Senior Sunrise

• Diet and supplements: The food you eat makes a big difference in your memory function. Certain high fat foods, such as grain-fed beef clog up your brain cells, while fish such as fresh frozen Alaskan salmon and some vegetables and fruit actually protect it.
• Stress Management: This is critically important, because, as we’ll see in future articles, chronic, unbalanced stress kills brain cells in the hippocampus, your brain’s memory center. The practice of regular relaxation techniques and social activity can help.
• Exercise: The latest research clearly shows the fundamental imperative of physical, mental, and mind/body exercise in maximizing your memory. Exercise may even grow new brain cells, recent research denotes.
• Anti-aging hormone replacement therapy. There may be a place for the artful replacement of certain hormones to help maintain not only optimal physical health, but brain health as well.
• Diet and supplements: The food you eat makes a big difference in your memory function. Certain high fat foods, such as grain-fed beef clog up your brain cells, while fish such as fresh frozen Alaskan salmon and some vegetables and fruit actually protect it.
• Stress Management: This is critically important, because, as we’ll see in future articles, chronic, unbalanced stress kills brain cells in the hippocampus, your brain’s memory center.
• Exercise: The latest research clearly shows the fundamental imperative of physical, mental, and mind/body exercise in maximizing your memory. Exercise may even grow new brain cells, recent research denotes.
• Anti-aging hormone replacement therapy. There may be a place for the artful replacement of certain hormones to help maintain not only optimal physical health, but brain health as well.

Types of Dementia

When dementia is suspected the first step is to get a more accurate diagnosis of the type of dementia, so that appropriate treatments can be offered to the patient.

• Alzheimer’s disease is the most common form of dementia

• Other disorders that can lead to dementia include: Pick’s, Vascular, Creutzfeldt-Jakob disease (CJD), Lewy Body, Frontotemporal dementia and Parkinson’s related dementia

• Infectious diseases such as HIV and AIDS, meningitis, advanced neurosyphilis can also lead to dementia.

• Dementia is also sometimes associated with drug abuse or toxins such as mercury, carbon monoxide and lead.

 A skilled physician will be able to diagnose the cause of Alzheimer’s-like symptoms with over 90% accuracy.

Diagnosis of Alzheimer’s Disease

A diagnostic workup will include the following:

• A medical history. Medications history. This includes current medications and dosage, medications taken for passed medical conditions, any incidence of drug allergies or drug misuse.

• Neurological examination. An examination of the motor system (movement),  an evaluation of reflexes, coordination, and sensory functioning;  to detect problems with the nervous system that may be causing problems with thinking and behavior.

• Premorbid history. How someone functioned before the occurrence of disease.

• Complete physical examination to assess hearing, vision, blood pressure, pulse, and other basic indicators of health and disease.

• Preliminary evaluation of current mood.

Tests for Alzheimer’s Disease

There are numerous and different tests.

• Mental status examination. The (MSE) Mental Status Examination test in onne of the key diagnostic tests for dementias such as Alzheimer’s The doctor/clinician makes judgments on the way the patient is functioning in a number of key areas. Each aspect will contribute to a diagnosis. The MSE will  assess memory, concentration, and other cognitive skills. Based on a series of questions and tests, points are achieved when they are answered correctly.

• The Clock Test. This is a simple test can be used as a part of a neurological test or as a screening tool for Alzheimer’s and other types of dementia.

• Laboratory tests usually include urine and blood tests to establish whether such things as diabetes, infections, heart disease are present.

• Imaging procedures such as a computed tomography (CT) scan, a magnetic resonance imaging (MRI), or a positron emission tomography (PET) scan can identify changes in brain structure or size indicative of Alzheimer’s. These tests give a detailed picture of the brain and can see if someone has blood clots, tumors, has had a stroke or other abnormalities that might account for Alzheimer’s type symptoms.

Who Can Diagnose Alzheimer’s Disease?

• The first person from who we seek help is a primary care physician (your family doctor), and they will be able to refer someone for further tests and consultations for an accurate diagnosis.

• There are many different health professionals who can diagnose or can contribute to a diagnosis of Alzheimer’s disease.  The choice of specialist depends on a number of factors that the individual is demonstrating. The recommendation from the primary care physician may be to recommend one or more of the following:

• A Gerontologist who specialize in the study and diseases of aging.

• A psychiatrist who specializes in mental, emotional, and behavioral disorders.

• A Neurologist- who specializes in diseases of the nervous system such as Alzheimer’s, Parkinson’s or strokes.

• A Neuropsychologist who specializes in brain-behavior relationships. They undertake neuropsychological testing to determine the type and level of impairment.

 

Twelve Steps for Caregivers

1. Although I cannot control the disease process, I need to remember I can control many aspects of how it affects my relative.

2. I need to take care of myself so that I can continue doing the things that are most important.

3. I need to simplify my lifestyle so that my time and energy are available for things that are really important at this time.

4. I need to cultivate the gift of allowing others to help me, because caring for my relative is too big a job to be done by one person.

5. I need to take one day at a time rather than worry about what may or may not happen in the future.

6. I need to structure my day because a consistent schedule makes life easier for me and my relative.

7. I need to have a sense of humor because laughter helps to put things in a more positive perspective.

8. I need to remember that my relative is not being difficult on purpose; rather that his/her behavior and emotions are distorted by the illness.

9. I need to focus on and enjoy what my relative can still do rather than constantly lament over what is gone.

10. I need to increasingly depend upon other relationships for love and support.

11. I need to frequently remind myself that I am doing the best that I can at this very moment.

12. I need to draw upon the Higher Power, which I believe is available to me.

Source: The American Journal of Alzheimer's Care and Related Disorders & Research, Nov/Dec 1989

About 80% of patients with Alzheimer’s disease are cared for by family members, who often lack adequate support, finances, or training for this difficult job. Few diseases disrupt a patient and his or her family so completely or for so long a period of time as Alzheimer’s. The patient’s family endures two separate losses and grieves twice:

• First, they must grieve for the ongoing disappearance of the personality they recognize. Dealing with the patient throughout the course of the disease is like Alice’s fall down the rabbit hole into Wonderland. No sooner has the caregiver grappled with one set of problems, when the patient’s further deterioration creates new and more intractable ones.
• Finally, the caregiver must grieve the actual death of the person.

Often, caregivers themselves begin to show signs of mental disorder or ill health. The disease may even have negative effects on the immune systems of the patients’ partners. Depression, empathy, exhaustion, guilt, and anger can play havoc with even a healthy individual faced with the care of a loved one suffering from Alzheimer’s. The care-giving spouse is usually elderly and often frail. Children are likely to have grown up and may live far away

Although the great majority of caregivers have expressed their need for good information, in a 2001 study only 28% of caregivers believe they have received thorough and helpful information from their doctors. It is important for caregivers to receive counseling and support for themselves. Studies suggest that caregivers who are offered counseling on coping and handling stress experience fewer reactions to their patient’s behavioral problems than those without such help. In one study in which caregivers took part in support programs, institutionalization of the patient was delayed by a year. National and local Alzheimer’s associations are available and can provide important support and other services.

 Source: The American Journal of Alzheimer’s Care and Related Disorders & Research, Nov/Dec 1989

Home Treatment During Later Stages

· Patients with Alzheimer’s disease need 24-hour a day attention.caregiver has the resources to keep the patient at home during later stages of the disease, outside help is still essential. If available, home visits by a health profession can have a favorable impact on survival and delay the need for a nursing home. Medicare now covers many Alzheimer’s services, and patients should be able to stay at home longer than previously.

· Incontinence. A patient’s incontinence is generally devastating to the caregiver and a primary reason why many caregivers decide to seek nursing home placement when the patient reaches this stage. When the patient first shows signs of incontinence, the doctor should make sure that it is not caused by an infection. Urinary incontinence may be controlled for some time by trying to monitor times of liquid intake, feeding, and urinating. Once a schedule has been established, the caregiver may be able to anticipate incontinent episodes and get the patient to the toilet before they occur.

· Immobility and Pain. As the disease progresses, patients become immobile, literally forgetting how to move. Eventually, they become almost entirely wheelchair-bound or bedridden. Bedsores can be a major problem. Sheets must be kept clean, dry, and free of food. The patient’s skin should be washed frequently, gently blotted thoroughly dry, and moisturizers applied. The patient should be moved every 2 hours and the feet kept raised with pillows or pads. Exercises should be administered to the legs and arms to keep them flexible.

· Dehydration. Dehydration can become a problem. It is essential to encourage fluid intake equal to eight glasses of water daily. Coffee and tea are diuretics and will deplete fluid.

· Eating Problems. Weight loss and the gradual inability to swallow are two major related problems in late-stage Alzheimer’s and are associated with an increased risk of death. Weight gain, however, is linked to a lower risk of dying. The patient can be fed through a feeding syringe, or the caregiver can encourage chewing action by pushing gently on the bottom of the patient’s chin and on the lips. The caregiver should offer the patient foods of different consistency and flavor. Because choking is a danger, the caregiver should learn to administer the Heimlich maneuver, which may be taught by the local Red Cross. In very late stages, some caregivers choose feeding tubes for the patient. They should be aware that feeding tubes have no measurable impact on survival.

Source: The American Journal of Alzheimer’s Care and Related Disorders & Research, Nov/Dec 1989

 Stages

The life span of patients with Alzheimer’s is generally reduced, although a patient may live anywhere from 3 to 20 years after diagnosis. The final phase of the disease may last from a few months to several years, during which time the patient becomes increasingly immobile and dysfunctional. Caregivers should understand the phases of this illness in order to help determine their own capacities for dealing with this painfully sad disease.

Home Treatment in Early Stages

Telling the Patient. Often doctors will not tell patients that they have Alzheimer’s. If a patient expresses a need to know the truth, it should be disclosed.

Mood and Emotional Behavior. Patients display abrupt mood swings and many become aggressive and angry. Some of this erratic behavior is caused by chemical changes in the brain. But it may also be due to the experience of losing knowledge and understanding of one’s surroundings, causing fear and frustration that patients can no longer express verbally.

The following recommendations for caregivers may help soothe patients and avoid agitation:

• Keep environmental distractions and noise at a minimum if possible. (Even normal noises, such as people talking outside a room, may seem threatening and trigger agitation or aggression.)
• Speak clearly. Most experts recommend speaking slowly to a patient with Alzheimer’s disease, but some caregivers report that patients respond better to clear, quickly spoken, short sentences that they can more easily remember.
• Use a combination of facial expression, voice tones, and words for communicating emotions. (One study suggested that patients may have difficulty in recognizing the meaning of facial expressions, particularly those signaling sadness, surprise, and disgust.)
• Limit choices (such as clothing selection).
• Offer diversions, such as a snack or car ride, if the patient starts shouting or exhibiting other disruptive behavior.
• Simply touching and talking may also help.
• Maintain as natural an attitude as possible. Patients with Alzheimer’s disease can be highly sensitive to the caregiver’s underlying emotions and react negatively to patronization or signals of anger and frustration.
• Showing movies or videos of family members and events from the patient’s past may be comforting.

·         Although much attention is given to the negative emotions of patients with Alzheimer’s disease, some patients become extremely gentle, retaining an ability to laugh at themselves or appreciate simple visual jokes even after their verbal abilities have disappeared. Some patients may seem to be in a drug-like or “mystical” state focusing on the present experience as their past and future slip away. Encouraging and even enjoying such states may bring some comfort to a caregiver.

·         There is no single Alzheimer’s personality, just as there is no single human personality. All patients must be treated as the individuals they continue to be, even after their social self has vanished.

Appearance and Cleanliness. For the caregiver, grooming the patient may be an alienating experience. For one thing, many patients resist bathing or taking a shower. Some spouses find that showering with their afflicted mate can solve the problem for a while. Often patient with Alzheimer’s disease lose the sense of color and design and will put on odd or mismatched clothing. It is important to maintain a sense of humor and perspective and to learn which battles are worth fighting and which ones are best abandoned.

Driving. As soon as Alzheimer’s is diagnosed, the patient should be prevented from driving. One study found that more than half of elderly people involved in fatal accidents had some degree of neurological damage.

Wandering. A potentially dangerous trait is the patient’s tendency to wander. At the point the patient develops this tendency, many caregivers feel it is time to seek out nursing homes or other protective institutions for their loved ones. For those who remain at home, the following precautions are recommended:

• Locks should be installed outside the door, which the caregiver can open, but the patient cannot.
• Alarms may be installed at exits.
• A daily exercise program should be implemented, which may help tire the patient. One study showed that walking 30 minutes, three times a day, also improved communication.
• The caregiver should contact organizations, such as Alzheimer’s Association or Medic Alert, for identification supplies and procedures that help locate patients who wander away from home and become lost.
• Some experts are discussing the benefits versus the ethics of electronic tagging, which would emit a radio signal or alarm that allows the patient to be tracked using a detector.

Speech Problems. Some evidence suggests that speech therapy combined with Alzheimer’s disease medications may be helpful for maintaining verbal skills patients with mild symptoms.

Sexuality. In many cases, the patient becomes uninhibited sexually. At the same time, the patient’s physical deterioration and receding capacity to recognize the spouse as a known and loved individual can make sexual activity unattractive for the care giving spouse. Other patients may lose interest in sex.

Source: The American Journal of Alzheimer’s Care and Related Disorders & Research, Nov/Dec 1989

Dr. Alios Alzheimer proved that this disease was much more than ordinary dementia. Because of his persistent research and study we know today that this disease is a slow deterioration of the brain cells caused by the accumulation of plaque. It is irreversible. No present day drugs can stop it. They can only slow its progression.

For those who have it, and cannot speak for themselves, I say, “Thank you for your love and patience.”

For those of you caring for someone who has it, I say, God bless you for showing them dignity, and respect.

To all of us who believe in it, and what it can do to ruin our quality of life, I say, keep your mind alert by learning new things. Stay active mentally, socially, physically, and spiritually.

Promote and support a cure for Alzheimer’s.