• Zyprexa

• Risperdal

• Seroquel

• Geodon

Associated with significant side effects

• Extrapyramidal effects

• Tardive dykinesia

• Hypotension

• Lethargy

ANTIPSYCHOTICS

Risk of Death

• Increased risk of death when used for residents with dementia

• FDA: 1.6 - 1.7 times increase in death rates

• Specific causes of death showed that most were due to heart related events or infections (e.g., pneumonia)

ANTIPSYCHOTICS

1) Work with the physician/prescriber

• Don’t just ask the doctor for a prescription

• Ask him/her for alternative solutions to manage the issue

• Don’t be afraid to advocate for your resident

REDUCING OVERUSE

2) Focus on Resident-Centered Care

• Use alternative interventions

• Physical activity

• Increased engagement

• Creating calm environments

• Identifying behavioral triggers

• Reminiscence therapy

REDUCING OVERUSE

3) Educate your staff

• Direct care staff, med aides, and nurses

• Dangers of overuse

• How to avoid it

• Address burnout and caregiver stress

REDUCING OVERUSE

4) Track and trend

• Quality improvement efforts

• Track and trend usage among your residents

• Establish realistic goals for reduction

• NCAL: Reduce off-label use of antipsychotics by 15 percent

REDUCING OVERUSE

www.ncal.org

NCAL

Incidence

• % of residents who have an antipsychotic drug initiated for an off-label use within the first 90 days in your community

QUALITY GOALS

Incidence

QUALITY GOALS

# of residents with antipsychotic drug use indicated on medical records over the first 90 days

# of residents who have been at AL for 90 days or less

Prevalence

• % of residents with off-label use of an antipsychotic drug

QUALITY GOALS

Prevalence

QUALITY GOALS

# of residents (over 90 days) with antipsychotic drug use indicated on

medical records

# of residents (over 90 days)

Exclusions: FDA Approved Uses

• Schizophrenia

• Bipolar disorder

• Major depressive disorder

• Tourette’s disorder

• Irritability associated with autistic disorder

• Treatment of resistant depression

QUALITY GOALS

ANY QUESTIONS?

Quiz

Which of the following is a good intervention for a resident with Dementia?

a) 3-5 medication prescriptions

b) Atkins diet

c) Regular exercise

d) Isolation

QUESTION #1

Which of the following is a good intervention for a resident with Dementia?

a) 3-5 medication prescriptions

b) Atkins diet

c) Regular exercise

d) Isolation

QUESTION #1

A swallowing disorder is NOT considered a co-morbidity when experienced by a person with Dementia.

a) True

b) False

QUESTION #2

A swallowing disorder is NOT considered a co-morbidity when experienced by a person with Dementia.

a) True

b) False

QUESTION #2

High blood pressure increases the risk of Alzheimer’s disease.

a) True

b) False

QUESTION #3

High blood pressure increases the risk of Alzheimer’s disease.

a) True

b) False

QUESTION #3

When redirecting a resident who is wandering, you should never:

a) Attempt change of face

b) Argue with or pull the resident

c) Allow them to wander in a safe area

d) All of the above

QUESTION #4

When redirecting a resident who is wandering, you should never:

a) Attempt change of face

b) Argue with or pull the resident

c) Allow them to wander in a safe area

d) All of the above

QUESTION #4

When conducting a pre-admission appraisal, it is best to:

a. Not allow the resident to answer questions, as they are not a reliable source of information

b. Interview only the resident, as they are the person you will care for

c. Interview both the family members and the resident

d. All of the above

QUESTION #5

When conducting a pre-admission appraisal, it is best to:

a. Not allow the resident to answer questions, as they are not a reliable source of information

b. Interview only the resident, as they are the person you will care for

c. Interview both the family members and the resident

d. All of the above

QUESTION #5

Studies how that a history of diabetes has no impact on the likelihood of developing dementia.

a. True

b. False

QUESTION #6

Studies how that a history of diabetes has no impact on the likelihood of developing dementia.

a. True

b. False

QUESTION #6

Alzheimer’s disease is the ______ leading cause of death in the United States

a. 1st

b. 3rd

c. 5th

d. 6th

QUESTION #7

Alzheimer’s disease is the ______ leading cause of death in the United States

a. 1st

b. 3rd

c. 5th

d. 6th

QUESTION #7

A lack of which of the following neurotransmitters is associated with Alzheimer’s disease?

a. Acetylcholine

b. Endorphins

c. Dopamine

d. Serotonin

QUESTION #8

A lack of which of the following neurotransmitters is associated with Alzheimer’s disease?

a. Acetylcholine

b. Endorphins

c. Dopamine

d. Serotonin

QUESTION #8

The main difference between delirium and dementia is that delirium is a chronic problem that develops slowly over time.

a. True

b. False

QUESTION #9

The main difference between delirium and dementia is that delirium is a chronic problem that develops slowly over time.

a. True

b. False

QUESTION #9

Which of the following are effective methods to reduce off-label use of antipsychotic medications?

a. Work with the physician

b. Educate staff

c. Track and trend

d. All of the above

QUESTION #10

Which of the following are effective methods to reduce off-label use of antipsychotic medications?

a. Work with the physician

b. Educate staff

c. Track and trend

d. All of the above

QUESTION #10

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