Dementia and Alzheimer’s Disease
It’s become common to incorrectly use the term Alzheimer’s
to describe all kinds of dementia. Dementia is the loss of
memory and the ability to think, to solve problems, and to use
reason. It affects memory, intelligence, judgment, language, and
behavior.
There are a number of subcategories under this broad term,
including Alzheimer’s, multi-infarct dementia (which is
stroke-related), senile dementia, and alcohol-related dementia.
Historically, all the types of dementia were called “senility.”
An older person with some form of dementia “became senile.”
Certainly your care-receiver has heard of and known people who have
“lost their minds” (to use another common expression) as they have
aged. Even if your loved one is seriously incapacitated because of
physical problems, he or she may proudly and thankfully state, “At
least I still have my mind.”
Of course he or she is worried about Alzheimer’s. The disease
has become well known, and it—or any form of dementia—takes a
horrible toll.
These are some points to consider:
--Dementia impairs functioning. Some memory loss is
common as we age. What’s not normal is significant memory loss, but
it can be hard to tell what’s “significant.” If Dad’s memory loss
impairs his daily activities, if it affects his independence, it’s
serious enough for concern. In the case of dementia following a
stroke, the changes may be obvious and sudden. If brain cells are
damaged by a series of small strokes, the changes may be difficult
to notice because they’re so gradual.
--You may see changes in your loved one’s personality.
Your wife was once so prim and proper, but now four-letter words are
part of her speech. Your husband was always so gung ho, but now he
just sits quietly.
--Dementia will affect your care-receiver’s daily
activities. He may be confused about what time of day it is. If
she is out and about, she may get lost even in a familiar place.
--It’s frightening. If the decline is gradual, your
loved one may be aware of it in its early stages and be very
frightened. He knows something is wrong. He may feel frustrated,
depressed, and angry and want to isolate himself.
--A doctor can help. While there may not be a way to
positively confirm Alzheimer’s disease, your mother’s doctor can
eliminate other possibilities with a CT scan or an MRI. If she’s
suffering from memory loss for reasons other than dementia, it may
be possible to stop and reverse what’s happening. (Dementia, on the
other hand, is a progressive decline.) The cause could be a new
medication, a combination of the medications she’s taking, or a
change in her metabolism that’s altered the side effects of a
medication she has been taking for some time.
--You shouldn’t accept an on-the-spot diagnosis of
Alzheimer’s. Ask for additional testing. Ask for a second
opinion. Ask for a psychiatric workup. Ask if there’s a nearby
university medical center conducting dementia assessments.
And if your loved one is diagnosed with dementia, these are
some suggestions for you:
--Get support for yourself. Become educated. The
road ahead won’t be easy, but it may be less frightening or
surprising if others are there to help you and if you know what,
typically, dementia can bring. Remember: while dementia is
progressive, it doesn’t follow a set pattern or time schedule.
Having gone through a particular stage doesn’t mean your loved
one won’t return to that problem or show those symptoms again.
--Help your care-receiver with modest memory loss. In
the early stages, you can help him with his remembering by writing
notes, setting up a calendar, leaving messages, and so on.
--Remember that this is out of the person’s control. As
the condition progresses, keep in mind that Mom can’t control what’s
happening. She may need to be constantly pacing or to repeat the
same question over and over. It doesn’t do any good to say to her,
“I just answered that.” Instead, keep your response short and simple
and then try to help her move on to another subject.
--Be aware that the person may exhibit what’s known
as confabulation. Your husband may make things up to fit the
circumstances. If he’s lost his wallet, then “someone broke in the
house last night and stole it.” If he’s been standing on the wrong
corner waiting for a bus that never came, then “the bus company
changed the route and didn’t tell anyone.”
--Try to accept the facts. Your wife may not remember
all that you’ve been doing for her lately. And, in fact, she may
tell others that you’ve neglected her. It can help to look at your
spouse’s dementia the same way you would view any physical illness:
if she had had a stroke and was no longer able to get out of bed,
you wouldn’t hold it against her that she didn’t come to the dinner
table. At the same time, it hurts when we do something for someone
and we feel we’re not appreciated. Remember, it isn’t that she isn’t
grateful for what you’ve done; she simply doesn’t remember it.
--Realize that communication may be affected. Your
parent may experience aphasia, the inability to come up with the
right word at the right time. This will make expressive language
difficult. If Mom has trouble with complicated questions (“What did
you have for breakfast today?”), substitute a series that can be
answered with yes or no. (“Did you eat breakfast today? Did you have
toast? Did you have fruit?”)
--Don’t jump to conclusions. If you live a distance from
your aging parent and he’s been complaining about the treatment he’s
receiving from family members or professional caregivers, don’t jump
to any conclusions. Check it out. Maybe he needs help, or maybe he
just doesn’t remember all the good help he’s getting.
--Stay positive. If your aging parent doesn’t remember
the things you’ve been doing for her or the times you’ve visited
recently, don’t scold her about it or test her. Calmly mention the
meal you shared a few days earlier or the television program you
enjoyed together. There’s no point in trying to get her to admit she
was wrong, to admit that you’re helping. Just state the fact and
gently move on.
--Look into arranging respite care for your loved one.
This could take place overnight, for several hours at home during
the day, or for a full day at an adult day center.
--Remember that dementia is progressive. Your
care-receiver will experience a loss of present skills and the
ability to learn new things. He or she is going to become more and
more dependent on you.
--Do the best you can in providing care but accept the fact
that your loved one may reach a point where you’re no longer able to
be the primary caregiver. He or she may need to move to a
skilled-care facility.
--Don’t be surprised if you begin to grieve before he or she
dies. One of the great heartaches of dementia is that your loved
one can slip away long before his or her body quits working.
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