|
UNCOVERING
THE MYSTERIES OF ALZHEIMER’S: "The
soul comes to the end of its long journey and naked and
alone draws near to the divine” |
This course meets the qualifications for 3 hours of continuing education
Welcome to what I hope you will find is a valuable educational experience on Alzheimer’s Dementia. In this course you are going to learn, from an holistic perspective, all about identifying, understanding, evaluating, and treating Alzheimer’s. No single practice discipline – medicine, psychiatry, nursing, psychology, social work, speech and language therapy -- is sufficient to address this devastating illness. Therefore, a variety of psychological, psychiatric, medical, and social service perspectives will be discussed. Throughout this course, you will find references to information from all of these disciplines with an emphasis on interdisciplinary consultation. Together, we can make a difference.
The older adult population is skyrocketing and as clinicians, we are all being asked to lend a professional hand addressing unfamiliar and often perplexing cognitive, emotional, and behavioral issues in our elders. Not only am I seeing more older adults in my practice for depression, anxiety, and decision-making deficits, more and more, I am seeing my younger clients wrestling with the stress of caring for parents and grandparents with these problems. Perhaps, you are finding this, too. With these issues in mind, I hope to take you on a journey of discovery about this crippling illness – so that you can better learn how to recognize it, measure it, treat it, and prevent it.
Throughout this course, I will be describing Alzheimer’s, taking you through protocols that various professionals employ in helping the patient and their family, and discussing ways to better understand the disorder. The biggest help you can be to all those who suffer from this debilitating disease is to translate what you read here in a way that the victims of Alzheimer’s and their care providers can understand. Right now -- in terms of treatment – the disease is winning. You can stem that tide by being a beacon of knowledge and understanding for patients and families alike. (NOTE: I will be using the term “care provider” or “caregiver” throughout the course and am intending it to mean all the people who provide help to the Alzheimer’s patient – that includes the family, friends, paraprofessionals like nurses aides, home health care staff, physicians, psychologists, social workers, nurses, or anyone else who makes a contribution to the patients life by lending a hand.)
This course is intended to be a simple, straightforward, and easy-to-read summary of what is currently known about this devastating disorder, as free as possible from technical jargon and impractical detail. There are over 130 references used in this course, and the interested reader is encouraged to explore the more technical material contained there. In order to maintain your interest, enthusiasm, and motivation to successfully complete the course, though, I have tried to condense the material into a readable form.
Rest assured, though, this course is considered a post-graduate learning experience. That’s because there are only a handful of credentialed graduate programs specializing in geriatrics and clinical gerontology. As things are now, when someone is having thinking problems the first and generally only contact they or their family might have is with their primary care physician. Although physicians undergo significant medical training, generally speaking, they are not gerontologists, they generally do not have specialized training in identifying and treating cognitive, emotional, and behavioral problems of older adults, and they generally do not posses a widespread specialized understanding of Alzheimer’s. Recognize, however, that once you complete this course you will have acquired more specific knowledge about Alzheimer’s than most physicians, and as a result, will then be one of the people that those who suffer from Alzheimer’s can look to for guidance and support.
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Learning Objectives
After taking this course, mental health professionals will be able to:
• Identify the 5 cognitive symptoms of Alzheimer's in the context of the normal aging process
• Describe the anatomical, microscopic, neurochemical, and genetic evidence of Alzheimer's
• Distinguish between Alzheimer's, Delirium, and other illnesses mimicking Alzheimer's
• Better recognize and treat depression, anxiety, and other psychiatric symptoms in Alzheimer's
• Describe 12 rules for optimizing the environment of people with Alzheimer's
• Implement 4 fundamental approaches in talking with people with Alzheimer's
• Identify 10 common behavioral problems in Alzheimer's and how to address them
Course Outline
Part 1. What Is Alzheimer's?
1. The Basics
2. Normal Aging
3. Alzheimer's Is a Type of Dementia
4. Evidence of Alzheimer's
5. Distinguishing Between Delirium, Alzheimer's, and Other Dementias
6. Two Case Studies: Applying the Basics
Part 2. How to Evaluate for Alzheimer's
7. This Person I Used to Know: Measuring the Status of Mental Functioning in
Alzheimer's
8. Measuring Alzheimer's in Action
9. The Question of Competence
Part 3. Disturbances in Mood and Perception
10. Geriatric Depression and Alzheimer's
11. I Know She Has Alzheimer's, But Why Is She Acting Like This? –
Recognizing Psychotic Symptoms in Alzheimer's
Part 4. Medical and Psychological Treatment Approaches
12. Treatment of Alzheimer's with Medicines
13. Changing the Person's Surroundings
14. Talking to People with Alzheimer's
15. Preventive Activities for Ourselves and Others:
Lowering Our Odds of Getting Alzheimer's Disease
From the course:
Course Overview
"The soul comes to the end of its long journey and naked and alone draws near to the divine” (from the film Fearless, 1993) To rst hear that your mother or father or anyone you love has Alzheimer’s leaves an empty feeling in the pit of your stomach. There are currently between 4.5 and 5.0 million families in the United States who have received just this kind of news, and I don’t think very many of them have really known quite what to do with it. It’s very difficult to have a family member or a close friend suffer from an incurable disease. It’s hard to know just what to say sometimes, how to help them, how to be with them. For those who know someone with Alzheimer’s, this is no exception.
As a clinician, what helps, though, is being willing to risk getting close enough to our patients to really understand what it means to have an illness like this. This takes courage. But if we are willing to do this we make ourselves more available to the person -- we can walk in his shoes, and in doing so, open ourselves to the possibility of helping them and all those around them discover those precious and intimate moments of closeness and connectedness that make our lives truly meaningful. With this in mind, I would like to help you get really close to Alzheimer’s -- to help you learn about the impact Alzheimer’s has on those who suffer from it and the effect it has on families, caregivers, and ourselves.
From a physical point of view, Alzheimer’s is a disease characterized by the destruction and degeneration of tissue in the brain. Its toll on the human spirit, however, is even more devastating. Alzheimer’s slowly robs its hosts of their memory, their ability to think, and ultimately, the very sense of their own existence. Alzheimer’s is a disease for which there is no cure—only medicines that can slow the progression of its symptoms or postpone its inevitable conclusion. This point of view is well known. From another perspective, however, Alzheimer’s is a psychiatric disorder—a mental illness—one that triggers a wide array of emotional and behavioral problems. These types of problems can be treated with medicines, but they can also be treated with counseling and psychotherapy, and this perspective is much less well known.
Counseling people with Alzheimer’s? Can you do that? For many Alzheimer’s patients, the answer is an emphatic “Yes!” Understanding Alzheimer’s from a psychosocial model (and not strictly from a medical one) opens up possibilities for new and expanded ways of relating to those afflicted with this illness. New intervention possibilities like these are available to the professional care provider, but they can also be taught to family members, friends, or anyone who provides care for someone with this disorder. Everyone in the individual’s family and social support system can learn to communicate better with the Alzheimer’s sufferer, and as clinicians, we can help them learn how.
Making the distinction between Alzheimer’s as a medical illness and Alzheimer’s as a mental disorder is essential. From a medical perspective, Alzheimer’s is a disease, like cancer, heart disease, or emphysema. As a disease, it progresses, its symptoms worsen, and eventually, it’s fatal. Alzheimer’s as a disease implies that it is a medical problem with medical solutions. Increasingly, we hear of “breakthrough research” on the genetic and biochemical links with Alzheimer’s. We also hear announcements of new image-scanning methods to better identify the illness or new drugs to treat its accelerating symptoms. These discoveries are important, but regarding what is known and generally applied in the treatment of Alzheimer’s, its treatment has essentially been relegated to medical staff prescribing and recommending medical interventions.
In addition to being classied as a medical disease, though, Alzheimer’s is also a mental illness, just like schizophrenia, depression, or anxiety disorder (American Psychiatric Association, 1994; Kaplan & Saddock, 1994). Alzheimer’s as a mental disorder implies, however, that in addition to medical interventions, there are also psychiatric and social-psychological interventions that can help. In addition to high-tech detection methods and new medicines to treat the spread of the disease, the symptoms of Alzheimer’s can be treated through psychological methods that include individual counseling, group interventions, interventions designed to change the person’s physical surroundings, and educational strategies to improve the person’s ability to cope with the emotional distress and cognitive loss. This is the focus of Uncovering the Mysteries of Alzheimer’s: Plain Talk and Practical Tools.
In addition to our role as clinicians, we are also family members, and about one in three of us will eventually provide care for someone with Alzheimer’s. Given the tremendous amount of care required to safeguard the medical well-being and mental health stability of people with Alzheimer’s, this course is intended to offer new options for clinicians, family members, and the many other caregivers who assist, support, and help to ease the impact of this quiet killer. The stress of providing care to a person with Alzheimer’s can be considerable, but caring for someone with Alzheimer’s can also be extremely rewarding. I have talked with many care providers whose pride in what they are doing far outweighs the challenges with which they struggle. For me, it’s been the joy of helping Alzheimer’s sufferers and their families hold on to the value they place on living. This course has been written to enhance your knowledge about the psychiatric and psychological aspects of Alzheimer’s as it helps you discover a wealth of effective interventions too infrequently utilized.
There are many excellent books on Alzheimer’s—ones that address the medical, financial, legal, and daily care needs of those afflicted with the disease. There are excellent sources of information on a variety of issues related to managing guardianship, powers of attorney, living wills, life and healthcare insurance, and on making choices about assisted-living facilities, nursing homes, in-home care, and safety preparation of the person’s living environment. These are all important areas of concern, and I have tried to provide a wealth of references to help you learn more about them. There has also been a great deal written about the self-preservation needs of family members and other caregivers who have been left with the disheartening and often daunting task of managing the aficted person’s waning competencies. References to these excellent sources of information are also included.
The thrust of Uncovering the Mysteries of Alzheimer’s, however, is on the psychosocial life of the Alzheimer’s sufferer. The course focuses on the whole person and his social, psychological, emotional, physical, and spiritual life.
Part 1: What Is Alzheimer’s? covers the basics of the disorder, how it can be distinguished from normal aging, and how it is similar to and different from other medical conditions that mimic its symptoms.
Part 2: How to Evaluate for Alzheimer’s deals with a variety of assessment methods that are commonly used to gauge the extent and progression of the disease. These include methods of measuring how the disorder affects changes in functional abilities and how the issue of competence to complete tasks of daily living is viewed by the psychiatric and legal communities.
Part 3: Disturbances in Mood and Perception covers the array of emotional and behavioral problems frequently encountered in Alzheimer’s—things like anxiety and agitation, depression, anger and impatience, inappropriate expressions of sexuality, wandering, and other troubling behavioral conditions. In this section, special attention is given to the issue of geriatric depression and its reciprocal relationship with Alzheimer’s. Also examined in this section is how Alzheimer’s affects distortions in rational thinking and psychotic disturbances in sensory perceptions.
Finally, in Part 4: Medical And Psychological Treatment Approaches, I discuss traditional and alternative medicines that are available to treat the disease itself and the emotional and intellectual symptoms commonly stemming from the disorder. I also discuss changes that can be made to the aficted person’s physical surroundings, simple and common-sense ways of enhancing communication, new ways of improving coping abilities, fun learning activities useful in stimulating and maintaining the aficted person’s thinking and emotional stability, and nally, ways of preventing the disease.
My hope is that taking this course will be just the beginning of your continued learning about Alzheimer’s. The more you know and share about Alzheimer’s as a medical illness and as a mental health disorder, the more the suffering from this devastating disease can be abated. I hope you enjoy the course.
Cost of the course is $77
George Kraus, Ph.D. is a clinical and consulting psychologist in private practice at Layh and Associates in Yellow Springs, Ohio and specializes in the care of older adults, especially those suffering from Alzheimer’s and other dementias. He is on the graduate faculty at the School of Professional Psychology at Wright State University where he teaches Geriatric Clinical Psychology and on the staff of Greene Memorial Hospital in Xenia, Ohio.
In addition to his specialty in clinical gerontology and geropsychology, Dr. Kraus has been a long-time addictions psychologist and is also certified by the National Registry of Certified Group Psychotherapists. His new book, At Wit's End: Plain Talk on Alzheimer's forFamilies and Clinicians, has just been released by Purdue University Press. He is a member of Psychologists in Long Term Care, Division 20: Adult Development and Aging of the American Psychological Association, and APA Division 12, Section II: Clinical Geropsychology.
Dr. Kraus' work has been published in a variety of professional journals including Clinical Psychology Review, Psychology Reports, Small Group Behavior, and Small Group Research, and he is currently on the editorial board of Aggression and Violent Behavior: A Review Journal. For the past 20 years, Dr. Kraus has presented on a wide variety of clinical topics at public seminars and in university graduate programs.
Learn more about Dr. Kraus and his practice at www.GeorgeKrausPhD.com.
ALZHEIMER'S LINKS
I have found the following links helpful. Check them out, and see what you think.
Alzheimer's Association - national voluntary organization dedicated to researching the prevention, cures, and treatments of Alzheimer's Disease. Includes information about the disease and available services.
Alzheimer's Caregiver Support - online education, support, and resources for caregivers.
Alzheimer's Disease Research Center at Johns Hopkins - dedicated to researching the biological basis of Alzheimer's Disease to advance treatment options, improve the prognosis of patients, and provide support for caregivers.
Alzheimer's Disease Information Sheet - from the National Institute of Neurological Disorders and Stroke.
Alzheimer Research Forum - nonprofit organization established for the purpose of supporting the information needs of researchers and to promote openness and collaboration with colleagues worldwide.
Alzinfo.org - collection of Alzheimer's information, guide to local caregivers, and community features from the Fisher Center for Alzheimer's Research Foundation.
Eldercare Locator - connects older adults and their caregivers with sources of information on senior services in any U.S. community, and it's a free service of the Administration on Aging, U.S. Department of Health and Human Services.
MayoClinic.com: Alzheimer's Disease - includes symptoms, causes, risk factors, diagnosis, and caregiving.
MEDLINEplus: Alzheimer's Disease - Alzheimer's disease web directory organized by topic. Includes general overviews, research, news, treatment, nutrition, organizations, and more.
Wikipedia: Alzheimer's Disease - hyperlinked article covering pathology, etiology, prevalence, diagnosis, prevention, nutrition, treatments, history, and more.
All artwork by Rembrandt van Rijn.
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