Understanding Mild Cognitive Impairment · 2019-08-22 · Understanding Mild Cognitive Impairment Enhancing Communication, Safety and Cognitive Engagement Kathryn Kilpatrick M.A

Understanding Mild Cognitive ImpairmentEnhancing Communication, Safety and Cognitive Engagement

Kathryn Kilpatrick M.A. CCC/SLP

Speech – language pathologist Geriatric Life Enhancement Consultant

Memory Fitness Coach

COMMUNICATION CONNECTION www.connectionsincommunication.comMEMORY FITNESS MATTERS www.memoryfitnessmatters.com

[email protected]

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Marcel Proust

The real voyage of discovery consists not

in seeking new landscapesbut it having new eyes.

Communication Connection Kathryn Kilpatrick 2

GERIATRIC Life Care Enhancement Meets the physical, emotional, intellectual and spiritual needs Builds on their strengths and interests Transforms days from mere existence into more enjoyment Promotes meaningful and memorable exchanges May engage older adults who may otherwise be removed from activities Provides the opportunity for each person to participate, elevating

the level of interactions Involves interaction of family, friends and care partners Elevates the value we place on the older adult


Memory and Normal Aging

Word finding complaints Names and places Remember later at times

Slower to process information Slower to learn new information Do not like to multitask

More distractible Need to focus on one thing at a time

4Communication Connection Kathryn Kilpatrick

Yesterday Today TomorrowWorking memory

• Recall for short period of time• Can hold about 7 items• Very vulnerable to lifestyle/environment

Long term memory• Stores what is important• Not so vulnerable to the aging process • Recall can be impacted by emotions


Doesn’t Change With Normal Aging

Semantic memory – facts and experiences

Prospective memory – remember perform an action in future (if write it down)

Remote memory – years ago

Immediate memory – recall small amount of information over few seconds


Memory Loss - CausesDiseases

Parkinson’s Lupus Multiple Sclerosis Huntington’s Disease Others

Dementia Alzheimer's Disease Stroke Head Injury etc.

Other possible causes

Reduced sensory input

Thyroid problems

Low blood sugar

Bypass surgery

Anesthesia

Allergies

Normal pressure hydrocephalus


Reversible Causes

Depression Grief Pain Stress Anxiety Hearing Loss Minor head injury Tumors

Medications Hypothyroidism Sleep Disorders Normal pressure

hydrocephalus Infections Thyroid Vitamin deficiency


Mild Cognitive Impairment It is NOT dementia On Global Deterioration Scale – 7 stages

Stage 2 is normal aging Stage 3 is MCI GDS – Stage 4 still able to learn GDS – Stage 5 - advanced to need supervision

MCI - options Some improve Some remain stable Others continue to advance to Stage 4


What are the Challenges?

Are they one of the “worried well”? Note increased challenges. Easily on cognitive overload Trouble with new, complex skills or overstimulation May not be obvious to others Impacts feeling of aging and self esteem Trouble creating appropriate compensatory strategies Personality changes and anxiety Apathy and/or depression Only shows up in an extensive interview


Amnestic and Non Amnestic Amnestic

Predominately an impairment in memory Subjective and objective complaints for age Largely intact functional activities

Non-amnestic Impacts thinking skills other than memory

Decision making - Judgment Sequencing steps Visual perception


Diagnosis https://www.youtube.com/watch?v=uAlkCMfTASQ

25% of those diagnosed may be experiencing normal agingbut have issues that can be resolved RX education and consultation including lifestyle choices

15 – 20 % of those over 65 may have MCI Average of 32 percent of individuals with MCI developed

Alzheimer’s disease in 5 years. In some cases MCI is actually an early stage of Alzheimer’s

(called MCI due to Alzheimer’s disease) or another form of dementia.


https://www.youtube.com/watch?v=uAlkCMfTASQ

https://www.youtube.com/watch?v=uAlkCMfTASQ


Young Onset - Who is Impacted? Those with younger-onset or early onset Alzheimer’s disease are

those under age of 65 Some are in their 30’s, 40’s and 50’s

Incidence about 5% of the population with Alzheimer’s disease –about 200,000 Americans

Some may be in the early stages of Alzheimer’s disease or Vascular dementia Frontotemporal lobe dementia (FTD) Dementia with Lewy bodies

More likely inherited if onset much earlier Communication Connection Kathryn Kilpatrick 14

What Does Young Onset Dementia Look Like? In the prime of their life Likely to be employed, active lifestyle and social life Adult children and grandchildren May be caregiver for parent or grandchild Married, single, no family in area May be a business owner May be a volunteer May be moving, downsizing, dealing with other health

concerns – concurrent?


Seeking the Diagnosis Not expected in younger population Diagnosis can take months or years May not be aware of available benefit programs Unaware person with diagnosis has a qualifying disease Social Security Administration (SSA) added early-onset

Alzheimer’s disease and related dementias to the Compassionate Allowance Insurance in 2010. SSDI –Social Security Disability Insurance SSI Supplemental Security Income


ROLE OF Speech-Language Pathologist

Identify Assess Develop interventions Counsel Educate Prevention


Why Strategies Matter Those with MCI or early stages of Young-Onset Dementia

Retain ability to learn Able to apply new information

MORE EDUCATION NEEDED How can we reach that population

Many will progress to Alzheimer’s disease so interventions earlier on can become habits

Who in their support system can we educate?


Challenges to Address Activities daily living

Health maintenance

Safety

Medications

Driving

Electronics

Finances/Shopping

Chores and leisure time activities

Travel and holidays

Correspondence/electronics and

other technology

Denial


Predicting Functional Dependence in Mild Cognitive ImpairmentDifferential Contributions of Memory and Executive Functions

Gerontologist. 2018 Aug 2018

Recent studies suggest that older adults with MCI can exhibit impairment in instrumental activities

of daily living (IADL).

Need information to better assist health care providers in detecting functional vulnerabilities that often precipitate

loss of independence


IADLS Care of others (including selecting and supervising caregivers) Care of pets Child rearing/caregiving Communication management Community mobility Financial management Health management and maintenance Home maintenance Meal preparation and cleanup and shopping Religious observances Safety procedures and emergency responses


Finding Out What Matters 61.04% of participants with MCI were dependent on one or more

IADLs.

MCI was associated with significantly greater odds of dependence than normal cognition on 7 of the 10 IADLs

Impairment in memory and executive functions significantly predicted IADL dependence

Executive functions were the stronger predictor, particularly for complex finances, complex cooking, and remembering events.


Ongoing Modification Understand deficits - build on strengths

Cognition Attention Memory Thinking Skills Problem Solving Speech and language Executive functioning


Factors to Consider Difficulty modifying strategies that were effective before to the next

level Impacts participation and self esteem

Factors Life in 21st century Fast pace - multitasking Cognitive overload Technology Approach of those younger than they are when communicating


Keys to Memory Fitness

Positive Attitude Paying Attention/ Hearing Loss Lifestyle Choices

Diet, hydration, nutrition, exercise, sleep Stress Management Strategies Socialization Brain Health, Memory Fitness Routine


** Multitasking vs Task Switching Erodes our focus, ability to encode, and impacts safety. Multitasking in most cases is task switching. Habits that are being formed are not helpful Memory no longer just the complaint of those with changes in normal

aging Education to understand impact of paying attention and handling

distractions. Tools are needed and brain fitness programs

online needed to be coupled with real life applications. No quick fixes – takes work!

https://www.youtube.com/watch?v=UyLtYULonY8





Assessing the Contributors to Distraction What is the environment like? What personally distracts a person the most?

Interruptions are NOT your friends! What is the level of chatter in your head? What is the chatter? Impact of depression, pain and grief Attitude is the foundation of any strategy program and includes

support system


Need Educate on Factors that Can Impact a Diagnosis of MCI

Medications Dehydration Nutrition Sleep Apnea Vitamin deficiency

B 12 and D Drinking Smoking

Stress

Depression

Hearing Loss

Thyroid problems

Decreased physical activity

Decreased cognitive stimulation


Typical Everyday Complaints Assess current strategy before developing a plan Consult and educate support partner Assess ability to follow through with plan

Peoples names Appointments Where park car Lost items Forget what do next Getting lost driving Miss paying a bill


Basic Strategies Can learn but takes more effort

Use more of their senses Will have good and bad days

Need be aware so can modify or postpone Less desire participate in prior activities especially

those for cognitive enhancement Try modifications

Naming issues Cheat sheet - Gesture Give cues, categories, describe, draw it


Take it to Another Level

What are their internal strategies? What are their external strategies? Start with simple tips and break down steps Make your notes detailed – print – larger print – number items Benefits of technology

“Google it: Take a picture of it Voice note Text yourself


Memory Props Calendars To do lists Post it notes Reference lists Recommend

Single source Portable Consistent place

SEE ITSAY IT

VISUALIZE IT5 -10 second rule

Create a routine With meds With appointments

Emails – add attachment first


HEARING LOSS AND MEMORY Impact on memory is significant Cognitive overload impacts attention/concentration Longer processing time – cannot keep all details Lose train of thought Refusal to use assistive devices Increased withdrawal Agitation, frustration, depression Decreased cognitive engagement Speakers need education on needed modification in their patterns of

communication Hard of hearing individual need to learn to speak up effectively


HEARING TIPS

Face the person – get their attention first. Person needs to acknowledge you are speaking to them. Do not multitask when communicating – electronic devices do

not help at all and one of their biggest frustrations. Slow your rate of speech – ask them to remind you if you start

speaking too fast of they are having trouble understanding you. Speak in shorter segments. Ask the person what is most helpful. Observe when they

disconnect, get upset or seem overwhelmed.


HEARING TIPS Write down the information especially if lengthy, complex or if a memory

issue is present. Printing is best. Number the items so they can more easily retrieve the

information. Turn off televisions etc. and move to a quieter setting or where there are

not distractions. Make sure the batteries are working in their hearing aides or check if they

are deliberately turned off. Closed caption may be helpful in SOME cases. CapTel phone should be explored. No longer need internet connection!


MEMORY TIPSNOTE: Many of the hearing tips are applicable to memory loss

Simple yes/ no questions may be easier. Written information may be helpful. Print size is important. Check to

make sure it can be read easily and not too busy. Give information in segments. Verify comprehension then and also

later. One on one conversation easier vs multiple speakers. Memory boards or other props may be helpful. One size does not fit all.


MEMORY TIPS For word retrieval, offer 2 word choices if you know the word

or give them a hint of the first one or two letters. Encourage them to give you a hint, gesture, draw or point. Reference lists for healthcare professionals, birthdays,

upcoming events, questions for MD appointments etc. and answers.

List of where you put things or where you moved them to.


“Good habits, once established,

are just as hard to break as are bad habits.”

Robert Puller


Dale E. BredesenAGING, September 21, 2014

Reversal of Cognitive Decline in Alzheimer’s Disease

Novel comprehensive and personalized therapeutic program which involves multiple modalities designed to achieve metabolic

enhancement for neurodegeneration.

The End of Alzheimer’s Dale E. Bredesen, MD


Case Studies Followed parts and pieces of a program found in article Included

Diet recommendations Sleep recommendations Stress management Exercise Schedules for eating Supplements etc.

Some familiar others NOT Cognitive stimulation


Increasing Cognitive Engagement

Many use apps but many cannot Tend to do the same thing repeatedly Once difficulties impact their ability, tend to withdraw from them Can look like apathy and disinterest With a support system and an awareness of interests, can modify

activities In some cases can develop new interests now that have more time

or revisit old interests set aside


BLUE ZONES Dan Buettner LESSON 7 – Belong /participate in a spiritual community→ Be more involved→ Explore a new traditionLESSON 8 – Make family a priority→ Get closer→ Establish rituals→ Put family firstLESSON 9 – Surround yourself with similar people → Identify your inner circle→ Be likeable→ Create time together

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What a Brain Fitness Plan Should Include Need to think while doing the activity

Playing cards, doing puzzle, word games Do a familiar activity a new way

Drive a different route Use your other hand Mow lawn in a different pattern

Ongoing learning process New hobby Use other options on electronic device Study a subject of interest


More of the Plan Makes you think in a new way

Learn a new dance step Present the opposite opinion Reorganize a storage area

Physical activity Do a new form of exercise Do it with a group

Socially interactive Group trips, take class, join book/magazine, good news club


“SuperAgers” December 31, 2016 New York Times

Term coined by neurologist Marcel Mesulam Emotional areas are crucial brain regions Need work hard at something – road to “Superager” is difficult” Need feel stymied/frustrated. Even need feel bad in the moment As age tend to sidestep discomfort

Helps maintain sharper memory and greater ability to pay attention Use it or lose it


Kathryn Kilpatrick www.memoryfitnessmatters.com 47

Keep Your Brain Sharp Program Brain Teasers and educational pieces on memory fitness Humor and riddles Conversation starters Attention and concentration tasks Reminiscence and trivia Naming strategies Word game puzzles started in the group then take home


An Alzheimer’s Patient’s Point of View Janis Hogan Aplin

Dear Friend, Oh, how can this be you and I are losing me. Some day soon maybe morning, maybe noon I will no longer be the me you and I know as me.I ask, what is happening to me, and the answer seems to be words and thoughts frequently scramble and my conversations seem to ramble……..What can we do from losing me? "Nothing’ say the experts. But in my confused and foggy state, to you I plea….."Love me, Remember me, help me to be all that I can be for as long

as I can be the me we know as me.”49

https://www.youtube.com/watch?v=Zl0kUziq7_s


INSIGHTS Peterson, B. Jan's Story : Love lost to the long goodbye of Alzheimer's (2010)

Behler Publications

Taylor, R. Alzheimer's from the Inside Out” (2006) Health Professions Press

Genova, L Still Alice (2007) iUniverse

Summit, P. And Jenkins, S. Sum it Up: A Thousand and Ninety – Eight Victories, a Couple of Irrelevant Losses, and Life in Perspective (2013) Crown Publishing Group

Documentary “Glen Campbell… I’ll Be Me," produced by James Keach and Trevor Albert.


RESOURCES Alzheimer’s Association

Help Line Support groups Care Partner Support Groups Ask about the SHARE program

Community Educational Programs Audiologists/Physical and Occupational therapists Speech-language pathologists Geriatric Consultants Websites / Podcasts and TED Talks


Communication Connection Memory Fitness MattersKathryn Kilpatrick M.A. CCC/SLP

www.connectionsincommunication.com [email protected]

Presentations to health care professional and support groups Private consultations: Strategies for communication, safety, and activity

modification and caregiver support/education Products for brain teasers, reminiscence and conversation starters Keep Your Brain Sharp – programs with education, brain games and activities

to support a positive attitude and socialization Memory Fitness Matters Blogs – Multitasking strategies, caregiver support, activity

modification and much more… Communication Connection Blogs - Travel and holidays, meaningful activities, hearing loss

and much more…


mailto:[email protected]

Documents

Understanding Mild Cognitive Impairment · 2019-08-22 · Understanding Mild Cognitive Impairment Enhancing Communication, Safety and Cognitive Engagement Kathryn Kilpatrick M.A