Related Dementia Links

A Guide for Families

THE LORD BLESS YOU AND KEEP YOU, THE LORD MAKE HIS FACE SHINE UPON YOU AND BE GRACIOUS TO YOU, THE LORD TURN HIS FACE TOWARD YOU AND GIVE YOU PEACE.
Numbers 6:24-26

 

The word dementia is taken from the Latin, meaning madness:
De = without / and ment  = mind

A generation ago it was referred to as senility or organic brain syndrome. Dementia may be defined as a serious loss of cognitive ability in a previously unimpaired person beyond what is expected with normal aging. Dementia is NOT a normal part of growing old. Symptoms can range from very mild memory loss to severe cognitive problems that make it impossible to manage without help


7 Stages of Dementia

It is generally accepted that there are 7 stages of Dementia.

It helps to have an idea of what to expect when someone you love has been diagnosed with dementia.
Understanding what the future holds helps families to formulate a plan of care.
Being aware of the stages of the disease may alleviate anxiety.

 

Normal Adult:

  • There are no signs of dementia and the person is able to function independently

 

Normal Elderly Adult:

  • Signs are barely noticeable.  There may be some forgetfulness, some difficulty with remembering names and dates.  This may be the normal kind of memory problems associated with aging e.g., misplacing keys but finding them after some searching

 

Possible Very Early Dementia:

  • The person is usually able to do basic activities, such as getting up in the morning, grooming and dressing, going to the bathroom without difficulty.  Symptoms may include:
    • Some forgetfulness and memory loss
    • Repetition
    • Losing items without being able to retrace steps to find them
    • Slight trouble managing finances, such as balancing a checkbook
    • Confusion while driving
    • Trouble managing medication
    • Loss of concentration

 

Mild Dementia:

  • The person has trouble doing routine tasks that they have always done in the past, such as cooking, using the washing machine, or making coffee.  Some other symptoms:
    • Trouble holding urine (incontinence)
    • Increase in memory loss and forgetfulness
    • Inability to use or find the right word and phrases
    • Difficulty with challenging mental health exercises such as counting backwards from 100 by 7
    • Increased social withdrawal

 

Moderate Dementia:

  • The person will need some assistance with their day to day activities.  Symptoms may include:
    • Increase in memory loss
    • Inability to remember home address, phone number, and other personal details
    • Confusion about location or chain of events
    • Trouble with less challenging mental math exercises
    • Needing help to select appropriate clothing for the climate, season, or occasion

 

Moderately Severe Dementia:

  • The person needs a lot more help with day to day activities.  Symptoms may include:
    • Needs help to get dressed
    • Needs help with toileting, such as wiping and flushing
    • Wandering and becoming lost if not supervised
    • Inability to recall the names of family members but is still able to recognize faces
    • Sleep disturbances
    • Changes in personality or behavior, such as increased paranoia or hallucinations

 

Severe Dementia:

  • The final stage.  Symptoms include:
    • Loss of language skills
    • Loss of awareness of surroundings
    • Requires feeding
    • May be able to feed self some finger foods
    • Lack of control over urination
    • Loss of muscle control to smile, swallow, or walk, or sit without support

The doctor is the one to determine if a person has dementia and if so, what stage.  SEE YOUR DOCTOR
THE INFORMATION PRESENTED HERE IS FOR INFORMATIONAL PURPOSES ONLY.
References: Stephen Fox, DO / Mayo Clinic / Everyday Health

The road ahead may be long and winding; we are here to help

Dementia or Alzheimer’s starts slowly.  In the beginning the only symptoms may be forgetfulness.  There may be some problem remembering recent events, activities, or the names of familiar people, such as grandchildren or nieces and nephews.  There may be difficulty in doing simple math and it may be harder for the person to write out a check and enter it in a checkbook. These things can be annoying but they usually are not too serious and do not cause alarm among a family
As the disease progresses, symptoms are clearer and more noticeable and usually cause the person or the family to see a doctor.

In later stages the person may not be able to brush his or her teeth, comb hair, do laundry, or go to the grocery store.  They can no longer think clearly and have problems speaking and understanding what is being said to them.  They do not read and cannot write.  Then they may become anxious or aggressive, or wander.  This is especially dangerous as the person may leave the house and wander away and be unable to find the way home again.  Sleep patterns may become erratic with many “cat naps” and no real sleep so the family is unable to get any rest.

Fortunately, dementia is not a physically painful disease.  In the advanced stages there seems to be reduced sense of pain.  There may be a loss of ability to distinguish hot from cold.

A cycle begins and things continue to deteriorate.  Nerves are frayed everyone is upset, and even angry.  Eventually, the person needs total care.  This causes increased anxiety for family members who are frequently angry at what has happened and / or guilty over their inability to care for the person. Early on it is usually the spouse or child or other family member who will provide day to day care for the person with dementia.

As the disease progresses the person needs more and more care.  This is difficult for care givers and can affect their physical health as well as their mental health, family life, job, and finances. Placement allows the family to regroup and continue with their lives and jobs. Patients can be kept at home with the help of an outside professional care giver service such as Home Helpers. The stress of daily life for all of us is constant, and job and family pressures are higher than at any other time in history.

Before diagnosis, a complete medical history is taken including information about lifestyle and past medical problems.  Questions will also be asked about any difficulties the person may have carrying out activities of daily living (ADL)

There may be medical tests, such as blood tests and urine analysis.  This helps rule out any underlying medical causes for changes. Neurology tests measure memory, problem solving ability, attention span and language skills. There may be a brain scan done to see if there is anything present that deviates from the norm. All of these tests help the doctor rule out causes other than dementia.  For example, thyroid problems, drug reactions, or brain tumors can all cause dementia like symptoms
Brain tissue analysis can accurately diagnose dementia.  This is done after the person has died so the medical community has devised other ways to arrive at a diagnosis.  This is why the diagnosis may say “possible” or “probable” dementia.

Dementia is a slow disease starting with mild memory problems and ending with severe brain damage  On average, patients live from 8 to 10 years after diagnosis although it is not unusual for someone to live as long as 20 years

NOTHING can stop the progression of the disease. There is still a long way to go to unlock the key to managing or curing dementia. Progress has been made and work is ongoing.

Dementia is a brain disorder and it affects a person’s ability to function and do ordinary things in life that most of us take for granted.  It involves the parts of the brain that are responsible for memory, thinking, and speaking. Dementia may be divided into three phases; mild, moderate, and severe.  Changes may be gradual and not apparent on a day to day basis.  Each phase can last for a few years. Memory may be the first loss.  This memory loss is not occasional absent mindedness; we all have that from time to time, at least I hope we do.  The memory loss is consistent and is accompanied by a decline in day to day functioning. Forgetfulness of recent events is greater than that for remote events. The same question is asked repeatedly; Learning new information is impaired; Memory impairment is consistent; Mild word finding difficulty is present.

In the moderate stage recent memory is more limited.  Many people can only remember simple things such as where they were born or their birthday.  Family members’ names may not be remembered and recent events or activities cannot be recalled.

Word finding difficulty continues.  The person may say “the thing that tells time” instead of watch or clock. In the severe stage there is great difficulty with long term memory loss.  The person may not recognize family members.  At this stage the person will not be oriented to the day, month, year, season, or place. In this stage there no problem solving and the person will need help with even simple tasks.


Dementia and the Person

  • Do not take away hope
  • The diagnosis of Dementia or Alzheimer’s is devastating to the person and the family and is often done too early
  • The person can also be wrongly diagnosed
  • Most dementia research being done today is on Alzheimer’s type dementia
  • In a person under the age of 50 dementia is considered a rare neurological disease of the young

 

The Meaning

The word dementia is a broad term that refers to any cognitive impairment, including memory loss. Dementia is classified by type, such as Alzheimer’s Dementia, AIDS Dementia, Parkinson’s Dementia, Head Trauma Dementia, Vascular Dementia, Lewy Body Dementia, or Creutzfeld – Jacob Dementia (the variant is known as Mad cow Disease). There are many, many, cause of dementia.

The onset of symptoms may be slow, and may take months or years before becoming a problem.  There will be memory deficits, impaired abstract thinking, and lack of judgment.

In the terminal stages there is disorientation and clouding of consciousness.  There can be depression, agitation, sleeplessness, and paranoid ideation.  The person may become combative and / or argumentative.

Patients become dependent for activities of daily living (ADL) such as bathing, toileting, and eating. Typically death comes from complications of immobility. The causes of most forms of dementia are not entirely clear. Treatment is symptomatic therapy for primary dementia and appropriate specific therapy for the reversible causes. Various drugs may be needed. Aricept (donezpril) is frequently used. Other drugs that may be used include Cognex (tancrine), Excelon (rivastigmine), and Reminyl (galantamine).  All of these drugs are for dementia.  They are thought to prevent some symptoms from becoming worse, for a limited time. Some doctors like to start one of these medications early with the hope of keeping the person “level” for as long a period of time as possible.

Scientists are testing non steroidal anti – inflammatory drugs, referred to as NSAIDS, to find out if they slow the disease.  There is some evidence that inflammation in the brain contributes to dementia changes. There is hope that the NSAIDS will slow the progression of dementia.  The NSAIDS Vioxx (rofecoxib) and Aleve (naproxen) are being tested.  There are many other NSAIDS available such as Celebrex (celecoxib), Motrin (Ibuprophen), Tylenol (acetaminophen), and aspirin
Vitamin E is also being studied.  Some think that this vitamin can slow progression for 6 months or so
Gingko biloba may be of some help with symptoms.  Can estrogen help?  Unsure as of now. The dementia drugs are thought to maintain the level of functioning for a longer period of time without further deterioration at least in the early and mild stages.

Tranquilizers such as low doses of Ativan (lorazepam) may be used to help calm the person. Antidepressants such as Celexa (citalopram), Prozac (fluoxetine), or Paxil (paroxetine) may relieve depression.  Desyrel (trazodone) may be utilized for sleep
Some of the newer atypical antipsychotics may be utilized.  These drugs include Zyprexa (olanzapine), Risperdal (Risperidone), Seroquel (Quetiapine), or Geodun (Ziprasidone). These drugs also help reduce some of the aggression or combativeness or restlessness that some dementia patients experience

Unfortunately, there is no cure available; no magic pill that will reverse the process. There isn’t even a clearly defined reason why some people develop this devastating problem. Dementia is a terrible diagnosis both for the afflicted person as well as the whole family. Millions of people suffer with dementia and their families suffer just as much if not more

Most people are diagnosed after the age of 60 but younger people can have the diagnosis.  People ages 65 to 75 account for about 3 % of Alzheimer’s Dementia but fully half (50 %) of people over the age of 85 have this diagnosis. As an aside, keep in mind that the fastest growing segment of the population in the United States is the 85 + group. Age is the single most important known risk factor for dementia. Family history is also a factor and while there is a form of familial Alzheimer’s, it is rare and usually occurs between the ages of 30 and 60 and can be inherited. More commonly, there is no family pattern seen when dementia occurs later in life

It is important to understand that dementia is NOT a normal part of the aging process. Scientists are studying several factors including education, diet, environment, lifestyle, activity level, and viruses to try and discover what triggers the disease

For informational purposes only
Please call your Health Care Provide for specifics


Dementia and Living Alone

Providing Care Giver services to the person with Dementia who lives alone presents special and unique challenges. It has been estimated that as many as one third of persons diagnosed with Dementia live alone in the community. These people have greater safety risks than those who reside with someone.  The very fact of living alone means less monitoring and awareness of the changes occurring. Frequently we are faced with self neglect, malnutrition, medication errors, injury, and even financial exploitation.  All of this can lead to placement in a long term care facility. Most elderly people living alone wish to remain in their own home.  With planning and the proper care this can be done.

The face of the average dementia person living alone is:

  • Female
  • Age 83
  • White
  • Widowed

The very person we seek to serve may not see the problem.

Safety issues abound:

  • Falls
  • Wandering
  • Home Safety
  • Driving
  • Response to emergencies

Home Helpers is there to help people remain in their homes for as long as it is feasible.

Some of the things our Care Givers monitor:

  • Temperature of hot water
  • Oven and range are turned off
  • Safety check of the premises
  • Assessing for risk of fire

We help the person stay connected to the community, to family, to life. Families are reluctant to face the situation and hesitate to ask for help as the person with Dementia frequently does not recognize the problem and refuses all offers of help.
Our services are personalized to the person to maximize effectiveness.  We provide structure and improve stability as the person becomes familiar with the Care Giver Staff.  We will learn about the persons:

  • Daily routine
  • Likes and dislikes
  • Life achievements
  • Hobbies
  • Favorite foods
  • Family and friends
  • Sleep habits
  • Childhood
  • Occupation
  • Significant events
  • Unique characteristics

 

A diagnosis of Dementia can be devastating to both the patient and the family.  One thing we NEVER do is take away hope.  We make a difference every day. There is no gold standard for the treatment of Dementia.

A word about Alzheimer’s:

  • It cannot be diagnosed with certainty while the person is living
  • It is not a disease
  • It cannot be cured currently
  • It is scientifically uncertain

childs_adminDementia Assessment, Care, and Management