This document provides information about Alzheimer's disease and dementia. Some key points: - Alzheimer's disease is the most common form of dementia and causes nerve cell death and brain tissue loss. It is progressive, irreversible, and fatal. - The first case was identified in 1901 by Alois Alzheimer. The term "Alzheimer's disease" was coined in 1910. - Risk factors include genetic mutations, age, and lifestyle. The disease develops due to plaques, tangles, and neuronal loss in the brain. - Symptoms start with mild cognitive decline and progress to severe cognitive and physical impairment. It affects memory, thinking, behavior, and ability to perform daily tasks. - Over 5 million

1. Chevahlyan Dozier

2. Dementia is a general term for a decline in mental ability severe
enough to interfere with daily life
Alzheimer's Dementia (AD) is the most common form of
dementia
AD leads to nerve cell death and tissue loss throughout the
brain. Over time, the brain shrinks dramatically, affecting nearly
all its functions.
AD is progressive, irreversible, and ultimately fatal

3. Before AD,
―senile
dementia‖ or
―senility‖ was
seen as a
normal part of
aging
In 1901,
German
psychiatrist and
neurologist Dr.
Alios Alzheimer
identified the 1st
case of AD
Alzheimer’s
diagnosis was
confirmed In
1906 after
performing a
brain autopsy
In 1910,
Psychiatrist
Emil Kraepelin
coined the term
―Alzheimer's
disease‖

4. Mutations on chromosomes 21, 14, and 1 cause familial AD (FAD).
Most cases of FAD have an early-onset (ages 65 0r under)
The root causes ―Young-onset‖ and ―Late-onset AD‖ (ages 65 or
over) is unknown
AD develops from neuritic plaques, neurofibrillary tangles, neuronal
loss, and angiopathy in the brain
It is suspected that a mix of genetic (APOE ε4), environmental, and
lifestyle factors influence a person's risk for developing AD.
Susceptibility genes do not cause the disease by themselves but, in
combination with other genes or epigenetic factors

5. “Neuronal Forest” with
healthy neurons unaffected
by AD

6. Plaques and Tangles
AD tissue has many fewer nerve cells
and synapses than a healthy brain
(bottom right).
Abnormal clusters of protein
fragments (beta-amyloid) build up
between nerve cells; these are called
plaques.
Dead and dying nerve cells contain
tangles, which are made up of twisted
strands of another protein.

7. An estimated 5.4 million Americans of all ages have AD in 2011
This figure includes 5.2 million people aged 65 and older
200,000 individuals under age 65 who have younger-onset Alzheimer’s
One in eight people aged 65 and older (13 percent) has
Nearly half of people aged 85 and older (43 percent)
An estimated 4 percent are under age 65
6 percent are 65 to 74
45 percent are 75 to 84
45 percent are 85 or older

8. Approximately 53 new cases per 1,000 people aged 65 to 74
Approximately 170 new cases per 1,000 people aged 75 to 84
231 new cases per 1,000 people over age 85
Scientific analysis indicates that dementia incidence may
continue to increase
Annual total number of new cases of Alzheimer’s and other
dementias is projected to double by 2050.
Every 69 seconds, someone in America develops Alzheimer’s
By mid-century, someone in America will develop the disease
every 33 seconds

9. Including psychiatric history and history of cognitive and
behavioral changes
medical and family
history
• Assesses the individual's memory skills, orientation to time and place, and ability to do simple calculations
• Also evaluates the nutrition level and overall condition of the patient
Tests the functionality of the brain and nervous system
Neurological and
Physical Examination
• Evaluates coordination, eye movement, speech and reflexes
• Also look for signs of other conditions that cause brain disorders (previous strokes, brain tumors, fluid accumulation in
the brain, Parkinson's disease, etc.)
Diagnose Alzheimer's disease by ruling out other conditions
Brain Scans and
Laboratory Tests
• Tests for anemia, diabetes, kidney or liver problems, abnormal levels of certain vitamins and thyroid hormones in the
body that can cause dementia
• ECGs look for evidence of seizures and other abnormal brain activity, CT scans and an MRIs look at brain images for
indications of abnormalities (blood clots, strokes and tumors)

10. ―Recently, simple and inexpensive tests have been developed
that can be used by primary care physicians for routine
assessment of patients in the clinic.‖
―Examples of such tests include the Mini-Cog test, the General
Practitioner Assessment of Cognition (GPCOG) and others.‖
―It must be noted, however, that such assessment is valuable
only for identifying people requiring more complete testing; it is
not sufficient to establish a diagnosis of dementia.‖
―The medical community has not yet developed a consensus
regarding which single test is best for routine assessment‖—
alz.org

11. Personality changes and
loss of social skills
Change in sleep patterns,
often waking up at night
Delusions, depression,
agitation
Difficulty performing IADL’s
Difficulty reading or writing
Forgetting details about
current events
Difficulty performing familiar
tasks that take some thought,
but used to come easily
Getting lost on familiar routes
Language problems, such as
trouble finding the name of
familiar objects
Losing interest in things
previously enjoyed, flat affect
Misplacing items

12. Forgetting events in your own
life history, losing awareness of
who you are
Hallucinations, arguments,
striking out, and violent behavior
Poor judgment and loss of ability
to recognize danger
Using the wrong word,
mispronouncing words,
speaking in confusing sentences
Withdrawing from social contact
Problems Understanding
language
Inability to Recognize family
members
Inability to Perform basic
activities of daily living, such as
eating, dressing, and bathing
Incontinence
Swallowing problems

13. Memory loss that disrupts daily
life
Challenges in planning or
problem solving
Difficulty completing familiar
home, work or leisure tasks
Confusion with time or place
Trouble understanding visual
images and spatial relationships
New problems with words in
speaking or writing
Misplacing things and losing
the ability to retrace steps
Decreased or poor judgment
Withdrawal from work or
social activities
Changes in mood and
personality

14. Abuse by an over-stressed
caregiver
Bedsores
Loss of muscle function that
causes inability to move your joints
Infection, such as urinary tract
infection and pneumonia
Other complications related to
immobility
Falls and broken bones
Harmful or violent behavior
toward self or others
Loss of ability to function or
care for self
Loss of ability to interact
Malnutrition and
dehydration

15. Cultural and educational background should be
accounted for in the evaluation of a consumers
level of mental functioning
Individuals from certain backgrounds may be
unfamiliar with the material used in certain tests
of general knowledge, memory, and orientation
The prevalence of different factors that
contribute to the risk of AD varies substantially
across cultural groups

16. Slow the progression of the disease (although this
is difficult to do)
Manage symptoms, such as behavior problems,
confusion, and sleep problems
Adapt the home environment in order to better
perform daily activities
Support family members and other caregivers
There is no cure for AD. The
goals of treatment for AD are to:

17. Drug Treatments used to
treat the symptoms of AD
Drug treatments used to
control aggressive, agitated, or
dangerous behaviors
Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Razadyne)
Memantine (Namenda)
Cognex (Tacrine)
Haloperidol
Risperidone
Quetiapine
These are usually given in very
low doses due to the risk of side
effects

18. Direct-care workers comprise the majority of the formal
(paid) healthcare delivery system for individuals with
AD, including assistance with ADL’s and IADL’s
(bathing, dressing, housekeeping, food preparation etc.)
These workers include nurse aides, home health aides
and personal- and home-care aides
―Their work is difficult, and they typically are poorly paid
and receive little or no training to assume these
responsibilities.‖—alz.org

21. Alzheimer's Association - www.alz.org
Alzheimer's Disease Education and Referral
Center - www.nia.nih.gov/alzheimers
Alzheimer's Disease Research -
www.ahaf.org/alzheimers
Support groups
The following organizations are good resources
for information on Alzheimer's disease:

22. Stage IV: Mild or early-stage AD
Moderate cognitive decline
Stage III: early-stage AD
Mild cognitive decline; AD may be diagnosed in
some, individuals
Stage II: earliest signs of AD
may be normal age-related changes; Very mild
cognitive decline
Stage I: No impairment
normal function
The progression of AD takes approximately 8-
10 years
Stage VII: Severe or late-stage AD
Very severe cognitive decline
Stage VI: Moderately severe or mid-stage AD
Severe cognitive decline
Stage V: Moderate or mid-stage AD
Moderately severe cognitive decline

23. Emotional regulation part of brain
Decreased control over moods and feelings
Logical thought part of the brain
Declining ability to problem solve, grasp concepts,
and make plans
Language processing part of the brain
Diminished capacity to use words correctly
Memory forming part of the brain
Decreased ability to form new memories
Automatic functions part of brain
Affects breathing, digestion, heart rate and blood
pressure.
Balance and coordination part of brain
Loss of ability to ambulate and perform most ADL’s
Memory storage part of brain
Loss of oldest memories
Sensory processing part of brain
Wreaks havoc on senses; sparks hallucinations

24. Brain Changes in AD
A brain without AD
A brain with advanced
AD
How the two brains
compare

26. Instrumental Activities of
Daily Living
Activities of Daily Living
 The cognitive capacity to plan,
initiate, and complete ADL’s in
a safe, consistent
(predictable), and efficient
manner may be compromised;
e.g., dressing, bathing,
grooming, and bowel/bladder
control.
 May wear multilayer clothing
inappropriately.
 Behavioral concerns such as
resistance or combativeness
may impede task completion
(especially true with bathing or
showering activities)
 AD may compromise the
ability to perform IADL’s
(drive, manage finances, self-
administer medications, make
a meal, etc.)
 The consumer may
experience incidents of:
 Getting lost while driving to a
familiar location
 Leaving the stove on
 Having rapid weight loss
 Having a medical crisis because
of poor medication management
 having unpaid bills because of
financial mismanagement.

27. Rest and Sleep Education and Work
 Among other factors, the
inability to problem solve,
grasp new concepts,
communicate effectively,
and execute more
complex tasks impact
performance in these
areas of occupation
 Sleep changes in
Alzheimer’s may include:
 Difficulty sleeping
 Daytime napping and other
shifts in the sleep-wake
cycle
 May experience
―sundowning‖

28. Leisure and Social Participation
 With AD, there is a gradual withdrawal from leisure activities due to
an inability to perform or frustration caused by increased cognitive
challenges.
 A tendency for occupational deprivation may occur if the activity
demands are not reformed to meet the consumers reduced abilities.
 There is a tendency to socially isolate
 Language problems such as expressive or receptive aphasia or
agnosia may affect social communication
 May desire to hide the disease from former acquaintances.
 ―Some individuals with dementia show disinhibited behavior, including
making inappropriate comments or jokes, neglecting personal
hygiene, exhibiting undue familiarity with strangers, or disregarding
conventional rules of social conduct.‖ (American Psychiatric
Association, 2000, p.148)

29. Sensory Perceptual Skills Motor and Praxis Skills
 Motor skills begin to decline in the
middle stages—especially in the areas
of motor planning, sequencing, and
executing new movements
 Cognitive deficits impede motor function.
 In the middle to later stages, the risk of
falls increases as the consumer
develops apraxia
 Falls may be caused by lack of judgment
in the ability to descend a staircase,
perceptual dysfunction, or failure to set the
brakes on a wheelchair when transferring.
 Motor skills in the later stages of the
disease are severely impaired, and the
consumer may require a positioning
evaluation for bed, wheelchair, or Geri-
Chair.
 Progressively affected
throughout the course of
Alzheimer's disease.
 all sensory areas may be
affected (visual, auditory,
tactile, proprioceptive,
vestibular, olfactory, and
gustatory)
 may report visual perceptual
disturbances
 may report an aversion to
certain foods or food textures
 Astereognosis is not unusual

30. Emotional Regulation
Skills
Cognitive Skills
 The primary impact in
performance skills is with
cognitive deficits.
 Although the primary cognitive
challenge is memory, clients
also lose executive function,
including:
 Judgment
 Problem-solving ability
 Sequencing
 Organizing
 Prioritizing
 Planning
 Initiating
 May have a sense of loss and
grieving if the person has a self-
awareness of memory loss.
 Can range from mild depression to
overt anger and aggression.
 Families may encounter increasing
frustration as the person has
difficulty verbalizing the experience
of memory loss or expressing fears
about the future.
 Feelings of confusion may alter
emotions
 In the later stages of the disease,
these behaviors may escalate to
aggression or catastrophic
reactions

31. Communication and Social Skills
 May lose the ability to interact
 This symptom may be manifested as receptive or expressive
aphasia
 Agnosia or problems recalling recent events impair the flow
of conversation, and the individual may retreat from group
discussions
 May be embarrassed by the challenges of communicating
and may attempt to hide the problem by withdrawing from
social situations
 Repeating questions or perseverating on a recent event or
health problem can lead to annoyances for the primary
caregiver

32.  Performance patterns are the habits, routines,
rituals, and roles in daily activity.
 Habits become strengths that the consumer
can draw from when he or she is no longer
able to remember how to perform.
 May have to step down from current roles due
to cognitive declines
 Experience a decreased capacity or complete
inability to learn new routines
 May become unable to participate in rituals
that are complex and/or more cognitively
demanding

33. Cultural Context Personal Context
 Alzheimer's disease is an age-
related disease in that the
greater majority of people in the
early to middle stages of the
disease are in late adulthood
 Individuals tend to become
disoriented to person—
becoming confused about their
age, marital status, and family
composition
 Younger-onset (before age 65)
poses a particular challenge
because decisions regarding
workforce involvement are
emotional and may negatively
affect self-worth
 Alzheimer’s disease may
viewed as normal aging among
Black/African American and
Hispanic/Latino culture
 Alzheimer’s disease may be
looked at as ―punishment‖ for
past sins, bad blood or mental
illness
 Families may not seek out
services because they do not
wish to bring shame upon the
family
 Alzheimer’s disease may be
attributed to ―el mal de ojo‖ –the
evil eye or ―nervios‖ –nerves.

34. Temporal Context Virtual Context
 The virtual context can
keep a person safe
within his or her own
home or in a residential
facility.
 behavioral issues related
to wandering or exiting
safe areas or potentially
hazardous activities may
require monitoring (home
surveillance system).
 Circadian rhythms are
altered due to the
prevalence of
"sundowner's syndrome"
in people with AD

35. Physical Context Social Context
 Relationships with spouse,
friends, and caregivers
may become strained
 Relationships with systems
(e.g., political, legal,
economic or institutional)
that are influential in
establishing norms, role
expectations, and social
routines may dissolve
 Consumer may
experience difficulty
negotiating and navigate
his or her physical
environment due to
increased cognitive
impairment
 Lighting, visual contrasts,
colors may affect the
consumers functional level

36. Due to the debilitating nature of AD, values, beliefs, spirituality, body functions, and body structures
that reside in the consumer and influence occupational performance may be compromised
Each client with Alzheimer's disease is a unique individual with a distinct set of underlying factors,
both physical and motivational.
Barriers to optimal performance on the basis of physiological functions of body systems or personal
values and beliefs should be identified by the OT practitioner
The individual may have visual deficits that impede unsupervised community mobility
The person with Alzheimer's may have apraxia that contributes to an unsafe environment but may not
have the cognitive ability to learn to use a mobility support.
A strong belief in self-determination may influence the desire to remain independent, but poor
judgment because of cognitive decline may create an unsafe situation for living alone.
The consumer's desire to pursue engagement in spiritual activities should influence recommendations
in the intervention planning process.

37. MOHO, OA and CMOP
Models of Practice
Cognitive Disabilities
Frame of Reference
 With AD, it is paramount to
obtain a measure of the
consumer’s cognitive functional
abilities, or how the consumer
draws from thinking and
memory to organize and
execute daily tasks.
 Because of the debilitating and
progressive nature of AD, new
learning is not the focus of the
intervention; rather, caregiver
education, environmental
adaptations, and compensatory
strategies in a family-centered
care approach are
recommended.
 Viewing human
occupation using the
concepts of MOHO, OA
and COPM will guide
practitioners in providing
the most comprehensive
treatment interventions
for consumers (both
patients and caregivers)
within the AD population

39. The limitations of having Alzheimer’s Dementia
influence the level and quality of engagement in all
areas of occupation. With more knowledge about this
condition and its limitations, occupational therapy
practitioners can better help these individuals link their
specific abilities with purposeful and meaningful
patterns of engagement in occupations, allowing
participation in desired roles and daily life situations at
home, school, work, and the community. Moreover,
the practitioner will be able to advocate on behalf of
the consumer and help caregivers attain the support
they need to care for this population.

40. Thank you 

41. http://www.alz.org
http://www.livestrong.com
http://www.guideline.gov
http://www.tangledneuron.info
http://www.pubmed.com
http://aboutalz.org
http://health.nytimes.com
http://ajot.aotapress.net/
http://occupational-therapy.advanceweb.com

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