Occupational Therapy Approach to Assessment and Intervention in Dementia

Thank you so much, Fawn, and thank you so much to everybody joining us today. I'm really excited to share this presentation. And something that I grow more and more passionate about all the time, which is really helping out our patient population with dementia, which is definitely growing. So, the outcomes today that we're gonna be talking through is really, I want you to understand the changes that you can see happen in different levels and different diagnoses of dementia with Alzheimer's, Parkinson's disease, dementia, Lewy body dementia, and frontotemporal dementia. And we're gonna get into appropriate screening and outcome measures that you can use to really make a client centered approach to your treatment. As well as then later on in the presentation, discussing the use of occupation-based and task oriented treatments, once again, to really make sure that our treatment is always client centered. But the one big outcome that I don't have listed on the screen here today is that in the research I was doing for this presentation, I noted in an article that when occupational therapists were surveyed, less than half felt that they were confident or even somewhat confident in being able to address and help people with dementia. And you'll notice as we talk through today what the research shows as far as interventions for dementia, it's really our wheelhouse. So, our unique skill sets as OTs is what's needed, as outside of medications and treatments, we need to use our skillset. So I hope that at the end of today, my big goal is that you'll all feel that you recognize the ways that you could help and really be an integral part of improving quality of life and treatment for these individuals. Okay. So, my disclosure, I don't really have anything to disclose as far as financial relationships. And so let's just hop to it. So, what is dementia? Well, we know that it basically is a clinical syndrome. So there's not a blood test. There's not even often any type of a brain test until after someone has passed, so, post-mortem. So it is a clinical syndrome, and there can be a lot of different manifestations and presentations that we see. It's chronic, and it's considered to be acquired loss of two or more cognitive abilities. So you can see this across different domains of cognition, visuospatial function, executive function, aspects of memory and language and attention, and it's caused by brain disease or an injury. So the decline in these abilities is considered to be from a prior level of function, so we're looking at a significant change. And the big difference to note is if we're thinking about mild cognitive impairment that we sometimes see with Parkinson's disease or different conditions, when we think of dementia, it impairs the ability of someone to function day to day, either in their self care or IDL or occupational interest and social engagement. But recently it's important to note that clinically you notice the diagnosis has always been based on this two or more cognitive abilities. But recently the DSM-5 is noting that dementia can involve impairment in a single domain with someone. So that's important to keep in mind as well. So, the most common form of dementia that we see, or the most common condition, is definitely Alzheimer's disease. And this is a progressive neurological disorder that is irreversible, and you see a loss of neurons in the hippocampus and the cortex. So, if you think about functionally what this can impact, we see significant changes with Alzheimer's in memory. Also with judgment and insight and decision making. There can be changes to language and also issues with orientation to their environment. So it is the most common neurodegenerative condition. It constitutes two thirds of dementia cases overall. The prevalence is about 1% of people in ages 65 to 69. But look at how that jumps up. It goes up to 40 to 50% when we get into our individuals that are older, 95 years or older. So you can think about in between that range from 69 to 95, how it's continuing to increase. About 7% of the early onset cases are familial, and there is an autosomal dominant genetic pairing. So, this is something to really keep an eye on. Probably a lot of you out there are possibly seeing patients in your practice with Alzheimer's, or you might have family members as well. Next is Parkinson's disease dementia. And so this is going to really accompany Parkinson's disease, and I'll offset it a little bit too, we're about to talk about dementia with Lewy bodies. And both of those presentations, I didn't really wanna get into a pathophysiology lecture 'cause that's a whole other topic for another time, they involve the presence of Lewy bodies. But it depends on where those deposits of Lewy bodies are in the brain, which is a buildup of an alpha-synuclein protein in the brain that causes the presentation that you see. So, with Parkinson's disease dementia, this comes on later in the diagnosis. So someone's had changes to their movement first. They've had some rigidity or tremor or slowness in their movement. And then over the course of that Parkinsonism, they develop a dementia presentation. So, they'll have changes to executive function, some changes to memory can be possible. Their clock-drawing will often be impaired. You'll see visuospatial deficits as well as impaired attention. And hallucinations will become prevalent in 45 to 65% of cases, where if you compare that to just Parkinson's disease, where people can also have some hallucinations separate even from dementia, we see that in about 25 cases of PDD. So then if we compare and contrast that to dementia with Lewy bodies, dementia with Lewy bodies, and sometimes you'll see patients will come in and they might be diagnosed with one and then it switches to the other. I had a gentleman recently that...