Alzheimer's & Dementia For Dummies E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 737

Veröffentlichungsjahr: 2016

Beschreibung

Your sensitive, authoritative guide to Alzheimer's and dementia

If a loved one has recently been diagnosed with dementia or Alzheimer's disease, it's only natural to feel fraught with fear and uncertainty about what lies ahead. Fortunately, you don't have to do it alone. This friendly and authoritative guide is here to help you make smart, informed choices throughout the different scenarios you'll encounter as a person caring for someone diagnosed with dementia or Alzheimer's disease. From making sense of a diagnosis to the best ways to cope with symptoms, Alzheimer's and Dementia For Dummies is the trusted companion you can count on as you navigate your way through this difficult landscape.

Affecting one's memory, thinking, and behavior, dementia and Alzheimer's disease can't be prevented, cured, or slowed—but a diagnosis doesn't mean you have to be left helpless! Inside, you'll find out how to make sense of the symptoms of dementia and Alzheimer's disease, understand the stages of the illnesses, and, most importantly, keep your loved one safe and comfortable—no matter how severe their symptoms are.

• Find out what to expect from Alzheimer's and dementia
• Discover what to keep in mind while caring for someone with Alzheimer's or dementia
• Uncover symptoms, causes, and risk factors of Alzheimer's and dementia
• Learn the critical information needed to help manage these illnesses

Whether you're new to caring for a person affected by Alzheimer's or dementia or just looking for some answers and relief on your journey, this is the trusted resource you'll turn to again and again.

Leseprobe

Alzheimer’s & Dementia For Dummies®

Published by: John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030-5774, www.wiley.com

Copyright © 2016 by John Wiley & Sons, Inc., Hoboken, New Jersey

Published simultaneously in Canada

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Library of Congress Control Number: 2016930756

ISBN 978-1-119-18773-8 (pbk); ISBN 978-1-119-18777-6 (ebk); ISBN 978-1-119-18776-9 (ebk)

Alzheimer’s & Dementia For Dummies®

To view this book's Cheat Sheet, simply go to www.dummies.com and search for “Alzheimer’s & Dementia For Dummies Cheat Sheet” in the Search box.

Table of Contents

Cover

Introduction

About This Book

Foolish Assumptions

Icons Used in This Book

Beyond the Book

Where to Go from Here

Part 1: Getting Started with Alzheimer’s and Dementia

Chapter 1: An Overview of Dementia and Alzheimer’s Disease

Defining the Relationship between Dementia and Alzheimer’s Disease

Looking at the Link between Age and Dementia

Realizing that Dementia Doesn’t Just Mean Alzheimer’s

Chapter 2: Spotting the Symptoms

Identifying the Early Warning Signs

Recognizing Thought-Processing Problems

Observing Emotional Changes

Noting Functional Problems

Picking Up on Physical Symptoms

Figuring Out Whether Your Loved One Needs an Assessment

Chapter 3: Considering Causes and Risk Factors

Taking a Quick Look Under the Hood

Understanding the Role of Genes and Family History

Taking a Long, Hard Look at the Risk Factors for Dementia

Considering Some Theories on the Causes of Alzheimer’s Disease

Chapter 4: Distinguishing Dementia and Alzheimer’s Disease from Other Medical Conditions

Making Sure That You Have a Reliable Diagnosis

Considering Copycat Conditions

Part 2: Helping a Loved One Manage the Illness

Chapter 5: Receiving a Diagnosis

Finding Someone to Do an Evaluation

Before You Seek a Diagnosis: Collecting Medical History

Knowing What the Doctor Will Ask during the Appointment

Thinking about the Examinations and Tests the Doctor Performs

Sorting Out Follow-Up and an Ongoing Plan for Care

Chapter 6: Looking at the Tests Used to Diagnose Alzheimer’s Disease

How Doctors Diagnose Alzheimer’s Disease

Understanding AD Diagnostic Tests

Chapter 7: Understanding the Stages of Dementia and Alzheimer’s Disease

Picturing Retrogenesis: The Opposite of Normal Human Development

Knowing How to Use the Classifications

Focusing on GDS

Staging with FAST

Current Thinking: Assessing Stages via Cognitive and Functional Impairment

Chapter 8: Eyeing Medical Treatments

Identifying the Medicines

Understanding How Alzheimer’s Disease Drugs Work

Knowing When to Start Taking the Drugs

Seeing How to Take the Medicines

Considering the Side Effects and Risks

Recognizing Drugs That Interact with the AD Medicines

Looking at Other Drugs That Help Alleviate Symptoms

Chapter 9: Considering Nonmedical Treatments

Eyeing the Different Vitamins and Herbal Remedies

Looking at Medical Foods

Relaxing with Aromatherapy

Tapping into Memories with Reminiscence Therapy

Trying Music Therapy

Investigating Reality Orientation

Treatments and Tests That Aren’t Worth Your Time or Money

Sniffing Out Scams: Five Warning Signs to Look For

Part 3: Providing Care for Your Loved One

Chapter 10: Managing Your Loved One’s Care and Day-to-Day Life

Caring for Dementia and AD Patients

Designing a Daily Routine That Works

Simplifying Washing, Dressing, and Grooming

Managing Diet and Eating Difficulties

Preventing Boredom

Preparing for Bed

Making the House Safer

Addressing Driving and Mobility

Staying on Top of Healthcare Issues

Dealing with the Patient’s Emotions

Chapter 11: Making Medical Decisions

Building a Team

Keeping Good Records

Using Alternative Therapies

Deciding on End-of-Life Care Options

Considering Brain Autopsy and Brain Donation

Chapter 12: Addressing Legal Issues

Getting Started

Setting Up an Advance Directive

Looking into a Durable POA

Looking At Guardianships or Conservatorships

Examining the Ins and Outs of Living Trusts

Making Decisions about Resuscitation (DNR)

Taking a Peek at Another Mechanism

Drawing Up a Will

Chapter 13: Working through Financial Issues on Behalf of Your Loved One

Reviewing Financial Needs and Resources

Taking Over the Financial Reins

Understanding Changes in Tax Status

Deciding Whether You Need a Financial Adviser

Quitting Work

Evaluating Insurance Coverage

Running Out of Resources: What Next?

Chapter 14: Choosing Ongoing Care for Your Loved One

Reaching a Realistic Decision

Considering Options for Providing Care at Home

Making the Transition to Residential Care

Eyeing Residential Care Options

Identifying a Quality Nursing Home

Checking the Home’s Reputation

Chapter 15: Easing the Transition to New Surroundings

Helping the Home Care Staff Get to Know Your Loved One

Visiting Regularly

Taking Part in Care and Activities in the Home

Acting as an Advocate If Problems Occur

Part 4: Respite Care for the Caregiver

Chapter 16: Coping While Caregiving

Caregiving Is Hard Work

Considering the Challenges of Caregiving

Looking At the Emotional Effects of Caregiving

Remembering Your Physical Health as a Caregiver

Taking Time Out

Using Humor to Cope

Avoiding Isolation

Sorting Out Your Own Finances

Chapter 17: Finding Support

Figuring Out What’s Available

Knowing When to Ask for Help

Looking into Support Groups

Finding a Counselor

Chapter 18: Knowing What to Do If the Person with Dementia Goes into the Hospital

Understanding the Emergency Room and Hospital Admission Process

Getting to Know the Hospital Staff and Doctors

Visiting Regularly

Helping at Mealtimes

Chapter 19: Keeping Up with Work and Family as a Caregiver

Recognizing the Importance of Routines

Juggling a Job and Caregiving Responsibilities

Balancing Family and Caregiving

Making Family Time a Priority

Chapter 20: Helping When You’re Not the Primary Caregiver

Understanding How Family Dynamics Affect Caregiving Decisions

Discovering How to Help

Dealing with Out-of-Towner’s Guilt

Part 5: The Part of Tens

Chapter 21: Ten Tips for Dealing with Dementia

Accept Changes

Let People Know What’s Happening

Be Realistic about Driving

Work Together with Your Partner

Keep Active

Sort Out Your Finances

Make a Will

Look After Your Physical Health

Get Your Annual Checkups

Continue Hobbies and Pastimes

Chapter 22: Ten Tips for Caregivers, Friends, and Families

Make Life as Normal as Possible for as Long as Possible

Encourage Her to Plan for the Future

Ensure That She Remains Healthy

Take Her for Health Checks

Consider Underlying Reasons for Changes in Behavior

Accept Professional Help

Continue to Be Involved When She Enters Residential Care

Think about End-of-Life Care

Look After Yourself

Take a Break

Chapter 23: Busting Ten Myths about Dementia and Alzheimer’s Disease

Dementia Is a Natural Part of Aging

Dementia Is the Same as Alzheimer’s Disease

Everyone with Dementia Becomes Aggressive

Alzheimer’s Disease Only Affects Old People

Aluminium Gives You Dementia

Alzheimer’s Disease Can Be Cured

Alzheimer’s Disease Is Progressive and Debilitating but Not Fatal

Women Are More Likely to Develop Alzheimer’s Disease than Men

If You’re Forgetting Things, You’re Definitely Developing Dementia

Red Wine Can Reverse Alzheimer’s Disease

Appendix: Resources for Caregivers

AARP Caregiving

ADEAR (Alzheimer’s Disease Education and Referral)

Alzheimer’s Association

Alzheimer’s Caregiver Support Online

The Alzheimer’s Foundation of America

Benefitscheckup.org

Caregiver.com

Caregiver Action Network

Family Caregiver Alliance

Leeza’s Care Connection

Medlineplus.gov

Needymeds.com

One Book to Add to Your Shelf

About the Authors

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End User License Agreement

Guide

Cover

Table of Contents

Begin Reading

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Introduction

Pick up a newspaper or turn on the television or radio, and it won’t be long before you come across a reference to Alzheimer’s disease (AD) or dementia. Either someone is touting a breakthrough in research, or someone famous has been diagnosed with it, or an expert has decided that some food or other, which people have previously enjoyed without a second thought, is now believed to double our risk of developing the condition.

But its media popularity isn’t really that much of a shock, because dementia is on the rise. In fact, scientists estimate that every four seconds someone somewhere in the world is diagnosed with dementia, so the number of cases is rising pretty fast.

Put simply, that increase means that more and more families are dealing with dementia or AD, trying to provide care for a loved one while maintaining some semblance of balance in their own lives. If you have a family member who’s been diagnosed with AD or dementia, chances are you’ve got a lot of questions. Alzheimer’s and Dementia For Dummies tries to help you find the answers that are right for your particular situation.

The media paints a big, frightening picture of how the increasing number of Americans with dementia will affect the economy, the healthcare industry, lost productivity, and a dozen other markers. However, little of that information is likely to hold much meaning for you as the family member that now must care for a loved one with a memory disorder. You want to know how Alzheimer’s or some other form of dementia is going to affect your loved one as time goes on. As a caregiver, you want to know how to provide the best care for the person with dementia while you keep all the other balls in the air (work, spouse, the rest of the family, and other obligations).

About This Book

Dementia and AD are progressive conditions that affect sufferers more as time goes on. At present no cures are available. Although that is tough to swallow, we want to help you realize that you can do many things to improve the quality of life both for your loved one with a memory disorder and yourself, particularly if you’re the primary caregiver.

Alzheimer’s and Dementia For Dummies takes a realistic look at dementia and AD and offers pertinent, practical advice for dealing with the myriad of concerns and responsibilities that a primary caregiver must assume when managing a patient with a memory disorder. We look at the treatments available, both from mainstream medicine and complementary therapies, and review the evidence of what works and what doesn’t. Other sections give tips to caregivers about how to handle difficult symptoms that may occur as the condition progresses. We emphasize the importance of taking care of yourself as the caregiver as you care for your loved one. We provide advice on the financial and legal issues that need to be considered. And we walk you through the details of how to choose the right residential care facility for your loved one should the need arise. Plus much more.

The main information about each topic is contained in the main text of each chapter, but you’ll also notice shaded boxes of text in each chapter, called sidebars. These boxes offer interesting asides, designed to complement the rest of the chapter, rather than essential information. So if a sidebar doesn’t interest you, just skip it; you’ll still be able to understand everything else without it.

Within this book, you may note that some web addresses break across two lines of text. If you’re reading this book in print and want to visit one of these web pages, simply type in the address exactly as it’s noted in the text, pretending that the line break doesn’t exist. If you’re reading this as an e-book, you’ve got it easy: just click or tap the web address to be taken directly to the page.

Foolish Assumptions

As we wrote this book, we kept in mind everyone who has dementia or AD, or who may one day be affected by them. It’s for those who are just generally worried about dementia and AD and want to find out more about the conditions and how they develop. If you’re currently experiencing symptoms that you think may mean you have a memory disorder and want to know what to do next, you’ll find valuable information here. We’ve also written this book for people who’ve already been given the diagnosis and need advice about how to get the best care available. People who are looking after people with dementia or AD can also use this book as a resource for being the best caregivers they can be.

But despite the wealth of information, we’ve designed this book so you don’t need to have a degree in medicine or biology to understand the science stuff or be a lawyer to write a watertight will. Everything in this book should make sense to everyone with an interest in dementia and how best to care for the people who develop it.

Icons Used in This Book

As you go through the book, you’ll notice that a variety of different icons pop up in the margins. These are designed to identify information that you need to know; information that may be interesting, but that you can live without; and hints about how to understand what you’re reading:

These are handy bits of information that are worth remembering because they will help you deal with problems and perhaps head them off before they arise.

These are key facts and important words that anyone wanting to get a handle on dementia or AD and what they’re all about will want to know.

This icon flags potential dangers and pitfalls that can lead to problems when managing dementia or AD.

This icon points out information that’s interesting or in-depth but that isn’t necessary for you to read.

Beyond the Book

In addition to the material in the print or e-book you’re reading right now, this product also comes with some access-anywhere goodies on the web. These resources are crammed with useful summaries about everything you need to know about dementia. To view this book's Cheat Sheet, simply go to www.dummies.com and search for “Alzheimer’s & Dementia For Dummies Cheat Sheet” in the Search box.

You’ll also find online articles at www.dummies.com/extras/alzheimersanddementia. One gives advice on how to cope with a patient who wanders; another discusses whether you should turn over power of attorney to a lawyer; the third talks about ensuring the patient’s spiritual needs are met in her final days; and the last one lists ten points to tell the hospital staff if the person with the memory disorder is hospitalized for more than a few hours.

Where to Go from Here

We didn’t design this book to be read from the front cover to the final page in order — although if you want to do that, it takes you on a logical journey from finding the diagnosis to dealing sensitively with end-of-life care. Instead, each chapter is designed to stand alone. You can read the chapters just as easily in a completely random order, according to your area of interest, as in numerical order by chapter.

If you don’t know a thing about dementia or AD (or you just can’t bring yourself to begin a book in the middle), start from the beginning with Chapter 1. If a loved one has received a diagnosis of dementia or AD and you want to know what treatments and care are available, check out Part 2. If you need advice on caring for someone with dementia or AD, see Part 3. If you’re at the end of your rope and need some advice about maintaining your own mental and physical health, flip to Part 4.

Basically, thanks to the organization of all For Dummies books, the choice of how you read through this book is completely yours. But, however you decide to set off, we hope you enjoy learning more about this increasingly important subject.

Part 1

Getting Started with Alzheimer’s and Dementia

IN THIS PART …

Get an overview of dementia and Alzheimer’s disease and see how the two are related.

Know what symptoms lead a doctor to consider the diagnosis of a memory disorder.

Discover the causes of dementia, the risk factors for developing it, and ways to possibly protect yourself from getting it.

Look at some other medical conditions whose symptoms, although similar to dementia, can be reversible with appropriate treatment.

Chapter 1

An Overview of Dementia and Alzheimer’s Disease

IN THIS CHAPTER

Seeing the relationship between dementia and Alzheimer’s disease

Understanding the link between age and dementia

Recognizing the four main types of dementia

If you’re reading a book about dementia, you first need to understand what the term means. People have a whole lot of different ideas about what sort of condition the word dementia suggests. For some, it’s the diagnostic label you give to people who keep having “senior moments” and regularly forget names and where they put their eyeglasses. To others, it refers to people who are old and confused and spend all day shouting at the television and letting their friends and neighbors know exactly what they think of them.

Although some of these symptoms clearly can be part of the picture of dementia, neither of the people described actually fit the diagnosis. The first is probably just forgetful but otherwise well, and the second may simply be grumpy and bad-tempered. Dementia has a very clear definition, and the diagnosis should never be made lightly.

This chapter looks in detail at what dementia is and what it certainly is not and serves a jumping-off point for what you can expect to face when your loved one receives a dementia or Alzheimer’s disease (AD) diagnosis.

Defining the Relationship between Dementia and Alzheimer’s Disease

This section explains what dementia is and isn’t and then does the same for Alzheimer’s. As you read this text, keep in mind the relationship between dementia and AD. In many cases, what we write about dementia applies to AD, but what we write about AD may not apply to dementia in all of its forms.

Understanding what dementia is

Dementia is a general term for a decline in mental ability (including impaired memory, language, reasoning, judgment, visuospatial skills, and orientation) severe enough to interfere with daily life. Think of dementia as a big general category like the word “building.” Just as there are many specific types of buildings (stores, houses, cabins, skyscrapers, factories, and so on), there are many specific forms of dementia. AD is the most common cause of dementia, making up about 60 percent of dementia cases. We discuss other forms of dementia later in this chapter.

Dementia isn’t a single entity. Multiple different medical conditions that affect normal brain functioning are causes of dementia.

The World Health Organization (WHO) defines dementia thus:

[A] syndrome — usually of a chronic or progressive nature — in which there is deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal aging. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgment. Consciousness is not affected. The impairment in cognitive function is commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behavior, or motivation.

This definition, however, still contains a fair amount of medical jargon. So we tried to come up with a simpler, but still accurate, version by considering each of the key terms used by the WHO:

Syndrome:

This word describes the symptoms that together are characteristic of a particular medical condition. People with the condition have most of these symptoms but don’t have to show all of them to receive the diagnosis. Thus with dementia, one person may have poor memory and language but still have judgment enough to not walk out into a busy road, whereas another may have problems with both memory and judgment but have no changes in language skills.

Chronic and progressive:

These terms mean that the condition is ongoing long term and gets steadily worse with time. Many people think that the word

chronic

means that something is severe. Although dementia may be severe for some people, it’s mild in others;

chronic

here means long-lasting.

Consciousness:

Used in relation to dementia, this word takes on both of its meanings. People with dementia are both awake (as opposed to unconscious) and mentally aware of their surroundings, although what’s going on around them is confusing to them.

A number of diseases of the brain that lead to a collection of progressively worsening symptoms affecting a person’s thought processes, mood, and behavior can cause dementia; eventually, the person loses the ability to carry out the basic tasks of daily living.

In the “Realizing that Dementia Doesn’t Just Mean Alzheimer’s” section later in this chapter, we explain the four main types of dementia to help you understand the bigger picture of memory disorders.

Grasping what dementia is not

In the past, dementia has been referred to as “senility” or “senile dementia.” This terminology reflects the previously common but incorrect belief that serious mental decline is a normal part of aging. Many myths and misunderstandings circulate about dementia. And to get a grasp of what dementia actually is, it’s important to have a clear idea about what it certainly isn’t. So here’s a selection of some of the most common misconceptions to help sort fact from fiction:

All old people get dementia.

Although the chances of developing dementia do increase as people get older, it’s not a normal part of the aging process. In the United States, 1 in 9 people older than 65 and 1 in 3 older than 85 suffer from it.

Dementia is the same as Alzheimer

’

s disease.

Alzheimer’s disease is just one of a number of brain diseases that lead to dementia.

Memory loss equals dementia.

Dementia does affect memory, but for someone to be diagnosed with the condition, he needs to show many other more complex symptoms rather than simply poor memory alone.

Everyone with dementia becomes aggressive.

Even though some people with dementia can become agitated, aggression isn’t a universal feature of dementia and is usually triggered by the way someone is treated or communicated with rather than being a symptom of the dementia alone.

A diagnosis of dementia means a person

’

s life is over.

Despite the fact that the condition is chronic and progressive, many medical, social, and psychological treatments and strategies are available to help make life as fulfilling as possible for someone with dementia, for many years.

Everyone with dementia ends up in a nursing home.

Although one-third of people with dementia do eventually need this level of intense care in the later stages of their condition, many people are able to access enough help and support to stay in their own homes.

My aunt has dementia, so I

’

m going to get it too.

Some forms of dementia do have a genetic component and may run in families, but these are in the minority. For most people, it doesn’t follow that because a relative has dementia, they’ll get it too. And contrary to what one patient thought, you can’t catch it from your aunt either.

Understanding what Alzheimer’s disease is

As previously stated, AD is a form of dementia. Although all AD patients have dementia, not all dementia patients have AD. The Alzheimer’s Association defines Alzheimer’s disease as “an irreversible, progressive brain disease that slowly destroys memory and thinking skills, eventually even the ability to carry out the simplest tasks.” AD is a fatal disease, ending inevitably in death.

Alzheimer’s disease was named after a German physician, Alois Alzheimer, who first identified the condition in 1906 when he performed an autopsy on the brain of a woman who’d been suffering severe memory loss and confusion for years. He observed microscopic amyloid plaques and neurofibrillary tangles in the woman’s brain tissue under a microscope. He then correctly hypothesized that these abnormal deposits were responsible for the patient’s loss of memory and other cognitive problems. To this day, AD can only be diagnosed with 100 percent accuracy through an autopsy that reveals the presence of the characteristic plaques and tangles in the brain. However, a comprehensive examination and good work-up do provide a reliable diagnosis with greater than 90 percent accuracy.

Abnormal deposits of specific proteins inside the brain disrupt normal brain function and cause the cognitive and functional problems typically associated with AD. Eventually, as these deposits spread throughout the brain, brain tissue starts dying, which leads to further cognitive impairment. The resulting brain shrinkage can be seen in CT scans and MRI scans. Current research is focused on trying to determine what causes these deposits and is looking for ways to prevent or reverse them before they cause permanent brain damage.

Seeing what AD is not

The preceding section talks about what AD is. Now allow us to go over what it isn’t. AD is not

Curable

Contagious

A natural part of the aging process

Something you get from using deodorant or cooking in aluminum pans

Inevitable if you live long enough

Although certain familial forms of AD do run in families, these forms are extremely rare, accounting for less than 5 percent of all cases. So just because your mother or your brother got AD doesn’t automatically mean that you’re going to get it as well.

No test can predict whether you’ll get AD unless you have the very rare inherited form of AD. A blood test exists that can tell you whether you have a certain form of a cholesterol-carrying protein associated with a higher incidence of AD, but that’s all that it can tell you. The test can’t tell you whether you’ll actually develop the condition because at least 50 percent of the people who have the risk factor never get AD.

For ethical reasons, healthcare professionals advise against taking this blood test or undergoing other genetic testing because they want to spare their patients unnecessary worry about something that’ll probably never happen even if the tests do come out positive. They also recommend against testing because if a person does find that he has inherited the gene or the risk factor, this information may negatively impact the person’s ability to get long-term care coverage and lead to increased cost for health insurance.

Looking at the Link between Age and Dementia

A clear correlation exists between increasing age and the chances of developing dementia. In fact, less than 1 percent of people are diagnosed under the age of 65. Table 1-1 breaks down these figures.

Table 1-1 Dementia Diagnosis by Age

Age

Number diagnosed

Younger than 65

1 in 1,500

65–70

1 in 100

71–79

1 in 20

80–89

1 in 4

90+

1 in 3

The obvious question is whether dementia will become more common as people live longer. Thanks to advances in science, medicine, and technology, as a species we’re living increasingly longer. Life expectancy until 30,000 years ago is believed to have been less than 30 years, and right up until the 1800s it was common for adults to die by the age of 40. Now the average man in the United States can expect to live for 76.4 years, whereas a woman can make it to the ripe old age of 81.2.

These figures represent an average, and life expectancy across the United States varies depending on levels of poverty and other factors. To the same extent, life expectancy in some countries is much lower than in the United States; in the African nation of Chad, for example, it’s only 49.5 years.

Over the next few decades these figures are expected to rise along with the proportion of older people in the population as a whole. According to government figures, currently 44 million people in the United States are older than 65 years of age. By 2030, it’s estimated that 25 million more elderly people will be residing in the United States, rising to around 79 million by 2050.

A boy born in the United States in 2030 will have a good chance of living until he’s 85, and a girl to 90. Given the rising chance of developing dementia with age, it’s feared that cases will become far more common as a result of this boom in life expectancy.

Realizing that Dementia Doesn’t Just Mean Alzheimer’s

One of the most common misconceptions about dementia is that it means AD. Alzheimer’s disease certainly does mean dementia, but numerous other causes of dementia also exist.

Also consider mild cognitive impairment, which isn’t yet dementia but not part of the normal aging process either. For 40 percent of those patients who show signs of mild cognitive impairment, dementia is unfortunately their next step, but for the remainder, their symptoms will either not develop further, or may even be reversible if they are due to depression or the effects of an acute infection.

Considering the big four types of dementia

On safari in Africa, the guides bust a gut to make sure you get the best chance of glimpsing the so-called “big five”: lions, African elephants, Cape buffalo, leopards, and rhinoceros. Dementia can be broken down into the “big four,” Alzheimer’s disease, vascular dementia, Lewy body disease, and frontotemporal dementia. Here is a quick field guide to each.

Alzheimer’s disease

Alzheimer’s disease is the most common cause of dementia worldwide. In the United States, it’s the cause of dementia in 62 to 80 percent of cases, accounting for the symptoms of more than 5.3 million people in 2015. According to the Alzheimer’s Association, one in nine Americans older than age 65 have Alzheimer’s disease. Alzheimer’s disease is the sixth leading cause of death in the United States and the fifth leading cause of death in Americans age 65 and older. Refer to the earlier section, “Understanding what Alzheimer’s disease is” for more information about this form of dementia.

Vascular dementia

After AD, vascular dementia is the next most common cause of dementia, affecting more than half a million people — roughly 10 percent of the total cases of dementia in the United States. It was previously known as multi-infarct or post-stroke dementia. It occurs because decreased blood flow from blood vessel blockage or bleeding from infarcts (strokes) in the brain, which limits oxygen supply to brain cells.

Vascular dementia symptoms are similar to those seen in AD, but depend on which parts of the brain the reduced blood flow affects — what parts of the brain have experienced oxygen deprivation from strokes and how many brain cells have been affected. A person who has experienced strokes may also suffer additional weakness or even paralysis of limbs and speech difficulties.

Circulation problems become more common as we get older and can affect people who already have AD. As a result, at least 10 percent of people have mixed dementia; that is, they have Alzheimer’s disease alongside vascular dementia, and a mix of symptoms of both.

Lewy body disease

A much rarer diagnosis, Lewy body disease makes up less than 4 percent of the number of dementia cases. Lewy bodies are protein deposits that damage brain cells. They’re also found in the brains of people with Parkinson’s disease, and as a result an overlap exists in the symptoms of people with these two conditions.

The symptoms of Lewy body dementia are also similar to those of Alzheimer’s, but in addition these sufferers also develop muscle stiffness, tremors, and shakiness in their limbs, and slower movement. They also frequently experience visual hallucinations, commonly seeing animals or people around them that aren’t really there.

Frontotemporal dementia

Frontotemporal dementia is the least common of the “big four,” affecting about 50,000 people in the United States and representing less than 2 percent of total dementia cases. It’s also the most likely of the four types of dementia to be diagnosed in people under the age of 65.

This type of dementia is named because of the areas of the brain that it affects most: the frontal and temporal lobes. These areas of the brain are involved in memory and personality. Thus frontotemporal dementia shares many of the features of AD, but has additional symptoms, including strange or sexually disinhibited behavior, lack of empathy, poor personal hygiene, apathy and loss of motivation, increased appetite for sweet or fatty foods, and repetitive and compulsive speech and actions.

Mild cognitive impairment: Dementia lite?

Dementia clearly isn’t simply a memory problem, because it affects other thought processes along with mood and the ability to carry out all sorts of everyday tasks. Mild cognitive impairment involves more than the limitations that occur as a result of a normally aging brain, but not enough to constitute dementia. Long-term studies suggest that 10 to 20 percent of people age 65 and older may have mild cognitive impairment.

Like dementia, mild cognitive impairment can affect a variety of normal thought processes including memory, planning, and judgment, but it doesn’t impact mood or a person’s ability to perform day-to-day functions. And, although it can be a sign of future dementia (most likely AD) for some people, around 60 percent of people who develop mild cognitive impairment don’t get any worse and some even get better.

The normally aging brain

It’s no secret that as people get older, bits start to wear out and don’t work quite as well as they once did. Joints become creakier, backs ache, eyesight isn’t quite as clear, hair falls out or goes gray, once excitable parts of the body barely raise a smile, and memory isn’t necessarily as sharp as it used to be.

Failing memory was once thought to result simply from a progressive loss of brain cells as people get older, but that’s no longer believed to be the case. Research now suggests that unless people have a disease that wipes out their brain cells, they die with the same number as they had when they were born. And although human brains do shrink in overall size — by about 10 percent during adulthood — that loss of volume isn’t the culprit behind memory problems.

A combination of factors actually conspires to create the infamous “senior moments.” These include a decreased effectiveness of communication between nerve cells that whizz information around the brain, increase of inflammation in brain tissue in response to infection and disease reduction in blood supply, and damage caused by exposure to free radical molecules such as oxygen throughout life.

All these factors make up the recipe for the wear-and-tear type changes seen in the aging brain. Reflexes become slower, and it may take longer to finish a crossword puzzle. It’s normal, although by no means universal, for people to experience these changes. Some people don’t have even this level of deterioration and are as sharp as tacks well into their 90s (and even beyond).

The abnormally aging brain

In a person with mild cognitive impairment (MCI), the symptoms are more significant than those just described for normal aging. It’s not uncommon for people to notice the following:

Forgetfulness

Difficulty following conversations

Declining ability to make sensible decisions

Getting lost easily

Poor concentration and attention span

Those people with MCI that do progress to dementia generally follow the progression charted by the Global Deterioration Scale (GDS) developed by Dr. Barry Reisberg in 1982. This score has seven stages:

Stage 1:

No problems identified by doctors or the patient.

Stage 2:

The patient recognizes that he has a problem, perhaps with remembering names, but he scores normally on diagnostic tests.

Stage 3:

Subtle problems carrying out thought processes start to affect work and social activities. Tests may begin to pick up problems (this is mild cognitive impairment).

Stage 4:

Clear-cut difficulties develop in terms of memory and carrying out tasks such as dealing with finances or traveling. Denial is common. Early dementia has set in.

Stage 5:

The person needs some assistance but is still quite capable of washing, dressing, eating, going to the bathroom, and choosing appropriate clothes. Forgetfulness in relation to names and places is becoming more severe.

Stage 6:

The person is largely unaware of anything that’s happened to him in the recent past. He needs help with most of the basic activities of daily living and may need to be looked after in a nursing home. Incontinence is common.

Stage 7:

By this stage the person is experiencing severe dementia. He’s completely dependent on others for everything, often including mobility. Verbal communication skills are extremely restricted.

Recognizing the causes of mild cognitive impairment and taking steps to avoid it

Some cases of MCI are caused by the development of similar protein deposits to those found in AD. This finding isn’t surprising, considering that those people with MCI who go on to develop dementia mostly develop AD. Other brain changes noted in MCI include worsening blood supply and shrinkage of the part of the brain called the hippocampus, which is involved with memory.

No specific treatment for MCI exists and, in particular, no evidence suggests that the drugs used to treat Alzheimer’s disease are of any use. You can gain some mileage, however, by addressing risk factors for poor circulation by controlling your blood pressure, eating a low-carbohydrate and high-fiber diet, quitting smoking, drinking alcohol within the limits of recommended guidelines, and getting regular exercise.

Increasing evidence suggests that keeping the brain mentally active by doing word and number puzzles, reading and maintaining stimulating hobbies, and social activities can help too. (Consider reading Staying Sharp For Dummies (John Wiley & Sons, 2016), which discusses this evidence in detail.)

Chapter 2

Spotting the Symptoms

IN THIS CHAPTER

Recognizing the early warning signs of dementia

Identifying cognitive problems

Understanding changes in emotional behavior

Looking at functional problems

Watching for the onset of physical symptoms

Considering when it’s time to seek medical advice

As doctors, we love to be able to categorize diseases, and our ability to do our jobs properly depends on it. It’s important to know that a certain set of symptoms means a patient simply has a nasty bout of the common cold, whereas another set of symptoms means she’s more seriously ill with influenza. Without knowing what someone is up against, we can’t advise on treatments or tell her the likely outcome of what she’s going through.

In this chapter, we look in some detail at the symptoms that show that someone has dementia, including Alzheimer’s disease (AD). And we help you understand when it may be time to see a doctor for a possible diagnosis.

Identifying the Early Warning Signs

Although dementia affects everyone slightly differently, a few common symptoms can alert you to the fact that it may well be on its way. In the early stages, though, it’s important not to panic and see dementia lurking behind every forgetful or confused senior moment, because these types of memory lapses are often a normal part of the aging process. And it’s important to bear in mind that there’s much more to all types of dementia than simply becoming forgetful. These sections explain what dementia is and isn’t so you know what to be worried about.

Differentiating between dementia and a few senior moments

Many things can make most people absentminded, from simple tiredness and poor concentration to a period of low mood or actual depression. How many people, busily caught up in an engrossing task or conversation, have forgotten a dental appointment or burned dinner?

Only when these symptoms become a regular feature of your behavior, or that of someone you love, may they be signs of something more serious. And the symptoms only really become significant when they start to interfere with a person’s ability to carry out the tasks of everyday life.

Also, it’s rare for memory issues alone to be enough to suggest that dementia is manifesting itself. Problems with finding the right words and confusion over using money or how to follow a favorite recipe are also likely to be evident, alongside changes in mood and loss of confidence in social situations.

Dementia is not just about losing memory. It’s also a decline in mental ability severe enough to interfere with daily life.

Knowing what to look out for

Here is a run-down of the top ten most important early symptoms to look out for, as voted for by pretty much every dementia charity website or research article you’re likely to come across.

As this list demonstrates, the symptoms of dementia are certainly more varied than simply being a bit forgetful. To be diagnosed, someone must show at least two, if not more, of these ten warning signs, which can themselves sometimes be fairly subtle to start with.

As the disease progresses, the symptoms become more obvious, because they become more permanent. Theses ten symptoms become part of a person’s usual day-to-day life and behavior, and there’s little doubt that the person has developed dementia.

In the rest of this chapter, we look in more detail at the symptoms, which can become more severe as time goes on. We split them into symptoms affecting thought processes, mood, and the way people function, for ease of explanation, but often a great deal of overlap exists between groups.

For now, we focus on some of the more general symptoms of dementia. People with different types of dementia can develop other symptoms that are particular to their specific diagnosis — for example, AD or Lewy body disease. Also bear in mind that some people may be lucky enough to develop few of the symptoms we describe, and that the examples in the following sections are offered as a guide to what may happen and not what always happens to someone with dementia.

Number 1: Memory problems that affect daily life

Forgetting the odd thing every now and again is perfectly normal as you get older; generally, you remember these things later. In dementia, you don’t remember things later; those forgotten things are gone. Unfortunately, you need to remember things such as the following to be able to function normally every day:

Important dates and events

The route taken on well-traveled journeys

Where you’ve left important paperwork

Names and faces of friends, neighbors, and work colleagues

Number 2: Difficulty with planning and problem solving

Co-author Dr. Atkins’s grandmother could cook a turkey with all the trimmings with her eyes closed — until she started to develop dementia. As the disease took hold, her ability to time the cooking of meat and vegetables completely deserted her, and she’d regularly burn some of the vegetables while undercooking the meat. In the end, grandpa had to take over the chef’s duties or everyone would regularly go hungry.

As well as having trouble following recipes, people in the early stages of dementia may also

Become confused using a debit card, credit card, or checking account

Lose track of what their bank statement or credit card statement shows

Have difficulty paying bills or filing taxes

Become confused while trying to put gas in the car

Number 3: Problems finding the right word

Most people will have had the experience of frantically hunting for the right word when chatting with someone or, worse still, when giving a presentation to a group of colleagues. Eventually, the word comes to mind, the panic’s over, and you stop feeling stupid.

In early dementia, many people find that words regularly become elusive, leading to difficulty communicating effectively and to huge amounts of frustration. People with early dementia may also substitute the word they’re after for something similar, such as a football becoming a kick ball, or a wristwatch becoming a hand clock.

People may also have problems following the thread of other people’s conversations and may therefore become less inclined to join in and socialize with others to save themselves embarrassment. Socializing can become a particular problem in noisy environments or in situations where other background conversations are going on, because people with dementia find it harder to focus on the conversation that they’re supposed to be having.

Number 4: Confusion about time and place

People with early dementia often lose track of time or become muddled about the date. They may also forget where they are or how they got there. As an example, a patient of Dr. Atkins’s sat in the waiting room for ages, expecting to be called in for his appointment. Unfortunately, although he did have an appointment at that time, it was across town with his dentist.

Number 5: Poor judgment

Another of the losses that occurs in early dementia is that of good judgment. Normally frugal people may end up spending money on things they don’t need and can be a telemarketer’s dream customer, signing up for all kinds of special offers.

Judgment about appropriate dress may also suffer, with people heading off to the beach wearing a coat, hat, and scarf or, conversely, going shopping in the pouring rain with only a T-shirt and sandals to protect them from the elements.

Number 6: Visuospatial difficulties

Increasing clumsiness can herald the start of dementia. As people are robbed of their ability to judge widths and distances, falls and breaks are common, as are bumps (or worse) when parking or driving a car.

Number 7: Misplacing things

Although everyone forgets where they’ve put their keys or cellphone from time to time, you can usually retrace your steps and eventually find them. This ability to retrace steps is lost in dementia. Coupled with an increasing tendency to leave things in the wrong place as well (such as slippers in the refrigerator), important objects go missing more often.

Number 8: Changes in mood

When our children were teenagers, rapid mood swings were an extremely common feature of life in our homes. One minute a decision we’d made meant we were the worst people in the world, and the children felt angry and a bit sorry for themselves; the next (usually when cash had changed hands), we were great people, and they couldn’t think of anyone they’d rather have as parents.

As people grow into adulthood, these extremes of mood and temperament thankfully tend to be much less evident. But in the early days of dementia, this type of fluctuating mood can return, with people often rapidly switching between extremes of sadness, fear, and anger. Low moods and depression are also extremely common in dementia. At times it can be hard to work out whether the symptoms of dementia are causing the depression or vice versa.

Number 9: Loss of initiative

Although anyone can become fed up with work, hobbies, and even social obligations, it’s often a passing phase after a tough day or a bad night’s sleep, and you snap out of it. People with dementia may lose interest in taking part in their usual activities altogether and repeatedly need prompting about what they should be doing or simply to join in with what friends or family are doing.

Number 10: Personality change

A number of different changes are possible here, and not all people who are developing dementia will change in the same way. In fact, often what changes is their normal behavior, so a reserved and quiet person may become flirty and disinhibited, whereas the life and soul of many an extrovert may become withdrawn and reclusive. Common changes include becoming

Confused

Suspicious

Withdrawn

Angry

Sexually disinhibited

Recognizing Thought-Processing Problems

The thought-processing (cognitive) symptoms of dementia are all those of loss. People with dementia will, to one degree or another, lose their memory, their judgment, and quite literally their way. These sections examine these problems a bit more so you can see how dementia may impact someone.

Forgetting things

When my (co-author Dr. Wasserman) uncle Eddie developed AD, he’d pop into my mom’s house around the corner four or five times a day to ask her what she was up to. If he got no reply, he’d put a note in her mailbox that simply said, “Fern, where are you?” And all this despite the fact that on his first and no doubt second visit, she’d told him exactly what she was up to that day and where she was going.

In contrast, my aunt, who had vascular dementia, was well aware of everything that was going on each day, but she had an awful memory for names and faces. Not only would she mix me up with my brother, but she’d also often call me Bill, which was her son’s name.

And the many aspects of forgetting that can occur in dementia go way beyond these two examples from family history.

Memory can be affected by dementia in more than one way. People with AD may experience problems learning new material or may forget information that they previously knew or both. Problems learning and retaining new information often precede the loss of already learned information.

The key point regarding memory loss due to AD is that it’s not static. As AD progresses, you realize you’re not seeing just occasional forgetfulness but a pattern of steadily worsening memory loss.

With more advanced AD, your loved one may have trouble recalling familiar people and places as well as forming new memories; recent events seem to drift away as soon as they’re over. For example, a person with dementia may forget that a grandchild visited only two hours before.

MEMORY FOR DUMMIES

A fully functional memory is vital for human existence. That’s because without some way of remembering what’s happened, every waking moment stands alone as a brand-new experience; you have no past and can’t plan for the future. Sadly, memory is one of the main casualties of the different dementia processes.

Two main types of memory exist: short-term and long-term memory. You also possess an emotional memory, which is completely preserved in dementia, and which we mention at the end of this sidebar.

Short-term memory:Short-term memory is your working memory, which stores information for a short time only (hence its name) before it’s either forgotten or transferred to long-term memory for storage, potentially for the rest of your life. Short-term memory, it’s believed, allows people to remember lists of only seven to nine items, for around 30 seconds. Repeating these items over and over in your head can help keep them there, but if you’re distracted by something else or the 30 seconds run out, the items are gone.Long-term memory:Long-term memory has unlimited capacity, and memories can be stored until your dying day. It has two main forms: Declarative memory: This is memory for facts such as bank account or phone numbers, computer passwords, meanings of words, general knowledge, and events in your past.Procedural memory: This allows you to remember how to carry out tasks without having to relearn them each time. It’s what makes riding a bike easy when you haven’t done it for a while. And it’s what enables us to know how to hold a knife and fork each time we pick them up, or to brush our teeth using the same technique each day.

The development of a long-term memory in the brain involves three crucial steps. If any of these steps don’t work, the memory is effectively lost — and that’s what can happen in dementia:

Encoding (which ensures that all types of sensory input are in a suitable form for storage)StorageRetrieval

Encoding can be thought of as the way in which the nervous system labels a fact, emotion, smell, image, or whatever is to be remembered so it can be stored for further use. It’s very similar to the way in which librarians assign specific numbers to books depending on their subject matter so someone searching for them among the many bookshelves can easily find them.

Emotional memory

Emotional memory allows you to recall the really important moments in your life, both good and bad. It stores not only the information about what happened, but also an exact memory of how you felt. It means that if you find yourself in a similar situation in future, you’ll probably experience those feelings again.

Classic short- and long-term memories are created in a part of the brain called the hippocampus, and long-term memories are stored in different parts of the outside of the brain called the cerebral cortex.