Posts tagged: Neuropsychology

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.
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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.

Vascular Dementia

Vascular dementia is a progressive loss of cognitive skills over time, secondary to a blockage or rupture of a blood vessel in the brain.  This term used to be called “multi-infarct dementia”, and other classification systems refer to it as an “arteriosclerotic dementia.”  The primary form is atherosclerosis, in which the plaques of fatty deposits form in the innermost layer of the cerebral artery.  It is almost exclusively a problem of the older adult.  Very young children are prone to arteriovenous malformations, which are congenital defects of the cerebral vascular system.  Most of these AVM’s are located in the brain stem, and do not result in the sort of symptoms observed in the older adult.

The primary deficit of multiple strokes is an impairment of memory.  The impairment may be the ability to recall old information or learn new information.  It is rare that someone forgets old information, yet learns new information at an average level.  The most common scenario is a decreased ability to retain new information, with increasing impairment of long-term personal information that declines with every subsequent stroke.  The specific deficit regarding loss of old personal information is called “episodic memory”, and it may be affected in isolation of other memory impairments.  A specific deficit of this type of memory is exceedingly rare, such that an impairment of new learning is much more common.

Vascular dementia is not limited to memory impairment alone.  The diagnostic criteria stipulates that a patient must have a memory impairment, as well as one other cognitive deficit, in order to be appropriately diagnosed with “Vascular Dementia”.  The most common cognitive impairment from stroke is difficulty with motor control; not just unilateral paralysis, but an impaired ability to carry out motor routines, despite a functional motor system.  Many stroke victims have difficultly recognizing and utilizing objects, despite having an intact sensory system.  Lastly, many stroke suffers have difficulty switching between mental tasks, making plans, and organizing the steps necessary to accomplish a plan.

Also essential is Ionix Supreme, and as an alternative to viagra in australia , levitra. Isn’t it funny how something so exciting and new can become so troublesome! We were lowest price on levitra all blown away when e-mail first came to fruition. Of course, buy cialis from canada let’s not forget dental care. Before you take this drug, check generic levitra regencygrandenursing.com out if you have heart, liver or kidney problems. Patients with a vascular dementia are impaired in work and/or social functioning.  If one performs well at work and socially, despite having multiple strokes, the diagnosis of “Vascular Dementia” would not be appropriate.  Usually, there are hard neurological signs of the multiple strokes; e.g., unilateral paralysis, gait disturbance (difficulty walking), unilateral weakness and lesions that appear on brain images.  It is also common to suffer with a delirium in the acute phase, which is an altered mental state where a person is incapable of focusing their attention. Immediate attention is often impaired after a stroke, but tends to resolve over several months.

Psychological problems are common after suffering one or more strokes.  It is not common to have delusions of persecution or grandiosity after a stroke.  Some forms of progressive dementia affecting the right prefrontal-temporal area exhibit delusions as an early symptom of the disease.  Neglect of the right or left visual space should not be mistaken for a delusion.  It is frequently the case that the patient suffered with a Delusional Disorder prior to the onset of the stroke.  The most common psychological symptom of “Vascular Dementia” is depression.  The depression may arise from difficulty with psychological adjustment to their declined condition, or a general psychomotor retardation without any awareness as to their own psychological condition.  This takes the form of a significantly reduced reaction time, both simple and complex.  The person appears chronically fatigued, laconic, and wanting to be left alone.  This type of depression is often deemed to be “organic” in nature.

The neuropsychological treatment of “Vascular Dementia” is to first determine the exact nature of the deficits through testing.  If the patient is experiencing psychological symptoms of depression or delusions, the clinician must determine if the patient is aware of their abnormal state.  For example, psychotherapy is appropriate for an adjustment problem in a self-aware person, but inappropriate for a severely depressed person with no awareness of their symptoms.  Neuropsychologists use the patient’s remaining cognitive strengths to compensate for their deficits.  Please leave comments regarding this article in the space provided below.