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

MILD COGNITIVE IMPAIRMENT AND REASONING

Dorothy is 80 years old and anyone would say she looks just great. Today she is volunteering at her local nursing home, as she has done for the last 15 years. Her hair looks perfect, her clothes always matching and becoming. She has her usual great smile and good humor for all of the residents.

However there had been a particularly bad snow and ice storm the night before. A nurse seeing Dorothy remarked that she was surprised to see her out on such a bad day. Dorothy seemed unfazed by the weather. “Aren’t you afraid of falling?” the nurse asked. Oh no, Dorothy assured her she never falls. Looking down at Dorothy’s feet the nurse commented on the dress shoes with 2 inch heels,  Dorothy was wearing. Pointing to all of the snow and ice patches still on the driveway, the nurse asked why she was going out in those shoes. As the conversation continued it was clear that Dorothy was not connecting the dots between safety, caution, weather, common sense and those very pretty and impractical shoes. In fact, Dorothy showed signs of losing her good humor, if pressed on the subject.

Mild cognitive impairment is considered a condition that might indicate that the diagnosis of Alzheimer’s disease will be next. It is considered a condition that really doesn’t interfere with normal life or activities. Mild cognitive impairment may improve, stay the same or progress. Mild cognitive impairment involves issues like searching for words, losing your train of thought in a conversation, mild forgetfulness, feeling sad or overwhelmed. Many things can account for these such as poor diet, anxiety, depression and especially loss of sleep can cause many of these problems in the elderly.

But the decline in reasoning and judgement are particularly worrisome. Reason involves thinking through a problem and coming up with a solution. It involves higher thinking abilities such as applying logic, verifying facts and making sense of a situation. When the loss of judgement or reasoning skills is lost, this now does interfere with normal life and activities. The loss of reason can have consequences, like Dorothy in her pretty shoes sliding around on ice.

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 – 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

FAST ONSET DEMENTIA – PROBABLY DELIRIUM

PART II

Delirium is a sudden change in a person’s mental abilities and is common in the elderly with acute medical illness. The elder with dementia will have a greater risk of developing delirium when ill, than the elder without dementia.

Delirium can be caused by infections, pain, sleep deprivation, dehydration, metabolic or electrolyte disturbances, constipation, and many times medications especially psychoactive medications. The evaluation process can be extensive because of the large number of possible causes.

Finding out the cause of the delirium is the first priority. Once the medical cause is brought under control it will usually still take some time for the delirium to resolve, even months.  During the time of recovery it is important to:

  • Provide optimal nutrition and hydration
  • Ensure the elder’s safety
  • Encourage a routine sleep – wake cycle
  • Provide a calm environment
  • Make sure that eye glasses are clean, hearing aids are working and dentures are in.
  • Provide good lighting, even during the day keep lights on
  • Simplify – reduce clutter, noise, few visitors

 

In his later years my father would become delirious every time he was hospitalized. I would position myself in front of him, smile and reassure him all was well. When staff would come into the room I would introduce them to Dad and tell him why they were there and what they were doing. I avoided side conversations with staff or visitors and only concentrated on Dad. When he recovered he would remember the bugs running up and down the walls, but he would also remember me just sitting there smiling.

 

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

 

FAST ONSET DEMENTIA – PROBABLY DELIRIUM

PART I

THE DEFINITION OF DELIRIUM: A condition of acute and sudden onset of impairment of attention, memory, orientation, language usage, consciousness, perception, behavior and/or emotions that may fluctuate. This is a condition that is directly related to a medical cause and is not due to dementia. It is often called “acute confusion.”

This is not the confusion associated with a terminal condition that occurs in the days before dying. This “terminal delirium” is irreversible and often calls for the use of anti-psychotic medications for the comfort of the patient. Sudden onset delirium is reversible and requires testing for possible cause.

Delirium caused by a medical condition is often confused with dementia and requires a clear history from the family. The areas to report to your healthcare provider are;

  • Is the person more confused today than yesterday? Was this a sudden change in the person’s mental status? If the person is more confused and the increase came on suddenly, you need to consider delirium.
  • Is the person more easily distracted, unable to focus his attention or unable to follow what is being said, than previously? A person with mild cognitive impairment can usually say the days of the week backwards or recite the months of the year backwards. The person with delirium is too distracted to focus on a task like this.
  • Is the person’s thinking disorganized or incoherent? Is the person rambling, has an illogical flow of ideas, or engages in irrelevant conversation? Ask the person a few questions to assess their train of thought:
  1. Will a stone float on water?
  2. Are there fish in the sea?
  3. Does one pound weigh more than two pounds?
  4. Can you use a hammer to pound a nail?

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

LET MUSIC HELP WITH DEMENTIA CARE

Anyone who has ever attended a concert has experienced a large group of people with synchronized brains. As a piece of music is played with emotion, dopamine is released in the brain and a person experiences pleasure. Added to that, a recognizable rhythm pattern and everyone’s brain is happy and synchronized.

Music affects deep emotions in the brain, releasing dopamine. As soon as a well-loved melody begins, small amounts of dopamine are released in the brain in anticipation. Anticipation, of the strong emotional, well remembered places in the music, yet to come. You know those parts that everyone remembers and sings along to. During especially emotional moments in the music an increase of dopamine is released. Dopamine makes, listening to familiar music with familiar rhythm, very rewarding for the listener.

Dopamine has long been considered the feel good neurotransmitter in the brain. A high level of dopamine helps with physical movement, positive emotions and is the reward transmitter. Many positive things in life can increase dopamine in the brain and music is one of them.

When a piece of music is unfamiliar the brain tries to search for that familiar rhythm, or note sequence. In the case of a jazz piece where there are odd or unexpected rhythms. The brain can’t connect to something familiar. Not only will dopamine not be released, but the experience may become difficult, stressful and unpleasant.

Give the confused person with dementia an opportunity to have that happy, good feeling music has to offer. Play some familiar music that allows the listener to “feel” a memory. Then go the extra step and synchronize your brains, sing along.

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing

DEMENTIA CARE – DRESSING FOR CAREGIVING, USING COLOR

The traditional color for healthcare workers has been white. There are good reasons for this. Many times when I have walked into a bedroom of an elderly confused person to check on them, if the elder wakes they immediately say “nurse”. I would reassure them that everything was alright, but that white uniform said much more.

White of course reflects and stands out in a dark room making the caregiver easier to see. White is connected in everyone’s brain with good, pure, heavenly, and clean. This perception doesn’t change when a person gets old or confused.

On the other hand when an athletic team wants to intimidate their opponent they will wear black. A team dressed in all black will look larger and more dangerous. Add a little red to that athletic uniform and red adds the message stay away, danger.

Any clothing in very dark, almost black, colors might be difficult for a confused elder to see, and they may only see black. Happy colors are in the yellow family. Also light green is considered a color that improves mental functioning. Green has been shown to improve test results with students, and light blue is shown to be a stay-awake color. The combination of white with yellow, light green or light blue is the perfect combination for caregiving.

Archive pictures show Florence Nightingale in her familiar uniform of long black dress. But that dress was softened by her white lace collar and lacy cap. Even pictures in her old age showed her in the same combination with the addition of a white lace shawl. However, for many years the color of healthcare has been white.

Every time research is conducted on what profession people think is the most trustworthy, nursing rises to the top. So dress the part, especially if you provide care at night, wear white and you will hear your elder say “nurse.”

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing