Course Book : #120 - Alzheimer's Disease Update

Alzheimer’s Disease

Course 120

Two contact hours

Monica Oram, RN, BSN

 

Upon completion of this course, the reader will be able to identify the following objectives:

  1. Understand the definition of Alzheimer’s Disease

  2. Understand the pathophysiology of what causes AD

  3. Understand what types of individuals are at risk for AD

  4. Understand treatment modalities for AD

  5. Differentiate between stages of dementia

  6. Understand how to deal with problem behavior

 

 

Understanding Alzheimer Disease

 

Alzheimer’s Disease, (here on out referred to as AD), was discovered in 1906 by a German scientist named Alois Alzheimer. AD is a disease of the brain which is a progressive worsening and debilitating dementia that affects the mind and the intellect.

 

Although some intellectual dysfunction is a natural result of the aging process, the dementia caused by Alzheimer’s disease is by no means natural. Life expectancy after diagnosis of the onset of symptoms ranges from 5-20 years, with an average expectancy of 8 years. The course of the disease progression is different for all individuals.

 

AD affects the body’s immune system, therefore it is correct to say that a person really does not die FROM Alzheimer’s, but rather from complications associated with the disease itself.

 

AD is a serious disease that interferes with memory and mental abilities.

 

AD most often affects individuals over the age of 65, but can affect those as young as 50. When a person develops dementia before the age of 65, they are said to have PRE-SENILE DEMENTIA. When the person develops dementia after the age of 65, they are said to have SENILE DEMENTIA.

 

The term dementia simply means old. It is denoted as a loss of mental faculties. The medical dictionary ( Mosby: Medical, Nursing, and Allied Health Dictionary: sixth edition,2002) sums it up as:

Dementia /dimen shea/ (mens=mind): A progressive organic mental disorder characterized by chronic personality disintegration, confusion, disorientation, stupor, deterioration of intellectual capacity and function, and impairment of control of memory, judgment, and impulses. Dementia caused by drug intoxication, hyperthyroidism, pernicious anemia, paresis, subdural hematoma, benign brain tumor, hydrocephalus, insulin shock, and tumor of islet cells of the pancreas are all types of dementia that can be reversed by treating the condition. Alzheimer’s Disease, Pick’s Disease, and other organic forms of dementia are considered non- reversible types of dementia. They are progressive and incurable. However, CONDITIONS that cause the decline may be treatable or partially reversible. Kinds of dementia include: (though there are about 140 types known….)

  • Dementia paralytica

  • Pick’s Disease

  • Secondary dementia

  • Senile dementia- Alzheimer’s type

  • Toxic dementia

 

AD gets progressively worse over time. It is a degenerative condition that is irreversible and has no cure. AD can only be DEFINITIVELY and ACCURATELY diagnosed on an autopsy, so then why is it so many people are diagnosed with AD when they are still alive, if we can’t be sure unless an autopsy is done?

 

DIAGNOSING AD

 

AD is diagnosed by a series of tests and symptoms. Basically, AD is ruled out by exception. This means that a physician has to determine what IT IS NOT, before he or she can determine that the person may have AD. By a series of examinations, a medical history, a medication profile, and a look at family history, can all provide clues to the diagnosis of AD.

 

AD is common. People once believed that the loss of memory- senility- was part of “just getting old”. Scientists today agree that AD- NOT OLD AGE- is the major cause of progressive memory loss in people over the age of 65.

 

By ruling out other conditions that resemble AD, a doctor can have a more sophisticated idea that a more accurate diagnosis is determined before labeling a person as having AD.

 

Neurological testing: A patient’s brain functions can be tested in a number of ways.

These tests would include:

  • EEG ( electroencephalogram)

  • CT Scan ( computerized tomography)

  • MRI ( magnetic resonance imaging)

  • Memory cards and evaluations

 

Psychological testing: A psychologist or psychiatrist determines a patient’s mental status by using a variety of testing, including the following:

  • A full clinical interview

  • Tests to determine memory loss and general mental health

 

 

In many cases, another cause of the symptoms are found, and then treated.

When the German Scientist, Alois Alzheimer did a study on a 56 yr old woman, he found that she was becoming more and more forgetful, as she could not remember the names of simple objects she was shown. Taking such an active interest in this case, He preformed an autopsy on the woman when she died. What he found was by using a new tissue - staining technique, which was on the cutting edge of technology in 1906, he discovered an odd disorganization of the nerve cells in the cerebral cortex, (the part of the brain responsible for memory and reasoning) The cells were all bunched together like ropes tied in knots. These became known as AMYLOID PLAQUES and NEUROFIBRILLARY TANGLES . He also noticed an unexpected amount of accumulation of cellular debris around the affected nerves.

 

What we know today is that as these cells begin to slough off of the brain, they do not disappear, or absorb into brain tissue. They accumulate on the neurons of the cell fibers, causing a thickening and plaque like substance to form. These are our best clues we have found yet, to determine if a person may have AD. These thickenings can sometimes be picked up on CT scan and MRI, making the diagnosis a bit easier for doctors today. Keep in mind that the doctors really are merely making a diagnosis based on symptoms, and can only make a “possible” or “probable” diagnosis, not a definitive one.

 

 

Treating AD

 

Currently, there is no cure or a way to prevent AD. Treatment modalities can improve the lives of some individuals with the disease. By the use of some medications it may make it easier to monitor and control some of the behavior seen with the progression of the disease progress.

 

TACRINE (cognex) and DONEPEZIL ( aricept) are prescription drugs that can help slow the development of mild or moderate AD in some cases. But be aware, there are no drugs that are without side effects.

 

Other drugs, such as prescription tranquilizers and anti-depressants, can help reduce anxiety, control outbursts and improve mood. By leveling out the dopamine and serotonin levels in the brain, it is believed to have a positive effect fro those with AD.

 

Some doctors have used vasodilators to help increase the blood flow to the brain, in an attempt to help relieve some symptoms.

There is some evidence that suggests that inflammation in the brain may contribute to AD damage. Scientists believe that the use of NSAID’s (non steroidal anti-inflammatory drugs) may help relieve some of the swelling, which in turn may improve symptoms. The use of NSAID’s do not slow down the disease progression, but may help make the person more comfortable with AD.

 

There has been research done regarding the use of Vitamin E, which has been said and documented that delay in progression may be as much as 7 months.

 

Physical activity can help reduce anxiety and restlessness. A person should consult a health care provider before beginning an exercise program.

 

A varied diet can keep resistance high and prevent;

  • Digestive problems

  • Dehydration

  • Malnutrition

  • Vitamin and mineral deficiencies

 

A positive attitude by both the patient and the families is an important part of treatment.

 

Causes of AD

 

Scientist’s are not really certain what causes an individual to develop AD. In AD, changes in nerve endings and brain cells interfere with normal brain functions.

 

Some scientists believe there may not even be a particular cause, but instead several factors that affect each person differently.

 

These changes can be caused by:

  • Genetic Influences: The presence of defective genes is known to increase a person’s risk of developing AD, especially if there is a familial tendency of downs syndrome in the family. It has to do with the chromosome 21 defect gene, that makes a person predisposed to the disease of AD.

  • Biochemical imbalance: A shortage of a vital chemical in the brain may contribute to AD. This chemical is known as amyloid.

  • A defective protein: Some scientists believe that AD develops when a certain protein fails to maintain and protect the nerve cells. This protein is called apolipoprotein ( apoE) Everyone has this gene which helps carry cholesterol in the blood, however there is a scientific connection that it can contribute to some more predisposed for the risk of developing AD.

  • A slow virus: Some scientists believe AD may be caused by a viral infection that takes years to develop fully. People do not “catch it” like other viruses.

  • Factors such as stroke may make AD symptoms more severe. Some strokes can be prevented by treating high blood pressure. Stroke has a direct correlation on the brain, and can increase the chances of a person developing AD.

 

 

 

What are some

of the symptoms of AD?

 

AD begins slowly. At first, the only symptoms may be a mild forgetfulness. These individuals have trouble remembering simple tasks, recent events, activities, or the name of people and things. However, as the disease goes on, the degree of memory loss begins to become significantly increased. Persons in the middle stage forget tasks like how to brush hair and how to brush teeth. They can no longer think rationally. They have problems speaking in a manner that makes any sense, they tend to wander away from home, or pose hazards like turning on the stove or leaving appliances running. They eventually need constant supervision.

 

The symptoms of AD differ for every individual, and will vary from day to day.

 

Early symptoms:

These may be so slight that they go unnoticed:

  • Forgetfulness

  • Shortened attention span

  • Trouble with simple math

  • Difficulty in expressing thoughts

  • Unpredicted moods

  • Less desire to do new things

  • Less desire to meet new people

 

Later symptoms:

Earlier symptoms become more intense:

  • Severe memory loss- including how to dress or how to eat

  • Mood and personality changes-including outbursts of anger, dissatisfaction or suspiciousness

  • Loss of judgment and concentration

  • Inability to complete routine tasks or take care of personal hygiene needs

 

Many other conditions- such as drug interactions, reactions, depression, bacterial infections, kidney problems, and malnutrition- can cause some of the same types of symptoms. Many of the secondary causes are treatable.

 

 

A person with AD often feels a mixture of emotions.

These include:

  • Confusion

  • Fear

  • Anger

  • Frustration

  • Uncertainty

  • Grief/depression

Confusion: Many people with AD realize that something is wrong to them, and something is happening to their memory, or ability to function, but they are not sure what it is.

 

Fear: Loss of memory and mental ability can make the world a very frightening place for these individuals.

 

Anger: Many people feel angry about their loss of abilities and ask, “Why is this happening to me?”

 

Frustration: No matter how hard people try, persons with AD just can not do all the things they used to do.

 

Uncertainty: Because the symptoms and progress of AD vary so much, it is hard to know exactly what lies ahead for them.

 

Grief/ Depression: Some people mourn the loss of their abilities and become increasingly depressed.

 

As a healthcare provider, we can help the person by taking positive action. Give support and understanding.

  • Do your best to help the person retain dignity and self- respect.

  • Be a good listener. Encourage the person to talk.

  • Reassure the person that life can still be enjoyed

  • Remind the person that people will continue to care about him or her.

  • Arrange for professional help and support groups for families in your area

  • Realize that a supporting family can make all the difference

  • Interaction in social groups may have some benefit

 

 

Most often, spouses and other family members are the ones who provide primary care to AD patients. As the disease gets worse, people often need more and more care. This can become a very taxing effort on the part of the caregiver. This can affect personal health and mental health to those who provide the care. The Alzheimer’s association has offices nationwide to offer information and support to those who care for AD patients.

 

We often refer to this as the “sandwich generation”…. Mom and Dad have kids, Mom and Dad raise their kids, then the kids turn around and “raise” Mom and Dad... This is one reason adult day care centers are increasingly popular, to allow the “kids” to go to work and the family member can have constant supervision throughout the day.

 

 

Let’s Learn about dementia

 

Dementia is a brain disorder that seriously affect’s a persons ability to think and reason. The most common form of dementia is Alzheimer’s but there are over 140 other types of dementia known today.

 

Scientists think that up to 4 million Americans suffer from AD. The disease usually does not become apparent until after the age of 65, and the risk goes up with age. While younger people may also develop dementia, the odds are not as great. Only about 5% of those between the age of 65-74 have AD, but about 50% of men and women over the age of 80 - 85 have AD. It is important to understand that AD is NOT a normal part of aging. Dementia progresses gradually from mild memory loss to severe loss of mental functioning. In normal aging, the brain cells are not lost in large numbers.

 

Dementia destroys the brain cells over a period of time, causing the short term memory center to no longer be able to transmit messages to the brain. As the disease progresses it attacks the cerebral cortex, and makes it very difficult for the person to have language skills and reasoning ability. Very often, personality changes are seen as the disease progresses.

 

There are a number of behavior problems that sometimes accompany Alzheimer’s disease and related dementias. Examples of such behaviors are wandering, resistance to care and agitation. To understand the given behavior, it is important to learn a little about each stage of the disease.

It is important to note that AD cannot be truly diagnosed unless it is ruled out by an autopsy. In addition, not all people stage the same way.

 

The following is a brief summary of what we know about the stages of dementia:

Stage 1: No Memory Problems

 

Individual functions on their own

 

Stage 2: Very mild memory problems-forgetful

 

Individual may have difficulty in locating keys or similar items.

Individual may forget names of individuals he or she knows well.

 

Stage 3: Early confusion

 

When speaking with them, it may seem obvious that they are forgetful, but some “cover up” their memory loss.

They may deny that they are forgetful.

They express concern over memory deficit.

It may become difficult for those who are employed

to continue to do their job.

 

Stage 4: Moderate confusion

 

May not remember current events in the news.

May forget facts about their past

Have difficulty with complex tasks

Decreased concentration

May withdraw from social events because they are aware that they have a memory problem and they do not want others to notice it.

 

Stage 5: Early Dementia

 

May have confusion as to day of the week, date, or where they live.

May need assistance in choosing clothing

Wears clothes appropriately

Can feed themselves, may need set up

May have sleep changes

May wander, looking for a way out

May be tearful

May resist caregivers

Needs verbal cues to complete bathing, grooming and dressing

 

Stage 6: Middle Dementia

 

Unable to remember recent events

May repeat themselves or do repetitive actions

May not wear clothing correctly, or may take clothing off

May refuse to change clothes

Problems with getting them to take a bath

May need to be fed or cues to eat

Wandering is common

 

Stage 7: Very severe dementia

 

May talk one word in a day or not speak at all

Unable to smile

Unable to feed self

Cannot complete a simple task

Cannot sit up unassisted

Cannot walk without help

Require total assistance with bathing, eating, and grooming

 

 

 

Managing difficult behavior

It can be helpful for caregivers to understand why a person with dementia is behaving in a particular manner. If a caregiver can determine what is causing the behavior, it may be possible to figure out ways to prevent the behaviors from occurring again. There are several causes for a person’s behavior, from environment, the task at hand, and communication.

  • Excessive stimulation: When there is too much noise going on, it is very distracting to these individuals, as with music, conversation, noise, they tend to become very angry and agitated easily.

  • Little information: As people with dementia become more confused, the person will rely heavily on help from caregivers. People with dementia may not even be able to find the restroom as all doors look alike to them.

  • Poor Senses: As people grow older, people may loose their ability to see and/or hear well

 

  • Unfamiliar environment: Please keep in mind that people who are first admitted to a nursing facility are unfamiliar with the facility routines, and behaviors will generally occur. People with dementia, are real good at picking up on negative body language.

 

 

There are several things to remember when dealing with problem behavior.

 

  • All behavior has meaning

  • All behavior has a cause

  • Everything surrounding a person could contribute to the behavior

  • Understand the changes that occur with AD

  • Distract when possible

  • Keep things very simple

  • Realize that behaviors are part of the disease

  • Know your people well! If you are having a difficult time with a particular behavior, ask the family if they have seen this same behavior. Communicate with the family and get to know the patient, the less likely some behavior can occur.

 

Dealing with Wandering

 

  • Make sure the person is not wandering because they need to use the bathroom

  • Distract with food, conversation, or drink

  • Reassure the person if they are agitated while wandering

  • Speak in a calm voice

  • Limit the number of people trying to interact and redirect the person. If they are already agitated, excess people and noise add to their confusion and the person may become aggressive.

 

 

Dealing with agitation

 

  • Make sure the person is comfortable

  • Make sure clothes are not too tight

  • Offer frequent use of restroom

  • Reduce noise in the environment

  • Try to keep daily routine as simple as possible

  • Validate what person is saying

  • Do not argue with the person

  • Distract person with a hobby or food

  • Speak slowly and clearly

  • Repeat as often as necessary for patient to understand

 

Dealing with bathing

 

  • Find out when the person is most used to bathing

  • Try to adhere to a consistent schedule

  • If the person refuses, reapproach at a later time

  • Create a feeling of privacy and maintain dignity

 

Keep in mind that even though they are confused, they still understand modesty often times…

  • Prepare soap, towels, and clothing ahead of time

  • Use a calm, quiet approach

  • Never yell at a patient

  • Avoid talking like a “baby” or talking to them as a child

  • Offer choices

  • Never force the patient into bathing

  • Use distraction with something to hold, such as a washcloth

  • Keep it simple

 

Keep in mind, that a person with dementia can only process 3-5 words at a time. Place the most important words at the END of the sentence.

 

SUMMARY

 

Caring for an AD patient can be exhausting. Keep in mind that the families need emotional support as well. Encourage the family to get involve din a support group, and to still participate in the things they like to do most.

A little relaxation will go along way to help the be more able to provide care to their family member. From a healthcare perspective, keeping those involved in learning more about AD and how to deal with the behavior of AD patients will be beneficial in providing optimal care to the patient.

 

Medical research and today’s advancing technology will continue to go along way in helping to find solutions for a cure to this devastating and deadly disease. It is predicted that by the year 2050, there will be well over 12 million individuals suffering from AD if no cure is found. There is promising research underway that may help bring a little light into view for a way to at least slow down the disease, if not cure it.

 

References:

 

Alzheimer’s Association

919 N. Michigan Ave.

Suite 1000

Chicago, Ill. 60611

1-800-272-3900

www.alz.org

 

ADEAR

Alzheimer Disease Education And Referral Center

1-800-438-4380

www.adear.org

 

www.webmd.com

 

www.aoa.gov

 

www.alzheimersupport.org

Alzheimer’s Disease

Course 120

Two contact hours

Monica Oram, RN, BSN

 

Upon completion of this course, the reader will be able to identify the following objectives:

  1. Understand the definition of Alzheimer’s Disease

  2. Understand the pathophysiology of what causes AD

  3. Understand what types of individuals are at risk for AD

  4. Understand treatment modalities for AD

  5. Differentiate between stages of dementia

  6. Understand how to deal with problem behavior

 

 

Understanding Alzheimer Disease

 

Alzheimer’s Disease, (here on out referred to as AD), was discovered in 1906 by a German scientist named Alois Alzheimer. AD is a disease of the brain which is a progressive worsening and debilitating dementia that affects the mind and the intellect.

 

Although some intellectual dysfunction is a natural result of the aging process, the dementia caused by Alzheimer’s disease is by no means natural. Life expectancy after diagnosis of the onset of symptoms ranges from 5-20 years, with an average expectancy of 8 years. The course of the disease progression is different for all individuals.

 

AD affects the body’s immune system, therefore it is correct to say that a person really does not die FROM Alzheimer’s, but rather from complications associated with the disease itself.

 

AD is a serious disease that interferes with memory and mental abilities.

 

AD most often affects individuals over the age of 65, but can affect those as young as 50. When a person develops dementia before the age of 65, they are said to have PRE-SENILE DEMENTIA. When the person develops dementia after the age of 65, they are said to have SENILE DEMENTIA.

 

The term dementia simply means old. It is denoted as a loss of mental faculties. The medical dictionary ( Mosby: Medical, Nursing, and Allied Health Dictionary: sixth edition,2002) sums it up as:

Dementia /dimen shea/ (mens=mind): A progressive organic mental disorder characterized by chronic personality disintegration, confusion, disorientation, stupor, deterioration of intellectual capacity and function, and impairment of control of memory, judgment, and impulses. Dementia caused by drug intoxication, hyperthyroidism, pernicious anemia, paresis, subdural hematoma, benign brain tumor, hydrocephalus, insulin shock, and tumor of islet cells of the pancreas are all types of dementia that can be reversed by treating the condition. Alzheimer’s Disease, Pick’s Disease, and other organic forms of dementia are considered non- reversible types of dementia. They are progressive and incurable. However, CONDITIONS that cause the decline may be treatable or partially reversible. Kinds of dementia include: (though there are about 140 types known….)

  • Dementia paralytica

  • Pick’s Disease

  • Secondary dementia

  • Senile dementia- Alzheimer’s type

  • Toxic dementia

 

AD gets progressively worse over time. It is a degenerative condition that is irreversible and has no cure. AD can only be DEFINITIVELY and ACCURATELY diagnosed on an autopsy, so then why is it so many people are diagnosed with AD when they are still alive, if we can’t be sure unless an autopsy is done?

 

DIAGNOSING AD

 

AD is diagnosed by a series of tests and symptoms. Basically, AD is ruled out by exception. This means that a physician has to determine what IT IS NOT, before he or she can determine that the person may have AD. By a series of examinations, a medical history, a medication profile, and a look at family history, can all provide clues to the diagnosis of AD.

 

AD is common. People once believed that the loss of memory- senility- was part of “just getting old”. Scientists today agree that AD- NOT OLD AGE- is the major cause of progressive memory loss in people over the age of 65.

 

By ruling out other conditions that resemble AD, a doctor can have a more sophisticated idea that a more accurate diagnosis is determined before labeling a person as having AD.

 

Neurological testing: A patient’s brain functions can be tested in a number of ways.

These tests would include:

  • EEG ( electroencephalogram)

  • CT Scan ( computerized tomography)

  • MRI ( magnetic resonance imaging)

  • Memory cards and evaluations

 

Psychological testing: A psychologist or psychiatrist determines a patient’s mental status by using a variety of testing, including the following:

  • A full clinical interview

  • Tests to determine memory loss and general mental health

 

 

In many cases, another cause of the symptoms are found, and then treated.

When the German Scientist, Alois Alzheimer did a study on a 56 yr old woman, he found that she was becoming more and more forgetful, as she could not remember the names of simple objects she was shown. Taking such an active interest in this case, He preformed an autopsy on the woman when she died. What he found was by using a new tissue - staining technique, which was on the cutting edge of technology in 1906, he discovered an odd disorganization of the nerve cells in the cerebral cortex, (the part of the brain responsible for memory and reasoning) The cells were all bunched together like ropes tied in knots. These became known as AMYLOID PLAQUES and NEUROFIBRILLARY TANGLES . He also noticed an unexpected amount of accumulation of cellular debris around the affected nerves.

 

What we know today is that as these cells begin to slough off of the brain, they do not disappear, or absorb into brain tissue. They accumulate on the neurons of the cell fibers, causing a thickening and plaque like substance to form. These are our best clues we have found yet, to determine if a person may have AD. These thickenings can sometimes be picked up on CT scan and MRI, making the diagnosis a bit easier for doctors today. Keep in mind that the doctors really are merely making a diagnosis based on symptoms, and can only make a “possible” or “probable” diagnosis, not a definitive one.

 

 

Treating AD

 

Currently, there is no cure or a way to prevent AD. Treatment modalities can improve the lives of some individuals with the disease. By the use of some medications it may make it easier to monitor and control some of the behavior seen with the progression of the disease progress.

 

TACRINE (cognex) and DONEPEZIL ( aricept) are prescription drugs that can help slow the development of mild or moderate AD in some cases. But be aware, there are no drugs that are without side effects.

 

Other drugs, such as prescription tranquilizers and anti-depressants, can help reduce anxiety, control outbursts and improve mood. By leveling out the dopamine and serotonin levels in the brain, it is believed to have a positive effect fro those with AD.

 

Some doctors have used vasodilators to help increase the blood flow to the brain, in an attempt to help relieve some symptoms.

There is some evidence that suggests that inflammation in the brain may contribute to AD damage. Scientists believe that the use of NSAID’s (non steroidal anti-inflammatory drugs) may help relieve some of the swelling, which in turn may improve symptoms. The use of NSAID’s do not slow down the disease progression, but may help make the person more comfortable with AD.

 

There has been research done regarding the use of Vitamin E, which has been said and documented that delay in progression may be as much as 7 months.

 

Physical activity can help reduce anxiety and restlessness. A person should consult a health care provider before beginning an exercise program.

 

A varied diet can keep resistance high and prevent;

  • Digestive problems

  • Dehydration

  • Malnutrition

  • Vitamin and mineral deficiencies

 

A positive attitude by both the patient and the families is an important part of treatment.

 

Causes of AD

 

Scientist’s are not really certain what causes an individual to develop AD. In AD, changes in nerve endings and brain cells interfere with normal brain functions.

 

Some scientists believe there may not even be a particular cause, but instead several factors that affect each person differently.

 

These changes can be caused by:

  • Genetic Influences: The presence of defective genes is known to increase a person’s risk of developing AD, especially if there is a familial tendency of downs syndrome in the family. It has to do with the chromosome 21 defect gene, that makes a person predisposed to the disease of AD.

  • Biochemical imbalance: A shortage of a vital chemical in the brain may contribute to AD. This chemical is known as amyloid.

  • A defective protein: Some scientists believe that AD develops when a certain protein fails to maintain and protect the nerve cells. This protein is called apolipoprotein ( apoE) Everyone has this gene which helps carry cholesterol in the blood, however there is a scientific connection that it can contribute to some more predisposed for the risk of developing AD.

  • A slow virus: Some scientists believe AD may be caused by a viral infection that takes years to develop fully. People do not “catch it” like other viruses.

  • Factors such as stroke may make AD symptoms more severe. Some strokes can be prevented by treating high blood pressure. Stroke has a direct correlation on the brain, and can increase the chances of a person developing AD.

 

 

 

What are some

of the symptoms of AD?

 

AD begins slowly. At first, the only symptoms may be a mild forgetfulness. These individuals have trouble remembering simple tasks, recent events, activities, or the name of people and things. However, as the disease goes on, the degree of memory loss begins to become significantly increased. Persons in the middle stage forget tasks like how to brush hair and how to brush teeth. They can no longer think rationally. They have problems speaking in a manner that makes any sense, they tend to wander away from home, or pose hazards like turning on the stove or leaving appliances running. They eventually need constant supervision.

 

The symptoms of AD differ for every individual, and will vary from day to day.

 

Early symptoms:

These may be so slight that they go unnoticed:

  • Forgetfulness

  • Shortened attention span

  • Trouble with simple math

  • Difficulty in expressing thoughts

  • Unpredicted moods

  • Less desire to do new things

  • Less desire to meet new people

 

Later symptoms:

Earlier symptoms become more intense:

  • Severe memory loss- including how to dress or how to eat

  • Mood and personality changes-including outbursts of anger, dissatisfaction or suspiciousness

  • Loss of judgment and concentration

  • Inability to complete routine tasks or take care of personal hygiene needs

 

Many other conditions- such as drug interactions, reactions, depression, bacterial infections, kidney problems, and malnutrition- can cause some of the same types of symptoms. Many of the secondary causes are treatable.

 

 

A person with AD often feels a mixture of emotions.

These include:

  • Confusion

  • Fear

  • Anger

  • Frustration

  • Uncertainty

  • Grief/depression

Confusion: Many people with AD realize that something is wrong to them, and something is happening to their memory, or ability to function, but they are not sure what it is.

 

Fear: Loss of memory and mental ability can make the world a very frightening place for these individuals.

 

Anger: Many people feel angry about their loss of abilities and ask, “Why is this happening to me?”

 

Frustration: No matter how hard people try, persons with AD just can not do all the things they used to do.

 

Uncertainty: Because the symptoms and progress of AD vary so much, it is hard to know exactly what lies ahead for them.

 

Grief/ Depression: Some people mourn the loss of their abilities and become increasingly depressed.

 

As a healthcare provider, we can help the person by taking positive action. Give support and understanding.

  • Do your best to help the person retain dignity and self- respect.

  • Be a good listener. Encourage the person to talk.

  • Reassure the person that life can still be enjoyed

  • Remind the person that people will continue to care about him or her.

  • Arrange for professional help and support groups for families in your area

  • Realize that a supporting family can make all the difference

  • Interaction in social groups may have some benefit

 

 

Most often, spouses and other family members are the ones who provide primary care to AD patients. As the disease gets worse, people often need more and more care. This can become a very taxing effort on the part of the caregiver. This can affect personal health and mental health to those who provide the care. The Alzheimer’s association has offices nationwide to offer information and support to those who care for AD patients.

 

We often refer to this as the “sandwich generation”…. Mom and Dad have kids, Mom and Dad raise their kids, then the kids turn around and “raise” Mom and Dad... This is one reason adult day care centers are increasingly popular, to allow the “kids” to go to work and the family member can have constant supervision throughout the day.

 

 

Let’s Learn about dementia

 

Dementia is a brain disorder that seriously affect’s a persons ability to think and reason. The most common form of dementia is Alzheimer’s but there are over 140 other types of dementia known today.

 

Scientists think that up to 4 million Americans suffer from AD. The disease usually does not become apparent until after the age of 65, and the risk goes up with age. While younger people may also develop dementia, the odds are not as great. Only about 5% of those between the age of 65-74 have AD, but about 50% of men and women over the age of 80 - 85 have AD. It is important to understand that AD is NOT a normal part of aging. Dementia progresses gradually from mild memory loss to severe loss of mental functioning. In normal aging, the brain cells are not lost in large numbers.

 

Dementia destroys the brain cells over a period of time, causing the short term memory center to no longer be able to transmit messages to the brain. As the disease progresses it attacks the cerebral cortex, and makes it very difficult for the person to have language skills and reasoning ability. Very often, personality changes are seen as the disease progresses.

 

There are a number of behavior problems that sometimes accompany Alzheimer’s disease and related dementias. Examples of such behaviors are wandering, resistance to care and agitation. To understand the given behavior, it is important to learn a little about each stage of the disease.

It is important to note that AD cannot be truly diagnosed unless it is ruled out by an autopsy. In addition, not all people stage the same way.

 

The following is a brief summary of what we know about the stages of dementia:

Stage 1: No Memory Problems

 

Individual functions on their own

 

Stage 2: Very mild memory problems-forgetful

 

Individual may have difficulty in locating keys or similar items.

Individual may forget names of individuals he or she knows well.

 

Stage 3: Early confusion

 

When speaking with them, it may seem obvious that they are forgetful, but some “cover up” their memory loss.

They may deny that they are forgetful.

They express concern over memory deficit.

It may become difficult for those who are employed

to continue to do their job.

 

Stage 4: Moderate confusion

 

May not remember current events in the news.

May forget facts about their past

Have difficulty with complex tasks

Decreased concentration

May withdraw from social events because they are aware that they have a memory problem and they do not want others to notice it.

 

Stage 5: Early Dementia

 

May have confusion as to day of the week, date, or where they live.

May need assistance in choosing clothing

Wears clothes appropriately

Can feed themselves, may need set up

May have sleep changes

May wander, looking for a way out

May be tearful

May resist caregivers

Needs verbal cues to complete bathing, grooming and dressing

 

Stage 6: Middle Dementia

 

Unable to remember recent events

May repeat themselves or do repetitive actions

May not wear clothing correctly, or may take clothing off

May refuse to change clothes

Problems with getting them to take a bath

May need to be fed or cues to eat

Wandering is common

 

Stage 7: Very severe dementia

 

May talk one word in a day or not speak at all

Unable to smile

Unable to feed self

Cannot complete a simple task

Cannot sit up unassisted

Cannot walk without help

Require total assistance with bathing, eating, and grooming

 

 

 

Managing difficult behavior

It can be helpful for caregivers to understand why a person with dementia is behaving in a particular manner. If a caregiver can determine what is causing the behavior, it may be possible to figure out ways to prevent the behaviors from occurring again. There are several causes for a person’s behavior, from environment, the task at hand, and communication.

  • Excessive stimulation: When there is too much noise going on, it is very distracting to these individuals, as with music, conversation, noise, they tend to become very angry and agitated easily.

  • Little information: As people with dementia become more confused, the person will rely heavily on help from caregivers. People with dementia may not even be able to find the restroom as all doors look alike to them.

  • Poor Senses: As people grow older, people may loose their ability to see and/or hear well

 

  • Unfamiliar environment: Please keep in mind that people who are first admitted to a nursing facility are unfamiliar with the facility routines, and behaviors will generally occur. People with dementia, are real good at picking up on negative body language.

 

 

There are several things to remember when dealing with problem behavior.

 

  • All behavior has meaning

  • All behavior has a cause

  • Everything surrounding a person could contribute to the behavior

  • Understand the changes that occur with AD

  • Distract when possible

  • Keep things very simple

  • Realize that behaviors are part of the disease

  • Know your people well! If you are having a difficult time with a particular behavior, ask the family if they have seen this same behavior. Communicate with the family and get to know the patient, the less likely some behavior can occur.

 

Dealing with Wandering

 

  • Make sure the person is not wandering because they need to use the bathroom

  • Distract with food, conversation, or drink

  • Reassure the person if they are agitated while wandering

  • Speak in a calm voice

  • Limit the number of people trying to interact and redirect the person. If they are already agitated, excess people and noise add to their confusion and the person may become aggressive.

 

 

Dealing with agitation

 

  • Make sure the person is comfortable

  • Make sure clothes are not too tight

  • Offer frequent use of restroom

  • Reduce noise in the environment

  • Try to keep daily routine as simple as possible

  • Validate what person is saying

  • Do not argue with the person

  • Distract person with a hobby or food

  • Speak slowly and clearly

  • Repeat as often as necessary for patient to understand

 

Dealing with bathing

 

  • Find out when the person is most used to bathing

  • Try to adhere to a consistent schedule

  • If the person refuses, reapproach at a later time

  • Create a feeling of privacy and maintain dignity

 

Keep in mind that even though they are confused, they still understand modesty often times…

  • Prepare soap, towels, and clothing ahead of time

  • Use a calm, quiet approach

  • Never yell at a patient

  • Avoid talking like a “baby” or talking to them as a child

  • Offer choices

  • Never force the patient into bathing

  • Use distraction with something to hold, such as a washcloth

  • Keep it simple

 

Keep in mind, that a person with dementia can only process 3-5 words at a time. Place the most important words at the END of the sentence.

 

SUMMARY

 

Caring for an AD patient can be exhausting. Keep in mind that the families need emotional support as well. Encourage the family to get involve din a support group, and to still participate in the things they like to do most.

A little relaxation will go along way to help the be more able to provide care to their family member. From a healthcare perspective, keeping those involved in learning more about AD and how to deal with the behavior of AD patients will be beneficial in providing optimal care to the patient.

 

Medical research and today’s advancing technology will continue to go along way in helping to find solutions for a cure to this devastating and deadly disease. It is predicted that by the year 2050, there will be well over 12 million individuals suffering from AD if no cure is found. There is promising research underway that may help bring a little light into view for a way to at least slow down the disease, if not cure it.

 

References:

 

Alzheimer’s Association

919 N. Michigan Ave.

Suite 1000

Chicago, Ill. 60611

1-800-272-3900

www.alz.org

 

ADEAR

Alzheimer Disease Education And Referral Center

1-800-438-4380

www.adear.org

 

www.webmd.com

 

www.aoa.gov

 

www.alzheimersupport.org

Alzheimer’s Disease

Course 120

Two contact hours

Monica Oram, RN, BSN

 

Upon completion of this course, the reader will be able to identify the following objectives:

  1. Understand the definition of Alzheimer’s Disease

  2. Understand the pathophysiology of what causes AD

  3. Understand what types of individuals are at risk for AD

  4. Understand treatment modalities for AD

  5. Differentiate between stages of dementia

  6. Understand how to deal with problem behavior

 

 

Understanding Alzheimer Disease

 

Alzheimer’s Disease, (here on out referred to as AD), was discovered in 1906 by a German scientist named Alois Alzheimer. AD is a disease of the brain which is a progressive worsening and debilitating dementia that affects the mind and the intellect.

 

Although some intellectual dysfunction is a natural result of the aging process, the dementia caused by Alzheimer’s disease is by no means natural. Life expectancy after diagnosis of the onset of symptoms ranges from 5-20 years, with an average expectancy of 8 years. The course of the disease progression is different for all individuals.

 

AD affects the body’s immune system, therefore it is correct to say that a person really does not die FROM Alzheimer’s, but rather from complications associated with the disease itself.

 

AD is a serious disease that interferes with memory and mental abilities.

 

AD most often affects individuals over the age of 65, but can affect those as young as 50. When a person develops dementia before the age of 65, they are said to have PRE-SENILE DEMENTIA. When the person develops dementia after the age of 65, they are said to have SENILE DEMENTIA.

 

The term dementia simply means old. It is denoted as a loss of mental faculties. The medical dictionary ( Mosby: Medical, Nursing, and Allied Health Dictionary: sixth edition,2002) sums it up as:

Dementia /dimen shea/ (mens=mind): A progressive organic mental disorder characterized by chronic personality disintegration, confusion, disorientation, stupor, deterioration of intellectual capacity and function, and impairment of control of memory, judgment, and impulses. Dementia caused by drug intoxication, hyperthyroidism, pernicious anemia, paresis, subdural hematoma, benign brain tumor, hydrocephalus, insulin shock, and tumor of islet cells of the pancreas are all types of dementia that can be reversed by treating the condition. Alzheimer’s Disease, Pick’s Disease, and other organic forms of dementia are considered non- reversible types of dementia. They are progressive and incurable. However, CONDITIONS that cause the decline may be treatable or partially reversible. Kinds of dementia include: (though there are about 140 types known….)

  • Dementia paralytica

  • Pick’s Disease

  • Secondary dementia

  • Senile dementia- Alzheimer’s type

  • Toxic dementia

 

AD gets progressively worse over time. It is a degenerative condition that is irreversible and has no cure. AD can only be DEFINITIVELY and ACCURATELY diagnosed on an autopsy, so then why is it so many people are diagnosed with AD when they are still alive, if we can’t be sure unless an autopsy is done?

 

DIAGNOSING AD

 

AD is diagnosed by a series of tests and symptoms. Basically, AD is ruled out by exception. This means that a physician has to determine what IT IS NOT, before he or she can determine that the person may have AD. By a series of examinations, a medical history, a medication profile, and a look at family history, can all provide clues to the diagnosis of AD.

 

AD is common. People once believed that the loss of memory- senility- was part of “just getting old”. Scientists today agree that AD- NOT OLD AGE- is the major cause of progressive memory loss in people over the age of 65.

 

By ruling out other conditions that resemble AD, a doctor can have a more sophisticated idea that a more accurate diagnosis is determined before labeling a person as having AD.

 

Neurological testing: A patient’s brain functions can be tested in a number of ways.

These tests would include:

  • EEG ( electroencephalogram)

  • CT Scan ( computerized tomography)

  • MRI ( magnetic resonance imaging)

  • Memory cards and evaluations

 

Psychological testing: A psychologist or psychiatrist determines a patient’s mental status by using a variety of testing, including the following:

  • A full clinical interview

  • Tests to determine memory loss and general mental health

 

 

In many cases, another cause of the symptoms are found, and then treated.

When the German Scientist, Alois Alzheimer did a study on a 56 yr old woman, he found that she was becoming more and more forgetful, as she could not remember the names of simple objects she was shown. Taking such an active interest in this case, He preformed an autopsy on the woman when she died. What he found was by using a new tissue - staining technique, which was on the cutting edge of technology in 1906, he discovered an odd disorganization of the nerve cells in the cerebral cortex, (the part of the brain responsible for memory and reasoning) The cells were all bunched together like ropes tied in knots. These became known as AMYLOID PLAQUES and NEUROFIBRILLARY TANGLES . He also noticed an unexpected amount of accumulation of cellular debris around the affected nerves.

 

What we know today is that as these cells begin to slough off of the brain, they do not disappear, or absorb into brain tissue. They accumulate on the neurons of the cell fibers, causing a thickening and plaque like substance to form. These are our best clues we have found yet, to determine if a person may have AD. These thickenings can sometimes be picked up on CT scan and MRI, making the diagnosis a bit easier for doctors today. Keep in mind that the doctors really are merely making a diagnosis based on symptoms, and can only make a “possible” or “probable” diagnosis, not a definitive one.

 

 

Treating AD

 

Currently, there is no cure or a way to prevent AD. Treatment modalities can improve the lives of some individuals with the disease. By the use of some medications it may make it easier to monitor and control some of the behavior seen with the progression of the disease progress.

 

TACRINE (cognex) and DONEPEZIL ( aricept) are prescription drugs that can help slow the development of mild or moderate AD in some cases. But be aware, there are no drugs that are without side effects.

 

Other drugs, such as prescription tranquilizers and anti-depressants, can help reduce anxiety, control outbursts and improve mood. By leveling out the dopamine and serotonin levels in the brain, it is believed to have a positive effect fro those with AD.

 

Some doctors have used vasodilators to help increase the blood flow to the brain, in an attempt to help relieve some symptoms.

There is some evidence that suggests that inflammation in the brain may contribute to AD damage. Scientists believe that the use of NSAID’s (non steroidal anti-inflammatory drugs) may help relieve some of the swelling, which in turn may improve symptoms. The use of NSAID’s do not slow down the disease progression, but may help make the person more comfortable with AD.

 

There has been research done regarding the use of Vitamin E, which has been said and documented that delay in progression may be as much as 7 months.

 

Physical activity can help reduce anxiety and restlessness. A person should consult a health care provider before beginning an exercise program.

 

A varied diet can keep resistance high and prevent;

  • Digestive problems

  • Dehydration

  • Malnutrition

  • Vitamin and mineral deficiencies

 

A positive attitude by both the patient and the families is an important part of treatment.

 

Causes of AD

 

Scientist’s are not really certain what causes an individual to develop AD. In AD, changes in nerve endings and brain cells interfere with normal brain functions.

 

Some scientists believe there may not even be a particular cause, but instead several factors that affect each person differently.

 

These changes can be caused by:

  • Genetic Influences: The presence of defective genes is known to increase a person’s risk of developing AD, especially if there is a familial tendency of downs syndrome in the family. It has to do with the chromosome 21 defect gene, that makes a person predisposed to the disease of AD.

  • Biochemical imbalance: A shortage of a vital chemical in the brain may contribute to AD. This chemical is known as amyloid.

  • A defective protein: Some scientists believe that AD develops when a certain protein fails to maintain and protect the nerve cells. This protein is called apolipoprotein ( apoE) Everyone has this gene which helps carry cholesterol in the blood, however there is a scientific connection that it can contribute to some more predisposed for the risk of developing AD.

  • A slow virus: Some scientists believe AD may be caused by a viral infection that takes years to develop fully. People do not “catch it” like other viruses.

  • Factors such as stroke may make AD symptoms more severe. Some strokes can be prevented by treating high blood pressure. Stroke has a direct correlation on the brain, and can increase the chances of a person developing AD.

 

 

 

What are some

of the symptoms of AD?

 

AD begins slowly. At first, the only symptoms may be a mild forgetfulness. These individuals have trouble remembering simple tasks, recent events, activities, or the name of people and things. However, as the disease goes on, the degree of memory loss begins to become significantly increased. Persons in the middle stage forget tasks like how to brush hair and how to brush teeth. They can no longer think rationally. They have problems speaking in a manner that makes any sense, they tend to wander away from home, or pose hazards like turning on the stove or leaving appliances running. They eventually need constant supervision.

 

The symptoms of AD differ for every individual, and will vary from day to day.

 

Early symptoms:

These may be so slight that they go unnoticed:

  • Forgetfulness

  • Shortened attention span

  • Trouble with simple math

  • Difficulty in expressing thoughts

  • Unpredicted moods

  • Less desire to do new things

  • Less desire to meet new people

 

Later symptoms:

Earlier symptoms become more intense:

  • Severe memory loss- including how to dress or how to eat

  • Mood and personality changes-including outbursts of anger, dissatisfaction or suspiciousness

  • Loss of judgment and concentration

  • Inability to complete routine tasks or take care of personal hygiene needs

 

Many other conditions- such as drug interactions, reactions, depression, bacterial infections, kidney problems, and malnutrition- can cause some of the same types of symptoms. Many of the secondary causes are treatable.

 

 

A person with AD often feels a mixture of emotions.

These include:

  • Confusion

  • Fear

  • Anger

  • Frustration

  • Uncertainty

  • Grief/depression

Confusion: Many people with AD realize that something is wrong to them, and something is happening to their memory, or ability to function, but they are not sure what it is.

 

Fear: Loss of memory and mental ability can make the world a very frightening place for these individuals.

 

Anger: Many people feel angry about their loss of abilities and ask, “Why is this happening to me?”

 

Frustration: No matter how hard people try, persons with AD just can not do all the things they used to do.

 

Uncertainty: Because the symptoms and progress of AD vary so much, it is hard to know exactly what lies ahead for them.

 

Grief/ Depression: Some people mourn the loss of their abilities and become increasingly depressed.

 

As a healthcare provider, we can help the person by taking positive action. Give support and understanding.

  • Do your best to help the person retain dignity and self- respect.

  • Be a good listener. Encourage the person to talk.

  • Reassure the person that life can still be enjoyed

  • Remind the person that people will continue to care about him or her.

  • Arrange for professional help and support groups for families in your area

  • Realize that a supporting family can make all the difference

  • Interaction in social groups may have some benefit

 

 

Most often, spouses and other family members are the ones who provide primary care to AD patients. As the disease gets worse, people often need more and more care. This can become a very taxing effort on the part of the caregiver. This can affect personal health and mental health to those who provide the care. The Alzheimer’s association has offices nationwide to offer information and support to those who care for AD patients.

 

We often refer to this as the “sandwich generation”…. Mom and Dad have kids, Mom and Dad raise their kids, then the kids turn around and “raise” Mom and Dad... This is one reason adult day care centers are increasingly popular, to allow the “kids” to go to work and the family member can have constant supervision throughout the day.

 

 

Let’s Learn about dementia

 

Dementia is a brain disorder that seriously affect’s a persons ability to think and reason. The most common form of dementia is Alzheimer’s but there are over 140 other types of dementia known today.

 

Scientists think that up to 4 million Americans suffer from AD. The disease usually does not become apparent until after the age of 65, and the risk goes up with age. While younger people may also develop dementia, the odds are not as great. Only about 5% of those between the age of 65-74 have AD, but about 50% of men and women over the age of 80 - 85 have AD. It is important to understand that AD is NOT a normal part of aging. Dementia progresses gradually from mild memory loss to severe loss of mental functioning. In normal aging, the brain cells are not lost in large numbers.

 

Dementia destroys the brain cells over a period of time, causing the short term memory center to no longer be able to transmit messages to the brain. As the disease progresses it attacks the cerebral cortex, and makes it very difficult for the person to have language skills and reasoning ability. Very often, personality changes are seen as the disease progresses.

 

There are a number of behavior problems that sometimes accompany Alzheimer’s disease and related dementias. Examples of such behaviors are wandering, resistance to care and agitation. To understand the given behavior, it is important to learn a little about each stage of the disease.

It is important to note that AD cannot be truly diagnosed unless it is ruled out by an autopsy. In addition, not all people stage the same way.

 

The following is a brief summary of what we know about the stages of dementia:

Stage 1: No Memory Problems

 

Individual functions on their own

 

Stage 2: Very mild memory problems-forgetful

 

Individual may have difficulty in locating keys or similar items.

Individual may forget names of individuals he or she knows well.

 

Stage 3: Early confusion

 

When speaking with them, it may seem obvious that they are forgetful, but some “cover up” their memory loss.

They may deny that they are forgetful.

They express concern over memory deficit.

It may become difficult for those who are employed

to continue to do their job.

 

Stage 4: Moderate confusion

 

May not remember current events in the news.

May forget facts about their past

Have difficulty with complex tasks

Decreased concentration

May withdraw from social events because they are aware that they have a memory problem and they do not want others to notice it.

 

Stage 5: Early Dementia

 

May have confusion as to day of the week, date, or where they live.

May need assistance in choosing clothing

Wears clothes appropriately

Can feed themselves, may need set up

May have sleep changes

May wander, looking for a way out

May be tearful

May resist caregivers

Needs verbal cues to complete bathing, grooming and dressing

 

Stage 6: Middle Dementia

 

Unable to remember recent events

May repeat themselves or do repetitive actions

May not wear clothing correctly, or may take clothing off

May refuse to change clothes

Problems with getting them to take a bath

May need to be fed or cues to eat

Wandering is common

 

Stage 7: Very severe dementia

 

May talk one word in a day or not speak at all

Unable to smile

Unable to feed self

Cannot complete a simple task

Cannot sit up unassisted

Cannot walk without help

Require total assistance with bathing, eating, and grooming

 

 

 

Managing difficult behavior

It can be helpful for caregivers to understand why a person with dementia is behaving in a particular manner. If a caregiver can determine what is causing the behavior, it may be possible to figure out ways to prevent the behaviors from occurring again. There are several causes for a person’s behavior, from environment, the task at hand, and communication.

  • Excessive stimulation: When there is too much noise going on, it is very distracting to these individuals, as with music, conversation, noise, they tend to become very angry and agitated easily.

  • Little information: As people with dementia become more confused, the person will rely heavily on help from caregivers. People with dementia may not even be able to find the restroom as all doors look alike to them.

  • Poor Senses: As people grow older, people may loose their ability to see and/or hear well

 

  • Unfamiliar environment: Please keep in mind that people who are first admitted to a nursing facility are unfamiliar with the facility routines, and behaviors will generally occur. People with dementia, are real good at picking up on negative body language.

 

 

There are several things to remember when dealing with problem behavior.

 

  • All behavior has meaning

  • All behavior has a cause

  • Everything surrounding a person could contribute to the behavior

  • Understand the changes that occur with AD

  • Distract when possible

  • Keep things very simple

  • Realize that behaviors are part of the disease

  • Know your people well! If you are having a difficult time with a particular behavior, ask the family if they have seen this same behavior. Communicate with the family and get to know the patient, the less likely some behavior can occur.

 

Dealing with Wandering

 

  • Make sure the person is not wandering because they need to use the bathroom

  • Distract with food, conversation, or drink

  • Reassure the person if they are agitated while wandering

  • Speak in a calm voice

  • Limit the number of people trying to interact and redirect the person. If they are already agitated, excess people and noise add to their confusion and the person may become aggressive.

 

 

Dealing with agitation

 

  • Make sure the person is comfortable

  • Make sure clothes are not too tight

  • Offer frequent use of restroom

  • Reduce noise in the environment

  • Try to keep daily routine as simple as possible

  • Validate what person is saying

  • Do not argue with the person

  • Distract person with a hobby or food

  • Speak slowly and clearly

  • Repeat as often as necessary for patient to understand

 

Dealing with bathing

 

  • Find out when the person is most used to bathing

  • Try to adhere to a consistent schedule

  • If the person refuses, reapproach at a later time

  • Create a feeling of privacy and maintain dignity

 

Keep in mind that even though they are confused, they still understand modesty often times…

  • Prepare soap, towels, and clothing ahead of time

  • Use a calm, quiet approach

  • Never yell at a patient

  • Avoid talking like a “baby” or talking to them as a child

  • Offer choices

  • Never force the patient into bathing

  • Use distraction with something to hold, such as a washcloth

  • Keep it simple

 

Keep in mind, that a person with dementia can only process 3-5 words at a time. Place the most important words at the END of the sentence.

 

SUMMARY

 

Caring for an AD patient can be exhausting. Keep in mind that the families need emotional support as well. Encourage the family to get involve din a support group, and to still participate in the things they like to do most.

A little relaxation will go along way to help the be more able to provide care to their family member. From a healthcare perspective, keeping those involved in learning more about AD and how to deal with the behavior of AD patients will be beneficial in providing optimal care to the patient.

 

Medical research and today’s advancing technology will continue to go along way in helping to find solutions for a cure to this devastating and deadly disease. It is predicted that by the year 2050, there will be well over 12 million individuals suffering from AD if no cure is found. There is promising research underway that may help bring a little light into view for a way to at least slow down the disease, if not cure it.

 

References:

 

Alzheimer’s Association

919 N. Michigan Ave.

Suite 1000

Chicago, Ill. 60611

1-800-272-3900

www.alz.org

 

ADEAR

Alzheimer Disease Education And Referral Center

1-800-438-4380

www.adear.org

 

www.webmd.com

 

www.aoa.gov

 

www.alzheimersupport.org