Working with Memory Problems Presented by Dr Nigel George Clinical Psychologist.

Working with Working with Memory ProblemsMemory Problems

Presented byPresented byDr Nigel GeorgeDr Nigel George

Clinical PsychologistClinical Psychologist

Growing OlderGrowing Older

““GrowingGrowing old… what is the opposite old… what is the opposite of ‘growing’? I ask myself. of ‘growing’? I ask myself. Withering perhaps? It is, I assume, Withering perhaps? It is, I assume, quite easy to wither into old age, quite easy to wither into old age, and hard to grow into it” (Mary and hard to grow into it” (Mary Sarton). Sarton).

Why has the person got Why has the person got memory problems?memory problems?

Any physical health issues: Any physical health issues: InfectionsInfections BloodsBloods FallsFalls Concussion Concussion CT scanCT scan

Depression Depression AnxietyAnxiety Mild Cognitive ImpairmentMild Cognitive Impairment DementiaDementia

Quick revision of Quick revision of memorymemory

How memory made?How memory made? Absorbing (encoding)Absorbing (encoding) StoringStoring RecallingRecalling

Process of making Process of making memoriesmemories

Working memoryWorking memory STMSTM LTM – autobiographical, procedural, LTM – autobiographical, procedural,

faces, words etc faces, words etc Different areas of the brain involved Different areas of the brain involved

and difficulties can occur in one or and difficulties can occur in one or many areasmany areas

Most common difficulty with emerging Most common difficulty with emerging Alzheimer dementia is ‘absorbing’ new Alzheimer dementia is ‘absorbing’ new verbal informationverbal information

MCIMCI

Mild Cognitive Impairment (MCI) – what is it? Mild Cognitive Impairment (MCI) – what is it? Still can function, neuro psych have only memory Still can function, neuro psych have only memory

problems or other subtle changes; MMSE not problems or other subtle changes; MMSE not specific enough to pick it upspecific enough to pick it up

How many convert to dementia? How many convert to dementia? 6-25% of people presenting with MCI will convert 6-25% of people presenting with MCI will convert

to Dementia each following yearto Dementia each following year Approximately 10% remain stable in fact some Approximately 10% remain stable in fact some

become normal again over timebecome normal again over time Diagnosis of increased risk rather than of Diagnosis of increased risk rather than of

degenerationdegeneration

Working with Memory Working with Memory Problems Problems

Treatments:Treatments: Physical - bodyPhysical - body MedicationMedication Social – the carerSocial – the carer EnvironmentalEnvironmental PsychologicalPsychological

Holistic is best!Holistic is best!

Journey of Increasing Journey of Increasing Memory IssuesMemory Issues

MCIMCI Clearer ForgetfulnessClearer Forgetfulness Early DementiaEarly Dementia Mild Mild ModerateModerate SevereSevere ‘‘Treatments in each area build on Treatments in each area build on notnot move on’ move on’

Strategies for Working Strategies for Working with Memory Problemswith Memory Problems

1. Absent minded – 1. Absent minded – normally more of an normally more of an attention problemattention problem Improve Improve

concentration:concentration: Make sure awake!!Make sure awake!! Focus attention and Focus attention and

avoid distractionsavoid distractions Don’t divide attention – Don’t divide attention –

do one thing at a timedo one thing at a time Short activitiesShort activities Frequent breaksFrequent breaks Give information in Give information in

slow, absorbable formslow, absorbable form

Absent minded - Absent minded - continuedcontinued

HydratedHydrated Blood sugarBlood sugar Time of the dayTime of the day Physical activity – good for lowering Physical activity – good for lowering

risk of a developing vascular dementia risk of a developing vascular dementia in particularin particular

Pain? – very distractingPain? – very distracting Other meds and side effects e.g. ValiumOther meds and side effects e.g. Valium Cognitive stimulationCognitive stimulation Maintenance of social networkMaintenance of social network

2. Early memory problem – forgetfulness – 2. Early memory problem – forgetfulness – aware of issues – still motivate self to do aware of issues – still motivate self to do these tasksthese tasks External aides to memory:External aides to memory:

Note booksNote books Memory stationMemory station DictaphoneDictaphone CalendarCalendar Clocks at right timeClocks at right time DiaryDiary Associate new information with older informationAssociate new information with older information Conscious of use of mnemonicConscious of use of mnemonic Repeat information – verbalRepeat information – verbal Chunk information – telephone numbersChunk information – telephone numbers Organise information – post it notesOrganise information – post it notes Bleepers for medicationBleepers for medication Begin to use more visual cues and promptsBegin to use more visual cues and prompts

3. Memory problem 3. Memory problem (Dementia) – can’t (Dementia) – can’t remember verbal remember verbal information just given – information just given – repeated asking, a little repeated asking, a little disorientated at timesdisorientated at times Reality orientation:Reality orientation:

Verbal prompts and cuesVerbal prompts and cues External cues – signs in External cues – signs in

rooms, clocks, rooms, clocks, calendars, etccalendars, etc

Structure/routineStructure/routine Medication (dementia)Medication (dementia)

4. Moderate memory problems:4. Moderate memory problems: Can’t remember much of what is said to them. Can’t remember much of what is said to them. Begin to not remember faces. Begin to not remember faces. Disorientated – place and time of day. Disorientated – place and time of day. Might be getting some other problem behaviours Might be getting some other problem behaviours

emerging – disinhibited/agitation etc.emerging – disinhibited/agitation etc. Reality orientation/validation:Reality orientation/validation:

More obvious cues (signs) and reminders around More obvious cues (signs) and reminders around homehome

Begin validation techniquesBegin validation techniques Start to rely more on autobio memory – reminiscence Start to rely more on autobio memory – reminiscence

therapytherapy Rely more on visual memory – use photos as prompts Rely more on visual memory – use photos as prompts

to lifeto life Use of routineUse of routine Carer starts to more clearly become ‘the environment’Carer starts to more clearly become ‘the environment’

5. Severe memory problems – appears 5. Severe memory problems – appears confused a lot of the time, can’t confused a lot of the time, can’t remember significant people, places, remember significant people, places, where they are etc. Maybe some where they are etc. Maybe some behavioural problems – aggressive, behavioural problems – aggressive, disinhibited etc disinhibited etc

Person centred care:Person centred care: Environment more importantEnvironment more important ABC chartsABC charts Comforters, manipulators, distractersComforters, manipulators, distracters Life booksLife books

Dementia with severe Dementia with severe behavioural and behavioural and

psychological symptoms psychological symptoms (BPSD)(BPSD) BPSD behaviours BPSD behaviours

might include:might include: WanderingWandering YellingYelling DisorientatedDisorientated DisinhibitedDisinhibited Personality changesPersonality changes Sun downingSun downing ApathyApathy

DementiaDementia Dementia – multiple cognitive (thinking) Dementia – multiple cognitive (thinking)

deficits – memory, language, frontal deficits – memory, language, frontal (organization, planning, inhibiting)(organization, planning, inhibiting)

Types:Types: Alzheimer'sAlzheimer's VascularVascular Frontal temporal and othersFrontal temporal and others

Treatments:Treatments: Environmental (nursing/psychological/activity)Environmental (nursing/psychological/activity) MedicationMedication

Approaches to dementia Approaches to dementia carecare

Reliance on care environment most important - Reliance on care environment most important - ‘rementing’ – environmentally driven behaviours‘rementing’ – environmentally driven behaviours

Behaviour modification – ABC – knowing the Behaviour modification – ABC – knowing the person’s history person’s history

Reality Orientation - 24hr/individualReality Orientation - 24hr/individual Reminiscence - life review/reminiscenceReminiscence - life review/reminiscence Validation therapyValidation therapy Stimulation - OT/exercise/Music/Dogs/SnoezelenStimulation - OT/exercise/Music/Dogs/Snoezelen Working with care givers - family therapy/elder Working with care givers - family therapy/elder

abuse/nursesabuse/nurses

How understand?How understand?

THE CARER1. Care practices

2. Attitudes of carers3. Relationships


THE ENVIRONMENT1. Architecture

2. Interior decoration3. Layout


BIOLOGY1. Dementia

2. Sensory Changes3. Physical Changes

4. Ill Health Pain


THE PERSON1. Life History2. Attributes

3. Beliefs and Expectations4. Habits and Needs


THE CARER1. Care practices2. Attitudes of carers3. Relationships

THE ENVIRONMENT1. Architecture2. Interior decoration3. Layout

BIOLOGY1. Dementia 2. Sensory Changes3. Physical Changes 4. Ill Health Pain

THE PERSON1. Life History2. Attributes3. Beliefs4. Habits

THE BEHAVIOURBehaviour

(ie. mood, thought, speech and action)

Working with Memory Problems Presented by Dr Nigel George Clinical Psychologist.

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Transcript of Working with Memory Problems Presented by Dr Nigel George Clinical Psychologist.