Dementia CE in Virginia

Need any last minute CEUs??

I will be giving two seminars in Virginia next week. 6 hours credit and I promise it will be an enjoyable and worthwhile day :-)

Here is the Richmond registration on Wednesday 12/7/2011.

And registration info for Roanoke on Thursday 12/8/2011.

See you there!!

Seminar Time VA & MD

Year end is approaching quickly.

Come on out and see me if you still need some CE credits. 6 hours approved for SLP, OT, PT, nurses, administrators, and other boards. Message me if you need details.

Fairfax, VA on Wednesday 10-18-2011
Baltimore, MD on Thursday 10-19-2011

www.summit-education.com to register & walk in registration accepted.

See you there :-)

Where are the Words?

Word finding is one of the most frustrating language symptoms of aphasia related to dementia. It comes about early in the process of the disease, and it exacerbates as the dementia progresses.

I could explain and describe, but I think this short video says it all. Link below.
"Forgetting words. I'm trying to think of it..."

So leave space for the person to think.

Provide time as the words may come slowly.

The video's example of a multi-sensory experience is ideal, the senses of touching, feeling, tasting, hearing, seeing, and smelling will work together and help elicit the verbal response.

Ask one question at a time and WAIT. Bombarding the system with information to comprehend without ample time to process and formulate a response will not be the most effective strategy.

Don't forget that words may not be the most important part. While losing language and memory is devastating it is not the only way in which people experience the world.

Skilled Dementia Care Coming to New England

Next week I'm hitting the road. 3 days of age related cognitive decline, dementia, & providing comprehensive assessment, treatment, & so much more!! The course is for therapists of any discipline, but I have had many family members or people in early stages of dementia come as well & they all have good things to say about the information covered during the day. Come talk with me & learn!!

Tuesday 6/21/2011 Portland, Maine.

Wednesday 6/22/2011 Manchester, New Hampshire.

Thursday 6/23/2011 South Burlington, Vermont.

To register click below
https://cart.summit-education.com/cart/jsp/course.jsp?categoryId=10011&courseId=GDEMEB.3

Can't wait to see your smiling faces :-)

Dementia: Coping with the Change

This is a beautiful film. Nic Askew and his Soul Biographies blow me away time and time again. "A Life Beyond" is so relevant to the changes we are coping with today. I may even say it showcases humanity at its finest. It is short, 7 minutes, and well worth your time. Click, watch, and listen. Be prepared for a transforming perspective.

I speak to this concept quite often, to families, therapists, nurses, any caregiver. A change of outlook can make everything we do when caring for someone with dementia much different, less burdensome, more joyful, and the shift happens not just for us but also for the person we love who has this horrible disease.

One of my favorite phrases about the work I do is "my patients give me so much more than I could ever give them". So true when the viewpoint is one of an exchange with this person you hold dear and not just the load of care-taking. This is a valuable angle that should be shared.

Thank you to Soul Biographies and Nic Askew for such meaningful films.

Moments of Clarity

If you have participated in my presentations/courses you know that I am most often the last to give up hope. I am the one who says over and over again that we need to look for the moments of lucidity, and take full advantage of the times when our patients and loved ones with dementia are a resemblance of their former self. So today I saw it, again, firsthand. A woman who I’d basically written off, told her family she was not going to regain any of her thinking skills, and told all of the staff that the compensation system we had in place was all we could do, proved me wrong.

I saw her spark come back a couple of weeks ago, and to my dismay that light remains consistent even now. A few months ago, when I first met her, she told me that if I just gave her time she would feel better and recover. I persisted with therapy then, and I failed. She was correct. Now, it seems like she has shed about 10 years. Today we had a wonderful conversation. She laughed, smiled, and discussed her life with a precision and simplicity that made me know this was improvement. She also gave me some insight that was very valuable. Listen to your patients. Sometimes even when they seem off base and confused if we can listen to what they are truly saying, and realize that our goals and our time frame is not always what best suits them.

By leaving my preconceived notions behind and remembering that we all know ourselves better than any medical professional could, I am able to see the value in reading beyond the uncertainty of dementia. We have a responsibility to help our people live their best lives for as long as possible. How can we possibly begin to do that if we don’t use what they know to our advantage? Use their moments of clarity, find some resolution for yourself, and consider what we are here for. Reflect on our purpose of helping the elderly exist in a way that makes keeps life normal.

November 16th: National Memory Screening Day

The Alzheimer’s Foundation of America is holding its annual National Memory Screening Day this upcoming Tuesday.

A screening is not a diagnosis, or in-depth testing, but a systematic way to look at areas of concern and determine if you or your loved one is at risk for dementia. It is also a great way to examine memory right now. Even if you are not having trouble the screen is helpful for future comparisons.

More than 2,000 locations nationally will provide the opportunity on Tuesday, November 16th for memory screening. Click on the link below for more detials.

http://nationalmemoryscreening.org/index.php

Take this opportunity and screen your parents’ memory, your grandparents’, and your memory. This valuable service could help for earlier diagnosis of dementia, and guess what…the medical treatment available right now for Alzheimer’s and other types of dementias is MOST EFFECTIVE in early stages. So why wait?

Perils of Presenting

I did a guest lecture last night at Marshall University. My talk centered on dementia and the SLP’s role. A day later, it is interesting to reflect on that brief time I spent with the class. A little nervousness came over me, far different from my typical experience presenting. I am rarely nervous for an 8 hour day and room full of therapists, but this hour lecture to a few graduate students caused me to loose the timing and fluency that I have worked hard to perfect.

So after sleeping on it I realized what my deal was. I had a room full of people who were seemingly eager to hear what I had to say. Not your standard CE course with texting, passing notes to one another, (both distractors I have learned to tune out completely), but now I had the full attention of 25ish speech-language pathologists in the making. A very different audience that my norm. They were all fully aware, took notes diligently, and the amount of motivation in that room was overwhelming. That is a different sort of pressure than I am used to. The ladies’ passion and desire to take in all of the information they possibly could was refreshing, but also a bit nerve-racking.

I did however enjoy my time with that class and their eagerness was what I appreciated most. They had a look in their eyes, apparent excitement to learn, and thoughtful questioning. Their questions were more frank and to the point than I anticipated. I talked about dementia, how we can provide services throughout the stages, as well some of the reasons I love working with this population. As I started to wrap things up, two unanticipated questions came barreling at me. The first student asked if “I felt prepared for the work I do when I started in the field”, and I answered with honesty. Maybe I even laughing a little at the thought of feeling completely equipped at any phase, new grad or seasoned professional. I didn’t and still can’t be prepared for everything I encounter. The next student asked me if “I wanted to leave them with one thing what would that be?” Now this was the question I had not thought about, and I completely veered off topic. I told students not to box themselves in, not to underestimate what they can achieve, or how their skills might provide service. She probably wanted to know the gold standard for dementia treatment, but if you know me I tend to go beyond, and wanted to bestow a grander knowledge for life fulfillment J

It’s remarkable that we ended on such a note. I was completely out of my element for the evening, and feeling less than confident about it. My guidance to these students was to push the boundaries, and believe in their abilities. You know what? I think that is sound advice. I operate that way in my clinical practice, in my life, and my career. Hopefully the students saw it that way as well, and know that there is no cookbook, there is no right way to do it, or wrong way to do it. Life, work, treating patients, we just have to take what we know and apply it to the reality at that moment.

Reminisce Resurrect

Easter Sunday, brings us to see our elders, a family dinner, baskets, eggs, church, a new dress or a nice suit. Easter sparks many memories for the neurotypical person like one of us. For instance, I can recall the exact shade of pink in the stripes on my dress one Easter, the scratchy knee socks, and the bright sun shining on my face while I posed for Easter photos in the nicely manicured lawn with my cousins. The patient with dementia will not have these memorable details easily accessible. So asking the person with memory and cognitive impairment about their favorite Easter, or what their Easter traditions are may be a great way to begin a conversation, without very fruitful discussion.

What we know about memory is that short term recall is the first to disappear, and then long term recall slips away more slowly. It manifests like this in the early stages…The person with dementia gets up and dressed in their Sunday’s best, the family leaves for church and no slip up yet. They go to service, sing the songs, read the scripture, and then time for family dinner. But this year family dinner is at the granddaughter’s home, and the driver is relying on the one with dementia to give directions, as he is in from another town. Travel there is not so easy, despite many visits prior to this one, wrong turns are made, even pulling into the wrong home, but thankfully noticing another family in the drive. Talking about the sermon this date is impossible, even though the person with dementia was present and participated during the service, no recollection of information so new exists. So, with a lack of interaction regarding current happenings, the family begins to dig back into days past. Reminiscing about the year that one lost egg from the hunt wasn’t found for a week, and only did the stench of the decorated egg lead them to find it. The person with dementia may remember this humorous event. Perhaps they break out the photo album. The senior with memory loss sees a photo of their children 20 years ago, outside the church after Easter, and with a quick comment from the daughter regarding the fun had that day, comments flow easily and memories though long lost begin surfacing.
Now how can we make this Easter, and everyday special? How do we help preserve memories and interactions in life while dementia is trying to take those skills away? Stick with tradition, and keep the events of the holiday as recognizable as possible. People with dementia will remember the familiar, and function optimally when provided with stimulation that is not constantly changing. Memory loss will often not attack the prayers that were repeated throughout life, the common routine of cooking the same recipe for the Easter ham will be intact, and even knowledge of the normal attire, or typical events of the day are tools to use to help the person with dementia live life as normally as possible. When it comes to remembering and conversing, use items and pictures from the past to elicit recall, and keep the demand simple. Allow the senior to recall what they easily can and keep the conversation flowing by feeding in missing details. Familiar smells, tastes, places, routines, and providing stimulus with emotional content will retrieve memories from places hidden.

Not only this Easter, or on special holidays, but everyday, we can draw from this knowledge to help those we love with memory loss have meaningful interactions. Keep routine intact, use familiar ritual, and pull in concrete items to stimulate memories and conversation. Fill the day with success driven interactions. We can tap into emotions, feelings of love, joy, and peace to promote pleasant contact with the senior suffering from dementia, and through these moments preserve quality of life in the face of a terrible disease.

Happy Easter!

End of Life: So Many Questions

For years I have known the devastation that comes about when making decisions regarding death and planning for end of life care. When do you opt for treatment? When is it time to just live the rest of your life? When do we as clinicians, nurses, doctors, stop fighting to fix the problem, and resolve to lend a hand for finding peace? Throughout personal experience, encounters with families, and interactions with dying patients I have come to realize that there is no consistency in ensuring that a dying person’s wishes are conveyed and carried out. Extreme variability exists in discussions about dying and one’s end of life wishes. Talk about death is complicated, dealing with death is difficult, and when you add in factors such as multiple medical conditions that take away communication, thinking, or weaken the patient to a point of compromise, it becomes essential to start the dialogue long before the disease takes over.


In the last year or so this specific notion of dealing with death has crept into my life time and time again. First in multiple encounters of working with elderly patients with dementia, or some other illness, who did not “have their ducks in a row” so to speak, left families with critical choices on their plate. Many times a person will have laid out the basics, but when critical moments arise it is much more complicated, emotions of family member take over, not wanting to “lose” their loved one, etc. Resuscitate or don’t? Ventilator or none? Feeding tube or pneumonia? So many intricate questions crop up. Also, I have spent time talking with friends and members of my own family who don’t work in the medical field and they have dealt with similar issues. They ask for guidance from medical professionals, but find it lacking. All of these end of life determinations in the midst of an emotionally trying time. Hoping they will know the right thing to do, while keeping with the wishes of their loved one.


Wouldn’t it be nice if we talked about these decisions with the one who really is responsible for making the call long before the time comes?


The following is a guide designed to be used in conjunction with Bill Moyers’ PBS series On Our Own Terms.

http://www.pbs.org/wnet/onourownterms/community/pdf/discussionguide.pdf



Use with the series is beneficial, but the guide alone also serves as an superb resource for topics of conversation, decisions to be considered, suggestions for dealing with death, and even how to make sure our needs are thoroughly document so no confusion arises.


Initiate the conversations and listen intently. Learn how your parents, grandparents, spouses, and patients what to live out their last months and days, and how they want to die. In spite of a distressful event, you won’t be sorry.

Meds and Memory Improvement

A body of evidence exists discussing a positive secondary effect of antidepressant use. Hippocampus cell growth is the result which comes as a byproduct. The hippocampus is a structure within the brain which stores memories systematically. Typically examined in those with long term depression, studies show that with use of antidepressants over extended periods of time, hippocampus cells proliferate and increase in plasticity. If the hippocampus cells are generating, or even if the plasticity is allowing new information to be stored and retrieved, then implications could be profound.

The use of antidepressants can be very beneficial for the elderly and those with dementia, for decreasing depression, but perhaps there is an additional benefit. Wouldn’t it be amazing if we could kills two birds with one stone, or at least slow down the migrating flight of memory loss throughout the fragile brains of those with dementia, Alzheimer’s, or normal age related memory impairment.

Now I have to say that doctors do not prescribe antidepressants for this purpose, and research is virtually nonexistent in hippocampus volume increase with the population whose diagnosis is that of a memory disease such as Alzheimer’s. What’s available is the promise of clinical trials related to this concept. Here is a link to one such trial, and this site will provide a tool to find other trials as well that may benefit our patients and loved ones with dementia.
http://clinicaltrials.gov/ct2/show/NCT00702780?term=Alzheimer%27s+and+antidepressant&rank=12

More than a clinical trial, the promise or hope that perhaps a treatment we use for one symptom, depression, will change the brain with memory loss in a positive way may provide solace in the face of a very challenging disease.

Photo By: Tom Varco