Introduction to Dementia and Alzheimer’s Disease
Johns Hopkins Medicine issued a Special Report on Alzheimer’s Disease in 2011 to help explain the condition to family members of those suffering from the disease. Dementia is a commonly accepted term that generally refers to cognitive problems such as loss of memory and communication skills, but it is not a specific disease. Alzheimer’s is a progressive disease that is estimated to make up anywhere from 60 to 80 percent of all dementia cases.
Dementia is thought to be the result of brain cell damage in the hippocampus. Some conditions that may result in dementia can actually be reversible – such as vitamin deficiencies, strokes, and problems caused by the thyroid.
However, there is no cure for Alzheimer’s and the rate of decline varies for every patient. We still do not know what causes Alzheimer’s Disease. Johns Hopkins reported that the leading theory is caused “by an accumulation of insoluble fragments of beta-amyloid.” They think the fragments essentially form plaque in the brain.
Diagnosing and Managing Alzheimer’s Disease
Before determining a diagnosis of Alzheimer’s, a physician may elect to conduct some diagnostic testing via CT and MRI scans to rule out any strokes or tumors. They will then begin interviewing family, friends, and the patient to gather a medical history and definitively rule out other potential cognitive causes. Using this method of clinical diagnosis is estimated to result in a 90 percent accuracy rate.
While there is no cure, early diagnosis can help patients plan for the future and delay the onset of the disease through medication. The FDA has approved three medications (called cholinesterase inhibitors) for those patients in the early stages of Alzheimer’s disease. Razadyne, Exelon, and Aricept are medications that are commonly prescribed in an attempt to delay the the breakdown of acetylcholine, which is thought to preserve memory and congitive abilities. During the later stages of Alzheimer’s Disease, patients may be prescribed Namenda (to regulate glutamate) or continue with Aricept.
What to Expect
There are three stages of progression for Alzheimer’s Disease. The first stage is mild, and this is when the disease can be most easily confused with the normal aging process. Your loved one may begin showing symptoms such as forgetting events and appointments, and start to lose track of their personal items. The Alzheimer’s Association has published a chart to help families differentiate between the early signs of Alzheimer’s and normal memory changes that come with age. The biggest point to bear in mind is that normal age-related issues revolve around sometimes forgetting things. Early signs of Alzheimer’s typically revolve around consistent memory problems or demonstrated inability to communicate, rather than sporadic problems.
During the second stage of Alzheimer’s Disease, your loved one will start to show a decline in their ability to undertake daily activities. Patients may not be able to feed, bathe, or dress themselves at all. The memory problems will become worse and more frequent. Patients may even begin to show signs of hallucinating.
The last stage of Alzheimer’s Disease is when the patient is completely dependent on a caregiver to meet all of their needs, and almost all cognitive reasoning is gone. This critical care stage is when patients are at the most risk of developing other fatal diseases, such as Pneumonia.
How a Professional Can Help Give Care
If diagnosed with Alzheimer’s Disease your loved one will most likely go through a series of behavioral changes. You may notice changes such as aggression, depression, anxiety, sleep problems, and hallucinations. It can be difficult to know how to offer the right kind of care when you are faced with all of these progressive changes.
During the early stages of Alzheimer’s Disease, the goal of the caregiver is to serve as more of a supportive partner to the patient. The caregiver team wants to help the patient remain independent for as long as possible. This is done through an active collaboration with the patient to figure out how to stay involved and participate in activities that they enjoy. The caregiver may provide more of an organizational and planning type of support in the early stages of the disease. It is during this initial onset when it is so important to make sure the patient is able to participate in legal, financial, and medical decisions for their own future needs.
When the patient reaches the second stage of Alzheimer’s, they will typically need someone to assist them with daily routines and activities. The most typical signs of reaching the second stage might be that the patient is showing some anger and frustration and “acting out” in an almost childlike manner when they have to bathe or get dressed. The patient might start having increasing difficulties speaking. They will not be able to drive any longer. During this stage, the Alzheimer’s Association recommends using written reminders for the patient, and advises caregivers to always remember to react calmly to the patient. Sometimes, the patient is going to ask questions that do not make any sense because they start to lose their communication abilities. A professional caregiver is trained in how to read the emotions behind the question, rather than trying to respond to the actual question that the patient is asking. This way, the patient receives calm assurance from the caregiver.
The most critical time to utilize a professional caregiver is during the last stages of Alzheimer’s Disease. At this stage, the patient will not be able to take care of himself or herself at all. They may need assistance with feeding and may not be able to speak at all. Taking care of the patient during this time will revolve around sensory perceptions that you can demonstrate through reading to the patient, cooking a favorite meal, or playing a favorite song.
