ALCOHOL RELATED DEMENTIA – THE DR. JECKEL & MR. HYDE STORY

Howard was a particularly difficult new patient in the dementia unit. Howard was young – only in his mid fifties, strong and very fit at least physically, not mentally.  Howard was easily upset, especially if a staff member told him “No”. And Howard presented us with many opportunities for saying no, as he literally ran through the unit. Having seen other patients like Howard, I asked his wife if Howard had had a drinking problem. She looked very surprise at the question, and yes Howard had been in the habit of drinking daily.

I then asked her if Howard had shown a significant change in personality when drinking, yes he did.  His demeanor changed and she remembered him having almost a “day and night personality change”. Eventually a Dr. Jeckel and Mr. Hyde personality switch was going on. Howard being normally a happy person, when starting to drink would soon become excessively friendly and happy to the point of being obnoxious. He would be very social and then become almost celebratory in his mood. When guest were over frequently jumping into the pool fully clothed.

After a seemingly shorter and shorter time of drinking,  Howard would literally check out, having a flat expression and appearing somewhere else.  His expression would then become very dark and scary while his vocabulary became suggestive and often he was vulgar.

Fortunately  Howard hadn’t been the drinker who becomes immediately angry, aggressive, rage-full and ready to fight. Of the two personality shifts the happy drinker is easier on the family, but maybe makes it harder for them to identify a drinking problem earlier.

So how much is too much, when it comes to drinking? Moderate consumption of alcohol is considered 1-2 drinks a day. A significant history of drinking is 35 or more drinks a week for a man and 28 a week for a woman.  Alcohol is quickly absorbed into the blood stream and goes directly to the neurons in the brain. Alcohol causes an increased release of dopamine in the brain (the pleasure/reward neurotransmitter), and over time you need a larger and larger amount of alcohol to realize the same effect.

When caught early, brain damage due to alcohol can be reversed. Alcoholism is caught too late when long term excessive consumption has been a toxin to the brain, resulting in neurological damage and changes to the brain including brain shrinkage.  Drinking to the point of drunkenness is particularity harmful to the brain.This was Howard’s story, and is he now is at the point where Dr. Jeckel is gone and all that is left of Howard is Mr Hyde.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

DEMENTIA 101 – DISEASES CAUSING DEMENTIA

Dementia is not a disease, but rather a combination of symptoms that may accompany a disease or physical condition.  These changes or symptoms, begin with memory loss, and slowly progress to the person having difficulty caring for themselves and eventually becoming totally dependent on others. The symptoms must include memory loss and at least one of the following to indicate dementia.

  • Loss of language skills, understanding words, spoken or written as well as the ability to speak coherently.
  • The loss of the ability to recognize objects and eventually people.
  • The loss of the ability to initiate and follow through with motor skills.
  • The loss of reason, judgement, planning and ability to follow through with a plan.

These changes have to be severe enough to interfere with the person’s ability to live independently, to be considered dementia. When the elder suffers only from occasional memory problems, that are not interfering with daily activities, they are considered to have mild cognitive impairment.

Alzheimer’s Disease: is the most common cause of dementia affecting between 50% – 70% of those diagnosed with dementia. By the time a person is 85 years old they will have about a 50% chance of developing Alzheimer’s Disease.

Vascular Dementia: The second leading cause of dementia is experiencing a stroke. This is not a slowly progressing dementia, it progresses as the elder continues to have small strokes causing more damage to the brain.

Lewy Body Dementia:  Named for the round structures, or Lewy bodies found in the brain. This is frequently connected to the person who has, Parkinson’s disease with dementia.

Frontotemporal Dementia: This dementia doesn’t present with memory loss until much later in the disease process. The first signs are personality changes, and lack of empathy for others.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

TEMPORARY DEMENTIA – REVERSIBLE DEMENTIA REALLY?

Really, there are some conditions that cause temporary dementia and are reversible. While there are many diseases or physical conditions that can cause dementia, some are reversible. Seeking medical assistance as soon as possible may make the difference in preventing any permanent brain damage.

Delirium often times resembles dementia so much so, that someone who knows the elder is very necessary to give a history, of the recent state of confusion. Dementia from a disease process develops slowly over time. However delirium may develop within hours, in the elderly. Knowing what is normal for the elder and the speed at which he became confused, is a significant part of the diagnosis. Many things can cause delirium, frequently in the elderly it is an infection. As well as the elder who becomes confused every time they are in the hospital, due to anesthesia.

Medications , when looking for the cause of sudden confusion, referencing the list of medications that can cause delirium is a good place to start. As the liver and kidneys age they are less able to remove medications from the body and the elder gets a build up of toxins. Added to this may be declining health and the number of medications our elders are now taking, can set the elder up for developing delirium, and a diagnosis of dementia.

Brain Tumor, the first symptom of slow growing brain tumors in the elderly, very much resembles dementia. Brain tumors are know to cause changes in cognition and even personality changes.

Depression, some people with depression may complain of forgetfulness, they looks sad or worried, have trouble concentrating, and look depressed. The important thing to notice is was the person depressed and then became confused? Or was the person experiencing mental decline, and that is what caused the depression. If in fact the depression came first, the symptoms that followed can be reversed when the depression is addressed.

Vitamin B12 deficiency, or pernicious anemia will cause confusion, slowness, irritability and the person appears to have lost their get up and go. Even though vitamin B12 is plentiful in the American diet, this deficiency develops because the elder can no longer absorb the vitamin and requires injections.

Water on the brain, hydrocephalus, an excess of spinal fluid around the brain. This can be caused by a head trauma, but usually begin without an obvious cause in the elderly. The elder literally slows down, walking as if their feet are stuck to the floor. They will lose bladder control as well as become confused. If the condition is caught early and a shunt is put in place to drain the fluid, the person can return to previous level of function.

As always, early identification of changes as well as quick intervention is the answer to mental recovery.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

DEMENTIA 101 – DISEASES THAT CAUSE DEMENTIA

Dementia is not a disease. The word dementia refers to a number of symptoms such as a decline in the ability to reason, remember, and even focus and think. There are many diseases that cause dementia and because each disease affects the brain in different ways, the word “dementia” is a broad term.

The most prominent disease is Alzheimer’s because it affects so many more people than Parkinson’s, Huntington’s, even stroke. Not only do the diseases resulting in dementia, affect the brain in many different ways, the cause and rate at which the dementia progresses is also variable.

In Alzheimer’s disease the outer layers of the brain are most affected resulting in the loss of memory and language. Other diseases such as Parkinson’s, and Hydrocephalus (fluid on the brain), affect the inner parts of the brain. This results in a decrease in the speed of thinking and an inability to initiate movement. Many times a person with Parkinson’s will actually get “stuck” in place while walking. They had a sudden inability to move and need to take a step backwards before they can once again go forward.

Dementia can also be the result of a severe trauma to the brain. Head injury resulting in blood clots can cause dementia. Brain tumors, a Vitamin B-12 deficiency, hypothyroidism, and of course multiple strokes may result in dementia.

As in all conditions what you are looking for is a change. If a person never could remember names, and they run into someone at the mall that they haven’t seen for years, and don’t know their name, it doesn’t mean they have Alzheimer’s disease. But when something is different and unusual for the person, especially if it has come on quickly, that requires a visit to the doctor for testing. Testing to rule out infection, drug interactions, depression, nutritional deficiencies, all of those things that can make a person appear to have Alzheimer’s disease.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

Dementia 101 – The First Case of Alzheimer’s Disease

Auguste Deter was born in 1850, and met Dr. Alzheimer in 1901 at the Institute for the Mentally Ill, Frankfurt, Germany. Dr Alzheimer was a psychiatrist and neuropathologist at the institute. This is Auguste’s story.

Auguste was married to Karl Deter, and was a housewife.  At the time Karl sought help at the institute, Auguste; had no sense of time/or place, and she wasn’t sleeping at night. During the day she was dragging sheets all over the house, she was very paranoid and was constantly accusing Karl of having affairs. She was having trouble with language and writing, as well as having signs of anxiety, mistrust and withdrawal, and oh yes, Auguste would also scream for hours.

Auguste was a danger to herself, especially in the kitchen using knives. She was recorded as saying repeatedly “I have lost myself.” Even though the institute was a scary place, known to the locals as the “Castle of the Insane,” her husband had no choice but to bring her there.  Karl was a middle aged man who had to work and no one else was able to care for her.

For thousands of years when the elderly had symptoms of memory loss doctors thought this was just normal aging.  Auguste Deter on the other hand wasn’t elderly, she was only 51 when she first met Dr. Alzheimer. He worked with her documenting her behaviors, memory problems, lose of her words, anger issues and constant paranoia. And later when he left the institute he requested that on her death Auguste’s brain be sent to him.

Auguste died at the age of 55, and her brain was sent to Dr. Alzheimer. Dr. Alzheimer had a very famous friend at that time, Carl Zeiss who had just invented the first distortion free microscope. Dr. Alzheimer took Auguste’s brain tissue, froze it and then sliced and stained the tissue. Putting it under the microscope, magnified 100’s of times he saw for the first time the plaques and tangles later to be known as Alzheimer’s disease.

Virginia Garberding RN

Certified in Restorative Nursing and Gerontology

DEMENTIA 101 – WHAT IS DEMENTIA?

Many people use “dementia” and “Alzheimer’s disease” interchangeably as though they are one and the same. Dementia is not a disease in itself, it is a combination of symptoms, which may accompany a disease.  Those symptoms are; the ability to reason, think, remember and often a change in behavior. There are many diseases that can cause dementia. Diseases such as Parkinson’s, Huntington’s, Pick’s, stroke, Creutzfeld-Jakob, as well as many physical conditions result in dementia.

Symptoms of dementia:

The ability to reason. Grace was in her late 70’s, living alone and coping just fine. That is until her local  grocery store decided to remodel. They relocated all of their products, moving them about all over the store. While Grace was in a routine, she had been able to locate all of her frequently purchased items, and she functioned well.

But this drastic change caused Grace to walk the store for hours a day, not buying anything. Grace was no longer able to reason and figure out for herself where new locations would be, nor was she able to ask for assistance. Very soon her daughter noticed that Grace was losing weight, and taking a closer look at her mother’s life, found out about the store re-model and her mother’s problem with reasoning.

The ability to think. In the early stages the person may have times when he appears confused, perplexed or is struggling to organize his thoughts. He may appear as if in a dream world and fail to respond to questions. He may report strange thoughts or be unable to think of the date or time.  He may be having trouble participating in small talk with friends or participate in activities.

The ability to remember. In normal aging memory loss, the elderly person has been distracted and failed to form a memory. As in those infamous lost keys, cell phone, pen, all of those things that everyone misplaces daily. As people age they begin to have distraction problems. If two older people  walk into a department store and they are talking, they may be distracted. When they leave they might not remember where they parked the car, because they never laid down that memory, due to distraction.

In Alzheimer’s disease this memory loss is not particularly worrisome for the elder. The elder with normal memory loss will be concerned about it, and just take a little longer to access memories. If given a few clues or reminders they will be able to retrieve those memories. For the person with Alzheimer’s disease the memory is just gone.

The public is more aware of Alzheimer’s disease because it is the most common cause of dementia. While many other diseases and conditions cause dementia, the most often source is Alzheimer’s disease.

Virginia Garberding R.N.

Certified in Gerontology and Restorative Nursing