Dementia: Starting the conversation

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Few things are more frustrating than misplacing the car keys – again. It is normal to forget things from time to time, like those keys, a wallet or that extra item on the grocery list. Even though this amounts to a mild inconvenience, it is aggravating and even distressing to have a lapse in memory.

Can you imagine how frightening it would be if you couldn’t remember the week-long vacation you just went on, as if the entire memory was erased? No matter how much you focused or concentrated you couldn’t remember taking that vacation. This is not an inconvenience; this is a symptom of dementia. dementia7

Dementia effects more than memory and can make everyday-life a struggle. Having a basic conversation is exhausting because every time you try to say a particular word, another comes out. You might read the simple instant-coffee directions over and over, but they never make sense. Easy tasks like buttoning your shirt seem impossible – as though your body isn’t doing what your brain is telling it to.

There are many aspects of dementia, and many misunderstandings. TMC is beginning a three-part blog series to discuss the definition, behaviors and treatment of dementia. This is the first blog, defining dementia and outlining its basic affects and characteristics. It might surprise you to learn all that dementia entails.

What is Dementia?
Dementia is a broad term for the diseases (or conditions) that cause nerve cells (neurons) in the brain to stop working or malfunction.

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Symptoms
When the nerve cells in the brain cease, a person will experience a decline in memory and the ability to think clearly and rationally. In addition, many experience changes in behavior, vision and motor function. The most common symptoms of dementia are:

•  Memory loss (affecting daily life)
•  Impaired judgment
•  Inability to reason
•  Problems focusing or paying attention
•  Confusion with time or place
•  Challenges completing familiar tasks
•  Problems finding the correct word(s) in speech and writing
•  Trouble understanding visual images and spatial relationships
•  Frequently misplacing things – inability to retrace steps
•  Changes in mood or personality

What are the causes?
The common causes of dementia are:

How does someone get a dementia-related disease?
Medical science has made significant advancements over the last thirty years, and dementia continues to be a dynamic research field. There are still many mysteries about the brain and it is not yet known, conclusively, what causes many dementia-related diseases.

Age is the greatest risk factor for acquiring dementia. According to the Centers for Disease Control and Prevention, about 10 percent of individuals over the age of 65 experience a form of dementia. Although the risk increases with age, not every senior will experience dementia.

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Family history is another strong risk factor. An individual is at higher risk if a sibling, parent or child has experienced dementia. Certain genes have been identified that indicate an increased risk for specific dementia-related diseases, such as Alzheimer’s.

Sudden or gradual?
Dementia symptoms progress slowly over several years. Many forms progress in stages:

  • Early Stage (Mild)
    • Recent memory loss
    • Difficulty managing money, driving, or handling social situations
  • Middle Stage (Moderate)
    • Difficulty with language
    • Problems keeping track of personal items
    • May need help with grooming
  • Late Stage (Severe)
    • Long- and short-term memory affected

If dementia symptoms are sudden and acute, it could suggest a reversible medical cause such as:

  • Urinary tract infections
  • Metabolic changes (Thyroid)
  • Nutritional deficiencies (Vitamin B12)
  • Tumors

The symptoms of dementia will drastically improve or alleviate when the reversible medical cause is treated. If sudden and severe symptoms arise, contact your doctor right away.

Behavior
Dementia can cause strange and unexpected behavior, which can be one of the most challenging symptoms for individuals and their caretakers. Like most chronic conditions, dementia can affect every person differently. Some of the more common behaviors are:dementia9

  • Repetitive actions, such as hitting, wiping surfaces, making noise (clapping, etc.), rocking
  • Wandering and pacing, not able to sit still
  • Going to the door often, trying to open locked doors, trying to leave when visitors leave
  • Boredom, lack of purpose, looking for something lost
  • Anxiety, stress, fear
  • Hunger, thirst, bathroom needs
  • Wanting to go home (even if at home)

Assisting a friend or family member who has dementia can be exceptionally challenging because symptoms can be severe and persistent. Often, a caretaker will have to repeat things several times – even within the span of a few minutes. The affected individual will usually respond negatively if someone tries to convince them that their thoughts or actions are irrational. The symptoms may become so acute that constant monitoring is needed.

Sound like it would be pretty hard to be the caretaker? It is, however, we must recognize the person’s behavior is beyond their control.

“If you are going to help a person with dementia, you must understand they cannot think, reason or remember,” said Terri Waldman, former director of memory and dementia care at Handmaker/Tucson Medical Center. “You have to let things go, and refrain from challenging their misconceptions.”
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What can we do?
Consult a physician who specializes in dementia-related illness. “It is important to get a diagnosis,” Waldman said. “A diagnosis will determine the most effective medical treatment(s) and will help the individual and their family develop the best care plan.”

 

Medical specialists will perform:
•  Mental status test (memory, reasoning, visual-motor skills)
•  Physical examination (lab tests, brain scan, test for other disorders)
•  Psychiatric evaluation (rule out emotionally related symptoms)
•  Family interviews (get more information about behavior and symptoms)
What treatments are available?
Currently, there is no cure for dementia and all dementia-related conditions are degenerative, meaning they will get worse over time. There are medications that can control or reduce the severity of symptoms, and there are medications that can slow the progression of dementia-related diseases. Medication therapy can help with behavioral and cognitive challenges, and improve the quality of life for some individuals experiencing dementia.

More than memory loss
Dementia is more than memory loss, and the numerous life-changing symptoms have a detrimental impact on individuals and families. Treatments are available, and it is important to know what symptoms to look for and who to talk with. Medical research continues to move quickly, in hope of finding a conclusive prevention and cure.

 

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Support resources:

Developing rituals can help build balance

Terri Waldman on developing rituals to balance lifeTerri Waldman, the Director of TMC’s Geropsychiatric Center, was one of the experts interviewed for the Arizona Daily Star’s series on dementia, Hope and Help. Among the stories was one on finding hope. Here is her monthly column on the importance of building ritual.

Every morning, I go for a walk with my dog.

If I miss that walk for some reason, my day just feels a little off.

It’s one of my rituals, along with meditation, that gives shape to my day.

Ritual, which is increasingly recognized as important to our health and wellbeing, is more than merely everyday habit. But to be clear, it also does not have to be reserved for just the sacred and complicated.

Whether we are talking about rituals of religion, families or individuals, those intentional steps we take on a regular basis help remind us about what’s important and help us build a sense of stability in our lives.

When I was a child, bedtime meant my parents would tell each other and their children that they were loved. For me, regardless of family squabbles or anything else that happened during the day, it gave me that sense of continuity. No matter what else I faced, love was not a negotiation.

When you hear “ritual,” there are all kinds of ideas in our head about what that looks like, often involving ceremonial trappings and historical foundations. But it can be as simple as having dinner as a family – a ritual that is growing in importance all the time as we lose some of that precious time to busy lives and technology.

It can be having a cup of coffee on your patio to start your morning. It could be a cup of tea in the evening. It could be a prayer before bed.  It’s any time you carve out that feels good and centering and maybe even healing to you.

In the work I do, I’ve noticed that some people’s lives become imbalanced because they lack structure. Rituals have a way of grounding you. Even if you’re traveling, you can still have that morning coffee or that bedtime tea and feel a sense of structure. Ritual does not have to be rigid. And it doesn’t have to be something handed down through generations – it can be something you create.

If ritual is something you want to more fully develop in your life, you might look at your life to see what you have in it already.  You probably have more of it in your life than you think. If it isn’t obvious to you, you might ask a friend: What do you see in my life that brings me comfort?

You might just start with something simple: Finding 5 minutes of quiet time with your thoughts. It’s easy to click on the TV or the radio for a distraction, but learning to be present with oneself can be a gift. And it might just start with one, simple ritual.

Terri Waldman has more than 20 years of experience in providing services, advocacy and leadership in the field of aging in Pima County. Currently the Director of the TMC Geropsychiatric Center at Handmaker, Waldman received her Masters in Social Work at Arizona State University. She follows her father’s philosophy that five minutes of laughter every day leads to quality in life.

World Alzheimer’s Day highlights the need for sufferers to be included

Today is World Alzheimer’s Day–a time to honor both people with dementia and their caregivers. Currently, 38 million people globally are affected by dementia. That number is expected to rise to 115 million by the year 2050.

Today is a good day to take a look at The World Alzheimer Report 2012: Overcoming the stigma of dementia. The report, released today, shares results from a worldwide survey conducted with people with dementia and carers on their personal experiences of stigma. The report provides information on stigma and dementia, highlights best practices in the field of dementia, and makes recommendations which could help reduce stigma.

Nicole Batsch, a former member of the TMC Senior Services team and one of the authors of the report, says,”I want you to take a moment to think about the people you know with dementia – whether in your family, or someone else’s family and think about how you can help them stay connected in everyday life perhaps with a smile, a conversation (being patient to wait for the answer) and activities you can enjoy together like visiting a park.”

According to Batsch, the message in the report is one of social exclusion by society. She insists that it is up to everyone to include people with dementia.

“Don’t be uncomfortable talking to a person with dementia or their carer. They need your help. Ask them how you can help,” she says.

The report and accompanying video can be found at: http://www.alz.co.uk/research/world-report-2012

 


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