Understanding Vascular Dementia, Stroke, & Depression 8.2.23

foreign formation there's my information and our objectives for those of you that are getting CES but let's jump right into vascular dementia and what is vascular dementia it was the second most common type of dementia but as you're going to see as we go through this it has actually been bumped to the third most common type of dementia because mixed dementia has become the second most common type of dementia and dementia is when somebody has at least two types of dementia and it's almost always but not always Alzheimer's and Vascular together what we're finding and there'll be a statistic in here later I just updated all these statistics yesterday is that a lot of people when they pass at the end of the disease at the end of dementia they then find out they had vascular disease especially if they have an autopsy some people that whenever you really start talking to families and digging into their history the person has had vascular disease and then they developed Lewy Body or they develop frontotemporal so they have frototemporal and Vascular at the same time and we'll talk about what that looks like it's very easy to think about what is vascular disease because when you think about vascular you probably think of cardiovascular so anything that's bad for the heart is bad for the brain and what happens in vascular dementia is that there's a reduction in blood flow to the brain well there's all kinds of things that can cause a reduction in blood flow to the brain but the most common cause of vascular dementia or reason that we have vascular dementia is due to a stroke or a series of Strokes called tias and tias are little bitty Strokes we're actually going to look at an MRI of some they can even look like pinpoints they can be so small but it can then cause issues with blood vessels other things that affect the cardiovascular system like diabetes smoking smokers are at a really high risk for vascular dementia hypertension that is not controlled high cholesterol that is not controlled depression that is not controlled and we're going to tie those two together in just a little bit there's now all kinds of research that shows that folks who have had untreated depression for many many years later showing up with vascular dementia because of the changes that happen in the chemistry in the brain also obesity is a cause of vascular dementia and let's look at some of the reasons why and again it's because of the limited blood flow to the brain so vascular dementia again many times coexist with other dementias it also can coexist with depression like we mentioned earlier vascular dementia is interesting because it is the one dementia that can come on suddenly all of the other dementias that we see over and over and over again Alzheimer's disease frontotemporal Lewy Body Parkinson's each of those those come on over a period of time but with vascular dementia a person can have a stroke and have dementia so one day they didn't have it and the next day they could have it all the others come on over time now vascular can also come on over time because like that third bullet point talks about it can develop gradually because think about what's going on in the blood vessels of somebody who is a smoker that doesn't just happen overnight that happens over time or with a diabetic or someone who has high blood pressure that is something that is happening over time that those blood vessels start to slowly narrow and it is slowly depriving the brain tissue of oxygen so we can see it either way but this is the one that can come on suddenly this is also the one that we have some control over because we there are treatments for depression and obesity and high blood pressure and cholesterol and all of those things that we just mentioned where with the other dementias we don't really know what makes that happen why do some people get Alzheimer's and some don't why do some people get frontotemporal and some don't we don't know so it can be subtle changes over time now I want us to look at the prevalence and again this is some new statistics that those of you who follow or who work in healthcare January and August is when new statistics do tend to come out so we do have some brand new statistics that are just coming out and so knowing that vascular has dropped to third behind Alzheimer's is the most common type or cause or form of dementia mixed dementia is now number two of vascular dementia it's about 17 to 30 percent of all dementias and it just depends on where the damage is in the brain as to what kind of and again those of you who are on our programs often know we're not using the word behaviors we try to say Expressions even though they may be challenging Expressions they are expressions now this particular graphic of the brain also shows what's controlled in different areas so if somebody has had tias or they have a stroke that it was in the temporal lobe it gives you an idea of what the temporal lobe what is in that temporal lobe or that frontal lobe some things that we can do to protect our brain because like I said this is the one that we do kind of have a little bit of control over maintaining a healthy lifestyle having regular Health checkups doing those appropriate interventions so that might be medications it might be controlling underlying issues like heart disease or diabetes or other vascular problems being careful with our diet our activity levels stop smoking using appropriate levels of alcohol consumption being careful about alcohol consumption and then you notice it says avoiding general anesthesia if possible the number one accelerator of all of the dementias is general anesthesia now general anesthesia is when someone is intubated this is not Twilight anesthesia this is general anesthesia for a major surgery a knee replacement a hip replacement a major surgery if our loved one or if we we've got to protect our brains have to have surgery we want to talk to that anesthesiologist ahead of time let them know that we want the least amount for the shortest amount of time they have all kinds of options now I spoke with a someone who works in this field very recently and they said absolutely it's not like the old days where everybody got the same thing they've got all kinds of options so make sure that you do that symptoms of vascular dementia again it varies widely because it depends on where the damage is in the brain and some people early on their memory loss isn't necessarily very significant it may be other things like the third bullet point impaired decision making impaired thinking confusion disorientation trouble with the language communication not just speaking but also understanding and then those physical symptoms so it may present in a little bit different way where we don't necessarily see memory loss right at the beginning or very much memory loss right at the beginning and when we don't understand maybe aging and we might think that somebody has had an age-related memory loss and then we realize there's not age-related memory loss there's age-related slowing down we may think that this is just something that's part of getting older when actually they have had some tias those small strokes and we don't we're not even aware of it yet some other things that we might see with vascular dementia is that not being able to do planning so impaired planning impaired judgment even with things they've always been able to do or you may have seen this on commercials uncontrolled laughing and crying some people call it emotional incontinence where they may cry or laugh at inappropriate times and it's because of the damage that's happened on the brain we may see some pretty severe mood changes or mood swings the inability to pay attention not functioning well in social situations and then having a hard time finding words now this is not where you or I are stuck on a word and saying okay just a minute it's on the tip of my tongue that's not what we're talking about this is when they truly cannot find the word and they end up using lots of thing and stuff you know the thing the thing you know the thing or the stuff you've you're supposed to figure out what they're talking about now what will happen with vascular dementia is they'll ride those plateaus for a long time and then there's a cardiovascular incident and instead of it being a plateau and a slight progression they will Plateau and then stair step down they'll have a big drop down because of the next cardiovascular incident so how to get diagnosed with this neurocognitive testing is what measures brain function and those results give a snapshot of what's happening right at that moment other things that they look at of course is memory loss attention span and how quickly a person can process information so if they have an MRI this can show evidence of strokes and other vascular changes and let me show you what that looks like there's arrows on these MRIs here and where the arrow is pointing you can see a lack of blood supply to the brain so if you look at the one that is C it's the lower left and you see that arrows pointing to it almost looks exactly like a perfect black circle and that's where somebody has vascular damage whatever is in that particular area of the brain that's going to be the symptoms that we see to where the rest of the brain isn't necessarily damaged but I wanted you to see what it looks like because if you've been on other programs where we've looked at pictures of Alzheimer's Lewy Body frontotemporal even Parkinson's the brain looks a little bit different but they can see this on an MRI so what are the outcomes of somebody with vascular dementia their life expectancy is a little bit different if they're diagnosed under the age of 65 the average life expectancy is about three years and if they're diagnosed after the age of 65 their life expectancy is about five the reason that is is because they typically have that underlying vascular issue and that's what they end up passing away from not from going to the end of dementia they end up having vascular issues and they die from that there are no drugs that are specific to vascular dementia just like there's no drugs specific really to any of the dementias other than to treat symptoms but there's not anything out there that is specific for vascular dementia treatment but there are things where we can treat symptoms this is where we continue to control the risk factors and somebody who has vascular dementia and then if you notice that very last bullet point and this is from the Alzheimer's Association there's substantial evidence that treatment of risk factors May improve outcomes and help postpone or prevent further decline so if somebody had had uncontrolled high blood pressure they have a stroke and then we control their high blood pressure they may sit on that Plateau for a long time very long time I found um a newer updated video about vascular dementia this is just a short overview of it and I want us to watch this real quick I think it's about two two and a half minutes vascular cognitive impairment occurs when blood vessels in the brain an image or blocked disrupting the supply of oxygen and nutrients to the brain cells this can be found on scanning in people with no cognitive symptoms but may lead to changes in functions such as language attention reasoning and memory the most severe form of vascular cognitive impairment is known as vascular dementia it can occur on its own but it is more commonly found in a person who also has Alzheimer's disease or Lewy Body Disease and this is known as mixed dementia a major cause of vascular dementia is small vessel disease where there is damage to the blood vessel Walls Within the brain their scalar dementia can also develop after a stroke causes a blockage or rupture to an artery in the brain it may also be a single stroke that causes these problems or it might be a series of smaller ones the brain needs a healthy vascular system to function properly a disrupted blood supply to the brain can cause symptoms of dementia the management of underlying health conditions such as high blood pressure diabetes and high cholesterol can reduce some of the risk factors for vascular dementia vascular dementia is highly variable depending on the area of the brain that is damaged and other factors affecting Business Health symptoms may include a declaration of planning reasoning and thinking skills confusion impaired attention mild memory problems difficulty finding the right words slurred speech changes in walking and movement behavioral changes such as agitation lack of bladder control and depression vascular dementia often occurs with another form of dementia it occurs when blood vessels in the brain are damaged or blocked symptoms depend on the part of the brain damaged managing health conditions can reduce the risk good overview that was from dementia Australia they've got a great website so let's look at some of the ways that we can treat and help vascular dementia this actually is with all of the dimensions that we're going to talk about these next four things a person with dementia is going to go in and out of physical therapy occupational therapy and speech therapy throughout the course of the disease I was actually speaking with some physical therapists yesterday in Arlington and telling them and reminding them that even though they are not curing the disease this is not Curative what a difference they make as far as comfort measures and quality of life goes so again they're going to go in and out of therapies but you've got to make sure you have a therapist who knows how to work with somebody with dementia otherwise they're going to mark them as non-compliant saying that they're not following directions and they're going to go on to their next client so we want to make sure and ask if our loved one is going into therapy that they have people who are trained in dementia but think about why physical therapy and occupational therapy is going to make such a difference in somebody with dementia and on this one we're talking specifically about vascular dementia they know how to tap into things like procedural memory and they know how to tap into muscle memory and muscle memory is still there in a person with dementia well into the disease so some of the reasons that we might do physical therapy is to help in the reduction of fall risk we know that eventually they're going to start to have a lot of Falls because when we learn to walk we had a lot of Falls so when they're to the point in the disease that they're about to stop walking they're going to have an awful lot of Falls it also helps increase their circulation because so many times when someone's at home they're doing a whole lot of sitting in the chair and looking at the TV so having that physical therapy gets them moving and helping with muscle tone flexibility their balance and their Mobility occupational therapy oh my goodness occupational therapy I've seen make such a difference in family lives because they really work on those activities of daily living and so activities of daily living is where they still can do things like feed themselves dress themselves toilet themselves and that occupational therapist can even come in and show you ways to adapt your own home to make it a safe place for somebody with dementia a physical therapist can show you how to safely lift move and transfer your loved one you just have to ask them to do that also occupational therapy can show you how to use and where to get things like adaptive eating utensils and other adaptive type things you can all you can go on places like Amazon there's something called alls store alz store and they have all kinds of adaptive utensils for people with dementia speech therapy and music therapy are the other two now so many times when we hear the word speech therapy we think that this is specific to Speech but especially with somebody with dementia this is going to be a lot about swallowing because think about what controls how we swallow that's our brain and so eating drinking and swallowing the speech therapists are the ones who do the swallow test and they are the ones who can tell us when it's time to change the diet of our loved one when they go from a regular diet to a soft maybe to a finger foods to a pureed diet or when it's time to thicken liquids because there does come a time that they're going to do better whenever they have thickened liquids and music therapy we know was great throughout the course of all of the dementias simply because we know that that amygdala stays intact in the brain and the amygdala controls those feelings and those emotions we know the right side of the brain deteriorates slower than the left and the right side is where Rhythm Is Right Rhythm remains and so it is a great mood stabilizer it helps us connect with our loved one if we do something with music together whether it's dancing or whether it is beating on a drum together or whether it is just sitting listening to something and tapping our hands together it really makes us be social other interventions that we can do for vascular dementia you're doing part of it right now as education to understand the disease process better making good choices as far as again anything that's good for the heart good for the brain anything that's bad for the heart bad for the brain making sure the person is getting adequate rest looking for any reasons behind a behavior you do have a challenging Behavior or a challenging expression about 80 percent of the time when we see that it was either our approach our tone the gestures we were using or our body language or the environment that caused it we didn't do it on purpose they're trying to get a need met and we have to figure out what's the reason behind the behavior and then the four things that we use to redirect food music animals and children food the sweeter the better music their music especially their music from the time they were 10 to 25 that's called our music set and when you study music therapy that for all of us that is our music set from the music between the ages of 10 and 25 and then animals and children YouTube is wonderful type in funny baby animals falling down that's one of the best or children laughing that's another really good one and use something a little bit bigger like an iPad to show them videos things that we can do to help somebody with dementia educating yourself is a big part of it and switching to focus on quality of life not necessarily how long are they going to live but how well are we going to live because there's quality of life to be had with dementia practicing that self-care and compassion is huge when we're a caregiver of somebody with dementia and then keep in mind that last bullet point the person with dementia is not giving you a hard time the person with dementia is having a hard time now I've got resources for each of the sections and so this section is on vascular dementia so here's some local information here in Fort Worth also there's type of snow is on there the Alzheimer's Association is on there and then the others are local and then here's resources for all of the statistics that we did today and again you're going to get copies of all of this and let's start talking about stroke because we said the most common cause for vascular dementia is a stroke and there are two different types of stroke so we need to understand that there are two different kinds there's the ischemic stroke and there's the hemorrhagic stroke so if you'll I found this graphic that I thought wow that really explains it in a way that we can understand it and the ischemic stroke it's an obstruction that's blocking the blood flow to the brain in the hemorrhagic stroke look what happens there that's when the wall ruptures and there's bleeding in the brain but what it comes down to with a stroke there's a supply of blood carrying oxygen to the brain and it is suddenly cut off for one reason or the other and vascular dementia again most commonly caused by Strokes whether it's a big stroke or a number of small strokes but here this also not everyone who has a stroke is going to develop dementia not everyone who has a stroke is going to develop dementia stroke symptoms and you may have seen this they came out with this fast uh this graphic is really good looking at a person's face does it look uneven is one arm hanging down is the speech slurred and then making sure that we call 9-1-1 immediately because time is so important we've got some other symptoms that are listed there trouble seeing a metallic taste in the mouth trouble swallowing difficulty walking all of those also can be a sign of a stroke diagnosis and prevention of a stroke so again they're going to do a physical exam first they're going to do a blood test they likely are going to do a CAT scan and an MRI because you can see a stroke like we saw earlier they may do an ultrasound also to check for the blood flow in the Carotid artery some of the things that we can do to prevent stroke and the first one that's listed is a diet and this is a diet that is rich in fruits and vegetables maintaining a healthy weight one of the best diets that we know that we can follow and some of you we've talked about this before on support groups and different programs there is a diet now that is called the Mind m-i-n-d mind diet and it is a combination of the Mediterranean diet and the DASH diet the DASH diet is the diet that came out that is specific for people with high blood pressure well some neurologists got together and they combined that DASH diet with the Mediterranean diet and they came out with the Mind diet supposed to be the best diet for our brains that's good for all of us again other things is controlling diabetes cholesterol blood pressure depression avoiding illicit drugs controlling alcohol consumption stop smoking and then treating sleep apnea we know that there is a link between untreated sleep apnea and vascular dementia or stroke because think about what's happening with sleep apnea we stop breathing we're not breathing and those of you who have it or you know people who have it I have it and use a CPAP when you have that initial sleep study they tell you how many times you stop breathing during an hour and sometimes it can be really scary and again think about what's happening when we stop breathing so we now know that there is a correlation between untreated sleep apnea and vascular dementia treatment for stroke this is why time is so important because we now have clot dissolvers that they can give us and it will dissolve the clot open the arteries anticoagulants so we want to make sure and call 9-1-1 get them to the hospital as soon as possible and if they even think that it is a stroke they have got medications that they can use there's procedures that they can use for stroke they can use catheters they can use angioplasty and stents they can even clip aneurysm aneurysms at this point so there are things that can be done there are therapy that's specific to somebody who's had a stroke in Rehabilitation and we want to get them into that therapy as soon as possible they typically are going to start with speech therapy because it's very common in someone who's had a stroke that they will lose part or all of their speech they can even do some cognitive therapy that again is specific to people who've had Strokes they'll work on sensory and motor skills and of course physical therapy now some of the things also after a stroke is usually that person is going to be on a very strict diet they'll probably send us to a dietitian and then they're going to recommend things like fruits vegetables whole grains lean meats low-fat and limited salt intake also avoiding anything that has heavy cholesterol alcohol and foods that are high in salt and sugar and then I wanted you to see here are some more images and these are specific to stroke and these if you notice especially like a that top left corner you can really see where that stroke is all of them I mean it stands out you can see thank goodness we now have the ability to see the stroke and see where the stroke is and then the neurologist can talk us through okay that particular area of the brain controls this so you're probably going to be seeing it gives us an idea of stroke related behaviors that we might see and I want us again to watch a very short video that is specific to things that might happen when someone has had a stroke it's true because when the blood supply into part of your brain is cut off this can cause your brain cells to become damaged or dying a stroke can happen to anyone and there are two main types the most common is an ischemic stroke which happens when a blood vessel in the brain becomes narrowed and a blood clot forms causing a blockage sometimes this blockage is only temporary this is a transient ischemic attack or Tia and is often called a mini stroke a TIA may feel like a funny turn as you may experience sled speech or confusion for a short time and then go back to feeling well again the other main type of stroke is a hemorrhagic stroke this happens on a blood vessel ruptures causing a bleed in the brain permanently damaging the surrounding brain cells risk of stroke is increased by an irregular heart rhythm called atrial fibrillation or having risk factors such as being older having high cholesterol high blood pressure diabetes smoking or being overweight Ellie was at home when suddenly her face dropped on one side she was unable to raise both of her arms and Her speech became slurred her husband immediately called 999. at the hospital doctors gave penny a clot busting drug to break down the clot in her brain some people may have an emergency thrombectomy a procedure to remove the Cod completely or another treatment to try and restore blood flow to the brain the treatment given will depend on the type of stroke you've had after her stroke Penny's family noticed mood and personality changes and she wasn't able to do as much as before depending on the area of the brain that is damaged and how quickly they receive treatment people may also experience memory loss tiredness difficulty swallowing muscle weakness on one side or problems communicating these can be permanent but many improve over time following a period of Rehabilitation in hospital and he made some lifestyle changes to continue her recovery and reduce her with suffering another stroke in the future whilst the effects of a stroke can be devastating if you act fast and get the treatment you need immediately this gives you the best chance of making a recovery and getting back to a normal life more information on Strokes can be found at bhf.org dot UK slash stroke bhf beat heartbreak from stroke beat and of course they said 999 where ours is 9-1-1 because that's from the UK but I thought the graphics in that were easy to understand and there's so many different things that they can do now for stroke we're going to move into depression and dementia now we know that early in the disease that a person who is in the early stages of all dementias many times has depression because of the diagnosis that they've been given it also can be because of the changes that they know are happening in their own body whether they're admitting it to us or not we all know when something is going on with our body and something's wrong so we will see people have depression in the early stages we then see it again in the later stages of the disease but it's because of the chemical changes that are taking place in the brain so what we're going to talk about right now though is depression throughout a person's life that if it goes untreated there is now a direct link between untreated depression and later developing dementia I've got a graphic I'm going to show you next that really links the two together there's more and more studies being done on this and I think it's really interesting for us to look at because I talked to so many families who say things like oh my mom has struggled with depression or entire life she wouldn't take antidepressants because she thought she's going to get hooked on them and then they end up with vascular dementia we're going to talk about each of those things there's overlaps overlapping symptoms between some of the earlier stages of dementia and depression but depression and anxiety are the most common mood disorders in the United States and as a licensed therapist myself I hate that we use the word mental illness and that depression and anxiety fall under what technically is called a mental illness it's brain health is what it is and I think if it did not have the stigma of being a mental illness maybe we'd talk about it a little bit more and maybe we wouldn't be ashamed to talk about our brain health because there's not anything to be ashamed of we talk about our heart health with no problems people will share I'm on blood pressure medication I'm on cholesterol medicine nobody wants to talk about an antidepressant only a third of people who have depression are actually receiving any type of treatment so let's look at what is actually happening to the brain whatever a person has depression and how it can end up leading to dementia later on depression is changing the brain it changes the chemicals in the brain and look that now we know it actually can increase those amyloid plaques and many of you know enough about dementia who have just heard the word plaque and go uh oh that's Alzheimer's disease those other types of dementias where we've got plaque inflammation also and then it leading to dementia here's another scan the healthy brain is on the left look especially in this frontal cortex depression actually changes the metabolism and blood flow and it pulls it away from the frontal cortex because look at the brain that has chronic depression it doesn't have the same blood flow in it it damages the brain due to the chemical changes and that's what antidepressants do is they help stabilize those chemical changes in the brain one of the areas that can be damaged from depression is conflict resolution we can see there from the skin the prefrontal cortex part of what's in the prefrontal cortex is planning an executive function being able to be reasonable and rational so a hypothesis is that vascular depression vascular depression is caused from these vascular lesions that are on the brain because of untreated depression this has really been coming out in the last two maybe going on they're studying this so let's look at what is depression and again we're going to look at some brand new statistics just came out on the next slide a person can be depressed and not be sad although typically when we think of depression the first thing is we think of as sadness loss of interest in activities because those are the most common things just like when we think of dementia we think of memory loss but then there's a couple of different types of dementia that present with no memory loss so a person can be depressed and not necessarily be sad but what happens with depression is that it can lead to other emotional and physical problems so here's these latest statistics these are 2022 statistics from the CDC and it was interesting how some of these had changed over the last year one in particular number of Physician Office visits with depressive disorders as the primary diagnosis for about 15 million in the United States last year number of suicides in the United States last year over forty eight thousand this is a typical patient Health questionnaire and the way that we answer this it's one of those I'm not crazy about these answers but it's the now what they have you do is they think over the last two weeks over the last two weeks and again you're going to get a copy of this and I want you to really look at this side 32 and think about it for yourself think about it with others around you again you think of the last two weeks would your answer be not at all several days more than half the days or nearly every day and be honest about it and be honest about it without saying something like but I well yeah yeah I've got that going on but I that's making an excuse we've got to admit there's something going on before we can seek treatment now let's look at these signs and symptoms of depression because just like with dementia that has over 35 common symptoms and most people can only name two or three depression also has a lot of symptoms and what yours looks like and what mine looks like may be completely different because it affects different people in different ways so take a look at that I encourage people to get a highlighter run this off and highlight any of the ones that you've had in the last month and especially if you are a caregiver of somebody with dementia being able to because what I have found is people will go well yes I'm having feelings of guilt or feelings of worthlessness or loss of interest in my hobbies are aches and pains in my back because but I'm a caregiver exactly your caregiver you're having what's called and we're going to talk about situational depression this is depression caused by the situation that you're in right now it's not because of something you did it's because of the situation that you're in right now so these are common signs and symptoms of depression now I want us to also look at what depression might look like in an older adult and by older adult the Mayo Clinic is using 65 and older it can look a little bit different now keep in mind that just like dementia depression is not a normal part of growing older and it should never ever be taken lightly because white men over the age of 75 have one of the highest risk of suicides of anybody depression will go undiagnosed and untreated in older adults many times because they're reluctant to seek help or to talk about it or they think it's just part of getting older it can show up as memory issues personality changes physical aches and pains kind of becoming anti-social that feeling of hopelessness fatigue even starting to have some difficulty performing tasks and I want us to look at there's many different types of depression we do not have time to go over all of those but I just have five pretty common ones here and I want us to look at this first one which is kind of a chronic depressive disorder this is a depression that lasts for a minimum of two years and it's almost like the major depression comes and goes and in the periods where it kind of wanes the symptoms aren't as severe but they're still there those symptoms that we looked at earlier but to get a diagnosis these need to have been present for two years postpartum depression you've probably heard of a major depression during after delivery this is not normal baby blues this is something much more intense than that it makes it difficult to even care for the baby or care for ourselves seasonal affective disorder is usually seen in the fall or winter but some people have it in the spring or summer but for the most part we see it in the fall or winter when the days are shorter there's not as much sunlight people will start to withdraw socially they may sleep more they may gain weight sometimes we'll use something like a light therapy to help with that and then there's major depressive disorder and this is also called clinical depression we saw a real rise in this during the pandemic I think a lot of us probably there was post-covered depression that was very real thing still is and then a lot of us went through a major depressive episode because of the pandemic this is where we were having those symptoms that we saw earlier that were starting to affect our daily life they were affecting our work our sleep our study habits the way we were eating and we might have one episode during a lifetime or we may have multiple episodes and then this is what I mentioned earlier situational depression and this is where we have depression because of the situation that we're in we're going through a divorce we've lost a job we have a loved one with dementia grief comes in waves where it feels like it can just knock us down in my grief support group we use the term grief burst where it is like this burst of grief that comes out of where did that come from I'm standing in the middle of a grocery store but then there's other times that I'm okay I'm still standing in the middle of this water but the waves aren't knocking me over during situational depression self-esteem is usually maintained keeping in mind that grief and depression can coexist and often do let's look at the risk factors for depression again it's big to see that only a third of people actually receive treatment we see a lot of depression in families about 40 percent of the time there's a family history and what's interesting with identical twins that if one twin has depression about 70 percent of the time in identical twins they'll both have depression we do see more depression in women than in men and part of that is due to hormonal factors in fact about a third of women will have at least one major depressive episode during their lifetime it can be Environmental it can be due to violence or neglect or abuse or a pandemic stress and Trauma a person's personality a diagnosis of a physical illness depression and surgery go together especially situational depression where maybe we have a surgery we're having to depend on other people I don't know how I'm going to do I'm going through therapy physical illness and depression go hand in hand and then sometimes it's a side effect of a medication now I think it's interesting to note here a couple of ways where men and women differ in depression for women the three most common things that we see are sadness a feeling of worthlessness and guilt I bet some of you are shaking your heads and in men the three things we tend to see are fatigue being tired irritability and being angry makes sense we think about it how we get diagnosed for depression with depression to get a diagnosis the symptoms need to be present for at least two weeks and typically by the time we talk to anybody about it what I found being a licensed therapist myself is people are long past two weeks before they start to talk about it but we can go to our primary care physician and have a diagnostic exam and interview a physical exam lab tests to rule out other conditions because things like vitamin deficiencies and thyroid problems can mimic depression so we're going to want to have a complete blood work up and then we want to look into a medical and family history as well as as as well as things like cultural and environmental factors a person can also go see a psychiatrist which can do the very same things is that primary care physician but this is someone who specializes in mental health they can perform therapy themselves more often than not they're going to send you to a counselor but they also can prescribe medications and recommend a therapist there are people like me a licensed professional counselor there are licensed clinical social workers licensed Master social workers who can do assessments and then do therapy we're going to talk about some different types of therapy and then there's psychologists that can also do in-depth psychological testing if it's needed now I think this is important to see because most people don't realize this the 80 to 90 percent of the time treated depression can be cured that doesn't mean that it's never going to come back especially situational depression and then another 20 percent of the time even in treatment resistant depression we can reduce some symptoms I've just read Naomi Judd's book that she wrote about her treatment resistant depression it's hard to read it's a hard read but when she was treating her depression and she tried all different types of things she would at least see some reduction in symptoms that she could never get to that point where it completely went away foreign of the time it can be cured but only a third of people seek treatment and the earlier we get that treatment the more effective it is there is not a one-size treats all a one-size-fits-all treatment for depression because it's different in everybody so let's look at medication it's so important to understand that antidepressants are not habit-forming and antidepressants are not uppers some of you may remember back in the 90s when Prozac first came out there were rumors and people were saying that they were you could get high using Prozac and that isn't how it works that's not how it affects the brain it takes a while and what happens is lots of times by the time we talk to a doctor or a therapist about depression is we're to the point that we want to take a pill right now and have it fix it today and that isn't how it works it can take two to four weeks and sometimes two to three months for it to completely go into effect that's why the earlier we go talk to somebody the quicker it can help and for many people this is short term while we're also doing some type of psychotherapy we're doing some talk therapy or some other things that we're going to look at but one of the things that we tend to see is that once somebody starts to take an antidepressant within a couple of weeks sleep improves and that's huge we know that appetites change and concentration improves now there's different types of therapy as well that I want us to talk about cognitive behavior therapy is probably the one you've heard of the most and it's used the most often I use cognitive behavior therapy in my support groups all the time where we focus on problem solving and reframing the situation it helps us recognize distorted thinking that we're having or sometimes we call that Twisted thinking that we're having or even just negative thinking and the goal of cognitive behavior therapy are to change those thoughts and respond to challenges in a more positive way there's other types of therapy interpersonal therapy problem solving therapy um and for those that need to really do some deep therapy about trauma that may have happened to them you may have really been hearing a lot about EMDR the eye movement desensitization therapy it allows people to heal from emotional distress of Trauma from their past I specialized in something called narrative therapy where I use a person's story to build their therapy around their story there's other things that we can do for depression and usually when we're depressed the last thing we want to do is exercise but it's actually one of the best things that we can do so I encourage people to commit to 15 minutes could you do 15 minutes three times a week because most all of us can say I can do that for 30 days I'll commit to doing that for 30 days and then we start to feel a little bit better that's part of the setting realistic goals we've got to set something that we know will do because if we say I'm going to exercise an hour every day well we know we're not going to do that educating ourselves about depression setting some priorities breaking tasks into smaller ones sleep and diet are huge and then last bullet point to avoid self-medicating and we can self-medicate with all kinds of things alcohol drugs food shopping pornography there's all types of things that we could Netflix there's all kinds of things that we can self-medicate let me just leave this reality for a little while and enter into and there's a time and place for sometimes I am a big person on saying let's go watch some Carol Burnett for a little while but I'm not going to sit there and watch it for eight hours how do we help people that are depressed offering their support and what I tell people what I tell folks is you don't necessarily have to try to fix it just be an ear because sometimes we just need somebody to hear us without trying to fix it don't ever ignore somebody's comments about suicide invite them to get out of the house let's go on a walk let's go on an outing let's go to a movie let's go to a restaurant just us making sure they have transportation to their appointments and that they're keeping up with their treatment plan here's some information about where you can get help and some resources and then I hope that everybody is aware of this but this went into effect last July so we've had it now for a year there is now a number that's 988 and when you call 988 you're going to get somebody who is trained it's a crisis hotline is what it is so you can call it if you feel like you're in trouble yourself you're going to get somebody who's trained you can call it if you're having a problem with your loved one you're going to get somebody who's trained if you ever have to call 9-1-1 because of your loved one with dementia and you are needing help from the police please make sure that you ask for the mental health officer because most big cities now do have mental health officers that are trained but notice there on that 988 Lifeline it's a local crisis center that provides free and confidential emotional support to people in distress you don't have to be suicidal you can just be in distress and you call 988 and you're going to get somebody who's trained to help there's our information I know we're right at time uh let me stop and let me just add for those of you who may have joined late that we do have a free CE with this Jamie Cobb Tinsley will send out an email in just a little bit with the recording of this and with the slides uh let's see the depression from the hardships we face that's right we do sometimes joke about dementia being contagious but you're exactly right it's not contagious but no symptoms yes men can also sew depression differently yes anger and frustration you're right that's right that's right from staying indoors too much thank you so much for adding all of that I appreciate all of you being on here today and taking your time to be with us be looking for an email from Jamie and she'll send you the slides the copy of the present the recording and information on how to get your CE thanks everybody we'll see you next time

Channel: James L. West Center for Dementia Care

Views: 10,119

Keywords: Dementia, dementia care, dementia education, alzheimers, alzheimers disease

Id: bCvyAaVb9FY

Length: 57min 33sec (3453 seconds)

Published: Fri Aug 04 2023