Depression comes in many forms. Mild depression may range from the colloquial use of “I’m having a bad day” to depressive symptoms that are not severe or pervasive enough to meet current diagnostic standards for Major Depressive Disorder (which is more severe and has to persist for at least two weeks). Dysthymia is an enduring but comparatively mild form of depression. Sadly, recent surveys indicate that as many as 40% of community dwelling elders (by most standards those over 55) have some form of depression. This puts those afflicted at greater risk of mortality and suicide as well as poorer quality of life than those who are not depressed. Does having a diagnosis of dementia increase the prevalence of depression in the elderly? The answer depends on the cause of dementia. The prevalence of depression in dementia due to Alzheimer’s […]
Dementia
Alzheimer’s disease unfolds over the course of decades. In the early stages (as discussed in part one), the afflicted person displays increasing loss of short-term memory and becomes increasingly disengaged from activities. Higher level, complex skills such as doing a checkbook and using a computer become more of a challenge. Older, overlearned skills work well whereas learning new skills or habits become increasingly difficult. Rehabilitation is self-generated if started early. If memory loss becomes severe enough to meet the criteria for dementia, rehabilitation must be accomplished by others (e.g., family, home care, or facilities) as independence is lost. The goal of treatment and rehabilitation is not to restore memory but rather to increasingly mold the environment to take advantage of learned habits and skills and keep the person with memory loss engaged and active. Competence no longer matters. What matters […]
Alzheimer’s disease is often misunderstood. These misunderstandings create a false sense of fear and futility. We are bombarded by new studies that are often contradictory. We are inundated with “alternative” treatments that are supported by anecdotal testimony and clever marketing. We live in a time of reductionist medicine that promises cures and preventative lifestyles but can’t deliver on all of its promises. We can treat chronic diseases: diabetes, certain cancers, heart disease, and chronic pain. Alzheimer’s is a chronic disease that is also easier to manage and treat if caught early. The key is to identify small changes early and, as with any chronic disease, focus on life style and proactive planning. 1. Alzheimer’s unfolds over the course of decades. There is a great deal of time to plan treatment strategies that work. Plan to have a good life even […]
Type 2 diabetes mellitus is associated with Mild Cognitive Impairment (often presenting as short-term memory loss that is either subjective or confirmed by rigorous memory tests) as well as dementia (moderate to severe short-term memory loss that causes a lack of independence). Furthermore, insulin resistance, the hall mark of adult onset or type 2 diabetes, increases the risk of developing Alzheimer’s disease. Results from the Honolulu aging study provide an example of the association of the balance of glucose and insulin with risk of dementia. Study participants who had either very high or very low levels of serum insulin were more likely than those in between to become demented over the course of 5 years. Other studies, but not all, have shown this link between insulin resistance, impaired glucose metabolism, diabetes and dementia. You have probably read the headlines generated […]
I have had many clients seek my assistance in determining whether their partner, parent, etc. have Alzheimer’s disease. In fact, I had one such client this week where a wife brought in her husband to seek an answer to the question of whether his diagnosis of Alzheimer’s was correct. This is also the question that also comes up in many of my talks. There are many myths surrounding what Alzheimer’s disease is. It is not a germ or virus that we contact. It is not a stroke. It is not a head injury. These events may all cause memory loss but they are not Alzheimer’s disease. Alzheimer’s disease is not the same as dementia. Dementia is a rating of the severity of memory loss. Dementia refers to the state of being so impaired in memory and/or other cognitive skills that […]
The latest article from the New York Times series, “The Vanishing Mind,” focuses on treatment for advanced Alzheimer’s disease. The article points to several programming methods that may be useful to many caregiver’s as well as facilities that wish to develop personalized dementia care programs that engage rather than medicate or force clients into group activities in which they have no interest or skills. They cite the Beatitudes Campus in Phoenix, AZ. Beatitudes is a continuing care retirement community focused dementia care on making Alzheimer’s patients clients receiving personalized care. They build programming on biography and personal history. Beatitudes builds on the obvious rather than trying to medicate problems as they arise. They have implemented techniques that we have known for years into their programming rather than forcing power struggles with clients and have had many successes with residents who […]
The first stages of Alzheimer’s disease are marked by decreasing self-determination. As one proceeds through early stages, there is an increasing need for external supports but independent survival is likely. In the later stages, independent survival in the community is no longer possible. The plans and skills learned in the early stages will determine, in part, the smoothness of these stages. The later stages are clearly marked by more than just memory loss. Indeed there are multiple skills lost (e.g., judgment, reasoning, planning, learning new skills or facts). There is often little self-directed engagement. Palliative memory care (e.g., day programs, placement in memory care units) is necessary, as short-term memory is severely impaired to the point that the forgetful person no longer is aware of forgetting. Each repeated question or comment is made for the first time from his or […]
I was recently confronted with a situation that has caused me to again rethink the use and abuse of the power that we have as professionals- especially those with the title of “doctor.” In my line of work, I am often confronted with difficult and emotional decisions that involve personal rights and freedoms. I provide opinions regarding the capacity of persons to drive, manage finances, and live independently. Most of the cases I am involved with involve various degrees of memory loss, sometimes to the point of impairment known as dementia. Dementia presents as an irreversible loss of ability and coping skills. Depending on the severity of the dementia, rights such as the freedom to come and go as one pleases must be removed for safety. These are often gut wrenching for both the afflicted individual and those who love […]
A new study in the journal Neurology asserts that a spinal tap can accurately detect the development of Alzheimer’s disease before symptoms appear. As quoted in The New Republic, “The unexpected presence of the AD signature in more than one-third of cognitively normal subjects suggests that Alzheimer’s pathology is active and detectable earlier than has heretofore been envisioned.” The “AD signature” is the presence of a protein called beta-amyloid in the spinal fluid. The implication is that people can be accurately diagnosed with Alzheimer’s disease years before they develop symptoms. This all sounds so neat and clean like genetic testing for neurological diseases such as Huntington’s chorea. As technologies like spinal taps and brain scans become more available outside of research settings, there seems to be increased interest in using them as diagnostic tools. But I feel we are getting […]
Dementia is a general term that is often misunderstood. Dementia refers to mental deterioration to the point that one can no longer do higher level mental tasks like doing a checkbook, using a computer, or preparing a meal. In more severe forms of dementia, one may no longer be able to tend to personal needs such as bathing, toileting, or changing clothes. In other words, dementia refers to mental decline where one can no longer function independently (i.e., needs at least some level of external care). Dementia refers to the severity of the mental deterioration. It is not a state of being. Dementia is caused by a loss of skills (i.e., brain function). There are many possible causes of dementia. For example, many who develop a progressive form of dementia have a heavy burden of amyloid plaques and tau tangles. […]
