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

WHAT DO THE ELDERLY AND TEENAGERS HAVE IN COMMON – MAKING BAD DECISIONS

They were clearly elderly, possibly in late 70’s. He walked with a four leg quad cane, very slowly as though he was chronically stiff in the joints. He probably had been about 5’9″ at one time, but now he was so stooped over, that he was the same height as his wife, who appeared to be about 5’2″. Yet, as they left the grocery store they were walking to a brand new, bright red, SUV in the parking lot.

In passing I remarked,  “boy, that car is very pretty, but looks hard to get into.” The wife sadly smiled at me and said “yes, but it is a little better since we got the running boards.”, Wow, a car with running boards at their age. Sure enough as she opened the door, she stepped up on the shiny chrome running board, as she tried to steady herself to slide onto the car seat.

I just knew this car was not her choice, yet there she was perched way up in the air as they crept out of the parking lot. I thought, what is going to happen to her when there is snow on the ground, or that running board is slick from rain or slush.

The frontal lobe of the brain, is where reason, judgement and decision making is located. As the frontal lobe of their brain begins to shrink and die, the elderly begin to make poor decisions. A newborn baby’s brain begins to develop fully from the back, neck area, going forward. A teenager’s brain hasn’t fully developed in their frontal lobe, which results in risky choices or bad decisions. The end result is in both cases a frontal lobe that isn’t very functional. Driving and safety turn out to be frequent concerns and conversations in families, for both generations.

Is buying a SUV, a red flag when it is clearly dangerous for you to enter and exit the vehicle? Yes, that is a red flag, even more so is this elderly man’s disregard for his wife and her safety. The first troubling sign families notice when the elderly have frontal lobe shrinkage, is the apparent disregard for others.

Would this be dementia? Yes, shrinkage in the frontal lobes of the brain are a form of dementia. Frontal-temporal dementia is probably the least diagnosed form of dementia. Families know that there is something wrong with the elder, that he is difficult to get along with, easy to anger, unable to change behaviors, decrease in personal hygiene, etc., but few use the word dementia.

Cars, driving, and bad decision making, whether very young or very old, a bad combination.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

EARLY STAGE ALZHEIMER’S DISEASE AND CAREGIVING

Caregiving for the person in early stage of Alzheimer’s disease, is in some ways very different from the mid-stage and late stage caregiver role.

The early stage caregiver is in many ways a companion. A very alert and involved companion. A person who is proactive in preventing accidents. Looking at the confused person’s environment, while not changing the environment, (which would increase confusion) but modifying as needed for safety. Knowing the confused elder may no longer be that aware of tripping hazards, the danger of walking in busy parking lots, or handling hot food. So many areas in our, day to day lives, where our own personal safety awareness and good judgement keep us safe.

Helping the confused elder with communication difficulties. Giving the person that extra time they now need to get their thoughts in order. Not rushing the person as they are searching for words, and when providing those words, doing it in a way that is supportive not critical.

By offering frequent reminders of where the person is and what is going on. When the person has a concerned puzzled look on her face, the caregiver gently reminds her that she is at the mall, close to her home. Providing information to the date, time of year, temperature and most of all who people are in relation to the confused elder.

Keeping to a routine and familiar places gives the mildly confused person a sense of security. When that is not possible, as in the case of a change in residence. The caregiver needs to use less verbal directions and more walking a person through the new environment. Accessing that body memory through repetition, by doing something over and over, can re-create that routine and familiarity. Routine and familiarity bring comfort.

Taking time, while stepping back and trying to see what might increase confusion, and what the caregiver can provide to decrease that confusion.

The need that remains is always the same throughout the disease process, is for the the caregiver to be so very kind and understanding. Understanding of the struggles the person is facing to still be here. Support to still maintain their independence as much and as long as possible.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

MILD COGNITIVE IMPAIRMENT – NOT ALWAYS EARLY DEMENTIA

“I think mom might have early Alzheimer’s disease” says the worried son. “I saw the other day that she had left the burner on the stove on, and walked into another room.” I wouldn’t worry too much about one incident the dementia specialist said, “sometimes I do things like that myself.”

The dementia specialist is over sixty-five herself, and knows she has a problem with distraction. As a person ages they begin to become more easily distracted. The classic story is always about walking into a room and forgetting what you are there for. If someone talked to you while you were going to get something, or you answered the phone on the way, you became distracted. I frequently remind people of times they might have forgotten where their car was parked.

The concerned son should keep his eyes open for other changes. How is his mom doing cooking? If she always was a great cook and made many things from memory, and still does, nothing to worry about there. If on the other hand she now has problems with things like measuring, getting confused with familiar recipes or putting together a meal, these could indicate a problem.

If his mom always followed the news, and now seems to be having trouble remembering news and recent events, this would indicate a problem. The problem comes when there is a change. If the person never was interested in the news, this is just in line with their personality.

If mom never was much for handling finances, then her lack of money sense is just her. However if mom always knew the price of everything on her shopping list, and now shows problems with handling money, it is time to take a close look.

If mom knows what day it is, doesn’t get lost in familiar places and recognizes people around her, and there are no other noticeable changes, then the stove incident was a simple lapse. Yes, a potentially safety issue, and mom should be as concerned as everyone else that she had this lapse. She should vocalize, that she will make an effort to focus more on what she is doing. But if there are indications in the kitchen that there have been other safety events. Such as burned cutting boards, charred pots, pans, cooking utensils, or possibly missing items because they were discarded after an incident. It is now time to closely monitor mom.

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

READING BETWEEN THE LINES, IS THE REAL STORY OF ALZHEIMER’S DISEASE

“Harvey died just before Thanksgiving,” his widow wrote, this is his story.

“Harvey showed signs of memory loss three or four years ago. Then after Christmas last year it got worse. In April he fell off our front step and all tests were negative, then it seemed to escalate. Through the summer the nights were really bad. Pills were not working. The month of August after what seemed like hundreds of phone calls we found a care center. Harvey had two good months there. Then one night he wanted to get up to go to the bathroom. Afterwards, the staff took him back to bed and he died in his sleep. What a blessing!”

One brief paragraph, nine short sentences, not really enough to tell the story of Harvey. But maybe it is, his story is like so many others.

Just a few years when the family identifies his memory loss?  We know he was struggling for longer than that. The time of mild cognitive impairment, when the person is mildly confused, yet functioning, can be many years. Years when the person doesn’t need any help dressing, bathing, eating, but might be having trouble remembering a word or an event. He could remember how to drive the car, and as long as his wife was giving him directions, they didn’t get lost. By having a routine to life and sticking to the routine, it makes it harder to see the changes, they just creep up on you.

The 3-4 years of memory problems she remembers, was most likely when his struggles were becoming more obvious. Especially if other people now noticed. Having a fall, any injury, infection, anything to change the normal routine tends to escalate the symptoms. And the person no longer bounces back to their previous level of function.

Pills were not working. No, medications for Alzheimer’s disease tend to only help for a period of time.

Nights were really bad. So many people caregiving for someone with Alzheimer’s disease come to that place where they are looking for a care center because the nights are bad.

But it wasn’t all bad. Between these few lines you know there were holidays and birthday celebrations. Grandchildren were born and many family get togethers were enjoyed by Harvey. The elderly couple enjoyed going to a movie, or out to eat. They were faithful members of their church, where Harvey was well known. He died at the age of 85, and only lived those last two months in a nursing home.  What a blessing!

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

ARE YOU AFRAID OF LOSING YOUR MEMORY? NORMAL AGING MEMORY LOSS

You can’t remember where you parked your car!  You arrive at the shopping center with your friend. You park, walk in, and are in conversation about where you might want to eat lunch. Hours later, when returning to that store, you don’t remember which door you came in. Not only that, once you remember the door,  you walk outside to try to get your bearings, and you still have no idea where your car is. Lucky for you, you have a key fob and can locate your car by the beeping horn.

In the same way, you may constantly be searching for; keys, pen, glasses, cell phone, pretty much anything a person lays down without thinking. You start wondering if you have Alzheimer’s disease. You start to question yourself, and worry about past lapses in memory.

The truth is, that as we age we can start to have problems with distraction. The memory is like a bank, you make deposits and when you need that information you make withdrawals. In this scenario, you never made that deposit into your memory bank. Due to the distraction of talking to a friend you never made a mental note of where you parked.  Which door you came in, and what merchandise was located at that entrance.

The inability to think or reason your way out of this situation could be a sign of mild cognitive impairment, but could more likely be due to stress. The awareness that you are having trouble focusing, and thinking through this problem are good things. Awareness is a good thing. When a person no longer thinks things through, weighs the pros and cons, uses critical thinking and their common sense seems to be out the door, that is the loss of reason. Losing the ability to reason, is cause for concern, not occasionally forgetting where you parked.

So should losing your car in parking lot, lead you to making an emergency appointment with your doctor? Probably not, what is more telling is how you handled it.

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