Dementia: What You Need to Know

Introduction

As we age, any loss of memory in ourselves or a loved one triggers instant concerned: Is it just forgetfulness as a natural part of aging?

Or could it be a sign of something more serious, such as dementia or even Alzheimer’s disease (AD)?


With people living longer than ever before, it is becoming an increasingly common worry. The older you get, the greater the risk of developing some form of dementia. But it is important to note that not all dementia is Alzheimer’s.

Alzheimer’s is just one form of dementia. It is also important to note that a lot of different things can affect our memory at any age, not just when we reach our senior years.
Alzheimer’s has been on the rise in the last 30 years or so, but not every older person will develop dementia.

Even if they do, there are a number of different kinds of dementia. It is important to get a proper diagnosis of the type of dementia in order to offer the best treatment.


One other important “hot button” when it comes to dementia is that it is bad enough to think about and deal with in terms of our own health, but often even worse when we have to cope with signs of dementia or AD in a loved one.

Many spouses, children and other family members may suddenly be confronted with a dementia diagnosis in a partner, parent or other relative. In this case, it is important to learn all you can about dementia in order to offer the best treatment possible and make smart decisions based on the person’s type of dementia.
Let’s start with a definition of dementia.


1: What Is Dementia

Dementia isn’t any one single health condition. It is actually an umbrella term used to describe the problems that older people begin to suffer in relation to their memories and ability to think clearly and function independently, carrying out their normal activities of daily living (ADLs), such as washing oneself, getting dressed, preparing and eating meals, and so on.

While it is true that Alzheimer's disease (AD) is the best-known form of dementia, forgetfulness is not usually a sign of dementia and not all dementia is AD. Memory and Aging As we age, we tend to become more forgetful, but the American Psychological Association has analyzed the research and argued that memory loss is not an inevitable sign of aging.

Rather, it can be the result of distraction, stress, and therefore a compromised ability to retrieve information.

Taking care of one’s brain health through diet, exercise and mental stimulation can all help maintain one’s full faculties and memory regardless of age. So too can being aware of “memory stealers,” including stress and depression.
However, some people will develop dementia despite doing their best to preserve their memory and brain health.

Symptoms of Dementia 

Typical symptoms of dementia to watch out for in yourself or a loved one include: 


1-Memory loss that disrupts daily life

We all forget things from time to time, especially when we are in a hurry and/or under stress. However, one of the most common signs of dementia is memory loss related to important events in a person's life that they should remember easily, or them asking for the same information over and over again without retaining it.


2-Challenges in planning or solving problems

This can show in a range of ways, including taking much longer to do things they used to find easy, or not being able to cope with their usual management-types of activities, such as:

✓ Making and following through with a grocery list 

✓ Paying bills that need to be paid

✓ Coping with a checkbook

✓ Dealing with their household budget

3-Difficulty completing familiar tasks at home, at work or at leisure

A person with dementia will gradually become less and less able to do things they normally do at work or in the home. They will forget how to do something on the computer, for example, have trouble finding things or places, or struggle to do their usual chores.

4-Confusion with time, place or people

A person with dementia can lose track of the hours in the day, the days of the week, or how much time has passed. They might forget where they are, how they got there, or how to get home. They might forget the faces of people they know or have trouble recalling the names of those most familiar to them. 


5-Trouble understanding visual images and spatial relationships

A person with dementia might have vivid visual hallucinations and believe them to be real. They might be more accidentprone, such as in the car, because they have trouble judging distance or making sense of traffic signs and signals. They might seem in a “fog” and not responsive to the things around them. 


6-Problems with words in speaking or writing

We all struggle from time to time with looking for the exact word we want to express, but a person with dementia may lose track of their sentences in the middle of speaking, or miss “cues” in a conversation and say things totally unrelated to what is being discussed (this is known as a non-sequitur). They might also repeat the same words and phrases over and over again, sometime obsessively. Their written work may not make sense and have gaps. 


7-Misplacing things and losing the ability to retrace their steps

A person with dementia may put things in unusual places, such as the milk in the freezer or their car keys in the bathroom. They might also have trouble remembering what they were doing before they lost the item and get more and more frustrated and upset the more they try to find what they’ve lost.

As a result of this emotional distress, they might accuse others of stealing the item or playing a practical joke on them. If they live alone, they might be convinced that someone has been in their home and take the missing item.

8-Decreased judgment or poor decision making
Decreased good judgement can take a number of forms, such as:
• giving away their money

• eating junk food all the time

• not taking care of themselves every day, such as neglecting to wash, comb their hair, or dress properly in clean clothes

• saying or doing inappropriate things in the context of a particular audience, such as swearing in front of or at the boss


In terms of poor decision making, they might:

• Get into bad habits, smoking, drinking alcohol, staying up all night

• Make mistakes at work or in their own business that can lead to negative consequences

9-Withdraw from work or social activities

As some of these signs of dementia start to become more obvious and worrying, the person with dementia might begin to isolate themselves due to their condition.

They might fear making mistakes, feel embarrassed or ashamed, or hate the idea of being laughed at by others.

They might be concerned about leaving the house, driving, shopping and so on. The trouble with withdrawing from others is that it can lead to depression and make the dementia symptoms even worse.


10-Changes in mood and personality

When the memory changes, the personality can too. Depending on the kind of dementia and how aware they are of it, a person with dementia can become depressed, anxious, frightened and withdrawn.

They will often feel confused and “lost”.

 They can be sad, withdrawn and uncommunicative even with close friends and relatives.
They can also swing to the other end of the spectrum, often unexpectedly, and become angry, suspicious, resentful, blaming and accusatory.

They might become paranoid, convinced that what is happening to them is due to others playing tricks on them or trying to harm them in some way.
Their anger, and any arguments they engage in or insults the utter can lead to damaged relationships and social isolation because loved ones do not understand what is happening, and/or find it difficult to deal with the person and choose to cope by avoiding the stress and strife.

The symptoms we’ve just outlined can become progressively worse over time. On the other hand, depending on the cause, some people can recover and go on to lead a normal life.

Let’s look at some of the main “memory stealers” that can often be reversed, and a few easy ways to boost your memory every day.

2: Watch Out for these Memory Stealers

We’re all familiar with the idea of a blow to the head having the potential to cause amnesia.

That’s an extreme example. 

There are, however, many reasons why a person might become forgetful or have short-term memory loss that can interfere with daily activities, but are not dementia. 

Here are few of the most common reasons:

Medications

A number of prescription and over-the-counter medications can interfere with or cause memory loss.

These include:

• Antacids for heartburn

• Antidepressants

• Antihistamines

• Anti-anxiety medication

• Insulin for diabetes

• Muscle relaxants

• Certain pain relievers

• Sleeping pills

• Statin drugs to lower cholesterol

• Tranquilizers

• Anesthesia given during surgery 

Alcohol Use

Alcohol damages brain cells and nerves. The sugar in alcohol is also harmful to the brain and has been linked with dementia. Alcohol is a depressant, slowing your responses, both physical and mental.

Carbohydrates

Sugar and large amounts of carbohydrates have been linked with diabetes, and with dementia. Those with diabetes are much more likely to develop dementia, and at an earlier age.

Dehydration

A lack of hydration can prevent the healthy circulation of the blood and starve the brain of oxygen. It can also lead to faintness and mental confusion. Try to drink eight 8-ounce glasses of fresh water every day.

Tobacco Use 

Cigarette smoking narrows the capillaries, leading to a lack of oxygen in the extremities, including the head, hands and feet. A lack of oxygen can lead to fuzzy thinking. A strong, steady flow of oxygen-rich blood, on the other hand, can help boost focus and concentration, so regular exercise is definitely one of your best bets when it comes to preserving your memory and brain health. 

Illicit Drugs 

Illicit drugs can change chemicals in the brain, making it more difficult to recall things, and also leading to mental confusion. Some have a depressive, sedative effect. Others can cause you to stay awake for long periods, leading to sleep deprivation.

Sleep Deprivation

Most adults need 8 hours of high-quality sleep each night. Some people have trouble falling asleep, and others with staying asleep. Even a loss of 1 hour of sleep can cause you to feel fuzzy-headed the next day.

Think of the impact of changing the clocks at Daylight Savings Time and how disruptive it can be to your sleep patterns, and you will have an idea of how negative an impact sleep deprivation can be. Sleep deprivation that lasts a month or more is termed insomnia.

A natural solution to sleep issues is to avoid sleeping pills and get into a good sleep routine, with a regular bedtime and wake up time. Those who snore and often wake up in the morning feeling unrested or foggy-headed should have a sleep study done to test for sleep apnea. 

Sleep apnea causes you to wake for milliseconds many times during the night in order to gasp for breath. You eventually become starved of oxygen, and the lack of quality sleep can also harm memory. If you do have sleep apnea, a number of treatments can help you get a more restful night’s sleep.

Depression 

Being depressed can make it difficult to pay attention and focus, which can affect memory. Depression can also interfere with sleep, healthy eating habits, and good self-care.

Stress

Stress and anxiety can also get in the way of concentration. When you are tense and your mind is overstimulated or distracted, your ability to recall important things can suffer. Stress triggers a “fight or flight” response, in which your body is primed for action and your attention is hyper-focused on the perceived danger, making it hard to remember things or concentrate on anything other than the source of the stress. Stress caused by an emotional trauma can also lead to memory loss.

Nutritional deficiencies

Good nutrition, including high-quality proteins and fats, is important for proper brain function. Deficiencies in vitamin B1 and B12 specifically can affect memory.
Certain foods also harm memory.

Too many carbs, saturated fats and trans fats can all take their toll. High-quality protein, foods that relieve inflammation and stress, and omega-3 fatty acids can help boost brain health. 

Head injuries

A severe blow to the head can injure the brain and result in memory issues, both short- and long-term, for some time after the injury. Concussion, injuries from a fall or automobile accident, sports-related injuries, and so on, can injure the brain and result in memory loss that should eventually improve.

Thyroid issues

Your thyroid is an important gland at the base of the neck that regulates hormones, affects your weight, and more. Abnormal thyroid activity, whether too fast or too slow, can lead to problems with focus, concentration, and recall.

Menopause

Menopause can be defined as the absence of a menstrual period for 1 year in an older woman. It usually hits women at around 50 years of age. Many report a brain fog as a result, due to lower hormonal activity.

Some have trouble sleeping, in part due to hot flashes. Some women take hormone replacement therapy (HRT), but it can carry a risk of severe side effects. Meditation and stress relief are two natural ways to help relieve troublesome menopause symptoms.

Referance

11 Surprising Factors That Mess With Your Memory

Stroke

A stroke occurs when the blood supply to the brain is stopped due to the blockage of a blood vessel to the brain, or leakage of a vessel into the brain. This is commonly referred to as vascular dementia.
Strokes often cause short-term memory loss. A person who has had a stroke may have vivid memories of childhood events, but be unable to recall what s/he had for lunch.
Stroke does tend to run in families, but this can be due to family members often making similar lifestyle choices. High blood pressure is a risk factor for stroke.

If you live in the US, depending on your location, you are at greater risk of stroke. Eleven states are referred to as the stroke belt.

The states that make up the stroke belt are:

• Alabama 

• Arkansas

• Georgia

• Indiana

• Kentucky

• Louisiana

• Mississippi

• North Carolina

• South Carolina

• Tennessee

• Virginia.

The highest rates of stroke occur in what is termed the stroke buckle of the stroke belt, namely: 

• Georgia

• North Carolina

• South Carolina.

Recognize the Signs of Stroke Spotting the signs of stroke quickly can make all the difference between severe damage and perhaps even death, versus a full recovery with little to no memory loss or other disability.

F.A.S.T. is a memory aid invented by the Stroke Association to help people remember the sudden signs of stroke so they can ring for ambulance right away.

F.A.S.T. stands for

F=Face Drooping
Look in the mirror. Does one side of the face droop or is it numb? Try to smile. Is the smile uneven?
A=Arm Weakness
Is one arm weak or numb? Raise both arms. Does one arm drift downward?
S=Speech Difficulty
Is speech slurred? Are you unable to speak or hard to understand? Try to repeat a simple sentence like, like "The sky is blue." Can you do it clearly and correctly?
T=Time to call 9-1-1

If you or someone you know shows any of these symptoms, even if the symptoms go away, call 9-1-1 and go to the hospital immediately. Check the time that you noticed the symptoms. Depending on the length of time, the doctor will be able to administer different therapies to try to minimize the damage of any stroke that might have occurred. 

Remembering F.A.S.T could just save your life, or that of a loved one.
The best way to keep blood pressure low is to eat a healthy diet low in salt. If your doctor recommends medication, it should be taken exactly as instructed.


Now that you are aware of the many memory stealers you might have in your life, you can start taking better care of yourself. If you notice memory loss in a loved one, helping them evaluate their lifestyle and habits might help them get back to their old self.

But in some cases, they might genuinely be suffering from dementia. Then the question becomes what kind and how severe is it.

There are varying degrees of dementia, which can range from mild cognitive impairment (MCI) on one end of the spectrum, to severe Alzheimer’s disease (AD) on the other.

Let’s look at the main types of dementia and their causes

3: What are the Main Types of Dementia and Their Causes?

There are different degrees of loss of memory and mental faculties. Not all of them are due to underlying damage to the brain as a result of aging, but are caused by other factors to do with brain health.

The Main Types of Dementia and Their Causes Part of the difficulty in getting a definitive dementia diagnosis is that there several types of dementia, including:
1-Mild Cognitive Impairment (MCI)
2-Lewy Body Dementia (LBD)
3-Parkinson's Disease Dementia
4-Vascular Dementia
5-Normal Pressure Hydrocephalus
6-Wernicke-Korsakoff Syndrome
7-Huntington's Disease
8-Creutzfeldt-Jakob Disease
9-Mixed Dementia
10-Alzheimer's Disease (AD)

Let’s look at each of these in turn.

Mild Cognitive Impairment (MCI)

This the mildest form of dementia, and common in people as they age, or if they have diabetes. Symptoms range from memory loss to a risk of progression to Alzheimer's. 

The changes are not so severe that they interfere with daily life or independent living, but they can be noticeable and frustrating. 

In some cases, the person can recover, such as in diabetics who practice tight glucose control and avoid carbohydrates. Exercise can also help improve MCI symptoms.

Lewy Body Dementia (LBD)

Lewy bodies are clumps of the protein alpha-synuclein. If they gather in the cortex of the brain, they can trigger dementia. These clumps are also found in those with Parkinson's, but in different areas of the brain.

The cortex of the brain is essential for mental functions that are quite complex. It is divided into 4 parts, or lobes. Depending on the lobe affected, certain symptoms will manifest.
LBD is challenging because the symptoms can come and go, leading people to think the sufferer is just being moody or difficult.

They can also cause balance and motor problems, leaving people suddenly unable to do normal physical activities. The actor Robin Williams had LBD.
People with LBD often have memory loss and thinking problems, but are more likely than people with Alzheimer's to have early warning signs there is an issue.

These include trouble sleeping, sleep, visual hallucinations, and issues with their muscles, such as weakness and tremor, that are similar to those found in a person with Parkinson's disease.

The musculoskeletal issues can lead to falls and various injuries, including head injuries, which can cause further health and memory issues.
http://www.webmd.com/alzheimers/guide/dementia-lewybodies

Parkinson's Disease Dementia

Parkinson's is a progressive degeneration of the nervous system. It is mainly caused by low and falling dopamine levels. 

Dopamine is an essential neurotransmitter that sends key signals to the brain, particularly in relation to rewards and satiation. It is only produced by a small number of cells in the brain in an area called the substantia nigra. No one is sure why these cells die, but as they do, the dopamine levels go down and lead to a range of symptoms.

Symptoms include muscle tremors, spasms, and rigidity, making it difficult for the person to perform basic activities of daily living (ADLs) without help. The boxer Muhammad Ali and the actor Michael J. Fox are two examples of high-profile individuals with the condition.

In addition to changes in dopamine levels and cell death, the proteins that cause LBD gather in the basal ganglia in people with Parkinson’s and result in a progressive dementia similar to that of LBD.

Vascular Dementia

Vascular dementia accounts for around 10% of dementia cases. It is caused by changes in the blood vessels in the brain due to cardiovascular health issues, in particular, high blood pressureand stroke. The most notable sign is not always memory loss, but rather, trouble making decisions. There might also be changes in mental and physical function, including paralysis. 

The paralysis will occur in relation to where the damage to the blood vessels in the brain has occurred. In some cases, the stroke can be treated and people regain function through rehabilitation. 

Knowing the signs and symptoms of stroke using the FAST system can help prevent serious damage. So can keeping blood pressure low through lifestyle measures, including the DASH diet. The DASH diet, Dietary Approaches for Stopping Hypertension, was developed as a natural way to lower blood pressure through smarter food choices and healthy recipes. 

Normal Pressure Hydrocephalus

Hydrocephalus is caused by a build-up of fluid in the brain. It can be triggered by a blockage, too much production of cerebrospinal fluid, or a head injury. Drainage will usually bring relief. Hydrocephalus will trigger loss of memory, trouble walking, and difficulty controlling bodily functions such as urination (incontinence). If left untreated, it can result in death.

Wernicke-Korsakoff Syndrome

Wernicke-Korsakoff Syndrome is a chronic memory disorder caused by a severe deficiency of Vitamin B1, also known as thiamine.

The most common cause is alcoholism, which tends to lead to poor food choices and malnutrition. Memory issues may be severe, but thinking and interacting with others might seem perfectly normal.

Stopping drinking can help. So too can adding thiamine to the diet.

Good sources include: 

• Beef 

• Liver

• Pork

• Nuts

• Oats

• Oranges

• Eggs

• Seeds

• Legumes

Many foods are also fortified with B1, such as cereal, bread and flour.

Huntington's Disease

Huntington’s Disease is a progressive brain disorder caused by a single defective gene on

chromosome. Over time, Huntington’s can lead to abnormal involuntary movements such as spasms and tremors, a severe decline in cognitive skills, and a noticeable change in moods, such as depression, irritability and anger.

Creutzfeldt-Jakob Disease (CJD)

CJD, commonly referred to as mad cow disease, is a rare condition that comes from eating beef from a cow infected with mad cow disease. CJD is a fatal brain disorder that impairs memory and coordination, and causes behavioral changes as a result of prion proteins, which make the brain malfunction. 

A small percentage of cases are believed to be inherited, that is, the virus passed down through family members.

There is no cure.

Mixed Dementia

This is defined as a person suffering from more than one form of dementia, such as vascular dementia and Alzheimer's at the same time.

Lewy bodies are also present in Parkinson’s disease dementia. In some cases, a person may have all three forms of dementia at the same time, vascular dementia, LBD and AD.
Having mixed dementia can complicate attempts to treat each issue present.
https://www.alzheimercalgary.ca/about-alzheimers-anddementia/types-of-dementia/mixed dementia

Alzheimer's Disease (AD)

AD makes up 60% to 80% of all dementia cases, and affects around 5.5 million people in the US. It affects 1 in 10 people over age 65.

The early symptoms may include:
• fatigue

listlessness

• depression

• memory loss

• difficulty communicating

• mental confusion

• disrupted sleep

• behavioral changes, sometimes extreme, such as aggression and violence

• behavioral changes that are not typical of the person, such as an outgoing person becoming withdrawn, and a normally quiet person suddenly becoming outgoing and aggressive

• trouble doing normal activities of daily living (ADLs), such as dressing, washing, eating

• trouble with basic skills: speaking, swallowing and walking As it advances, these symptoms can become more extreme.

Memory loss will often reach the point where the person will not recognize loved ones or have no sense of the present, but rather, live in the past.

They can also “sundown”, act in a more confused and/or disruptive manner. This is thought to be due to them getting to a point in the day where they are overstimulated and start to have episodes similar to temper tantrums in children. 

AD is diagnosed by a doctor not just on the basis of memory issues, but through marked changes in the brain, including:
1-deposits of the protein fragment beta-amyloid (plaques)
2-twisted strands of the protein tau (tangles)
3-nerve cell damage
4-nerve cell death

AD is now considered to be a progressive, fatal illness with a life expectancy of 5 to 7 years after diagnosis.
AD is the sixth leading cause of death in the US after heart disease, cancer, respiratory diseases, accidents and stroke.
http://www.medicalnewstoday.com/articles/282929.php
The loss of memory and personality can be very frightening for people who receive a diagnosis of AD.

It can be terrifying to think of being completely dependent on other and losing all that makes them an individual.
The diagnosis and progression of AD can be even more distressing for caregivers trying to do their best for their loved one with AD, especially as the disease progresses.

It can be devastating news, but the knowledge can also empower family members to give their loved one better end of life care because they will have some idea of what to expect. 

It is a case of quality of life rather than duration.
Learning more about palliative care can help you offer better care in relation to all of the main issues related to AD. 

Now that you know about the different types of dementia and their causes, let’s look next at the stages of dementia.

4: What are the Stages of Dementia and Alzheimer’s?

Dementia, sometimes described as dementia without Lewy bodies, has 3 to 5 stages depending on how you wish to define a stage.

AD has 7 stages.

A scale of cognitive functions and abilities is used to make the diagnosis. Knowing what to expect at each stage can help people learn coping strategies, or make end of life decisions. For caregivers, this knowledge can help them take better care of their loved one.

Dementia Staging Dementia staging is based on the Clinical Dementia Rating (CDR) scale. It helps to determine if dementia is present, and if it is, how severe it might be.

The score is based on a patient’s ability to perform in six different cognitive areas:

• memory

• judgment

• home and hobbies

• personal care

• orientation/awareness

• community.

The 5 stages are:
1: CDR-0 or No Impairment
2: CDR-0.5 or Questionable Impairment
3: CDR-1 or Mild Impairment
4: CDR-2 or Moderate Impairment
5: CDR-3 or Severe Impairment
http://madrc.mgh.harvard.edu/clinical-dementia-rating-cdrscale
http://www.alzheimer.wustl.edu/cdr/pdfs/cdr_overviewtranscri pt-revised.pdf

In terms of lifestyle planning and/or your caregiving, understanding stages 3 to 5 will help best determine what to do next.

Trying to improve symptoms through diet and exercise, and tight glucose control in those with diabetes, can help improve symptoms.

Stages of Alzheimer’s and Dementia 

The 7 stages of AD are: 
1: No impairment
2: Very mild decline
3: Mild decline
4: Moderate decline
5: Moderately severe decline
6: Severe decline
7: Very severe decline

It is important to note that some of these stages may overlap. Late stage care will involve the loved one needing more and more assistance, which the caregiver can provide and/or get help with.
http://m.alz.org/late-stage-caregiving.asp

Note that not all dementias are progressive, and some can even be reversed. As we have discussed, there are a range of ways for dementia sufferers can to help themselves through diet, exercise and trying to keep their brain healthy and active. A supportive caregiver can support and encourage all their efforts.

5: Coping with Dementia

We will look at ways of coping with dementia as far as you are able given your symptoms, and ways to deal with it if you are a caregiver for someone with dementia.

If you are worried about memory loss, a first step might be to start a diary of your observations about symptoms, lifestyle issues, steps you take to improve symptoms, and the results.
Tackling lifestyle issues is the first step, such as smoking and alcohol use, and dealing with diabetes. You can also try an antidementia diet.

An Anti-Dementia Diet Researchers have recently published a promising study in relation to an effective diet shown to improve cognition even in people of advanced age.

They named it the MIND Diet, and it is a combination of the Mediterranean diet and the DASH diet for those with high blood pressure.

A good diet for brain health will include B vitamins, omega-3 fatty acids and antioxidants.
The cornerstones of the MIND diet are:


➢ Green leafy vegetables

➢ A wide range of vegetable proteins from beans and legumes, rather than meat

➢ Nuts like walnuts and almonds

➢ Berries such as blueberries, blackberries and strawberries

➢ Beans and legumes such as kidney beans

➢ Whole-grain bread and cereal, such as oatmeal

➢ Fatty fish like salmon, which are rich in omega-3 fatty acids, which have been shown to help brain health and improve memory

➢ lean poultry (white meat chicken and turkey) rather than red meat

➢ olive oil in small amounts

➢ a small amount of red wine, which has certain antioxidants in it, or grape juice

Foods to avoid include:

➢ fast food/fried foods

➢ pastries, cakes, and candy

➢ butter and margarine (high in fat) and foods with trans fats

➢ cheese and full fat yogurt (also high in fat)

➢ red meat, especially if it is charred, since this can also trigger certain cancers

➢ high-carbohydrate / highly refined foods

If none of these lifestyle strategies offer any improvement, then it is time to start giving more supportive care appropriate to the particular stage of dementia that is developing.

Caregiving for Early Dementia Stage 1

 There are a number of activities that can help with early memory loss and other signs of dementia:

• memory aids like a diary and checklists

• a pill carrier for all of their most important medicines, divided by days of the week and time of the day http://amzn.to/1QS065b

• an electronic calendar, or mobile phone reminders, for important appointments, taking medications on time, and so on

• online bill-pay and keeping money in the bank account to cover essential expenses

• exploring caregiving wishes and options

• considering end of life wishes

• getting all the paperwork in place to ensure proper medical care and the person’s wishes being carried out if they are not able to make care decisions for themselves.

The paperwork can include a living will, medical proxy forms, durable power of attorney, and so on 

Stage 2 Suggested activities include: 


• giving some assistance with ADLs such as washing, toileting, shopping, meal preparation and so on

• dealing with depression, anxiety, and/or mental confusion

• checking in with the doctor regularly about their treatment plan-bring your symptom diary with you to share steps and results

• making sure there is a good support network in place for yourself if you have dementia, and for yourself as a caregiver if you are tending to a loved one

• researching care options such as assisted living, nursing homes and hospices, to ensure 24-hour care if and when you advance to Stage 3

• discovering palliative care options 

• making sure all legal paperwork is filled out and is easily accessible, with everyone clear about roles and expectations

Stage 3 These are suggested activities for caregivers 

Dealing with someone whose dementia has progressed to severe: 

• giving a lot of help with ADLs

• dealing with behavioral changes, such as anger, moodiness, depression, anxiety and so on

• making sure your loved one will be supervised throughout the day and night

• checking in with their doctor regularly about care, medications and so on, and bringing them to regular appointments

• making sure you have a good care team in place to support the loved one

• take steps to move your loved one out of their home if they can no longer be independent, into assisted living, a nursing home, or hospice

• dealing with any other medical issues they might have in addition to the dementia

• taking care of your own health so you do not burn out; this can include getting counselling, joining a support group, working out a timetable and so on

• making sure all legal paperwork is in place and easily accessible

• knowing what to expect when a person dies, such a required paperwork, funeral arrangements, costs, executorship of the estate, and so on.

No one likes to think about end of life issues, but it is better to know about all of your options in advance, so you can have your wishes followed. If you are serving as a caregiver, it can help you feel better about the situation.

You can be sure you are carrying out your loved one’s wishes and not being left to make important decisions on your own without any guidance. It is also better to deal with these big questions calmly, over time, then when you are faced with an emergency and/or are very stressed or grief-stricken.

Now that you have discovered a range of care options for early, middle and late stage dementia, let’s look in a bit more detail at the medications available for treating dementia and its symptoms.

6: Current Treatments

There a number of medication options for a person with dementia which can be helpful in relieving systems and maintaining function for as long as possible.

The drugs can be classified as 4 types:
Correcting
Maintaining
Preventing
Managing Moods

1-Correcting
Doctors will try to correct any issue that might be causing the dementia. They might prescribe thyroid hormones or hormone replacement therapy.

They could suggest adding B and/or D vitamins to the diet, and cutting back or changing medications that can cause memory loss.

2-Maintaining
The drugs donepezil, galantamine, and rivastigmine will try to maintain mental ability for as long as possible. Many of these drugs have been developed for those with AD, but might also help patients with dementia. Side effects include nausea, vomiting, diarrhea, and weight loss.
Memantine is also used with AD patients, but might also be effective for those with vascular dementia.

3-Preventing
Since some dementia is vascular, that is, caused by cardiovascular issues strokes, your doctor may prescribe drugs to lower blood pressure and cholesterol. If you have diabetes, your doctor might change your medication in order to keep your blood glucose levels under tighter control.

4-Managing Moods
Dementia and AD can result in significant mood changes. There can be a number of reasons for this in relation to brain chemistry, but also stress, anxiety and depression.

The first step will be to check the person’s overall health to see if there are any other medical issues the person is suffering from, such as pain. If nothing is found, or they treat the issues and things still don’t improve, the doctor may prescribe various treatments, including:

Antipsychotic drugs such as olanzapine (Zyprexa) and risperidone (Risperdal).
Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft.

Remember that all medications carry a risk of side effects, whether prescription or over the counter. Note any sudden changes in behavior or memory loss. It could be the drugs being taken, rather than a progression of the dementia.

Alternative Remedies
An increasing body of research has tried to pinpoint whether or not there are any natural remedies which could help with symptoms of dementia or even Alzheimer’s.

Some of the most promising treatments include:

Coenzyme Q10
Coenzyme Q10 is required by every cell in the body in order to maintain its health.

It also serves as an antioxidant that helps reduce the wear and tear on the body caused by aging. 

Coenzyme Q10 is present in most foods, but main sources include: 

• Beef

• Mackerel

• Organ meats such as heart, liver, and kidneys

• Peanuts

• Sardines

• Soy beans

Coral calcium
Calcium is important for healthy bones and muscles. Thus far, however, it has not been proven to work specifically in relation to Alzheimer’s.

Fish oil

Oily fish like salmon, tuna and mackerel are oily fish rich in omega-3 fatty acids. Fish is known as “brain food.” Omega-3s can also be taken as supplements, such as pure salmon oil or krill oil. They are also being added to foods in order to help people add more of them to their diet.
http://www.webmd.com/diet/guide/your-omega-3-familyshopping-list#1

Ginkgo biloba
Ginkgo biloba has been used for thousands of years as part of Traditional Chinese Medicine (TCM). It is supposed to enhance memory. Side effects include allergic reactions, gastric upset, bruising, bleeding, blood thinning, and potentially, an increased risk of thyroid or liver cancer. Avoid eating the seeds.
http://www.webmd.com/vitaminssupplements/ingredientmono-333ginkgo.aspx?activeingredientid=333

Vitamin B1 (thiamine)
As we mentioned above, B1 can help improve brain health and memory.

Add it to your diet through a range of foods.

Vitamin B3 (niacin)
B3 is essential for brain function and mood.
1-Turkey breast
2-Chicken breast
3-Peanuts 
4-Mushrooms 
5-Liver 
6-Tuna 
7-Green peas 
8-Beef 
9-Sunflower seeds 10-Avocado

Vitamin D
Those with AD have been found to have low levels of Vitamin D. You can take supplements, but 15 minutes of exposure to sunlight (using sunscreen) can help raise it naturally.

http://www.alz.org/alzheimers_disease_alternative_treatments .asp

Driving and Dementia

When an individual is diagnosed with dementia, one of the first concerns that families and caregivers face is whether or not that person should drive. 

A diagnosis of dementia may not mean that a person can no longer drive safely. In the early stages of dementia, some—though not all—individuals may still possess skills necessary for safe driving. Most dementia, however, is progressive, meaning that symptoms such as memory loss, visual-spatial disorientation, and decreased cognitive function will worsen over time.

This also means that a person’s driving skills will decrease and, eventually, he or she will have to give up driving. Many people associate driving with self-reliance and freedom; the loss of driving privileges is likely to be upsetting.

Some individuals, recognizing the risks, will limit or stop driving on their own. Others may be unable to assess their own driving skills and may insist on driving even when it is no longer safe. Families and caregivers may have to intervene when an individual’s symptoms pose too great a traffic risk.

Because the progression of dementia varies from person to person, it is difficult to know at what point an individual can no longer drive safely.

This fact sheet provides guidelines to help caregivers and persons with dementia decide when and how to limit or stop driving.

Deciding When to Stop

As a general rule, individuals with early stage or mild dementia who wish to continue driving should have their driving skills evaluated immediately (see “Arrange for an Independent Driving Evaluation” below). 

Individuals with moderate or severe dementia should not drive.

Observe Behavioral Signs

You can assess an individual’s level of functioning by observing his or her day-to-day behavior outside of a motor vehicle. Following are some signs that a person no longer has the necessary skills to drive safely. He or she:

  • Has become less coordinated.
  • Has difficulty judging distance and space.
  • Gets lost or feels disoriented in familiar places.
  • Has difficulty engaging in multiple tasks.
  • Has increased memory loss, especially for recent events.
  • Is less alert to things happening around him or her.
  • Has mood swings, confusion, irritability.
  • Needs prompting for personal care.
  • Has difficulty processing information.
  • Has difficulty with decision-making and problem solving.

It is important to compare present behavior with behavior before the onset of dementia. For example, weigh an individual’s degree of “difficulty engaging in multiple tasks” in relation to his or her prior ability. Changes in behavior will be most noticeable to family and friends who have closely interacted with the individual over time. Share and discuss your observations with other family members, friends, and health care providers.

Arrange for an Independent Driving Evaluation

The safest option for assessing a person’s driving skills is to arrange for an independent driving evaluation. Prior to the evaluation, inform the examiners that the person being evaluated has dementia. Evaluations are sometimes available through driver rehabilitation programs or State Departments of Motor Vehicles (DMV).

Although laws vary from state to state, some states require physicians to notify the DMV (DVLA (UK))  of any patient diagnosed with dementia. The person with dementia may then be required to report to the DMV for a behind-the-wheel driver re-examination.

In some states, individuals diagnosed with moderate or severe dementia may have their licenses automatically revoked. To find out about driving and dementia laws, you can call the Department of Motor Vehicles for the state in which the individual resides.

Because symptoms of dementia are likely to worsen over time, individuals who pass a driving evaluation should continue to be re-evaluated every six months. Individuals who do not pass must discontinue driving immediately.

Continue to Monitor Driving

If an individual clearly demonstrates that he or she can drive safely, it is still important for family and friends to continue monitoring the individual’s driving behavior, as the individual’s driving skills may decrease significantly in a short period of time. 

The objective of monitoring is to detect a problem before it becomes a crisis. If there are any doubts about safety, the person with dementia should not be driving.

It is often helpful to keep a written log of each incident of poor driving behavior. Following are some of the common warning signs.

  • Drives too slowly.
  • Stops in traffic for no reason or ignores traffic signs.
  • Becomes lost on a familiar route.
  • Lacks good judgment.
  • Has difficulty with turns, lane changes, or highway exits.
  • Drifts into other lanes of traffic or drives on the wrong side of the street.
  • Signals incorrectly or does not signal.
  • Has difficult seeing pedestrians, objects, or other vehicles.
  • Falls asleep while driving or gets drowsy.
  • Parks inappropriately.
  • Gets ticketed for traffic violations.
  • Is increasingly nervous or irritated when driving.
  • Has accidents, near misses, or “fender benders.”

Discuss any concerns you have with the individual, family members, and health care providers. All involved will need to weigh potential risks and decide when the individual needs to stop.

Ask Individual to Co-pilot

You can also estimate an individual’s potential for a traffic accident by taking the person along as a passenger and asking him or her to co-pilot. 

Ask the person to give you specific instructions about using blinkers, changing lanes, and following the rules of the road. If he or she has difficulty or becomes frustrated easily, it may be time for another independent driving evaluation.

Involve Person in Discussions

Some individuals are aware of having difficulty with driving and are relieved when others encourage them to stop. Many people, however, will find the loss of driving privileges and the inherent loss of independence upsetting. 

Encourage the individual with dementia to talk about how this change might make him or her feel. Try to imagine what it would be like if you could no longer drive. Support groups provide a good venue for both the caregivers and the individual to talk about their feelings and get advice from others in a similar situation. 

A person often adjusts better if he or she is involved in discussions and decisions about when to stop driving.

If the individual is reluctant to talk about driving, ask the individual’s physician or care manager to bring up the subject of driving during health care visits.

A lawyer or financial planner may also be willing to discuss driving as part of the individual’s legal and financial planning.

Begin discussions early and try to establish guidelines about when and how to limit, and eventually stop, driving. Try to reach an agreement regarding which types of driving behavior would signal the need to stop driving. Each family will need to find the solutions that work best in their situation.

Limit Driving

Because the progression of dementia varies, individuals who have demonstrated the ability to drive safely should still begin gradually to modify their driving. 

This can reduce the risk of an accident if the individual’s driving skills decrease significantly between evaluations. Making the transition from driver to passenger over time can help ease the adjustment. Encourage individuals to try some of the following examples:

  • Drive only on familiar roads and avoid long distances.
  • Avoid heavy traffic and heavily traveled roads.
  • Avoid driving at night and in bad weather. 

    Reduce the Need to Drive

Individuals able to maintain an active life often adjust better to the loss of driving privileges. Following are some ways to reduce the need to drive:

  • Have groceries, meals, and prescriptions delivered to the home.
  • Arrange for a barber or hairdresser to make home visits.
  • Invite friends and family over for regular visits.
  • Arrange for family and friends to take the individual on social outings.
  • Make Arrangements for Alternative Transportation

It will be important to make alternative transportation arrangements so that the individual’s mobility and activity level are not unduly restricted.

Commonly used transportation options are:

  • Family and Friends. Family members, friends, and neighbors can offer to drive the individual to social engagements and appointments. Consider making a list with the names, phone numbers, and times of availability of those willing to provide transportation.
  • Public Transportation. For individuals in the early stage of dementia, public transportation may be a good alternative to driving. It works best for those who are already familiar with the public transportation system in their area. Persons in the later stages of dementia may not be able to figure out routes and schedules.
  • Taxis. For individuals in the early to middle stages of dementia who do not have behavior problems, taxis can be a good option if someone meets the individual at both ends of the taxi ride. You may be able to set up a payment account with the taxi company so that the individual with dementia does not have to handle money.
  • Senior and Special Needs Transportation Services. The Yellow Pages of many telephone books have a special section in the front with the names and addresses of various service organizations. Look under transportation or community services for the names of agencies that provide transportation for special needs.
  • Eldercare Locator (eldercare.acl.gov), a nationwide directory assistance service designed to help older persons and caregivers locate local support resources, including transportation, for aging Americans.

When Persuasion Fails

Ideally, an individual will limit or stop driving on his or her own. However, some individuals with dementia may forget that they should not drive or insist on driving even though it is no longer safe. While it is important to maintain respect for the individual’s feelings, you must put safety first.

As a last resort, you may have to prevent his or her access to a car. Some methods to do that include:

  • Hiding the car keys.
  • Replacing the car keys with a set that won’t start the car.
  • Disabling or selling the car.
  • Moving the car out of sight.
     

Caregiver Support

Balancing safety with respect for an individual’s desire to drive can be difficult and emotionally trying. Enlist the support of other family, friends, caregiver support groups, and health professionals when making and implementing difficult decisions about driving. 

For further information and support, contact the service organizations under “Resources” at the end of this fact sheet.

 Resources

Family Caregiver Alliance
National Center on Caregiving
(415) 434-3388 | (800) 445-8106
Website: www.caregiver.org
E-mail: [email protected]
FCA CareJourney: www.caregiver.org/carejourney
Family Care Navigator: www.caregiver.org/family-care-navigator

Family Caregiver Alliance (FCA) seeks to improve the quality of life for caregivers through education, services, research, and advocacy.

Through its National Center on Caregiving, FCA offers information on current social, public policy, and caregiving issues and provides assistance in the development of public and private programs for caregivers.

For residents of the greater San Francisco Bay Area, FCA provides direct support services for caregivers of those with Alzheimer’s disease, stroke, traumatic brain injury, Parkinson’s, and other debilitating health conditions that strike adults.

Conclusion

With so many worrying headlines about the increasing prevalence of Alzheimer’s disease as we age, and few breakthroughs in terms of treatment, it’s only natural to be worried if we start to show signs of memory issues or see memory changes in a loved one.


It is important not to panic, however. In many cases, memory loss can be triggered by a range of lifestyle issues. Stress relief, diet, exercise and so on can all help to boost memory no matter what your age. 

Changes in memory can also be caused by a wide range of over the counter and prescription medications, so it is important to be aware of the potential side effects and not pop antacids and so on every time you have a twinge.


Getting a correct diagnosis can help you identify the type of dementia you or your loved one has, so you can make plans for the future based on knowledge and the most effective treatment options, so you can maintain a good quality of life for as long as possible. 


To your best brain health, no matter what your age!

RESOURCES

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