Dementia

I had the pleasure of being invited to observe a workshop by Teepa Snow (http://www.TeepaSnow.com).  The event was hosted by the Alzheimer’s Support Network and, to my great pleasure, was attended by staff from diverse facilities and organizations that provide dementia care.  Teepa is a very skillful and talented presenter/trainer.  Her focus was on doing.  She presented conceptual training in the form of role-plays of many challenges we face when trying to get into the world of someone who is demented.  Her teaching style focused on doing rather than saying.  She challenged but always coached participants into a success by offering specific prompts and modeling.  Caregiving is not an intellectual exercise but is a hands on, participatory activity. Teepa’s message is clear.  You must provide person-centered care to be effective in caring for those with severe cognitive decline.  We often […]

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Stress is a pervasive condition that affects our mental and physical functioning.  The term covers both situations that we may call “stressful” such as being told we have cancer or Alzheimer’s disease, caregiving for someone with dementia, or having to give a speech or our reaction to the stressful event such as racing heart, dry mouth, or worry.  Stress can be “negative,” as in being sued, having a car accident, or getting divorced, or “positive,” as in taking a vacation, getting married, or winning the lottery.  Stressors vary in terms of duration, intensity, novelty, and type.  The ranges of stressors includes threat of death, threat of bodily injury, illness, grief, divorce, grief, moving, night shift work, commuting, and noise. The formal study of stress started with the seminal book The Stress of Life by Hans Selye that was published about […]

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How does caregiving unfold over time?  Diseases such as Alzheimer’s disease evolve over time – usually decades.  The person who is forgetful can manage early changes in memory.  But as the disease progresses, there is an increasing need for external guidance, prompts, and caregiving as the problems extend beyond just forgetfulness.  There are seven general stages of memory loss per the global deterioration scale.  The following presents general needs for care at each stage. Stage one – normal.  This is the stage that we all hope to stay.  There are the typical “senior moments.”  No caregiving is needed. Stage two – forgetfulness.  In this stage there is minor consistent forgetfulness and the person in this stage is typically aware that there are changes.  There may be an incident or pattern that raises minor concerns.  There is no need for caregiving […]

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Alzheimer’s disease unfolds over the course of decades.  Despite the intensive search, there are no accurate and reliable biological markers for Alzheimer’s disease.  Diagnosis is based on a combination of factors including details of course and history gathered from the person who has memory loss as well as family and/or friends.   There must also be a medical work up searching for treatable causes of memory loss such as thyroid function, status of diabetes, anemia, and imaging studies.  The standard of care also requires cognitive evaluation to map out strengths and weaknesses and stage the disease.  Finally, diagnosis requires clinical judgment. There is a push for a new set of criteria that diagnoses Alzheimer’s disease into three stages and is based on the fact that Alzheimer’s disease begins well before symptoms emerge (Practical Neurology, 2013, March/April, 34-35)).  The first stage is […]

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To quote from my article for August 2011,  “It is clear that anesthetic agents may be neurotoxic for some and more so after 60.”  This statement was predicated on findings from that time suggesting that undergoing general anesthesia may cause cognitive decline especially in the elderly.  Delirium and postoperative cognitive decline are the two most common untoward effects of surgery.  Delirium is transient and obvious but may last days to weeks.  Postoperative cognitive decline is a more long lasting condition, often subtle at first. But not so fast, understanding is a process that evolves over time and must integrate new information as it becomes available.  A new study (Mayo Clinic Proceedings, May 2013) states that there is no association between anesthesia and dementia.  The data were obtained from medical records on nearly 2000 cases.  Results were based on individuals that […]

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I keep hoping for more useful research on treatments and management techniques that may potentially benefit those with memory loss and their caregivers.  There are three recent studies that caught my attention as examples of movement in the right direction. First, “The effect of stimulation therapy and donepezil on cognitive function in Alzheimer’s disease” (BMC Neurology, 2012, 12, 59).  The study compared the effects of stimulation therapy, treatment with donepezil (Aricept), or to combined treatment during the first year after diagnosis with mild to moderate Alzheimer’s disease.  Stimulation therapy consisted of multiple elements including physical activity (e.g., dancing, walking, fitness training), as well as cognitive and social activities (e.g., reading, listening to music, crossword puzzles, reminiscence) for at least 30 minutes each day 5 times per week.  Donepezil (or placebo) was started at 5 mg and increased after four weeks […]

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“Alzheimer’s epidemic puts advisers – and their practices – at risk” (InvestmentNews.com, February 26, 2013).  “Clients with Alzheimer’s pose “scary” legal risks” (InvestmentNews.com, February 13, 2012).  “Money woes can be early clue to Alzheimer’s” (New York Times, October 2010).  The worry has been there for some time.  The problem of risk management is as clear as is the solution.  Alzheimer’s disease unfolds over the course of 30 or so years, progresses slowly, and does not produce disability until well advanced.  Progressive dementias unfold like reverse development.   First in, last out.   We learn walking and talking very early.  Managing technology and complex decision-making comes much later.  It’s no wonder that complex decision-making, like investing and managing money and legal decisions, are the first signs of decline.  It appears to sneak up on us – but it does not. Alzheimer’s disease gives […]

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One of the most difficult lessons for those who are caregivers for persons with Alzheimer’s disease or other dementias to learn is to not fight futile battles.  The mind over matter strategy does not work.  We are used to being persistent to teach or learn new things and used to the benefits of practice in learning new behaviors, skills, or information.  These practices offer diminishing returns as the memory loss progresses.  Caregiving – whether in a facility or at home – needs to be built around what still works and needs to increasingly involve external prompts to initiate even retained skills. Let’s consider some examples of strategies that were helpful to several of my clients.  The intention was to reduce frustration, errors, and conflict as well as to improve stimulation for persons in early to middle stage dementia. Those in […]

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One way to understand progressive changes resulting from dementia is to compare them to the changes that occur as a result of human development.  Dementia unfolds as reverse development.  As a general rule, those skills we learn later in life (e.g., managing investments, complex technology, doing a checkbook, and writing poetry) decline earlier than those learn earlier in life (e.g., toileting, dressing, and language).  The major difference is that as we develop from infancy, we constantly learn new skills and information.  The opposite is true for most dementias.  Learning new skills becomes increasingly difficult or impossible.   Those who are demented must be managed based on skills that are already there and those skills progressively deteriorate.  Dementia is a backward moving target. The good news is that we can learn a lot about managing dementia by understanding and using principles of […]

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Two recent headlines caught my attention. “Eating berries linked to delay in cognitive decline” (Annals of Neurology, 2012, April 25) and “Coffee may ward off progression to dementia” (Journal of Alzheimer’s Disease, 2012, 30, 559-572). I drink blueberry flavored coffee each morning. Does this give me double the protection? The first study demonstrated that higher consumption of either blueberries or strawberries “slowed memory decline by up to 2.5 years. The study, Nurses’ Health study, had a very large sample size, 16,010, with an average age of 74. Cognitive function was assessed every two years between 1995 and 2001. “Protective” associations were found for women who ate 1 or more servings of blueberries per week or ate 2 or more servings of strawberries per week. On the surface the findings look encouraging. But the rub comes with some of the details. […]

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