December 6, 2005 > Dementia and Alzheimer's disease
Dementia and Alzheimer's disease
by Natalia Smothers
Amazing medical discoveries in the last 50 years have advanced the treatment of heart, intestinal and many other diseases while extending our general life expectancy. Parents and grandparents are enjoying their kids and grandkids much longer than did their peers a century ago. However, this extension comes with a price - we see proportionate growth of senile dementia among our loved family members. And, we struggle adjusting to this change.
"I never imagined that my mother-in-law, Gloria, who was a bookkeeper before she retired would not be able to balance her checkbook," said Joyce Peters, Fremont resident and owner of Internet children's book and toy store, Giant Steps. "Now I am used to her calls every week or so complaining that she lost her checkbook again or that she is afraid the housekeeping service may have 'stolen' her account information."
Gloria is in her mid-80s and considered to have a mild form of dementia. She still drives but only with navigation help from her 91-year-old husband because she may forget how to get back home. She is relatively organized putting most things in the house in the same place but panics immediately if she accidentally misplaces something and turns the whole house upside down looking for the lost item.
"My major concern is Gloria's safety," said Joyce. "If she falls and breaks a bone, this would trigger a further restriction in her movements and contribute to deterioration of her mental abilities."
A similar shock happened to Gloria about two years ago when she had a surgery on her lungs at the hospital. After that, her dementia seemed to escalate much more rapidly.
"Being on the 'in-law' side, I think, helped me approach the problem more rationally," said Joyce. "I prepared some organizing suggestions, and my in-laws readily accepted most of them. Consistency in following through has been a challenge though."
Joyce calls her list of recommendations "senior-proofing" - analogous to the common term of child-proofing. She learned and practiced some of the principles at the time when she worked after college as a dietician in Pittsburgh, Pa. and at a nursing home in Brooklyn, N.Y. However, the majority of the tips came from the experience of adjusting her parents-in-law's house to Gloria's deteriorating condition.
Senior-proofing tips from Joyce Peters
"I would recommend starting senior-proofing adjustments ahead of time, with the first signs of forgetfulness, before your loved one develops full confusion about the life around them," said Joyce. "Senior people in general are very slow in adapting to changes. A senile person in such situation often feels vulnerability and fear of being cheated and abused. Everything should be done gradually, without quick changes. As adults, they always should make the final decision, but you can limit their choices."
Safety concerns should be addressed first. Remove all throw rugs and obstacles on which a senior person can trip. Clear pathways and place nightlights everywhere in the home, especially on the way to the bathrooms.
Teach your loved one to get in the habit of carrying a small notebook with names, addresses, important numbers etc. Writing down things would help them avoid asking the same questions or losing track of things. It is the same way our to-do lists and palm pilots help us stay organized in the hectic world.
Print all instructions and labels in large font or using simple pictures. Be particularly careful labeling the medications.
To avoid paper overload, introduce a simple paper shredder and show them how to use it. Encourage them to shred most of their reviewed bills and documents. Have really important papers sent to a trusted family member.
Explain how simplified finances would help them avoid paranoia over "stolen" account numbers. Convince them to open a joint account with a trusted family member who can check online for unauthorized or unusual withdrawals from the bank account. Organize a paper trail and keep it safe with that most important document - the will.
Encourage your loved one to stop saving for old age and spend money on things that make their life more pleasant, like a new appliance or comfortable chair. Joyce's grandmother is 103 years old. She lives in New York City, is still socially active and remembers all important events and phone numbers. Only last summer did she finally agreed to stop saving on electricity and used an air conditioner for the first time.
Senior people would feel more in control if they develop a habit of putting things in the same place. They can spend an incredible amount of time looking for a misplaced item while feeding on their paranoia.
Help them pick some comfortable clothing with plenty of pockets - something like a house jacket or apron for women, a favorite vest for men where they can always carry their keys, a pen and a notebook. Select their pants with elastic waist and Velcro instead of buttons, laces or zippers.
Expect the unexpected. Sometimes people suppress their hidden personality during the life, and then it comes to the surface with the onset of dementia. Button-down, non-emotional people can turn into mushy types, and polite ones could say exactly what's on their mind.
Discuss in advance options for possible nursing care in the late stages of dementia. People with severe forms of the disease can escape from locked up hospital facilities.
Finally, follow the advances in the medical research. There are still a lot of mysteries about causes and risk factors for dementia and Alzheimer's disease. Who knows, the time of crucial discoveries may come sooner than we think.
According to Alzheimers.org, "the term 'dementia' describes a group of symptoms that are caused by changes in brain function. Dementia symptoms may include asking the same questions repeatedly; becoming lost in familiar places; being unable to follow directions; getting disoriented about time, people, and places; and neglecting personal safety, hygiene, and nutrition."
Sometimes older people have emotional problems that can be mistaken for dementia. Some seniors may feel sad, lonely, worried, or bored because of their retirement or the death of a spouse, relative, or friend. Adapting to these changes leaves some feeling confused or forgetful. Support from family and friends or professional help from a doctor or counselor is usually sufficient to relieve these dementia-like symptoms.
Among a variety of dementia-causing conditions, there are some that can be reversed. For example, those that are influenced by a high fever, dehydration, vitamin deficiency and poor nutrition, bad reactions to medicines, problems with the thyroid gland, or a minor head injury, are some that can be helped favorably.
Unfortunately, the two most common forms of dementia in older people cannot be cured, according to the current state of medical research. They are Alzheimer's disease and multi-infarct dementia (sometimes called vascular dementia).
Symptoms that begin suddenly may be a sign of multi-infarct dementia. They are caused by a series of small strokes or changes in the brain's blood supply which result in the death of brain tissue. The location in the brain where the small strokes occur determines the seriousness of the problem and the corresponding symptoms. Often control over high blood pressure prevents additional strokes and development of new symptoms.
About Alzheimer's disease
The most common form of dementia among older people is Alzheimer's disease (AD), which initially involves the parts of the brain that control thought, memory and language. Although scientists are learning more every day, right now they still do not know what causes AD.
AD is named after Dr. Alois Alzheimer, a German doctor. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. He found abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary tangles). Today, these plaques and tangles in the brain are considered signs of AD.
Scientists also have found other brain changes in people with AD. Nerve cells die in areas of the brain that are vital to memory and other mental abilities, and connections between nerve cells are disrupted. There are also lower levels of some of the chemicals in the brain that carry messages back and forth between nerve cells. AD may impair thinking and memory by disrupting these messages.
Scientists think that up to 4.5 million Americans suffer from AD. That number is projected to double in the next 20 years as baby boomers age. The disease usually begins after age 60, and risk goes up with age. While younger people also may get AD, it is much less common. About 5 percent of men and women ages 65 to 74 have AD, and nearly half of those age 85 and older may have the disease.
AD is a slow disease, starting with mild memory problems and ending with severe brain damage. The course the disease takes and how fast changes occur vary from person to person. On average, AD patients live from eight to 10 years after they are diagnosed, although the disease can last as long as 20 years.
Currently doctors can only make a diagnosis of "possible" or "probable" AD while the person is still alive because finding plaques and tangles in brain tissue is difficult even with brain scans. However, specially designed questionnaires, cognitive and medical tests allow doctors to diagnose AD correctly up to 90 percent of the time.
An early, accurate diagnosis of AD helps patients and their families plan for the future. It gives them time to discuss care options while the patient can still take part in making decisions. Early diagnosis also offers the best chance to treat the symptoms of the disease.
At first, the only symptom may be mild forgetfulness, which can be confused with age-related memory change. Most people with mild forgetfulness do not have AD. In the early stage of AD, people may have trouble remembering recent events, activities, or the names of familiar people or things. They may not be able to solve simple math problems. Such difficulties may be a bother, but usually they are not serious enough to cause alarm.
However, as the disease goes on, symptoms are more easily noticed and become serious enough to cause people with AD or their family members to seek medical help. Forgetfulness begins to interfere with daily activities. People in the middle stages of AD may forget how to do simple tasks like brushing their teeth or combing their hair. They can no longer think clearly. They can fail to recognize familiar people and places. They begin to have problems speaking, understanding, reading, or writing. Later on, people with AD may become anxious or aggressive, or wander away from home. Eventually, patients need total care.
The current medications prescribed to AD patients do not stop AD; they only slow down the process for a limited time. Some medicines may help control behavioral symptoms of AD such as sleeplessness, agitation, wandering, anxiety and depression. Treating these symptoms often makes patients more comfortable and makes their care easier for caregivers.
Everybody is at risk of developing this disease. Several genetic factors are known to increase the risk, without themselves being the cause. The probability is higher for women and for people having a lower level of education.
Scientists are finding increasing evidence that some of the risk factors for heart disease and stroke, such as high blood pressure, high cholesterol and low levels of the vitamin folate, may increase the risk of AD. Evidence for physical, mental and social activities as protective factors against AD is also increasing.
If we expect to live to our 80s and 90s, we should definitely consider focusing on the risk factors for dementia and Alzheimer's disease, trying to eliminate them from our life and taking full advantage of the extended lifespan.