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The training we're doing today is a positive approach to care, training methodology. So positive

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approach to care is a national and international organization that works to change the way people

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living with dementia are cared for and supported to be emphasizing the positive relationship

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as the basis of the care. And we really want to be talking a lot about it as we go through

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today, understanding what's happening in the changing brain of people who are living

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with brain-changing disease processes, and understand that they're really doing the best they

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can, and what can we do as the support community with them to help support them better.

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So our positive approach to care is a very interactive type of training and educating our people

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in the community about dementia care.

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There is a proverb, one more of us saying in our culture in Hawaii, Makahana Kaike in

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doing relearn, and a lot of stuff that we're going to be doing tonight, we'll be using

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our hands, we'll be using our peering off.

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So I want you guys to do this with me.

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So Makahana Kaike means in doing relearn, so Makahana, right, so we're working, Makahana

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Kaike, the knowledge, right, we're going to learn as we do.

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So the more we makahana, the more we eke, mopopo means do we understand?

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Al-Anui.

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So that was the first time of many times you're going to be waving your arms around today and

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touching your head.

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We're going to do this a lot because it's all about our brains.

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It's all about our brains.

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So I want to start with, I mentioned a second ago, about the relationship.

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So, our core beliefs in underpinning this training method is that the relationship, and

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I'm going to have you use your hands, one is hand is you, the loving supporting hand,

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and the other person is the person that you're working to support.

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How can we form a positive connection in relationship so that we can move forward in a positive

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supportive way?

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So we're going to focus on the relationship and that we are the key to this and that people

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living with dementia with brain change are really doing the best they can every single

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moment.

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They cannot help what happened and is happening in their journey of living with any of

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the diseases that caused dementia, Alzheimer's, strokes, Parkinson's.

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And we are the ones who have touch your heads again, the healthy brains who have the capacity

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for change.

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But it's not an easy thing and we're going to look at some techniques that will help

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with that.

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I'm going to step this side a little so everybody can see.

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So we're looking at brains and we're not here just to look at people who are living with

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brain change with dementia's brains.

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We're going to look at our brains too because we're all in this together.

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So the brain on the left is that this is a PET scan, a 20-year-old, healthy, 20-year-old male.

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On the right, healthy, 80-year-old male.

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No neurodegenerative disease, no Alzheimer's, none of that.

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So PET scans will be looking at a number of PET scans together today.

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Measure glucose burn.

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So when your brain is working hard, your brain loves glucose.

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coast, the bright red that you see is high burn, like all pistons firing, and then it

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kind of goes gradually down to yellow, green, then to that dark blue.

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That is no brain activity, and that is normal.

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We have pockets of fluid in our brain that is normal, so these are two normal brands.

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So when you look at the pattern of red, the high glucose burn in the 20-year-old and the

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80-year-old, they're lying in a PET scan machine and ask to do a cognitive task like,

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okay, name all the animals you can without repeating in one minute, ready, go.

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So you lie in tiger bear, you go through all the zoo animals, they're like, uh, pig, chicken,

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you start going through the farm animals, so your brain is like really working to try not

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to repeat the animals, so that's the kind of thing these people are doing in the brain

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scan.

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So what do you notice about the patterns of red?

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What do you, between the two, comparing and contrasting?

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What do you notice?

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Less and the older.

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Well, yet some parts have less.

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Which part exactly do you notice has less?

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The red from the bottom.

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On the bottom, on the bottom, on the aiding year old,

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there's a little less red than in the 20 year old.

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Touch the back of your head.

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This is your occipital lobe.

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This is where you process vision,

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for the, generally speaking, process vision.

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So in normal aging, there's a little change here that you've noticed.

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We're going to explore that.

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So this is the brain.

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The eyes are separate organs.

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Brains one organ.

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Eyes are different.

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Eyes are organs, right?

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People can have all kinds of problems with their eyes themselves.

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But we're going to talk about that.

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But the rest of the brain, the red,

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more similar, pretty similar, or any other big differences.

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Pretty similar, right?

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A little darker.

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Which one?

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Maybe the third.

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Despite a little bit darker, this guy's a little bit darker,

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slightly darker there.

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Yeah, yeah, pretty close though, right?

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Pretty close, yeah.

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So overall, these two brains look more similar

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than they do different.

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They're different. We all know as from looking around the audience. If you remember when you were 20,

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what your physical body looked like at 20 as opposed to wherever we are in the journey now,

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it's changed, right? So we're not just aging on the outside with gray hair and changing skin and things like that.

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that our organs are aging on the inside too.

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So we're going to look at what is, in this first part,

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what is typical aging changes for brains

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and what's atypical, atypical.

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So looking at those 20-year-old and this 80-year-old,

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the 80-year-old has not lost a lot of function

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except for maybe some changes there in the occipital area

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unless something goes wrong with our brains.

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So, the dementia itself is not a normal part of aging.

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So, something has to go wrong with our brains for it to be reached the level of dementia.

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So, we're going to take a look here at another set of pet scans.

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So, these pet scans, so this one looks pretty familiar, right?

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It looks a little more to different person, but a little more dark reds here.

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So this person is about a 75-year-old man.

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If you were to slice my head like this on the fattest part

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of my circumference, there's that part that you're seeing here.

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And then one above is a little higher up, a little higher slice.

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What was the top of my head?

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So it's the same brain twice here.

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So this person, 75, healthy brain, no demand, no neurodegenerative disease.

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I'll put that way.

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This person here living with early Alzheimer's late Alzheimer's getting close to the end of life 18

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month old child on the end here so I want you to focus your attention first we know red is high

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glucose burn to the I will look at this one versus this one so the the person who with no these are by

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By the way, the same heads are comforts.

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These are also 75-year-old men, and their skulls are the same size.

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So if you took a tape measure, it would be the same size, so this skull would be the

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same when all of them.

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So what do you notice in the red between the normal and the early?

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Less red.

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Yeah, a little less red or a lot less red.

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Yeah, a lot less red.

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We saw that the 80-old man had a little less red than a 20-year-old here in their

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occipital lobe. What's happening with the occipital lobe here? Yeah, it's a lot.

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It's like half the action going on. What other parts look significantly less

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red? The top, touch the front of your head. This is your frontal lobe, your executive

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function, right? It's okay. So, wow. And when I say early, very likely, undiagnosed. Most

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people don't get a diagnosis until it's obvious to everyone around them that there's a serious

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problem. You don't even need to be a doctor to say, oh my god, I think this person is living

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with dementia related to some kind of disease process going on. So, that's a whole another

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another topic, getting early checkup, early diagnosis, but this, someone with living

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with a, this much brain change could still be living alone, driving, right?

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Well, we're going to explore what's happening.

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So this is early, so when I do this training with caregivers, I say, and I work at a memory

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care home, this isn't, they're not living in a care home yet, right?

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That's a little further down between these next two.

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So we can see there's significant change even in the early stages.

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So how about between early and late?

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What do you notice there?

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Like night and day.

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Night and day.

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So what's the difference that you notice specifically?

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Well, there's hardly any yellow, right, so there's no middle ground.

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There's still red?

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Little bit, yeah.

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Yeah, back here again, right?

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It's not all gone.

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More purple.

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And more purple, right?

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a lot less red than the other parts which we'll discuss later, but this little center everybody has this red in the center all the way through.

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If you were to take your fingers, take your two fingers, put them up to your temples and don't actually do it and just jam them into your head and then you're in the center of your head.

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That's your deep primitive center of your brain, your primal thrive to survive center.

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there, that's working hard for us all the way through our lives from the beginning, all

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the way through the end, right?

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Thrive to survive, that is, that is always there, you're amygdala in there.

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So a lot has changed, and there's certainly a lot of loss, but it's not all gone.

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They are who they were, but they're different.

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And now the 18-month-old child, let's take a look at that.

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What do you notice comparing those two?

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Very similar, right?

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Yeah, very similar. We're not born with this brain on the left. We grow into it. We grow

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into it. So we start out and grow into it. It takes a lot of time. Our brain is not fully

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developed until 25, 26, so for boys, yeah, girls maybe a little younger, but yeah, it takes a

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long time. But when I want to think about, when you think of an 18-month-old child, how advanced

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is their language? Not very well. Is it hard to understand them sometimes? Do they

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sometimes not understand what you're saying? No. How's their toileting habits?

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Not very

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well. Are they in continent? Yeah, yeah. How about their safety awareness? None. Who's

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in charge of safety? Somebody else, not them, right? But can you connect and communicate

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with an 18-month-old child. What do you have to do?

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Touch them. What do you have to do with your language?

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You have to get on their level. You have to simplify your language.

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You have to use a lot of sign language visuals.

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But you can still connect. No one says,

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that kid can hardly talk and it just uses diapers.

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Why should I even bother to connect with them?

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But there's a lot there, and I kind of want to challenge our conception of late Alzheimer's

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disease.

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Yes, there's a lot of loss, but there's still a lot there if we know how to connect.

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And we can connect and be together in that moment, and we'll be doing a lot more on communications

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as we go through.

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I go through.

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So how can we know when it's normal aging, or typical aging,

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versus a possible dementia?

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How do we know?

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I know for myself, if I'm sitting in, let's say, the living

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room, and I think I want to get up and get a cup of coffee.

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I'll get up and start going to get the coffee.

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And then if I get a phone call, when I'm done with the phone

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call, I'll put it down and be like, wait a minute.

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Why did I come in here?

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I hear some left. How many of you? Does this happen to you? You go into all the time today?

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Has it happened today? Yeah, it's just probably happened today. What do you have to do to figure out

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what it was you came in here for? Backtrack. Backtrack. You gotta go all the way back,

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something you have to sit back right in the same seat, put your butt right where it was,

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and then you're like, oh, and you think, oh my God, am I losing it?

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my grandma had dementia. Do I have this thing? I want everybody to take a deep breath because

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I saw you almost all raised your hand to say that this happens to you. Typical, normal,

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aging. Right? We have a lot of input. Things change. So I want to take a look at these two columns

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here. The one on the left says typical aging and just focus on that one first. So it's slower

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the things, lower to do, hesitate, pause. What do you notice about the language on that side in

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these descriptions? What's kind of a commonality that you see? Slow, pause, okay? Wait a minute,

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wait a minute, give me a minute, I'm going to remember the actor's name, Cheryl, the actor's name,

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he's kind of tall, he's in that new show, he's in that new show, the Hawaiian show, the one

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Jason Mahmoud, yeah, yeah, yeah, yeah.

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Someone young.

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Someone young.

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Young people like to help us older people out before we need it.

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Right?

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I would have that there.

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I would have described him like, oh, he's like.

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I would get so close, but not quite there. And then maybe a step away, and I'd be like, oh, it's Jason

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And this is a specific noun, a name of something, your name, Jason Memorial's name, a specific

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name of something, O-L-O, a specific name.

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And if we use a different name, it doesn't work, it's not the right label, kind of go

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like this.

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I talked around that name, it's called Circumlocution, I can talk around it, and that helps my brain

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I'll eventually get there, look at there, or I talk around it enough that some young person

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blurt it out.

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Right?

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It's like, ah, because his brain is quicker than mine.

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So that's, it takes me a while, so I know the person, but not the name.

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But that's very different than, look at the atypical side.

228
00:16:00,420 --> 00:16:03,220
What kind of language do you notice on that side?

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00:16:03,780 --> 00:16:07,380
Can't, can't, can't, can't, doesn't, won't.

230
00:16:07,380 --> 00:16:16,280
Right? Those are all not, cannot, will not. So not just that I'm slower or that I need

231
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to pause. It said, I can't get there at all. We want to keep in mind, when we, this,

232
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today, as we go through, this a typical side, when we start to see signs that it's not just

233
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that they're not remembering the name, they're not recognizing, they just cannot do it, cannot

234
00:16:35,120 --> 00:16:40,560
new things they used to do before. I love to cook and there's certain things I can cook without

235
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even looking at a recipe. But now it's something I used to make all the time. I'm making like major

236
00:16:45,560 --> 00:16:52,200
mistakes. That's a sign. Not just the occasional. Like, oh, I forgot to put the salt in. It's very

237
00:16:52,200 --> 00:17:01,400
different than putting in a cup of salt instead of a tablespoon. Something like that. So, okay. So,

238
00:17:01,400 --> 00:17:04,380
Oh, notice that these say typical and atypical,

239
00:17:04,540 --> 00:17:09,980
and not normal and dementia, because we don't know

240
00:17:09,980 --> 00:17:14,040
what these symptoms mean yet.

241
00:17:14,580 --> 00:17:16,240
If you're seeing these, you want to get it checked out

242
00:17:16,240 --> 00:17:19,440
because it could be something else that is not dementia.

243
00:17:20,120 --> 00:17:21,860
It could be medication side effect.

244
00:17:22,120 --> 00:17:24,920
It could be hearing or vision loss because that happens.

245
00:17:24,920 --> 00:17:26,200
A lot of people get older.

246
00:17:26,540 --> 00:17:29,980
It could be depression, pain, a lot of different things.

247
00:17:29,980 --> 00:17:33,040
So if you notice any of those things, get them checked out.

248
00:17:33,380 --> 00:17:36,600
Well, want to focus on what we call the three Ds.

249
00:17:36,700 --> 00:17:37,680
So put your three fingers up.

250
00:17:38,500 --> 00:17:42,820
The first one here on the left, depression, say with me.

251
00:17:43,080 --> 00:17:43,420
Depression.

252
00:17:44,720 --> 00:17:46,020
Take a look at these symptoms.

253
00:17:46,240 --> 00:17:47,280
Can't think, can't remember.

254
00:17:47,720 --> 00:17:50,900
Kind of looks familiar to the similar to the other one.

255
00:17:51,380 --> 00:17:53,460
There's a lot of overlap in symptoms

256
00:17:53,460 --> 00:17:56,260
between depression and dementia.

257
00:17:56,920 --> 00:17:59,000
So you, things you might say, oh, I think they're getting dementia.

258
00:17:59,000 --> 00:18:02,820
maybe it's depression. You need to get a full clinical workup to figure that out.

259
00:18:03,180 --> 00:18:08,300
Number two, put your second finger up. Delirium. Say, Delirium with me. Delirium.

260
00:18:09,840 --> 00:18:13,460
Swift. Swift changes. Not gradually getting worse, but like

261
00:18:14,640 --> 00:18:18,040
my baseline is here. Go like this. Go like this is your baseline.

262
00:18:18,600 --> 00:18:22,260
I can dress myself pretty well. If you lay the food out, I can eat it.

263
00:18:22,640 --> 00:18:27,360
And then all of a sudden, like in a couple days, I'm like a lot more confused.

264
00:18:27,360 --> 00:18:28,880
I'm putting things on backwards.

265
00:18:29,060 --> 00:18:30,900
I'm just like, I'm lost.

266
00:18:31,100 --> 00:18:33,000
You're like, oh, my God, they've heard a bunch of get this bad,

267
00:18:33,080 --> 00:18:33,620
that fast.

268
00:18:34,100 --> 00:18:37,740
Oh, ho, ho, swift changes mean something

269
00:18:37,740 --> 00:18:40,080
possibly could be going on underneath some sort

270
00:18:40,080 --> 00:18:42,260
of infection that could become toxic.

271
00:18:42,820 --> 00:18:45,860
The most common, I know we have a lot

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of different kinds of caregivers here today.

273
00:18:49,500 --> 00:18:53,560
The most common cause of infection for older people,

274
00:18:53,560 --> 00:18:55,460
but also older, especially living with dementia,

275
00:18:57,160 --> 00:19:04,720
is UTIs, bladder infections, yay, top, top, yep, top most wanted list of things that happen.

276
00:19:05,220 --> 00:19:09,500
So, if you notice a swift change, don't wait, get it checked out.

277
00:19:09,920 --> 00:19:12,700
You might have to go to, you know, the urgent care clinic or something, but get it checked

278
00:19:12,700 --> 00:19:17,720
out right away, because you and I know when we have a bladder infection, I'm not going

279
00:19:17,720 --> 00:19:21,640
to ask you to raise your hand if you've ever had a bladder infection, but if you have,

280
00:19:21,640 --> 00:19:28,460
you know, right? Pain, you know where the pain is? Yes, you do. Can you describe it

281
00:19:28,460 --> 00:19:33,020
to other people? Yes, you can. But I'm living with brain change. That you saw

282
00:19:33,020 --> 00:19:36,420
those PET scans, right, with the change advancing, with, say, of mid-stage

283
00:19:36,420 --> 00:19:42,280
dementia. I am also feeling that pain, but I can't articulate it. And it comes out

284
00:19:42,280 --> 00:19:46,360
in other ways. And we'll get into that, but break them out in different behaviors,

285
00:19:46,700 --> 00:19:51,200
mood, things like that. So, very important. So that's one D. So, depression,

286
00:19:51,200 --> 00:19:54,880
Go ahead and move with me, depression, delirium, you get that checked out.

287
00:19:54,980 --> 00:19:58,660
Oh, it's not either of these three, the third-dead dementia.

288
00:19:59,000 --> 00:20:00,520
What's your three fingers together?

289
00:20:01,160 --> 00:20:02,740
These three loved hang out together.

290
00:20:03,240 --> 00:20:04,600
They loved hang out through there.

291
00:20:05,240 --> 00:20:11,500
So you can have dementia and have depression and have delirium.

292
00:20:11,860 --> 00:20:13,500
You can have all three at once.

293
00:20:13,840 --> 00:20:20,280
So it's very important to have a good, as part of your care team, a good medical connections

294
00:20:20,280 --> 00:20:27,700
as well, geriatrician, or interdistered and possibly geriatric psychiatry to really get

295
00:20:27,700 --> 00:20:33,120
down to the bottom of it, because usually the things that cause delirium and depression

296
00:20:33,120 --> 00:20:34,380
they are treatable.

297
00:20:34,800 --> 00:20:39,740
You can't improve someone's quality of life and possibly save their life through treatment

298
00:20:39,740 --> 00:20:40,980
of the delirium.

299
00:20:42,080 --> 00:20:43,440
Dementia is a little bit different.

300
00:20:44,140 --> 00:20:48,600
So this term dementia, the most common question that I get asked, and I'm sure Cheryl too,

301
00:20:48,600 --> 00:20:52,180
is what's the difference between Alzheimer's disease and dementia?

302
00:20:52,400 --> 00:20:55,720
Or I hear my mom has Alzheimer's, but she doesn't have dementia.

303
00:20:55,920 --> 00:20:58,060
Or the other way around, I would dementia, but not here.

304
00:20:58,320 --> 00:21:02,000
So we throw these words around, and I think it's very helpful

305
00:21:02,000 --> 00:21:04,280
for us to understand what it is actually.

306
00:21:04,900 --> 00:21:07,740
So the word dementia, it's not actually a disease.

307
00:21:08,640 --> 00:21:13,100
It's the word that describes a set of symptoms that have one

308
00:21:13,100 --> 00:21:15,960
of which is often memory changes, memory impairment,

309
00:21:15,960 --> 00:21:24,200
but could be others usually two or more parts of the brain function are affected and it's gotten to the point where it defects you cannot live independently anymore.

310
00:21:24,580 --> 00:21:32,260
So it's not mild for getting forgetfulness, it's to the point where you need help, you cannot function independently anymore.

311
00:21:32,680 --> 00:21:41,140
So I'm going to have you make a big go hit your neighbor, make a big umbrella, big umbrella because it's an umbrella term, umbrella term.

312
00:21:41,140 --> 00:21:45,680
And under that umbrella are the causes of these brain change.

313
00:21:46,040 --> 00:21:50,060
Alzheimer's disease, frontal temporal dementia, vascular dementia,

314
00:21:50,240 --> 00:21:53,360
Lewy body disease, and then there's over 100 different causes.

315
00:21:54,120 --> 00:21:59,620
Basically, it's neurodegenerative diseases that over time

316
00:21:59,940 --> 00:22:02,080
change the damage of the brain.

317
00:22:02,560 --> 00:22:07,140
Or you can have something sudden happen like poor NFL football players

318
00:22:07,140 --> 00:22:09,780
with too many concussions, bad for your brain.

319
00:22:09,780 --> 00:22:12,580
you know, over time, so add the actual brain damage.

320
00:22:13,140 --> 00:22:14,460
Alcoholism, the other cause.

321
00:22:15,420 --> 00:22:16,980
And you can have more than one,

322
00:22:17,300 --> 00:22:18,660
so you can have Alzheimer's disease

323
00:22:18,660 --> 00:22:20,720
and have a history of alcoholism.

324
00:22:21,460 --> 00:22:23,480
So we're going to take a look at actual brains,

325
00:22:23,720 --> 00:22:25,200
because what we want to get behind,

326
00:22:25,380 --> 00:22:26,860
now we've looked at what's normal,

327
00:22:27,040 --> 00:22:28,000
what's typical aging,

328
00:22:28,320 --> 00:22:31,580
and we really are now looking hard at what's atypical.

329
00:22:32,200 --> 00:22:34,880
And I want to kind of look at the whole brain

330
00:22:34,880 --> 00:22:36,640
and a couple different parts of the brain first,

331
00:22:37,160 --> 00:22:40,140
about where we're going to start to see early changes,

332
00:22:40,700 --> 00:22:43,660
that you can recognize and tie to the specific brain part.

333
00:22:44,120 --> 00:22:48,020
So when you think of dementia or Alzheimer's disease,

334
00:22:48,180 --> 00:22:49,980
what's the first symptom that comes to mind?

335
00:22:50,060 --> 00:22:51,640
Like I said, oh my grandma had Alzheimer's.

336
00:22:52,560 --> 00:22:55,340
What do you think her major symptom was?

337
00:22:56,500 --> 00:22:57,380
Forgetfulness, yep.

338
00:22:58,540 --> 00:22:59,420
Memory, memory impairment.

339
00:22:59,860 --> 00:23:01,240
That's like the first thing.

340
00:23:01,440 --> 00:23:03,220
So a lot of times can take your finger,

341
00:23:03,220 --> 00:23:04,220
we're going to write in the air.

342
00:23:04,800 --> 00:23:13,680
People say dementia, so dementia, you can write messy equals Alzheimer's, equals memory loss.

343
00:23:14,340 --> 00:23:16,660
So we wrote that, and I'm going to put a big fat extra like this.

344
00:23:17,780 --> 00:23:22,060
But that's the common equation that we have. You have dementia, you have memory loss.

345
00:23:22,920 --> 00:23:28,040
Yes, you can have dementia and have memory loss, but it's much, much, much more than that.

346
00:23:28,040 --> 00:23:38,800
So here's, we looked at the PET scan of this normal brain before, and fortunately this individual is passed away, passed away, and kindly donated his brain, again another male,

347
00:23:39,500 --> 00:23:46,880
um, diagnosed car accident, no neurodegenerative disease. So this is a actual healthy brain, um, no disease process.

348
00:23:47,200 --> 00:23:56,020
So his skull would be right around here, and we have fluid in our brains, it keeps our brain from like, bashing up against the side of the skull, right?

349
00:23:56,580 --> 00:24:01,040
This individual passed away 10 years after diagnosis of Alzheimer's disease.

350
00:24:01,440 --> 00:24:05,040
What do you think was the disease working on this brain before he got diagnosed?

351
00:24:05,980 --> 00:24:12,140
Absolutely, because generally diagnosis is late, and his skull is the same size as this guy's skull.

352
00:24:13,260 --> 00:24:14,260
So up here.

353
00:24:15,760 --> 00:24:21,360
So looking at these two brains, so this would be the PET scan of the late Alzheimer's that we saw.

354
00:24:21,560 --> 00:24:24,360
That was mostly blue, and this is the PET scan that had tons of red.

355
00:24:24,360 --> 00:24:27,780
So what do you notice by looking at these two actual brains?

356
00:24:28,940 --> 00:24:29,440
The size.

357
00:24:29,900 --> 00:24:30,380
Yeah.

358
00:24:30,960 --> 00:24:32,300
Huge difference in size.

359
00:24:32,520 --> 00:24:33,500
So go like this.

360
00:24:33,900 --> 00:24:35,800
The cells are shrinking and dying.

361
00:24:36,500 --> 00:24:36,660
Shrinking.

362
00:24:36,800 --> 00:24:39,780
So there's actual physiological cellular change.

363
00:24:40,380 --> 00:24:40,980
What else do you notice?

364
00:24:41,280 --> 00:24:41,460
Color.

365
00:24:41,720 --> 00:24:42,020
Color.

366
00:24:42,520 --> 00:24:43,680
So what about the color?

367
00:24:44,520 --> 00:24:45,280
One stark girl.

368
00:24:45,340 --> 00:24:45,480
Yeah.

369
00:24:45,760 --> 00:24:46,360
Pretty dark.

370
00:24:46,580 --> 00:24:47,600
Somebody said to me once,

371
00:24:47,640 --> 00:24:49,160
this looks like an old bruise.

372
00:24:49,660 --> 00:24:52,760
I think that's a good way of thinking about it because our brains

373
00:24:52,760 --> 00:24:58,520
our vascular organs. We want to have good blood flow to our brains. And as that

374
00:24:58,520 --> 00:25:03,700
brain is shrinking, what else is shrinking in there? What do we have with blood vessels?

375
00:25:04,380 --> 00:25:10,860
How good is the blood flow in that brain? Not very good. Not very good. So we can see

376
00:25:10,860 --> 00:25:16,980
the real cellular shrinking and dying. So we talked about where the memory center,

377
00:25:17,180 --> 00:25:20,880
the memory center in the brain was. I had you like drive your fingers into the

378
00:25:20,880 --> 00:25:26,680
very center, but looking at that one on the right, is there any part of this individual's

379
00:25:26,680 --> 00:25:34,120
brain function that is not affected by the changes that they experienced?

380
00:25:34,800 --> 00:25:35,880
You're the very center.

381
00:25:36,780 --> 00:25:38,520
Oh, that's good because we're going to look at that.

382
00:25:39,040 --> 00:25:42,620
We're going to see what the very center looks like because yeah, we're seeing the outside,

383
00:25:42,800 --> 00:25:43,860
what's happening on the inside.

384
00:25:44,300 --> 00:25:45,180
So we know it's smaller.

385
00:25:45,800 --> 00:25:46,500
We know it's smaller.

386
00:25:47,700 --> 00:25:48,120
Okay.

387
00:25:48,420 --> 00:25:48,920
Here we go.

388
00:25:49,500 --> 00:25:53,960
We're going to look at the very center, the very center, because as we said, memory is

389
00:25:53,960 --> 00:25:55,820
the first thing we think of, right?

390
00:25:56,340 --> 00:25:58,780
Mom, I'm not asking the same question over and over and over again.

391
00:25:59,120 --> 00:26:02,040
With my grandma, she would come out of her room every five minutes.

392
00:26:02,160 --> 00:26:04,840
What time does the van come for senior citizens at ten o'clock?

393
00:26:05,260 --> 00:26:07,520
Go back to her room, five minutes later. What time does the van come?

394
00:26:07,900 --> 00:26:12,080
Ten o'clock. We had the sign that had van comes ten o'clock, picture of a van,

395
00:26:12,300 --> 00:26:13,660
the big Alzheimer's clock, all those things.

396
00:26:14,260 --> 00:26:17,560
It's like, oh, yeah. So what's happening?

397
00:26:17,560 --> 00:26:23,140
She was giving me a signal, not signal, a clue, and this is where I'm going to have us pause for a moment.

398
00:26:23,980 --> 00:26:27,260
And you know Sherlock Holmes? What the Sherlock Holmes hat looks like?

399
00:26:27,820 --> 00:26:30,940
Go ahead and imagine yourself putting on a Sherlock Holmes hat, like that.

400
00:26:31,340 --> 00:26:34,740
And what's that called? A deer hunter? Is that right? A deer hunter hat? Anyway.

401
00:26:35,320 --> 00:26:37,740
Because we're going to become dementia detectives now.

402
00:26:38,340 --> 00:26:43,960
Because everything we see and hear and experience in our interactions with those we love living with dementia

403
00:26:43,960 --> 00:26:51,440
is a clue for us to what's happening under underlying in their brains, because unlike

404
00:26:51,440 --> 00:26:56,500
other disease processes, so other organs get the general diseases too, right?

405
00:26:56,800 --> 00:27:03,160
Heart disease, lung disease, kidney disease, so like if someone has heart disease, what are

406
00:27:03,160 --> 00:27:06,660
the symptoms you might see that on the external that you would know that they have heart

407
00:27:06,660 --> 00:27:06,960
disease?

408
00:27:09,320 --> 00:27:13,760
Yeah, labored breathing, maybe swelling, lack of energy.

409
00:27:13,760 --> 00:27:18,700
So if I see someone sitting with a lot of edema swelling and heavy breathing, I'm not going

410
00:27:18,700 --> 00:27:22,280
to say, hey, hurry up, all right, I'm not okay.

411
00:27:22,860 --> 00:27:27,720
But that shrinking brain that you just saw, the skull stays the same size.

412
00:27:28,200 --> 00:27:31,980
Their heads don't shrink, so it's hard to know what's happening.

413
00:27:32,340 --> 00:27:35,540
So again, we have to be those detectives and look at what's underneath.

414
00:27:36,180 --> 00:27:42,320
So the hippocampus, this is deep inside your brain and it is our learning and memory center.

415
00:27:42,320 --> 00:27:47,480
So the description I did of my grandmother asking the same question, but it does a lot

416
00:27:47,480 --> 00:27:48,300
more than that.

417
00:27:48,740 --> 00:27:51,820
And very early on, you might start seeing problems with these.

418
00:27:51,980 --> 00:27:56,980
I'm going to have you take your hands, go like this, and so you have fingers in the front.

419
00:27:57,660 --> 00:28:01,160
I think that does look like this, actually, deep inside the brain, little hippocampus you

420
00:28:01,160 --> 00:28:01,500
have here.

421
00:28:01,800 --> 00:28:03,380
Here's what it looks like there, like that.

422
00:28:04,760 --> 00:28:09,820
So the first thing your hippocampus does for you, the three things, is called wayfinding.

423
00:28:09,820 --> 00:28:15,240
So I'm going to have you put your hands close to you and say familiar, familiar, so you

424
00:28:15,240 --> 00:28:20,780
can get from some place familiar to some place unfamiliar, unfamiliar, and back to familiar.

425
00:28:21,960 --> 00:28:26,560
So if I told you how to get to the bathroom, oh, you go out that door, you go left, you go

426
00:28:26,560 --> 00:28:31,640
right, you go right, and then you go left, like okay, you just made a mental map, that's

427
00:28:31,640 --> 00:28:32,900
your hip, thank your hippocampus.

428
00:28:33,300 --> 00:28:39,000
And you go there, you find your way, you go to the bathroom, then you do it backwards and

429
00:28:39,000 --> 00:28:41,360
And you come back and you find your way back to your seat.

430
00:28:42,500 --> 00:28:44,340
It's an amazing feat, honestly.

431
00:28:45,480 --> 00:28:50,700
Some people have better wayfinders than others, but you start to notice someone living with

432
00:28:50,700 --> 00:28:55,060
brain change, this is the healthy hippocampus, this is someone what's happening on the inside,

433
00:28:55,920 --> 00:29:03,200
getting lost in familiar places, driving to lungs in here on a Wahoo, you know, I live in

434
00:29:03,200 --> 00:29:06,840
town driving down to Polly Longs and I end up in Wainai.

435
00:29:07,600 --> 00:29:14,980
that's a sign. It's more than just getting lost. It's a clue. My wayfinder, my

436
00:29:14,980 --> 00:29:22,200
hippocampus, is broken, right? It's broken. So it's a sign of not normal atypical

437
00:29:22,200 --> 00:29:28,000
changes. The next one, take your hand again. Oops, sorry, like this. So you're here to

438
00:29:28,000 --> 00:29:32,160
learn something today, right? Right? So you've got to take in information, bring it

439
00:29:32,160 --> 00:29:39,380
I didn't say learn, learn, and remember, remember, that's the goal, learn, and remember,

440
00:29:39,860 --> 00:29:44,100
because remembering part is great to learn stuff but it's even more helpful to remember.

441
00:29:44,940 --> 00:29:50,860
So all these things that Sheryl and I are doing with you with your hands and arms and are

442
00:29:50,860 --> 00:29:54,700
designed to help your hippocampus learn something new and remember.

443
00:30:00,000 --> 00:30:28,960
People who are living with changing hippocampuses are going to have trouble. They might learn something. So let's say Cheryl has a fall and ends up in the hospital, ends up in rehab. And now they're going to teach her how to use a walker. So make like you're using a walker. So I'm the OT, the PT, and she's a very cooperative patient, and she uses, oh, Mrs. Diaz, you're doing really great. You know, stand up straight. Oh, great. She's doing really great. I think I'm going to be able to discharge her now because she's got this.

444
00:30:28,960 --> 00:30:34,140
the minute she's left alone sitting in a chair without the walker with the walker

445
00:30:34,140 --> 00:30:37,660
to the side and she wants to get up somewhere what's gonna happen she's living

446
00:30:37,660 --> 00:30:42,100
with dementia she's gonna fall but is she gonna use the walker she's not gonna

447
00:30:42,100 --> 00:30:47,340
use the walker she's not gonna use the walker or she might pick it up because maybe

448
00:30:47,340 --> 00:30:50,800
you said okay she didn't use it last time so I'm gonna put it right in front of her

449
00:30:51,560 --> 00:30:57,980
right so oh what might you do with it move it to the side use it backwards what

450
00:30:57,980 --> 00:31:05,100
happened to all that training that the nice PT lady gave her. She did try to learn.

451
00:31:07,670 --> 00:31:07,750
She

452
00:31:07,750 --> 00:31:12,530
couldn't, didn't have any place to put it. I want to challenge the concept of forgetting

453
00:31:12,530 --> 00:31:18,050
and not remembering. Because if you're unable to form the memory in the first place, have

454
00:31:18,050 --> 00:31:24,150
you truly forgotten? No amount of, don't you remember? If I have the memory I would, but

455
00:31:24,150 --> 00:31:28,970
But it's not that you can, look, look, we had birth date, we were here for your birth

456
00:31:28,970 --> 00:31:29,410
they see.

457
00:31:29,750 --> 00:31:30,430
Here's a picture.

458
00:31:31,090 --> 00:31:34,470
It's like, oh, because I desperately with all my heart want her to remember.

459
00:31:34,990 --> 00:31:39,090
But she's giving me a clue that hippocampus is not working properly.

460
00:31:39,910 --> 00:31:46,390
The last one, if you don't have to wear a watch, if you imagine you do, time, time awareness.

461
00:31:47,150 --> 00:31:52,810
So the kind of time that we keep track of is go like this the day sunrise to sunset and

462
00:31:52,810 --> 00:31:53,050
nighttime.

463
00:31:53,050 --> 00:31:57,070
time. Right, so we have a 24-hour clock. What time is it? Is it the afternoon? What's

464
00:31:57,070 --> 00:32:02,550
dark in here? But is it the afternoon or night or morning? Your brain knows, even though

465
00:32:02,550 --> 00:32:07,430
you can't see the sun right now. But your hippocamp is something you keep track of that. But

466
00:32:07,430 --> 00:32:11,490
that might get turned around for someone living with dementia. Night is day and day is night.

467
00:32:12,570 --> 00:32:20,090
Those days stack up into weeks. Right? Go like this. Stack up into weeks. 365 year. We keep

468
00:32:20,090 --> 00:32:25,030
track of what month is this, what day is this, what day of the week is this, I can keep

469
00:32:25,030 --> 00:32:29,830
your hippocampus, how to keep track of that. I might lose certain making errors, you

470
00:32:29,830 --> 00:32:35,470
notice errors in that time. And the last one is, imagine you're looking at the rear view mirror,

471
00:32:36,150 --> 00:32:40,650
all those years stacked up like this, look back there. I don't know how old you are, but how

472
00:32:40,650 --> 00:32:45,070
many years that time when you got behind you in the rear view mirror, and you have a concept

473
00:32:45,830 --> 00:32:53,150
generally, what, where you are in that timeline, right? I know my grandmother and my parents

474
00:32:53,150 --> 00:33:00,190
have passed away, but if I'm living with dementia, hopefully much more down the line, I might

475
00:33:00,190 --> 00:33:04,250
think they're still living. My grandmother was always looking for her parents, and she was

476
00:33:04,250 --> 00:33:10,110
like 85, and I thought in my kind heart, and I didn't know anything about dementia, that

477
00:33:10,110 --> 00:33:14,850
But if I used rational logic that it would, she would be, so grandma, how old are you?

478
00:33:15,090 --> 00:33:15,430
85.

479
00:33:15,670 --> 00:33:17,170
How old do you think your parents would be?

480
00:33:17,950 --> 00:33:20,130
Well, they'll tell you they would be like a hundred.

481
00:33:20,430 --> 00:33:25,410
So do you think they could still be like, I wasn't trying to be cruel, but I didn't, I wanted

482
00:33:25,410 --> 00:33:28,990
so desperately to drag her into this timeline.

483
00:33:29,830 --> 00:33:35,050
I didn't understand that she can't be here with me in this time at the moment.

484
00:33:35,310 --> 00:33:36,750
She's remembering her parents.

485
00:33:37,010 --> 00:33:38,950
So those, again, signs.

486
00:33:38,950 --> 00:33:45,330
So when you start to see those kinds of changes, just take a deep breath because the first

487
00:33:45,330 --> 00:33:48,250
time you actually notice them, it's alarming.

488
00:33:49,390 --> 00:33:50,310
But take notes.

489
00:33:50,470 --> 00:33:55,770
I encourage caregivers to take notes, take a keep a drone, something to keep track because

490
00:33:55,770 --> 00:33:56,930
it's hard to remember.

491
00:33:57,170 --> 00:34:02,490
So when you do talk to professionals, you'll be able to describe accurately what you're

492
00:34:02,490 --> 00:34:04,270
seeing because that's so helpful to them.

493
00:34:04,950 --> 00:34:08,850
And the other part of the brain we want to look at, which you also would see early changes

494
00:34:08,850 --> 00:34:12,730
is you noticed in that normal to early Alzheimer's

495
00:34:12,730 --> 00:34:15,970
that there was a lot, almost no red in the front.

496
00:34:16,130 --> 00:34:16,990
So touch the front of your head.

497
00:34:17,110 --> 00:34:18,050
This is your frontal lobe.

498
00:34:18,330 --> 00:34:19,690
This is the part that, for boys,

499
00:34:19,830 --> 00:34:21,710
develops quite late, well, it's not late.

500
00:34:21,830 --> 00:34:24,250
It's right on time, 25, that on time.

501
00:34:24,650 --> 00:34:25,830
But a little later than girls.

502
00:34:26,290 --> 00:34:29,130
So when you think of teenagers and how well

503
00:34:29,650 --> 00:34:31,570
they have underdeveloped frontal lobes,

504
00:34:31,730 --> 00:34:34,210
that's why rena-car companies won't rent to them, right?

505
00:34:35,630 --> 00:34:37,270
How good is their impulse control?

506
00:34:37,830 --> 00:34:39,030
Are they very logical?

507
00:34:39,230 --> 00:34:40,050
Did they make great choices?

508
00:34:40,750 --> 00:34:42,910
You know, they have a hole in their frontal lobe.

509
00:34:42,990 --> 00:34:44,290
It's not their fault, right?

510
00:34:44,650 --> 00:34:46,090
It will come in time.

511
00:34:46,470 --> 00:34:48,390
But this is our grown-up part of our brain.

512
00:34:48,930 --> 00:34:51,670
And before you might even see any memory problems,

513
00:34:51,930 --> 00:34:53,670
be like, oh, my mom doesn't have Alzheimer's.

514
00:34:54,010 --> 00:34:55,150
Her memory is just fine.

515
00:34:57,010 --> 00:35:00,250
But she can't stop eating all the chocolates that are in the house.

516
00:35:00,970 --> 00:35:03,930
She's coming to irrational conclusions by,

517
00:35:04,590 --> 00:35:08,130
She can't find her person. She thinks the neighbors are coming in and stealing it.

518
00:35:09,670 --> 00:35:11,690
She has trouble making choices.

519
00:35:15,040 --> 00:35:17,060
She has troubles getting things started.

520
00:35:17,520 --> 00:35:20,800
So she'll get things set out. But she just can't get started. The food's there.

521
00:35:20,940 --> 00:35:25,580
But she just doesn't get started. Or she can't stop. So she's cleaning something.

522
00:35:26,400 --> 00:35:29,060
And you come back an hour later and she's cleaning the same spot.

523
00:35:29,060 --> 00:35:36,040
So you can't stop and move on and take this last one, I'm going to have these last two

524
00:35:36,040 --> 00:35:37,080
and I have you take your hand out.

525
00:35:37,560 --> 00:35:41,100
So this one is a mirror, you're looking in the mirror, take a look in your mirror, look

526
00:35:41,100 --> 00:35:43,180
how great you look, great, everybody looks great.

527
00:35:44,000 --> 00:35:46,080
This is your mirror for self-assessment.

528
00:35:46,980 --> 00:35:51,800
So think of one thing that you're really good at, right, so I'm going to say I'm a really

529
00:35:51,800 --> 00:35:52,340
good listener.

530
00:35:53,020 --> 00:35:54,720
Okay, that is an accurate self-assessment.

531
00:35:55,060 --> 00:35:57,260
I'm also a really good cook, also accurate, great.

532
00:35:57,740 --> 00:36:02,680
but also I know what I'm not good at so I might say like I don't really like

533
00:36:02,680 --> 00:36:07,440
driving at night especially when it's raining it's very hard for me to see so I

534
00:36:07,440 --> 00:36:12,260
might say I'm gonna raise your other hand I need help so look in the mirror and

535
00:36:12,260 --> 00:36:15,660
think of one thing you're not so great at that you might could use some help so

536
00:36:15,660 --> 00:36:19,560
this is healthy accurate self-assessment using your frontal lobe I know what I'm

537
00:36:19,560 --> 00:36:24,420
good at I know what I'm not good at I'm not gonna do some things I'm not good at so

538
00:36:24,420 --> 00:36:31,380
So when the frontal lobe is changing, I have, I'm self-assessing, but it's inaccurate.

539
00:36:31,780 --> 00:36:36,840
So my grandmother side-swipe, God bless her, side-swipe the garbage truck twice with the

540
00:36:36,840 --> 00:36:39,820
old guys, with the guys on the back, they have to jump off in things.

541
00:36:40,600 --> 00:36:46,560
And her self-assessor was, I am a very good driver, it's like, oh my God, no, you would

542
00:36:46,560 --> 00:36:50,600
still, it's like, oh no, it was all their fault or I don't remember that happening.

543
00:36:50,600 --> 00:36:55,220
like it's like she's just so stubborn she's making this crazy but what she was

544
00:36:55,220 --> 00:37:00,960
actually showing us is she could not accurately self-assess anymore and that

545
00:37:00,960 --> 00:37:07,520
is so hard for care partners because their impairments are so obvious to us

546
00:37:07,520 --> 00:37:12,380
like oh my god no you're not oh no you fell five times you have to use the

547
00:37:12,380 --> 00:37:16,660
walker I'm fine I don't I don't need that yeah so that's really really hard but

548
00:37:16,660 --> 00:37:20,220
But again, it's not just being stubborn, it's an inaccurate self-assessment.

549
00:37:20,700 --> 00:37:25,080
The other one is take your hand here, put on your head here, so you have a point of view.

550
00:37:25,880 --> 00:37:27,340
Everybody, we all each have our point of view.

551
00:37:28,480 --> 00:37:31,920
And take your other hand, and other people have their point of view.

552
00:37:33,060 --> 00:37:37,880
And with our healthy from lobes, we can see other people's points of view.

553
00:37:38,480 --> 00:37:42,540
We might not agree, but we can see them, and we can talk it through.

554
00:37:42,540 --> 00:37:50,300
And with our healthy, this is how hopefully humanity should be, we can take our healthy

555
00:37:50,300 --> 00:37:55,200
frontal lobes, the two of us, and come together to some sort of understanding, hopefully

556
00:37:55,200 --> 00:37:55,720
compromise.

557
00:37:56,280 --> 00:38:01,680
You at least not get in a fight, but we can see each other's point of view and co-exist

558
00:38:01,680 --> 00:38:02,260
in a way.

559
00:38:02,780 --> 00:38:06,000
So I'm living with this changed frontal lobe.

560
00:38:06,600 --> 00:38:08,040
I see my point of view.

561
00:38:09,240 --> 00:38:10,780
I cannot see yours.

562
00:38:11,820 --> 00:38:16,680
I cannot see how hard I'm making it for you even though you're crying right in front

563
00:38:16,680 --> 00:38:17,020
of me.

564
00:38:17,580 --> 00:38:20,740
I can't see the mistakes that you're pointing out.

565
00:38:21,160 --> 00:38:22,580
I just think you're being mean.

566
00:38:23,100 --> 00:38:27,280
So when my grandmother would come out and ask the same question over again, what times

567
00:38:27,280 --> 00:38:27,700
of income?

568
00:38:28,200 --> 00:38:31,120
At one point, I remember clearly again, we didn't know anything about dementia.

569
00:38:31,840 --> 00:38:33,580
She came out, what time is the income?

570
00:38:34,580 --> 00:38:38,420
Well, I'm sorry, we told her 10 o'clock, she goes back, she came out again, before she even

571
00:38:38,420 --> 00:38:43,180
asked anything, my mom and I in unison just by chance turned around and said 10 o'clock

572
00:38:44,760 --> 00:38:50,140
and there was like dead silence because she hadn't even asked and she said why are

573
00:38:50,140 --> 00:38:57,880
you so mean because for her for us it was the what number time you think 50 I don't know

574
00:38:57,880 --> 00:39:02,340
who was big and we didn't know what else to do right and it but for her it was what number

575
00:39:02,340 --> 00:39:09,920
time. Why? I didn't understand that she was stuck in a loop and but who else was stuck

576
00:39:09,920 --> 00:39:14,920
in a loop? He and my mom. Somehow we thought if we keep saying the same thing, she was

577
00:39:14,920 --> 00:39:20,860
going to behave differently. Isn't that the definition of insanity? Keep doing the

578
00:39:20,860 --> 00:39:26,580
same thing. Expect a different outcome. But we didn't know. So I give myself the grace

579
00:39:26,580 --> 00:39:34,280
I've made lots of mistakes, but so now you have some detective skills towards early changes

580
00:39:34,280 --> 00:39:41,420
because the memory centers, not just memory, way finding time, learning, remember these

581
00:39:41,420 --> 00:39:47,420
executive higher functioning things you might see before you see like serious, you know,

582
00:39:47,520 --> 00:39:52,580
not remembering people's names, not the more obvious, obvious symbols.

583
00:39:52,580 --> 00:39:59,380
Obvious. Yeah. Yeah. So. And keep in mind, you know, as a caregiver, you're still human.

584
00:40:00,160 --> 00:40:05,260
It's okay to get angry sometimes. It's important to express those feelings when talking about the

585
00:40:05,260 --> 00:40:11,140
counseling side. You know, take a deep breath, take a break, and know that it's going to be okay.

586
00:40:11,980 --> 00:40:17,480
It's okay to get angry. It's okay to get fussy. We're all human. But if we think about it's the brain

587
00:40:17,480 --> 00:40:21,980
change, it's two parts of the brain, normally on the left side that's dying, they don't

588
00:40:21,980 --> 00:40:22,900
have control over that.

589
00:40:23,200 --> 00:40:26,760
We control how we preserve their dignity.

590
00:40:27,500 --> 00:40:31,080
We have to, hopefully, the operating brain that's working well.

591
00:40:31,420 --> 00:40:32,740
So don't be too hard on yourself.

592
00:40:34,200 --> 00:40:40,280
So this is the healthy individual who died in a car accident, and this is the man who had

593
00:40:40,280 --> 00:40:42,040
Alzheimer's disease after 10 years.

594
00:40:42,040 --> 00:40:47,620
So specifically this occipital lobe, what do you notice about that area of the brain?

595
00:40:48,340 --> 00:40:48,400
Shrunk.

596
00:40:48,560 --> 00:40:49,040
Shrunking.

597
00:40:49,260 --> 00:40:50,600
Shrunking a lot, right?

598
00:40:51,800 --> 00:40:56,320
And remember, in the very beginning, we looked at the pet scans of the healthy 80-year-old,

599
00:40:56,320 --> 00:40:58,120
and there was a little less red there, too.

600
00:40:58,500 --> 00:41:03,760
So we're going to look at what's happening behind normal aging vision change,

601
00:41:03,860 --> 00:41:06,040
and then also this, this.

602
00:41:06,400 --> 00:41:08,460
So it doesn't go just from here to here.

603
00:41:08,800 --> 00:41:14,360
there's a gradual change. There's a lot in the middle. Not everybody will possibly get

604
00:41:14,360 --> 00:41:18,380
to this stage, might pass away from something else before then, but we're going to take

605
00:41:18,380 --> 00:41:24,180
a look at that. And so we're going to do this together. So what I'm going to ask you to

606
00:41:24,180 --> 00:41:29,240
do is stand up and I'll share what's going to stand next to me. So we're going to give

607
00:41:29,240 --> 00:41:32,800
an example here. Come stand right next to me. So you guys are all kind of standing next

608
00:41:32,800 --> 00:41:37,700
to each other. This is going to take a little bit of logistics for you. So don't do this

609
00:41:37,700 --> 00:41:40,280
But if I put my hand up like this, I'm going to hit Cheryl.

610
00:41:40,660 --> 00:41:42,420
So I'm kind of alternating.

611
00:41:42,800 --> 00:41:43,620
I'm going to be the one.

612
00:41:43,640 --> 00:41:46,600
I'm going to step forward so I can do like this and not hit Cheryl.

613
00:41:46,700 --> 00:41:49,980
So kind of one person step forward because you want to not hit each other.

614
00:41:49,980 --> 00:41:51,600
So Kathleen, take a little step forward.

615
00:41:51,700 --> 00:41:54,420
You want to be able to put your arms out but not hit anybody.

616
00:41:54,460 --> 00:41:55,080
That's the goal.

617
00:41:55,180 --> 00:41:56,160
Don't slap your neighbor.

618
00:41:56,440 --> 00:41:57,620
Don't slap your neighbor.

619
00:41:57,880 --> 00:41:58,100
Okay.

620
00:41:58,620 --> 00:41:58,980
Okay.

621
00:41:59,160 --> 00:41:59,320
Great.

622
00:41:59,620 --> 00:42:01,320
Some people have really long wingspan.

623
00:42:01,380 --> 00:42:02,800
So make sure you have a lot of room.

624
00:42:04,240 --> 00:42:07,880
So, first we're going to look at typical age, normal healthy aging.

625
00:42:07,980 --> 00:42:12,260
Remember that 80-year-old had less red, high burn in the occipital lobe.

626
00:42:12,660 --> 00:42:17,580
So, as we're getting older, where there are some processing changes in the brain.

627
00:42:17,720 --> 00:42:20,420
So, not the eyes, let's say our eyes are perfectly healthy.

628
00:42:20,780 --> 00:42:25,800
No macular degeneration, none of that, no cataracts, healthy eyes.

629
00:42:26,400 --> 00:42:30,540
So, if you're young, I think we have a young person here.

630
00:42:30,540 --> 00:42:37,340
If you're young in your 20s and if the 30 or so, when you look straight forward, everybody

631
00:42:37,340 --> 00:42:37,900
looks straight forward.

632
00:42:38,000 --> 00:42:41,420
Put your hands out to 180 degrees and wiggle your fingers.

633
00:42:42,280 --> 00:42:43,780
You can detect motion.

634
00:42:44,400 --> 00:42:45,000
I cannot.

635
00:42:45,460 --> 00:42:47,040
I am in my 60s.

636
00:42:47,240 --> 00:42:47,960
I cannot.

637
00:42:48,500 --> 00:42:49,800
That is perfectly normal.

638
00:42:50,520 --> 00:42:53,640
When you're young, you have a full range of peripheral awareness.

639
00:42:54,180 --> 00:42:57,520
So I'm going to turn sideways so you can see I'm looking straight forward.

640
00:42:57,520 --> 00:43:01,560
I have to move my hands to write about here for me to be able to detect motion.

641
00:43:01,960 --> 00:43:04,280
So move them in just as far as you need to.

642
00:43:04,500 --> 00:43:06,880
It probably is a little bit and it's okay.

643
00:43:07,400 --> 00:43:11,800
This is normal change, that little change you saw in that 80 year old.

644
00:43:12,200 --> 00:43:13,240
So go like this.

645
00:43:13,760 --> 00:43:18,280
It's not just the sides, even though when you take the driver's test, what do they have you

646
00:43:18,760 --> 00:43:19,200
test you?

647
00:43:19,740 --> 00:43:19,860
Right?

648
00:43:20,380 --> 00:43:24,520
Because your peripheral awareness is your safety awareness, right?

649
00:43:24,520 --> 00:43:28,580
you detect motion before you even see it properly see it right so you're

650
00:43:28,580 --> 00:43:31,600
like oh there's a car there so they want to make sure you see the blinking

651
00:43:31,600 --> 00:43:37,980
lights right otherwise you're not safe to drive so but it's 360 so as we get

652
00:43:37,980 --> 00:43:45,620
older you might notice you trip more easily anybody yes yes when we were all

653
00:43:45,620 --> 00:43:49,560
wearing masks all the time or if you work in healthcare and you wear them you might

654
00:43:49,560 --> 00:43:54,400
notice your peripheral awareness is a little less there it's easier to

655
00:43:54,400 --> 00:43:58,440
trip when you're wearing a mask, you have to look down more, but that's normal and that's

656
00:43:58,440 --> 00:44:02,140
about as far as it would go without any other disease process.

657
00:44:02,520 --> 00:44:06,220
So we learned older drivers get a bad rap because their cars are scraped up or they park

658
00:44:06,220 --> 00:44:11,280
a little crooked or something, but if you lost a little peripheral awareness, you might have

659
00:44:11,280 --> 00:44:12,820
that problem, but we can compensate.

660
00:44:13,240 --> 00:44:14,720
I know I need to really look.

661
00:44:15,060 --> 00:44:17,260
I can't, like a young person, just flick my eyes.

662
00:44:17,660 --> 00:44:21,240
I need to, I mean, you're supposed to turn and look, but I should really turn and look

663
00:44:21,240 --> 00:44:25,960
the older I get to make sure that I'm safe and I find myself looking down a

664
00:44:25,960 --> 00:44:29,380
little more as I go downstairs than when I was young and I would just fly

665
00:44:29,380 --> 00:44:35,740
down the stairs run without regard to falling down so so that I'm gonna have

666
00:44:35,740 --> 00:44:40,600
you take your hands and make two L's L's like this because that everybody here is

667
00:44:40,600 --> 00:44:45,000
in their 70s and put them up to your face like this like you're looking through

668
00:44:45,000 --> 00:44:51,920
to the port hole of a ship. Hello. This simulates the visual awareness field for someone

669
00:44:51,920 --> 00:44:56,700
who's 70. Do you have an awareness of your neighbors? Make to the right and left? A little

670
00:44:56,700 --> 00:44:59,640
bit, right? If you take it off, is it better? Yeah.

671
00:45:00,000 --> 00:45:29,680
But you're pretty functional. Good. Great. You're still functional. You're allowed to drive. You can see the red, red dots. Great. But make sure you turn and look. But now we're going to take this changing normal brain, healthy brain, but getting older. And we're going to overlay dementia on it. So we're going to go from here. You were about here, right here. And you're going to come into about 45 degrees. So you have like an L. This cone that you've made in front of you is the visual awareness field for someone living in

672
00:45:29,680 --> 00:45:36,560
with early dementia, like we saw in that PET scan, make two C's, two C's, and make

673
00:45:36,560 --> 00:45:41,660
like you're going snorkeling, put it right on your eyes. So snorkel mask. Now

674
00:45:41,660 --> 00:45:46,080
what happened to your neighbors? You disappear, you disappear, so you can't even

675
00:45:46,080 --> 00:45:52,620
see them, right? How about, if you take it off and then put it back on, what

676
00:45:52,620 --> 00:45:59,520
else do you notice? It's darker, it feels a little darker. You feel like a real

677
00:45:59,520 --> 00:46:04,460
tunnel, right? You get a real tunnel vision. So go ahead and take your hands down. This

678
00:46:04,460 --> 00:46:09,520
stuff in front, go like this, curiosity. This is our curiosity vision. This is where all

679
00:46:09,520 --> 00:46:15,400
the good stuff is. Where's the chocolate? Where's my helper? It's in the front, right? So

680
00:46:15,400 --> 00:46:23,580
as my brain is shrinking and dying, it's actually, I cannot process all this, but I can keep my

681
00:46:23,580 --> 00:46:28,420
focus on here. So it's nothing, it's not like glasses will fix this. It's a change in the

682
00:46:28,420 --> 00:46:33,020
brain. I'm focused here. I'm so focused here. And we do it too. And we're super focused.

683
00:46:33,500 --> 00:46:37,140
You can't see the stuff on the side because you're so hyper focused in the front. It's

684
00:46:37,140 --> 00:46:44,060
like it's like that. So this is early stage. So again, early driving. Possibly. Possibly.

685
00:46:44,100 --> 00:46:49,600
There are plenty of people living with early stage Alzheimer's out there driving and having

686
00:46:49,600 --> 00:46:55,360
some challenges like my grandmother did. That's why she hit those garbage trucks. Okay. So

687
00:46:55,360 --> 00:46:59,240
So now put your hand shoulder with the part, make a little tube.

688
00:47:00,160 --> 00:47:07,100
So this is mid stage, mid stage, make two o's like you're going to have binoculars, put

689
00:47:07,100 --> 00:47:08,040
those binoculars on.

690
00:47:08,840 --> 00:47:11,160
So now what happened to your neighbors?

691
00:47:12,460 --> 00:47:14,100
Completely gone, completely gone.

692
00:47:14,500 --> 00:47:18,520
Now just imagine you have some food on your shirt and I say, hey you got some food on your

693
00:47:18,520 --> 00:47:19,400
shirt, try and find it.

694
00:47:25,700 --> 00:47:27,280
I'm trying to find your neighbor.

695
00:47:28,720 --> 00:47:30,200
What do you notice you have to do?

696
00:47:31,080 --> 00:47:31,220
Turn.

697
00:47:31,980 --> 00:47:32,660
What are you turning?

698
00:47:33,300 --> 00:47:40,920
You have to turn your whole body and when you find them, it's a little bit of a surprise.

699
00:47:41,400 --> 00:47:45,120
Like, oh, because you're like scanning, scanning, oh, he's right there.

700
00:47:45,560 --> 00:47:46,220
How can I miss him?

701
00:47:46,320 --> 00:47:46,660
He's tall.

702
00:47:46,880 --> 00:47:47,260
Right?

703
00:47:47,260 --> 00:47:55,160
But I can see him now, even though I'm looking at Lenora, but with this, I don't see him until,

704
00:47:56,320 --> 00:47:57,820
oh, when did you get here?

705
00:47:58,680 --> 00:47:59,940
Where'd you come from?

706
00:48:00,240 --> 00:48:00,480
Exactly.

707
00:48:01,760 --> 00:48:03,900
Because I'm just missing the outside edges.

708
00:48:04,140 --> 00:48:05,220
That's a different part of the brain.

709
00:48:05,800 --> 00:48:06,760
That's another part of the brain.

710
00:48:07,380 --> 00:48:14,760
Okay, so now, one, we're getting to the later stage, one, oh, and close the other eye.

711
00:48:14,760 --> 00:48:20,200
So you can have your hand over it or close it. So this is called monocular vision, monocular.

712
00:48:22,100 --> 00:48:26,740
So go ahead and look down. I'm not going to walk but imagine if you're going to try and walk.

713
00:48:29,040 --> 00:48:34,720
And keep when I close and put the monocle on and reach up like you're going to touch the lights.

714
00:48:35,860 --> 00:48:42,320
What do you notice about that when you try and do it? Can you tell how far away anything is? You lose all depth perception.

715
00:48:44,480 --> 00:48:51,140
So my brain has shrunk to the point that I can't take in data in from two eyes, I'm not

716
00:48:51,140 --> 00:48:55,940
blind in one eye, my eyes actually working okay, but I can't process vision from two

717
00:48:55,940 --> 00:48:56,040
eyes.

718
00:48:56,160 --> 00:49:00,620
So I start to have trouble, I'm going to just focus on one, and so I start to have trouble

719
00:49:00,620 --> 00:49:01,340
with that perception.

720
00:49:01,540 --> 00:49:06,640
So you might see me like, if there's a mat here, stepping over it like it's a hole, because

721
00:49:06,640 --> 00:49:08,720
I can't tell, is it a hole or not?

722
00:49:08,720 --> 00:49:12,200
and my balance is probably not very good, my fold fall down.

723
00:49:12,620 --> 00:49:15,860
I start to have trouble with something on the table.

724
00:49:16,020 --> 00:49:17,880
I might miss it when I first grab for it,

725
00:49:18,100 --> 00:49:19,680
and that's a sign of depth perception.

726
00:49:19,860 --> 00:49:21,900
So again, with your detective hat,

727
00:49:22,420 --> 00:49:25,100
you can kind of see the changes that are happening.

728
00:49:25,620 --> 00:49:28,700
So not saying things like, oh, when did you get here?

729
00:49:29,320 --> 00:49:32,540
Or getting startled very easily when you come from the side.

730
00:49:32,740 --> 00:49:35,840
It's a sign that their visual awareness

731
00:49:35,840 --> 00:49:37,580
is becoming more and more now.

732
00:49:37,580 --> 00:49:38,540
Go ahead and sit down.

733
00:49:38,780 --> 00:49:39,580
Great job, everybody.

734
00:49:40,160 --> 00:49:40,520
Great job.

735
00:49:41,140 --> 00:49:42,100
So that was the vision.

736
00:49:42,640 --> 00:49:42,920
Vision.

737
00:49:43,360 --> 00:49:48,220
We're going to look to, because vision is, hey, we want to see what's coming.

738
00:49:48,480 --> 00:49:52,880
We human, our human brains are not comfortable if we don't see what's coming.

739
00:49:53,000 --> 00:49:55,840
If we hear a loud sound to the side, what's the first thing you're going to do?

740
00:49:56,360 --> 00:49:57,340
Look, right?

741
00:49:57,820 --> 00:50:00,780
See, if something touches you, go ahead and bend the ocean, something touches you, like,

742
00:50:01,040 --> 00:50:03,080
ah, you're going to scream, but you're going to look.

743
00:50:03,580 --> 00:50:06,440
Because once we can look and see, it's like, oh, oh, it's you.

744
00:50:06,440 --> 00:50:10,380
Oh, it's just a piece of seaweed, then we can calm down.

745
00:50:10,780 --> 00:50:12,700
But it's a startling thing, right?

746
00:50:13,300 --> 00:50:18,760
So we're going to look at hearing now because we as caregivers, care partners, we love

747
00:50:18,760 --> 00:50:19,400
to do something.

748
00:50:20,580 --> 00:50:21,660
We love to talk.

749
00:50:22,600 --> 00:50:28,580
We give instructions all day long, possibly a lot of corrections too, but we love to talk.

750
00:50:28,900 --> 00:50:32,740
And you signed up to come here and to listen to us talk for like two hours straight.

751
00:50:32,740 --> 00:50:39,340
So, we're counting on you, understanding our language, and you're counting on us, understanding what you say as well.

752
00:50:41,700 --> 00:50:47,460
But, here is, like I said, almost like if your bread was a toaster, if the chewing piece of toast comes up,

753
00:50:48,360 --> 00:50:53,860
your left touch the left side of your brain, your left temporal lobe, and your right temporal lobe.

754
00:50:54,240 --> 00:50:57,860
So, we're going to look really quickly at the functions that are changing here.

755
00:50:57,860 --> 00:50:59,120
For some reason, touch the left.

756
00:50:59,620 --> 00:51:01,300
The left temporal lobe is affected

757
00:51:01,300 --> 00:51:04,140
with all dimensions earlier and more severely.

758
00:51:04,760 --> 00:51:07,940
And your left side is your higher language centers.

759
00:51:08,600 --> 00:51:11,000
So first thing that's over there is your vocabulary,

760
00:51:11,380 --> 00:51:12,360
maybe multiple languages.

761
00:51:13,260 --> 00:51:15,820
Your ability to generate, take that vocabulary

762
00:51:15,820 --> 00:51:18,200
and spit out full sentences, generate speech.

763
00:51:18,620 --> 00:51:21,180
The ability to hear other people's speech

764
00:51:21,900 --> 00:51:23,900
and process it using your vocabulary

765
00:51:23,900 --> 00:51:25,520
to understand the content.

766
00:51:25,520 --> 00:51:33,980
these three things work together as this left side is changing I might lose

767
00:51:33,980 --> 00:51:38,640
vocabulary so we have language touch your left side again and say language on

768
00:51:38,640 --> 00:51:42,700
the left one more time tap your head tap when I bang it into your head

769
00:51:42,700 --> 00:51:47,660
language on the left now you're gonna say rhythm on the right rhythm on the right

770
00:51:47,660 --> 00:51:52,640
one more time laying on the left rhythm on the right now with your left hand

771
00:51:52,640 --> 00:51:59,460
and throw it away and say, lose on the left and with your right hand, put it in like this.

772
00:51:59,900 --> 00:52:05,500
Say, retain on the left and retain on the right.

773
00:52:06,000 --> 00:52:11,180
So this side, the higher language is kind of going out the window and everybody's different

774
00:52:11,180 --> 00:52:12,660
but it becomes harder and harder.

775
00:52:13,000 --> 00:52:14,960
But on the right side, this is the gift side.

776
00:52:16,160 --> 00:52:17,340
There's a lot left.

777
00:52:17,340 --> 00:52:24,100
It's not affected as severely and can last be functional through very late in disease.

778
00:52:26,100 --> 00:52:32,880
Rhythm, music, poetry, prayer, social chit-chat, social chit-chat, hi, how are you?

779
00:52:33,360 --> 00:52:33,940
How are you?

780
00:52:34,180 --> 00:52:35,080
I'm good in you.

781
00:52:35,260 --> 00:52:35,740
I'm fine.

782
00:52:35,780 --> 00:52:36,960
How's your family?

783
00:52:37,140 --> 00:52:37,680
She's doing great.

784
00:52:37,680 --> 00:52:38,220
She's doing great.

785
00:52:38,320 --> 00:52:39,960
This is very shallow conversation.

786
00:52:40,500 --> 00:52:41,560
It's like a little song.

787
00:52:41,740 --> 00:52:43,520
I can do this late into the disease.

788
00:52:45,100 --> 00:52:49,000
Because someone can come and visit and say, oh, your mom seems fine, I just had a social

789
00:52:49,000 --> 00:52:52,020
tip, because that is a skill that I still have.

790
00:52:52,480 --> 00:52:58,080
Music, I might not be able to speak a full sentence, but I can sing all the song words

791
00:52:58,080 --> 00:53:00,820
to the early songs, different part of the brain.

792
00:53:01,160 --> 00:53:05,440
You don't have to remember the words to the songs, your favorite song from high school, it

793
00:53:05,440 --> 00:53:11,260
comes on old school, the radio, comes on the radio, the first two notes, boom, all the words

794
00:53:11,260 --> 00:53:12,940
come out of your head, no problem.

795
00:53:12,940 --> 00:53:22,800
So it's a different part of the brain and it's a way, take this two hands again, that we can get connected, even late in the disease, late through music.

796
00:53:23,220 --> 00:53:28,260
Poetry and prayer are kind of music, they're rhythmic, they're memorized.

797
00:53:29,200 --> 00:53:37,860
And so someone who maybe has a Christian background, you might be able to start the Lord's Prayer, just like the first few notes of a song, and they can say the whole thing.

798
00:53:37,860 --> 00:53:43,880
And that is a way to get connected there and rhythmic movements.

799
00:53:44,700 --> 00:53:50,480
So if I'm working with Cheryl, so Cheryl is later into the disease and I'm going to

800
00:53:50,480 --> 00:53:53,400
ask Cheryl to take a step, but she's not going to take a step so I go, okay, let's go.

801
00:53:54,420 --> 00:53:55,300
Come on, let's go.

802
00:53:55,660 --> 00:54:00,900
She's not going to want to get started, but if I start making some rhythmic movements

803
00:54:00,900 --> 00:54:16,340
and maybe when the saints go marching in yeah, when the saints go marching and she has rhythm and I can

804
00:54:16,340 --> 00:54:21,500
use that to get her started. Remember she has trouble getting started and but that's preserved.

805
00:54:21,660 --> 00:54:28,380
This is a really gift. The last one, permitting words, I'm going to call them a gift even though some

806
00:54:28,380 --> 00:54:33,660
people, we call them a curse. So for bit in words, what kind of words are we talking about?

807
00:54:33,920 --> 00:54:39,440
You want us to say it? Well, this is on television. I don't know. Children might see.

808
00:54:39,760 --> 00:54:46,920
So the children might see, okay, curse words, right? That's bomb, curse words, sex talk,

809
00:54:48,520 --> 00:54:54,380
body parts, racial slurs, right? Yeah, things like that. Things you're like, oh my god,

810
00:54:54,900 --> 00:55:00,460
You know, you're a saint-aid grandmother who never used those language.

811
00:55:00,980 --> 00:55:04,400
I'm going to have everybody take a deep breath because it's awesome stress and faces.

812
00:55:05,440 --> 00:55:06,680
We all know these words.

813
00:55:07,540 --> 00:55:08,540
They're just words.

814
00:55:09,140 --> 00:55:12,220
They're very special words for very special occasions.

815
00:55:13,280 --> 00:55:18,620
And so when you were little and you heard grown-ups using those words, think about the first

816
00:55:18,620 --> 00:55:23,260
time you swore in front of a grown-up, you might not even know what the word meant, what

817
00:55:23,260 --> 00:55:23,540
happened.

818
00:55:23,540 --> 00:55:30,180
Yeah. Big, big, old school, right? You got, you got yelled at, you got punished. Don't

819
00:55:30,180 --> 00:55:33,940
ever say that again. You might have a corporal punishment mouthwash with soap, local,

820
00:55:33,940 --> 00:55:39,360
wet, chili pepper water, right? Chili pepper water. And you learn some things about

821
00:55:39,360 --> 00:55:46,560
these words. One, you learn, not to say, so you learn, touch your forehead, impulse control,

822
00:55:47,140 --> 00:55:52,180
right? You can think those words, but not say them, right? So you start to develop impulse

823
00:55:52,180 --> 00:55:56,700
control. You know if you say them around grown-ups, you're going to get in big trouble. You also

824
00:55:56,700 --> 00:56:02,460
learn that they're very powerful words. And you watch adults use them with specific purpose.

825
00:56:03,140 --> 00:56:11,200
And that purpose is either to hurt and harm or to self-protection scare away. So they have a

826
00:56:11,200 --> 00:56:17,080
purpose. And it's been shown that cursing can relieve pain. If you're spending a lot of pain,

827
00:56:17,720 --> 00:56:20,680
It's not a bad person, but it does help.

828
00:56:21,020 --> 00:56:23,060
I once had some surgery on my foot.

829
00:56:23,240 --> 00:56:24,080
I think it's something removed.

830
00:56:24,280 --> 00:56:27,400
The doctor very kindly said, swear all you want, but don't move.

831
00:56:28,440 --> 00:56:30,500
So I'm like, okay, that's great instructions.

832
00:56:31,460 --> 00:56:35,300
She wanted to give me an outlet, because it was going to hurt.

833
00:56:35,940 --> 00:56:38,160
The last one is the sensory motor.

834
00:56:38,280 --> 00:56:38,900
This one touched.

835
00:56:39,900 --> 00:56:44,460
So human beings, we are hardwired when something feels good, we keep doing it.

836
00:56:44,460 --> 00:56:48,200
But if it does feel bad, kind of poke your arm, don't hurt yourself.

837
00:56:48,520 --> 00:56:49,200
We pull away.

838
00:56:49,420 --> 00:56:49,800
Stove's hot.

839
00:56:49,960 --> 00:56:51,160
You don't even have to think.

840
00:56:51,320 --> 00:56:51,620
It's automatic.

841
00:56:52,260 --> 00:56:56,160
So when touch feels good, we are happy to stay connected.

842
00:56:56,720 --> 00:57:00,520
So take your two palms and put them together and kind of give yourself a little hand.

843
00:57:01,180 --> 00:57:02,340
Palm to palm pressure.

844
00:57:02,840 --> 00:57:04,200
We love it.

845
00:57:04,700 --> 00:57:05,940
It's comforting, right?

846
00:57:06,280 --> 00:57:08,720
When we're anxious, what's this called?

847
00:57:09,560 --> 00:57:10,420
Bringing your hands?

848
00:57:11,020 --> 00:57:11,520
It's comforting.

849
00:57:11,820 --> 00:57:12,680
We're yourself soothing.

850
00:57:13,160 --> 00:57:13,820
Self soothing.

851
00:57:13,820 --> 00:57:18,600
So this is something that we know about us as human beings and we can, we can connect

852
00:57:18,600 --> 00:57:19,860
this way, palm to palm.

853
00:57:20,800 --> 00:57:24,580
And the top touch the top of your head, this is your sensory motor area.

854
00:57:24,760 --> 00:57:26,600
We have a lot of real estate dedicated to this.

855
00:57:27,940 --> 00:57:30,080
It starts to also go on the fritz.

856
00:57:30,880 --> 00:57:36,160
So take your two hands and these three fingers, these are your skill fingers.

857
00:57:36,780 --> 00:57:42,800
So your skill fingers do things like button a button, thread a needle, take your glasses

858
00:57:42,800 --> 00:57:47,860
is on and off, if you wear earrings, if you wear earrings, this is fine motor skills.

859
00:57:48,520 --> 00:57:58,220
These two strength fingers, so pliers, door knobs, peanut butter jack, it's all this,

860
00:57:58,760 --> 00:57:59,600
all dimensions.

861
00:58:00,520 --> 00:58:09,140
You start to lose skill, but you keep strength, so I'm able to grab onto things, sometimes

862
00:58:09,140 --> 00:58:10,300
I can't let them go.

863
00:58:10,880 --> 00:58:15,800
Things that require fine motor, like these darn buttons, I just why did they?

864
00:58:16,640 --> 00:58:16,740
Right?

865
00:58:17,300 --> 00:58:19,700
I button it all wrong, if I'm able to button it at all.

866
00:58:20,200 --> 00:58:21,820
I start to have a lot of trouble.

867
00:58:22,360 --> 00:58:26,120
So people who are living with dementia, they really are doing the best way they can.

868
00:58:26,520 --> 00:58:28,420
And remember who has a healthy brain?

869
00:58:28,820 --> 00:58:33,220
And there are things that we can do to adjust our approach to be able to get connected

870
00:58:33,220 --> 00:58:35,040
and then to move forward together.