Points to Ponder for Seniors Making Housing Choices

One of the most critical choices older adults need to make is where they will live as they age. A variety of factors will go into making that decision. Do they have an active lifestyle? If their activity level changes, will there be support services available to them? What about location? How much will housing options cost? Should relatives be involved in the decision-making process? Whatever option is chosen, the best choice needs to ensure that the older adult’s health, welfare, legal rights and financial needs are protected.

Owning a home

Many homeowners hope to stay in the home where they have lived for many years, raising a family and staying close to family and friends. Some may downsize, but continue to live in the same area. Benefits include continuing relationships they have made through the years, the privacy offered by owning your own home, and being able to count on the home as a future financial resource. Challenges include keeping up with home maintenance or making modifications to be able to still live there comfortably and safely.

Renting options

Renting a room, apartment, or a single-family home can free the older adult of worries of expenses associated with home ownership. Some seniors may be eligible for state or federal rent subsidy programs – another plus. On the list of downsides, there may be restrictions when it comes to owning a pet and a loss of some independence for tenants.

Living in a group setting

Group settings provide housing, a range of in-home support services and some social activities. Assistance with personal care (bathing, dressing, or eating, for example) or activities related to independent living (housework, preparing meals, or managing money) is offered. Benefits include choosing from a variety of housing types (adult foster homes, assisted living facilities, and continuing care retirement communities, to name a few) as well as providing socializing opportunities. Challenges include a lack of privacy or lack of services should the older adult’s needs change.

Living in a nursing home

Nursing homes, or long-term care facilities, are for those who need 24-hour supervision, providing medical and personal care assistance. Organizations such as the National SeniorCitizen’s Law Center (NSCLC) and the National Citizens’ Coalition for NursingHome Reform (NCCNHR) can be used as resources in researching nursing homes.

Source: “Housing Options for Older Adults: A Guide for Making Housing Decisions” produced by the National Association of Area Agencies on Aging and written by Holly Robinson, associate staff director at the American Bar Association Commission on Law and Aging.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society of America does not provide medical advice. Please consult your doctor.

How to Keep Communicating

Dementia is a set of conditions, which can be caused by a variety of known neurodegenerative diseases*, and some still-yet-unknown triggers, which progress over time, and will likely affect a person's ability to remember and understand basic facts, such as names, dates, and places. Aside from that, it may gradually affect the way a person communicates as well. His or her ability to present rational ideas and to reason clearly could change, and it is up to those surrounding their affected loved one to modify their ways of communication to reach out and still have a connection.

If you are a caregiver to a person with Dementia, you may find that as the illness progresses, you'll have to start discussions to get the person to make conversation. This is common. The person’s ability to process information gets progressively weaker and responses can become delayed.

Encouraging someone with Dementia to communicate

Try to start conversations with the person you're looking after, especially if you notice that the person with Dementia is starting fewer conversations on his or her own.

Ways to encourage communication include:

• Speaking clearly and slowly, using short sentences.
• Making eye contact with the person when talking, asking questions or having other conversations.
• Giving the person time to respond, because he or she may feel pressured if you try to speed up answers.
• Encouraging the person to join in conversations with others, where possible.
• Letting them speak for themselves during discussions about their welfare or health issues, as they may not speak up for themselves in other situations.
• Do not patronize, or ridiculing what he or she says.
• Acknowledging what is said, even if your question has not been answered, or what is said seems out of context – show that you've heard the person and encourage the person with Dementia to say more.
• Giving the person simple choices when conversing.
• Using other ways to communicate – such as rephrasing questions because the affected person can't answer in the way he or she used to.

Communicating through body language and physical contact

Communication isn't just talking. Gestures, movement, and facial expressions can all convey meaning or help you get a message across. Body language and physical contact become significant when speech is difficult for a person with Dementia.

Communicating when someone has difficulty speaking or understanding can be made easier by:

• Being patient and remaining calm, which can help the person with Dementia communicate more easily.
• Keeping the tone of voice positive and friendly, where possible.
• Talking to the person at a respectful distance to avoid intimidation – being at the same level or lower can also help.
• Patting or holding the person’s hand can provide reassurance and make you feel closer, but watch the person’s body language to make sure the person with Dementia is comfortable with you doing this.

Listening to and understanding someone with Dementia

Communication is a two-way process. As a caregiver of someone with Dementia, you will probably have to learn to “listen” more carefully. You may need to be more aware of non-verbal messages, such as facial expressions and body language. You may have to use more physical contact, such as reassuring pats on the arm, or smiles, as well as speaking.

When communicating with someone with Dementia, “active listening” skills can help. These include:

• Using eye contact to look at the person, and encouraging that person to look back at you.
• Trying not to interrupt the affected person, even if you think you know what that person is saying.
• Stopping what you’re doing so you can give the person your full attention while he or she is speaking.
• Minimizing distractions that may get in the way of communication, such as the TV or radio playing too loudly.
• Repeating what you heard back to the person and asking if it’s accurate.
• “Listening” in a different way – shaking your head, turning away or murmuring are alternative ways of saying no or expressing disapproval.

It’s important to encourage the person with Dementia to communicate wants and needs – however, he or she can. Remember, we all find it frustrating when we can’t communicate effectively, or are misunderstood.

*More common diseases which have been identified: Alzheimer's, Vascular Dementia, Lewy Body Dementia, Frontotemporal Dementia, Chronic Traumatic Encephalopathy, among many others.

Source: This article was provided by the UK National Health Service (NHS), revised in December 2017. All rights reserved.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society of America does not provide medical advice. Please consult your doctor.

Never Underestimate the Power of Hope

When we talk about the "C-word" (cancer), or the "D-word" (Dementia), it often seems difficult to include the concept of HOPE within our conversations.

Both conditions, while very different, take a similarly tremendous physical and mental toll, both on the individual and the family. Yet, the psychological benefits of hope can go a long way. Hope can improve our mood, outlook, and the way we partner with a person living with Dementia. 

According to a 2010 study, the same is true for cancer patients. In the study, women with breast cancer demonstrated that hope is an essential factor for coping and reducing the psychological distress of cancer treatment. The research shows that lower levels of hope were tied to the patient’s lower satisfaction with life. It also showed that hope intervenes and reconciles the relationship between distress and health status. In other words, the association between anxiety and disease was no longer as significant with hope at their side. Hope created an opportunity to look at the situation through a more hopeful lens, in the same way in which we talk about a glass of water being half full or half empty. It all depends on you.

Having hope at your side is extremely valuable when dealing with Dementia, as well. As advocates and educators, we are poised to help individuals, families, and medical professionals become “Dementia-aware.” In doing so, these newly educated advocates can provide the kind of compassionate and fulfilling care a person living with Dementia needs and caregiver desires.

As we become more Dementia-aware, we experience more reasons for hope and find that nuggets of inspiration are all around us if we look. When we present our talks and workshops across the country, there's no need to hammer the point that Dementia is stubborn and progressive. We get that. But instead, we focus on the simple steps that each of us can aspire to ascend: we can rise to the occasion; we can change our outlook; we can alter our perspective to discover the smallest day-to-day accomplishments ... and therefore, celebrate! 

When we do, we might just experience the joy and happiness that we had lacked in our journey up until that moment. That’s the goal: unlocking our abilities to make meaningful connections and uplifting moments, by approaching Dementia in a new light. As we do, we can discover greater hope within ourselves and create new hope with others!

Contributors: Laura Wayman, “The Dementia Whisperer,” an internationally recognized Dementia care expert who offers professional caregiver training services to providers and families, along with Kevin Jameson, DrHC.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society of America does not provide medical advice. Please consult your doctor.

Being Grateful - Can Change Your Life

The concept of keeping a gratitude journal has gained attention as a focal point for brain writings and research. Forbes published an article within recent years that explored the value of keeping a gratitude journal.  

Something happens neurologically when we reflect on our choices, relationships and special events in our lives. Actively reflecting starts to hardwire neurological changes in the brain. If you’re constantly focusing on emotions that make you fearful, angry and resentful, they eventually get hardwired into your brain. The opposite outcome holds true for gratitude.  

Research has found that keeping a gratitude journal can help pull you out of negative patterns, and start you on a course that leads to positive thoughts and actions. Gratitude journals have been shown to be even more effective than simply focusing on having positive thoughts in your day.  

Keeping one has many different benefits:  

One of the biggest improvements comes with the ability to open up new relationships, or to communicate better in your current relationships. Reflecting and being grateful for the people that help you in life expands your empathy, and empathy is one of the cornerstones of healthy relationships.  

It also improves physical health. Research, published in 2012 in the Journal of Personality and Individual Differences, found that people stuck in negative emotional patterns feel pain more intensely than people who practice gratitude and positive thinking on a daily basis.  

Keeping a gratitude journal also helps people manage depression and feelings of aggression.  

A study published by the Journal of Applied Psychology found that people who wrote in a gratitude journal for 15 minutes at night before going to bed experienced better quality of sleep on a regular basis.  

It also has a positive impact on self-esteem. Sitting down to reflect on what you’ve accomplished and what you’re grateful for ingrains the value of the experience in your memory. This also helps to reduce social comparisons, because focusing on what you appreciate about yourself impedes the negative impulse to judge others.  

Gratitude journaling has also been shown to be a therapeutic tool that can help people deal with conditions like PTSD and other stress-related disorders.  

It costs little more than a cheap composition notebook or simply maintaining a special file on your computer’s hard drive. I think you’ll find if you take the time to reflect on your life and the things you’re grateful for, results will be nothing short of amazing.  

Contributor: Dr. Michael Trayford is a Board-Certified Chiropractic Neurologist and Founder of APEX Brain Centers in Asheville, NC. 

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society of America does not provide medical advice. Please consult your doctor.

The Hazards of Paying the Bills and all that Paper!

Paper may seem innocuous. It arrives our homes daily in the form of mail, magazines and newspapers, and it piles up often in a haphazard manner. We usually don’t give it too much thought. But for many people, especially seniors, and those living with Dementia (or as a caregiver), bills and personal papers can lead to identity theft and fraud.

The best practice for managing monthly bills is to shred all documents that contain personal information. It is recommended that documents be shredded, because thieves have gone so far as to steal garbage to obtain innocent victims’ personal financial information. Many banks and community service organizations offer a free "shredding day," and it's worth packing up a couple of file boxes, worst case, once or twice year, if you don't yet have or can't afford a personal/home shredder.

So, if you are receiving monthly bills in the mail, they should be shredded after paying them, or as soon as possible. Documents that are necessary for tax or other important purposes should be maintained for a period of time specified by your lawyer and accountant. However, such documents should be kept in a small locked, waterproof, fireproof filing cabinet so they can only be accessed by authorized parties.

In February 2016, the New York Times published an article about a scam artist who was able to steal many tens of thousands of dollars from a victim, simply by stealing a check that the victim had placed in the mailbox.

Once the criminal stole the check, he was able to empty significant amounts of funds from the victim’s account, because he had the bank’s routing number and the account number. This incident highlights another opportunity for criminal activity based on unsecured documents:  mail theft.  If you or a loved one are not using online bill paying, consider mailing checks in a secure U.S. Post Office mailbox rather than leaving the envelopes to be picked up in a personal mailbox attached to the house, apartment or out at the end of your driveway.

If you need assistance with bill paying, consider using a service. There are a number of services available throughout the country like the one I founded called, SilverBills. We receive, scrutinize and ensure that your bills are paid accurately and on-time. You no longer need to open envelopes, write checks or remember deadlines. Once enrolled in this type of service, you will likely receive a lot less paper in the mail and that will further decrease the potential for theft and fraud.

A last reminder: securely keep, and don't shred important paper documents like your social security card (which is not really a card - it's more like a piece of thick paper), certain tax, financial, legal, insurance and healthcare documents. Shredding is pretty permanent, so if ever in doubt, ask your attorney, insurance agent, banker or financial professional before shredding.

Contributor: Marci Lobel-Esrig founded SilverBills after witnessing the challenges faced by her elderly relative paying bills on time and correctly. Marci has been a practicing attorney for more than 20 years. Marci received her J.D. from New York University School of Law and her B.A. degree Magna Cum Laude from Columbia College, Columbia University.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Finding Ways to Reduce the Stress of Caregiving

Family caregivers often feel stressed, exhausted, anxious, sad, angry, and sometimes hostile. However, caring for a person who has Dementia does more than affect behavior.

According to psychiatrist Dr. Linda Mah and colleagues, unrelenting stress and anxiety compromises health as well as contributes to increased risk for depression and Dementia. Many of their findings are sobering. Their discovery that unrelenting anxiety and stress damages areas of the brain that regulate emotional responses, thinking, and memory, is particularly relevant. They conclude that some treatments relieving depression may aid in repairing the damage created by caregiving stresses.

But don't let Dr. Mah’s findings be another reason to cause worry in your already stress-filled life. Having risk factors does not mean you are predestined to develop Dementia. Risk factors do not cause the disease; risk factors increase the probability of (someday) having the disease.

There are many reasons why it is important for family caregivers to get relief from the months and years of doing more than their abilities, circumstances, and resources would normally withstand. 

Caregivers have several options available to them in order to reduce their stress. One of them is to look closely at their own behavior. Some family caregivers feel they are the only person who can give their loved-one the proper care. Usually, this is not true. Often family members and friends can step up as good substitute caregivers and will volunteer to help if the primary caregiver appears interested or receptive.

In addition to family and friends, community and faith-based organizations provide affordable respite care. Local nonprofit support groups, as well as the U.S. Administration on Aging, are examples of community resources. The Catholic Charities and Jewish Family Service are examples of faith-based, nonprofit organizations that, regardless of ethnicity or religion, can give the primary caregiver time away from his or her full-time care commitment.

Adult daycare is another possibility. Located in community senior centers, nursing homes, churches, synagogues, hospitals, and schools, adult daycare provides stimulation and companionship for seniors who need medical assistance and other kinds of supervision.  Usually open during business hours, adult daycare centers give the family caregiver time to go to work, to attend to personal business, or to relax while knowing their loved-one is safe.

Family caregivers use respite time in different ways. Some sleep, while others go shopping, spend time with friends, read, walk, or take time to participate in a favorite hobby or sport. Make an effort to set aside time for a daily 15- to 30-minute break for an enjoyable physical activity such as walking. Good times to grab these important moments are when your loved-one is asleep, is in the doctor’s office, or when a friend or relative pays a visit

Schedule longer respite breaks for the same time each week. Plan ahead so you will know how you will spend that precious time. That way, even on a difficult day you will always have something to look forward to doing. But whatever you decide, make respite a priority before feelings of exhaustion, isolation, and resentment take over.  

Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.  

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society of America does not provide medical advice. Please consult your doctor. 

Hearing Test Protocol For Those With Dementia

For most of us, we are busy with our daily lives engulfed with family activities, work, education, and all the things that consume our time. We never give it a thought and often take it for granted how our senses keep us connected with our world.

As we age there are changes confronting us in the realm of our health and quality of life. These changes are age-related and present a disability to be addressed and remedied. Most of these are hearing, vision, speaking, various motor skills, and cognition. Hearing loss is estimated to affect some 39 to 50 million Americans.  

Research has indicated that almost three out of every four individuals age 80 and above will have at least one disability to deal with. Most often, hearing loss is most common. Dr. Frank R. Lin, MD of Johns Hopkins University has been one of the leading researchers over the past ten years to make the connection with untreated hearing loss being a provocateur in the area of Dementia.

Our loved ones and senior friends impacted with hearing loss and some type of Dementia are especially at risk for decreased quality of life. Often these people require special care in a licensed facility with a professional medical staff 24/7.

Ideally, I recommend to every one of my patients to have a complete audiological evaluation on an annual basis. Following this guideline as an associated part of having an annual physical by their family physician, enables the audiologist to detect and monitor adverse changes in hearing acuity, abnormalities, and other medical issues to be addressed.  

This evaluation provides the baseline and documentation on future tests that help the patient later in life. The protocol includes, but is not limited to: case history, otoscopic inspection, pure tone (air & bone) audiometry, speech audiometry, tone decay, tympanometry, acoustic stapedial reflexes, and distortion product otoacoustic emissions testing.

One avenue where this documentation will be critical is in handling hearing health care for those requiring amplification and knowing what the previous status was for Dementia-affected patients.

For the reader of this article, you would undoubtedly be able to participate in and complete an audiological evaluation administered by an audiologist. For a person with advancing Dementia, in a facility such as a nursing home or special care unit, it may that up to 95% cannot complete or tolerate the standard evaluation. Even though Congress in 1987 mandated a Minimum Data Set for a required evaluation of incoming residents to a facility, it does not guarantee a successful finding, in hearing, comprehending speech, and producing language.

For those people with mid to later stages of Dementia, alterations in testing protocol could be required. Behavioral tests are mostly eliminated from the battery.

There are many considerations in handling hearing loss, amplification, and proper examination and assessment for the person with Dementia. Since much of the protocol below is rather scientific-sounding and not easily expressed in lay terms, please print out this blog post and/or bring the information to your doctor to get the process underway.

A suggested protocol may include:

• Case history – Since the patient may not be able to provide complete and accurate information, a family member or friend should be queried. This step will require a review of previous audiologic studies.

• Otoscopic inspection – The audiologist will utilize an otoscope to examine the outer ear canals and visually assess for any apparent abnormalities.

• Audiometry for pure tone and speech stimuli – This component requires participation by the patient and test reliability in subjective responses. There will be some that may not tolerate the headset or canal inserts nor provide reliable information.  Research has shown that only 5% may be able to complete this step.

• Tympanometry and acoustic stapedial reflexes; impedence testing – This assessment will show whether a perforation, abnormal middle ear pressure, or fluid is present and requiring otologic intervention.

• Distortion product otoacoustic emissions (DPOAE) testing – This is a truly objective test to determine the status of the outer hair cells of the cochlea.  Normal responses are seen in threshold level up to 35 dBHL. The frequency range of DPOAE is 1500 to 6000 Hz.

• Amplification check – The doctor of audiology will clean, check, repair as needed, readjust, and refit the patient’s amplification if they are a current wearer. If replacement is indicated, this will be noted.  As for a new fitting to a patient who has not previously been fitted, it will not be advised due to issues involving reliability of the assessment and tolerance of fitting.

If you wish to explore this subject further, please contact a board certified & licensed private practice doctor of audiology today. 

Hearing loss, once addressed, may result in a much richer and more meaningful quality of life for all those affected!

Contributing Author: 
Dr. Patrick M. Murphy, Au.D., M.Ed., CCC-A, FAAA
http://www.murphyhearingservices.com/

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Alzheimer's Disease-Type Dementia

Alzheimer's Disease (AD) is thought to be the most common kind of Dementia. Researchers estimate that as many as 5.4 million people living in the United States have this type of Dementia.¹  Whereas, when you combine all forms of Dementia together, it is estimated to affect 9 million or more people in the U.S.

According to the Centers for Disease Control and Prevention, Alzheimer's Disease is the fifth most frequent cause of death for adults aged 65 years and older.² Further, in high-economic countries³  like the U.S. and Canada, when considering the larger domain - that includes of all types of Dementia - Dementia is thought to rank even higher as the third leading cause of death, behind heart disease as number 1 and stroke as number 2.

While it is hard to say what actually causes Alzheimer's Disease, we do know the deposition and accumulation of fibrous proteins accompanies irreversible brain damage. It is thought that these insoluble proteins form β-amyloid plaques that disrupt brain architecture alter how brain cells use energy, and promote cell death. The second hallmark of AD, also seen by Dr. Alois Alzheimer over 100 years ago under a microscope, are the neurofibrillary tangles of dead and dying neurons seemingly connected to Tau, another type of protein. That's why medical professionals will often speak of the "plaques and tangles" of AD.

The result is a slow and progressive decline in memory, thinking, and reasoning skills. Eventually people lose the ability to swallow and breathe in a coordinated fashion. Even in the absence of other catastrophic diseases such as kidney failure and cancer, Alzheimer's Disease is a terminal illness.

Alzheimer's Disease comprises a spectrum rather than a defined set of signs and symptoms. Slow progression, rather than sudden change, is often the key to differentiating Alzheimer's behaviors from those associated with other kinds of Dementia. Life expectancy after an Alzheimer's diagnosis can be anywhere from four to 20 years. People who have Dementia often die from other causes such as cancer, kidney failure, and cardiovascular disease.

The Alzheimer's Association lists the 10 warning signs of Alzheimer's Disease – the first of which is memory loss. After reading the list you might think, How are these behaviors different from what everybody does at one time or another? The difference is the frequency and the ability to make self-corrections.

Healthcare providers often use staging to describe the progression and severity of diseases such as cancer, kidney failure, and Dementia. The following staging criteria will help you understand your loved-one’s condition and plan for future caregiving needs.

Mild or Early-stage Alzheimer's Disease

In this first stage, people experience memory loss, difficulty remembering newly learned information, and have trouble completing complex tasks such as planning a family event. Personality changes such as uncharacteristic anger and increasing difficulty in finding the right words, getting lost, or misplacing items are other common signs. With help, your parent, spouse, or sibling may still be capable of independent living.

Moderate or Mid-stage Alzheimer's Disease

During this phase people may confuse family members with close friends, forget personal history details such as where they went to school or where they were born, and need help with dressing and personal hygiene. Some people may become restless, suspicious of others, and confrontational. At this stage, your relative will need close supervision and assistance during the day and perhaps a caregiver during the night.

Severe or Late-stage Alzheimer's Disease

In the course of this last stage, people who have Dementia lose the ability to speak coherently, need help with eating, dressing, using the bathroom, and walking. Eventually, Late-stage Alzheimer's patients lose the ability to swallow and control their bladder and bowels. During this final stage, your loved-one will need 24-hour care, either at home or in a Dementia care facility.

Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor.

References

1. 2017 Facts and Figures: Alzheimer’s Disease Facts and Figures, Download source here: 2017 Alzheimer’s Disease Facts and Figures. (accessed September 18, 2017). 

2. ibid

3. 2017 World Health Organization Factsheet Download source here: 2017 World Health Organization Factsheet.

Symptoms for Vascular Dementia can Vary Widely

Vascular Dementia may account for 12 to 20 percent of all Dementias, and is the second most common age-related Dementia.1 Unlike the gradual progression of Alzheimer's disease, the onset of Vascular Dementia symptoms is often abrupt and occurs when a heart attack or a stroke dramatically reduces blood flow to or through the brain. Hallucinations, rather than the memory loss associated with early-stage Alzheimer's disease, is another indicator of Vascular Dementia. 

Vascular Dementia can also have a slow progression. This happens when the accumulative damage of transient ischemic attacks – often called TIAs – cause many small areas of brain damage and, eventually, noticeable symptoms. The descriptive name “multi-infarct Dementia” is the term healthcare providers use to describe this kind of Vascular Dementia. Infarcts refer to the many (multiple) areas of non-functioning brain tissue that accumulate over time. Multi-infarct Dementia is the most common type of Vascular Dementia.1  

Depending on the location within the brain, multi-infarct Dementia produces a spectrum of physical, behavioral and emotional changes. An example of a physical change is shuffling or walking with small rapid steps. Behavioral symptoms can include slurred speech, getting lost in familiar surroundings, and difficulty in following instructions. Sometimes people cry or laugh at inappropriate times. 

As you can now appreciate, telling the difference between Alzheimer's disease and Vascular Dementia can be difficult. If the changes appear rapidly, Vascular Dementia, resulting from a stroke or heart attack, is the likely culprit. To make things even more complicated, many people have both Alzheimer's disease and Vascular Dementia.

There several ways you can reduce risk for Vascular Dementia. Some of these include: maintaining a healthy blood pressure; eating a healthy, low-fat diet; maintaining a healthy weight; regular exercise; and to refrain from or stop smoking.2 It is well worth noting that all of these modifiable conditions and behaviors are ones that affect the cardiovascular system and blood flow to the brain. 

#VascularDementia #MultiInfarct #KnowDementia

Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of  “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of content contained within blog posts - that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor.  

References

Source 1, accessed March 4, 2016

Source 2, accessed March 4, 2016

How to Distinguish Dementia with Lewy Bodies From Other Types

 

Lewy Body Dementia (named after Frederich Heinrich Lewy, who in 1912 described the disease) is a spectrum disorder described by a rapid decline in the patient’s cognition and behavior. Hallucinations and delusions, as well as alterations in sleep, heart rate, and digestion are other Dementia with Lewy body characteristics. Certain subtypes of Dementia with Lewy Bodies cause people to experience shaking, rigidity, and balance difficulties.

The presence of Lewy bodies – abnormal brain deposits composed of several proteins located throughout the brain, is the post-mortem diagnostic hallmark. Dementia with Lewy bodies is a rapidly progressing disease. Death usually occurs within five to seven years of diagnosis.

Unlike Alzheimer's Disease, Dementia with Lewy bodies does not have predictable stages. Early symptoms of the disease vary. Some people first experience cognitive and memory changes similar to those associated with early Alzheimer's Disease. For other people, first symptoms may include shaking and a shuffling gait. Sometimes hallucinations are a first symptom. Therefore, a thorough medical exam plays an important role in ruling out other causes such as Parkinson's Disease or the side effects of medications used to treat other illnesses and conditions.

Responses to the medications used to treat or reduce the severity of hallucinations can inadvertently confirm a diagnosis of Dementia with Lewy bodies. Unlike people who have Alzheimer's Disease, people who have symptoms commonly associated with Dementia with Lewy bodies can have dangerous, and sometimes fatal reactions to antipsychotic medications such as haloperidol (Haldol) and risperidone (Risperdal). (See References 1 and 2 below.) This finding points to the importance of keeping detailed medical history notes and prescription records. This is especially true for first-time appointments and in the emergency room.

Lewy bodies are also found in other brain disorders such as Parkinson's Disease. Many people who have Parkinson's Disease eventually develop the thinking and reasoning difficulties associated with Dementia with Lewy bodies. Conversely, many people who have Dementia with Lewy bodies experience the shaking and shuffling gait associated with Parkinson's Disease. The overlap in symptoms and other evidence suggest that Dementia with Lewy bodies, Parkinson's Disease and Parkinson's Disease Dementia may share underlying abnormalities.

#lewybodydementia #unpredictable #earlysymptomsvary

Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of content contained within blog posts - that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor.

Source 1, accessed March 6th, 2016
Source 2, accessed March 15th, 2016

Identifying Frontotemporal Dementia

In 1892, the German neurologist and psychiatrist Arnold Pick described a case involving an elderly patient with progressive loss of speech and Dementia. Later, when the patient had died, the autopsy showed that certain parts of the brain had shriveled. Unlike the widespread shrinkage associated with Alzheimer’s Disease, this type of Dementia appeared to target the frontal and temporal lobes.

The two frontal lobes, located on the front of each half of the brain, contain the structures that control our executive functions such as planning, organizing, and solving problems. The frontal lobes also control behavior, emotions, and personality.

The two temporal lobes, located on each side of the brain just above the ear, give us the ability to perceive and recognize faces and objects and transfer short-term memories into our long-term memory banks.

It is not surprising to discover that people who have Frontotemporal Dementia may no longer seem like the people we once knew. A parent who was once friendly, polite, and careful about their appearance may say and do socially unacceptable things. Emotional blunting, or the inability to express verbal and non-verbal feelings, is another characteristic of this type of Dementia.

Another clue that can indicate Frontotemporal Dementia is difficulty in using and understanding spoken and written language. Language difficulties include repeated mispronunciations, and the inability to make appropriate associations between objects and their name. Frontotemporal lobe patients may use words and phrases like “this,” “that” and “over there” in the place of specific nouns and descriptions. People who have Frontotemporal Dementia are not aware of how they have changed.

Scientists do not know the cause of Frontotemporal Dementia. However, research demonstrates that genetics often plays a role in its development. Some studies show alterations in genes that code for specific brain proteins in nearly 45 percent of people who have family members who have certain types of Frontotemporal Dementia.1 These altered proteins form insoluble deposits in brain neurons. The deposition of the proteins causes the neurons to swell, burst open and die.2

It appears that genes play a role in nearly 45 percent of people who have Frontotemporal Dementia.1 However, it is also important to remember that for more than in 50 percent of Frontotemporal Dementia families, genetics either does not play a role or is not yet an understood factor.

Tests are available to determine if the Frontotemporal Dementia that you, or another family member, have is genetic in origin. Making the decision to undergo testing is not always easy. It is important to consider how you and other family members might feel if you should receive positive results. Will knowing make you anxious, relieved, or empowered? Will other family members also want testing? How might this information affect family planning for you or your adult children? Will having a positive test influence your employer or make it more difficult to receive health or life insurance?


Anybody would find these and many other questions difficult to answer. Often, people find talking with a genetic counselor can make the decision to test – or not – easier. The genetic counselor, by explaining the technical and emotional issues associated with genetic testing, can help you make a comfortable decision. Afterwards, the genetic counselor can explain the test results to you and guide discussion about any further steps you may want to take. 

Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through

Amazon.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org.

#frontotemporaldementia #emotionalblunting #genetictesting #dementiasocietyBLOG

References:
1.     HS Kirshner, “Frontotemporal lobe dementia: Genetic Distribution and Variation,” http://emedicine.medscape.com/article/1135164-overview#aw2aab6b4 (accessed March 5, 2016).
2.     W Leonard, MpH“Causes of Dementia,” http://www.healthline.com/health/dementia (accessed March 6, 2016).

What is Your Compass Rose?

Have you ever taken a cruise, or even thought about doing so? Getting aboard a cruise ship for the first time and not knowing what is coming next might create a bit of fear. Fear that may have kept you from booking the trip for months, and maybe from doing it at all. Not being able to “see land,” or the destination, can sometimes lead to anxiety. But turn that understanding around, once experienced, you may not be able to imagine a life without the joy of meeting new people and exploring new cultures. But even well-worn ship captains use tools on every voyage, to safely navigate and make steady progress, a map and a compass. Not knowing what’s coming next can be frustrating and even disastrous, but with guidance and the right information, there can be a steady calm in the midst of the stormiest weather.

Dementia, like cancer, is a term often fraught with an enormous amount of fear and anger stemming in large part, from a shortage of information, or sometimes, too much. It's not uncommon for someone who has lived with a chronic and/or life-threatening illness, or who has acted as a caregiver, upon hearing the topic of a specific disease feels so much pain that they do not wish to revisit the experience in any way, shape or form. Repeated exposure may help dampen the immediate response, but deep down, without an ability to process the unpleasant feelings, and without the right tools, it can remain painful for some time.

In the case of Dementia, knowing is hard, but good. It's hard because we basically understand the nature of what it is, a gradual loss of cognitive abilities. But it's also good, and valuable, because the act of “knowing more” can actually relieve at least some of the anxiety. Having a map and a compass allows you to plan your actions and enhance your responses as you cross the sea of life.

Without a doubt, if you believe you or a loved one or friend is experiencing one or more cognitive challenges, it is imperative to sort through what's going on and begin to understand the possible causes, progression (if, in fact, it's Dementia), care or interventions that make the most sense given whatever you learn. Neurologists (brain specialists), and particularly those who specialize in Dementia, are the current “Ship Captains” for a full cognitive work-up. 

That's not to say that primary care physicians don't play an important role, they do. Even trained social workers, nurses, psychologists, psychiatrists and many other types of healthcare professionals can lend a hand with identifying issues which need more insight and testing. Don't walk out of an annual check-up and say “everything's okay,” if you know in your heart-of-hearts it isn't, or if others you respect and love say that there's something “still going on.” Dig deeper. Get a check-up from the neck-up, as Zig Ziglar used to say. Having a “neuropsych” examination, as well as blood tests, a nutritional evaluation and maybe even certain scans or more advanced tests are often the right thing to do. Eliminate all possible causes, even reversible forms, of cognitive difficulty and as with most major health issues, seek second opinions as necessary.

Over the next four months we're going to more closely explore the following leading forms of Dementia: Alzheimer's Disease, Vascular Dementia, Lewy Body Dementia and Frontotemporal Dementia. Then we will follow with lesser known types of Dementia which may result from traumatic brain injury (TBI), repetitive concussions (CTE), infections/viruses (CJD and HIV), alcoholism and others. Knowledge is like a compass rose, always pointing north, it can guide, empower, and reduce anxiety. Like a ship setting sail to a new port of call, with a good map and a reliable compass, having "knowledge" tools enable you to chart a course towards your best possible tomorrows.

Author: Kevin Jameson, Volunteer | President | Chairman, Dementia Society of America. 

Dementia Society, Inc. does not provide medical advice. Please consult your doctor.

Learn more at www.dementiasociety.org.

#KnowDementia #DementiaSociety #CompassRose