Facts About Alzheimer’s and Dementia
- Over 5 million Americans are currently affected by Alzheimer’s
- Every 66 seconds, someone in the United States develops Alzheimer’s
- Approximately 2/3 of those affected by Alzheimer’s are women
- It is the 6th leading cause of death in the United States
- 1 in every 3 seniors die from some form of dementia
- It is the only top ten disease that cannot be slowed down or is not curable
- There are currently over 15 million unpaid caregivers who are providing 18 billion hours of care
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Types of Dementia
Alzheimer’s Disease – This is the most common type of dementia and is the 6th leading cause of death in the United States. It is estimated that over 5 million people over the age of 65 suffer Alzheimer’s. The disease progressively destroys a person memory and thinking ability.
Vascular Dementia – This is the second most common form of dementia. Causes of vascular dementia include stroke, hypertension, smoking, diabetes, lupus, and cardiovascular disease. A person who has vascular dementia can also have other forms of dementia including Alzheimer’s and Lewy body dementia.
Lewy Body Dementia – This is the third most common form of dementia. It is causes by abnormalities in the brain. Lewy bodies are abnormal accumulations of protein in the brain. The symptoms include hallucinations, confusion, depression, stooped posture and shuffling gait. Lewy bodies are found in other diseases of the brain such as Alzheimer’s and Parkinson’s.
Parkinson’s Disease – This is a neurodegenerative disease that affects the nerves that produce dopamine. It is a slow progressing disease and includes symptoms such as tremors, stooped posture, muscle stiffness, and problems with speech and gait.
Frontotemporal Dementia – This type of dementia is cause when there is damage to the cells in the brain resulting in shrinkage of the frontal and temporal lobes. Symptoms include memory loss, and changes in personality and behavior.
Huntington’s Disease – Huntington’s is an inherited disease that is caused by a single defective gene. Anyone who inherits the gene from their parent will eventually develop the disease. The defective gene leads to the breakdown of the central nervous system. A person with Huntington’s disease will experience confusion, memory loss, uncontrollable jerking movements, hallucinations, and behavior changes.
Creutzfeldt – Jakob Disease – This type of dementia only affects one in every one million persons world-wide. It progresses much more rapidly than other forms of dementia. Symptoms include anxiety, impaired thinking, insomnia, muscle jerks, blurred vision, memory loss, and personality changes.
Chronic Traumatic Encephalopathy – CTE is caused by repeated trauma to the head over a period of time. It is often found in people who play professional sports such as football and boxing, military veterans, and victims of domestic abuse. It can only be diagnosed by examining the brain tissue after a persons death. Symptoms include impulsive behavior, suicidal thoughts, emotional instability, short-term memory loss, depression, and difficulty thinking.
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Risk Factors for Dementia
- Heart Disease
- Advanced Age
- Family History
- Smoking
- High Cholesterol
- High Blood Pressure
- Traumatic Brain Injury
- Uncontrolled Diabetes
- Alcoholism
- Vitamin B12 Deficiency
- Thyroid Disease
- Exposure to Chemicals, Heavy Metals or Pesticides
Signs & Symptoms
- Short Term Memory Loss
- Difficulty with Communication
- Difficulty Finding the right Words
- Poor Coordination and Motor Functions
- Difficulty identifying Common Objects
- Difficulty Recognizing People
- Changes in Personality
- Depression
- Anxiety
- Hallucinations
- Mood Swings
- Agitation
- Fatigue
- Difficulty with Ordinary Tasks
- Lack of Problem-Solving Ability
- Doesn’t Recognize Familiar Places
- Difficulty Reading and Writing
- Repetitive Speech
- Poor Hygiene
Dementia is a condition which manifests a set of symptoms that include the loss of memory and the ability to perform normal activities of daily living including behavior, speech, thought patterns, motivation, and emotions.
Dementia symptoms can be categized into two groups; reversible and irreversible.
Examples of Reversible Dementia
- Depression
- Dehydration
- Urinary Tract Infection
- Brain Tumor
- Substance Abuse
- Lyme Disease
- Nutritional Deficiencies
- Medications
- Thyroid Disease
- Liver or kidney disease
- Infections
- Head Trauma
- Vitamin deficiency
Examples of Irreversible Dementia
- Vascular Dementia
- Alzheimer’s
- Picks Disease
- Huntington’s Disease
- Lewy Body Disease
- Frontotemporal Dementia
Stages of Alzheimer’s
First Stage – Lasts 2 – 4 years
Symptoms during the first stage:
- Confusion
- Fatigue
- Mood swings
- Poor judgement
- Getting lost in familiar places
- Problems handling finances
- Memory impairment
- Isolating themselves
- Withdrawn and depressed
- Easily becomes overwhelmed
- Is aware that something is not right
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Second Stage – Lasts 2 – 10 years
Symptoms during the second stage:
- Existing symptoms worsen
- Short attention span
- Unable to live alone, must be supervised
- Issues with wandering
- Poor personal hygiene
- Difficulty following conversations
- Unable to preform activities of daily living independently
- Unable to complete complicated tasks
- Paranoid and suspicious
- Hallucinations
- Repetitive movements
- Repetitive speech, asking the same questions over and over
- Overwhelmed by noise
- Unable to recognize familiar faces
- Unable to remember where they live
- Incontinence of bladder / bowel
- Unstable gait
- Using incorrect words
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Third Stage – Last 1-3 years
Symptoms from stage 1 and 2 continue to progress
- Do not form logical sentences
- Has difficulty eating
- Pockets food in their mouth
- Needs to have food pureed
- Incontinence
- Cannot ambulate
- Does not hold head up
- Unable to participate in simple activities
- Needs liquids thickened to avoid choking
- Unable to ambulate
- Loses their identity
How to Communicate with Someone with Dementia
- Speak in a low tone voice
- Do not overwhelm them with too much information
- Pause in between topics
- Speak at a slower pace
- Tell the person what you are going to do before you begin
- Do not make abrupt changes in their daily routine
- Respect their personal space, don’t get up in their face
- Use positive, encouraging words when speaking to them
- Accept their feelings are genuine and valid
How to Handle Their Roll Coaster of Emotions
Validation
Validating their feelings is a therapeutic technique in which you give answers that make sense to them and to their reality. You acknowledge and validate their thoughts and feelings.
Common Emotions Expressed by a Person with Dementia
- Sadness
- Anger
- Anxiety
- Guilt
- Shame
- Fear
- Grief
It’s important that you accept and acknowledge their reality and their truth. Trying to orient them to the present and correct them will only foster feelings of distrust, anger, confusion and suspiciousness.
Best Way to Handle Their Distorted Reality
- Live in their reality
- Show empathy and support for what they believe to be true
- Offer reassurance and praise
- Let them know its ok to express their negative feelings
- Remember if you project negative emotions, so will they
- Identify the feelings behind their behavior
- Guide the conversation to positive feelings
Dementia and Depression
Depression is usually described as feelings of extreme, prolonged sadness. It can be a mood and a syndrome. Feeling depressed is a normal reaction to an event such as the loss of a loved one or some major change in life.
A syndrome is a collection of symptoms usually consisting of:
- Depress mood
- Loss of interest in previously enjoyed activities
- Lack of energy
- Loss of appetite
It’s important to note that depression is not a normal part of aging. Depression is common among people with dementia. Approximately 40-50% of people with Alzheimer’s suffer from depression.
Other factors that can cause depression:
- Physical illness
- Side effect of medication
- Social isolation
- Fatigue
- Environmental factors
If you suspect someone with dementia is suffering from depression, the first thing to do is to determine if there are any medical issues going on. The doctor may prescribe antidepressant medication to help improve their symptoms of sadness as well as help them sleep better.
You do not want to ignore symptoms of depression. Getting a person with depression medical help can make a huge difference in their quality of life.
What You can do to Help
- Stick to a regular daily routine as much as possible
- Avoid overstimulation
- Avoid large groups or noisy situations
- Have realistic expectations of the person capabilities
- Be positive when interacting with them
Non-Medical Ways to Help Someone with Dementia Fight Depression
- Exercise
- Music
- Dance
- Go for a Walk
- Reminisce
- Participate in spiritual activities
- Let them help out with small projects
- Frequently offer praise and encouragement
Repetitive Behaviors
Repetitive behaviors can either be vocal or physical. Some may be disruptive or even harmful. They can be caused by stress, overstimulation, pain, illness, medications, thirst, or boredom.
It would be helpful to monitor and document the repetitive behaviors in order to determine the cause of the behavior. Document the time of day when the behaviors occur, the circumstances, the surroundings, the behavior displayed, any medications taken shortly before the behavior started.
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Interventions to Help When Repetitive Behaviors Occur
- Consult with their doctor
- Remove them from the environment if it is over stimulating them
- Provide a quiet place for them
- Provide comfort items such as a blanket, stuffed animal,
- Music
- Rocking chair
- Special treats
Delusions and Hallucinations
A delusion is a false belief. It can be a misinterpretation of a situation or the inability to separate fact from fiction.
A hallucination is a false sensory experience that can involve sight, hearing, smell, taste or touch.
Difference Between Dementia and Delirium
Delirium:
Can occur suddenly or over a short period of time
Dementia:
Minor symptoms occurs at first but then progress and worsen over an extended period of time
Delirium:
The person is unable to stay focused and struggle to pay attention
Dementia:
During the early stages the person can focus and pay attention and can often function fairly normally
Delirium:
The symptoms will fluctuate throughout the day
Dementia:
The Cognitive impairments will continue steadily throughout the day
Causes of Delirium
- Drug Abuse
- Alcohol Abuse
- Fever
- Infection
- Surgery
- Medication
- Mental Illness
Causes of Hallucinations
- Lack of oxygen
- Medications
- Infections
- Sensory deficit: loss of vision or hearing
- Pain
- Alzheimer’s
- Low lighting
- Misinterpretation of sights and sounds
- Isolation
If someone is experiencing delusions of hallucinations consult with their doctor. If they wear hearing aides make sure they are working properly, if they wear glasses make sure they are clean. Make sure they are drinking plenty of fluids and are staying hydrated.
Hoarding
Hoarding is a behavior in which a person accumulated objects that they believe to be valuable and necessary to keep. People hoard different types of things for different reasons.
Causes of Hoarding
- They believe the item is valuable
- It is a source of security for them
- The constant desire to collect items
- Obtaining love not sensed from others
- The items bring them comfort from sadness or loneliness
- Inability to organize
- Physical limitations
- Stress
People with dementia, especially Alzheimer’s love to hide things and they are creative with their hiding places. They may change their favorite hiding spot if they feel you are on to them or have discovered they hiding spot.
Places to Check for Hidden Objects
- In their purse
- Under cushions
- In drawers
- In trash cans
- Under pillows
- In the toilet or in drains
- In body orifices
- In closets or cabinets
How to Address the Issue of Hoarding
- Don’t approach them in an angry way
- Speak to them in a soft understanding tone
- Treat them with respect
- Don’t make sudden changes, go slowly and gradually
- Do not be judgmental
- Remove any mirrors if they believe the person in the mirror is a stranger
- Try placing a sign on the door of areas you do not want them to go ie: “NO”
- Keep the doors of rooms you don’t want them to go in locked
- Provide a drawer, basket or container full of old, non-valuable items that they can rummage through and take what they want, which will help fill that desire to collect and store items
- Identify their favorite hiding spots
- Retrieve items when they are not present
- Simplify the environment, keep areas decluttered.
- Provide tactile stimulation for them
- Provide magazines and books for them to look at
Wandering
Triggers that can Cause a Person to Wander
- Change in medication
- Unfamiliar environment
- Change in routine
- Fear
- Over stimulation
- Boredom
- Need to use the bathroom
Interventions for Wandering
- Make sure their basic needs are being met: Thirst, fear, toileting, hunger, boredom
- Provide one to one attention
- Provide them with a rocking chair
- Give them small tasks to do
- Provide stimulation
- Involve them in the daily routine
- Avoid arguing
- Create safe walking paths for them
Aggressive Behavior
Aggressive behavior can include
- Hitting
- Biting
- Verbal outbursts
- Socially inappropriate behaviors
- Repetitive behaviors
Causes of aggressive behavior can include
- Pain
- Illness
- Frustration
- Inability to communicate
- Misinterpretation of light and sounds
- Boredom
- Loneliness
- Demands not met
Interventions
- Keep a behavior log to track what is triggering them. Look for the who, what, where, when and why.
- Watch for signs of stress, anxiety and restlessness
- Provide a quiet space for them
- Approach them in a non-aggressive or threatening way
- Speak in a slow, calm tone
- Introduce yourself
- Play soothing music
- Eliminate noise or any source of over-stimulation
- Remove mirrors
- Provide comfort items
- Use soft lighting
When Aggression Happens
- Approach the person from the side not the front. It is less threatening. It also makes if harder for them to hit you
- Remain calm. The more agitated you become, the more agitated they will become
- Watch what you say and how you say it
- Be mindful of your body language. They may pay less attention to what you are say, and more attention to your body language
- Take them to a quiet area, away from other people
- Make eye contact with them
- Respect their personal space
- Keep arm distance away, in case they take a swing at you
- Do not turn your back on them
- Stay near at exit, do not let yourself get cornered in