look like you know mines predisposed tional too but i know what it means and i think the proof in a check registers how many checks of events over the last year if you look down some tracks i think you're doing falling my mom has a system that she has devised actually very cute system my mom absolutely hates to pay annual pills property taxes property insurance car insurance so she knows that that's tough runs about thirty five hundred dollars a year so what she does is that every month when she gets her eleven hundred and seven dollar social security check she shows that a positive eight oh seven takes three hundred apt so every month she has an increasing three hundred dollar balance their checkbook so once a year when she has to pay those in your bills she writes the bills but she didn't have to subtract anything from ballots are free kit and see the system works quite well and it makes her feel better about doing it et cetera but if you look at her checkbook you see three hundred circle with red and the next month it'll say six hundred circled with red ink the nine hundred circled with reading so i told her one time i said perjure nursing home i'll just bring in your checkbook show people that sees she even circle stuff with blood in her checkbook now what kind of judgment is that okay more dementia comments that you do not have handout pages for and i'll bring you back when we go back to the handout dimension is defined as a group of symptoms referring to a global impairment of mental functioning the impairment interferes with the client's ability to perform daily activities dementia is caused by a variety of diseases and it is never ever part of the normal aging process dementia is difficult to distinguish from delirium or depression based solely on behavior dementia results from organic disease and it's usually irreversible in progressive you are shut that door back there the big picture of dementia is that we have brain cells neurons with dementia get damaged in some manner so there's actual physical damage to the neurones those neurons are responsible for storing transmitting in utilizing information when they get damaged they don't work anymore so with alston immersed in the chip they get tangle they get twisted they develop plaque or deposits on and they're not unlike our troops chronic plaque in the group in the blood vessels and when that happens they stop being functional once that starts it's generally irreversible and it's progressing so the personable all timidly get weaker and weaker in topic with other types of dementia is there's different types of physical decay the neurons but they all involve physical decay to neurons prevalence rates of dementia are not nearly as high as you would think that they are i've someone from age sixty five to seventy four the odds of than having a sip as severe dementia is one percent from age seventy five to eighty four that jumps to seven percent and eighty-five and over it goes to twenty five percent that's from a new jersey alzheimer's disease study someone challenge that the other day in seminar and we were to be a sermon looked it up bsn prevalence rates are very similar to things so one-in-four is really a significant number at the age of eighty five but it's not the number that you would think that was seems like to me they taught us in graduate school that it eight to eighty eighty percent of people were demented age nineteen ninety percent of people were demented and if you live long enough everybody got to meet well it's just double row by the numbers you know it's just not true dimension is a reasonably rare disease i mean one and four at the age of eighty five but that still means three and four don't of all the types of dimensions probably sixty percent of these are in fact alzheimer's dementia but the only way to no one type of dementia from the other is on brain biopsy and most people don't like to have that done so we generally find out on autopsy what type of dementia that it was so that sixty percent turnout to be alzheimer's twenty percent multi infarct twenty percent something else the multi infarct we can distinguish by the way because we do ct scan it see if we see multiple layers of infor thomas each year the mri_ is some forty are has sort of recognize that it would now simplified dementia coach down to two we have one code for multi infarct dementia one code for everything else and then make some sense because for the everything else we generally are guessing we get some clues from patterns on your oath psych testing of various types of impairments being more 