Caring for people with Alzheimer's

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A caregivers guide For Alzheimers Care

• IN THE HOME RESIDENTIAL SETTING

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Overview of Alzheimers Disease and Related
Dementias

• Different types of Dementia
• What is Alzheimers Disease (AD)?
• The A, B, Cs of Alzheimers Disease
• Symptoms and stages of Alzheimers Disease
• Risk Factors for AD
• Diagnosing AD
• See Alzheimers Disease Inside Looking Out (a
  video)
• Treatment Options
• See Alzheimers How Families Cope (a video)
• Caregivers Solving Day-to-Day Problems
• Caregivers Creating a Safe Home Environment
• What is new? Clinical Trials (www.alzheimers.org/
  trials or call ADEAR Center at 1-800-438-4380
• See Losing it All The Reality of Alzheimers
  Disease (a video)
• Caregivers Bill of Rights
• Resources in the Community
• GLOSSARY

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INTRODUCTION

• What is your experience with Alzheimers?
• What is your experience with Dementia?
• What do you want to know about Alzheimers today?

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Different Types of Dementia
Dementia refers to a general loss of intellectual
functions (i.e., memory, reasoning,
concentration, attention, abstract ability, and
reduced language function), plus personality
changes (though not always disorientation). There
are two types of dementia reversible and
irreversible.

• Reversible dementia can go away when the cause
  of what is affecting the brain is removed. It is
  extremely important for caregivers to identify
  reversible dementia so it can be treated! When a
  person begins to exhibit forgetfulness,
  inattention, slower thinking, listlessness, and
  inability to think straight, do not attribute
  these behaviors to getting older.
• Possible reasons for reversible dementia
• Infection (often pneumonia or urinary tract
  infection (UTI).
• Dehydration / poor nutrition.
• Electrolyte imbalance, diabetes out of control,
  thyroid problems, renal problems.
• Medications / alcohol Always suspect medication
  as a cause of confusion in elderly.

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Examples of reversible Dementia

• Transient Isachemic Attack (TIA), mini stroke)
• This is a partial blockage of blood flow to the
  brain. Possible symptoms include visual
  disturbances in on one or both eyes, dizziness,
  weakness, difficulty swallowing, numbness or
  unconsciousness. The attack usually lasts a few
  minutes with symptoms rarely continuing for
  several hours.
• Delirium
• This is an acute state of mental confusion,
  characterized by disorientation and an inability
  to process information or focus on immediate
  surroundings. It is usually Temporary and is
  reversed when the illness or condition that
  caused it is treated. Delirium is one of the
  most common mental disorders in the elderly and
  one of the most serious.
• Depression
• This can appear to be dementia. Chronic
  depression is very common in the elderly and it
  can be treated effectively with medications.
• Anxiety/Grief
• If identified, it can be dealt with to reduce
  confusion and other dementia symptoms.

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Reversible dementia, continued

• Head Injury / Traumatic Brain Injury
• The most common is a closed head injury. A
  closed head injury is usually caused by rapid
  acceleration and deceleration of the head during
  which the brain is whipped back and forth,
  bouncing off the inside of the bony skull. Skull
  fractures are a common result of closed head
  injuries.
• Symptoms of a head injury include
• Motor Problems weak paralysis, poor balance,
  coordination, decreased endurance, loss of
  ability to control motor movement, or abnormal
  muscle tone and stiffness are often problems
  relating to head injury.
• Perceptual Problems Changes in sensations
  related to hearing, vision, taste, smell, and
  touch.
• Speech and Language Deficits Difficulty in
  understanding what is said or difficulty in
  expressing thought (aphasia).
• Cognitive Problems Changes may occur in mental
  activities, personality, and social behavior.
  Cognitive problems include disorientation,
  distractibility, memory loss, and
  disorganization, lack of generalization, poor
  judgment, and impaired problem solving skills,
  inflexibility, and loss of abstract reasoning.
• Memory A person with a head injury may
  experience short-term of long-term memory, and a
  problem storing or retrieving information.
  Amnesia, a lack of memory for a period of time.
• Denial The person may not even be aware or
  understand his or her current situation and may
  deny there are any problems they may reject
  treatment, attempt to perform potentially
  dangerous activities such as driving, or return
  to work before mentally or emotionally ready.
• Regulatory Deficits There may be changes in
  basic bodily functions related to body
  temperature, level of awareness, swallowing and
  bladder/bowel control. They may fatigue easily
  and require frequent rest. The patient may have
  a short attention span. External stimulation
  (visitors, sounds, etc.) must often be limited in
  the early stages of recovery.
• Seizures Seizures may occur immediately
  following the brain injury or develop several
  months later. Doctors will often prescribe
  medication that will help prevent seizures, just
  as a precautionary measure.

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• Irreversible Dementia A condition that comes on
  gradually and has no cure. The patient may
  progress through several stages
• Loss of memory, insight, judgment, personality
  changes, mental confusion, language disturbances,
  and severe disorientation
• The patient may eventually become incontinent,
  wander, and have behavior changes
• The patient will eventually become totally
  dependent on others.

• Other Causes of Irreversible Dementia Diseases
  Besides Alzheimers Disease
• Multi-Stroke Dementia A rapid form of brain
  disease with rapid deterioration of the
  intellectual functioning, caused by vascular
  disease such as one or more ongoing small strokes
  that destroy or damage brain tissue.
• Parkinsons Dementia Occurs when there is a
  defect in the part of the brain that controls the
  bodys voluntary
• AIDS Dementia This dementia is related to
  having AIDS (HIV disease) in which the immune
  system is constantly attacked and weakened. AIDS
  dementia symptoms can stabilize for months at a
  time if the patient responds to medications that
  reduce the amount of virus in the body.

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What is Alzheimers Disease? This section is
adapted from the Alzheimers Disease Education
Referral Center. Dementia is a brain disorder
that seriously affects a persons ability to
carry out daily activities. Alzheimers Disease
(AD) is the most common form of Dementia among
older people. It involves the parts of the brain
that control thought, memory, and language.

• Scientists think up to four million Americans
  suffer from AD. The disease usually begins after
  the age of 60, and the risk increases with age.
• AD is not a normal part of aging!
• AD is named after Dr. Alois Alzheimer, a German
  doctor.
• In 1906, Dr. Alzheimer noticed changes in the
  brain of a woman who died of an unusual mental
  illness.
• The woman had experienced severe memory problems,
  confusion, and difficulty understanding
  questions.
• Upon her death, he performed an autopsy on her
  brain, and described dense deposits outside and
  around nerve cells that looked like abnormal
  clumps (now called amyloid plaques, and tangled
  bundles of twisted bands of fibers (now called
  neurofibrillary tangles.).
• Today these plaques and tangles in the brain are
  considered the hallmarks of AD.

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The A, B, Cs of Alzheimers Disease.AD causes a
gradual decline in three main areas which you can
think of as ABC for short. A is for
Activities of daily living. This means a person
is able to care for him or herself doing routine
tasks such as getting dressed or cooking. B is
for Behavior This relates to mood and
personality changes, such as a persons emotions,
interest in being with others, and eating and
sleeping C is for Cognition This includes
mental tasks such as thinking, reasoning, and
learning. Being able to remember friends names,
past or current events, or where you live.
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Symptoms and Stages of Alzheimers
Disease Adapted from the Growing challenge of
Alzheimers Disease in Residential Settings. The
Alzheimers Disease Education Center (pages
21-23) Early Stage of Alzheimers Disease
Memory Recent memory loss of the time
Language mild aphasia (difficulty understanding and expressing languages difficulty following instructions difficulty following conversations difficulty expressing feelings
Orientation Seeks the familiar and avoids the unfamiliar
Mood and Behavior Apathy, depression
Motor Some difficulty writing and using objects
Activities of Daily Living Needs reminders with some ADLs
Your notes
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Early Stages of Alzheimers Disease
The symptoms are more obvious - The symptoms are more obvious -
Memory Routine loss of recent memory
Language Moderate loss, difficulty understanding and expressing language
Orientation May get lost at times, even inside the home
Motor Repetitive action, problems processing meanings
Mood Possible mood and behavior disturbances
ADLs Needs reminders and help for daily living activities
Your notes
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Stages of Alzheimers Disease (continued)
Late stages of Alzheimers Disease Late stages of Alzheimers Disease
Memory Mixes up past and present
Language Impaired in understanding and expressing language impaired ability to process information
Orientation Misidentifies familiar persons and places
Motor Bradykinesia lowness of movement, difficulty imitating movement, poor handwriting, inability to button clothes
Activities of Daily Living Needs help with ALL activities
Your notes
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Terminal Stages of Alzheimers Disease
Memory No apparent link to past or present
Language Mute or few incoherent words
Orientation Mostly oblivious to surroundings
Motor Little spontaneous movement, possible seizures
Mood and Behavior Generally passive
ADLs Needs total care
Your notes
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Possible Risk Factors for AD Adapted from The
Growing Challenge of Alzheimers Disease in the
Residential Settings., The Alzheimers Disease
Education Center (pages 24-28)

• Environmental Toxins
• Possible low education occupational attainment
• Head Trauma
• Cardiovascular Disease
• Genes Linked to AD
• Down Syndrome
• Family History
• Female Gender
• Increasing Age
• Loss of Estrogen Production

Your notes
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• Diagnosing AD
• Benefits of Early Diagnosis
• Allows time to initiate appropriate treatments
• Delay cognitive deterioration
• Gives the caregiver / family time to plan
• Health, financial, and estate planning
• Proper referrals
• Your doctor can only diagnoses Probable AD
• A definite diagnosis is possible only after
  death, and the autopsy reveals brain changes,
  formation of the plaque and neurofibrillary
  tangles.

Diagnostic Evaluation of Dementia
Patient History Mini-Mental State Examination Physical Exam Chest X-Ray Blood Work Urine Test CT or CAT scan EEG Magnetic resonance spectroscopy (MRSI) Magnetic Resonance Imaging (MRI) Electrocardiogram (ECG /EKG) Neuropsychological Testing Position emission tomography (PET) Single photon emission computed tomography (SPECT)
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Treatment OptionsAdapted from MSN.com Health
with Web MD http//content.health.msn/content/arti
cle/9/1626
There is currently no cure for AD. However,
planning and medical/social management can help
ease the burden on both the patients and family
members. There are a number of medications to
help preserve the intellectual functioning for
patients with AD. These medications help
preserve the function and the ability to carry
out the daily functioning. Medication should be
given EARLY in the course of the disease. There
are also medications to help manage the most
troubling symptoms of AD, including depression,
behavior problems, and sleeplessness.
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• Specific medications used to treat AD
• Tacrine (Cognex)
• Slows the breakdown of acetylcholine (the
  chemical that helps nerve endings communicate).
  Helps relieve memory impairment.
• Side effects appear to gastrointestinal
  (vomiting, diarrhea, stomach pain, indigestion,
  and may damage the liver or produce a skin rash.

• Donepezil (Aricept)
• Slows the breakdown of acetylcholine, like
  Tacrine. However, it has less die effects.
• Rivastigmine (Exelon) or Galantamine (Reminyl)
• A newer Drug Slows the breakdown of
  acetycholine.
• Other drugs that treat disruptive symptoms like
  depression, paranoia, wandering, hallucinations,
  agitation, and confusion
• Antyphsychotics Used to treat paranoia and
  confusion.
• Anti-Depressants Treats depression.
  Side-effects can be drowsiness, dry mouth,
  constipation, and anxiety.
• Anti-Anxiety Side effects include drowsiness.
• Other treatments that are preventative
• Estrogen
• Vitamin E
• Anti-Oxidants
• Alternative Medication

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Caregivers Solving Day-to-Day ProblemsAdapted
from http//www.ahaf.org/alzdis/
about/Solving-problems.htm 2003

• Communications
• Daily Grooming
• Dressing
• Driving
• Mealtime
• Sleeping Problems
• Sundowning
• Toileting / Wandering
• Catastrophic Behavior

Caregivers Creating a Safe Environment

• Bathroom
• Kitchen
• Stairs
• Windows and Doors
• Fire, Burn and Electrical Shock Safety
• Personal Safety

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Your Notes
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Caregivers Bill of Rights
Providing care for a person with Alzheimers
disease is often a stressful and demanding
ordeal. It is important to remember that
caregivers have human needs and emotions. They
must care for the patient as well as themselves.
The Alzheimers Family Relief Programs
Caregivers Bill of Rights offers some tips for
coping.

• IT IS ALL RIGHT TO
• BE ANGRY. Turn this energy into positive action.
  Clean closets, take a walk, talk with someone.
• BE FRUSTRATED Stop the present activity, take a
  deep breath, and begin a different activity.
• TAKE TIME ALONE A favorite chair in a quiet
  room, a trop to the store, or a few hours out
  with friends.
• TRUST YOUR JUDGMENT Relax, you are doing the
  best you can.
• RECOGNIZE YOUR LIMITS You are a valuable
  person. Take care of yourself too!
• MAKE MISTAKES No one is perfect. This is how
  we learn.
• GRIEVE This is a normal response to a loss.
  You may be sad over the loss of the way things
  used to be.
• LAUGH and LOVE It may seem out of place, but
  your capacity to feel is not gone, and can occur
  unexpectedly.
• HOPE Tomorrow, the day may go smoother, a
  friend may call, a cure may be found.

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