Posts tagged: Alzheimer’s Disease

What’s Up with Mom?

What’s up with Mom?  We moved her into a new apartment over the weekend, and she is not like anything or anyone I’ve seen before.  She is so confused she has forgotten to eat; sitting and staring for hours, or up at night and wondering the hallways.  All the children take shifts supervising her, but the situation does not appear to be resolving.  It tears me up to see her like this.  What is worse, the our family is splitting down the middle; some favor keeping her in the apartment no matter what arises, and the rest believe she should be in a nursing home.  I don’t know where to turn.

This is a paraphrased narrative that I have heard literally hundreds of times.  Neurologists of old called this the “Monday Morning Disease.”  It refers to family that did not notice a loved one becoming senile until some change in their environment produced confusion.  Most families will report changes in the patient’s behavior over a one to two year period prior to an incident, only they did not ascribe them to a senile dementia of the Alzheimer’s type.

One of the earliest symptoms of Alzheimer’s to escape the notice of others is a deficit of planning.  It is not as noticeable as memory or attention deficits, yet it causes profound functional impairment.  As long as the dementia victim relies on old well-learned behavioral routines, there is minimal trouble living independently.  Once a person’s daily behaviors are upset by a move, they must develop new functional behaviors that accomplish goals necessary to live; for example, shopping for food.  In a new environment, the person lacks clues to their old behaviors, and so are at a complete loss for where to go and what to do.  Many cognitive scientists (fancy term for psychologist) conceptualize humans as planning machines.  As you read this post, you may also be thinking of what you are going to do next, and you may even formalize the steps to accomplish this goal.  Children burst with plans for what they will do after school.  Do not mistake deficient planning for a lack of energy or optimism.  Planning is a necessary cognitive skill for survival, and it is one of the earliest functions to decline in a senile dementia.
usa generic viagra If 100 mg of the medicine is not showing the wonders for the users. Because memories are mental, they subject to the laws of the universe. prescription female viagra Both physical and cheap viagra india psychological factors are the major cause of this disease. Some of the common side effects encountered were; Frequent headaches Flushing of the sildenafil 100mg tablet face for sometime after the use.
Another early cognitive deficit is a decline of mental flexibility.  This is not to be confused with someone who is easygoing and complaint with the wishes of others.  Cognitive flexibility refers to a person’s ability to switch between mental sets; for example, glancing at a drawing and putting together a model.  It is a necessary skill we all employ every day to accomplish tasks with greater efficiency and accuracy.  It is evident while doing the dishes and answering the telephone, alternating between tasks at work, and making conversation while driving.  When this skill declines, the person is noticed to be performing behaviors that are out of character with the situation.  In my residency, the team was to discharge a patient to independent living when I noticed he had taken apart his shaver and laid it across his bed.  The patient missed several physical therapy sessions due to his insistence he had to fix the shaver.  The shaver was busted, but he could not conceive of working alternately on the shaver and his ambulation.  He became obsessed (stimulus bound) to the shaver; neglecting more important goals that he had to accomplish.  While it may appear as a failure to prioritize his goals, this unfortunate man could not accomplish the main goal because he was stimulus bound to an unimportant goal.

The early deficits of a senile dementia are subtle, yet as real and damaging to an independent existence as the deficits of verbal and visual memory.  The latter deficits are well known to the average person.  Memory skills are the main determinant of Alzheimer’s Disease in most people’s minds.  Actually, verbal and visual memory may be functional well into the disease, and these “executive” deficits of planning and flexibility may be crippling at an earlier stage of the disease.  In terms of planning the future for someone with a known or suspected senile dementia, the family should take these symptoms into account.  It reduces the probability of a Monday morning surprise.  Please leave comments regarding this post in the space provided below.

Alzheimer’s Disease-What You Need to Know

If you suspect a loved one has a dementia, a progressive deterioration of memory and other cognitive skills, please consider these recommendations.

The primary consideration in all such circumstances is the safety of the loved one.  There may be months of time between calling a specialist and receiving an appointment; perhaps longer before a meaningful diagnosis is achieved and treatment is initiated.  As I have pointed out many times, there is no guarantee of treatment effectiveness.  Even after treatment, your loved one may still suffer with the same symptoms, or worse, the initial treatment appears to cause a decline in the patient’s condition.  It is this last group that calls my office in the most desperate fashion.  Typically, the decline is not from practitioner incompetence, but poor standardized treatment protocols for victims of senile dementia.  The focus is almost exclusively on medications for memory, and these come with a host of side-effects that may be worse than the symptoms for which you sought treatment.  Unfortunately, in the last twenty years of assessing victims of senile dementia, I have not witnessed an institutionalized patient regain functionality through the use of  memory boosting medications.  As a caregiver of a dementia victim, do not believe that memory medications will slow or halt the progression of Alzheimer’s Disease.

Knowing that it may be months until meaningful help arrives, consider a few simple steps to make your loved one safer in their home.  The risk of fires and falls are preeminent.  I strongly suggest unplugging stoves anytime someone is inattentive or actually confused.  This includes barbecues and working fireplaces.  Microwave ovens are generally safer, since they will usually blow a fuse before starting a fire, but you may want to observe the loved one’s actual use of the device before making that determination.  Smoking in bed is almost a cliche, but it is a very real danger, and all confused people should be supervised while smoking.  Matches or lighters should never be in their possession.
Individuals with a smaller amount of your time to pay impart the benefits of web-based teaching techniques. low price viagra Servicing the car and discover for source purchase cheap viagra using best quality engine oil and brake oil is a worthy gas saver tip. ) You can install a gas saver device. Otherwise, it is buy cialis not obtainable as an over-the-counter pill. Their service levitra samples opacc.cv gives better consumer loyalty and issues identified with apparatus dysfunction are rectified.
Falls are the bane of every caregiver, and the source of most nursing home admissions.  Kitchens and bathrooms are the big culprits, with sharp corners and hard surfaces everywhere.  A consult with a physical therapist is an excellent early intervention to determine your loved one’s ability to safely ambulate.  As with all behavior, past behavior is the greatest predictor of future behavior.  If your mother has fallen twice in their home, it is likely that a third will occur.  The interval between falls is very important.  If you as a caregiver notice a doubling or trebling of fall occurrences, than consider rapid follow-up with a physician to rule out common causes of weakness and imbalance.  Here again, consulting with a physical therapist is very important.  The use of an assistive device for ambulation is not always straight forward.  Consider the charitable act of giving the demented person a walker for balance.  Unless trained on how to use the walker over a number of sessions, the walker may increase the number of falls.  Negotiating transitions between floor surfaces and maintaining a forward upward gaze is critical to the use of a walker, and it is not always self-evident.

What if your loved one’s ambulation is so good they are wandering away from home?  This is an intolerable situation from a safety standpoint.  If the person is confused, simply putting curtains over the door will decrease exit seeking, but not entirely prevent the same.  Installing double dead bolts will keep the person inside, but may seal their fate if a fire is started.  The best solution, and most expensive, is to purchase an alarm placed on the patient’s body and corresponding sensors placed on every door.  Please keep in mind that this only is effective if someone is able to respond to the alarm in under five minutes, or the patient is unaware how to remove the bodily alarm.  Even in the nonverbal seventh stage of a senile dementia, I have witnessed these poor people remove alarm bracelets from arms and ankles, as they have no idea as to the purpose of the alarm.  The only iron-clad way to keep a demented person safe from exit seeking is to have eyes on them 24 hours a day-7 days a week.

There is no realistic method to keep a demented person completely safe.  Even in facilities dedicated to the treatment and maintenance of the terminally demented, falls and exit seeking are a fact of everyday life.  All a caregiver can do is try their best.  Please avoid trying so hard that sheer exhaustion nullifies your effectiveness as a caregiver.  Comments are always welcome in the space provided below.