Holidays and Alzheimer's

The holidays are typically a joyous time, a time for friends and family to come together, a time for food and festivities. Holidays with a person coping with Alzheimer’s disease can be a challenge. The activity and noise can be confusing, the gatherings of people can be disruptive, and the lights and sounds can be upsetting. There are things you can do to help make the holidays more manageable.

1. Minimize the loud noises that we often associate with the holidays. A football game on television, holiday music and multiple conversations around a person with Alzheimer’s can be confusing. A calm, quite gathering is usually best. Limiting the number of people at a gathering can also help with the noise factor.

2. Keep decorations simple. Blinking lights and decorative displays can be confusing. Avoid artificial fruits, which can be mistaken for real food. In addition, do not use candles or decorations with an open flame.

3. Keep the day short so that it is not over-stimulating or over-tiring. The same is true for travel.

4. Whenever possible, hold events in familiar places. This will help minimize confusion for a person with memory loss.

5. Engage the person with Alzheimer’s but keep it simple and familiar. Putting ornaments on a tree, decorating cookies or singing familiar holiday songs can be enjoyable options.

6. If the person lives in a facility, try bringing them home for a short visit once or twice beforehand. If the home visit seems too stressful, consider visiting the facility instead. This will help minimize confusion and agitation.

7. Schedule festivities and visits for the best time of day for the person with Alzheimer’s. Typically morning or early afternoon is better than later in the day.

8. Consult a Geriatric Care Manager to assess your loved one and develop a plan of care to help you manage the holiday season.

Celebrating the holidays with a person coping with Alzheimer’s disease requires some planning and may require a change to the prior year’s routine. Following these steps will help make the holiday joyous and less confusing for the person with memory loss. Remember, although Alzheimer’s disease affects a person’s ability to remember, they can still enjoy the holidays in the moment.

By Heather Frenette, RN, MSN, CMC

Chief Operating Officer- Arizona Care Management

Parkinson’s Signs and Symptoms

There are various Parkinson’s signs and symptoms, some people suffer from all the symptoms others suffer only a few symptoms.

Most people with Parkinson's do not develop all of the symptoms associated with the disease.
Parkinson’s disease might progress quickly and for others it’s a more gradual process over years. Some Parkinson’s sufferers become slowly more disabled and others function fairly well.

Parkinson’s symptoms vary from day to day or even moment to moment. This could be because of the disease process or to the anti-parkinson medication.

Parkinson’s Primary Symptoms:
Bradykinesia: A slowness in controlled movement. It produces difficulty start a movement, or a difficulty finishing movement once it is in progress. It’s because there is a delay in transmitting a signal from the brain to the muscles – this is due to low dopamine in the brain, this produces bradykinesia.

Tremors: Tremors occur in the hands, fingers, forearm, or foot tend usually when the limb is at rest. Usually there are no tremors when performing a task. Tremors can also occur in the mouth and chin as well.

Rigidity: Rigidity produces stiff muscles, which in turn can produce muscle pain in the sufferer. Also rigidity can give the Parkinson’s sufferer an expressionless face as if they are wearing a mask. Rigidity tends to become worse during movement.

Poor balance: Parkinson’s sufferers often suffer from poor balance this is because of loss of the reflexes that usually adjust the posture in order to maintain balance. Poor balance can lead to falls which is common in people with Parkinson's.

Parkinsonian gait: Is a very distinctive walk which is connected to Parkinson's disease. A Parkinson’s gait will make the sufferer lean forward or backward in a very unnaturally way. The person will also develop a stooped, head-down, shoulders-drooped stance. Also instead of the normal stride a Parkinson’s sufferer will take small shuffling steps (called festination). Often people who suffer from Parkinson’s may also have trouble starting to walk – it’s as if they are glued to the spot. They can also freeze in mid-stride, and have difficulty making a left or right turn.

Parkinson’s Secondary Symptoms
Parkinson’s is a progressive disease and in the secondary stages will affect the loss of voluntary and involuntary muscle control. Though not all patients experience all of these symptoms and they can vary from person to person.

Here are some secondary symptoms:
Anxiety, isolation and depression – Parkinson’s sufferers can feel extreme anxiety for instance: if things are not put in the right place or if people visit. They often also feel very isolated which can cause depression.

Difficulty swallowing (dysphagia)– saliva and food can collect in the mouth and may cause choking, coughing, or drooling.

Excessive salivation (hypersalivation)

Excessive sweating – sufferers can suffer from excessive sweating. Make sure they wear layered clothing that are easy to take on and off.

Loss of bladder and/or bowel control – Some of Parkinson’s sufferers become incontinent over time. They can also suffer from constipation.

Loss of intellectual capacity (dementia)– This is a late symptom in Parkinson’s disease – often childhood memories are the strongest while things that happened in the last few years are forgotten.

Scaling, dry skin on the face and scalp (seborrhea)

Slow response to questions – Ask questions in a very simple form – it is already often that a question such as “would you like jam or marmite?” can confuse a Parkinson’s sufferer. It is better to ask “would you like jam?” and go from there.

Small, cramped handwriting (micrographia)

Soft, whispery voice – The voice of a Parkinson’s sufferer can become so soft that you can hardly hear them. It’s very important to always take the time to sit and listen to the patient.

By Beth Maxwell

Dementia and How it is Diagnosed

Many of us may from time to time, forget our neighbor’s name or the items to purchase at the grocery store, and we wonder if this is part of normal aging. Your doctor is the best person to speak with regarding these concerns. There are many conditions that are treatable that may be contributing to periodic memory lapses.

Often when we think of dementia we think of Alzheimer’s disease. While Alzheimer’s disease is considered to be the underlying cause of between 60 and 80% of all dementia cases, there are also other conditions that might cause dementia. It is important to know about the other types and causes of dementia because treatment can vary between diseases and early detection can be beneficial in slowing the progression of incurable dementia's.

According to Dr. Harvey Gilbert, MD of the Gilbert Guide, some of the most common types of dementia and their causes are:

1. Vascular Dementia
This type of dementia is the second most common. It is caused by poor blood flow to the brain, depriving brain cells of the nutrients and oxygen they need to function normally. Vascular dementia can be caused by any number of conditions which narrow the blood vessels, including stroke, diabetes and hypertension.

2. Mixed Dementia
Sometimes dementia is caused by more than one medical condition. Most commonly, mixed dementia is caused by both Alzheimer's and vascular disease.

3. Dementia with Lewy Bodies (DLB)
Sometimes called Lewy Body Disease, this type of dementia is characterized by abnormal protein deposits called Lewy bodies that develop in nerve cells in the brain stem. This disrupts the brain’s ability to function normally and impairs cognition and behavior. It can also cause tremors and is often linked with Parkinson’s Disease and dementia. It is not reversible and there is no known cure.

4. Parkinson’s Disease Dementia (PDD)
Parkinson's disease is a chronic, progressive neurological condition, and in its later stages can affect cognitive functioning. Not all people with Parkinson’s disease will develop dementia, however. This type of dementia is also a lewy body dementia. Symptoms include tremors, muscle stiffness and speech problems. Reasoning, memory, speech, and judgment are also usually affected.

5. Frontotemporal Dementia
Pick's disease is the most common and recognized form of frontotemporal dementia. It is a rare disorder which causes damage to brain cells in the frontal and temporal lobes. This affects the individual’s personality significantly, usually resulting in a decline in social skills, along with emotional apathy. Unlike other dementia's, Pick’s disease usually results in behavior and personality changes occurring before memory loss and speech problems.

6. Creutzfeldt-Jacob Dementia (CJD)
A degenerative neurological disorder, CJD is also known as “mad cow disease”. The incidence is very low, occurring in only about one in one million people. There is no cure. Caused by viruses, CJD progresses rapidly, usually over a period of several months. Symptoms include memory loss, speech impairment, confusion, muscle stiffness and twitching, and a general lack of coordination, which makes the individual susceptible to falls. Sometimes blurred vision and hallucinations also occur with this form of dementia.

7. Normal Pressure Hydrocephalus (NPH)
Normal pressure hydrocephalus involves an accumulation of cerebrospinal fluid in the brain's cavities. When this fluid does not drain as it should, the associated build-up results in added pressure on the brain, interfering with the brain’s ability to function normally. Individuals with dementia caused by normal pressure hydrocephalus often experience problems with ambulation, balance and bladder control, as well as cognitive impairments involving speech, problem-solving abilities and memory.

8. Huntington’s Disease
Huntington's disease is an inherited progressive dementia that affects the individual’s cognition, behavior and movement. Symptoms include memory problems, impaired judgment, mood swings, depression and speech problems (especially slurred speech). Delusions and hallucinations may also occur. Individuals with Huntington’s disease may also experience difficulty walking, and uncontrollable jerking movements of the face and body

9. Wernicke-Korsakoff SyndromeWernicke-Korsakoff syndrome is caused by a vitamin B1 (Thiamine)deficiency and often occurs in alcoholics, although it can also result from malnutrition, cancers, abnormally high thyroid hormone levels, long-term dialysis and long-term diuretic therapy (used to treat congestive heart failure). The symptoms include confusion, permanent gaps in memory, and impaired short-term memory. Hallucinations may also occur. If treated early by supplement, this dementia can be reversed.

10. Mild Cognitive Impairment (MCI)
Dementia can be due to illness, medications and a host of other treatable causes. With mild cognitive impairment, an individual will experience memory loss, and sometimes impaired judgment and speech, but they are usually aware of this decline. These problems usually don’t interfere with the normal activities of daily living. Individuals with mild cognitive impairment may also experience behavioral changes that involve depression, anxiety, aggression and emotional apathy. This is often due to the awareness of and frustration related to his or her condition.

With an understanding of the types of dementia, questions begin to arise about how these diseases are diagnosed. What can a patient expect when trying to determine whether he or she has some form of dementia? What can a caregiver expect?

When you initially meet with your doctor, it is important to be honest with them about the symptoms the patient is experiencing, their duration, frequency and rate of progression. The doctor will then review your current health status, family history and medication history. This includes evaluating the patient for depression, substance abuse and nutrition, and other conditions that can cause memory loss, including anemia, vitamin deficiency, diabetes, kidney or liver disease, thyroid disease, infections, cardiovascular and pulmonary problems. The patient also undergoes a physical exam and blood tests. Diagnosing specific diseases causing dementia can be difficult and it may be necessary to ask for a referral to a doctor with expertise in this area. Additional tests that may be used in conjunction with the aforementioned approaches include the Mini Mental State Evaluation (MMSE), the Mini Cog Screen, and Medical Imaging (CT, MRI and PET scans).

The MMSE is an evaluation of the patient’s cognitive status. The patient is required to identify the time, date and place where the test is taking place, be able to count backwards, identify objects previously known to him or her, be able to repeat common phrases, perform basic skills involving math, language use and comprehension, and demonstrate basic motor skills.
The Mini Cog Screen takes only a few minutes to administer, and is used as an initial screening for dementia. The patient is required to identifying three objects in the office, then draw the face of a clock in its entirety from memory, and finally, recall the three items identified earlier.
Finally, medical imaging helps doctors see images of the patient’s brain to determine whether there are any growths, abnormalities or general shrinkage which occurs in Alzheimer’s disease. These medical imaging tests can help improve the accuracy of a dementia diagnosis to 90%.

Once a diagnosis has been made, doctors can help patients to look at various treatment options and can often provide information for caregivers and families about support groups and organizations that can provide them with information about their specific diagnosis. It is recommended that patients and their families try to learn as much as they can about the disease and how it is expected to progress. Organizations like Alzheimer’s Association or the Parkinson's Society can provide valuable information about the disease, its progression and tips on how to slow the progression of the disease and deal with symptoms. These organizations also provide support groups to both the patient and their caregivers to help deal with the blow of a dementia diagnosis. As mentioned earlier, early detection is often key in being able to reverse or slow the progression of many of these diseases. Having a basic understanding of the many dementia's that may occur and how they are diagnosed will be beneficial to physicians and families alike.

If you find that you simply do not know where to begin or how to handle this change in status and what it means for your future, a Geriatric Care Manager can assist you in making plans for the future.

For information on Care Managers in your area go to http://www.caremanager.org/ or for a care manager in Maricopa County click here.

By ElderCaring.ca