Articles

10 Warnings of Signs of Alzheimer's
Senior Home Care - Is it Right for You?
Stages of Alzheimer's Disease
Sundowers Syndrome
What is Alzheimer's Disease (AD)?

10 Warnings of Signs of Alzheimer's

1. Memory loss. Forgetting recently learned information is one of the most common early signs of dementia. A person begins to forget more often and is unable to recall the information later.

What's normal? Forgetting names or appointments occasionally.

2. Difficulty performing familiar tasks. People with dementia often find it hard to plan or complete everyday tasks. Individuals may lose track of the steps involved in preparing a meal, placing a telephone call or playing a game.

What's normal? Occasionally forgetting why you came into a room or what you planned to say.

3. Problems with language. People with Alzheimer’s disease often forget simple words or substitute unusual words, making their speech or writing hard to understand. They may be unable to find the toothbrush, for example, and instead ask for "that thing for my mouth.”

What's normal? Sometimes having trouble finding the right word.

4. Disorientation to time and place. People with Alzheimer’s disease can become lost in their own neighborhood, forget where they are and how they got there, and not know how to get back home.

What's normal? Forgetting the day of the week or where you were going.

5. Poor or decreased judgment. Those with Alzheimer’s may dress inappropriately, wearing several layers on a warm day or little clothing in the cold. They may show poor judgment, like giving away large sums of money to telemarketers.

What's normal? Making a questionable or debatable decision from time to time.

6. Problems with abstract thinking. Someone with Alzheimer’s disease may have unusual difficulty performing complex mental tasks, like forgetting what numbers are for and how they should be used.

What's normal? Finding it challenging to balance a checkbook.

7. Misplacing things. A person with Alzheimer’s disease may put things in unusual places: an iron in the freezer or a wristwatch in the sugar bowl.

What's normal? Misplacing keys or a wallet temporarily.

8. Changes in mood or behavior. Someone with Alzheimer’s disease may show rapid mood swings – from calm to tears to anger – for no apparent reason.

What's normal? Occasionally feeling sad or moody.

9. Changes in personality. The personalities of people with dementia can change dramatically. They may become extremely confused, suspicious, fearful or dependent on a family member.

What's normal? People’s personalities do change somewhat with age.

10. Loss of initiative. A person with Alzheimer’s disease may become very passive, sitting in front of the TV for hours, sleeping more than usual or not wanting to do usual activities.

What's normal? Sometimes feeling weary of work or social obligations.

The difference between Alzheimer's and normal age-related memory changes

Someone with Alzheimer's disease symptoms	Someone with normal age-related memory changes
Forgets entire experiences	Forgets part of an experience
Rarely remembers later	Often remembers later
Is gradually unable to follow written/spoken directions	Is usually able to follow written/spoken directions
Is gradually unable to use notes as reminders	Is usually able to use notes as reminders
Is gradually unable to care for self	Is usually able to care for self

Senior Home Care - Is it Right for You?

Senior Home Care is a relatively new service compared to older care services such as nursing homes or even assisted living. So what is senior home care and when is it appropriate?

When someone has trouble taking care of certain activities of daily life such as bathing, dressing, or just managing certain tasks for awhile during convalescent recovery after an illness, they often faced with the choice of getting some help or leaving their home to stay in a facility that can offer that daily care.

The problem with the latter is that it's often just not the right time and it can be very expensive. Most seniors want to stay in their home as long as they can. If it's a matter of recovering from surgery, the cost to stay elsewhere because of minor inconveniences can be a serious financial drain.

The idea of getting help can take two paths. In many cases, adult children and grandchildren, other family, neighbors, and friends can and do pitch in. The problem is that it's often not enough. Working adult children find it hard to run over to mom's in the morning to help her in and out of the shower and wait till she dresses. Other family and friends aren't consistently available.

Senior Home Care is a paid alternative where an expert in handling these kinds of situations comes to the home on a regular schedule to pick up where the relatives can't. Senior Home Care specialists do a wide variety of duties and though these may cross over some duties of other services such as maid services, Senior Home Care specialists are there to provide assistance wherever it is necessary.

Senior Home Care service specialists provide assistance with daily tasks such as bathing and dressing, can assist with cooking, cleaning, provide transportation, go get prescriptions and groceries, or sometimes even just sit and talk.

Sometimes seniors feel as though their independence is threatened when help services are required. Nobody likes to have to admit that they need help with these kinds of basic functions and this can sometimes mean that home care services are refused.

So how does one know when it's time to bring someone in?

The first thing that must be considered is when there are safety issues involved. If there is danger of falling while getting in and out of the shower, dizziness or eyesight have the potential to cause an accident, or if there have been issues with forgetfulness or an inability to process information, then concern over physical safety must take precedence over feelings that independence is being threatened.

If these are not issues, then home care services may indeed be implemented over a period of time, starting first with duties that are most despised. It is not that uncommon that a senior home care specialist may be called in to provide some light housekeeping. If they also happen to be there during normal shower time, so much the better.

In many cases where an individual initially exhibits certain reactions to the idea of home care, actually meeting the senior home care specialist can put these fears to rest.

The interview stage is always a requirement for Senior Home Care companies. During this time, they do a "needs-analysis" profile and can usually alleviate the concerns over bringing assistance home.

If you think that senior home care is something that needs to be examined further, consider having someone come out for a visit to talk about services. These visits are generally free, and responsible home care service companies understand that there may be concerns. These are no-pressure and no-obligation meetings, and just the human face can often mean a better degree of acceptance of this new idea.

Stages of Alzheimer's Disease

Alzheimer's Disease is Not a Normal Part of Aging

Misplacing car keys. Not remembering a familiar name. Some people do become more forgetful as they get older. That's a normal part of aging. Alzheimer's disease is not. Alzheimer's disease affects approximately 5 million people in the U.S. Over time, Alzheimer's disease gradually destroys a person's memory and ability to learn and carry out daily activities such as talking, eating, and going to the bathroom. As the disease progresses, individuals may also experience changes in personality and behavior. Unfortunately, there are no cures for Alzheimer's disease and there is no way to predict how fast someone will progress through the stages of the disease.9

However, early Alzheimer's diagnosis and treatment can slow the progression of Alzheimer's symptoms.

Using the Functional Assessment Staging (FAST) scale developed by Dr. Barry Reisberg, director of the New York University School of Medicine's Silberstein Aging and Dementia Research Center, doctors are able to make a determination about which stage of the disease a person is suffering from, based on the Alzheimer's symptoms being experienced. The FAST scale divides the progression of Alzheimer's disease into areas of functional loss, such as degrees of forgetfulness, agitation and behavior and deficits in intellect and reasoning, as well as the ability to perform daily activities. By understanding the various areas, Alzheimer's caregivers can better meet the needs of the person suffering from Alzheimer's.

Alzheimer's Disease: Progressing through Three Stages

In people with Alzheimer's disease, changes in the brain may begin 10 to 20 years before any visible signs or symptoms appear. Some regions of the brain may begin to shrink, resulting in memory loss, the first visible sign of Alzheimer's disease.

Over time, Alzheimer's disease progresses through three main stages: mild, moderate, and severe. Because it is not easy to look inside a living brain to see the damage Alzheimer's disease causes, these stages are characterized by a collection of signs and symptoms and behaviors the people with Alzheimer's disease experience.

Mild Alzheimer's Disease

People with mild symptoms of Alzheimer's disease often seem healthy, but they are actually having trouble making sense of the world around them. It often takes time for an observer to realize that something is wrong because the initial symptoms are often confused with changes that take place in normal aging. Symptoms and early signs of Alzheimer's disease may include:

· Difficulty learning and remembering new information

· Difficulty managing finances, planning meals, taking medication on schedule

· Depression symptoms (sadness, decreased interest in usual activities, loss of energy)

· Still able to do most activities such as driving a car

· Gets lost going to familiar places

Moderate Alzheimer's Disease

In moderate Alzheimer's disease, the damaging processes occurring in the brain worsen and spread to other areas that control language, reasoning, sensory processing, and thought. In this stage, symptoms and signs of Alzheimer's disease become more pronounced and behavioral problems may become more obvious. Signs and symptoms of moderate Alzheimer's disease may include:

· Forgetting old facts

o Continually repeats stories and/or asks the same questions over and over

o Makes up stories to fill gaps

· Difficulty performing tasks

o Following written notes

o Using the shower and toilet

· Agitation, behavioral symptoms common

o Restlessness, repetitive movements

o Wandering

o Paranoia, delusions, hallucinations

· Deficits in intellect and reasoning

· Lack of concern for appearance, hygiene, and sleep become more noticeable

Severe Alzheimer's Disease

In the advanced stage of Alzheimer's disease, damage to the brain's nerve cells is widespread. At this point, full–time care is typically required. For friends, family, and Alzheimer's caregivers, this can be the most difficult stage. People with severe Alzheimer's disease may have difficulty walking, and they often suffer complications from other illnesses, such as pneumonia. Signs of severe Alzheimer's disease may include:

· May groan, scream, mumble, or speak gibberish

· Behavioral symptoms common

o Refuses to eat

o Inappropriately cries out

· Failure to recognize family or faces

· Difficulty with all essential activities of daily living

With this information on the various stages of Alzheimer's disease – and the symptoms associated with them – you are in a better position to discuss Alzheimer's treatment options with the doctor.

Sundowers Syndrome

Dr. Vanda

“Dad and I were about to take Mom home from the hospital. It was in the afternoon, I remember,” Lori Wark, a caretaker daughter, told me. “Then we realized she was too weak to take a cab so we sent for an ambulance. While we were waiting, Mom and I had a great time talking and laughing. Everything seemed so normal. Then Mom got tired and decided to take a short nap.

“When she woke up she was a completely different person. She accused Dad of keeping some important information from her; she thought we were taking her away from a former home she had loved. She was very upset.” Gone was the playful woman she’d been just a few minutes ago.

The above story is an example of a typical sundowners syndrome incident. Although there is very little agreement on the defining characteristics of the syndrome (also known as sundowning) some studies suggest that it is a phenomenon in which an elderly person shows an increase in confusion and agitation in the late afternoon or evening.

Most professionals believe sundowning occurs only in elderly who exhibit symptoms of dementia such as Alzheimer’s Disease, but this may not always be the case. Dr. Maria Sullivan, associate professor of clinical psychiatry, at Columbia University and the New York State Psychiatric Institute, explained that all elderly people exhibit some age-related cognitive decline, even if it cannot be termed dementia. Therefore, even a minimal mental degeneration may predispose someone to sundowning. It is also important to note that not all those with dementia exhibit symptoms of sundowners syndrome and as definitive sundowning characteristics have not been defined, as a caregiver, all unusual behaviors should be checked out with your doctor.

Symptoms

Visual Hallucinations
According to Dr. Sullivan the primary symptom that she has observed besides confusion and agitation is benign visual hallucinations. These hallucinations are considered benign because they tend not to be threatening or frightening as is frequently the case with psychotic hallucinations. A common hallucination is seeing a stranger (that no one else can see) who has come to the hospital room to visit the elderly person. In the story at the beginning of this article “Mom” saw the place where she once had lived, even the furniture seemed the same. This qualifies as a benign visual hallucination.

Disorientation and Agitation
Disorientation and agitation tend to go together. A familiar room that suddenly seems strange to the elderly person is an example. Disorientation can often provoke fear and hostility.

Cortical disinhibition
During a sundowning episode an elderly person who has never cursed before may begin to use language that shocks relatives.

Paranoia
An increase in suspicion toward relatives and caretakers can occur. “Mom” in the above example accused her husband of hiding some important piece of information from her.

Cause

The cause of sundowning is still unknown. One of the most popular myths about the cause is the decreased light in the late afternoon and evening. Some sources have compared it to Seasonal Affective Disorder (SAD), which causes a person to become more depressed in winter because of the fewer daylight hours. The recommended treatment based on this so-called cause of sundown syndrome then becomes “keep the lights on.” Professional research, however, has found that added illumination in the late afternoon or evening does not curtail the problem.

Some Possible Causes

Although research is very sketchy when it comes to Sundowners Syndrome some theories have been suggested: Unmet psychological needs due to the lower number of evening/night shift staff Disordered circadian rhythm Afternoon fatigue due to high levels of activity earlier in the day.

Treatment

Very little data exist to support the effectiveness of the following treatment measures. However, as caregivers we like to feel that we are doing something so here are some suggestions that have been made by professionals.

Structured Activity
Some have suggested that planned activities that interest the elderly person might decrease the incidence of agitation.

Redirection, Reassurance, Distraction
Speaking in gentle, loving tones and not being directly confrontational may help to prevent or lessen agitation in an elderly person. It might, then, be possible to involve the person in a new activity. Meeting Physical Needs Be sure basic physical needs like toileting and relief of pain or hunger have been met

Antipsychotic Medicines
Antipsychotic medication has had the greatest success with sundowners syndrome; however, these medicines can also cause sedation. A balance has to be found between the anti-psychotic and sedating affect for this treatment to be truly affective for the elderly person.

Clearly, a lot more research needs to be done. But as a caregiver knowing that this syndrome exists is important. Seeing a usually clear and cognizant loved one suddenly exhibit odd behaviors towards the end of the day can be very disconcerting to say the least. Talking to your doctor or geriatric manager should be your first step when this happens, but knowing that such a syndrome exists can also give you hopes that the person you know will return in the morning.

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Special thanks to:Maria Sullivan, M.D., Ph.D., Associate Professor, Clinical Psychiatry, Columbia University/ New York State Psychiatric Institute.

References Bachman, D & Rabins, P. (2006). “Sundowning” and other temporally associated agitation states in dementia patients. Annual Review of Medicine, 57:499-511. Rindlisbacher, P. & Hopkins, R. W. (1992). An investigation of the sundowning syndrome. International Journal of Geriatric Psychiatry, 7, 15-23.

What is Alzheimer's Disease (AD)?

Dementia is a brain disorder that seriously affects a person’s ability to carry out daily activities. The most common form of dementia among older people is Alzheimer’s disease (AD), which initially involves the parts of the brain that control thought, memory, and language. Although scientists are learning more every day, right now they still do not know what causes AD, and there is no cure.

AD is named after Dr. Alois Alzheimer, a German doctor. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. He found abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary tangles). Today, these plaques and tangles in the brain are considered signs of AD.

Scientists also have found other brain changes in people with AD. Nerve cells die in areas of the brain that are vital to memory and other mental abilities, and connections between nerve cells are disrupted. There also are lower levels of some of the chemicals in the brain that carry messages back and forth between nerve cells. AD may impair thinking and memory by disrupting these messages.

How many Americans have AD?

Scientists think that up to 4.5 million Americans suffer from AD. The disease usually begins after age 60, and risk goes up with age. While younger people also may get AD, it is much less common. About 5 percent of men and women ages 65 to 74 have AD, and nearly half of those age 85 and older may have the disease. It is important to note, however, that AD is not a normal part of aging.

How long can a person live with AD?

AD is a slow disease, starting with mild memory problems and ending with severe brain damage. The course the disease takes and how fast changes occur vary from person to person. On average, AD patients live from 8 to 10 years after they are diagnosed, though the disease can last for as many as 20 years.

What is Dementia?

The term "dementia" describes a group of symptoms that are caused by changes in brain function. Dementia symptoms may include asking the same questions repeatedly; becoming lost in familiar places; being unable to follow directions; getting disoriented about time, people, and places; and neglecting personal safety, hygiene, and nutrition. People with dementia lose their abilities at different rates.

Dementia is caused by many conditions. Some conditions that cause dementia can be reversed, and others cannot. The two most common forms of dementia in older people are Alzheimer's disease and multi-infarct dementia (sometimes called vascular dementia). These types of dementia are irreversible, which means they cannot be cured.

Reversible conditions with symptoms of dementia can be caused by a high fever, dehydration, vitamin deficiency and poor nutrition, bad reactions to medicines, problems with the thyroid gland, or a minor head injury. Medical conditions like these can be serious and should be treated by a doctor as soon as possible.

Sometimes older people have emotional problems that can be mistaken for dementia. Feeling sad, lonely, worried, or bored may be more common for older people facing retirement or coping with the death of a spouse, relative, or friend. Adapting to these changes leaves some people feeling confused or forgetful. Emotional problems can be eased by supportive friends and family, or by professional help from a doctor or counselor.