Teepa Snow, Positive Approach, LLC to be reused

 Teepa Snow, Positive Approach, LLC  to be reused

Teepa Snow, Positive Approach, LLC to be reused only with permission. For the slides from this presentation, visit: www.teepasnow.com/presentations Slides will be available for 2 weeks Teepa Snow, Positive Approach, LLC to be reused only with permission. Handouts are intended for personal use only. Any copyrighted materials or DVD content from Positive Approach, LLC (Teepa Snow) may be used for personal educational purposes only. This material may not be copied, sold or commercially exploited, and shall be used solely by the requesting individual.

Copyright 2017, All Rights Reserved Teepa Snow and Positive Approach to Care Any redistribution or duplication, in whole or in part, is strictly prohibited, without the expressed written consent of Teepa Snow and Positive Approach, LLC Teepa Snow, Positive Approach, LLC to be reused only with permission. Dementia Screening and Assessment: Options and Value Teepa Snow, Positive Approach, LLC to be reused only with permission.

Where Did We Start? Alzheimers first diagnosed in 1907 OBS: Organic Brain Syndrome common term: 60s Psychiatric illness/mentally ill: 60s-80s

SDAT became popular: 80s De-institutionalization, nursing homes: 70s-80s Drugs and restraints:60s-80s Diagnosis of Alzheimers at death: until 90s

Little could be done once diagnosed until the 90s Families - do the best you can: 60s-90s First family support program Duke: early 80s Teepa Snow, Positive Approach, LLC to be reused only with permission.

Over the past 25 years, research and knowledge has increased dramatically Teepa Snow, Positive Approach, LLC to be reused only with permission. Where Are We Now? - 90-95% accuracy on syndrome identification- if done Early diagnosis offers best treatment and planning Some drugs may help with some symptoms Strategies to improve care and quality of life 5.8 million diagnosed people in the US

Over 100 known causes or forms of dementia Pseudo-dementias are reversible with early identification and treatment We can reduce our risks for getting dementia Genes have been identified for more study New information each week Differential diagnosis matters Teepa Snow, Positive Approach, LLC to be reused only with permission. What is Available Now? - Risk reduction - Improved diagnosis - Better symptom management - Better care strategies

- Increased public awareness - Some support for those with dementia - More understanding of different dementias Teepa Snow, Positive Approach, LLC to be reused only with permission. What Is On The Horizon? Research and Genetic work to: - Identify all genes - Slow the progression - Keep it from happening - Determine family inheritance - Identify who is at risk and what they should do to reduce risk

- Develop better targeted treatments Teepa Snow, Positive Approach, LLC to be reused only with permission. Understanding the Condition: - Differential diagnosis is possible - There is a latency period of 5-15 years - We are closer to understanding what causes some dementias: Alzheimers, Vascular, Lewy Body, Fronto-Temporal - As we get closer to the causes, we may be able to develop treatments that specifically address symptoms Teepa Snow, Positive Approach, LLC to be reused only with permission.

Tools and Diagnostics: - Autopsy - X-Ray - CAT scan or CT Scan - MRI - PET Scan or Functional MRI - SPECT scan - Protein evaluation of CSF - Clinical interaction and report of observable behaviors Teepa Snow, Positive Approach, LLC to be reused only with permission. Normal Brain

Used with permission from Alzheimers:The Broken Brain, 1999 University of Alabama Alzheimers Brain Teepa Snow, Positive Approach, LLC to be reused only with permission. PET and Aging: PET Scan of 20-Year-Old Brain ADEAR, 2003 PET Scan of 80-Year-Old Brain

Teepa Snow, Positive Approach, LLC to be reused only with permission. Positron Emission Tomography (PET) Alzheimers Disease Progression vs. Normal Brains Norma l Early Alzheimer s G. Small, UCLA School of Medicine. Late

Alzheimers Chil d Teepa Snow, Positive Approach, LLC to be reused only with permission. Alzheimers: A Window of Opportunity Loss of brain function in 20-40 yearolds with a common AD risk gene

Teepa Snow, Positive Approach, LLC to be reused only with permission. Normal vs. Not Normal Aging: Normal Aging: Not Normal Aging: Slower to think Cant think the same Slower to do

Cant do like before Hesitates more Cant get started More likely to look before leaping Cant seem to move on Know the person but not the name

Cant place the person Pause to find words Reminded of the past Harder Doesnt think it out at all Words wont come even later Confused about past versus now Very different! Teepa Snow, Positive Approach, LLC to be reused only with permission.

Be Careful! It Could Be: - Another medical condition - Medication side effect - Hearing loss or vision loss - Depression - Delirium - Severe but unrecognized pain - Other things Teepa Snow, Positive Approach, LLC to be reused only with permission. Drugs That Can Affect

Cognition: Anti-arrhythmic agents Antibiotics Histamine receptor blockers Antihistamines decongestants Immunosuppressant agents Tricyclic antidepressants

Muscle relaxants Anti-hypertensives Narcotic analgesics Anti-cholinergic agents Sedative hypnotics Anti-convulsants Anti-Parkinsonian agents

Anti-emetics Washington Manual Geriatrics Subspecialty Consults edited by Kyle C. Moylan (pg 15) published by Lippencott, Wilkins & Williams , 2003 Teepa Snow, Positive Approach, LLC to be reused only with permission. Mimics of Dementia: Depression/Anxiety: Delirium: Cant think Swift change

Cant remember Hallucinations Not worth it Delusions Loss of function On and off responses Mood swings

Infection Personality change Toxicity Change in sleep Dangerous Teepa Snow, Positive Approach, LLC to be reused only with permission. Dementia

Alzheimers Memory Problems Teepa Snow, Positive Approach, LLC to be reused only with permission. About 90-95% of the general public think Dementia Alzheimers Problems Memory

Teepa Snow, Positive Approach, LLC to be reused only with permission. BETTER ANSWER: Dementia Alzheimers Problems Memory Teepa Snow, Positive Approach, LLC to be reused only with permission. BEST ANSWER: Dementia

Alzheimers Memory Problems Teepa Snow, Positive Approach, LLC to be reused only with permission. So, What is Dementia? - Its a syndrome, not a single condition - It can be primary or secondary, and cortical or sub-cortical - It can strike at any age, although more common when older - It has many causes, forms, and patterns

- It has two major mimics - It is progressive but duration varies - It is a terminal illness: 5th leading cause Teepa Snow, Positive Approach, LLC to be reused only with permission. How Common is Dementia? 60 50 40 30 <60 at 60

20 >85 10 0 Percent with Dementia - The risk goes up dramatically with increasing age - America is aging - Dementia may increase by 400% over the next 50 years without medical advances

Teepa Snow, Positive Approach, LLC to be reused only with permission. Four Truths About Dementia: - At least 2 parts of the brain are dying: - One related to memory and the one other - It is chronic cant be fixed - It is progressive it gets worse - It is terminal it will kill, eventually Teepa Snow, Positive Approach, LLC to be reused only with permission. Dementia: What Changes?

- Structural changes: permanent - Cells are shrinking and dying - Chemical changes: variable - Cells are producing and sending less chemicals - Can shine when least expected due to a chemical rush Teepa Snow, Positive Approach, LLC to be reused only with permission. Ten Early Warning Signs for Alzheimers and Some Other Dementias: 1. Memory loss for recent or new

information, repeats self frequently 2. Difficulty doing familiar but difficult tasks: managing money, medications, driving 3. Problems with word finding, mis-naming, or misunderstanding 4. Getting confused about time or place, getting lost while driving, missing several appointments 5. Worsening judgment, not thinking thing through like before 6. Difficulty problem-solving

or reasoning 7. Misplacing things or putting them in odd places 8. Changes in mood or behavior 9. Changes in typical personality 10. Loss of initiation: withdraws from normal patterns of activities and interests Teepa Snow, Positive Approach, LLC to be reused only with permission. MCI: Mild Cognitive Impairment

- The beginning of Not Normal cognition: - Memory - Language - Behavior - Motor skills - Inconsistent - Worse when tired or sick or in unfamiliar or uncomfortable setting - Not life-altering, but definitely different for others close to them Teepa Snow, Positive Approach, LLC to be reused only with permission. Positron Emission Tomography (PET)

Alzheimers Disease Progression vs. Normal Brains Norma l Early Alzheimer s G. Small, UCLA School of Medicine. Late Alzheimers Chil

d Teepa Snow, Positive Approach, LLC to be reused only with permission. Normal Brain Alzheimers Brain Used with permission from Alzheimers:The Broken Brain, 1999 University of Alabama Teepa Snow, Positive Approach, LLC to be reused only with permission. Storage units - data Executive

Control Center: Emotions Behavior Judgment Reasoning Wiring connecting, bringing data in and sending data out Teepa Snow, Positive Approach, LLC to be reused only with permission. Hippocampus Big Changes:

Learn and remember Way-finding Passage of time Teepa Snow, Positive Approach, LLC to be reused only with permission. Changes in Language Skills Vocabulary Comprehension Speech Production

Understanding Language Big Change Teepa Snow, Positive Approach, LLC to be reused only with permission. Hearing Sound Not Changed Teepa Snow, Positive Approach, LLC to be reused only with permission. Sensory Strip Motor Strip White Matter Connections: Big Changes Automatic Speech

Rhythm Music Expletives: Preserved Formal Speech and Language Center: Huge Changes Teepa Snow, Positive Approach, LLC to be reused only with permission. Executive Control Center Changes:

Being logical, reasonable, rational Controlling impulses Making decisions Initiatingsequencingterminatingtransitioning Being self-aware Seeing other

perspectives Teepa Snow, Positive Approach, LLC to be reused only with permission. Vision Center Big Changes Teepa Snow, Positive Approach, LLC to be reused only with permission. For all that is lost, some remains! 1/3 of brain remains Know what still works Know how we support in areas of loss used with permission from Alzheimers:The Broken Brain, 1999

University of Alabama Teepa Snow, Positive Approach, LLC to be reused only with permission. Teepa Snow, Positive Approach, LLC to be reused only with permission. Teepa Snow, Positive Approach, LLC to be reused only with permission. Screening Options: - Old: MMSE - New: - AD-8 Interview - Animal fluency: 1 minute # of animals - Clock Drawing: 2-step - Trail making

- SLUMS: 7 minute screen - SAGE - MoCA - Full Neuropsychological testing panel Teepa Snow, Positive Approach, LLC to be reused only with permission. AD8 Dementia Screening Interview: - Does your family member have problems with judgment? - Does your family member show less interest in hobbies/activities? - Does your family member repeat the same things over and over? - Does your family member have trouble learning how to use a tool, appliance, or gadget? - Does your family member forget the correct month or year?

- Does your family member have trouble handling complicated financial affairs ? - Does your family member have trouble remembering appointments? - Does your family member have daily problems with thinking or memory? - Scores: Changed, Not Changed, Dont Know Teepa Snow, Positive Approach, LLC to be reused only with permission. Animal Fluency: - Name as many animals as you can - Give one minute: dont highlight time limit - Count each animal named: not repeats - Establish Baseline versus Normal/Not Normal - Old Guidelines: 12 normal for > 65 and 18 for

<65 - New: Compare you to you over time Teepa Snow, Positive Approach, LLC to be reused only with permission. Clock Drawing: - Give a big circle on a blank sheet of paper - Ask to draw the face of a clock and put in the numbers - Watch for construction skills and outcome - Ask to put hands on the clock to indicate 2:45 - Watch for placement and processing - Scoring: 4 possible points - 1-12 used, correct quadrants, minute hand

correct, hour hand correct Teepa Snow, Positive Approach, LLC to be reused only with permission. SLUMS: - Orientation: day of week, month, state (3) - Remember 5 items: ask later (5) - $100: buy apples $3 and Trike $20 - What did you spend? What is left? (2) - Animal fluency: <5, 5-9, 10-14, >14: (0-3) - Clock drawing: numbers in place, time right (4) - Number reversals: 48, they say 84 (2) - Shapes: identify correct, which is largest (2) - Story recall: recall of info from a story 4?s (8) Teepa Snow, Positive Approach, LLC to be reused only with permission.

SLUMS: Rating High School Education: Less than High School: 27-30: Normal 25-30: Normal 21-26: MNCD (MCI) 20-24: MNCD (MCI)

1-20: Dementia 1-19: Dementia Teepa Snow, Positive Approach, LLC to be reused only with permission. MoCA, SAGE, Trail making Teepa Snow, Positive Approach, LLC to be reused only with permission. Dementia does not equal

Alzheimers does not equal Memory Problems Teepa Snow, Positive Approach, LLC to be reused only with permission. Teepa Snow, Positive Approach, LLC to be reused only with permission. Teepa Snow, Positive Approach, LLC to be reused only with permission. Alzheimers:

New info lost Recent memory worse Problems finding words Mis-speaks More impulsive or indecisive Gets lost Notice changes over 6 m 1 yr Lasts 8-12 years 2 Forms: Young Onset and Late Life Onset Teepa Snow, Positive Approach, LLC to be reused only with permission. Young Onset: 3 groups: genetics, Downs, lifestyle Young family, kids often involved

Mis-diagnosis and non-diagnosis is common Work may be first place to notice Relationships are strained early due to misunderstanding Services are a problem usually Finances are problematic Executive decision making and sequencing Teepa Snow, Positive Approach, LLC to be reused only with permission. Typical Treatment for Alzheimers: Try an AChEI as soon as diagnosis is made If side effects are too much, try another one Stay on the AChEI until: 3 groups of thought

1. Placement in a facility 2. Considering other med stops near end 3. Not sure if helping or hurting taper and see Try Namenda for mid-stage disease Stay on Namenda as above Teepa Snow, Positive Approach, LLC to be reused only with permission. Normal Brain Cells Neurotransmitters (AChE) being sent, message being communicated to the next cell

Teepa Snow, Positive Approach, LLC to be reused only with permission. Normal Brain Cells: Once the message is sent, then enzymes lock onto the messenger chemicals and take them out of circulation so a new message can be sent Teepa Snow, Positive Approach, LLC to be reused only with permission. Brain Cells with Alzheimers: Less neurotransmitter Plaques

Tangles Further to go to get to the next cell Enzymes (AChE inhibitors) get to them before they deliver their message Teepa Snow, Positive Approach, LLC to be reused only with permission. What do Alzheimers Drugs Do? Alzheimers drugs provide

fake messenger chemicals that distract the enzymes. They attach to the fake AChE and the message can get through Aricept, Exelon, Reminyl (Razadyne) Teepa Snow, Positive Approach, LLC to be reused only with permission. One Other Dementia Drug: Memantine - Namenda From Europe - 10 years of research Different effect

Moderates glutamate absorption Works best in combination with AChE inhibitors Keeps the cell from getting so much glutamate in it Can use it with AChE inhibitors: two actions Teepa Snow, Positive Approach, LLC to be reused only with permission. Vascular Dementia: Sudden changes: stepwise progression Other conditions: diabetes, hypertension, heart

disease So, damage is related to blood supply/not primary brain disease: treatment can plateau Picture varies by person: blood/swelling/recovery Can have bounce back and bad days Judgment and behavior not the same Spotty loss: memory, mobility Emotional and energy shifts Teepa Snow, Positive Approach, LLC to be reused only with permission. Vascular Dementia: CT Scan The white spots indicate dead cell areas: mini-strokes

Teepa Snow, Positive Approach, LLC to be reused only with permission. Positive Teepa Snow, Positive Approach, LLC to be reused only with permission. Latest Thinking About Vascular Treatment? Lots of similarity with Alzheimers Manage blood flow issues carefully! Watch for and manage depression Teepa Snow, Positive Approach, LLC to be reused only with permission.

Lewy Body Dementia: Movement problems/falls Visual hallucinations: animals, children, people Fine motor problems: hands and swallowing Episodes of rigidity and syncopy Nightmares or insomnia Delusional thinking Fluctuations in abilities Drug responses can be extreme and strange Can become toxic, can die, can become unable to move Can have an opposite reaction Teepa Snow, Positive Approach, LLC to be reused only with permission.

Latest Thinking About Lewy Body Treatment: Try AChIs: Start low and go slow Then Try Namenda early: start low and go slow Be very careful about anti-psychotic meds: avoid Haldol

Need to balance movement losses and aid to function Parkinsons meds may/may not help movement but may make hallucinations and delusions worse Anti-depressants may be used to help anxiety, sleep, and depression but can increase confusion, movement

and drowsing Sleep aids or anti-anxiety medications can cause paradoxical reactions Teepa Snow, Positive Approach, LLC to be reused only with permission. Fronto-Temporal Dementias: Many types: typically younger onset Frontal: impulse and behavior control loss (not memory issues) Says unexpected, rude, mean, odd things to others Disinhibited: food, drink, sex, emotions, actions

OCD-type behaviors Hyperorality Temporal: language loss Cant speak or get words out Cant understand what is said, sound as if they are fluent but are using nonsense words Teepa Snow, Positive Approach, LLC to be reused only with permission. Latest Thinking About FTD Treatments: - Consider Namenda earlier - Look at SSRI medications

- May use medications used to treat OCD - May not use AChI Medications Teepa Snow, Positive Approach, LLC to be reused only with permission. What if it doesnt seem to be one of these dementias? - Atypical or other dementias - Mixed picture Teepa Snow, Positive Approach, LLC to be reused only with permission. Other Dementias: Genetic syndromes: Huntingtons Chorea

ETOH related: Wernickes or Korsakoffs Drugs/toxin exposure: heavy metals, pesticides White matter diseases: MS Mass effects: tumors and NPH Depression and other psychological conditions Infections: BBB cross such as C-J, HIV/Aids, Lymes Parkinsons: 40% about 5-8 yrs in Progressive Supranuclear Palsy Teepa Snow, Positive Approach, LLC to be reused only with permission. Mixed Picture: - Can have multiple forms - Can start with one and add another

- Can have some symptoms and not all - Also can have other lifelong issues and then develop dementia: Downs, mental illness, personality disturbances, substance abuse Teepa Snow, Positive Approach, LLC to be reused only with permission. So, You are Noticing Changes: What Should You Do? Get it assessed! Go see the doctor!

Teepa Snow, Positive Approach, LLC to be reused only with permission. Amygdalae: Threat Needs + Pleasure Dangerous Need Aroused/Risky Want

Alert/Aware Like Teepa Snow, Positive Approach, LLC to be reused only with permission. Primitive Brain is in Charge of: Survival: Autonomic protective: Fright, flight, fight + hide or seek Pleasure seeking: Meeting survival needs and finding joy Thriving/Running the Engine:

Maintain vital systems: BP, BS, Temp, Pain, Oxygen Reflexes: Breathe, suck, swallow, digest, void, defecate Circadian rhythm Infection control Learning New and Remembering: Information Places: spatial orientation Passage of Time: temporal orientation Teepa Snow, Positive Approach, LLC to be reused only with permission. As part of the disease people with dementia tend to develop typical patterns of speech,

behavior, and routines. These people will also have skills and abilities that are lost while others are retained or preserved. Teepa Snow, Positive Approach, LLC to be reused only with permission. INTENT I'm sorry I was trying to help THIS IS HARD I'm sorry,

this is hard, I hate it for you THAT HAPPENED I'm sorry, it should NOT have happened EMOTION I'm sorry I made you angry

Im sorry I disappointed you INTELLECTUAL CAPACITY I'm sorry, I had no right to make you feel that way Teepa Snow, Positive Approach, LLC to be reused only with permission. Global Deterioration Scale:

1 No cognitive decline 2 Very mild cognitive decline Age Associated Memory Impairment 3 Mild cognitive decline Mild Cognitive Impairment 4 Moderate cognitive decline Mild Dementia 5 Moderately severe cognitive decline Moderate Dementia 6 Severe cognitive decline

Moderately Severe Dementia 7 Very severe cognitive decline Severe Dementia So what can they do? The scale doesnt address that? Teepa Snow, Positive Approach, LLC to be reused only with permission. No Cognitive Decline No subjective complaints of memory deficit. No memory deficit evident on clinical interview. Teepa Snow, Positive Approach, LLC to be reused only with permission.

Very Mild Cognitive Decline (Age Associated Memory Impairment) Subjective complaints of memory deficit, most frequently in following areas: (a) forgetting where one has placed familiar objects; (b) forgetting names one formerly knew well. No objective evidence of memory deficit on clinical interview. No objective deficits in employment or social situations. Appropriate concern with respect to symptomatology.

Teepa Snow, Positive Approach, LLC to be reused only with permission. Mild Cognitive Decline (Mild Cognitive Impairment) Earliest clear-cut deficits. Manifestations in more than one of the following areas: (a) patient may have gotten lost when traveling to an unfamiliar location; (b) co-workers become aware of patient's relatively poor performance; (c) word and name finding deficit becomes evident to intimates; (d) patient may read a passage or a book and retain relatively little material; (e) patient may demonstrate decreased facility in remembering names upon introduction to new people; (f) patient may have lost or misplaced an object of value; (g) concentration deficit may be evident on clinical testing. Objective evidence of memory deficit obtained

only with an intensive interview. Decreased performance in demanding employment and social settings. Denial begins to become manifest in patient. Mild to moderate anxiety accompanies symptoms. Teepa Snow, Positive Approach, LLC to be reused only with permission. Moderate Cognitive Decline (Mild Dementia) Clear-cut deficit on careful clinical interview. Deficit manifest in following areas: (a) decreased knowledge of current and recent events; (b) may exhibit some deficit in memory of ones personal history; (c) concentration deficit elicited on serial subtractions; (d)

decreased ability to travel, handle finances, etc. Frequently no deficit in following areas: (a) orientation to time and place; (b) recognition of familiar persons and faces; (c) ability to travel to familiar locations. Inability to perform complex tasks. Denial is dominant defense mechanism. Flattening of affect and withdrawal from challenging situations frequently occur. Teepa Snow, Positive Approach, LLC to be reused only with permission. Moderately Severe Dementia May occasionally forget the name of the spouse upon whom they are entirely dependent for survival. Will be largely unaware of all recent events and experiences in their lives. Retain some knowledge of their past lives but this is

very sketchy. Generally unaware of their surroundings, the year, the season, etc. May have difficulty counting from 10, both backward and, sometimes, forward. Will require some assistance with activities of daily living, e.g., may become incontinent, will require travel assistance but occasionally will be able to travel to familiar locations. Diurnal rhythm frequently disturbed. Almost always recall their own name. Frequently continue to be able to distinguish familiar from unfamiliar persons in their environment. Personality and emotional changes occur. These are quite variable and include: (a) delusional behavior, e.g., patients may accuse their spouse of being an impostor, may talk to imaginary figures in the environment, or to their own reflection in the mirror; (b) obsessive symptoms, e.g., person may continually repeat simple cleaning activities; (c) anxiety symptoms, agitation, and even previously nonexistent violent behavior may occur; (d) cognitive abulla, i.e., loss of willpower because an individual cannot carry a thought long enough to

determine a purposeful course of action. Teepa Snow, Positive Approach, LLC to be reused only with permission. Very Severe Dementia All verbal abilities are lost over the course of this stage. Frequently there is no speech at all -only unintelligible utterances and rare emergence of seemingly forgotten words and phrases. Incontinent of urine, requires assistance toileting and feeding. Basic psychomotor skills, e.g., ability to walk, are lost with the progression of this stage. The brain appears to no longer be able to tell the body what to do. Generalized rigidity and developmental neurologic reflexes are frequently present.

Teepa Snow, Positive Approach, LLC to be reused only with permission. Who in these pictures has dementia? Teepa Snow, Positive Approach, LLC to be reused only with permission. Progression of Dementia: The GEMS Sapphires Diamonds Emeralds Ambers

Rubies Pearls Teepa Snow, Positive Approach, LLC to be reused only with permission. Why Use GEMS States? - Uses familiar concepts to talk about a difficult subject - Focuses on what is valued rather than on a number or amount of decline - Like people, gems are precious and unique, with common characteristics - Allow to us to get beyond the words dementia and Alzheimers

- Opens the door to talking about changes - Allow us to speak in a code to protect dignity Teepa Snow, Positive Approach, LLC to be reused only with permission. What Could/Should Be Done? Establish a baseline of function and be curious about changes A thorough physical and medical history for rapid shifts Blood work and cultures to rule out infections, inflammations and possible new onset of treatable health issues A neurological and psychological assessment A good history from the person and the family of the changes or the problem

A complete medication review: OTC plus all others Neuropsychological testing: screening for cognitive changes full eval Follow-up and and counseling, or at least a referral A CAT scan, MRI, or a PET scan: for cause Teepa Snow, Positive Approach, LLC to be reused only with permission. Treatment With Medications: - Meds to treat depression or mood swings - Meds to help with pain from other conditions - Meds for severe problems with: - Paranoia - Hallucinations that are scary - Violence that is unprovoked

Teepa Snow, Positive Approach, LLC to be reused only with permission. Medications Research: Mice and animal studies do not necessarily lead to success with human studies Flurizan: keep proteins from sticking, at first looked promising, then failed Alzemed: prevent the formation of plaques, didnt show effectiveness, still in Europe Immunoglobulin pheresis: get amyloid plaques out of the brain, failed in phase 3 trials

Teepa Snow, Positive Approach, LLC to be reused only with permission. Newer Medication Research: - A new BACE inhibitor is being tried to keep proteins from grouping - CHF5074 is being used to turn down inflammation in the brain by modulating microglial cells worked best for people with APoE4 allele, but many people had problems with the med - More trials happening: details at www.clinicaltrials.gov Teepa Snow, Positive Approach, LLC to be reused only with permission.

More Research: - Managing cholesterol levels: trying ideas out, could it help Vascular or Lewy Body Dementia? - Control sugar processing: Type II diabetes medications to help keep brain from having problems in microcirculation, in process but at least buys time with better health - Use of curry curcumin: causes an enzyme called hemoxygenase to be produced which may prevent brain lipid perioxidation, research ongoing Teepa Snow, Positive Approach, LLC to be reused only with permission.

Latest Thinking: Risk Reduction De-stressing Get enough sleep Work to stay in good health Get changes in function looked in a timely manner Aerobic activity Engage socially Have fun with your brain and learn new stuff Consider

meditation/mindfulness and yoga Lower weight Reduce risk of head injuries Manage BP Keep iron in limits Manage depression and anxiety Control diabetes better Right levels of vitamins Complexes D, C, B, E

Mediterranean Diet Fish, vegetables, whole grain Teepa Snow, Positive Approach, LLC to be reused only with permission. Family and Care Partners: - Take care of yourself: stress dementia - Understand the symptoms and progression - Skills in support and caregiving - Skills in communication and interactions - Understand the condition: letting go, not giving up - Identify and use resources before its an emergency - Try a support group or other support network

- Set limits for yourself: its a marathon! Teepa Snow, Positive Approach, LLC to be reused only with permission. People with Dementia are doing the best that they can: - The person with dementia is likely not able to change, so you must be willing to change how you act to improve outcomes Teepa Snow, Positive Approach, LLC to be reused only with permission. DISCLAIMER The content contained in this presentation is strictly for informational purposes. Therefore, if you wish to apply concepts or ideas

contained from this presentation you are taking full responsibility for your actions. Neither the creators, nor the copyright holder shall in any event be held liable to any party for any direct, indirect, implied, punitive, special, incidental or other consequential damages arising directly or indirectly from any use of this material, which is provided as is, and without warranties. Any links are for information purposes only and are not warranted for content, accuracy or any other implied or explicit purpose. This presentation is copyrighted by Positive Approach to Care and is protected under the US Copyright Act of 1976 and all other applicable international, federal, state and local laws, with ALL rights reserved. No part of this may be copied, or changed in any format, sold, or used in any way other than what is outlined within this under any circumstances without express permission from Positive Approach to Care. Copyright 2017, All Rights Reserved Teepa Snow and Positive Approach to Care Teepa Snow, Positive Approach, LLC to be reused only with permission.

To learn more about the information covered in this educational presentation, join our email list. Text TEEPA to 22828 Resources are provided free of charge. Message and data rates may apply to text. Teepa Snow, Positive Approach, LLC to be reused only with permission.

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