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Neurocognitive Disorders Neurodegenerative Disorders

Going Back to School: Adult Day Care

When someone says “daycare”, what is the image that pops into your head? Primary colors abound the alphabet on the walls, and the smell of crayons heavy in the air. And obviously, children running around playing, possibly with paint from arts and crafts on their shirt or remnants of snack time on their face, with a teacher or two trying to wrangle them all in. This is what a daycare center entails… or is it? While the term daycare might be commonly associated with young children who are being cared for while their parents are in work, there is another population that has been using daycare: elderly individuals with dementia.

Adult day care centers for individuals with dementia have become increasingly popular to help engage the growing number of individuals suffering from dementia and help alleviate the stress off of their caregivers. Currently, there are 50 million people with dementia around the world, and approximately 10 million new cases are being diagnosed every single year. With this massive population that is just growing, there need to be effective ways to help minimize the suffering that the individuals and their families face.  This is where adult day care center can come into play.

One particular center in Chula Vista, California that opened up earlier this year was designed to look like a town square from the 1950’s, a time when most of these patients were young. The town has 14 activity centers that appear to be storefronts, with anything you can think of it a town: vintage clothing stores, a gas station with a Thunderbird, dinner, movie theater and more. This specific center is trying to engage the participants by using what they call reminiscence therapy, trying to promote socialization by creating an environment where their memories are more easily recalled.

Though not every center uses such elaborate techniques, simpler applications of these principles are used in other centers. They try to engage these people by allowing them to socialize and participate in a variety of activities. Some of these activities could include outings, pet therapy, counseling and therapy, health services, behavior management, along with recreational activities like music and art.

Using the Montessori method, which is commonly used to teach social, cognitive and functional skills to children, has been found to be beneficial in this setting to engage individuals socially and with their environment. This can be extremely helpful in minimizing behavioral issues that are common among dementia patients, especially apathy and agitation.  Along with potentially helping behavioral and cognitive symptoms, these patients may also foster physical improvements. This population often is associated with degrees of frailty and fall risks. By being a part of a program like this, there may be improvements in gait, especially after longer participation.

With so many people suffering from dementia, be it a specific form such as Alzheimer’s or any other form, there will also inherently be an increase in the number of people that care for them. Currently, according to the Alzheimer’s Association,  16.1 million Americans provide unpaid care for people with Alzheimer’s or other dementias. Caring for someone with dementia can take an incredible toll on caregivers, one-third of who are 65 years old and older. The sandwich generation, as they are called, are responsible for not only caring for an aging family member but also a child under 18. These individuals make up approximately one-fourth of all caregivers. Could using an adult daycare service be beneficial to the caregivers, on top of being helpful for those with dementia?

The short answer: yes! Studies have shown that after only a three month period, caregivers who used an adult daycare service had significantly fewer feelings of overload and strain, as well as lower levels of depression and anger. The reasoning for this may be that having the adult daycare gives the caregiver more time to do other necessary tasks, allowing them to feel less stressed. It was also found that for caregivers with a family member that had their memory symptoms improve when using the adult daycare, there was a correlation with a reduction of overload, or feeling mental and emotionally drained.

By away giving a break to the caregiver and an avenue for socialization for someone with dementia, adult day care seems to be an amazing opportunity. Hopefully, this will become more accessible to a greater number of people, with increasing the number of locations worldwide and decreasing the cost or having this service be covered by more insurances. To find out more information about how to find an adult day care center near you, check out the Alzheimer’s Association’s resources!  

References:

Adult Day Centers. (n.d.). Retrieved from https://www.alz.org/help-support/caregiving/care-options/adult-day-centers

Dementia. (n.d.). Retrieved from http://www.who.int/news-room/fact-sheets/detail/dementia

Facts and Figures. (n.d.). Retrieved from https://www.alz.org/alzheimers-dementia/facts-figures

Hageman, P. A., & Thomas, V. S. (2002). Gait performance in dementia: The effects of a 6-week resistance training program in an adult day-care setting. International Journal of Geriatric Psychiatry, 17(4), 329-334. doi:10.1002/gps.597

Judge, K. S., Camp, C. J., & Orsulic-Jeras, S. (2000). Use of Montessori-based activities for clients with dementia in adult day care: Effects on engagement. American Journal of Alzheimers Disease, 15(1), 42-46. doi:10.1177/153331750001500105

Powell, R., & Pawlowski, A. (2018, April 10). Dementia day care looks like 1950s town to stimulate patients’ memories. Retrieved from https://www.today.com/health/dementia-day-care-looks-1950s-stimulate-patients-brains-t126727

Steven H. Zarit, Mary Ann Parris Stephens, Aloen Townsend, Rickey Greene; Stress Reduction for Family Caregivers: Effects of Adult Day Care Use, The Journals of Gerontology: Series B, Volume 53B, Issue 5, 1 September 1998, Pages S267–S277,

Zarit, S. H., Stephens, M. A., Townsend, A., & Greene, R. (1998). Stress Reduction for Family Caregivers: Effects of Adult Day Care Use. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 53B(5). doi:10.1093/geronb/53b.5.s26

Categories
Neurocognitive Disorders

Searching for the Right Words: Living with Aphasia

Imagine waking up one morning and forgetting how to speak your native language, the one you have spoken for most of your life. Your loved ones try speaking to you, and while you know how you’d like to respond, you just can’t seem to find the words to say. You become tongue-tied, embarrassed, and increasingly frustrated when no one can seem to understand the words that you do get out of your mouth. Trying to write what you are thinking is to no avail as well. You feel isolated in your inability to communicate, stranded on an island with no way to get off. Now, imagine living like this every day.  For close to two million Americans, this, or something similar to this, is their everyday existence. This is known as aphasia.

Aphasia is a cognitive disorder that involves the loss of language function, particularly in regards to speaking, reading, and writing. Though commonly considered to be a speech disorder and treated by speech-language pathologists, aphasia has origins in the brain. Aphasia is most often the results of a stroke, but can also come from other traumatic brain injuries, brain tumors, or other neurological issues. There are several different treatment options available, but recovery is often very slow and laborious, and a full recovery is not often seen.

As language is something that many people take for granted, it may be hard to conceptualize the cognitive difficulties that these individuals are facing.  Wheeler E. Hubbard, a man who has been suffering from aphasia, describes what his personal experience with aphasia:

“Imagine that you are playing bingo. My brain is like the drum that they turn to pick a number.  I have about 2,000 words in my brain. To speak, I have got to go into the “drum” and find the word that I want, concentrate on it, bring it to my mouth and figure out how to say it, what tense to make it, then get it in the right order in the sentence.  Something you take for granted takes all my effort, energy, and concentration to do.”

While this is one individual’s experience with living with aphasia, aphasia can actually mean different things depending on what area of the brain is impacted. There are three major categories of aphasia: Wernicke’s, Broca’s and Global aphasia. Wernicke’s aphasia is the most common type of fluent aphasia, meaning that a person ’s sentences may sound completely fluent, but the word choice can have no meaning, contain extra words, or even use made-up words. Individuals with Wernicke’s aphasia do not often recognize that they have made any mistakes in their sentences, and often have difficulty understanding what others say. Broca’s aphasia, on the other hand, is nonfluent aphasia. This means that they may understand speech and know what they want to say, but have a hard time producing sentences. They may omit smaller words and speak in shorter phrases. They are more likely to recognize their mistakes and become frustrated. Global aphasia is a more severe type of aphasia. These individuals may only be able to say a few words, repeat the same phrase over and over again, and have severe difficulties understanding others.

Now that you are well armed with the knowledge of aphasia, a question you might be having is “How can I communicate with someone with aphasia?” Though it depends on every individual, here are a few suggestions!

  1. Allow the individual time to speak. Trying to offer up words and finishing the individual’s sentences, may make them feel like you are rushing them or do not care about what they have to say.
  2. Try to find non-verbal ways to communicate, such as gestures, facial expressions, or even drawings. This will allow for the conversion to rely not so heavily on language.
  3. Give them praise when they are able to say or pronounce something clearly, and downplay any mistakes that they might make. This does not mean pretending that every single word is perfect if it isn’t; lying to them will not make the situation any better, especially if they can tell that you are lying.
  4. Make sure that you do not come across as speaking down to them. Though it may seem like you are trying to be nice and use simple words to communicate, as if talking to a child, it’s important to remember that this individual is still an adult, and should be treated as one.

Ultimately, the most important thing that you can do is to be empathetic. Understand that however frustrated you are with your inability to communicate with an individual with aphasia, that they are most likely frustrated with themselves. Showing the individual that you care by including them in conversations and allowing them the space to talk reminds them that they do have people who care about them and want to communicate with them.

References:

Aphasia. (2018, June 15). Retrieved September 30, 2018, from https://www.nidcd.nih.gov/health/aphasia

Aphasia FAQs. (n.d.). Retrieved September 30, 2018, from https://www.aphasia.org/aphasia-faqs/

Communication Tips. (n.d.). Retrieved from https://www.aphasia.org/aphasia-resources/communication-tips/

My Story of Aphasia. (2015, February 25). Retrieved from https://www.aphasia.org/stories/my-story-of-aphasia/

Categories
Neurocognitive Disorders

Neurocognitive Disorders: What Are They?

When people think about different types of disorders that can affect the brain, many different things might come to mind. Depression, anxiety, epilepsy, autism spectrum disorder and other types of psychological and neurological disorders, probably top the list; however, there are plenty of other disorders that can have a significant impact on daily living and impact a huge number of people. One of these, in particular, is neurocognitive disorders.

Now, you might be asking yourself “what is a neurocognitive disorder?” If you are, don’t fret, there’s a reason you might not be as familiar with the diagnosis. The diagnosis of neurocognitive disorders was only added to the DSM-V, the most recent iteration of the manual. Prior to that, the closest diagnosis that existed was Delirium, Dementia, Amnestic, and Other Cognitive Disorders. The current diagnosis of neurocognitive disorders covers individuals with cognitive decline across many domains. While this might sound complex, this means that individuals who have issues with attention, executive functioning, like planning and organization, memory and/or language, that causes some significant level of impairment in their daily functioning would meet the qualifications to be diagnosed with a neurocognitive disorder.

There are two different methods that are used to classify neurocognitive disorders. The first way is by establishing the severity of symptoms with one of two diagnoses: major and minor neurocognitive disorders. For individuals that feel there are severe decline and significant impact on daily functioning, a diagnosis of major NCD would be more appropriate, whereas those with a mild decline and modest impairment would most likely be diagnosed with minor NCD. While some health care providers feel that the division between the two disorders are unnecessary and even artificial, most find this division to be helpful in terms of establishing a diagnosis much earlier than it has been previously.

The other classification within these diagnoses are based on the etiology, or the underlying issue, causing the neurocognitive issues. Some examples of these categories include Alzheimer’s NCD, vascular NCD, and frontotemporal NCD. This can be extremely helpful to specify what type of treatment an individual should be receiving. For example, the term dementia is frequently used synonymously with neurocognitive disorders. Using this term, however, might cause some to think that the associated disorders are exclusively Alzheimer’s disease, Lewy body disease or other types of neurodegeneration. These, however, are not the only types of diseases or disorders that can cause neurocognitive disorder to be diagnosed. Parkinson’s disease, vascular disease, HIV, substance abuse, traumatic brain injury and Huntington’s disease are all highly related with the cognitive decline that can be classified as a  neurocognitive disorder. Each of these specific diseases and disorders may all have a different underlying reason for how the cognitive issues came about, and therefore most likely would need different types of treatments to help resolve the symptoms that the individual is facing.

Though this is a new diagnosis, the symptoms that the individuals diagnosed with these disorders are faced with are not new. The prior confusing diagnoses did not fully explain why individuals were having cognitive problems and what these cognitive challenges are. This makes it much more complicated for both those with the diagnosis as well as those who are trying to understand or treat the individual. Hopefully, having a clear diagnosis will allow more people to get treated effectively for these cognitive complaints that come along with so many different diseases and disorders.

References:

Blazer, D. (2013). Neurocognitive Disorders in DSM-5. American Journal of Psychiatry, 170(6), 585-587. doi:10.1176/appi.ajp.2013.13020179

Ganguli, M., Blacker, D., Blazer, D. G., Grant, I., Jeste, D. V., Paulsen, J. S., . . . Sachdev, P. S. (2011). Classification of Neurocognitive Disorders in DSM-5: A Work in Progress. The American Journal of Geriatric Psychiatry, 19(3), 205-210. doi:10.1097/jgp.0b013e3182051ab4

Symptoms of Major Neurocognitive Disorder. (2017, August 24). Retrieved from https://psychcentral.com/disorders/symptoms-of-major-neurocognitive-disorder/

Symptoms of Minor Neurocognitive Disorder. (2018, February 04). Retrieved from https://psychcentral.com/disorders/symptoms-of-minor-neurocognitive-disorder/