EARLY STAGE DEMENTIA – SYMPTOMS OF EARLY CONFUSION

Harry has currently un-diagnosed early stage dementia. How can he be so happy and content, seemingly unfazed by his confusion. All due to his wife Ann’s attention.

Harry’s wife of over 45 years was at his side while he greeted friends outside of church. Harry loves to talk and has many friends. These friends don’t seem to notice that Harry is having memory retrieval problems.  And that is all due to the wife at his side who is seamlessly providing words and cues to Harry. Harry never seems to be stumbling in his conversation or  searching for words. Ann knows Harry so well that she just fills in for him with the right word at the right time and he accepts her help.

At this point in time Harry might not even be aware of his memory loss, his wife makes no effort to point it out to him. Harry drives the couple around but you know it is Ann who is navigating because Harry would be disoriented without her.

This partner in life, is now the decision maker, for today deciding where the couple will go for lunch. Because of their warm trusting relationship, Harry trusts Ann to now manage their finances.  When shopping he might just joke that the “little lady takes care of all of those money things.” This saves Harry the stress of trying to pay bills, balance the checkbook, and make poor financial decisions, all signs of early stage dementia.

Emotional outbursts and anger directed at others and situations come from anger at oneself. The person who has early stage dementia and rejects any help or assistance from others may be a risk to himself and others. The inability to change a bad behavior is a symptom of early stage dementia.

For Harry, the frustration that accompanies trying to understand where he is, what is going on, and what might be expected of him is all reduced because of his partner, and yes now his caregiver, Ann.

Virginia Garberding

Certified in Gerontology and Restorative Nursing  

HOLIDAYS A GOOD TIME TO HAVE THAT FAMILY TALK ABOUT GRANDPA’S DEMENTIA

Grandpa still lives alone in the family home and his daughters keep in constant communication with him by phone. Getting ready for the family holiday get together, required several phone calls to Grandpa to remind him of where and when they were meeting. After the big event , the daughters used their time with Grandpa to compare notes on how well their Dad is still able to function.

What they found:

  • Dad needed those frequent phone reminders – he had a 15 minute chat with the oldest daughter and the next day didn’t remember she had called
  • Dad had been mentioning that neither of his 2 hearing aids still worked, yet he was wearing both
  • Dad was now making strange and inappropriate comments to strangers, he asked a man in a restaurant if the design on his shirt was Nazi swastikas
  • Dad’s personal hygiene was in question, even though the holiday event was for an entire weekend at a hotel, Dad was wearing exactly the same clothes every day and on arrival it was apparent that Dad hadn’t bathed for some time
  • When asked what he has been eating, even though the daughters kept him well supplied with grocery delivery, he was choosing to eat all of his meals at the local fast food carry out
  • Dad had been asked to bring his latest report from his physician, after reviewing the doctor’s findings and recommendations, it was clear that Dad not only had no intention of following the doctor’s advise but didn’t understand most recommendations
  • Dad asked one of his daughters for a type of first alert button – in case he was taken to a hospital he could push the button and an ambulance or “someone” would come and take him out of the hospital

On the positive side, all of the daughters are on the same page, that Dad has dementia and needs their monitoring any changes. It is terribly hurtful and lonely to be the  only member of a family seeing signs of dementia. When even some of the family members are in denial of signs of confusion, it delays solutions. These daughters are realistic and pro-active trying to get ahead of future problems and support for their Dad.

Now after this holiday, they know that Dad might be needing some house help if the reason he doesn’t make meals is that he no longer can put a meal together. Some home help might be also needed for hygiene. One of the daughters needs to get involved in going with Dad to have his hearing aids taken care of as well as accompany him to his physician.  Dad probably would benefit by having a calendar to write down appointments and events. This way the daughters could check, just by calling and asking Dad what he has written down for a certain date.

The daughters know that as Dad continues to decline, (and they realize he will) he will be a candidate for an assistive living facility. When that day comes they will have to be united, it really helps to start now.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

SUDDEN INCREASE IN CONFUSION IN ALZHEIMER’S PATIENT – IS THAT EVEN POSSIBLE?

Harold came into the skilled nursing facility, admitted from the local hospital. Harold lives at Pleasant Meadows, an assisted living community where he has been independent. The problem arises when the nurse from the skilled facility  calls the nurse from Pleasant Meadows. The Harold that the nurse now describes in not the man the Pleasant Meadows nurse has know for the last 6 month, before he went to the hospital. Harold?  Uncooperative, disoriented, unsteady on his feet, falling, with generalized weakness? No, no the nurse from Pleasant Meadows insists that they (the skilled facility) don’t know what they are doing and don’t know how to take care of Harold.

Sadly this scenario is not unusual, for one healthcare facility to accuse another of not knowing what they are doing. Doesn’t the fact that because Harold already has the diagnosis of Alzheimer’s disease mean that it is understood that he is confused? Yes, Harold is always confused, but this new Harold is in an altered mental state. He was admitted to the hospital with pneumonia. Infections in the elderly many times can cause confusion. This infection caused Harold to experience a rapid decline in his mental functioning and an increase in his confusion.

Sudden increase in confusion can result in very vague symptoms. The family member might say he is “not acting right”, has different behavior, is either more sleepy or more agitated, is extremely distracted,  has recent inappropriate behavior. These sudden changes can come within days or even hours of onset. The great difficulty comes in diagnosing why the individual is suddenly more confused. As well as realizing that it is going to take much more time for the problem to resolve compared to the fast onset.

Harold will continue to have increased confusion even after he has recovered from his pneumonia. And Harold is likely not to return to his previous level of mental functioning.  This infection has tragically caused him to lose some mental clarity  and has resulted in progression of his dementia. Right now Harold needs one on one care, with people who explain the environment and what is going on, as well as protecting him from unsafe activities. All the while giving his mind the time to heal as well as his body.

Yes, it is not only possible for someone with Alzheimer’s disease to suddenly become more confused, it is more than likely when there is an infection involved. A sudden increase in confusion, or delirium continues to be misunderstood.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

IS DEMENTIA THE SAME AS MENTAL ILLNESS?

Mental illness is a broad term for disorders that affect thinking and behaviors. That, at first glance, can sound like dementia. However, there are known causes for many forms of mental illnesses. Also, strong effective treatment programs will include cognitive behavioral therapy, which is not used for persons with dementia.

Mental illnesses range from mood disorders; major depression, anxiety disorders, panic disorders, personality disorders, obsessive-compulsive disorder, to psychiatric disorders; anti-social, narcissistic, schizophrenic, and so many more.  These conditions are traceable to poor parenting practices, childhood trauma, bereavement, unemployment conditions, social stresses including cultural stresses, as well as abuses; drug abuse, cannabis, and alcohol abuse.

Cognitive behavioral therapy involves helping the individual in identifying their distressing thoughts, while seeing how realistic these thought patterns really are. This therapy, stresses working on distorted thinking, and coming up with positive problem solving techniques. Consistently focusing on how valid the person’s thoughts are, as well as examining how useful this thinking is to the individual. Cognitive behavioral therapy when successful will change troubling behaviors.

In order to be successful with this therapy the person has to possess the ability to reason. Loss of reason and judgement are early signs of dementia. As well as loss of the ability to focus, persons with dementia due to Alzheimer’s disease, are very easily distracted.  Persons with dementia, due to Alzheimer’s disease, will have short term and eventually long term memory loss.  Memory loss not a symptom of mental illness.

Above all, despite the changes seen in the individual with a dementing illness, he is not really distressed by his losses. For the most part his frustration is due to misunderstanding the environment and cooping with the loss of communication skills.  In contrast, persons with mental illness are very much distressed by their thoughts and behaviors.

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

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

STRANGE AND EMBARRASSING BEHAVIORS IN THE ELDERLY – FRONTOTEMPORAL DEMENTIA

Urinating in public, touching strangers, angry outbursts, running stop lights, driving on the wrong side of the road, shoplifting, indecent exposure, and so many more behaviors that those very elders would have found shockingly inappropriate in the past.

However for families the most troubling and strange behavior that is first noticed is the disregard for other people. Fran first noticed this in Charles when he traded in his sedan for a huge truck. A vehicle that she would never be able to get into. This purchase demonstrated a disregard for his wife’s arthritic condition which she had struggled with for the past 20 years. A disregard for her height, as she is a very petite woman. A disregard for her age, basically a disregard for Fran.

Now, whenever the couple went anywhere together, they had to use Fran’s car. This meant that now Charles was very involved every time Fran bought a new car. If Fran liked a car, no Charles needed more leg room, you can’t get that car. Instead of driving a car she liked, Fran now had to drive a large sedan, more to Charles’s liking.

Fran now was paying for a more expensive vehicle than she needed. Her up keep on the car was more expensive, as it always was a gas guzzler that Charles insisted upon. And no, Charles felt no need to contribute in any way, as he continually showed no regard for Fran.

With frontotemporal dementia, as these areas of the brain shrink, the person you once knew changes into another person. A person with increasingly strange and often embarrassing behaviors.

The frontal lobe of the brain is where reason, judgement, safety awareness, organization, planning, all of a person’s higher functions are located. Once this form of dementia, this disease progresses, those higher functioning abilities are diminished.

So now as Fran can see that Charles is showing little regard for societies norms, while he drives on the opposite side of the road because as he says “whats the problem, no one is coming!” She remember years ago when he started showing no regard for her, when buying his truck.

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

5 CRITICAL AREAS OF DEMENTIA CARE

Dementia care involves first and foremost, providing for the safety of the person with dementia. One of the major symptoms of dementia, is the loss of safety awareness. Hand in hand with that, is the loss of the ability to reason, or think your way out of a situation. A real problem, if the situation is dangerous.

Added to providing for safety, is having good dementia communication, knowing what a happy environment looks like for someone with dementia, providing for social and spiritual needs as well as addressing everything physical.

5 Critical Areas of Dementia Care:

  1. Safety – walking alone across a busy highway, putting something on a hot burner and walking away forgetting about it, going outside in sub-zero temperatures without a coat, and more. Protecting the confused elder without having him feel he is being controlled, is good dementia care.
  2. Communication – just having the most beautiful home, with the best security system, won’t lead to great dementia care. Especially if the caregiver doesn’t know how to effectively communicate with a confused person. Good communication involves the speaker and the listener. When the confused elder is no longer able to communicate well, the burden is on the caregiver. The caregiver must know how to communicate through touch, gestures, smiles, patience and kindness.
  3. Environment – the environment needs constant review, and may change over time. Thinking of the environment as a way to make the elder with dementia know where they are and what is expected, is great dementia care. Clutter needs to be eliminated as it contributes to confusion. A kitchen needs to be used for preparing and eating meals. Having a TV running at all times in a kitchen reduces the environmental cues, that are telling the confused person, where he is. Creating a happy environment involves using music, activities, creating enjoyable smells, like the smell of cookies baking.
  4. Social and spiritual needs – whether this means continuing in church attendance, or participating in social groups, these connections remain important.  When the elder can no longer play that card game they won at for years, continuing the activity, while changing the level of the game is what is important. Getting together with familiar people, playing a game, laughing together, watching a movie together, these are important parts of dementia care.
  5. Physical – involves really knowing the person physically. What are the physical problems the person is challenged with other than dementia? Does this person have a vision or hearing deficit? Also good dementia care means knowing when the confused person has had a physical change in condition, when they cannot tell you. Physical also literally means engaging in physical activity to keep the body strong.

Many of these areas crossover to other areas. The person with a hearing deficit, will have an added burden of communication, increasing their confusion. The person who may be diabetic, will no longer be able to understand, how unsafe it is to not follow their diet restrictions.

To provide over all wellness, only 5 areas of dementia care turns, into a very big job.

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