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About Alzheimer and Dementia

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About Alzheimer and Dementia Powered By Docstoc
					                                               You are not Alone..
About Alzheimer and Dementia




                                                         2008
                                   Archy Nasala BSN-RN




                                                                About Dementia             About Alzheimer’s

                                                                Defination                   Defination
                                                                Warning Signs                Warning Signs
                                                                Diagnosis                    Treatment
                                                                Symptoms                     Diagnosis
                                                                Delirium                     Symptoms
                                                                Depression
                                                                Communication : Techniques

                                                                Activities of Daily Living
                                                                     Eating
                                                                     Bathing
                                                                     Dressing
                                                                     Incontinence
                                                                Behavioral Challenges:
                                                                     Strategies to Head off or Deal with Behavioral Problems
                                                                     Potential Causes of Bahavior Problem
                                                                     Coping with Anger and Aggression
                                                                     Coping with Paranoia
                                                                     Coping with Traveling
                                                                     Coping with Sundowning
                                                                     Coping with Wandering
                                         Riethofstr 15          Therapy: Music Therapy
                                         8355 Aadorf TG         Story Telling
                                          052 365 45 09         Safeproofing your Surroundings
                               arvanroche@swissonline.ch        Checklist
                                                                Home Supervision
                                            Dementia

Definition

 Dementia is a general term that describes a group of symptoms-such as loss of memory, judgment,
language, complex motor skills, and other intellectual function-caused by the permanent damage or
death of the brain's nerve cells, or neurons.

 One or more of several diseases, including Alzheimer's disease, can cause dementia.

 Alzheimer's disease is the most common cause of dementia in persons over the age of 65. It
represents about 60 percent of all dementias.

 The other most common causes of dementia are vascular dementia, caused by stroke or blockage
of blood supply, and dementia with Lewy bodies. Other types include alcohol dementia, caused by
sustained use of alcohol; trauma dementia, caused by head injury; and a rare form of dementia,
frontotemporal dementia.

 The clinical symptoms and the progression of dementia vary, depending on the type of disease
causing it, and the location and number of damaged brain cells. Some types progress slowly over
years, while others may result in sudden loss of intellectual function.

 Each type of dementia is characterized by different pathologic, or structural, changes in the brain,
such as an accumulation of abnormal plaques and tangles in individuals with Alzheimer's disease, and
abnormal tau protein in individuals with frontotemporal dementia.




Warning Signs

   Trouble with new memories
   Relying on memory helpers
   Trouble finding words
   Struggling to complete familiar actions
   Confusion about time, place or people
   Misplacing familiar objects
   Onset of new depression or irritability
   Making bad decisions
   Personality changes
   Loss of interest in important responsibilities
   Seeing or hearing things
   Expressing false beliefs




Archy Nasala Riethofstr. 15, 8355 aadorf
arvanroche@swissonline.ch                                                                       Page 2
Diagnosis

 Experienced clinicians can accurately diagnose dementia 90 percent of the time.

 Accurate diagnosis is critical. Some conditions that cause symptoms of dementia, such as hormone
imbalance, vitamin deficiency and infections, can be reversed. For irreversible dementias, treatment
options vary depending on the disease.

 Obtaining a proper diagnosis involves consulting with a healthcare professional expert in dementia,
communicating symptoms and undergoing extensive testing.

 Diagnostic tools include a complete medical history; blood, urine or other medical tests;
neuropsychological tests that measure memory, problem solving, attention, and language; and brain
scans.

 Individuals with clinically diagnosed dementia have clear cognitive loss in two or more intellectual
domains, such as amnesia (loss of memory) and aphasia (inability to communicate effectively), but
almost all individuals with Alzheimer's disease demonstrate short-term memory impairment.

 Other types of dementia may begin with a slow loss of memory function; however, a careful, clinical
evaluation will usually provide information that suggests dementia other than Alzheimer's disease.




Symptoms

 Symptoms of dementia are divided into two categories: cognitive, or intellectual, and psychiatric.

 Differentiating them is important so that behavioral problems that are caused by loss of cognitive
functioning are not treated with anti-psychotic or anti-anxiety medications.

 The clinical symptoms of dementia vary, depending on the type of disease causing it, and the
location and number of damaged brain cells. With Alzheimer's disease, manifestation of all of these
symptoms is quite probable; with other types of dementia, it is possible to have some or all of these
symptoms.

 Cognitive, or intellectual, symptoms are amnesia, aphasia, apraxia and agnosia.

 Amnesia is defined as loss of memory, or the inability to remember facts or events. We have two
types of memories: the short-term (recent, new) and long-term (remote, old) memories. Short-term
memory is programmed in a part of the brain called the temporal lobe, while long-term memory is
stored throughout extensive nerve cell networks in the temporal and parietal lobes. In Alzheimer's
disease, short-term memory storage is damaged first.

 Aphasia is the inability to communicate effectively. The loss of ability to speak and write is called
expressive aphasia. An individual may forget words he has learned, and will have increasing difficulty
with communication. With receptive aphasia, an individual may be unable to understand spoken or
written words or may read and not understand a word of what is read. Sometimes an individual
pretends to understand and even nods in agreement; this is to cover-up aphasia. Although individuals
may not understand words and grammar, they may still understand non-verbal behavior, i.e., smiling.

 Apraxia is the inability to do pre-programmed motor tasks, or to perform activities of daily living
such as brushing teeth and dressing. An individual may forget all motor skills learned during
development. Sophisticated motor skills that require extensive learning, such as job-related skills, are
the first functions impaired by dementia. More instinctive functions like chewing, swallowing and
walking are lost in the last stages of the disease.
Archy Nasala Riethofstr. 15, 8355 aadorf
arvanroche@swissonline.ch                                                                         Page 3
 Agnosia is an individual's inability to correctly interpret signals from their five senses. Individuals
with dementia may not recognize familiar people and objects. A common yet often unrecognized
agnosia is the inability to appropriately perceive visceral, or internal, information such as a full bladder
or chest pain.

 Major psychiatric symptoms include personality changes, depression, and hallucinations and
delusions.

 Personality changes can become evident in the early stages of dementia. Signs include irritability,
apathy, withdrawal and isolation.

 Individuals with dementia may show symptoms of depression at any stage of the disease.
Depression is treatable, even in the latter stages of dementia.

 Psychotic symptoms include hallucinations and delusions, which usually occur in the middle stage of
dementia. Hallucinations occur in about 25 percent of dementia cases and are typically auditory
and/or visual. Sensory impairments, such as hearing loss or poor eyesight, tend to increase
hallucinations in the elderly with dementia. Delusions affect about 40 percent of individuals with
dementia.

 Hallucinations and delusions can be very upsetting to the person with dementia. Common reactions
are feelings of fear, anxiety and paranoia, as well as agitation, aggression and verbal outbursts.

 Individuals with psychiatric symptoms tend to exhibit more behavioral problems than those without
these symptoms. It is important to recognize these symptoms so that appropriate medications can be
prescribed and safety precautions can be taken.

 Psychotic symptoms can often be reduced through the carefully supervised use of medications. Talk
to your primary care doctor, neurologist or geriatric psychiatrist about these symptoms because they
are treatable




Delirium

 Delirium is defined as a temporary confusion caused by underlying medical problems, drug toxicity
or environmental factors.

 Delirium is a very common, yet often unrecognized condition in elderly individuals with dementia.

 It is marked by confusion and disorientation; fluctuating levels of consciousness; jerking motions;
disruption of sleep-wake cycles; hallucinations, delusions and anxiety; memory impairment and
altered speech; intermittent agitated behavior; mood changes; behavioral problems such as
aggression and wandering; and changes in blood pressure and pulse.

 Delirium follows a time pattern. It has an abrupt onset—less than one month; and a short
duration—not more than one month from the time the symptoms are detected to intervention and
recovery.

 Medications are often the major cause of delirium in the elderly. This results from drug interactions,
failure to take medication, slow absorption of medications, characteristics of the drug itself, or the use
of anesthesia and other medication during and after surgery.

 Underlying medical problems that may cause delirium are bladder infection, pneumonia,
dehydration, metabolic disorders, oxygen deficiency, constipation, and urinary retention.


Archy Nasala Riethofstr. 15, 8355 aadorf
arvanroche@swissonline.ch                                                                            Page 4
 Environmental factors may also contribute to delirium. This ranges from sensory overload, such as
too much noise, to sensory deprivation stemming from isolation, hearing impairment and lack of
environmental stimulation.

 It is important to identify the risk factors for delirium and learn about preventative measures. For
example, providing adequate hydration and carefully managing medication are preventative
approaches.

 Delirium does not involve structural brain damage.

 Individuals may completely improve from delirium if the medical problem is identified and treated.

 If delirium is left untreated, individuals develop additional complications that may result in poor
outcome or death.




Depression

 Individuals diagnosed with dementia can present with coexisting depression.

 Several symptoms are common to both dementia and depression: apathy, lack of interest in people
or activities, poor sleep, restlessness, memory loss, and difficulty concentrating.

 Distinguishing between dementia and depression, and determining whether each condition exists or
if they co-exist is critical to ensure proper treatment.

 The frequency and severity of depression remain fairly constant through most stages of Alzheimer's
disease.

 For most individuals with Alzheimer's disease who develop depression, it tends to be mild and
moderate in severity, and suicidal behavior or completed suicide is rare.

 Depression may cause or worsen memory loss and other cognitive impairment.

 It appears that Alzheimer's disease is more likely to develop in people who have depression plus
cognitive impairment, but that depression occurring without cognitive impairment does not increase
the risk of developing the disease.

 Counseling or psychotherapy may be helpful in mild to moderate depression in the earliest stages of
dementia, but systematic studies on this issue are lacking.

 Antidepressants are usually indicated for those with Alzheimer's disease who demonstrate persistent
or severe depression. However, only half of the published research shows superiority for
antidepressant medication over placebo in the treatment of depression in those with Alzheimer's
disease or dementia in general.

 If a physician prescribes antidepressant medications, it is important to monitor the choice of
medication, dosage, possible side effects, impact on cognition and activities of daily living, and the
status of the depression.




Archy Nasala Riethofstr. 15, 8355 aadorf
arvanroche@swissonline.ch                                                                          Page 5
Communication: Techniques

"t's not what you say, but how you say it." This expression holds doubly true when communicating
with individuals with dementia.

Alzheimer's disease or related illnesses impair a person's ability to understand words and to speak.
However, they can still benefit from non-verbal communication—body language, voice tone and facial
expressions. As the individual's ability to process verbal information declines, the importance of how
caregivers communicate with them, verbally and non-verbally, increases.

Here are some tips to enhance interactions:
 Remember that the individual with dementia might be feeling confused, anxious, irritable and
depressed, and suffering from low self-esteem.

 Rely on the four Ss: Simple, Slow, Show and Smile.

 Simple—Use simple words and simple sentences. And give instructions one step at a time. Too
much information can be overwhelming for a person with dementia. Slow—Speak slowly, and allow
enough time for the person to understand each thought or question. Show—Show the person with
dementia what you are saying; don’t just say it. Use body language, facial expressions and gestures
to tell your story so the person can benefit from your words and your actions. For example, point to
objects or demonstrate an action, such as brushing your teeth.

 Smile—A smile sends a powerful message of reassurance. Be conscious of your facial expressions.
Using facial expressions to show that you are friendly will help the person with dementia better
understand the tone of the discussion.

 Speak in a tone that is calm and reassuring.

 Make certain that the person with dementia has the best chance of seeing and hearing you. This
involves checking that the person is wearing glasses and hearing aids, if necessary, and that talking
occurs in a quiet environment.

 Approach the individual from the front. It may startle and upset him if you touch him unexpectedly
or draw near from behind.

 Before asking the individual to do something, address him by name to get his attention. While you
are speaking, maintain eye contact to help him focus.

 Ask only one question at a time and allow time for an answer. If he does not seem to understand,
repeat the question using the same wording. If this does not work, after a few minutes, rephrase it.

 Allow the individual adequate time to respond in conversation or when performing an activity.
Rushing will increase confusion.

 If the individual repeatedly asks a question, keep in mind that he cannot remember the response
you have just given him. Instead of answering the question after a second or third repetition, reassure
the individual in some way-everything is fine, you will be with him, you will help him.

 Eliminate distractions, such as the TV or radio, when talking to the person with dementia.

 Avoid statements that sound negative. For example, instead of "Don't go outside," say, "Stay
inside."

 Use humor whenever possible, though not at the individual's expense.



Archy Nasala Riethofstr. 15, 8355 aadorf
arvanroche@swissonline.ch                                                                        Page 6
     Break down all tasks into simple steps. Tell the individual one step at a time what to do. Giving too
    many directions at once or too quickly will increase confusion. If the individual gets upset and
    becomes uncooperative, stop and try again later.

     Keep on talking, even when a person may no longer be verbal. Chat about things that mattered to
    the person and mention names of family and friends. Even if communication is one-sided, it can loudly
    show that you care.



    Activities of Daily Living: Eating

    'Weight loss is common among individuals with dementia, regardless of whether they are cared for at
    home or in a long-term care facility. Assessing why they are not eating and obtaining an accurate
    diagnosis are the first steps toward maintaining adequate nutrition and body weight.

    Possible problems:
     Has the individual forgotten how to feed himself?

     Do they have trouble chewing or swallowing?

     Are they having problems with dentures or gums?

     Have they lost the ability to taste?

     Is the individual having coordination problems, such as difficulty in using the silverware?

     Are there co-existing medical or psychiatric problems, such as ulcers, depression or delusions, that
    are causing loss of appetite?

     Do they seem disinterested in eating?

     Is the person fearful at meal times? For example, do they say or think that the food is poisoned?

     Are they unable to ask for food?

     Do they dislike the food?

     Is there too much noise or other environmental stimuli?

     Do they eat only sweets, or like to eat them first?

     Are they filling up on fluids?

     Are other residents in a group setting eating the individual's food?




    Tips:

   Consult a physician to detect any medical causes.

   Seek a swallowing assessment from a speech therapist if the person is regularly having trouble
    chewing and swallowing.

   Have the individual sit in an upright, comfortable position.
    Archy Nasala Riethofstr. 15, 8355 aadorf
    arvanroche@swissonline.ch                                                                        Page 7
   Try to have them eat with others to increase socialization and make mealtimes more pleasant.

   Check that their mouth is empty, especially if they hoard food or cigarette butts.

   Make sure they have their glasses, dentures, hearing aids or any other appliances they need.

   Prompt or feed those who can't feed themselves (apraxia).

   Give the individual food they like and adequate snacks.

   Provide nutritional supplements if there is significant weight loss.

   Present one item at a time if the person seems confused by too much food in front of them.

   Consider moving food to a different location on the tray or table.

   Serve the drink last if the individual drinks too much and will not eat.

   Serve pre cut or finger food, if using utensils becomes difficult.

   Keep stressing that the food is safe if the individual believes it is poisoned.

   Reassure the person that you will make sure they are well fed.

    Note:
    If someone loses five pounds within a month or 2.5 pounds in two consecutive weeks, aggressive
    intervention should be undertaken to prevent further weight loss and to help them gain the weight
    back.




    Activities of Daily Living: Bathing

    The bathing habits of an individual with dementia ideally should follow the same pattern as prior to
    the onset of the disease. If someone showered every day in the morning, aim for that; if they bathed
    every other evening, stick with that routine. The rule of thumb: Bathing should occur as frequently as
    before unless specific hygiene needs or behavioral changes arise. For example, adjustments may be
    necessary if an individual is severely agitated, wakes up soiled in the morning, or experiences
    behavioral problems, or "sundowning," as evening approaches.

    Bathing is a complex activity of daily living composed of several phases: undressing, introduction into
    the shower or tub, washing, drying and re-dressing. Recognizing a person's abilities and preparing
    ahead of time can help simplify the process.

    Possible Problems:
     Most older individuals retain a sense of modesty and resist undressing; this is a normal response.

     Frightened, disoriented individuals may not recognize the family or professional caregiver.

     They may have forgotten how to undress, wash or dry themselves, or redress.

     Individuals, especially those who are visually or hearing impaired, recovering from recent medical


    Archy Nasala Riethofstr. 15, 8355 aadorf
    arvanroche@swissonline.ch                                                                        Page 8
    problems or on certain medications, are at risk of falling.

     Shower and bathtub surfaces can be dangerous—cold, hot or slippery.

     An individual, especially in the middle to late stages, may forget how to pick up their legs or sit in a
    bathtub.

     Someone can become alarmed during any part of the process and attempt to flee.


    Tips:

   Give one-step instructions in short, simple terms, and go slowly.

   Communicate with non-verbal cues to help the individual understand.

   Remember to provide privacy, and ensure dignity.

   Be reassuring since concern over modesty also may increase agitation.

   Approach the individual from the front whenever possible.

   Make sure the room temperature is appropriate for disrobing.

   Smile, speak calmly and do not express any frustration.

   Remove the bathroom door lock for safety.

   Do not leave the individual unattended in the bath area.

   Minimize safety risks by installing a no-skid surface and grab bars.

   Try the shower instead of the tub, or vice versa, if someone becomes afraid of either.

   Keep the individual in a bathrobe until they are in the bathing area.

   Make sure the individual uses the toilet prior to bathing to prevent accidents during or after the
    bathing process.

   Secure soap, towels and other bathing items in advance.

   Ensure appropriate water temperature, especially to prevent scalding.

   Keep the individual in a warm room until they are completely dry and clothed.

   Lay out clothing in advance to proceed quickly from drying to dressing.



    Note:
    Be flexible. Bathing does not have to occur daily. If the regular routine stops working, try sponge
    baths, switch to every other day or change the time of day.


    Archy Nasala Riethofstr. 15, 8355 aadorf
    arvanroche@swissonline.ch                                                                            Page 9
Activities of Daily Living: Dressing

Getting dressed can pose a complicated series of challenges for individuals with dementia. Their need
for assistance could range from having someone select outfits for them to physically dressing them
from head to toe.

Possible problems:
 Loss of communication skills and motor coordination makes the process difficult.

 Too many choices of clothing can be confusing and frustrating.

 Clothing may be difficult to put on or remove due to zippers, buttons, etc.




Tips:

 Encourage the individual to dress himself to whatever extent possible.

 Intervene when attempts at self-dressing are not working.

 Recognize the need for a sense of dignity.

 Set a daily routine; try to have the individual get dressed at the same time each day.

 Do not rush the process.

 Give one-step instructions if the person needs prompting.

 Limit the choice of outfits to two.

 Clear closets and drawers of excess clothing to reduce confusion.

 Provide loose-fitting, comfortable clothes with elastic waistbands.

 Lay out the articles of clothing in the order they are to be put on.

 Use a consistent method of helping the individual dress each day. For example, first dress their
upper body and then the lower body. If the individual can still dress himself, hand him one article of
clothing at a time in the same order each day.

 Use gestures to show the individual what to do.

 Do not argue if they want to repeat the same outfit.




Archy Nasala Riethofstr. 15, 8355 aadorf
arvanroche@swissonline.ch                                                                       Page 10
Activities of Daily Living: Incontinence

Proper use of the toilet requires a complex mixture of motivation, internal cues, visual recognition and
motor skills—all of which diminish with dementia. Therefore, as the disease progresses, many people
develop incontinence, or loss of bladder or bowel control. Typically, an individual first develops
episodic urinary incontinence that slowly progresses over a period of years to total loss of bladder
control. A similar pattern is seen with bowel control, which becomes impaired in the latter stages of
dementia. The rapid onset of incontinence suggests a behavioral or medical change, and should be
evaluated by a physician.

Possible problems:
 Medical problems, such as enlarged prostate glands and urinary tract infection, or medication side
effects.

 An individual cannot remember where or what the bathroom is.

 Loss of verbal skills makes them unable to express their needs.

 Clothing is hard to remove in time.

 Individuals are not able to perceive internal signals for urination.
Tips:
 Treat the individual with respect and dignity.

 Be understanding and reassuring when accidents occur.

 Establish a routine; for example, take the person to the bathroom every two hours while they are
awake.

 Try to respond quickly to an individual's request for the bathroom.

 Watch for non-verbal cues, such as facial expressions or tugging on clothing.

 Put up signs (with illustrations) to indicate the bathroom door.

 Use easy-to-remove clothing, such as those with elastic waistbands.

 Avoid caffeine and other stimulants in the evening.

 Continue to let ambulatory individuals use the bathroom, even if they are managed with adult
continence products, until such efforts are counter-productive, e.g., the individual fights during
attempts to place them on the toilet.

 Do not give liquids a few hours before bedtime.

 Place a commode in the bedroom at night for easy access.




Archy Nasala Riethofstr. 15, 8355 aadorf
arvanroche@swissonline.ch                                                                       Page 11
Behavioral Challenges:
Strategies to Head Off or Deal With Behavior Problems

 Pay attention to what the individual with dementia is saying—both verbally and non-verbally.
Caregivers also should be aware of their communication techniques, including providing one-step
instructions and speaking in a reassuring tone.

 Think ahead and plan for situations that could result in problem behaviors.

 Understand that trying to argue with someone who has dementia only results in frustration for both
them and the caregiver.

 Distract and divert attention whenever possible.

 Hold to the same routine.

 Keep things simple to avoid frustration.

 Promote a sense of security and comfort.

 Use positive reinforcements, such as smiles, a gentle touch, personal attention and praise.

 Allow the individual to have some sense of control. Being able to "save face" is important to
someone who is very confused.

 Maintain a calm manner even when the individual becomes aggressive or agitated. This can defuse
a tense situation and help reduce a person's fears.

 Assess the situation to protect yourself. Should an individual's aggression become violent, be
mindful of your own safety first.

 Caregivers should practice ways to reduce stress when they become angry or frustrated, since
anger and frustration could aggravate a behavior problem.

 Remember that behavior problems result from the disease. Do not take things that the person says
and does personally; it is the disease speaking.

 Be creative and use common sense.

 Try to keep a sense of humor even in the most difficult situations.




Archy Nasala Riethofstr. 15, 8355 aadorf
arvanroche@swissonline.ch                                                                         Page 12
    Behavioral Challenges:
    Potential Causes of Behavior Problems

    Symptoms of dementia can cause a flood of emotions and physical reactions, which can manifest in
    behavioral problems. Understanding the cause and effect can help family and professional caregivers
    cope better with situations that may arise.

    Reaction to Loss:
    We all rely on input from our environment to guide us in activities and relationships. An individual with
    dementia has lost both the benefit of such input and the ability to inform us of their internal world.
    This absence causes fear, insecurity and frustration, which may present in the form of aggression and
    agitated behavior.

    Some Suggestions:

   Provide reassurance.
   Speak in a calm voice.
   Promote a sense of security and comfort.

    Inability to Meet Basic Needs:
    As a result of cognitive impairment and psychiatric symptoms, a person's basic needs might not be
    met. The resulting hunger, dehydration, elimination problems and fatigue can produce behavioral
    changes. Individuals with dementia may stay hungry because of, for example, their inability to feed
    themselves, depression or loss of muscle coordination. They may show their discomfort through
    agitated and aggressive behavior.

    Likewise, they may forget how to pour water into a cup or never ask for a drink due to their inability
    to communicate. Dehydration can lead to urinary tract infection, constipation and fever—putting
    individuals at a high risk for delirium and consequently more behavioral problems.

    Similarly, an individual may forget where or what the bathroom is, and eventually may not recognize
    the internal cues for urination or a bowel movement. Elimination problems may manifest in the form
    of agitation, aggression, wandering, pacing, and incontinence. Compounding this, they may develop
    urinary tract infections or constipation which, left untreated, could result in delirium.

    Lastly, someone with dementia may get tired easily because of wandering, pacing and disruption of
    the sleep-wake cycle. Fatigue often leads to irritability and aggression.

    Some Suggestions:

   Offer verbal and physical assistance during meals.
   Serve foods that the individual likes.
   Provide adequate snacks and supplements.
   Prevent distraction during meals by rearranging the environment
   Serve pre-cut or finger food if using utensils becomes difficult.
   Consult with a healthcare professional about swallowing problems.
   Schedule fluid intake to ensure six to eight glasses of liquid per day.
   Avoid coffee, tea beverages with caffeine that act as diuretics.
   Establish a routine for using the toilet, such as assisting them to the bathroom every two hours.
   A commode, obtained at any medical supply store, can be left in the bedroom at night for easy


    Archy Nasala Riethofstr. 15, 8355 aadorf
    arvanroche@swissonline.ch                                                                       Page 13
    access.
   Put up signs (with illustrations) to indicate the bathroom door.
   Use easy-to-remove clothing, such as those with elastic waistbands.
   Try soothing music or a massage to induce sleep.
   Reduce environmental stimuli.
   Encourage short periods of napping to prevent exhaustion.

    Co-Existing Medical Problems:
    Pain and discomfort from a medical problem (i.e., dental pain, urinary tract infection) or medication
    side effects can go unnoticed because of the individual's inability to report it due to poor memory
    and/or loss of verbal skills. In addition, caregivers may have difficulty gauging the individual's pain
    because they do not respond to questions. As a result, these individuals may not receive necessary
    medication or treatment. Those who are in pain and discomfort tend to exhibit verbal and physical
    aggression, restlessness, wandering and pacing behaviors.

    Some Suggestions:

   Become familiar with the person's medical history.
   Assess their non-verbal behavior to help identify the cause of distress.
   Watch for signs of urinary tract infection and other medical conditions.
   Monitor medications for side effects.

    Co-Existing Psychiatric Disorders:
    Individuals with a previous diagnosis of psychiatric disorders, such as schizophrenia, depression or
    mania, and those with mental retardation are likely to exhibit more behavioral problems when they
    develop dementia than other individuals without psychiatric illnesses. Those with hallucinations or
    delusions and who are depressed or manic tend to exhibit more aggressive and agitated behavior.

    Some Suggestions:

   Consult with your physician about available medications, such as anti-depressants, anti-psychotics and
    other mood stabilizers, to control symptoms.
   Provide reassurance.
   Distract and redirect with other activities.

    Environmental Factors:
    Excessive noise, poor or glaring lighting and cold temperature in the home or a long-term care facility,
    and overcrowding in a group setting can increase agitation, screaming and aggressive behavior. Any
    change in the environment or routines, such as bathing and eating, can cause frustration and
    agitation. As well, boredom that results from lack of activities, and conflicts among residents in a
    group setting can manifest in behavioral changes.

    Some Suggestions:

   Reduce excess stimuli, such as the TV or radio.
   Elevate the room temperature.
   Ensure adequate lighting.
   Carefully and gradually introduce changes in routine or the environment.
   Provide activities that are simple and creative.
   In a group setting, staff should anticipate the characteristics of each resident and adjust the



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    arvanroche@swissonline.ch                                                                         Page 14
    environment accordingly.

    Sensory Impairment:
    Individuals with hearing or visual impairments tend to be more paranoid, hallucinate more, and feel
    more frightened and frustrated. For example, those with poor eyesight may not eat their food or they
    may be at risk for falls.

    Some Suggestions:

   Assess vision and hearing.
   Ensure that individuals who wear glasses or hearing aids have them in place.
   Evaluate problems such as cataracts, glaucoma or other eye diseases, and correct them with surgery,
    if feasible, or by creative environmental changes.

    Factors Related to the Caregiver:
    A caregiver's attitude and knowledge of dementia affect the care of individuals with the disease. The
    more one knows about dementia, the less likely they will be to resent certain behavioral problems.
    Individuals usually respond to a caregiver's mood and behavior accordingly.

    Some Suggestions:

   Become educated about the disease.
   Learn effective communication techniques and how to cope with specific behavioral challenges.
   Use a calm tone of voice combined with physical touch to convey reassurance.
   Be patient and kind.
   Take care of your own physical and mental health.
   Remember that behavior problems result from the disease. Do not take things that the person says
    and does personally; it is the disease speaking.




    Behavioral Challenges:
    Coping With...Anger and Aggression

    Dementia affects the parts of the brain that control mood and behavior. An individual can become
    anxious and fearful, which often manifest as anger and aggression.

    Possible problems:
     Seek a doctor's advice to determine if there is a medical cause, or if medications are causing
    adverse side effects.

     Limit outside noise, clutter or the number of persons in a room.

     Keep to the same routines.

     Reduce caffeine intake.

     Restrict choices to minimize confusion. Do not ask, "What would you like for lunch-soup or a
    sandwich?" Instead, say, "Here's some soup."

     Keep objects and furniture in the same places.



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    arvanroche@swissonline.ch                                                                      Page 15
 Help orient the confused person with calendars and clocks.

 Dot the environment with familiar objects and photographs to provide a sense of security and
promote pleasant memories.

 Try gentle touch, soothing music, reading or walks.

 Speak in a reassuring voice.

 Distract the person with a snack or an activity.

 Learn to recognize certain behaviors. An agitated state or pulling at clothing, for example, could
indicate a need to use the bathroom.

 Do not try to restrain the person during a catastrophic reaction.

 Keep dangerous objects out of reach.

 If agitation increases at night, a nightlight may reduce confusion.

 In severe cases, doctors can prescribe medication to calm an individual.

 Acknowledge the person's anger over the loss of control in their life.



Behavioral Challenges:
Coping With...Paranoia

Individuals with dementia may become paranoid as a result of false beliefs, or delusions, which are a
symptom of the disease. Examples of paranoia are accusations that someone is poisoning their food
or stealing their money, or statements such as, "My spouse is an imposter."

Possible problems:
 Discuss paranoid behaviors with the individual's doctor. Medications may need to be adjusted.

 Explain to other family members and caregivers that suspicious accusations are a part of the illness.

 Respond to the feeling behind the accusation. If the accusation involves hurting someone who has
passed away, you might suggest, "You really miss your mother; tell me about her."

 Try non-verbal reassurances like a gentle touch or hug.

 If the individual suspects money is "missing," allow them to keep small amounts of money in a
pocket or pocketbook for easy inspection.

 Assist the person in looking for a missing object. Try to learn where their favorite hiding places are
for storing objects that are frequently "lost."

 Avoid arguing.



Behavioral Challenges:
Coping With...Traveling

A change in routine or environment can be upsetting and confusing to an individual with dementia.

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arvanroche@swissonline.ch                                                                        Page 16
New and different surroundings can produce anxiety and disorientation.

Tips:
 Do not "negotiate" an outing. Do not ask, "Are you ready to go out?" Instead, use statements, such
as, "Here's your coat" and "We're getting into the car now."

 Reassure the person.

 Plan your route as carefully as possible, with attention to parking, elevators and other details.

 Leave plenty of time so you do not have to rush.

 Consider taking along another adult to assist you.

 Bring items, such as snacks or books, to occupy the person if you must wait somewhere.



Behavioral Challenges:
Coping With...Sundowning

Sundowning is a dementia-related symptom that refers to increased agitation, confusion and
hyperactivity that begins in the late afternoon and builds throughout the evening. Most sundowning
emerges in mid-stage dementia and slowly worsens as the disease progresses. What causes it?
Dementia may damage the body's internal clock, causing a disruption of sleep-wake cycles. Secondly,
individuals with dementia become fatigued by their inability to process information; the more hours
spent on this process, the more exhausted—and irritable—they may become.

Tips:
 Plan activities or outings in the morning.

 Do only simple, calming activities in the afternoon.

 Keep individuals awake during the day.

 Increase indoor lighting before dusk.

 Ensure that the individual is not suffering from hunger, thirst, pain or fear.

 Correct potential causes with basic interventions such as hydration and snacks.

 Remove excess stimuli and clutter.

 Watch for sundowning in early-stage dementia or rapidly worsening symptoms, both of which may
suggest delirium.

 Consult your doctor to see if medications may help.

 Be twice as patient and kind during these hours.

Behavioral Challenges:
Coping With...Wandering

This behavior includes attempting to leave, roaming, visiting and rummaging. To assure safety,
individuals should be assessed to determine possible causes of these episodes, and treated with
behavioral, medical or pharmacological interventions.

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arvanroche@swissonline.ch                                                                        Page 17
Tips:
 Do not leave a person with dementia home alone.

 Monitor and record the individual's wandering patterns—frequency, duration, time of day, etc. For
example, if wandering occurs first thing in the morning, they might be hungry; in the late afternoon or
early evening, they might be experiencing "sundowning"; and during the night, they might need to
use the bathroom.

 Consult with a physician to see if medications can help. Individuals who wander as a result of
delusions or hallucinations may require psychotropic medications.

 Provide recreational activities—music therapy, physical exercise or movies, for example—to reduce
boredom, under-stimulation or lack of socialization that prompts wandering.

 Ensure that the individual is well fed, well hydrated and using the bathroom since individuals may
wander to fulfill these basic needs. Consider setting a schedule.

 Reduce environmental stimuli like loud music, screaming or overcrowding that might spark this
behavior.

 Outfit the individual with an identification bracelet, and put some form of identification in every
jacket, pocketbook or other article.

 Obtain a wristband transmitter, such as those used by Project Lifesaver, to more easily track
wanderers.

 Have a current photo readily available and find out about leaving one on file at the police
department.

 Secure doors in a way that are difficult to open.

 Add electronic chimes or doorbells so a caregiver is alerted if the individual attempts to exit.

 Identify bathrooms and other rooms with colorful signs to re-orient individuals.

 Post a large sign that says "stop" or "do not enter" on exits.

 Mask exit doors with a curtain.

 Place a black mat or paint a black space by an exit, which may appear to be an impassable hole to
those with dementia. Likewise, a large line, strip of tape or VelcroTM may act as a barrier.

 Provide familiar objects, such as family photographs, slippers and a quilt, to an individual living in a
long-term care facility to make it feel like home.

 Put away essential items, such as the person's coat, shoes, pocketbook or glasses, since some
individuals will not go out without certain articles.

 Tell neighbors about the person's wandering behavior and make sure they have your phone
number.

 Look for changes in patterns. For example, those who begin to wander after a prolonged period in
a facility may suffer from a new medical, psychiatric or cognitive complication. For instance, delirium
may produce the abrupt onset of wandering.



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arvanroche@swissonline.ch                                                                         Page 18
                                          Music Therapy



Music has power—especially for individuals with Alzheimer’s disease and related dementias. And it can
spark compelling outcomes even in the very late stages of the disease.

When used appropriately, music can shift mood, manage stress-induced agitation, stimulate positive
interactions, facilitate cognitive function, and coordinate motor movements.

This happens because rhythmic and other well-rehearsed responses require little to no cognitive or
mental processing. They are influenced by the motor center of the brain that responds directly to
auditory rhythmic cues. A person’s ability to engage in music, particularly rhythm playing and singing,
remains intact late into the disease process because, again, these activities do not mandate cognitive
functioning for success.

Music Associations. Most people associate music with important events and a wide array of
emotions. The connection can be so strong that hearing a tune long after the occurrence evokes a
memory of it.

Prior experience with the piece is the greatest indicator of an individual’s likely response. A melody
that is soothing for one person may remind another of the loss of a loved one and be tragically sad.

If the links with the music are unknown, it is difficult to predict an individual’s response. Therefore,
observe a person’s reaction to a particular arrangement and discontinue it if it evokes distress, such as
agitation, facial grimaces or increasing muscular tension.

Top Ten Picks. Selections from the individual’s young adult years—ages 18 to 25—are most likely to
have the strongest responses and the most potential for engagement.

Unfamiliar music can also be beneficial because it carries no memories or emotions. This may be the
best choice when developing new responses, such as physical relaxation designed to manage stress or
enhance sleep.

As individuals progress into late-stage dementia, music from their childhood, such as folk songs, work
well. Singing these songs in the language in which they were learned sparks the greatest involvement.

 Sound of Music. Typically, “stimulative music” activates, while “sedative music” quiets. Stimulative
music, with percussive sounds and fairly quick tempos, tends to naturally promote movement, such as
toe taps. Look to dance tunes of any era for examples. Slightly stimulative music can assist with
activities of daily living: for example, at mealtime to rouse individuals who tend to fall asleep at the
table or during bathing to facilitate movement from one room to another.

On the other hand, the characteristics of sedative music—ballads and lullabies—include unaccented
beats, no syncopation, slow tempos, and little percussive sound. This is the best choice when
preparing for bed or any change in routine that might cause agitation.

Responses that are opposite of those expected can occur and are likely due to a person’s specific
associations with the piece or style of music.

Agitation Management. Non-verbalindividuals in late dementia often become agitated out of
frustration andsensory overloadfrom the inability to process environmental stimuli. Engaging them in

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arvanroche@swissonline.ch                                                                       Page 19
singing, rhythm playing, dancing, physical exercise, and other structured music activities can diffuse
this behavior and redirect their attention.

For best outcomes, carefully observe an individual’s patterns in order to use music therapies just prior
to the time of day when disruptive behaviors usually occur.

 Emotional Closeness. As dementia progresses, individuals typically lose the ability to share
thoughts and gestures of affection with their loved ones. However, they retain their ability to move
with the beat until very late in the disease process.

Ambulatory individuals can be easily directed to couple dance, which may evoke hugs, kisses or
caresses; those who are no longer walking can follow cues to rhythmically swing their arms. They
often allow gentle rocking or patting in beat to the music and may reciprocate with affection.

An alternative to moving or touching is singing, which is associated with safety and security from early
life. Any reciprocal engagement provides an opportunity for caregivers and care receivers to connect
with one another, even when the disease has deprived them of traditional forms of closeness.

How-to of music therapy:

Early stage—

 Go out dancing or dance in the house.

 Listen to music that the person liked in the past—whether swing or Sinatra or salsa. Recognize that
perceptual changes can alter the way individuals with dementia hear music. If they say it sounds
horrible, turn it off; it may to them.

 Experiment with various types of concerts and venues, giving consideration to endurance and
temperament.

 Encourage an individual who played an instrument to try it again.

 Compile a musical history of favorite recordings, which can be used to help in reminiscence and
memory recall.

Early and middle stages—

 Use song sheets or a karaokeplayer so the individual can sing along with old-time favorites.

Middle stage—

 Play music or sing as the individual is walking to improve balance or gait.

 Use background music to enhance mood.

 Opt for relaxing music—a familiar, non-rhythmic song—to reduce sundowning, or behavior
problems at nighttime.

Late stage—

 Utilize the music collection of old favorites that you made earlier.

 Do sing-alongs, with “When the Saints Go Marching In” or other tunes sung by rote in that person’s
generation.
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arvanroche@swissonline.ch                                                                        Page 20
 Play soothing music to provide a sense of comfort.

 Exercise to music.

 Do drumming or other rhythm-based activities.

 Use facial expressions to communicate feelings when involved in these activities.




Storytelling

Creative storytelling is catching on as a therapeutic tool for individuals with Alzheimer's disease—and
their families. It is increasingly being used in adult day programs and other group settings. Pleased
with the results, experts say families can adapt this technique for use in their home environments as
well.

Storytelling sparks memories, encourages verbalization and promotes self-esteem among those with
dementia, according to healthcare professionals. "Inevitably, storytelling is about memories, but it
opens the rules to include imagination and to create something new that accepts who they are and
where they are in the moment. That's a great thing for families," noted Anne Basting, founder of the
Milwaukee-based National TimeSlips Project.

Renya Larson, a TimeSlips facilitator and the associate director of the National Center for Creative
Aging, Brooklyn, NY, calls TimeSlips a "potent" tool designed for individuals in the middle to late
stages of Alzheimer's disease who can no longer communicate through conventional methods.
Participants can comfortably incorporate gestures, sounds and facial expressions into the story.

For individuals still in the earlier stages, Larson suggested, "Creativity may be threatening. They want
to hold on to the true stories they still have." However, it may be possible to adjust the program by
including more reminiscence and current events.

How-to of creative storytelling:

 Create the right scene. Eliminate background noise, like TV and radio, and set up in a dedicated
space. Prepare a sketchpad, brightly colored markers and an image. Do storytelling during the "magic
hour" for higher cognitive functioning—9:30 am to 11:30 am or right after lunch. Maintain eye
contact.

 Choose pictures carefully. The more unrealistic the picture, the better. Large, colorful pictures
that are odd or include animals mimicking what people do spark creativity. While you might be
inclined to use family photos, they raise the possibility of right and wrong answers, and a sense of
failure. Instead, try a picture that triggers something from the past, but that is not too close so that it
prompts the person to focus on remembering.

 Learn questioning techniques. The wording of the questions is even more critical than the
images. Questions that elicit yes and no, or direct answers will not work. Inquiries like "Who is this?"
or "What is this?" are outlawed. These create a pressure cooker for an individual with dementia, and
set them up for a wrong answer. Only open-ended questions are encouraged, such as: "What should
we call the person?" "Where are they going?" "What could this be?" "What is going on here?"

 Be persistent. If the method does not click one day, try again another day. It might take a lot of
cajoling to get the person to respond. Engaging other family members in storytelling can stimulate
more responses from the person with dementia, bringing the process closer to a group experience.

 Keep a stiff upper lip. The whole idea is to open up the thought process. Responses may be

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arvanroche@swissonline.ch                                                                          Page 21
negative, incorrect or resurrect family baggage. Individuals often voice their contrariness or use
sexual or bathroom language. Still, echo whatever is said and make that the story. Otherwise, if you
frown upon their answers, they will be afraid to participate. It is important to validate comments-
however shocking, and move on.

 Integrate music. Sometimes music will prompt responses even among individuals who are no
longer verbal. Bring in music by asking open-ended questions, such as, "What might she be singing?"
or "What music does the character like?"

 Go with the flow. You do not have to write the story down if you feel it will distract from enjoying
the moment. Consider using a tape recorder or involving a youngster as the scribe.

 Redefine "story." Creative storytelling does not have to have a beginning, middle and end, nor
does it have to make sense. For example, a character can have three names and words can be
nonsensical. Most of all, remember this is creative storytelling. Noted Basting: "It can be scary for
people to let go of literal language. But if you can follow to where the person is, you can find a whole
new way to connect to your loved one."

Note:
Experts caution that creative storytelling can be more challenging one-on-one than in a group setting.
Families will need to jump over some hurdles, but, with that done, this technique can be successfully
adapted to the home—and can be very rewarding all-around.




Safeproofing Your Surroundings

Turning a home into one that is dementia-friendly can help minimize accidents and maximize well-
being. It can also give peace of mind and reduce stress for at-home and long-distance caregivers.

Act before a crisis. In safeproofing surroundings, it is best to take preventative steps, rather than
scramble around to solve an immediate crisis. This way, options can be more carefully weighed. The
challenge is to balance a desire to keep individuals with dementia as functional as possible against the
hazards posed by their cognitive decline, which may include poor judgment, difficulty with spatial
perception and inability to react appropriately. Observing an individual's patterns and how they
navigate their environment, looking for red flags, and pinpointing causes and effects are all very
telling.

Professionals or caregivers themselves should survey a home three times, progressing in security at
each inspection. Look for safe, safer and safest.

 Safe involves detecting basic dangers and fixing or removing those items, such as movable
furniture that people wrongly rely on for support, chairs that blend in with the walls behind them, and
loose extension cords and telephone wires;

 Safer means locating ways to minimize injury in the event of accidents, like replacing glass tables
with furniture that has blunt edges, and locating a soft rubber mat by the bed in case of a fall; and

 Safest is maximizing access to help in an emergency, such as installing a monitoring device.

Look at critical areas. Since those with dementia need a quiet, orderly environment, it is critical to
address factors such as noise, color and lighting. Modifying kitchens and bathrooms, and taking steps
to deter wandering are primary concerns. The key is to pay special attention to lighting, furnishings,
textures, changes in elevation, handrails, and types of flooring, and to remove hazardous clutter from
floors, stairways, etc. Often, small changes can make big differences. For example, reducing the level
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arvanroche@swissonline.ch                                                                       Page 22
of light during meals can prompt better eating habits; camouflaging an exit door with a curtain can
prevent wandering; and removing clutter and unnecessary furniture can reduce confusion.

Be creative. Products do not have to be taken at face value; rather, consider a person's specific
condition and further adapt products for an even greater sense of security. And always keep in mind
that, with this progressive disease, what works one day may not the next.

Consider redundant strategies for life-threatening situations. For example, to prevent wandering,
install multiple locks on a door, each at varying heights out of direct sight and requiring different skill
sets to open, and supplement them with an alarm. Or when buying a personal response system that
uses pendants with a call button to alert a central monitoring station, spring for extras. Use one as a
pendant, and cut off the strings from the others and use double-sided tape to install the help buttons
to base moldings in key spots. This way, if the individual falls while not wearing the pendant, he could
crawl to an emergency button in, say, the foyer or shower.

Walk gently. While many changes sound easy enough, convincing the at-home caregiver and/or
their loved one to alter their environment can be the hard part. Often, their reluctance boils down to a
sense of shame or the feeling that many assistive devices are unattractive.

Look for designs and assistive devices that give people independent functioning while maintaining
privacy and dignity. One example of a perfect solution: grab bars so individuals can get on and off the
toilet by themselves. Manufacturers are increasingly designing products without a medical-type
appearance, addressing the "shame" issue for both caregivers and those with dementia. Products are
nicer looking, boasting decorative colors and style.

In presenting home safety features to those with dementia, be delicate. Since most people do not
welcome change, caregivers may need to broach the subject on several occasions and make gentle
suggestions. Also, try to include the person with dementia in the decision-making process. And use
language that empowers the person to agree to the safety features for someone else's sake, such as,
"It's not for you; it's for me so I don't worry so much." Another effective strategy is to call solutions by
another name—gifts.



Checklist

       Clear all passageways.
       Remove unnecessary furniture, knickknacks, clutter and items that may cause confusion.
       Fix loose or uneven steps, and loose or broken handrails.
       Put gates at the top of stairways.
       Install safety latches on cabinets that store dangerous items, such as knives, firearms,
        medications and cleaning products.
       Place guards around radiators and other heaters.
       Install secure locks that are higher or lower than eye level on outside doors and windows.
       Eliminate poisonous houseplants.
       Keep small objects that may be swallowed out of sight.
       Make sure electrical wires and phone cords are secured and cannot be tripped over, and that
        lamps cannot fall over.
       Remove or fasten down scatter rugs to prevent slipping.
       Put nightlights in bathrooms, hallways and bedrooms.
       Make sure light fixtures are easy to turn on, such as switches near doorways and glow-
        switches.
       Use maximum wattage allowed by fixtures.

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arvanroche@swissonline.ch                                                                          Page 23
       Reduce glare with frosted bulbs.
       Ensure adequate lighting by stairways and passageways.
       Remove stove and oven knobs when not in use.
       Install an automatic shut-off switch on the stove.
       Put away kitchen appliances such as blenders and toasters.
       Use non-slip decals or mats in the tub and shower.
       Install grab bars around the tub, shower and toilet.
       Try a bathtub bench or a hand-held shower.
       Keep the temperature gauge on the hot water heater at 120 degrees or lower to prevent
        scalding.
       Remove locks on bathroom doors.
       Outfit the individual with an ID bracelet or some other form of identification.
       Obtain a wristband transmitter or other tracking device to locate wanderers.
       Post emergency telephone numbers in large print near phones.
       Prepare and practice an emergency exit plan.

Note:
Don't leave someone home alone—even for a few minutes—if they cannot respond to an emergency
situation.




Home Supervision

A person's right to dignity and need for independence complicate the decisions surrounding home
safety and supervision. Individuals with Alzheimer's disease and other dementias are likely to be
convinced that it is safe to be alone long after it has clearly become unsafe-even after several
accidents or injuries have occurred.

Always ask yourself: Is it still harmless for my loved one to be alone? If it is, these steps
can help:

 Provide reassurance before you leave the house, since being alone can cause anxiety and fear for
those with dementia.

 Explain that you are only running out for a minute, and remind your loved one that he can call you
or another family member if he feels concerned.

 Put important telephone numbers and step-by-step instructions at each phone.

 Make some simple activities, like a favorite movie or puzzle, readily available to provide distraction.

 Ask a friend or another family member to call to chat while you are out, and to reorient your loved
one and provide reassurances.

 Leave large, simple notes around the home, such as "Joan is at the store and will be home soon" or
"Joan will be home when this clock says 4:30."

 To ward off wandering, put up visual cues on the exits, like "Stop" or "Do Not Leave."

 Make sure that your loved one has some type of identification bracelet, such as those available

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arvanroche@swissonline.ch                                                                        Page 24
from local Alzheimer's agencies.

 Consider enrolling in Project Lifesaver, which uses state-of-the-art radio technology to quickly locate
wanderers.

Heightened anxiety can indicate that it is no longer okay for your loved one to be home
alone. Then, consider making other arrangements, such as:

 Ask a neighbor or family friend to visit in your absence.

 Invite a friend to accompany you and your loved one outdoors, running errands together as a
group.

 Hire a trustworthy individual from the community—a high school student or member of your
congregation, for example—to come in for a few hours.

 Bring in trained dementia care professionals.

Note:
As a caregiver, you must assess when to change routines to assure adequate supervision. The last
thing that a well-intended caregiver needs is a crisis situation that could have been prevented. These
crises can also be construed as neglectful, possibly leading to a Protective Services investigation. It is
the caregiver's legal and ethical responsibility to intervene when supervision is needed.




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arvanroche@swissonline.ch                                                                         Page 25
                                            About Alzheimer's



    Definition of Alzheimers

   Alzheimer's disease is a progressive, degenerative disorder that attacks the brain's nerve cells, or
    neurons, resulting in loss of memory, thinking and language skills, and behavioral changes.

   These neurons, which produce the brain chemical, or neurotransmitter, acetylcholine, break
    connections with other nerve cells and ultimately die. For example, short-term memory fails when
    Alzheimer's disease first destroys nerve cells in the hippocampus, and language skills and judgment
    decline when neurons die in the cerebral cortex.

   Two types of abnormal lesions clog the brains of individuals with Alzheimer's disease: Beta-amyloid
    plaques—sticky clumps of protein fragments and cellular material that form outside and around
    neurons; and neurofibrillary tangles—insoluble twisted fibers composed largely of the protein tau that
    build up inside nerve cells. Although these structures are hallmarks of the disease, scientists are
    unclear whether they cause it or a byproduct of it.

   Alzheimer's disease is the most common cause of dementia, or loss of intellectual function, among
    people aged 65 and older.

   Alzheimer's disease is not a normal part of aging.

   Origin of the term Alzheimer's disease dates back to 1906 when Dr. Alois Alzheimer, a German
    physician, presented a case history before a medical meeting of a 51-year-old woman who suffered
    from a rare brain disorder. A brain autopsy identified the plaques and tangles that today characterize
    Alzheimer's disease.

    Warning Signs

    Although every case of Alzheimer's disease is different, experts have identified common warning signs
    of the brain disease. Remember, Alzheimer's disease is not a normal part of aging, and it is important
    to look for signs that might indicate Alzheimer's disease versus basic forgetfulness. With Alzheimer's
    disease, these symptoms gradually increase and become more persistent. Typical warning signs
    include:

   Memory loss, especially of recent events, names, placement of objects, and other new information

   Confusion about time and place

   Struggling to complete familiar actions, such as brushing teeth or getting dressed

   Trouble finding the appropriate words, completing sentences, and following directions and
    conversations


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    arvanroche@swissonline.ch                                                                        Page 26
   Poor judgment when making decisions

   Changes in mood and personality, such as increased suspicion, rapid and persistent mood swings,
    withdrawal, and disinterest in usual activities

   Difficulty with complex mental assignments, such as balancing a checkbook or other tasks involving
    numbers




    Diagnosis

           Clinicians can now diagnose Alzheimer's disease with up to 90 percent accuracy. But it can
            only be confirmed by an autopsy, during which pathologists look for the disease's
            characteristic plaques and tangles in brain tissue.

           Clinicians diagnose "probable" Alzheimer's disease by taking a complete medical history and
            conducting lab tests, a physical exam, brain scans and neuropsychological tests that gauge
            memory, attention, language skills and problem-solving abilities.

           Proper diagnosis of Alzheimer's disease is critical since there are dozens of other causes of
            dementia that could exhibit the same symptoms. Some of these dementias, such as those
            caused by vitamin deficiency, thyroid problems and depression, are reversible; of those that
            are irreversible, Alzheimer's disease is the most common.

           The sooner an accurate diagnosis of "probable" Alzheimer's disease is made, the easier it is to
            manage symptoms and plan for the future.




    Symptoms

   Symptoms are divided into two categories: cognitive, or intellectual, and psychiatric.

   Differentiating them is important so that behavioral problems that are caused by loss of cognitive
    functioning are not treated with anti-psychotic or anti-anxiety medications.

   Cognitive, or intellectual, symptoms are amnesia, aphasia, apraxia and agnosia (the 4 As of
    Alzheimer's).

   Amnesia is defined as loss of memory, or the inability to remember facts or events. We have two
    types of memories: the short-term (recent, new) and long-term (remote, old) memories. Short-term
    memory is programmed in a part of the brain called the temporal lobe, while long-term memory is
    stored throughout extensive nerve cell networks in the temporal and parietal lobes. In Alzheimer's
    disease, short-term memory storage is damaged first.



    Archy Nasala Riethofstr. 15, 8355 aadorf
    arvanroche@swissonline.ch                                                                       Page 27
   Aphasia is the inability to communicate effectively. The loss of ability to speak and write is called
    expressive aphasia. An individual may forget words he has learned, and will have increasing difficulty
    with communication. With receptive aphasia, an individual may be unable to understand spoken or
    written words or may read and not understand a word of what is read. Sometimes an individual
    pretends to understand and even nods in agreement; this is to cover-up aphasia. Although individuals
    may not understand words and grammar, they may still understand non-verbal behavior, i.e., smiling.

   Apraxia is the inability to do pre-programmed motor tasks, or to perform activities of daily living such
    as brushing teeth and dressing. An individual may forget all motor skills learned during development.
    Sophisticated motor skills that require extensive learning, such as job-related skills, are the first
    functions that become impaired. More instinctive functions like chewing, swallowing and walking are
    lost in the last stages of the disease.

   Agnosia is an individual's inability to correctly interpret signals from their five senses. Individuals with
    Alzheimer's disease may not recognize familiar people and objects. A common yet often unrecognized
    agnosia is the inability to appropriately perceive visceral, or internal, information such as a full bladder
    or chest pain.

   Major psychiatric symptoms include personality changes, depression, hallucinations and delusions.

   Personality changes can become evident in the early stages of Alzheimer's disease. Signs include
    irritability, apathy, withdrawal and isolation.

   Individuals may show symptoms of depression at any stage of the disease. Depression is treatable,
    even in the latter stages of Alzheimer's disease.

   Psychotic symptoms include hallucinations and delusions, which usually occur in the middle stage.
    Hallucinations typically are auditory and/or visual, and sensory impairments, such as hearing loss or
    poor eyesight, tend to increase hallucinations in the elderly.

   Hallucinations and delusions can be very upsetting to the person with the disease. Common reactions
    are feelings of fear, anxiety and paranoia, as well as agitation, aggression and verbal outbursts.

   Individuals with psychiatric symptoms tend to exhibit more behavioral problems than those without
    these symptoms. It is important to recognize these symptoms so that appropriate medications can be
    prescribed and safety precautions can be taken.

   Psychotic symptoms can often be reduced through the carefully supervised use of medications. Talk to
    your primary care doctor, neurologist or geriatric psychiatrist about these symptoms because they are
    treatable.




    Life Expectancy

           Alzheimer's disease stretches from two to twenty years, and individuals live on average for
            eight to ten years from diagnosis.


    Archy Nasala Riethofstr. 15, 8355 aadorf
    arvanroche@swissonline.ch                                                                           Page 28
      Individuals with Alzheimer's disease are likely to develop co-existing illnesses and most
       commonly die from pneumonia.

      Alzheimer's disease is the sixth leading cause of death in the U.S.




Treatment

      Currently, there is no cure for Alzheimer's disease.
      Researchers are continually testing the effectiveness of various drug therapies that will control
       symptoms; slow, reduce and/or reverse mental and behavioral symptoms; and prevent or halt
       the disease.
      The U.S. Food and Drug Administration (FDA) has approved medications known as
       cholinesterase inhibitors: donepezil hydrochloride (Aricept), approved for all stages of
       Alzheimer's disease; rivastigmine (Exelon), approved in pill and patch form for mild to
       moderate Alzheimer's disease; and galantamine hydrobromide (Razadyne), approved for mild
       to moderate Alzheimer's disease. These drugs inhibit the enzyme that breaks down the brain
       chemical acetylcholine, and thereby may help slow the worsening of symptoms.
      The FDA has approved memantine HCI (Namenda) for the treatment of moderate to severe
       Alzheimer's disease, which may help slow the worsening of symptoms.

Research

   o   The causes of Alzheimer's disease are still unknown.

   o   Current research indicates that Alzheimer's disease may be triggered by a multitude of
       factors, including age, genetic makeup, oxidative damage to neurons from the overproduction
       of toxic free radicals, serious head injuries, brain inflammation, and environmental factors.

   o   Age is the most important known risk factor for Alzheimer's disease.

   o   There are two types of the disease: sporadic Alzheimer's disease and familial Alzheimer's
       disease (FAD). Unlike sporadic Alzheimer's disease, FAD follows an obvious inheritance
       pattern. Less than ten percent of Alzheimer's disease cases are FAD. This rare form of
       Alzheimer's disease usually occurs between the ages of 30 and 60.

   o   On the genetic front, scientists have zeroed in on three mutations on chromosomes 1, 14 and
       21 that cause early-onset Alzheimer's disease, which generally affects those aged 30 to 60.

   o   Other genes boost susceptibility, but do not signal that a person will definitely develop the
       disease. Multiple research studies indicate that inheritance of a specific one of the three
       forms, or alleles, of the apolipoprotein E (apoE) gene on chromosome 19 heightens the risk of
       late-onset Alzheimer's disease. Those who carry one copy of the allele e4 face a higher risk of
       developing Alzheimer's disease, and those with two copies of e4 confront the greatest risk.
       Another relatively rare apoE allele, e2, appears linked to a lower risk of the disease.

Archy Nasala Riethofstr. 15, 8355 aadorf
arvanroche@swissonline.ch                                                                         Page 29
   o   Several other studies suggest that a gene or genes on chromosome 10 may also boost an
       individual's risk of developing late-onset Alzheimer's disease.




AFA Alzheimer Foundation of America




Archy Nasala Riethofstr. 15, 8355 aadorf
arvanroche@swissonline.ch                                                               Page 30

				
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