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Alzheimer’s Awareness Understanding the Signs for Alzheimer’s Disease Means Decoding Dementia, Delirium, and Depression Today more than five million people live with Alzheimer’s disease. Alzheimer’s is a progressive and degenerative disorder of the brain and is reported to be the most common cause of dementia in older adults. Our brains age, so most of us notice some slowed thinking and occasional problems remembering certain things over time. However, serious memory loss, confusion and other major changes in the way our minds work are not a normal part of aging. Is it Alzheimer’s? There are many causes for memory problems. Some are reversible through treatment and some are a cause for concern. Dementia Dementia ■ People with Alzheimer’s do suffer from dementia; however, people with dementia don’t necessarily have Alzheimer’s. ■ Dementia is characterized by mental decline and impairment and is a term that describes disorders that affect functioning of the brain: loss of memory, judgment, language, complex motor skills, and other intellectual functions. Warning signs of dementia: ■ Trouble with new memories ■ Relying on memory helpers ■ Trouble finding words ■ Struggling to complete familiar actions ■ Personality changes—such as appearing anxious ■ Loss of interest in important responsibilities ■ Withdrawing from social activities ■ Confusion about time, place or people ■ Seeing or hearing things that are not a part of reality ■ Misplacing familiar objects ■ Expressing false beliefs ■ Onset of new depression or irritability ■ Inappropriate sexual behavior in public ■ Making bad decisions Causes of dementia: ■ Stroke ■ Malnourishment ■ Hospitalization ■ Trauma People with a progressive dementia will most likely lose the ability to perform everyday tasks necessary to live independently. Delirium Delirium is a cognitive or mental disorder, not a disease, which appears suddenly, often within hours or days, and may come and go throughout the day. Delirium is defined as a temporary confusion caused by underlying medical problems, drug toxicity, or environmental factors. Delirium does not involve structural brain damage. It is a very common, yet often unrecognized condition in elderly individuals with dementia, including Alzheimer’s disease. Warning signs of delirium: ■ Confusion and disorientation ■ Disorganized speech ■ Varying levels of consciousness ■ Jerking motions ■ Disruption of sleep-wake cycles ■ Hallucinations ■ Delusions and anxiety ■ Memory impairment and altered speech ■ Intermittent agitated behavior ■ Mood changes ■ Behavioral problems such as aggression and wandering ■ Changes in blood pressure and pulse Warning signs of delirium: ■ Delirium follows a time pattern. It has an abrupt onset—less than one month; and a short duration—not more than one month from the time the symptoms are detected to intervention and recovery. Causes of delirium: ■ Infection ■ Trauma ■ Dehydration ■ Substance abuse ■ Physical illness ■ Reaction to medications ■ Head injury Once the cause is identified and treatment begins (changing medications, increasing fluids, or treating infections), there is often a quick and complete turn-around. Depression Depression is a mood disorder. It can and often does affect both a person’s mind and body. Experts estimate up to 40 percent of people with Alzheimer’s disease suffer from significant depression. Treatment of depression in Alzheimer’s disease can improve a person’s sense of well-being, quality of life, and individual function. It is normal to occasionally feel depressed or sad; however, depression is characterized by intense sadness lasting for a period of two weeks or longer, and impacts a person’s ability to lead a normal life. Depression can mask as dementia in an older person and oftentimes a depressed person will be inaccurately diagnosed as having a dementia. Warning signs of depression: ■ Sadness ■ Changes in sleep patterns ■ Lack of energy ■ Constant aches and pains ■ Feeling of hopelessness and worthlessness ■ Change in appetite ■ Social isolation or withdrawal ■ Recurrent thoughts of death, suicide plans or a suicide attempt ■ Irritability ■ Inappropriate or excessive guilt ■ Difficulty concentrating Causes of depression: ■ Hereditary predisposition ■ Physical limitations ■ Diagnosis of a medical condition ■ Grief or loss of a spouse or loved one ■ Substance abuse ■ Conflict ■ Reaction to medication ■ Abuse ■ Significant change in one’s life ■ Loneliness Delirium and depression are also sometimes mistaken for Alzheimer’s or dementia. Understanding these two will also be helpful in understanding options when one is confused or having problems associated with memory. Alzheimer’s Disease Alzheimer’s disease is a common and serious brain disease. Although symptoms can vary widely, the first problem many people notice is forgetfulness severe enough to affect their work, lifelong hobbies, or social life. Alzheimer’s disease is not a normal part of aging. It is a disease. Warning signs of Alzheimer’s disease: ■ Memory loss, especially of recent events, names, placement of objects, and other new information ■ Confusion about time and place ■ Struggling to complete familiar actions, such as brushing teeth or getting dressed ■ Trouble finding the appropriate words, completing sentences, and following directions and conversations Warning signs of Alzheimer’s disease: ■ Poor judgment when making decisions ■ Changes in mood and personality, such as increased suspicion, rapid and persistent mood swings, withdrawal, and disinterest in usual activities ■ Difficulty with complex mental assignments, such as balancing a checkbook or other tasks involving numbers Facts about Alzheimer’s disease: ■ Advancing age. The Alzheimer’s Association reports: “As many as 13% of all people 65 years of age and older have Alzheimer’s and as many as 43 percent of all people 85 and older have the disease.” However, Alzheimer’s is certainly not an inevitable part of aging. Additionally, there is an early-onset form of the disease that can strike people as early as their 30’s, although this form of the disease is rare. Facts about Alzheimer’s disease: ■ Genetic factors. Just because someone in the family has the disease, it does not necessarily mean others in the family will have the disease; however there has been a familial link shown with some forms of the disease. ■ Other risk factors that increase one’s chances of getting Alzheimer’s disease include a serious head injury, high blood pressure, heart disease, high cholesterol, type 2 diabetes and glaucoma. Seek medical attention if you notice a change in a loved one’s behavior. Diagnosing Alzheimer’s disease involves a battery of tests and ruling out several other conditions. People who receive treatment often experience improvement in their overall medical condition and realize a better quality of life. Helpful Suggestions for Care Partners of Those with Alzheimer’s ■ Get educated about the disease. Read books, attend workshops, and consult with healthcare professionals. ■ Learn caregiving techniques. Key areas are communication skills, safety concerns, and managing behavioral challenges and activities of daily living. ■ If a friend or loved one has Alzheimer’s, try to understand the experience. Adjust your expectations. ► Be patient and kind. Helpful Suggestions for Care Partners of Those with Alzheimer’s ■ As a care partner to a person with Alzheimer’s: ► Avoid care partner burnout. Make time for yourself. Join care partner support groups. Pursue interests beyond your caregiving role, such as exercise, hobbies, journaling, and art. ► Maintain your own physical and mental health. Exercise, respite, and other activities can reduce stress. Seek medical help if there are signs of depression. Helpful Suggestions for Care Partners of Those with Alzheimer’s ► Discuss the situation with family and friends. Support systems are critical. ► Do cognitive stimulation activities with your loved one. Listening to music, solving word puzzles, and playing memory games can easily be done at home. ► Foster communication with physicians. Be involved in your loved one’s medical care. Ask questions about the progression of the disease, express concerns, and discuss treatment options. Helpful Suggestions for Care Partners of Those with Alzheimer’s ► Take care of financial, legal, and long-term care planning issues. Try to involve your loved one in decision-making, if he or she is still capable of providing input, and consider his or her wishes related to future care and end-of-life issues. ► Smile. Kindness, humor and creativity are essential parts of caregiving. Hugs, hand massage, and other gentle physical contact will help your loved one feel connected and loved. ► Think positively. Focus on your loved one’s remaining strengths and enjoy your relationship while you are still able. Stages of Alzheimer’s ■ While not everyone experiences the same symptoms in the same order or with the same time schedule, Alzheimer’s disease can generally be categorized into seven stages of brain deterioration. Stages of Alzheimer’s 1. No impairment (normal function) ► The person does not experience any memory problems. An interview with a medical professional does not show any evidence of symptoms of dementia. Alzheimer’s Association, 2011. Stages of Alzheimer’s 2. Very mild cognitive decline ► The person may feel as if he or she is having memory lapses—forgetting familiar words or the location of everyday objects. But no symptoms of dementia can be detected during a medical examination or by friends, family or co-workers. Alzheimer’s Association, 2011. Stages of Alzheimer’s 3. Mild cognitive decline ► Friends, family or co-workers begin to notice difficulties. During a detailed medical interview, doctors may be able to detect problems in memory or concentration. Alzheimer’s Association, 2011. Stages of Alzheimer’s 4. Moderate cognitive decline ► At this point, a careful medical interview should be able to detect clear-cut problems in several areas: ● Forgetfulness of recent events ● Impaired ability to perform challenging mental arithmetic ● Greater difficulty performing complex tasks ● Forgetfulness about one’s own personal history ● Becoming moody or withdrawn, especially in socially or mentally challenging situations Alzheimer’s Association, 2011. Stages of Alzheimer’s 5. Moderately severe cognitive decline ► Gaps in memory and thinking are noticeable, and individuals begin to need help with day-to-day activities. Alzheimer’s Association, 2011. Stages of Alzheimer’s 6. Severe cognitive decline ► Memory continues to worsen, personality changes may take place and individuals need extensive help with daily activities. Alzheimer’s Association, 2011. Stages of Alzheimer’s 7. Very severe cognitive decline ► In the final stage of this disease, individuals lose the ability to respond to their environment, to carry on a conversation and, eventually, to control movement. They may still say words or phrases. ► At this stage, individuals need help with much of their daily personal care, including eating or using the toilet. They may lose their ability to smile, to sit without support, and to hold their head up. Reflexes become abnormal. Muscles grow rigid. Swallowing is impaired. Alzheimer’s Association, 2011. So is it Alzheimer’s? Some of the many causes for memory problems have been presented here. Some are reversible through treatment and some are a cause for concern. Awareness is the first step towards getting help. Alzheimer’s disease strips the mind of its memories, but it doesn’t have to strip people from their familiar surroundings. Many people with loved ones suffering from Alzheimer’s or dementia are unaware of the options available to them—like in-home care. Mayo Clinic reports that people with Alzheimer’s do better when they have a routine and maintain familiar surroundings. It allows them to refresh and reinforce their pattern of behavior every day. People have choices when it comes to Alzheimer’s care. Loved ones can remain safe, active, and comfortable—at home. Call Sovereign Home Health for more information. For more information… ■ Sovereign Home Health ► (888) 978-5234 ► [email protected] ► www.SovereignHomeHealth.com Sources: The Alzheimer's Foundation of America, Alzheimer’s Association, D.P. Devanand, M.D., a professor of clinical psychiatry and neurology at the College of Physicians and Surgeons at Columbia University in New York., and B. Reisberg’s Clinical Presentation, Diagnosis, and Symptomatology of Age-Associated Cognitive Decline and Alzheimer’s disease (Alzheimer’s Disease: the Standard Reference, New York Free Press, 1983).