This interactive Illinois Psychology Ebook contains 24 hours of continuing education. To complete click the Complete Your CE button at the top right of the screen.
ILLINOIS Psychology Continuing Education
Elite Learning
Inlcudes mandatory topics for license renewal
ELITELEARNING.COM/BOOK Complete this book online with book code: PYIL2426 24-Hour Continuing Education Package $135.00
What’s Inside
ALZHEIMER’S DISEASE AND OTHER DEMENTIAS: SYMPTOMS, STAGES, AND COMMUNICATION STRATEGIES EXPANDED (MANDATORY) 1 [2 CE hours] Alzheimer’s disease is one of the leading illnesses affecting the elderly and is the most prevalent of the dementias. As people are living longer, the number of Americans diagnosed with AD is expected to reach 82 million by 2030, according to the World Health Organization (Zhou et al 2022). Learning about AD’s brain impact, stages and their respective symptoms, patient responsiveness, and caregiver burden will enable you to align with colleagues to share information that will impact lives. This course will provide insight and understanding based on the most current data to enable you to have deeper insight into the impact of AD. THIS COURSE FULFILLS THE REQUIREMENT FOR ALZHEIMER DISEASE AND OTHER DEMENTIAS 28 [3 CE hours] This basic-level course will help practitioners approach documentation in a way that is guided not solely by what is mandated, but by what is mutually beneficial to all stakeholders in the documentation process: The practitioner, the agency, the funding source, and – most of all – the clients. THIS COURSE FULFILLS THE REQUIREMENT FOR ETHICS ETHICS IN BEHAVIORAL HEALTH DOCUMENTATION: REASONS, RISKS, AND REWARDS (MANDATORY)
CULTURAL HUMILITY IN BEHAVIORAL HEALTH (MANDATORY)
61
[3 CE hours] The purpose of this education program is to present an introduction to cultural humility and offers tools for psychologists and other behavioral healthcare professionals to use when working with patients from diverse backgrounds in a culturally humble manner THIS COURSE FULFILLS THE REQUIREMENT FOR DIVERSITY 87 [3 CE hours] The role of implicit biases on healthcare outcomes has become a concern as some cite that implicit biases contribute to health disparities, professionals’ attitudes toward and interactions with patients, quality of care, diagnoses, and treatment decisions. This course will explore definitions of implicit and explicit bias, the nature and dynamics of implicit biases, and how they can affect health outcomes. Because implicit biases are unconscious, strategies will be reviewed to assist in raising professionals’ awareness of and interventions to reduce them. IMPLICIT BIAS IN HEALTH CARE (MANDATORY)
THIS COURSE FULFILLS THE REQUIREMENT FOR IMPLICIT BIAS AND CULTURAL COMPETENCY
©2026: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials.
i
PSYCHOLOGY CONTINUING EDUCATION
MANAGING PROFESSIONAL BOUNDARIES (MANDATORY)
103
[3 CE hours] This course is intended for healthcare professionals who provide care to clients/patients. The course discusses professional standards and principles for providing safe ethical care, how those standards are reflected in clinical boundaries, common boundary dilemmas faced by clinicians, and how to apply a decision-making model to navigate boundary situations.
THIS COURSE FULFILLS THE REQUIREMENT FOR ETHICS
SEXUAL HARASSMENT PREVENTION: THE ILLINOIS REQUIREMENT(MANDATORY) 130 [1 CE hour] Sexual harassment in the workplace can be prevented and/or discouraged with training, anti-harassment policies, and reporting. Employers are responsible for creating work environments that are safe for all employees and are free from harassment. Following the correct state and federal reporting guidelines, as well as having a clear understanding of what constitutes sexual harassment, can help to reduce the cases of harassment and provide a safe environment for all. This course will discuss the laws and regulations that define sexual harassment. It will also outline the many consequences that are caused by sexual harassment and how to report sexual harassment if one experiences or witnesses it in the workplace. Lastly, this course will review the laws that are in place to protect those who make a report.
THIS COURSE FULFILLS THE REQUIREMENT FOR SEXUAL HARASSMENT AWARENESS TRAINING
BRIDGING THE GAP: INTEGRATING BEHAVIORAL HEALTH INTO PRIMARY CARE [9 CE hours] This comprehensive CME course provides primary care professionals with the essential knowledge and skills to effectively integrate behavioral health into their practice. Through online modules, interactive case studies, and downloadable resources, participants will learn to identify, assess, and manage common mental health disorders in primary care settings.
137
ii
PSYCHOLOGY CONTINUING EDUCATION
Frequently Asked Questions What are the requirements for license renewal? Licenses Expire CE Credit Hours
Mandatory Subjects
3 hours Ethical Practice of Psychology; 3 hours related to Diversity; 1 hour Sexual Harassment Prevention training; 1 hour Implicit Bias Awareness training; 1 hour Alzheimer’s Disease and Other Dementias training; 1 hour Cultural Competency training; and 1 hour DCF’s mandated reporter training
24 (18 allowed through self-study)
September 30, 2026
How much will it cost?
Enter the code that corresponds to the online course listed below.
Course Title
Hours
Price
Course Code
Alzheimer's Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded
2
$16
PYIL02AL
3
$24
PYIL03ET
Ethics in Behavioral Health Documentation: Reasons, Risks, and Rewards
3
$24
PYIL03BH
Cultural Humility in Behavioral Health
3
$24
PYIL03IB
Implicit Bias in Health Care
3
$24
PYIL03PB
Managing Professional Boundaries
1
$15
PYIL01SP
Sexual Harassment Prevention: The Illinois Requirement
9
$72
PYIL09BG
Bridging the Gap: Integrating Behavioral Health into Primary Care
Best Value - Save $64.00 - All 24 Hours
24
$135
PYIL2426
How do I complete this course and receive my certificate of completion? See the following page for step-by-step instructions on how to complete and receive your certificate. Are you a Illinois board-approved provider? In support of improving patient care, NetCE
What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Psychology you will see our robust FAQ section that answers many of your questions. Simply click FAQs at the top of the page, email us at office@elitelearning.com, or call us toll-free at 888-857-6920, Monday - Friday 9:00 am - 6:00 pm and Saturday 10:00 am - 4:00 pm EST. Important information for licensees Always check your state’s board website to determine the number of hours required for renewal, mandatory topics (as these are subject to change), and the amount that may be completed through home study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file. Disclosures Resolution of conflict of interest Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a
is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the
American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibility for the content of the programs. Are my hours reported to the Illinois board? No. The Illinois Department of Financial and Professional Regulation requires licensees to certify at the time of renewal that they have complied with the continuing education requirement. The board performs audits at which time proof of continuing education must be provided. Is my information secure? Yes! We use SSL encryption, and we never share your information with third parties. We are also rated A+ by the National Better Business Bureau.
position to control content of the course activity. Sponsorship/commercial support and non-endorsement
It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners. Licensing board contact information: Illinois Department of Financial and Professional Regulation 555 West Monroe Street, 5th Floor Chicago, IL 60661
iii
PSYCHOLOGY CONTINUING EDUCATION
How To Complete This Book For Credit
Please read these instructions before proceeding.
• Go to EliteLearning.com/Book and enter the code that corresponds to the course below, then click GO . Each course will need to be completed individually, and the specified course price will apply. • Proceed to your exam. If you already have an account, sign in with your username and password. If you do not have an account, you’ll be able to create one now. • Follow the online instructions to complete your exam and finalize your purchase. Upon completion, you’ll receive access to your completion certificate. ONLINE FASTEST AND EASIEST!
Enter book code
PYIL2426
GO
Complete your CE
Course Title
Hours Price Course Code
ENTIRE PROGRAM (All 24 Hours)
24
$135
PYIL2426
Alzheimer's Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded 2
$16
PYIL02AL
Ethics in Behavioral Health Documentation: Reasons, Risks, and Rewards
3
$24
PYIL03ET
Cultural Humility in Behavioral Health
3
$24
PYIL03BH
Implicit Bias in Health Care
3
$24
PYIL03IB
Managing Professional Boundaries
3
$24
PYIL03PB
Sexual Harassment Prevention: The Illinois Requirement
1
$15
PYIL01SP
Bridging the Gap: Integrating Behavioral Health into Primary Care
9
$72
PYIL09BG
Note: Prices are subject to change
iv
PSYCHOLOGY CONTINUING EDUCATION
____ Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded
PYIL02AL — 2 CE CREDITS
R elease D ate : 12/13/2023
E xpiration D ate : 12/13/2027
Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded
Audience This course is designed for the interprofessional healthcare team and professions working in all practice settings. Course Objective The purpose of this course is to provide healthcare workers with a deeper understanding of how to care for patients with Alzheimer’s disease (AD) or another dementia. Learners can be the providers of direct care, staff in the community, at home, or in a residential environment. Lessons address symptoms and causes of AD, insight into other types of dementia, methods of diagnosis, cognitive and behavioral aspects of the disease, and ethical issues. There will be a review of disease symptoms, behavioral changes, and activities and environmental modi- fications that can be implemented and modified to improve care for the patient while providing support to the caregiver. Understanding the caregiver role in the life of an AD and/ or dementia patient will be explored, as will medical treat- ment, research, and patient interaction. Disease (symptom) management will be expounded upon, with insight into stress management tools to provide support for the unique situations that can compound the lives of those affected. Standard care approaches for patients with AD and/or other dementia is reli- ant upon ethical care, a theme that will be present throughout the course Learning Objectives Upon completion of this course, you should be able to: 1. Define dementia, the symptoms, and various types of dementia. 2. Discuss Alzheimer’s disease to include the causes, history, and types. 3. Evaluate the various stages of Alzheimer’s. 4. Describe the impact of Alzheimer’s on the brain. 5. Recognize variables and factors that have been identified as linkages to Alzheimer’s. 6. Examine the steps taken for an Alzheimer’s diagnosis. 7. Define steps for best practices caring for caring for a patient with Alzheimer’s.
8. Describe appropriate activities to engage a patient with Alzheimer’s. 9. Recognize the impact of Alzheimer’s disease on activities of daily living and independent activities of daily living within the disease stages. 10. Recognize strategies to accommodate activities of daily living and independent activities of daily living. 11. Recognize the behavioral changes according to the clinical stage of Alzheimer’s. 12. Evaluate the importance of the environment, and mental and physical activity for improving the well-being of a patient with Alzheimer’s. Faculty Joy Siegel, EdD, MBA , has dedicated her professional life to building a strong community for improved health outcomes. She has consulted with more than 200 community-based orga- nizations and led campaigns for societal issues such as home- lessness, cancer, lifelong learning, Parkinson’s and Alzheimer’s diseases, and the arts. Joy has designed annual funds, capital campaigns, social media campaigns, Medicare- and Medicaid- funded programs for dementia and mental illness, loneliness mitigation programs, and many special events for outreach and fundraising. When Joy’s mother was 59, she was diagnosed with Parkinson’s disease, a life-altering diagnosis for herself and the family. Joy became an integral part of her mother’s care team. She also went back to school and earned a doctoral degree in organizational leadership and gerontology and began working in the healthcare sector with providers, plans, systems, and communities to create and deliver programs promoting nonclinical aspects of wellness. Joy most recently worked with a regional Medicare Advantage plan designing retention and outreach programs and pilots designed to improve health and minimize loneliness. She is on the faculty at the Nova South- eastern University’s Kiran C. Patel College of Osteopathic Medicine and teaches public health to future healthcare lead- ers. Her career is an aggregate of personal, professional, and academic experiences that have shown her that community is often the answer. Joy has more than 100 hours of continu- ing education programs running nationally for allied health professionals, providers, and administrators.
1
EliteLearning.com/Psychology
Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded ____
Faculty Disclosure Contributing faculty, Joy Siegel, EdD, MBA , has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned. Division Planners Margaret Donohue, PhD Senior Director of Development and Academic Affairs Sarah Campbell Division Planners/Director Disclosure The division planners and director have disclosed no relevant financial relationship with any product manufacturer or service provider mentioned. Accreditations & Approvals In support of improving patient care, NetCE is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
About the Sponsor The purpose of NetCE is to provide challenging curricula to assist healthcare professionals to raise their levels of exper- tise while fulfilling their continuing education requirements, thereby improving the quality of healthcare. Our contributing faculty members have taken care to ensure that the information and recommendations are accurate and compatible with the standards generally accepted at the time of publication. The publisher disclaims any liability, loss or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents. Participants are cautioned about the potential risk of using limited knowledge when integrating new techniques into practice. Disclosure Statement It is the policy of NetCE not to accept commercial support. Furthermore, commercial interests are prohibited from distrib- uting or providing access to this activity to learners. HOW TO RECEIVE CREDIT • Read the entire course online or in print. • Complete a mandatory test (a passing score of 75 percent is required). Test questions link content to learning objectives as a method to enhance individualized learning and material retention. Provide required personal information and payment information. • Complete the mandatory Course Evaluation.
Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psycho-
logical Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibil- ity for the content of the programs.. Designations of Credit NetCE designates this continuing education activity for 2 credits.
Sections marked with this symbol include evidence-based practice recommendations. The level of evidence and/or strength of recommendation, as provided by the evidence-based source, are also included
so you may determine the validity or relevance of the information. These sections may be used in conjunction with the course material for better application to your daily practice.
2
EliteLearning.com/Psychology
____ Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded
INTRODUCTION Alzheimer’s disease is one of the leading illnesses affecting the elderly and is the most prevalent of the dementias. As people are living longer, the number of Americans diagnosed with AD is expected to reach 82 million by 2030, according to the World Health Organization (Zhou et al 2022). The impact that AD has on society has become a public health challenge. In May 2022, the federal government increased funding for AD research to almost $350 billion. As a major cause of physical and mental disability, and increased functional dependency, AD impacts the patient and caregiver. Allied healthcare pro- viders will play a major role in education, communication, and treatment related to this disease, and the research shows that their interaction is with the patient and their respective support team. Learning about AD’s brain impact, stages and their respective symptoms, patient responsiveness, and caregiver burden will enable you to align with colleagues to share information that will impact lives. This course will provide insight and under- standing based on the most current data to enable you to have deeper insight into the impact of AD.
DEMENTIA Dementia is a common brain disorder throughout the world characterized by memory loss, cognitive impairment, and ulti- mately loss of independence (Zhou et al., 2021). Over time, capacity is diminished, deeply impacting well-being, self-care, and the ability to perform activities of daily living. Symptoms of dementia can include: • Memory loss • Poor judgment and confusion
• Confusion with finances • Wandering or getting lost
• Inability to capture words for objects • Loss of interest in normal activities • Inability to perform normal activities • Paranoia and/or delusions
• Difficulty expressing thoughts • Loss of ability to read or write
It is important that people with any type of dementia-like attributes receive a diagnosis from a trained provider (Ophey, 2021). Experts are needed to ensure diagnostic accu- racy with screening methodologies to create and implement care plans that will improve outcomes.
TYPES OF DEMENTIA
Disease
Symptoms
Attributes/Causation
Parkinson’s disease (Ophey et al., 2021)
• Poor executive function • Trouble walking • Unstable gait • Impaired responsiveness to visual cues • Speech impairment • Impaired affect/modified facial expression • Decreased eye blinking • Depression • Dementia • Insomnia • Rigidity/freezing • Shaking • AD traits: Memory loss, confusion, and language • Frontal lobe brain cell damage due to nerve damage • Diagnosis confirmed postmortem • Drastic change in behavior and personality • Aggression • Loss of speech
• Basal ganglia cells die, causing dopamine levels to drop • Progressive, chronic disease • Personalized treatments for symptom relief • Exercise can improve symptoms and may protect the brain (Michael J. Fox Foundation, 2022) • No cure
Frontotemporal dementia (Alzheimer’s Associa- tion, n.d.)
• Frontal lobe controls language and personality • Also known as Pick’s disease • No cure
• Loss of decision-making ability • Loss of sense of self-awareness • Will become completely dependent
Table 1 continues on next page
3
EliteLearning.com/Psychology
Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded ____
Lewy body dementia (LBD) (Johns Hopkins Medi- cine 2022)
• Progressive dementia • Affects ability to think, reason, and process information • Impaired movement, mood, and behavior
• 1.4 million people living with this disease • Due to unusual deposits of alpha-synuclein protein on brain • Initial diagnosis may be mental/ psychological health • No cure • Caused by constriction or breakdown of blood vessels in and around the brain • Can be the result of a stroke(s) • Symptoms vary by location of actual constriction • Lifestyle factors (diet, lack of movement, smoking) contribute to disease progression • Disease can be allayed by exercise, diet, avoiding alcohol and smoking • Originally referred to as punch drunk syndrome • Caused by extensive hits to the head • Brain has tau protein similar to AD, but presents uniquely in CTE • Some symptoms can be addressed with medication • Diagnosed postmortem • No cure • Also known as pseudodementia • Outcome of a lack of stimulation • Person can improve if they respond to help • Engaging activities, exercise, cognitive- behavioral therapy, medication can all help person recover • Person can return to their prior intellect • Standalone diagnosis • Person can be engaged in their life, can still work • Various reasons for MCI • Can be a precursor to another diagnosis • Can be a side effect of a urinary tract infection (UTI) • Should be monitored by a physician • Root cause is important for improvement or for planning for more severe situation • Person should have medication evaluated/ monitored/managed
• Parkinsonian-like rigidity • Hallucinations, paranoia
Vascular dementia (Mayo Clinic, 2022)
• Problems with reasoning • Impacted judgement, memory, and other thought processes
Chronic traumatic encephalopathy (CTE) (JNaraparaddy, 2018)
• Extreme dementia • Memory loss, confusion • Mood disorder
• Personality changes, rage • Can present in mid-life • Person becomes erratic and unpredictable
Depression dementia (Alzheimer’s Associa- tion, 2022)
• Lethargy • May or may not appear depressed
• Person may not realize that they are depressed • Person can be in denial about opportunity to get better • Person can realize that they are slow moving and uninspired • Person can recognize their memory loss • Person may accept that they have dementia, even before they are diagnosed
Mild cognitive impair- ment (MCI) (Alzheimer’s Society UK, 2022)
• Mild memory loss • Can present as exhaustion • Mild confusion
• Person can be aware of their symptoms • MCI may be a symptom of another illness
Atypical Alzheimer’s disease (Alzheimer’s Associa- tion, 2022)
• Amnestic problems • Unusually early symptoms impacting executive and motor functioning
• Frontal variant Alzheimer’s disease • Posterior cortical atrophy
Table 1 (continued)
4
EliteLearning.com/Psychology
____ Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded
Self-Assessment Quiz Question 1. What is dementia?
The causes of AD vary and are impacted by environmental factors. The following lifestyle factors are linked to the devel- opment of the disease: • Age
A) Memory loss that is intermittent. B) A combination of behaviors and impairment that are a result of a brain disorder. C) Immediate diminished capacity. D) A loss of sensation.
• Limited physical activity • Poor diet and nutrition • Gene mutation • Poor cardiovascular health • Alcohol intake • Lack of social connection • Isolation • Poor sleep
OTHER DEMENTIAS (ALZHEIMER’S ASSOCIATION, 2022)
Corticobasal syndrome (CBS) Creuzteldt–Jakob disease (CJD) HIV-associated neurocognitive disorder (HAND) Huntington’s disease
Alzheimer’s disease results from the formation of amyloid plaques and neurofibrillary tau tangles (NFT) that present and impede normal cognitive functioning. The plaques and tangles develop in the affected brain 15–20 years prior to presenting AD symptoms. Early detection and a healthy lifestyle may allay the progress of the disease while addressing symptoms. Healthy living habits such as diet, improved sleep hygiene, participation in physical exercise, social connection, and stimulating brain activities can significantly impact quality of life, especially for those who have genetic or other predisposi- tions to any type of dementia. It is important to note that it is never too late to implement lifestyle changes to modify disease progression. Self-Assessment Quiz Question 4. What is true about the plaques and tangles that present in the AD brain? A) Plaques and tangles will go away with proper hygiene. B) Plaques and tangles develop 15–20 years prior to an AD diagnosis. C) Plaques and tangles are in the spine. D) Plaques and tangles develop immediately after carbon dioxide exposure. Alzheimer’s disease is named after German psychiatrist Dr. Alois Alzheimer, who published the first case of the illness, initially called presenile dementia. He recognized that the dis- ease stemmed from the cerebral cortex after studying the brain of a diseased patient who had struggled with memory loss and cognitive decline resulting in complete loss of independence. Dr. Alzheimer noted the presence of amyloid plaques and a diminished number of neurons in this brain. He shared his findings in an article read by his colleague Dr. Emil Kraeplin, considered the founder of modern psychiatry and psychiatric genetics. When Kraeplin wrote the eighth edition of his psy- chiatry handbook, he referred to this disease as Alzheimer’s disease. It was characterized by memory loss, as well as specific behavior and personality changes that rendered the person unable to perform activities of daily living (Breijyeh & Kara- man, 2020).
Normal pressure hydrocephalus (NPH) Progressive supranuclear palsy (PSP)
Self-Assessment Quiz Question 2. How does Lewy body dementia often present?
A) Blindness. B) Flexibility. C) Claustrophobia. D) Hallucinations, paranoia.
Self-Assessment Quiz Question 3. Mild cognitive impairment (MCI):
A) Is a precursor to other types of dementia. B) May be reversible. C) Is a reliable way to verify an Alzheimer’s diagnosis. D) Both a and b.
ALZHEIMER’S DISEASE Alzheimer’s disease (AD) is a chronic neurodegenerative disorder that affects people primarily age 65 and over. AD is accountable for 60%–80% of confirmed cases of dementia (Zhou, 2021). This disease may vary, and symptoms include personality and behavior changes such as apathy, disorienta- tion, memory loss, and/or cognitive impairment. In the final stages cognitive and physical decline will render the person unable to live independently. AD is a leading cause of death for people over age 65 in the U.S. According to the World Health Organization (Zhou, 2021) there are approximately 50 million people globally living with dementia. The WHO projects that these numbers will almost double by 2050.
5
EliteLearning.com/Psychology
Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded ____
AD is traumatic for all involved, impacting the person as well as their loved ones. In 2022 it is estimated that over 6.2 million people in the U.S are afflicted (Young Shin & Habermann, 2022). The prevalence of AD and other dementias is expected to increase as society ages. As AD progression causes cognitive and physical health diminishment, the person will need care support. In 2020 U.S. dementia patients benefited from more than 11 million unpaid caregivers, for an estimated total of 15.3 billion hours, costing approximately $257 billion (Alzheimer’s Association, 2021). Understanding the cause of AD and other dementias is for the betterment of public health. While one day there may be a cure, today people need to manage and improve symptoms. CLASSIFICATION OF ALZHEIMER’S DISEASE Early-Onset Alzheimer’s Disease According to the Alzheimer’s Association, up to 5% of all people with AD develop this type, and patients with Down syndrome have a higher risk. While these patients share the same symptoms as individuals with late-onset AD, they may also have accompanying muscle twitching and spasms, known as myoclonus. This type of AD is thought to be linked to defec- tive DNA on chromosome 14. These patients also experience a greater loss of brain volume, as well as brain changes related to plaque development and expanded tangles (Rhagavan et al., 2018). Early-onset typically occurs when people are in their 40s or 50s. Gene mutations potentially correlated to early-onset AD are: • Amyloid precursor protein (APP) on chromosome 21
Genetic research may offer insight into who may be predisposed to AD. For people who may carry any of the genes that can be correlated to AD, early lifestyle changes can be important to allay development of the disease. Table 2 discusses genes that are being researched as potential connectors to all forms of AD.
POTENTIAL GENE CONNECTORS
Gene
Description
ABCA7
Linked to greater risk according to the delivery of cholesterol through the blood system Helps with the clearance of amyloid-beta from the brain The complement component receptor gene that has been identified as one of the top risks for developing AD Linked to communication between neurons Coding variant of this gene could be linked to an increase in AD Directly involved in the brain’s response to addressing inflammation AD patients carrying this mutated gene had increased risk of developing the disease seven years earlier than noncarriers
CLU
CR1
PICALM
PLD3
TREM2
SORL1
Adapted from Raghavan et al., 2018 Table 2 It is important for the appropriate people to participate in clinical research trials. Children of parents who have had early-onset AD may want to learn about clinical research trials, if available. Additionally, although genetic testing is not typi- cally recommended for late-onset AD, testing for early-onset AD may open the door to therapeutic drug trials for people who meet the criteria. Some clinical research trials are exploring genetic correlations for AD and other dementias. Participation in these studies is also crucial to explore cures and treatments. Opportunities to participate in clinical trials can be found at Find Clinical Trials (alzheimers.gov). Through genetic testing, research, and clinical tests scientists are working to develop predictive models from various perspectives. Designing pharmacological protocols that are individualized and designed to give people with AD the opportunity to maintain functional autonomy and participate in care planning is a priority (Nicholas et al., 2021).
• Presenilin 1 (PSEN1) on chromosome 14 • Presenilin 2 (PSEN2) on chromosome 1
Late-Onset Alzheimer’s Disease Late-onset AD is most common in people older than age 65 (Mayo Clinic, 2022). People with this form are diagnosed by neurological testing, scans, and physical examination, but the confirmation of the disease can occur only postmortem. (Scans can show the presence of plaque and tangles.) There may not be a genetic component to late-onset AD but having the genetic variant of the apolipoprotein E (APOE) gene on chromosome 19 can be an indicator of risk. The APOE gene is involved in the composition of the protein that helps to deliver cholesterol and other fats throughout the bloodstream. Each person receives one APOE allele from each biological parent, for a total of two. • APOE e2 is the least common and very rare and may provide some protection against AD. • APOE e3 is the most common of these alleles and does not seem to impact the risk of AD. • APOE e4 is more common, and about 25% of people carry one copy of this allele that appears to increase the risk of AD; About 2%–3% of people carry two copies of APOE e4.
6
EliteLearning.com/Psychology
____ Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded
Self-Assessment Quiz Question
Healthcare Consideration: Engaging a patient’s support team, which can include family, caregivers, or other loved ones, is an integral component of disease management, care plan adaptation, safety, and planning. Insight into the respec- tive stages can provide a frame of reference to the patient and team and can also be empowering for the long-term plan. Additionally, providers have found the information about the stages can help establish meaningful connections with patients (Wollney, 2022).
5. What is true about clinical research trials for AD?
A) Only patients with late-onset AD should participate. B) There are no clinical research trials in this arena. C) While genetic testing may not be appropriate for all AD patients, clinical research trials need all types of people. D) Clinical research trials are specifically for children of early-onset AD patients.
STAGES OF ALZHEIMER’S DISEASE
Self-Assessment Quiz Question
6. Understanding the aspects of clinical stage 4 can help with:
SEVEN CLINICAL STAGES OF ALZHEIMER’S DISEASE The Reisberg Alzheimer’s Scale is the clinical standard used to determine patient disease stage (Alzheimer’s Association, 2019). Also known as the Global Deterioration Scale (GDS), it is used by clinicians and in residential care settings, and it offers expectations for caregivers. The scale divides the disease into seven stages, with two categories. Category 1 includes Stages 1–3 and is considered predementia. Category 2 covers Stages 4–7, the dementia stages. See Table 3. Early detection of AD may impact the stage development of the disease. It may permit time for potential pharmacological interventions, clinical trials, and environmental and lifestyle adjustments. Additionally, proactive approaches may allow time to plan and identify healthcare providers that are engag- ing in progressive approaches toward the disease.
A) Potentially minimizing the loss of social connections and isolation. B) Limiting potentially unsafe behavior. C) Both a and b. D) Retraining.
Self-Assessment Quiz Question
7. Early detection of AD may impact stage
development and progression because doing so is related to: A) Pharmacological interventions. B) Clinical trials. C) Learning about healthy options. D) All of the above.
CARING FOR PATIENTS WITH ALZHEIMER’S DISEASE
Stage
Description
Clinical Presentation
Stage 1
No evident dementia
• No identifiable dementia • Person is mentally healthy
Stage 2
Subjective memory loss and age-related forgetfulness • Can last 15 years in healthy people
• May have difficulty remembering where they have placed things • May not be able to recall names as they have in the past • Subjective cognitive decline • Memory issues may be noticed by loved ones or coworkers • May repeat statements • Job performance may be impaired • Concentration may be impacted • High levels of anxiety • Patient should visit a physician to understand root cause of MCI • Lifestyle changes can be made to reduce stress, improve diet, and increase physical exercise Table 3
Stage 3
Mild cognitive impairment (MCI)
7
EliteLearning.com/Psychology
Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded ____
Stage 4
Moderate cognitive decline; mild dementia
• Diagnosis by a trained professional can be made with great accuracy • May sense a loss of independence • May become forgetful with finances, bill paying, organizing the home • Poor time management • May inadvertently engage in unsafe behavior (e.g., leave door unlocked or forget to shut off oven) • May be aware but lack understanding
• May be in denial or embarrassed • May isolate and avoid socialization
Stage 5
Moderately severe cognitive decline; moderate dementia • Evident decline in activities of daily living • May start to wear the same clothing, be resistant to changing • Needs daily assistance with life management, including finances • Cannot recall daily occurrences, cannot comprehend concepts such as the weather or their current address
• Memory is erratic from moment to moment • May exhibit a lack of control, agitation, and aggression
Stage 6
Severe cognitive decline; moderately severe dementia • Will be unable to dress themselves properly • Will require full-time oversight and assistance for activities of daily living • Bathing issues present—may not discern water temperature, and personal hygiene will be impaired, including toileting and brushing teeth; ultimately person becomes incontinent
Neurons are comprised of the following: • Cell body: Houses the nucleus that directs and manages cell activity • Dendrites: Like tree branch structures that extend from the cell body to communicate with other neurons • Axon: Cable-like structures extend from the cell body, opposite the dendrites; share/transmit messages to the neurons • Unintelligible; speaks very few words • Physical decline imminent due to lack of self-care • People with AD who have been in good physical health and do not have cooccurring illnesses may be able to maintain some abilities longer • Limited to no mobility • Ultimately, rigid and unable to move • More vulnerable to normal aging diseases that can impact mortality Table 3 (continued) • Will exhibit radical changes in emotions and express frustration with inability to communicate
Stage 7
Very severe cognitive decline; severe dementia
IMPACT OF ALZHEIMER’S DISEASE ON THE BRAIN A typical healthy brain is comprised of billions of neurons that transfer signals and information from the brain throughout the body to communicate overall functioning (Flo et al., 2022). Alzheimer’s disease is a brain disruptor, impacting normal functioning and impairing communication between neurons. This results in diminished capabilities.
8
EliteLearning.com/Psychology
____ Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded
Neurons are integral to the brain and central nervous system for healthy functioning and body communication (Lourenco et al., 2019). For healthy brain function the neurons must communicate as detailed in Image 1.
brain, including the cerebral cortex, which is responsible for behavior, emotional regulation, memory, critical thinking, and reasoning. As the brain becomes more impaired, the stages of AD become more evident.
COMMUNICATION OF NEURONS
In March 2022, federal funding for the National Institute of Health’s research on Alzheimer’s disease was increased to approximately $3.5 billion. The NIH leads the global effort to address AD and serves as a resource for those seeking information
about this disease. Understanding root causes of AD, as well as actual aging, will help scientists address symptoms as they develop, which may prevent them from worsening. There is a time crunch to get this work done as society ages, people work longer, and longevity increases. The increased funding is the federal government’s recognition that AD is a public health challenge.
Adapted from Lourenco et al. (2019)
Image 1
ALZHEIMER’S DISEASE AND OTHER DEMENTIAS: CAUSE AND EFFECT
This happens throughout the expansive brain neuron network, comprising the communications system of almost 7,000 poten- tial synaptic connections between neurons. Neurons evolve over time to support the needs of a function- ing brain. Their process includes perpetual maintenance and repair as they adjust the synaptic connections needed for message conduction and stimulation received from other neurons. This process happens throughout life for the brain to effectively function, since neurons can break down connec- tions and build new connections throughout the life span. Neurogenesis, the process of generating and developing new neurons, continues through adulthood, allowing the brain to remodel synaptic connections and perform functions such as learning, memory, and brain repair. Other cells, glial cells, are also necessary for healthy brain function. Glial cells work with blood vessels to protect and clear debris from the brain and to regulate brain balance. These cell types exceed the number of neurons in the brain almost 10 to 1. There are three types of glial cells.
CAUSE AND EFFECT: AGE Scientists are researching age-related brain changes such as chronic inflammation, atrophy, production of free radicals, vascular damage, and changes to cell activity to further com- prehend their potential to impact symptoms of AD (Askarova et al., 2020). These changes are a byproduct of aging that can be positively influenced by lifestyle, nutrition, exercise, and social connections. Depression, memory loss, and lethargy are often attributed to aging. Aging does present normal physical and mental changes, but it is important to visit a physician to set benchmarks and note any changes that may be indicative of an age-related illness. There may be times when confusion or memory loss will pres- ent, but it may be situational. Experiencing loss or transition is a part of life that may present confusion or memory loss, as can a UTI or taking medication improperly. CAUSE AND EFFECT: GENDER Women develop AD at greater rates than men (Viña & Lloret, 2010); however, more research must be done to understand the pathogenic mechanism responsible for this reality. At this time research shows that estrogen may be helpful in protecting cells that have some amyloid plaque. Women with the APOE gene are known to experience a higher incidence of brain atrophy, as well as mild cognitive impair- ment, compared to men. The National Institutes of Health is now requiring all federally funded brain research to include gender information in both preclinical and clinical studies to distinguish and explore potential differences.
• Microglia • Astrocytes • Oligodendrocytes
The brain is dependent on the fine-tuning and efficiency of neurons, cells, and the bloodstream. As a person ages, the brain decreases in size; however, there is very limited loss of neurons. For the person with AD or other type of dementia, neurons stop working and interneuron communication is disrupted, causing the neurons to be dysfunctional and ultimately die. Over time this lack of brain function impairs parts of the
9
EliteLearning.com/Psychology
Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded ____
CAUSE AND EFFECT: CHRONIC INFLAMMATION A potential cause of chronic inflammation in the brain may be failing glial cells that are unable to clear brain debris, which causes an increase in plaques and tangle. One type of glial cell, the microglia, is directly responsible for brain cleanup, including clearing amyloid plaques. In AD patients the microglia appear to not perform this function. There is a genetic component being researched, gene TREM2 (Kulkarni et al., 2021), which is correlated to the clearing function of the microglia cells in the brain. In AD patients the following occurs, resulting in chronic inflammation that can lead to impaired brain function. • Microglia fail to clear debris in the brain, including amyloid plaque. • The gene TREM2 does not function normally and therefore does not tell the microglia to clean the brain, plaque buildup results. • Astrocytes, a type of glial cell, also fail to clear up brain debris. • The microglia and astrocytes release chemicals that cause inflammation, resulting in increased brain damage.
CAUSE AND EFFECT: PHYSICAL EXERCISE/ MOVEMENT Physical activity improves memory and can potentially reduce the risk of AD (Lourenco et al., 2019). This is potentially due to irisin, a hormone that circulates when exercising. It is thought to promote the growth of neurons in the hippocampus. CAUSE AND EFFECT: TRAUMATIC BRAIN INJURY/ HEAD TRAUMA Head trauma is a leading environmental factor that causes AD and other dementias (Shively et al., 2012). Head trauma can cause chronic inflammation, resulting in permanent damage to the brain. When the skull receives a harsh jolt, it disrupts brain function, disabling protective abilities and perpetuating more trauma. Ongoing damage can result in brain dysfunction that can disrupt thought patterns, clarity, problem solving, and executive functioning. Balance and core strength can prevent brain and head injuries. Strength-building exercises help with balance, as do vision and hearing tests, which confirm if there is a need for assis- tive devices, respectively. Falls are a leading concern of older adults. They can lead to broken bones, concussions, and other bodily trauma.
CAUSE AND EFFECT: MILD COGNITIVE IMPAIRMENT (MCI)
Self-Assessment Quiz Question
8. When a patient has AD, the microglia do not perform which function in the brain? A) Creating amyloid plaque and debris. B) Clogging coronary arteries. C) Increasing causation. D) Clearing away debris, including amyloid plaque.
People with a lifetime of mild cognitive impairment (MCI) or Down’s syndrome are more vulnerable to AD and other demen- tias (National Institute on Aging, n.d.). MCI may include memory loss, confusion, poor focus, and impaired critical thinking, spatial and visual perception, and decision-making capabilities. These can result in progressive dementia-like symptoms. It is important for people with MCI to maintain a healthy lifestyle MCI presents in the earlier stages of AD; however, not all MCI is AD. Upon presentation of symptoms, a person should visit their physician to ensure proper diagnosis, pharmacological support, identification of lifestyle modifications, and develop- ment of a plan of action and care. CAUSE AND EFFECT: CARDIOVASCULAR HEALTH The vascular system significantly impacts cardiac and brain function, metabolism, and cell migration (Govindpani et al., 2019). Vascular changes are noted in the preclinical stage of AD, as amyloid plaques may contribute to constrictions that impact blood supply. The changes in arterial functioning will impact the transfer and communication of neurons as well as metabolic function, resulting in worsening of the disease over time. Destructive stages of AD progression may be due to vascular issues and brain inflammation.
CAUSE AND EFFECT: SELF-CARE FACTORS Social Connection/Stimulation
An active life leads to better physical and mental wellbeing. Absent of social connection people can become sedentary, higher risk of dementia, heart disease, and stroke. Group activities can be stimulating, engaging, and improve health. Poor Nutrition A poor diet does not support brain and overall health. High cholesterol and blood pressure can be present, as can diabetes. These conditions can lead to heart attack and stroke, which can impair physical and cognitive abilities as well as memory. They can also worsen chronic conditions and increase morbidity. Microbiome/Gut Health The “Western diet,” which includes high levels of saturated fats and added sugars, is a risk factor for AD (Askarova et al., 2020). Early studies show a correlation between a notable increase in AD and a high-fat diet that changes the gut microbiota and causes inflammation and metabolic changes.
10
EliteLearning.com/Psychology
____ Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded
CAUSE AND EFFECT: GENETICS The apolipoprotein E (APOE) gene on chromosome 19 is an indi- cator of late-onset AD. However, even if a person carries this gene, it is not a guarantee that they will develop AD (National Institutes of Health, n.d.). While early-onset AD is rare, impact- ing less than 10% of all AD patients, there are three single-gene mutations that contribute to the development of amyloid plaques on the brain, a leading confirmation of the disease. Genetic counseling may be helpful for children of people with early-onset AD. Even though there is no guarantee that the person will develop AD, understanding if they carry the genetic markers will provide them with an opportunity to commit to healthy lifestyle choices. Mutations on the following genes may play a role in develop- ing early-onset AD. • Amyloid precursor protein on chromosome 21
Behaviors that promote heart health are correlated to brain health. Smoking; high stress; poor diet; and unmanageable chronic conditions such as diabetes, high blood pressure, and heart disease can lead to AD and other dementias. Limited blood and oxygen supply to the brain can impair overall func- tion and memory. A heart healthy lifestyle is also good for brain health. Modify- ing diet, increasing movement, and engaging in preventative health care can improve vascular health outcomes. CAUSE AND EFFECT: SLEEP Exhaustion and sleepiness during the day can contribute to dementia (Carroll & Macauley, 2019). Obstructive sleep apnea (OSA) in the elderly may lead to dementia, cognitive impair- ment, and AD symptoms. Sleep deprivation increases tau levels and over time can cause increased plaques and tangles. Sleep disorders can be a part of AD pathology, but the exact role is unknown at this time. Sleep has two stages: Rapid eye movement (REM) and nonr- apid eye movement (NREM), and their respective restorative powers impact neuronal functioning and recovery. When these stages are interrupted, amyloid and tau levels increase, potentially impacting cognition. Additionally, restricted sleep directly correlates to a reduction in glucose tolerance as well as insulin sensitivity. These risks are present in the early stages of AD. It is thought that this can be the outcome of impaired brain metabolism. These factors indicate the significant impact that good sleep has on brain health. Sleep hygiene is an invalu- able component of care in all stages of AD. CAUSE AND EFFECT: LACK OF LEARNING AND SKILL ACQUISITION Neural pathways in the brain develop throughout life. Ongoing learning challenges the brain to retain information through regular exposure (Guglielman, 2012). Lifelong learning is an integral component of a fit brain. Reading, planning, and focused mindfulness activities such as meditation allow the brain to pause and take in new information, while preventing decline. Many healthy brain activities provide social connec- tions. Card games, book clubs, and guided meditation multiply the benefits. Word games, puzzles, and crosswords also keep the brain active and challenged. A stagnant brain will lose its abil- ity to retain, focus, and expand—leading to cognitive decline. Self-Assessment Quiz Question
• Presenilin 1 (PSEN1) on chromosome 14 • Presenilin 2 (PSEN2) on chromosome 1
Children of parents with AD should, at a minimum, ensure that they make appropriate lifestyle choices. Children of par- ents with early-onset AD may be at a higher risk of developing the disease and should undergo appropriate genetic counseling to identify any mitigating opportunities and to learn lifestyle choices that may stave off symptoms. CAUSE AND EFFECT: ENVIRONMENT With the increase in the number of AD patients and the realiza- tion that there are limited curative solutions, researchers are looking at the impact of the environment on dementia (Zhou et al., 2021). Causation is not known, but air pollution causes oxidation of the brain that appears to lead to inflammation. Other aspects of the environment, such as green space, have shown to be calming for people with AD. This could be due to the positive factors from green space that include social connectedness, outdoor physical activity, and engagement in gardening activities. (Seaton, 2020) Healthcare Consideration: A third of AD attributes include inactivity, poor diet, education, smoking, chronic condi- tions, and mental health (Zhou et al., 2021). Researching social determinants of health such as the environment is imperative in exploring root causes.
9. Which of the following statements is true?
A) Lifestyle changes for heart health can also help improve symptoms of AD. B) Lifestyle changes will not impact the trajectory of AD. C) People who participate in word games and puzzles are may experience less cognitive decline over time. D) Both a and c
11
EliteLearning.com/Psychology
Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 64 Page 65 Page 66 Page 67 Page 68 Page 69 Page 70 Page 71 Page 72 Page 73 Page 74 Page 75 Page 76 Page 77 Page 78 Page 79 Page 80 Page 81 Page 82 Page 83 Page 84 Page 85 Page 86 Page 87 Page 88 Page 89 Page 90 Page 91 Page 92 Page 93 Page 94 Page 95 Page 96 Page 97 Page 98 Page 99 Page 100 Page 101 Page 102 Page 103 Page 104 Page 105 Page 106 Page 107 Page 108 Page 109 Page 110 Page 111 Page 112 Page 113 Page 114 Page 115 Page 116 Page 117 Page 118 Page 119 Page 120 Page 121 Page 122 Page 123 Page 124 Page 125 Page 126 Page 127 Page 128 Page 129 Page 130 Page 131 Page 132 Page 133 Page 134 Page 135 Page 136 Page 137 Page 138 Page 139 Page 140 Page 141 Page 142 Page 143 Page 144 Page 145 Page 146 Page 147 Page 148 Page 149 Page 150 Page 151 Page 152 Page 153 Page 154 Page 155 Page 156 Page 157 Page 158 Page 159 Page 160 Page 161 Page 162 Page 163 Page 164 Page 165 Page 166 Page 167 Page 168 Page 169 Page 170 Page 171 Page 172 Page 173 Page 174 Page 175 Page 176 Page 177 Page 178 Page 179 Page 180 Page 181 Page 182 Page 183 Page 184 Page 185Powered by FlippingBook