Dementia: Dementia: Efficacious Efficacious

Diagnosis, Care & Diagnosis, Care & PreventionPrevention

2009 MGS Annual Spring Conference2009 MGS Annual Spring ConferenceCatherine Johnson PsyD LPCatherine Johnson PsyD LP

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ObjectivesObjectives

• GGain a better understanding of the etiology, ain a better understanding of the etiology, diagnosis, treatment and prevention of diagnosis, treatment and prevention of Alzheimer’s disease and other dementiasAlzheimer’s disease and other dementias

• Enhance ability to detect signs and symptoms Enhance ability to detect signs and symptoms of dementia to support early diagnosis.of dementia to support early diagnosis.

• Learn how to enhance the therapeutic Learn how to enhance the therapeutic response to persons and families response to persons and families experiencing dementia. experiencing dementia.

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What is dementia?What is dementia?

Dementia is a disease of the brain:Dementia is a disease of the brain:

• causes a decline in memory and intellectual causes a decline in memory and intellectual functioning functioning

• from some previously higher level of from some previously higher level of functioningfunctioning

• severe enough to interfere with everyday life.severe enough to interfere with everyday life.

Dementia is a syndrome, a collection of signs Dementia is a syndrome, a collection of signs and symptoms occurring together, not the and symptoms occurring together, not the

name for a single disorder.name for a single disorder.33

What is Dementia?What is Dementia?

• Deficits generally apparent in more than one cognitive domainDeficits generally apparent in more than one cognitive domain

- Ability to learn, retain, and retrieve newly acquired information Ability to learn, retain, and retrieve newly acquired information (recent memory)(recent memory)

- Ability to comprehend and express verbal information Ability to comprehend and express verbal information (language)(language)

- Ability to manipulate and synthesize nonverbal, geographic, or Ability to manipulate and synthesize nonverbal, geographic, or graphic information (visuospatial function)graphic information (visuospatial function)

- Ability to perform abstract reasoning, solve problems, plan for Ability to perform abstract reasoning, solve problems, plan for future events, mentally manipulate more than one idea at a future events, mentally manipulate more than one idea at a time, maintain mental focus in the face of distraction, or shift time, maintain mental focus in the face of distraction, or shift mental efforts easily (executive function).mental efforts easily (executive function).

(Knopman, Boee, & Peterson, 2003)(Knopman, Boee, & Peterson, 2003)

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Types of DementiaTypes of Dementia• Alzheimer’s Disease – Most common, accounts for Alzheimer’s Disease – Most common, accounts for

50-70% of dementias50-70% of dementiasEarly Onset/Late Onset Alzheimer’sEarly Onset/Late Onset Alzheimer’s

• Dementia with Lewy Bodies – ParkinsonismDementia with Lewy Bodies – Parkinsonism

• Dementia due to Cerebrovascular Disease Dementia due to Cerebrovascular Disease (Vascular Dementia, Multi-Infarct Dementia), (Vascular Dementia, Multi-Infarct Dementia),

• Frontotemporal dementiaFrontotemporal dementia

• Mild Cognitive Impairment (MCI) – Not a DementiaMild Cognitive Impairment (MCI) – Not a Dementia55

Dementia and AD Statistics:Dementia and AD Statistics:

• 6 million people in the United States have 6 million people in the United States have dementia, with a projected increase to 9 dementia, with a projected increase to 9 million by the year 2030. (100,000 – MN)million by the year 2030. (100,000 – MN)

• 10 percent of Americans age 65 or older 10 percent of Americans age 65 or older have Alzheimer’s - 47% percent of have Alzheimer’s - 47% percent of Americans age 85 or older have Alzheimer’sAmericans age 85 or older have Alzheimer’s

• Cognitive health improved 93-02 Cognitive health improved 93-02 (education)(education)

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Dementia Research Dementia Research

• Alzheimer’s Disease Education and Alzheimer’s Disease Education and Referral Center (ADEAR) Referral Center (ADEAR)

800-438-4380800-438-4380

e-mail: e-mail: adear@nia.nih.gov

Website: Website: www.nia.nih.gov/Alzheimers

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Dementia ResearchDementia Research

• Chronic Care Network for Alzheimer’s Disease Chronic Care Network for Alzheimer’s Disease Project (CCN/AD). Project (CCN/AD). www.nccconline.org and MN and MN Dementia Identification ProjectDementia Identification Projectwww.alzmndak.org/docs/DIDP Manual.pdf

Contact Metro Area Agency on AgingContact Metro Area Agency on Aging

National and MN initiatives to improve the National and MN initiatives to improve the identification and diagnosis of dementia and identification and diagnosis of dementia and the ongoing management of care for the ongoing management of care for persons/families to create a comprehensive persons/families to create a comprehensive model of care. model of care.

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What Causes Dementia?What Causes Dementia?

• Researchers believe dementia may Researchers believe dementia may be caused by a variety of influences. be caused by a variety of influences. Evidence supports a combination of Evidence supports a combination of genetic and environmental factors.genetic and environmental factors.

• Dementia is NOT a normal part of the Dementia is NOT a normal part of the aging process.aging process.

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Genetic and other Factors Genetic and other Factors Affecting AD and other Affecting AD and other

DementiaDementia• Genetic –Genetic –

Early: Ch 21, 14, 1Early: Ch 21, 14, 1Late: gene Late: gene APOE4/SORL1APOE4/SORL1

• (soluble) Beta-amyloid (soluble) Beta-amyloid plaques, Neurofibrillary plaques, Neurofibrillary tanglestangles

• Inflammation, oxidative Inflammation, oxidative stress, calcium levelsstress, calcium levels

• Aging: neuronal Aging: neuronal vulnerability vulnerability

• History of head injuryHistory of head injury• Vascular risk factors, Vascular risk factors,

health disease, health disease, diabetes diabetes

• Mental health Mental health disorders: depression, disorders: depression, alcohol abuse, anxietyalcohol abuse, anxiety

• Education Education • Gender – F/MGender – F/M• Down SyndromeDown Syndrome

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Current Research FocusCurrent Research Focus

• cardiovascular cardiovascular

• hormones hormones

• type 2 diabetestype 2 diabetes

• antioxidantsantioxidants

• omega-3 fatty acids omega-3 fatty acids

• immunizationimmunization

• cognitive trainingcognitive training

• neuroimagingneuroimaging

• exerciseexercise

• DHA supplementsDHA supplements

• proteins in blood and proteins in blood and cerebrospinal fluid. cerebrospinal fluid.

• vitamin E and vitamin E and Selenium (Preadvise) Selenium (Preadvise)

• motion detector’s motion detector’s

• biomarkers for biomarkers for

• Care modelsCare models

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Dementia Treatment Dementia Treatment StrategiesStrategies• Prevention Prevention of dementia by mitigating of dementia by mitigating

risk factors associated with dementiarisk factors associated with dementia

• Early detection Early detection to support the to support the identification and diagnosis of dementia identification and diagnosis of dementia and the ongoing management of care and the ongoing management of care for persons/families to create afor persons/families to create a

• Comprehensive model of care. Comprehensive model of care.

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Dementia Research FindingsDementia Research Findings

– People can increase their knowledge of People can increase their knowledge of dementia and comfort level to work and live dementia and comfort level to work and live with dementia to prevent and respond it.with dementia to prevent and respond it.

– Early detection is beneficial Early detection is beneficial

– Persons with dementia and families benefit Persons with dementia and families benefit from dementia detection, diagnosis, and from dementia detection, diagnosis, and ongoing support based on the phases of the ongoing support based on the phases of the disease the family is experiencing.disease the family is experiencing.

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Dementia Prevention: Dementia Prevention: Mitigating RiskMitigating Risk

• Do not smokeDo not smoke• Regular physical Regular physical

examsexams• Continue learningContinue learning• Regular ExerciseRegular Exercise• Have fun and relaxHave fun and relax• Cardiovascular careCardiovascular care

(Nussbaum, 2003)(Nussbaum, 2003)

• Be financially stableBe financially stable• Be spiritualBe spiritual• Eat less and include Eat less and include

antioxidantsantioxidants• Maintain family and Maintain family and

friendship networksfriendship networks• Do not retire from Do not retire from

life: have a life: have a role/purposerole/purpose

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Early Dementia Detection Early Dementia Detection

• Identify potentially reversible illnesses Identify potentially reversible illnesses that manifest as symptoms of dementia.that manifest as symptoms of dementia.

• Enable the primary care physician to Enable the primary care physician to diagnose and optimize treatment plans.diagnose and optimize treatment plans.

• Education of persons with dementia and Education of persons with dementia and their care partners (caregivers) for the their care partners (caregivers) for the development of advanced care planning.development of advanced care planning. 1515

Early Dementia Not Identified?Early Dementia Not Identified?

• In spite of the high prevalence of In spite of the high prevalence of individuals with dementia. We still have individuals with dementia. We still have difficulty detecting and responding.difficulty detecting and responding.

• Why?Why?

- AGEISM Myth: aging = dementia - AGEISM Myth: aging = dementia

-Don’t know the signs & symptoms to -Don’t know the signs & symptoms to detect dementiadetect dementia

-Belief that nothing can be done.-Belief that nothing can be done.

-Are not well informed of support services.-Are not well informed of support services.1616

Identification of Dementia and Follow up: Identification of Dementia and Follow up: Clinical Guidelines RecommendClinical Guidelines Recommend

• Respond to the person who expresses concerns about Respond to the person who expresses concerns about memory loss.memory loss.

• Learn and monitor for signs, symptoms, and behavioral Learn and monitor for signs, symptoms, and behavioral triggers of dementia.triggers of dementia.

• Document warning signsDocument warning signs

• Refer to the physician for diagnosis and treatmentRefer to the physician for diagnosis and treatment

• Refer to the Alzheimer’s Association and community-Refer to the Alzheimer’s Association and community-based services for education and support.based services for education and support.

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Dementia Identification is Dementia Identification is PossiblePossible

• Helpful tools for detection:Helpful tools for detection:

- - Ask about memory loss concernsAsk about memory loss concerns– Alzheimer’s Association Ten Warning Alzheimer’s Association Ten Warning

SignsSigns– Symptoms and Triggers – your clinical Symptoms and Triggers – your clinical

judgmentjudgment– Collateral information from care partnersCollateral information from care partners

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Alzheimer’s Ten Warning Alzheimer’s Ten Warning SignsSigns

– Memory Loss that affects job skills. Memory Loss that affects job skills. Forgetting recently learned informationForgetting recently learned information

– Difficulty Performing Familiar TasksDifficulty Performing Familiar Tasks– Problems with Language – word findingProblems with Language – word finding– Disorientation to Time and PlaceDisorientation to Time and Place– Poor or Decreased JudgmentPoor or Decreased Judgment

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Ten Warning Signs: Ten Warning Signs: (continued)(continued)

– Problems with Abstract ThinkingProblems with Abstract Thinking– Tendency to Misplace ThingsTendency to Misplace Things– Changes in Mood or Behavior – rapid Changes in Mood or Behavior – rapid

mood swings for no apparent reason.mood swings for no apparent reason.– Changes in Personality – suspicious, Changes in Personality – suspicious,

fearfulfearful– Loss of Initiative - passiveLoss of Initiative - passive

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Patient Behavior TriggersPatient Behavior Triggers

• Patient is a “poor historian” or Patient is a “poor historian” or “things seem off”“things seem off”

• Is inattentive to appearance, Is inattentive to appearance, inappropriately dressed for the inappropriately dressed for the weather or disheveled.weather or disheveled.

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Patient Behavior Triggers Patient Behavior Triggers (Continued)(Continued)

• Fails to appear for scheduled Fails to appear for scheduled appointments or arrives at the wrong appointments or arrives at the wrong time/or wrong daytime/or wrong day

• Repeatedly and unintentionally fails Repeatedly and unintentionally fails to follow instructionsto follow instructions

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Patient Behavior Triggers Patient Behavior Triggers (continued)(continued)• Has unexplained weight lossHas unexplained weight loss

• Seems unable to adapt or experiences Seems unable to adapt or experiences functional difficulties under stressfunctional difficulties under stress

• Defers to the care partner – or a Defers to the care partner – or a family member answers questions family member answers questions directed to the patient/clientdirected to the patient/client

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Symptoms That May Indicate Symptoms That May Indicate Dementia:Dementia:• Learning and retaining new information.Learning and retaining new information.

• Handling complex tasks.Handling complex tasks.

• Reasoning abilityReasoning ability

• Sense of directionSense of direction

• LanguageLanguage

• BehaviorBehaviorFrom: Costa, P.T., Jr., T.F. Williams, M. Somerfield, et al. 1996. “Early Identification of Alzheimer’s Disease and Related Dementias.”From: Costa, P.T., Jr., T.F. Williams, M. Somerfield, et al. 1996. “Early Identification of Alzheimer’s Disease and Related Dementias.”

Clinical Practice Guidelines, Quick Reference Guide for Clinicians, No 19. Clinical Practice Guidelines, Quick Reference Guide for Clinicians, No 19. Rockville, Md.: U.S. Department of Health and Rockville, Md.: U.S. Department of Health and Human Services. AHRQ Publication No. 97-0703.Human Services. AHRQ Publication No. 97-0703.

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Family Questionnaire:Family Questionnaire:Collateral InformationCollateral Information

• Family Care partners (caregivers) are a vital source of Family Care partners (caregivers) are a vital source of information, they are a key, valid second source of information, they are a key, valid second source of information.information.

• Family care partners are able to compare current Family care partners are able to compare current functioning to previous functioning.functioning to previous functioning.

• Family care partners are advocates for their family Family care partners are advocates for their family members/the person with the memory loss.members/the person with the memory loss.

• Family Questionnaire enables the care partners to Family Questionnaire enables the care partners to communicate their experience of dementiacommunicate their experience of dementia

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Dementia Identification:Dementia Identification: Family Questionnaire Family Questionnaire

In your opinion does ________________ have problems with any of In your opinion does ________________ have problems with any of the following?the following?

1.1. Repeating or asking the same Repeating or asking the same Not at all Sometimes FrequentlyNot at all Sometimes FrequentlyDoes not applyDoes not apply

thing over and overthing over and over

2.2. Remembering appointments, familyRemembering appointments, familyNot at all Sometimes FrequentlyNot at all Sometimes FrequentlyDoes not applyDoes not apply

occasion, holidays?occasion, holidays?

3.3. Writing checks, paying bills,Writing checks, paying bills, Not at all Sometimes FrequentlyNot at all Sometimes FrequentlyDoes not applyDoes not apply

balancing the checkbook?balancing the checkbook?

4.4. Shopping independently (e.g.,Shopping independently (e.g., Not at all Sometimes FrequentlyNot at all Sometimes FrequentlyDoes not applyDoes not apply

for clothing or groceries)?for clothing or groceries)?

5.5. Taking medications accordingTaking medications according toto Not at all Sometimes FrequentlyNot at all Sometimes FrequentlyDoes not apply Does not apply instructions? instructions?

6.6. Getting lost while walking orGetting lost while walking or Not at all Sometimes FrequentlyNot at all Sometimes FrequentlyDoes not applyDoes not apply

driving in familiar places?driving in familiar places?

Scoring: Not at all = 0, Sometimes = 1, Frequently = 2. A score of 3 or more should prompt the Scoring: Not at all = 0, Sometimes = 1, Frequently = 2. A score of 3 or more should prompt the consideration of a more detailed evaluation. consideration of a more detailed evaluation.

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Dementia Identification Follow Dementia Identification Follow up and Referral.up and Referral.

• Suggest a visit to the Primary Care Suggest a visit to the Primary Care Physician for additional screening and Physician for additional screening and diagnosis to begin establishing a treatment diagnosis to begin establishing a treatment plan plan

• Suggest the person contact the Alzheimer’s Suggest the person contact the Alzheimer’s Association or other community-based Association or other community-based resources for education and support resources for education and support

• Integrate dementia screening/care into Integrate dementia screening/care into your workyour work

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How is Dementia How is Dementia Diagnosed?Diagnosed?• Complete Medical HistoryComplete Medical History

• Mental Status AssessmentMental Status Assessment

• Functional Assessment of ADLs and IADLsFunctional Assessment of ADLs and IADLs

• Physical ExamPhysical Exam

• Neurological ExamNeurological Exam

• Series of Lab Tests and CT/MRISeries of Lab Tests and CT/MRI

• Psychological and Other ExamsPsychological and Other Exams

No single test can identify Dementia.No single test can identify Dementia.

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Dementia Treatment PlanDementia Treatment Plan

• Cognitive Loss Symptoms: cholinesterase Cognitive Loss Symptoms: cholinesterase inhibitors & Vitamin Einhibitors & Vitamin E

• Cognitive Retraining (ACTIVE)Cognitive Retraining (ACTIVE)

• Behavioral Symptoms: Behavioral Symptoms: – Modification of the environment and learn Modification of the environment and learn

therapeutic approaches. (driving/sexuality)therapeutic approaches. (driving/sexuality)– Medications for depression, agitation, Medications for depression, agitation,

psychosis if these are not alleviated by psychosis if these are not alleviated by environmental changes environmental changes

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Dementia Treatment Plan Dementia Treatment Plan Cont.Cont.

• Co-existing Conditions: treatment Co-existing Conditions: treatment deemed appropriate by the Primary deemed appropriate by the Primary Care PhysicianCare Physician

• Referral of patient and family to Referral of patient and family to educational and support serviceseducational and support services

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Medication OptionsMedication Options

Donepezil - AriceptDonepezil - Aricept®®Rivastigmine - ExelonRivastigmine - Exelon®®Galantamine - RazadyneGalantamine - Razadyne® ®

Memantine - Namenda®Memantine - Namenda®

The four drugs listed above have been The four drugs listed above have been approved by the FDA and may approved by the FDA and may

temporarily improve the symptoms of temporarily improve the symptoms of the disease.the disease.

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Caregiver Support ProgramsCaregiver Support Programs

• Information and problem-solving Information and problem-solving tailored to the needs of the tailored to the needs of the caregivers as various stages of caregivers as various stages of caregiving/disease. caregiving/disease.

• Culturally appropriate and sensitive Culturally appropriate and sensitive to factors that influence caregivers’ to factors that influence caregivers’ attitudes and ability to care.attitudes and ability to care.

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Caregiver Support ProgramsCaregiver Support Programs

• Use multiple types of support over an extended Use multiple types of support over an extended period of time; information sharing, period of time; information sharing, instructions, role-playing, problem solving, skills instructions, role-playing, problem solving, skills training, stress-management techniques, training, stress-management techniques, telephone support grouptelephone support group

• Develop ways to help caregivers become Develop ways to help caregivers become educated about AD, improve flexibility in educated about AD, improve flexibility in responding to caregiving demands, and learn a responding to caregiving demands, and learn a variety of practical strategies can helpvariety of practical strategies can help

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Caregiver Support ProgramsCaregiver Support Programs

• Help caregivers deal with placementHelp caregivers deal with placement

• Help caregivers stay physical active – Help caregivers stay physical active – exerciseexercise

• Use technology like Alternative Care; Use technology like Alternative Care; internet based videoconferencing to internet based videoconferencing to monitor from a distancemonitor from a distance

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Alzheimer’s Association Alzheimer’s Association ResourcesResources

• Family/Care Partner Care ConsultationFamily/Care Partner Care Consultation• Web and Print Resources regarding Web and Print Resources regarding

dementias, resources, dementias, resources, signs/symptoms…signs/symptoms…

• Family/Care Partner EducationFamily/Care Partner Education• Professional EducationProfessional Education• Support GroupsSupport Groups• 24/7 Helpline 1-800-272-390024/7 Helpline 1-800-272-3900• Safe Return Program Safe Return Program

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Additional Community Additional Community Resources:Resources:• Senior LinkAge Line: 1-800-333-2433Senior LinkAge Line: 1-800-333-2433

• www.firstcallnet.org – United Way 211 – United Way 211

• www.MinnesotaHelp.info – Sr. Services – Sr. Services

• National Institute on Aging National Institute on Aging www.alzheimers.org -1-800-438- -1-800-438-43804380

• www.eldercarepartners.org – Caregiver Education & Care – Caregiver Education & Care ManagementManagement

• www.madsa.org – Minnesota Adult Day Services Association – Minnesota Adult Day Services Association

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Implications: Your RoleImplications: Your Role

• Change attitudes and practice of Change attitudes and practice of stakeholders and increase knowledge stakeholders and increase knowledge & skills regarding dementia & skills regarding dementia prevention, identification, diagnosis, prevention, identification, diagnosis, treatment, and care partner support.treatment, and care partner support.

• Increase coordination of care.Increase coordination of care.

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Dementia Identification/CareDementia Identification/CareAddressing the AmbivalenceAddressing the Ambivalence

• We often know something is wrong-we We often know something is wrong-we sense it – what challenges us, sense it – what challenges us, sometimes, is the ability to bring the sometimes, is the ability to bring the impairment to the attention of the impairment to the attention of the patient/care partner in a compassionate, patient/care partner in a compassionate, therapeutic manner that actually therapeutic manner that actually improves “life” for the person and the improves “life” for the person and the care partner. care partner. WHY?WHY?

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Addressing the Ambivalence: Addressing the Ambivalence: Awareness of our FearAwareness of our Fear

• Internalized AgeismInternalized Ageism

• Fear of Getting a Dementia/Loss of SelfFear of Getting a Dementia/Loss of Self

• Inability to Help – Fear of InadequacyInability to Help – Fear of Inadequacy

• Taking responsibility for our own feelings Taking responsibility for our own feelings

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The Myths of AgeismThe Myths of Ageism

• You are old at age 65.You are old at age 65.• Old equal sick.Old equal sick.• People over the age of People over the age of

65 are unable to 65 are unable to remember well or remember well or learn new things.learn new things.

• People over 65 are People over 65 are unhappy, fearful and unhappy, fearful and depressed.depressed.

• Older adults do not Older adults do not pull their own weight; pull their own weight; relatively relatively unproductive.unproductive.

• Older adults are Older adults are sexless.sexless.

• When one is old, it is When one is old, it is too late to change. too late to change. Older adults are not Older adults are not capable of change.capable of change.

• Older adults are Older adults are pretty much the pretty much the same.same.

• Older adults are Older adults are isolated, alone, isolated, alone, disconnected from disconnected from family and friends. family and friends.

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Therapeutic ResponseTherapeutic Response

• Clinical guidelines suggest we respond Clinical guidelines suggest we respond based on individual preferences – when in based on individual preferences – when in doubt be;doubt be;

• Person-centered – care partner centeredPerson-centered – care partner centered

• Empathy – Acceptance - PresenceEmpathy – Acceptance - Presence

Connell, C. M. et al. (2004) The Gerontologist Connell, C. M. et al. (2004) The Gerontologist

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Person/Care Partner-CenteredPerson/Care Partner-CenteredDementia CareDementia Care

• Focus on the person and care partners and Focus on the person and care partners and their need to connect and communicate their need to connect and communicate emotionally, if not cognitively.emotionally, if not cognitively.

• Talk and listen to the person/care partners in a Talk and listen to the person/care partners in a manner that identifies the underlying emotions manner that identifies the underlying emotions that are present.that are present.

• Validate the person/care partners when Validate the person/care partners when

medical modalities alone cannot produce the medical modalities alone cannot produce the desired healing. Attend with empathy. desired healing. Attend with empathy.

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Beneficent CareBeneficent Care

• Persons with dementia continue to be social Persons with dementia continue to be social beings in need of communication; to share beings in need of communication; to share thoughts and feelings that provide self-thoughts and feelings that provide self-esteem, security, and connectedness.esteem, security, and connectedness.

• The sense of touch is maintained; the ability The sense of touch is maintained; the ability to sense your presence and acceptance. to sense your presence and acceptance.

• There is cellular memory – our body cells There is cellular memory – our body cells remember what the mind cannot.remember what the mind cannot.

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Cultural-Centered Dementia Cultural-Centered Dementia IdentificationIdentification

• There is more diversity within ethnic groups than There is more diversity within ethnic groups than between groups, especially as we age.between groups, especially as we age.

• Cultural and family values and norms will generally Cultural and family values and norms will generally govern familial relationships and care for the patient. govern familial relationships and care for the patient. Who makes the family decisions and who is the “hands Who makes the family decisions and who is the “hands on” care partner?on” care partner?

• Utilize bilingual, bicultural health-care providers.Utilize bilingual, bicultural health-care providers.

• Cultural proficiency is a long-term process.Cultural proficiency is a long-term process.

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SummarySummary

• Create practices/protocols based on best Create practices/protocols based on best practices, local guidelines, current practices, local guidelines, current research research

• Increase awareness of the need for Increase awareness of the need for prevention, early dementia detection, prevention, early dementia detection, diagnosis, treatment, and caregiver diagnosis, treatment, and caregiver support across the phases of the diseasesupport across the phases of the disease

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SummarySummary

• Case management and care Case management and care coordination: clinic providers, coordination: clinic providers, community resources and community resources and patient/family/care partnerspatient/family/care partners

• Medical management: Medical management:

detection, diagnosis, medical detection, diagnosis, medical management and co-morbidity caremanagement and co-morbidity care

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SummarySummary

• Caregiver Interventions:Caregiver Interventions:

education, skills, social support, cognitive education, skills, social support, cognitive strategies for negative emotional strategies for negative emotional responses and strategies for enhanced responses and strategies for enhanced healthy behaviors and managing stress.healthy behaviors and managing stress.

• Take action to mitigate risk factors for Take action to mitigate risk factors for dementia to improve your lifestyle.dementia to improve your lifestyle.

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Contact: Additional Contact: Additional InformationInformation

Catherine@ alumni.stthomas.eduCatherine@ alumni.stthomas.edu

952-412-7300952-412-7300

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