Quick Facts...
- Alzheimer's Disease (AD) is the most common form of primary
dementia.
- The primary sign of AD is gradual loss of memory.
- People who suspect they might have AD should undergo a
complete examination by a physician experienced in dementias.
- AD will affect a person's food intake, preferences and appetite.
- The best way to cope with wandering is prevention. Caregivers
should know which places appear safe but may be hazardous.
When a person's daily functioning is adversely affected by
cognitive losses in the areas of thinking, remembering and
reasoning, the person is said to have "dementia." Dementia itself
is not representative of normal aging, nor does it refer to a
single disease. Rather, dementia is a broad term that refers to a
group of diseases. Some are reversible (secondary
dementias) and others are irreversible (primary dementias).
Alzheimer's Disease (AD) is the most common form of primary
dementia, accounting for 55.6 percent of all dementia. Other
primary dementias include Multi-Infarct Dementia (MIS),
Parkinson's Disease and Huntington's Disease.
Symptoms
Although the signs of AD vary considerably, there are some
common symptoms. The primary one is gradual loss of memory. Other
symptoms include a loss in the ability to perform routine tasks,
disorientation in time and space, personality change (sometimes
involving displays of aggressive behavior), difficulty in
learning, and loss of language and communication skills. AD
victims eventually reach the point where they can no longer care
for themselves.
Causes
While there are many theories and speculations on the causes
of AD, at present there is no known cause. It is possible that
there are several causes, some inherited and some not. Stress,
environmental toxins, immunological dysfunctions, and slow-acting
viruses all have been identified as possible causes.
Diagnosis
Because many dementias have similar symptoms, not all people
with AD symptoms actually have AD. It is
important that an individual suspected of having AD undergo a
complete examination by a physician (or a team of physicians)
experienced in diagnosing dementias.
The process of diagnosis is one of elimination. Tests are conducted
to rule out a variety of other causes and types of dementia (e.g., dementia
due to certain tumors or infections in the brain, stroke, Vitamin B12
deficiency, interaction of prescription and over the counter drugs, stress
and emotional depression, chronic alcoholism, etc.). If all other causes
and types of dementia are ruled out, the probability is high that the
individual is afflicted with AD.
Diagnosis should include a complete health history, a
thorough physical examination, neurological and mental status
assessments (e.g., the Mini Mental Status Exam), blood studies,
urinalysis, electrocardiogram, and chest x-rays. Other procedures
often recommended include computerized tomography (CT scan),
electroencephalography (EEG), removal from medication, formal
psychiatric assessment and neuropsychological testing.
While these procedures may provide a clinical diagnosis of
AD, the only accurate confirmation of the disease is an
examination of brain tissue during an autopsy performed after
death. An autopsy performed on an individual afflicted with AD
usually shows two abnormal formations in the brain: neuritic
plaques containing excessive amounts of the beta-amyloid protein,
and neurofibrillary tangles (twisted fibers of nerve cells).
Economics and Incidence
The financing of AD -- including costs of diagnosis,
treatment, nursing home care, informal care and lost wages -- is
estimated to be more than $80 billion annually. The federal
government covers only about $4.4 billion of this cost, and the
states $4.1 billion. Much of the remaining costs are shouldered
by AD patients and their families.
Although accurate data are difficult to obtain, it is
estimated that AD afflicts more than 4 million Americans. More
than 100,000 deaths each year are attributed to AD, making it the
fourth leading cause of death, after heart disease, cancer and
stroke. In 1992, there were 45,000 cases of AD in Colorado. The
percentage of adults with AD increases with age. It is estimated
that 6 to 10 percent of Americans 65+ have AD, 10
to 20 percent of those 75+, and 20 to 45 percent of those
85+.
Care and Assistance
AD affects patients' food intake, preferences and
appetite. They may develop a craving for sweets, as they have a
changed sensitivity to salty or sweet tastes (usually less sensitive).
They experience changes in sense of smell. Changes in
memory, judgment and decision-making make shopping, cooking and
storing food more difficult and slower. They may eat spoiled
foods or forget if they have eaten at all.
There is little conclusive evidence to support the
restriction against using aluminum cookware or increasing Vitamin
B supplements, choline, lecithin and mega-vitamins to improve
memory.
To use the title from Mace and Rabins' well-known book on
AD, caring for an AD victim is indeed a "36-hour day." Between 67
and 85 percent of AD victims are cared for outside
institutional settings, usually in their own homes or in the
homes of close family members. Caring for a victim of AD is
frustrating, lonely and burdensome, with little hope for
improvement in the AD patient.
For families who care for a loved one suffering from AD,
remember the following points:
- Above all, take care of yourself so you are able to care for
a loved one with AD.
- Surround yourself with support systems (i.e., family, friends, respite care, support groups for individuals caring for AD victims).
- Accept the fact that the patient's lost skills are gone for
good.
- Remember, even small levels of excitement can upset the AD
patient.
- Focus on what the AD patient can do.
- Remember, you must assume responsibility for guiding the
conversation when an AD patient no longer can.
- Provide as much consistency and routine as possible,
especially at bedtime. Provide a night light so that unfamiliar darkness will be less frightening.
- To reduce wandering, encourage physical
activity, discourage naps and restrict evening intake of
liquids.
- Remove yourself from the presence of the AD patient when he
or she begins to demonstrate aggressive behavior.
- Remember that AD patients do not have extreme emotional
reactions on purpose.
- Try to understand, accept and manage your own emotions to
reduce irritating the AD patient.
Wandering
Researchers estimate that at least 70 percent of AD patients
wander and are at risk of becoming lost. Some AD patients have
driven hundreds and even thousands of miles from their homes.
Others become disoriented while traveling out of town or around
the local mall. Many AD patients are not able to ask for
assistance when they become lost. Wandering behavior can be
extremely frightening to loved ones who feel responsible for the
well-being of the AD patient.
Causes and Prevention of Wandering
Clinicians and researchers do not know the exact cause of
wandering. They do speculate that restlessness might be due in
part to lack of exercise, boredom, a change in the physical
environment, stressful living conditions, or fear produced by
delusions or hallucinations. Wandering behavior may be a product
of trying to search for something familiar or reassuring.
Researchers claim it is nearly impossible to predict when a
person afflicted with AD will wander from safe surroundings.
However, it is important for caregivers to recognize that
wandering is a common symptom of dementia, and can be potentially
dangerous to victims of Alzheimer's Disease.
The best way to cope with wandering is prevention.
Caregivers should recognize that many places that appear safe may
be hazardous for an Alzheimer's patient. As a result, caregivers
should carefully examine and evaluate all aspects of the AD
patient's physical environment. Potential hazards for AD patients
include swimming pools, steep stairways, high balconies, and
streets with heavy traffic. Once these hazards are identified,
the caregiver can begin to make them less accessible to the AD
patient.
Preventive measures might also include placing door locks
out of the AD patient's normal line of vision (either very high
or very low), using a double-bolt lock, and using safety latches.
Checklist to Control or Prevent Wandering
- Use safety gates across doors and on openings at the top
and bottom of stairs. This helps keep the AD patient in a
limited area where she or he can wander safely.
- Explore the possibility of installing electronic buzzers,
chimes or other security alarms at all exits.
- Place locks on all doors and gates.
- Encourage movement and exercise. Allow the AD patient to
walk around in a secured environment (e.g., a fenced yard)
and make exercise part of the AD patient's daily routine.
- Set up a place in the home where the AD patient can safely
wander, directed by lights, signs or familiar objects.
- Discourage naps and restrict the evening intake of liquids.
Resources
The "Safe Return" Program
The Alzheimer's Association (headquartered in Chicago) developed "Safe Return" to
help identify, locate and return AD patients to their families.
The Safe Return Program registers AD patients in a national
database by age, name, address, physical description and medical
conditions. In addition, the name, address and telephone numbers
of up to three contact people are listed, as well as the AD
patient's local police department. The database is kept private
and secure so only authorized personnel have access to the
information.
The registration fee is $25. To register or for more
information, call (800) 272-3900 for the nearest Alzheimer's
Association chapter. Once registered, AD patients receive an
identity bracelet or necklace, clothing labels and wallet cards.
These items indicate that the individual's memory is impaired
and provide an identification number and a toll-free number to
call.
If a loved one leaves home or gets separated from family or
guardian, caregivers also can call the toll-free number to report
the missing person. An alert is sent to a computer network of
17,000 law enforcement agencies nationwide. Anyone trying to help
a memory-impaired person can get the toll-free number from the
identity bracelet and call the national database. The database
will contact the caregiver and notify where the AD patient can be
picked up.
The Alzheimer's Association
Annoncements of new developments in Alzheimer's research, as well as
news stories about public figures with the disease, increase awareness
of just how common AD is and how much it impacts the family. Early diagnosis
is important in helping families plan, as well as improve quality of life
for the patient and the caregiver. The Alzheimer's Association can help
with all issues AD families face, and maintains offices across Colorado,
including Denver, Colorado Springs, Pueblo, Durango, Grand Junction, Fort
Collins, and Greeley. They can also be reached at 1-800-535-3241 and are
always available to assist individuals and their families who are faced
with any type of dementia. Visit their Web site at www.alzco.org for more
information.
References
- Coping and Caring: Living With Alzheimer's Disease, American
Association of Retired Persons, Washington, D.C., 1991
(Publication Stock #D122441).
- The Vanishing Mind: A Practical Guide to Alzheimer's Disease
and Other Dementias, by L. Heston and J. White; New York: W. H.
Freeman and Company, 1991.
- Comforting the Confused: Strategies for Managing Dementia,
by S. Hoffman and C. Platt; New York: Springer Pub. Co., 1991.
- Simple Techniques for Communicating With People With
Alzheimer's Type Dementia, by N. Feil; Baltimore: Health Professions
Press, 1992.
- The 36-Hour Day: A Family Guide to Caring for Persons With
Alzheimer's Disease, Related Dementing Illnesses and Memory Loss
in Later Life, by N. L. Mace and P. V. Rabins; Baltimore: Johns
Hopkins University Press, 1991.
- "Aging Brain, Aging Mind," by D. J. Selkoe, Scientific
American, September 1992, pages 135-142.
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