MCI Today, Dementia Tomorrow: Improving Clinical Strategies Presented

MCI Today, Dementia Tomorrow: Improving Clinical Strategies Presented

MCI Today, Dementia Tomorrow: Improving Clinical Strategies Presented by Dr. William Mansbach CEO & Founder, Mansbach Health Tools, LLC www.thebcat.com 1 Highlights on Prevalence Over 5 million Americans have Alzheimers disease (AD), anticipated to be 13-16 million by 2050

Numbers are vastly greater if you include other dementias and people with Mild Cognitive Impairment (MCI) 15-20% of people 70 and older have MCI 2 What is Cognition?

Cognition is the sixth vital sign Cognition is at the center of our experience Cognition consists of multiple domains Cognition is a fluid process Cognitive Task Manager 3

Review of the Cognitive Continuum The Three Cognitive Stages: Birds Eye View Normal: Inefficiencies but not pathology MCI: The four subtypes Amnestic (aMCI) Executive (eMCI) Multi-domain (mMCI) Undifferentiated (uMCI) MCI conversions to dementia Dementia: Mild, Moderate, & Severe

4 Normal Cognition Anticipate cognitive decline Peak in the 30s Plateau in the 50-60s

Slow decline in the late 70s 5 Normal Cognition Working Memory is reduced Cognitive processing speed declines Reduced cognitive flexibility 6

A Consensus Set of MCI Criteria A subjective or objective concern regarding a change in cognition Impairment in one or more cognitive domains (decline from previous performance) General preservation of functional abilities (can have mild problems) Not demented Cognitive deficits not primarily caused by delirium or Axis I (psychiatric) disorder 7

Problems with the Functional Criterion Substantial evidence that higher order functional abilities can be compromised in cognitively impaired patients who do not meet criteria for dementia. Many clinicians dont actually assess functional skills. 8 Additional Insights

Mild Cognitive Impairment misleading term Transitional Cognitive Impairment more accurate An in-between state of impairment 10-15% conversion rate to dementia Reversion rates to normal

9 MCI Subtypes based on BCAT Research Amnestic (aMCI) Executive (eMCI) Multi-domain (mMCI)

Undifferentiated (uMCI) 10 What is Amnestic MCI? The primary issue is memory

Memory prospectvely, not retrospectively Approximately 70% of MCI cases Strong conversion to Alzheimers disease (AD) 11 What is Executive MCI?

Impairment in one or more executive skills Set-shifting, reasoning, judgment, problem solving Divided attention is often a problem Look for deficits in performing IADLs Strong conversion to AD and other dementias 12 What is Multi-domain MCI?

Impairment in multiple domains Typically in attention, memory, and executive functions May or may not be more severe than single domain MCI Strong conversion rate to AD 13 What is Undifferentiated MCI? Deficits are not clearly expressed in one or more

cognitive domains Higher percentage of reversion to normal Look for medical contributors Conversion to AD is unclear 14 A Few Words about Dementia

Severe and disabling Strong impact on function Progressive Cognitive, mood, and behavior Multiple causes 15

The State of the State: Why Non-medication Memory Interventions Matter Very limited effectiveness of medications (nootropics) Positive effects of neuroplasticity Positive effects of cognitive reserve Premium matching interventions with

patient/resident cognitive capabilities 16 The Importance of Starting with Cognitive Assessment Subjective diagnoses are inaccurate Using BCAT cognitive test scores to plan cognitive treatments 17

The BCAT Approach The BCAT Approach is a unique applied concept for assessing and working with people who have memory and other cognitive impairments. It is designed for any clinical and residential setting in which cognitive functioning and cognitive impairment is a central issue. The BCAT Approach integrates the BCAT Test System, BCAT Brain Rehabilitation Modules, the BCAT Working Memory Exercise Book, and the MemPicsTM series.

18 The Four Components of the BCAT Approach The Test System rapidly, yet comprehensively, assesses current cognitive functioning and depression/anxiety. Online Brain Rehabilitation modules are guided by Test System scores. 19 The Four Components of the BCAT Approach

(continued) The BCAT Working Memory Exercises approaches are developed based on patient cognitive capabilities and can be used for acute and post-acute phases of rehab. The MemPics series are designed to produce meaningful engagement in persons with cognitive impairment. 20 The BCAT Test System Descriptions

The BCAT was designed as a multi-domain cognitive screening tool that assesses orientation, verbal recall, visual recognition, visual recall, attention, abstraction, language, executive functions, and visuo-spatial processing. Cognitive staging, Memory Factor Score, and Executive Functions Score provide essential clinical information. The BCAT-SF was designed as a shorter version of the full BCAT and can be administered in three minutes or less. 21

The BCAT Test System Descriptions (continued) The BADS was designed as a "process" screening instrument to very rapidly assess depression and anxiety status. It can be administered in three minutes or less. The Kitchen Picture Test of Judgment (KPT) was designed as a visually presented test of practical judgment. It can be administered in less than five minutes. The BCIS was developed not only to track cognitive changes in severely demented patients specifically, but to provide information to better manage behavior problems. It can be administered in less than three minutes.

22 The BCAT Test System The Five Tests The Test System is a comprehensive approach for rapid assessment of memory, executive functions, and attentional capacity. The Main BCAT (21 items) is the featured test. The other four tests make unique contributions to assessment We recommend administering the BCAT and BADS first. The System is an excellent method for tracking cognitive and mood changes over time.

All tests have interactive online scoring programs with test reports. 23 A Close-up of the Main BCAT Sensitive to full cognitive continuum (normal, MCI, dementia) with score ranges Particular emphasis on Mild Cognitive Impairment (MCI) MCI subtypes (amnestic, executive, multi-domain and undifferentiated)

24 A Close-up of the Main BCAT Memory and Executive Functions Factors Full, Memory Factor, Executive Functions Factor scores Helps predict: ADL, IADL, falls, residential placement, person-centered ability to participate in care decisions Interactive website scoring program with test report 25

The BCAT Short Form (BCAT SF): What is it? Abbreviated version of the full BCAT Can be administered in about three (3) minutes Pulls from the three full BCAT clusters Attention Contextual memory Executive functions 26 The BCAT Short Form (BCAT SF): What is it?

Has six items 21 points Can be scored online Has a test report Cut score differentiating dementia, MCI (without

sub-types), and normal 27 Psychometrics for the BCAT and BCAT-SF BCAT BCAT-SF Sensitivity

.99 .90 Specificity .77 .81 PPV

.91 .95 NPV .96 .74

Note: These tests have been validated and normed in multiple clinical settings. Each patient population is associated with specific psychometric values. 28 Philosophically Person-centered care Life quality (from the perspective of the person) Demented older adults are still ADULTS Purposeful engagement

Impact on cognition Impact on mood 29 Meaningful Engagement as a Care Intervention 30

Lets Begin with BPSD Three clusters Behavioral dyscontrol Mood disturbance Perceptual disturbance 31 Common Causes of BPSD Overwhelmed overstimulated Underwhelmed understimulated

Cognition mood behavior 32 Examples of Behavioral Dyscontrol

Combativeness Verbal aggression Disrobing Wandering Repetitive behaviors 33 Examples of Mood Disturbance

Depression Anxiety Emotional restlessness Apathy 34 Examples of Perceptual Disturbance

Delusions Hallucinations Bizarre thoughts 35 What is Meaningful Engagement? Involves Four Features: an interpersonal interaction involving the resident/patient and one or more other people present-focused, with an emphasis on the here-and-now

the subject or content of the interaction is meaningful to the resident (i.e., patient can relate to it) the activity activates preserved memories 36 How Meaningful Engagement Activities Reduce BPSDs

Meets a social need Activates cognitive processes Connects participants to meaningful personal content Addresses disparity between stimulation and cognitive resource 37 38

39 40 41 42 43

44 MCI Today, Dementia Tomorrow: Improving Clinical Strategies Presented by Dr. William Mansbach CEO & Founder, Mansbach Health Tools, LLC www.thebcat.com 45

Recently Viewed Presentations

  • Bim Mediated Mass Customization Applied to Engineered-to ...

    Bim Mediated Mass Customization Applied to Engineered-to ...

    O template preparado . Como apresentar o método. Destaque para a contribuição. SBTIC 2019, Campinas - SP, ANTAC. Introdução. Cada autor terá 5 minutos para apresentar seu trabalho. As apresentações serão na forma de pecha-kucha. Para cada 4 artigos apresentados...
  • AP Chemistry Chapter 7

    AP Chemistry Chapter 7

    Development of the Periodic Table. Meyer and Mendeleev both demonstrated a connection between atomic mass and elemental properties. Mendeleev arranged the table by properties and then atomic mass. Moseley rearranged the table by increasing atomic number. Periodic . law
  • Unit Based Champions Infection Prevention eBug Bytes

    Unit Based Champions Infection Prevention eBug Bytes

    Unit Based Champions Infection Prevention eBug Bytes September 2012 New 'SARS-like' respiratory illness identified The World Health Organization has issued an international alert after the discovery of a new respiratory illness similar to the SARS virus which swept the world...
  • DoD Foreign Comparative Test FCT Overview May 2104

    DoD Foreign Comparative Test FCT Overview May 2104

    Comparative Technology Office. Where can we partner with friends and allies for affordable options? Achieve Affordable Programs. Strengthen . Partner. Capacity. Acquisition, Technology and Logistics. Support the. Warfighter. Research and Engineering. Rapid Fielding Directorate. Page-Distribution Statement A: Approved for Public...
  • 'Rethinking Key Issues in School Bullying and Violence

    'Rethinking Key Issues in School Bullying and Violence

    University of British Columbia, Vancouver. April 21st 2017. Dr Paul DownesDirector, Educational Disadvantage CentreSenior Lecturer in Education (Psychology)Member of the European Commission Network of Experts on the Social Aspects of Education and Training (NESET I & II) (2011-2017) Institute of...
  • الشريحة 1 - WordPress.com

    الشريحة 1 - WordPress.com

    9 10 identify some of the theories of modern education, such as the theory of multiple Intelligence. 11 12 13 identification of new sites, such as (wikis, plogs, lonline ) keeping pace with technical developments and the recruitment of new...
  • New Treatments for SLE

    New Treatments for SLE

    25-OH Vitamin D May (or May Not) Be Inversely Associated with Blood Pressure. Inverse association of 25-OH vitamin D and systolic blood pressureScragg R, et al. Am J Hypertens 2007;20:713-9.
  • 3-1 Discrete Random Variables 3-1 Discrete Random Variables

    3-1 Discrete Random Variables 3-1 Discrete Random Variables

    3-1 Discrete Random Variables 3-1 Discrete Random Variables 3-2 Probability Distributions and Probability Mass Functions 3-2 Probability Distributions and Probability Mass Functions 3-2 Probability Distributions and Probability Mass Functions Definition Example 3-5 Example 3-5 (continued) 3-3 Cumulative Distribution Functions Definition...