Language Intervention and Language Intervention and Alzheimer’s DiseaseAlzheimer’s Disease

Lindsay K. TiceLindsay K. Tice

May 6, 2006May 6, 2006

Statistics of Alzheimer’s Statistics of Alzheimer’s disease…disease…

By 2050 the number of individuals By 2050 the number of individuals with Alzheimer’s could range from with Alzheimer’s could range from 11.3 million to 16 million. 11.3 million to 16 million.

One in 10 individuals over 65 and One in 10 individuals over 65 and nearly half of those over 85 are nearly half of those over 85 are affected. affected.

The average lifetime cost of care for The average lifetime cost of care for an individual with Alzheimer’s is an individual with Alzheimer’s is $174,000.$174,000.

Half of all nursing home residents Half of all nursing home residents have Alzheimer’s disease or a have Alzheimer’s disease or a related disorder.related disorder.

(www.alz.org) (www.alz.org)

Alzheimer’s disease…Alzheimer’s disease…

Found by Dr. Alois Alzheimer in 1907 Found by Dr. Alois Alzheimer in 1907 Characterized by plaques and Characterized by plaques and

neurofibrillary tangles neurofibrillary tangles The amyloidal plaques are of a The amyloidal plaques are of a

protein make-upprotein make-up Affects over 12 million people Affects over 12 million people

worldwideworldwide(Jarvik & Winograd, 1988, (Jarvik & Winograd, 1988,

Khachaturian & Radebaugh, 1996, Khachaturian & Radebaugh, 1996, Citron, 2002 ) Citron, 2002 )

Alzheimer’s disease…Alzheimer’s disease…

Usually defined in two Usually defined in two categoriescategories

Pre-senile dementia or Early Pre-senile dementia or Early Onset Alzheimer’s disease, Onset Alzheimer’s disease, which affects people under the which affects people under the age of 65 and is usually age of 65 and is usually attributed to genesattributed to genes

Senile dementia or Alzheimer’s Senile dementia or Alzheimer’s disease which affects those over disease which affects those over 65, no known cause so far…65, no known cause so far…

Alzheimer’s disease…Alzheimer’s disease… Tests such as MMSE are helpful in Tests such as MMSE are helpful in

gauging progression of the gauging progression of the disease.disease.

MMSE is limited to those who have MMSE is limited to those who have no auditory or visual impairmentsno auditory or visual impairments

The brain is affected in the frontal, The brain is affected in the frontal, temporal, and the parietal cortex temporal, and the parietal cortex and atrophy of the hippocampus and atrophy of the hippocampus and amygdala, where the main and amygdala, where the main sites for memory are found sites for memory are found

Stages of Alzheimer’s diseaseStages of Alzheimer’s disease Stage 1:No impairment Stage 1:No impairment Stage 2:Very mild cognitive Stage 2:Very mild cognitive

declinedecline Stage 3:Mild cognitive declineStage 3:Mild cognitive decline Stage 4:Moderate cognitive Stage 4:Moderate cognitive

declinedecline Stage 5:Moderately severe Stage 5:Moderately severe

cognitive declinecognitive decline Stage 6:Severe cognitive declineStage 6:Severe cognitive decline Stage 7:Very severe cognitive Stage 7:Very severe cognitive

declinedecline(www.alz.org)(www.alz.org)

Kitwood’s Theory of caregiving for Kitwood’s Theory of caregiving for a person with Alzheimer’s diseasea person with Alzheimer’s disease

recognition recognition negotiation negotiation collaborationcollaboration playplay Timalation Timalation celebration celebration relaxation relaxation validation validation holding holding facilitation facilitation (Seman & Stansell, 1999)(Seman & Stansell, 1999)

Intervention in Facility Intervention in Facility Caregiving…Caregiving…

Base training program for Base training program for nursing and activity staff on nursing and activity staff on Kitwood’s theory.Kitwood’s theory.

Preserve human dignity and Preserve human dignity and self-worth of individualself-worth of individual

Stress importance of caring Stress importance of caring attitudeattitude

Gain trust of the residentGain trust of the resident

Intervention in Facility Intervention in Facility Caregiving…Caregiving…

Train staff to respond to resident Train staff to respond to resident in a positive matter even if speech in a positive matter even if speech is disturbedis disturbed

Stress importance of gestures to Stress importance of gestures to complete ADL’scomplete ADL’s

Use language style preferred by Use language style preferred by resident (e.g., name for bathroom)resident (e.g., name for bathroom)

Encourage easy-going attitudes Encourage easy-going attitudes that can relax and help the that can relax and help the resident form clear thoughts.resident form clear thoughts.

Speak in a clear, audible voice for Speak in a clear, audible voice for those with hearing impairmentsthose with hearing impairments

When visiting with someone When visiting with someone with Alzheimer’s disease…with Alzheimer’s disease… Implement manipulatives into the Implement manipulatives into the

session (folding clothes, puzzles, session (folding clothes, puzzles, etc. to engage conversation)etc. to engage conversation)

Take walksTake walks Speak clearlySpeak clearly Hold hands, give hugs, touch Hold hands, give hugs, touch

person’s armperson’s arm Use helpful reminiscingUse helpful reminiscing Implement music for relaxationImplement music for relaxation

On a Personal Note…On a Personal Note… After spending countless hours working After spending countless hours working

with people with varying levels of with people with varying levels of Alzheimer's disease, I have found that Alzheimer's disease, I have found that Kitwood’s theory of caregiving is ideal Kitwood’s theory of caregiving is ideal for CNA's to gain the trust of a resident for CNA's to gain the trust of a resident for hands-on care. for hands-on care.

I am also a believer in using gestures I am also a believer in using gestures and language that the resident and language that the resident understands to communicate properly understands to communicate properly with him or her. I try to have a deep with him or her. I try to have a deep feeling of empathy for what they must feeling of empathy for what they must feel when they cannot understand feel when they cannot understand language and sometimes can’t form language and sometimes can’t form their own sentences to communicate.their own sentences to communicate.

ReferencesReferences Citron, M. (1998). Alzheimer’s Disease: Citron, M. (1998). Alzheimer’s Disease:

Treatments in discovery and development. Treatments in discovery and development. Nature NeuroscienceNature Neuroscience, 5, 1055-1057., 5, 1055-1057.

Jarvik, L. F. & Winograd, C. H. (1988). Jarvik, L. F. & Winograd, C. H. (1988). Treatments or the Alzheimer’s Patient.Treatments or the Alzheimer’s Patient. New York, NY: Springer Publishing New York, NY: Springer Publishing Company, Company, Inc.Inc.

Khachaturian, Z. S., & Radebaugh, T. S. Khachaturian, Z. S., & Radebaugh, T. S. (1996). (1996). Alzheimer’s Disease, Causes, Alzheimer’s Disease, Causes, Diagnosis, Treatment, and CareDiagnosis, Treatment, and Care. New . New York, NY: CRC Press.York, NY: CRC Press.

Seman, D. & Stansell, J. (1999). Seman, D. & Stansell, J. (1999). RethinkingRethinkingAlzheimer’s CareAlzheimer’s Care. Baltimore, MD: Health . Baltimore, MD: Health Professions Press, Inc.Professions Press, Inc.

Alzheimer’s Association. www.alz.orgAlzheimer’s Association. www.alz.org

“We t

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-Emily Dickinson