Alzheimer's Knowledge

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					                          10 Signs of Alzheimer's
Memory loss that disrupts daily life is not a typical part of aging. It may be a symptom of Alzheimer's, a
fatal brain disease that causes a slow decline in memory, thinking and reasoning skills. Every individual
may experience one or more of these signs in different degrees. If you notice any of them, please see a
doctor. Learn how Alzheimer's affects the brain and take the Brain Tour.


10 warning signs of Alzheimer's:
           Memory loss that disrupts daily life

           One of the most common signs of Alzheimer's is
           memory loss, especially forgetting recently learned
           information. Others include forgetting important
           dates or events; asking for the same information
           over and over; relying on memory aides (e.g.,
           reminder notes or electronic devices) or family
           members for things they used to handle on their own.
           What's a typical age-related change? Sometimes forgetting names or
           appointments, but remembering them later.


           Challenges in planning or solving problems

           Some people may experience changes in their ability
           to develop and follow a plan or work with numbers.
           They may have trouble following a familiar recipe or
           keeping track of monthly bills. They may have
           difficulty concentrating and take much longer to do
           things than they did before.
           What's a typical age-related change? Making occasional errors when
           balancing a checkbook.


           Difficulty completing familiar tasks at
           home, at work or at leisure
           People with Alzheimer's often find it hard to
           complete daily tasks. Sometimes, people may have
           trouble driving to a familiar location, managing a
           budget at work or remembering the rules of a
           favorite game.
           What's a typical age-related change? Occasionally
           needing help to use the settings on a microwave or to record a
           television show.
Confusion with time or place

People with Alzheimer's can lose track of dates,
seasons and the passage of time. They may have
trouble understanding something if it is not
happening immediately. Sometimes they may forget
where they are or how they got there.
What's a typical age-related change? Getting
confused about the day of the week but figuring it out later.


Trouble understanding visual images and
spatial relationships
For some people, having vision problems is a sign of
Alzheimer's. They may have difficulty reading,
judging distance and determining color or contrast.
In terms of perception, they may pass a mirror and
think someone else is in the room. They may not
realize they are the person in the mirror.
What's a typical age-related change? Vision changes related to
cataracts.



New problems with words in speaking or
writing
People with Alzheimer's may have trouble following
or joining a conversation. They may stop in the
middle of a conversation and have no idea how to
continue or they may repeat themselves. They may
struggle with vocabulary, have problems finding the
right word or call things by the wrong name (e.g.,
calling a "watch" a "hand-clock").
What's a typical age-related change? Sometimes having trouble finding
the right word.



Misplacing things and losing the ability to
retrace steps
A person with Alzheimer's disease may put things in
unusual places. They may lose things and be unable
to go back over their steps to find them again.
Sometimes, they may accuse others of stealing. This
may occur more frequently over time.
What's a typical age-related change? Misplacing
things from time to time, such as a pair of glasses or the remote
          control.



          Decreased or poor judgment

          People with Alzheimer's may experience changes in
          judgment or decision-making. For example, they
          may use poor judgment when dealing with money,
          giving large amounts to telemarketers. They may
          pay less attention to grooming or keeping
          themselves clean.
          What's a typical age-related change? Making a bad decision once in a
          while.


          Withdrawal from work or social activities

          A person with Alzheimer's may start to remove
          themselves from hobbies, social activities, work
          projects or sports. They may have trouble keeping
          up with a favorite sports team or remembering how
          to complete a favorite hobby. They may also avoid
          being social because of the changes they have
          experienced.
          What's a typical age-related change? Sometimes feeling weary of work,
          family and social obligations.


          Changes in mood and personality

          The mood and personalities of people with
          Alzheimer's can change. They can become confused,
          suspicious, depressed, fearful or anxious. They may
          be easily upset at home, at work, with friends or in
          places where they are out of their comfort zone.
          What's a typical age-related change? Developing
          very specific ways of doing things and becoming irritable when a
          routine is disrupted.
The U.S. Food and Drug Administration (FDA) has approved two types of medications —
cholinesterase inhibitors (Aricept, Exelon, Razadyne, Cognex) and memantine (Namenda) — to treat
the cognitive symptoms (memory loss, confusion, and problems with thinking and reasoning) of
Alzheimer's disease.

As Alzheimer’s progresses, brain cells die and connections among cells are lost, causing cognitive
symptoms to worsen. While current medications cannot stop the damage Alzheimer’s causes to brain
cells, they may help lessen or stabilize symptoms for a limited time by affecting certain chemicals
involved in carrying messages among the brain's nerve cells. Doctors sometimes prescribe both types of
medications together. Some doctors also prescribe high doses of vitamin E for cognitive changes of
Alzheimer's disease.


Treating Agitation in Alzheimer's Disease Patients
There are a number of problems with the behaviors of people with Alzheimer's disease. These include
depression, paranoia, wandering, hallucinations (seeing, hearing, or feeling things that are not there),
restlessness, irritability, uncharacteristic cursing, threatening language, and confusion. These problems
can interfere with normal daily activity and sleep and may increase the risk of harm to the person with
Alzheimer's and their caregiver.
Often, agitation is triggered by a change in environment, fear, or fatigue. Other times, it's triggered by
an infection or another medical problem. Therefore, it's important to receive a medical evaluation to
look for treatable causes of agitation.
If a medical problem does not exist, then the agitation can be managed using medication and simple
behavioral techniques to simplify the patient’s routine and distract them from the stress that caused the
problem.
Medications often used to treat agitation include:
    • Antipsychotics. Medicines used to treat paranoia and confusion are called neuroleptics or
      antipsychotics. Examples of these medicines are haloperidol (Haldol), Risperdal, Zyprexa,
      Clozaril, Geodon, and Seroquel. Side effects can include drowsiness, rigidity, and unusual
      movements.
    • Antidepressants. Antidepressants, such as Prozac, Paxil, Celexa, Zoloft, and Pamelor, are used
      to treat depression. Side effects of these medicines can include drowsiness, dry mouth,
      constipation, and anxiety.
    • Anti-anxiety medications. These medications, which include Xanax, Ativan, Serax, and
      BuSpar, often cause drowsiness.


Preparing the Home for an Alzheimer's Patient
Caring for an Alzheimer’s patient at home can be difficult. In taking the proper steps to become a
successful caregiver, it is essential that you prepare your home for your loved one's arrival. Likewise, if
your loved one's Alzheimer's is mild and they still live on their own, it is important that you ensure that
their living environment is safe.
Not only must space often be reorganized, but every room in the house that your loved one will be
using should also be made as accident-proof as possible. There are many basic guidelines that can be
followed in order to provide safe and effective caregiving in the home.
In order to ensure a thorough approach, a room-by-room checklist can be very helpful. The following
guidelines can be used for the caregiver's own home if the loved one is living with the caregiver, or for
an elderly loved one's home.
Note: Not all of these recommendations may benefit your loved one's situation.

Entrance and Exit
    • Can the house or apartment be entered and exited safely?
    • Is there a secure railing?
    •   Are the stairs or ramps in good repair, without loose or uneven boards?
    •   Can visitors be seen prior to their entering the house or apartment?
    •   Does the lock work?
    •   Can the lock easily be opened for an emergency exit?
    •   Is the entrance/exit well lit and free of clutter?
    •   Do you have an emergency exit plan and more than one fire escape route?

Living Areas
    • Are the walking pathways uncluttered?
    • Can your loved one get up and down from the sofa or chair safely? If not, consider investing in
      chairs with straight backs, armrests, and firm seats. Adding a firm cushion to existing pieces of
      furniture adds height to them, making it easier to move.
    • Can windows and doors be opened easily and locked securely?
    • Can the television be easily managed?
    • Can the light switches be manipulated easily? If not, try touchable lamps or those that react to
      sound.
    • Are electrical cords and telephone cords secured and out of the way to prevent tripping? Do not
      run cords under furniture or rugs where they can become frayed or damaged. Secure them with
      tape, not sharp tacks or nails.
    • Adapt the telephone by changing the small buttons to larger push buttons to ease dialing. Have
      frequently called and emergency numbers programmed into speed dial or tape these numbers to
      the phone receiver. Keep a portable or tabletop phone where it can be accessed in case of a fall.

Kitchen
    • Is the doorway accessible?
    • Are the appliances in working order?
    • Can the faucets of the sink be manipulated? If not, consider extended hand levers to make them
      easier to turn.
    • Can the refrigerator and freezer be opened and closed?
    • Can the high and low cabinets be safely opened and closed?
    • Is there adequate workspace?
    • Can utensils, pots and pans, and food be safely reached?
    • Can the stove controls and door be safely managed?
    • Can the outlets be reached?
    • Can food be safely transported to the eating area?
    • Are sharp objects safely stored?
    • Are flammables kept away from the stove area?
    • Keep towels, curtains and other flammable items away from the range/stove


Preparing the Home for an Alzheimer's Patient
(continued)
Bedroom
   • Is the doorway accessible?
   • Can your loved one get in and out of bed safely? If not, consider purchasing an electric bed or
     mattress.
   • Is the light accessible from the bed?
   • Can the phone be easily reached?
   • Can clothing in the closet and dresser be reached?
   • Is there a clear path to the bathroom?
   • A "trapeze" bar can be installed if your loved one has difficulty getting out of bed.

Bathroom
   • Is the doorway accessible?
   • Can your loved one safely get in and out of the shower or bathtub? If not, install grab bars on
     the inside and outside of the bathtub or shower. Towel racks are not sturdy enough to be used as
     grab bars.
   • Will a tub bench or tub chair be needed? If so, use only ones with nonskid tips.
   • Are there bath mats or nonskid strips in place?
   • Can your loved one safely transfer to the toilet? If not, install a safety frame, raised seat, or grab
     bar.
   • Can the outlets be reached? Test GFCI outlets monthly by pushing the test button and making
     sure that the appliance turns off and that it resets.
   • Can the light switches be turned on and off?
   • Can the faucet be easily used? If not, consider extended hand levers to make them easier to turn.
   • Is there a nightlight?
   • If there is a small bathroom rug, get rid of it. Replace it with a large rug that covers most of the
     floor and apply an adhesive back to it.

Stairways
   • Is a secure handrail present? It may be helpful to install a second handrail so there is one on
     both sides of the stairs.
   • Is there adequate lighting at the top and bottom of the stairs?
   • Is the carpet secure?
   • Put rough texture treads on steps with a smooth surface.
   • Are the steps free of clutter?
   • If stairs are difficult, it may be helpful to arrange most of the activities on the lower level of the
     house.

General
   • Are there working smoke detectors on every floor? Remember to change the batteries
     frequently.
   • Are there space heaters, electric blankets, or other fire hazards? If so, remove them. If they must
     be used, follow the manufacturer's safety instructions and keep them on a sturdy surface away
     from rugs, curtains, furniture, or papers.
    • Is there a carbon monoxide detector? If so, is it working properly?
    • Are the electrical cords in good condition and free of frays?
    • Are there outlets or switches that are unusually warm or hot to touch? If so, have the wiring
      replaced as soon as possible and do not use them.
    • Is there adequate lighting throughout the house or apartment? Consider using small nightlights
      to light up the hallways or bathroom to assist your loved one during the night.
    • Are all of the small rugs and runners slip resistant? If your loved one requires the use of a
      walker or wheelchair, remove all throw rugs.
    • Is the house or apartment free of insects or other pests?
    • Are the plumbing and utilities working? Make sure the hot water thermostat is set to "low" or
      120 degrees to prevent burns.
    • Can the mail be retrieved safely? If not, arrange for someone to pick up the mail for your loved
      one.
    • Is phone accessible to your loved one? Suggestion: keep a cordless phone near your loved one's
      chair or put it in a pocket/pouch and attach it to their walker/wheelchair (if applicable).
    • Are emergency phone numbers posted on or near the telephone?
    • Are all medicines stored in the containers that they came in?
    • Are all medications clearly marked and stored away from children and confused family
      members?
Reviewed by the doctors at the The Cleveland Clinic Neuroscience Center


Alzheimer's Disease Frequently Asked Questions
Print these questions and answers to discuss with your health care provider.



1. Are there any medications that someone with Alzheimer's disease should avoid?
A person with Alzheimer's disease may be taking medicines to treat symptoms of the disease, as well as
other health problems. However, when a person takes many medications there is an increased risk of
having an adverse reaction, including confusion, agitation, sleepiness or sleeplessness, mood swings,
memory problems, and/or stomach upset.

While it may become necessary for a person to take medicine to treat the severe symptoms of
Alzheimer's disease -- such as hallucinations or aggressive behavior -- some of these medications can
worsen other symptoms of the disease. For example:
     Some drugs such as tranquilizers can cause confusion, increased memory impairment, and
      slowed reactions, which can lead to falls.
     Certain medicines to treat depression, such as tricyclic antidepressants, can cause sedation and
      other side effects of particular concern to the elderly.
     These drugs also can react with medicines used to treat Alzheimer's disease, including Aricept,
      Cognex, Exelon, Namenda, and Razadyne.
     Some medicine used to treat hallucinations can cause sedation, confusion, and drops in blood
      pressure. They also can react with medicines used to treat Alzheimer's disease.
It is important to discuss the pros and cons of these treatment options with your doctor before making a
decision regarding medication. In addition, it is important to consider the possible side effects of over-
the-counter medications, including cough and cold remedies, and sleep medicines. These drugs may
also react with other medications taken by the person with Alzheimer's disease. It is best to consult
your doctor before using any over-the-counter medication.

2. I'm thinking about taking a trip with my father, who has Alzheimer's disease. Is
there anything special I should do?
The most important things to do when traveling with someone with Alzheimer's disease are to plan
ahead and try to anticipate the person's needs, so you'll be ready for any changes or problems. As you
plan, be sure to consider the stage of the person's illness and any behaviors that may be affected by
traveling away from home. You may want to try taking a short trip to see how your loved one reacts to
traveling. Here are a few other tips to consider:
     Plan some activities for the person with Alzheimer's disease to do when traveling. Simple things
      -- such as reading a magazine, playing with a deck of cards, or listening to music -- can help
      keep your loved one calm when traveling.
     Never leave a person with dementia alone in a car. When moving, be sure to keep the seat belt
      buckled and the doors locked.
     Plan regular rest stops.
     Bring an extra driver if your trip involves more than six hours of driving time.
     If the person becomes agitated while traveling in a car, stop at the first available place. Don't try
      to calm the person while driving.
     Consider planning your vacation at a place that is familiar to the person with Alzheimer's
      disease; for example, at a lake cabin that he or she has visited in the past.
     If your loved one is easily agitated, it may be wise to avoid places that are very crowded. You
      may also want to avoid fast-paced sightseeing trips.
     If your loved one has never been on a plane, it may be wise to consider driving, if possible.
     Alert the airlines and hotel staff that you are traveling with a person who is memory impaired
      and make sure the person is carrying or wearing some sort of identification.
     Don't forget that your caregiving responsibilities continue even though you are on vacation. It
      may help to bring someone along who can help you with these duties

5. Is there anything I can do to help my mother preserve what memory she has left?
Losing cherished memories is one of the devastating consequences of Alzheimer's disease. Some
medications used to treat Alzheimer's disease may help slow down symptoms and there are some
techniques you can use to help enhance what memory exists.
     Use notes, lists, memos, etc., to help remind the person with Alzheimer's disease of his or her
      daily tasks.
     Keep photos of family members and friends where the person can see them. Label photos with
      names, if necessary. Reminisce with him or her about the family, or activities he or she once
      enjoyed.
     Use memory "tricks"; for example, thinking of the word HOMES to remember the great lakes:
      Huron, Ontario, Michigan, Erie and Superior.
     Use labels (with words or pictures) placed on drawers and shelves to identify their contents.
     Limit your loved one's alcohol consumption and try to ensure he or she gets adequate sleep.
     Remind him or her of the date, day, time, place, etc., and repeat the names of the people with
      whom he or she has contact.
     Encourage your loved one to exercise his or her mind by reading, doing puzzles, writing, etc., as
      well as to exercise his or her body as appropriate. However, avoid challenging your loved one to
      the point of frustration.



6. Can ginkgo biloba cure Alzheimer's disease?
Ginkgo biloba -- an extract from the ginkgo tree -- has been touted by many as a memory booster.
Although a 1997 study in the U.S. suggested that ginkgo extract may be of some value in treating the
symptoms of Alzheimer's disease and other forms of dementia, more recent studies have not found that
ginkgo biloba will cure or prevent Alzheimer's disease. Other studies also suggest that daily use of
ginkgo biloba may cause side effects, such as too much bleeding (especially when combined with daily
use of aspirin).

There is not enough information available for doctors to recommend the broad use of ginkgo biloba for
Alzheimer's disease or other forms of dementia.

7. Is exercise recommended for someone with Alzheimer's disease?
Exercise offers many benefits for people with Alzheimer's disease. The major benefits include
improved strength, endurance, and heart fitness. Exercise can also increase energy, and improve mood
and sleep. Exercise also helps people with Alzheimer's disease preserve motor skills and improve
balance, which in turn, can help prevent serious injury from falls. Further, exercise can help improve
mental function.

The type and intensity of exercise appropriate for someone with Alzheimer's disease depends on the
person's degree of impairment. People in the early stages of the disease may enjoy exercises such as
walking, bowling, dancing, golf, and swimming, although supervision may be necessary. Greater
supervision may be required as the disease progresses. Activities that could lead to injury should be
avoided.

It is important to talk to the person's doctor before beginning any exercise program. There may be other
factors -- such as bone disease, a heart condition, or balance problems -- that could limit or restrict
activity.

8. Do the symptoms of Alzheimer’s disease vary by the time of day?
Sundown syndrome -- also called sundowning -- is a behavior common in people with Alzheimer's
disease. It describes the confusion, anxiety, agitation, or disorientation that often occur at dusk and into
the evening hours. The episodes may last a few hours or throughout the night.

While the exact cause of sundown syndrome is not known, experts believe there are several
contributing factors. These include physical and mental exhaustion (after a long day), and a shift in the
"internal body clock" caused by the change from daylight to dark. Some people with Alzheimer's
disease have trouble sleeping at night, which may contribute to their disorientation. Medication that can
cause agitation or confusion also may contribute to this syndrome.
Sundown syndrome can be draining for the person with Alzheimer's disease and his or her caregivers.
Here are some suggestions for helping a loved one with sundown syndrome cope:
     Schedule the day so that the more difficult tasks are done early in the day, when the person is
      less likely to become agitated.
     Watch the person's diet and eating habits. Restrict sweets and drinks with caffeine to the
      morning hours. Try serving the person a late afternoon snack or early dinner.
     To help the person relax, try decaffeinated herbal tea or warm milk.
     Keep the house or room well lit. Close the drapes before the sun goes down so that the person
      doesn't watch it become dark outside.
     If the person falls asleep on the sofa or in a chair, let him or her stay there. Don't wake the
      person to go to bed.
     Try distracting the person with activities he or she enjoys. Soothing music or a favorite video
      may help, as well.
     Encourage the person to engage in some physical activity -- such as walking, if able -- during
      the day. This may help him or her to sleep better at night.

9. When will a Alzheimer's disease vaccine be available?
One of the first Alzheimer's disease vaccines to undergo clinical testing produced an unacceptably high
rate of serious side effects, and the trial was discontinued. Other vaccines are being studied.

10. Does the desire for sex diminish or totally disappear in people with early or
mid-stage Alzheimer's disease?
Sexuality has not been studied in Alzheimer's disease per se. However, many individuals with
Alzheimer's disease have a mood disorder such as depression or other medical problem, which can
contribute to sexual problems. In addition, medications used to treat depression or other medical
problems can also cause sexual problems. Many persons with dementia also have decreased motivation
that affects much of their lives, such as their interest in their appearance, clothes, friends, etc., and may
affect their sexual function as well.

If you are concerned about your partner's sexuality, try the following recommendations:
     Have your loved one's doctor assess the presence of a mood disorder, which may cause sexual
      problems.
     Make sure your loved one's medical problems are managed properly. For example, if they have
      pain from arthritis, make sure they are treated.
     Have your loved one's doctor review each medication for its possible effect on sexuality.


Alzheimer's Disease: Your Role as Caregiver
Do You Realize How Much You Do?
Your role as caregiver to a loved one suffering from Alzheimer’s disease can be very involved.
    • You help maintain the quality of life for your spouse, parent, family member, or friend with
      Alzheimer's disease.
    • You have become educated about symptoms, treatments and the progression of the disease.
    • You probably keep track of appointments with the doctor, medication schedules, and exercise.
    • You offer the love and support necessary to meet the challenges of Alzheimer's disease.
You are a caregiver. While many patients retain their independence for a period of time after being
diagnosed with Alzheimer's disease, some may need more help with performing daily activities. For
others, the diagnosis may come after weeks or months of you coping with symptoms that did not have a
name. Regardless of how long you've been dealing with Alzheimer's disease or to what degree, in some
way Alzheimer's has affected your life and responsibilities -- physically, emotionally, or economically.
The role you have taken on is not an easy one. However, the following tips offer some guidance on
how to maintain and improve your caregiving relationship:
    • Take time for yourself. Make sure you have time to relax. If necessary, enlist the help of other
      family members or even hire someone to help out.
    • Learn as much as you can about your loved one's disease so you will know how you can
      help. You'll also understand what changes to expect in your loved one's behavior or symptoms.
    • Help your loved one participate in as many activities in the home and outside the home as
      possible. Maintain the intricate balance between helping your loved one accomplish a task and
      actually doing the task for him or her. Allow the patient the time needed to complete daily
      activities on his or her own, such as dressing.
    • Consult your loved one about his or her family affairs. Although it's not easy to discuss these
      topics, you should be informed of your loved one's wishes regarding a living will, durable
      power of attorney, and do-not-resuscitate (DNR) order.
    • Set realistic goals for yourself and your loved one. Do not attempt to do everything. By
      setting attainable goals, you are setting everyone up for success, rather than disappointment.
    • Do not put your life on hold. Continue to meet with friends, participate in hobbies or groups,
      and maintain a schedule as normally as possible. You will feel more energized and are less
      likely to feel resentful in the long run.
    • Have someone you can talk to. You are there for your loved one -- to listen and to offer
      support -- but you also need a support person. Talk openly and honestly with a friend or family
      member. If this is not possible, join a support group. Understanding that you are not alone and
      that someone else is in a similar situation helps you to feel nurtured.
The most effective caregiver is well informed, prepared, and asks for help and support from all
resources that are available.


Alzheimer's Disease and Other Forms of Dementia
Dementia is the loss of mental functions -- such as thinking, memory, and reasoning -- that is severe
enough to interfere with a person's daily functioning. Dementia is not a disease itself, but rather a group
of symptoms that are caused by various diseases or conditions. Symptoms can also include changes in
personality, mood, and behavior. In some cases, the dementia can be treated and cured because the
cause is treatable. Examples of this include dementia caused by substance abuse (illicit drugs and
alcohol), combinations of prescription medications, and hormone or vitamin imbalances. In some cases,
although the person may appear to have dementia, a severe depression can be causing the symptoms.
This is known as pseudo-dementia (false dementia) and is highly treatable. In most cases, however, a
true dementia cannot be cured.
Dementia develops when the parts of the brain that are involved with learning, memory, decision-
making, and language are affected by one or more of a variety of infections or diseases. The most
common cause of dementia is Alzheimer's disease, but there are as many as 50 other known causes.
Most of these causes are very rare.
Because some causes of dementia can be cured or partially treated, it is very important that your doctor
is thorough when making the diagnosis, so as not to miss potentially treatable conditions. The
frequency of "treatable" causes of dementia is believed to be about 20%.

What Causes Dementia?
There are several things that could cause dementia:
    • Diseases that cause degeneration or loss of nerve cells in the brain such as Alzheimer's,
      Parkinson's and Huntington's.
    • Diseases that affect blood vessels, such as stroke, which can cause a disorder known as multi-
      infarct dementia.
    • Toxic reactions, like excessive alcohol or drug use.
    • Nutritional deficiencies, like vitamin B12 and folate deficiency.
    • Infections that affect the brain and spinal cord, such as AIDS dementia complex and
      Creutzfeldt-Jakob disease.
    • Certain types of hydrocephalus, an accumulation of fluid in the brain that can result from
      developmental abnormalities, infections, injury, or brain tumors.
    • Head injury -- either a single severe head injury or longer term smaller injuries, like in boxers.
    • Illnesses other than in the brain, such as kidney, liver, and lung diseases, can all lead to
      dementia.
Alzheimer's disease causes 50% to 60% of all dementias. But researchers have found that two nervous
diseases, which were originally incorrectly diagnosed as Alzheimer's, are emerging as major causes of
dementia: Lewy body disease and Pick's disease.

How Common Is Dementia?
Dementia caused by nervous system disease, especially Alzheimer's disease, is increasing in frequency
more than most other types of dementia. Some researchers suspect that as many as half of all people
over 80 years old develop Alzheimer's disease. Also, the increased incidence of AIDS dementia
complex, which results from HIV infection, helps account for the increased dementia in recent history,
although with the invention of newer and better drugs to treat HIV, the occurrence of AIDS-associated
dementia is declining.


Alzheimer's Disease and Other Forms of Dementia
(continued)

Who Gets Dementia?
Dementia is considered a late-life disease because it tends to develop mostly in elderly people. About
5% to 8% of all people over the age of 65 have some form of dementia, and this number doubles every
five years above that age. It is estimated that as many as half of people in their 80s suffer from
dementia.
Which Dementias Are Treatable?
    • Dementia due to long-term substance abuse.
    • Tumors that can be removed.
    • Subdural hematoma, accumulation of blood beneath the outer covering of the brain is the result
      of a broken blood vessel, usually the result of a head injury.
    • Normal-pressure hydrocephalus.
    • Metabolic disorders, such as a vitamin B12 deficiency.
    • Hypothyroidism, a condition that results from an underactive thyroid.
    • Hypoglycemia, a condition that results from low blood sugar.



What Are Some of the Untreatable Causes of Dementia?
    •   Alzheimer's disease.
    •   Multi-infarct dementia (Dementia due to multiple small strokes).
    •   Dementias associated with Parkinson's disease and similar disorders.
    •   AIDS dementia complex.
    •   Creutzfeldt-Jakob disease (CJD), a quickly progressing and fatal disease that consists of
        dementia and muscle twitching and spasm.




Alzheimer's Disease Stages
Alzheimer's disease isn't an immediate descent into forgetfulness. Instead, it is a progressive decline in
cognitive function that erodes memory and reduces the ability to perform tasks over a period of several
years.
Experts have designated a series of Alzheimer's stages that can help patients and their families plan for
future care. Each of these stages includes symptoms that are typical as the disease advances.

Recommended Related to Alzheimer's
Assisted Living Facilities for Alzheimer's Disease
Assisted living is a type of housing for people, such as those with Alzheimer's disease, who need
various levels of medical and personal care. Living spaces can be individual rooms, apartments, or
shared quarters. The facilities generally provide a home-like setting and are physically designed to
promote the residents' independence. Services are offered to assist residents with daily living.
Read the Assisted Living Facilities for Alzheimer's Disease article > >
Alzheimer's stages typically follow this progression: mild Alzheimer's, moderate Alzheimer's, and
severe Alzheimer's. It's important to remember that the stages of Alzheimer's disease can vary from
person to person. One person's decline may be slower or steadier than another's.
Mild Cognitive Impairment
Everyone becomes forgetful from time to time, especially as they get older. More than half of people
over age 65 experience at least some age-related forgetfulness. When memory loss and problems with
mental function become more regular, but not yet severe enough to interfere with daily life, people are
said to have mild cognitive impairment (MCI). Some people with MCI never get any worse. Others
progress to Alzheimer's disease within a few years.

Mild Alzheimer's
Alzheimer's-related changes can begin in the brain as much as 10 to 20 years before the first symptoms
appear. As tangles and plaques form in the brain, the areas of brain tissue that are affected become
damaged and work less effectively.
In most people with the condition, Alzheimer's develops after age 65. However, in rare cases
Alzheimer's can affect people at a younger age. This is called early-onset Alzheimer's and it's linked to
genetic changes.
The first sign of early or mild Alzheimer's disease is usually memory loss. A person with mild
Alzheimer's may forget where he or she put the car keys, or be unable to remember the names of people
and objects. Sometimes people with mild Alzheimer's will substitute a real or made-up word for the one
they've forgotten, such as saying "tiger" instead of "cat." The difference between Alzheimer's disease
and normal forgetfulness is that the memory loss occurs with regularity.
As the disease progresses, the symptoms may become more noticeable to family, friends, and co-
workers. People with mild Alzheimer's may repeat questions, get lost in once-familiar areas, and have
trouble remembering what they've just read or heard. It may be difficult, if not impossible, for them to
learn new things. As they become more forgetful, they will often get quieter or withdraw from social
situations out of embarrassment.
Organizational difficulties and poor judgment are two other hallmarks of mild Alzheimer's. Some
people at the mild Alzheimer's stage start to experience moodiness, and their personality changes.
At this stage, dementia can be diagnosed with a mental status exam and testing the person's knowledge
of current events as well as their ability to recount their own personal history and perform complex
tasks (such as doing math problems or paying bills).

Moderate Alzheimer's
People with moderate Alzheimer's may begin to have trouble recognizing their family members and
friends. At this stage, for example, a woman with Alzheimer's may mistakenly believe that her niece is
her daughter or her husband is her father. She may not be able to remember her home address or
telephone number, and may forget what day of the week it is or simple details about her past, such as
where she went to high school.
Those with moderate Alzheimer's may have difficulty following instructions and performing tasks they
once did with ease, such as getting dressed (people with moderate Alzheimer's may put their underwear
on over their pants or try to look for their lipstick in the freezer) or adding numbers in a checkbook.
Even simple tasks like eating or going to the bathroom will become increasingly difficult as the disease
progresses.
People with moderate Alzheimer's have trouble sleeping through the night. Instead of going to bed in
the nighttime, they will take naps during the day. As the disease worsens, they may eventually spend
much of their day asleep.
Personality changes become more pronounced by the moderate stage of Alzheimer's. People at this
stage may experience hallucinations (seeing and hearing things that aren't there), delusions (mistaken
beliefs), paranoia (accusing others of lying, cheating, or stealing from them), and compulsive behaviors
(rubbing their hands together over and over or tearing tissues into tiny pieces). They may become angry
and even violent, hitting, kicking, or screaming out of frustration.

Severe Alzheimer's
People with severe Alzheimer's are virtually unable to respond to the people around them. They lose
the ability to walk, talk, and care for themselves. They must rely on caregivers to handle even their
most basic needs, including eating, washing, and going to the bathroom. Instead of communicating,
they may repeatedly cry out, groan, or scream.
People at the end of this Alzheimer's stage can no longer sit unsupported or hold up their head. They
have trouble eating or refuse to eat because swallowing is difficult. They are unable to control their
urination or bowel movements.
Alzheimer's disease progresses at a different rate for each person. Some people live for 10 years with
the disease; others can live for as long as 20 years. Alzheimer's itself rarely causes a patient to die.
Complications of the disease, such as a fall or respiratory infection, are typically the cause of death.


Alzheimer's Disease: Your Role as Caregiver
Do You Realize How Much You Do?
Your role as caregiver to a loved one suffering from Alzheimer’s disease can be very involved.
    • You help maintain the quality of life for your spouse, parent, family member, or friend with
      Alzheimer's disease.
    • You have become educated about symptoms, treatments and the progression of the disease.
    • You probably keep track of appointments with the doctor, medication schedules, and exercise.
    • You offer the love and support necessary to meet the challenges of Alzheimer's disease.
You are a caregiver. While many patients retain their independence for a period of time after being
diagnosed with Alzheimer's disease, some may need more help with performing daily activities. For
others, the diagnosis may come after weeks or months of you coping with symptoms that did not have a
name. Regardless of how long you've been dealing with Alzheimer's disease or to what degree, in some
way Alzheimer's has affected your life and responsibilities -- physically, emotionally, or economically.
The role you have taken on is not an easy one. However, the following tips offer some guidance on
how to maintain and improve your caregiving relationship:
    • Take time for yourself. Make sure you have time to relax. If necessary, enlist the help of other
      family members or even hire someone to help out.
    • Learn as much as you can about your loved one's disease so you will know how you can
      help. You'll also understand what changes to expect in your loved one's behavior or symptoms.
    • Help your loved one participate in as many activities in the home and outside the home as
      possible. Maintain the intricate balance between helping your loved one accomplish a task and
      actually doing the task for him or her. Allow the patient the time needed to complete daily
        activities on his or her own, such as dressing.
    •   Consult your loved one about his or her family affairs. Although it's not easy to discuss these
        topics, you should be informed of your loved one's wishes regarding a living will, durable
        power of attorney, and do-not-resuscitate (DNR) order.
    •   Set realistic goals for yourself and your loved one. Do not attempt to do everything. By
        setting attainable goals, you are setting everyone up for success, rather than disappointment.
    •   Do not put your life on hold. Continue to meet with friends, participate in hobbies or groups,
        and maintain a schedule as normally as possible. You will feel more energized and are less
        likely to feel resentful in the long run.
    •   Have someone you can talk to. You are there for your loved one -- to listen and to offer
        support -- but you also need a support person. Talk openly and honestly with a friend or family
        member. If this is not possible, join a support group. Understanding that you are not alone and
        that someone else is in a similar situation helps you to feel nurtured.
The most effective caregiver is well informed, prepared, and asks for help and support from all
resources that are available.
Challenges of Caregiving for Patients with Alzheimer's Disease

There are some unique challenges that confront a patient with Alzheimer's disease.
    • The disease is quite variable. There may be times when the patient can function almost normally
      and then other times in which he/she may be very dependent. This is a natural part of the
      disease. In addition, his/her response to medications may fluctuate. Because caregivers see this,
      there is a natural tendency for some caregivers to suspect that the person with Alzheimer's is
      unnecessarily demanding or manipulative.
    • Alzheimer's disease is a progressive disorder. While medications may provide some delay in
      worsening of symptoms for a period of time, they do not stop the progression of the disease.
    • Depression is very much a part of the disease. Alzheimer's symptoms and disability can be
      made worse by depression, so it is important to recognize the signs and symptoms of depression
      and help your loved one seek treatment promptly.



Alzheimer's Disease: Tips for Maintaining a Normal Life
Living with Alzheimer's disease is a challenge for anyone. It's difficult to remember things, make
decisions, and find your way around the way you used to. It can be frustrating a good deal of the time,
but there are good days and bad days. Here are some helpful tips and things you can do to make things
easier for yourself -- to make things feel a bit more normal again.

How Do I Cope With My Memory Problems?
To help cope with memory problems:
    • Always keep a book with you to record important information, phone numbers, names, ideas
      you have, appointments, your address, and directions to your home.
    • Place sticky notes around the house when you need to remember things.
    • Label cupboards and drawers with words or pictures that describe their contents.
    • Place important phone numbers in large print next to the phone.
    • Ask a friend or family member to call and remind you of important things that you need to do in
      the day, like meal times, medication times, and appointments.
    • Use a calendar to keep track of time and to remember important dates.
    • Use photos of people you see often labeled with their names.
    • Keep track of phone messages by using an answering machine.



What's the Best Way to Plan the Day?
In planning your day:
    • Find things to do that you enjoy and are able to do safely on your own.
    • It will be easier to accomplish tasks during the times of the day when you feel best.
    • Allow yourself the time to do the things you need to do, and don't feel rushed or let other people
      rush you.
    • If something gets too difficult, take a break.
    • Ask for help if you need it.

How Do I Avoid Getting Lost?
To keep from getting lost:
    • Ask someone to go with you when you go out.
    • Ask for help if you need it and explain that you have a memory problem.
    • Always take directions for where you're going with you.

What Will Make Communicating Easier?
Communicating with others will be easier if you:
    • Always take your time, and don't feel rushed.
    • If you need to, ask the person you're speaking with to repeat what he/she is saying or to speak
      slowly if you do not understand.
    • Avoid distracting noises, and find a quiet place to talk.

What About Driving?
Driving can be of particular concern for Alzheimer's patients. Here are some things to consider:
    • Have someone else drive you where you need to go.
    • If you tend to get lost or confused easily, consider alternative modes of transportation.
    • Drive only in areas that are familiar to you.
    • Contact organizations like the Alzheimer's Association to learn what local transportation
      services are available.
    • The Department of Motor Vehicles will assess your driving skills if you're not sure whether you
      should drive.
    • At some point, it may no longer be safe for you to drive.
How Do I Take Care of Myself at Home?
To make sure you are well taken care of at home, put some of these measures into place early so they
become routine:
    • Local Alzheimer organizations or your doctor will be able to tell you how to get help with
      things like shopping, housekeeping, meals (including home-delivered meals), and
      transportation.
    • Ask a neighbor you trust to keep a set of house keys.
    • Ask a friend or family member to help you to organize your closets and drawers to make it
      easier for you to find things.
    • Ask a family member to check things out around the house, such as electrical appliances, mail,
      and perishable food items.
    • Keep a list of important and emergency numbers by the phone.
    • Have family, friends, or a community service program call or visit daily to ensure that
      everything is all right.
    • Ask someone to check your smoke alarm regularly.

How Do I Maintain My Responsibilities?
    • Arrange for direct deposit of checks, such as your retirement pension or Social Security
      benefits.
    • Inform your bank if you have difficulty keeping track of your accounts and record keeping.
      They may provide special services for people who have Alzheimer's.
It is important to realize that at some point, it will become too difficult or dangerous for you to live by
yourself. But, in the earliest stages of the disease, many people do manage on their own -- with support
and help from friends, family, and community programs and with simple adjustments and safety
practices in place.
Early Warning Signs: When to Call the Doctor About Alzheimer's
Are you worried about an older loved one’s memory or behavior? Has your mom been getting lost
while running errands? Has your dad started to ask the same questions, over and over? Signs of the
early stages of Alzheimer’s disease aren’t always clear-cut -- after all, it can be hard to distinguish them
from age-related memory changes.

To help guide you, here are the Alzheimer’s warning signs to watch for, along with advice about seeing
a doctor and getting a diagnosis.

Alzheimer Disease Warning Signs
Many people confuse Alzheimer’s disease with dementia. What’s the difference? Alzheimer’s is a
disease; dementia is a group of symptoms that include loss of memory, thinking, and reasoning skills.
However, dementia isn’t always caused by Alzheimer’s disease; it can be result from other conditions
as well.
Although some memory changes may be age-related, memory problems that interfere with daily life
are not. According to experts, common early signs of Alzheimer’s disease or other dementias include:
    • Memory loss. Although older memories might seem unaffected, people with dementia might
      forget recent experiences or important dates or events that interferes with daily life. Anyone can
      forget some details from a recent event or conversation or recall them later. People with
        dementia might forget the entire thing.
    •   Repetition. People with dementia may repeat stories, sometimes word for word. They may keep
        asking the same questions, no matter how many times they’re answered.
    •   Language problems. We all struggle to remember a word occasionally. People with dementia
        can have profound problems remembering even basic words. Their way of speaking may
        become contorted and hard to follow.
    •   Personality changes. People with dementia may have sudden mood swings. They might become
        emotional - upset or angry - for no particular reason. They might become withdrawn or stop
        doing things they usually enjoy. They could become uncharacteristically suspicious of family
        members -- or trusting of telemarketers.
    •   Disorientation and confusion. People with dementia may get lost in places they know very well,
        like their own neighborhoods. They may have trouble completing basic and familiar tasks, like
        cooking dinner or shaving.
    •   Lack of hygiene. Sometimes this is the most obvious sign of Alzheimer’s disease. People who
        have dressed smartly every day of their lives might start wearing stained clothing or stop
        bathing.
    •   Odd behavior. We all misplace our keys from time to time. People with Alzheimer’s disease and
        other dementias are prone to placing objects in odd and wholly inappropriate places. They
        might put a toothbrush in the fridge or milk in the cabinet under the sink.
If your loved one is exhibiting any of these Alzheimer’s warning signs, don’t panic. Having these
symptoms doesn’t mean that your loved one necessarily has Alzheimer’s disease. But you need to
schedule an appointment with the doctor for an evaluation.
Seeing the Doctor With Alzheimer’s Disease Concerns

For a first appointment, you can start with your loved one’s primary care provider. Or you might go
right to a specialist, like a psychiatrist or a neurologist. Over time, you may have a number of experts
involved in your loved one’s care.
Unfortunately, there’s no definitive test for Alzheimer’s disease. So doctors can use a number of
different techniques to come up with a diagnosis. In addition to a typical physical exam and blood and
urine tests, these could include:
    • Mental status tests. The doctor may ask a series of questions that assess a person’s mental
      function. They test a person’s short-term memory, ability to follow instructions, and problem-
      solving skills. Specific tests include the mini-mental state exam (MMSE) and the “mini-cog.”
    • Neurological exams. In checking for signs of Alzheimer’s, doctor will also check your loved
      one’s neurological function, including speech, balance, coordination, and reflexes.
    • Imaging tests. CT scans, MRIs, and PET scans can help rule out other causes for the symptoms
      - like tumors or strokes.
Make sure to do your part. The doctor will need some basic information from you, so go in prepared
with details about:
    •   The Alzheimer’s symptoms you’ve noticed and when they began.
    •   Other health conditions your loved one has.
    •   The daily medications she uses, including supplements and alternative treatments.
    •   Your loved one’s diet and alcohol use.
    •   Any important changes in your loved one’s life -- like retirement, a recent move, or the death of
        a spouse.
Because Alzheimer’s warning signs may be confused with changes that can come with old age, its
diagnosis may not be clear-cut.
If you’re not satisfied with the doctor's assessment, get a second opinion. Alzheimer’s disease can go
on a long time, and during those years you’ll need to work closely with a doctor. It’s key that you find a
caring, sympathetic healthcare professional you trust.

Don’t Ignore Alzheimer’s Warning Signs
Of course, you might not want to see a doctor yet. You might want to wait and see if things get worse.
Many people put off consulting an expert for years - long after they’ve noticed obvious symptoms of
Alzheimer’s disease. Why?
    • People worry that their loved ones will be offended or angry if they mention their memory
      problems.
    • Considering that Alzheimer’s disease has no cure, people might assume that there’s no point in
      rushing off to get the bad news.
    • Deep down, people don’t want to admit to themselves that something might be wrong.
These are all very understandable, very human reasons to put off seeing an expert. But if you suspect
your loved one might have Alzheimer’s, you need to see a doctor soon. Here’s why.
    • Your loved one may not have Alzheimer’s disease. Don’t assume the worst. Even if your love
      one has dementia, it might not be Alzheimer’s. Other conditions can cause dementia or similar
      symptoms. They include vitamin deficiencies, thyroid problems, depression, drug interactions,
      and alcohol abuse. Many of these conditions are treatable. Putting off a trip to the doctor could
      leave your loved one suffering pointlessly.
    • The sooner Alzheimer's disease is diagnosed, the sooner you can get treatment. Alzheimer’s
      disease isn’t curable, but it is treatable. Drugs can help slow down the progression of
      Alzheimer’s symptoms for a limited time. Your loved one may also be eligible for clinical trials,
      in which new, cutting-edge Alzheimer’s treatments are available.
    • The sooner Alzheimer’s disease is diagnosed, the sooner you can plan for it. Accepting that a
      loved one has Alzheimer’s is terribly difficult. But the sooner you do, the better off you are. The
      earlier you catch it, the more time you’ll have to learn about the condition and prepare for
      what’s ahead.
For your loved one’s sake -- and for your own -- don’t ignore the possible warnings signs of
Alzheimer’s disease. Don’t wait until there’s a crisis before you see a doctor. If you have any concerns
about your loved one’s memory or behavior, schedule an evaluation now.Alzheimer's Disease:
Nutrition.While there is no special diet required for people with Alzheimer's disease -- unless they have
another condition, such as high blood pressure or diabetes, that may require a particular diet -- eating a
well-balanced, nutritious diet is extremely beneficial. This article addresses the basics of good nutrition
and the challenges faced by a person with Alzheimer's disease.

The Basics
    •   Eat a balanced diet with a variety of foods from each food group.
    •   Maintain a healthy weight with a good balance of exercise and food.
    •   Limit foods with high saturated fat and cholesterol.
    •   Cut down on sugars.
    •   Limit foods with high sodium and use less salt.
    • Stay hydrated (some people may have fluid restrictions due to another medical condition, such
      as heart failure or liver cirrhosis).

Medications
Ask your health care provider if any foods or drinks can interfere with the medicines you're taking.
Check to see if any medicines you are taking are affecting your appetite, bowel movements, or other
side effects that can affect your nutrition. Your health care provider may be able to make adjustments to
your medication regimen or recommend alternatives to alleviate side effects.

Preventing Constipation
    • Eat plenty of fruits, vegetables, and whole grains. These are great sources of fiber, which can
      help curb constipation.
    • Drink enough water or other fluids.
    • Stay physically active.

Relieving Dry Mouth
With Alzheimer's, the body's signal for thirst may be diminished. In addition, some medications can be
drying. Besides drinking water, other ways to relieve dry mouth or increase fluids include
    •   Dunk breads, toast, cookies, or crackers in milk, hot chocolate, or tea to soften them.
    •   Take a drink after each bite of food to moisten your mouth and to help you swallow.
    •   Add broth or sauces to foods to make them softer and moister.
    •   Eat sour candy or fruit ice to help increase saliva and moisten your mouth.

Maintaining Your Weight
Malnutrition and weight maintenance is often an issue for those with Alzheimer's disease. Poor
nutrition related to Alzheimer's may be related to different reasons such as a diminished sense of
hunger and thirst, problems eating or swallowing, problems using utensils or inability to self-feed, poor
food choices, and depression.
    • Eat smaller meals or snacks more frequently. Eating 5-6 times a day may be easier than eating
      the same amount of food in three meals.
    • Take a daily multivitamin/mineral supplement.
    • Eat the more nutritious, higher-calorie foods in the meal first.
    • Prepare meals that are easy to make and eat.
    • Make meals enjoyable. Eating with others may encourage you to eat better.
    • If you have problems eating or swallowing, talk to your health care provider. Chewing and
      swallowing problems can be a choking risk. Your health care provider can recommend a special
      diet or certain foods to make it easier for you to eat.
    • Maintain good oral care. Brush and floss your teeth and clean dentures regularly. Make sure to
      see your dentist for checkups and routine cleanings.
    • If you have a problem using particular utensils or dishes, choose a different utensil or dish that
      is easier to handle. For example, it may be easier for you to eat with a spoon and bowl than a
      fork and plate. Have finger foods available to eat or ask a friend or family member to help
      prepare foods that are easier to handle.
    • Staying physically active can stimulate appetite.
    • Seek treatment if you are feeling depressed. Poor appetite and weight changes can also be
      symptoms of depression.
Please consult your doctor before making any dietary changes. You doctor may recommend a
nutritionist to make dietary recommendations depending on your individual needs.

                              The End

				
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