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Dementia & Alzheimer's Information

Alzheimer's Support Group -  The support group is open to family members and to the community and meets every 3rd Tuesday of the month at 5:30pm.  The support group has speakers from the Alzheimer's Association and people from the community who have loved ones with Alzheimer's.  This is a time for sharing and support. It allows the family to know there are people like them and they have someone to call on should they need help.

Princeton Health Care Center works with two hospice entities from our area to help residents and their families cope with end of life issues.

Dementia

Overview 

Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior.

Alternative Names 

Chronic brain syndrome; Lewy body dementia; DLB; Vascular dementia; Mild cognitive impairment; MCI

Causes 

Most types of dementia are nonreversible (degenerative). Nonreversible means the changes in the brain that are causing the dementia cannot be stopped or turned back. Alzheimer's disease is the most common type of dementia.

Lewy body disease is a leading cause of dementia in elderly adults. People with this condition have abnormal protein structures in certain areas of the brain.

Dementia also can be due to many small strokes. This is called vascular dementia.

The following medical conditions also can lead to dementia:

Some causes of dementia may be stopped or reversed if they are found soon enough, including:

Dementia usually occurs in older age. It is rare in people under age 60 - although some people in their 40s and 50s have been diagnosed with dementia. The risk for dementia increases as a person gets older - 50% of people 85 and older will get dementia.

Symptoms 

Dementia symptoms include difficulty with many areas of mental function, including:

  • Language
  • Memory
  • Perception
  • Emotional behavior or personality
  • Cognitive skills (such as calculation, abstract thinking, or judgment)

Dementia usually first appears as forgetfulness.

Mild cognitive impairment is the stage between normal forgetfulness due to aging and the development of dementia. People with MCI have mild problems with thinking and memory that do not interfere with everyday activities. They are often aware of the forgetfulness. Not everyone with MCI develops dementia.

Symptoms of MCI include:

  • Forgetting recent events or conversations
  • Difficulty performing more than one task at a time
  • Difficulty solving problems
  • Taking longer to perform more difficult mental activities

The early symptoms of dementia can include:

  • Language problems, such as trouble finding the name of familiar objects
  • Misplacing items
  • Getting lost on familiar routes
  • Personality changes and loss of social skills
  • Losing interest in things you previously enjoyed, flat mood
  • Difficulty performing tasks that take some thought, but that used to come easily, such as balancing a checkbook, playing games (such as bridge), and learning new information or routines

As the dementia becomes worse, symptoms are more obvious and interfere with the ability to take care of yourself. The symptoms may include:

  • Forgetting details about current events
  • Forgetting events in your own life history, losing awareness of who you are
  • Change in sleep patterns, often waking up at night
  • More difficulty reading or writing
  • Poor judgment and loss of ability to recognize danger
  • Using the wrong word, not pronouncing words correctly, speaking in confusing sentences
  • Withdrawing from social contact
  • Having hallucinations, arguments, striking out, and violent behavior
  • Having delusions, depression, agitation
  • Difficulty doing basic tasks, such as preparing meals, choosing proper clothing, or driving

People with severe dementia can no longer:

  • Understand language
  • Recognize family members
  • Perform basic activities of daily living, such as eating, dressing, and bathing

Other symptoms that may occur with dementia:

  • Incontinence
  • Swallowing problems

Tests & diagnosis 

Dementia can often be diagnosed with a history and physical exam by a skilled doctor or nurse. A health care provider will take a history, do a physical exam (including a neurological exam), and perform some tests of mental function called a mental status examination.

The health care provider may order tests to help determine whether other problems could be causing dementia or making it worse. These conditions include:

  • Thyroid disease
  • Vitamin deficiency
  • Brain tumor
  • Intoxication from medications
  • Chronic infection
  • Anemia
  • Severe depression

The following tests and procedures may be done:

Treatment 

For information on how to take care of a loved one with dementia, see: Dementia - home care

The goal of treatment is to control the symptoms of dementia. Treatment depends on the condition causing the dementia. Some people may need to stay in the hospital for a short time.

Stopping or changing medications that make confusion worse may improve brain function.

There is growing evidence that some kinds of mental exercises can help dementia.

Treating conditions that can lead to confusion often greatly improve mental functioning. Such conditions include:

  • Anemia
  • Decreased oxygen (hypoxia)
  • Depression
  • Heart failure
  • Infections
  • Nutritional disorders
  • Thyroid disorders

Medications may be needed to control behavior problems caused by a loss of judgement, increased impulsivity, and confusion. Possible medications include:

  • Antipsychotics (haloperidol, risperdal, olanzapine)
  • Mood stabilizers (fluoxetine, imipramine, citalopram)
  • Serotonin-affecting drugs (trazodone, buspirone)
  • Stimulants (methylphenidate)

Certain drugs may be used to slow the rate at which symptoms worsen. The benefit from these drugs is often small, and patients and their families may not always notice much of a change.

  • Donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne, formerly called Reminyl)
  • Memantine (Namenda)

A person's eyes and ears should be checked regularly. Hearing aids, glasses, or cataract surgery may be needed.

Psychotherapy or group therapy usually does not help because it may cause more confusion.

Prognosis 

People with mild cognitive impairment do not always develop dementia. However, when dementia does occur, it usually gets worse and often decreases quality of life and lifespan.

Complications 

Complications depend on the cause of the dementia, but may include the following:

  • Abuse by an overstressed caregiver
  • Increased infections anywhere in the body
  • Loss of ability to function or care for self
  • Loss of ability to interact
  • Reduced lifespan
  • Side effects of medications used to treat the disorder

When to contact a doctor 

Call your health care provider if:

  • Dementia develops or a sudden change in mental status occurs
  • The condition of a person with dementia gets worse
  • You are unable to care for a person with dementia at home

Prevention 

Most causes of dementia are not preventable.

You can reduce the risk of vascular dementia, which is caused by a series of small strokes, by quitting smoking and controlling high blood pressure and diabetes. Eating a low-fat diet and exercising regularly may also reduce the risk of vascular dementia.

Alzheimer's Disease

What is Alzheimer's

Alzheimer's is a brain disease that causes problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks.

 The basics

  • Alzheimer's is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer's disease accounts for 50 to 70 percent of dementia cases.
  • Alzheimer's is not a normal part of aging, although the greatest known risk factor is increasing age, and the majority of people with Alzheimer's are 65 and older. But Alzheimer's is not just a disease of old age. Up to 5 percent of people with the disease have early-onset Alzheimer's (also known as younger-onset), which often appears when someone is in their 40s or 50s.

  • Alzheimer's worsens over time. Alzheimer's is a progressive disease, where symptoms gradually worsen over a number of years. In its early stages, memory loss is mild, but with late-stage Alzheimer's, individuals lose the ability to carry on a conversation and respond to their environment. Alzheimer's is the sixth leading cause of death in the United States. Those with Alzheimer's live an average of eight years after their symptoms become noticeable to others, but survival can range from three to 20 years, depending on age and other health conditions.

  • Alzheimer's has no current cure, but treatments for symptoms are available and research continues. Although current Alzheimer treatments cannot stop Alzheimer's from progressing, they can temporarily slow the worsening of symptoms and improve quality of life for those with Alzheimer's and their caregivers. Today, there is a worldwide effort under way to find better ways to treat the disease, delay its onset, and prevent it from developing.
    Symptoms

The most common early symptom of Alzheimer's is difficulty remembering newly learned information.

Just like the rest of our bodies, our brains change as we age . Most of us eventually notice some slowed thinking and occasional problems with remembering certain things. However, serious memory loss, confusion and other major changes in the way our minds work may be a sign that brain cells are failing.

The most common early symptom of Alzheimer's is difficulty remembering newly learned information because Alzheimer changes typically begin in the part of the brain that affects learning. As Alzheimer's advances through the brain it leads to increasingly severe symptoms, including disorientation, mood and behavior changes; deepening confusion about events, time and place; unfounded suspicions about family, friends and professional caregivers; more serious memory loss and behavior changes; and difficulty speaking, swallowing and walking.

There are many conditions can disrupt memory and mental function. Anyone experiencing significant memory problems should see a doctor as soon as possible. If you need assistance finding a doctor with experience evaluating memory problems, your local Alzheimer's Association chapter can help. Early diagnosis and intervention methods are improving dramatically, and treatment options and sources of support can improve quality of life

10 Signs of Alzheimer's

Memory loss that disrupts daily life is not a typical part of aging. It may be a symptom of Alzheimer's, a fatal brain disease that causes a slow decline in memory, thinking and reasoning skills. Every individual may experience one or more of these signs in different degrees. If you notice any of them, please see a doctor. Learn how Alzheimer's affects the brain and take the Brain Tour.

10 warning signs of Alzheimer's:

 

Memory loss that disrupts daily life


One of the most common signs of Alzheimer's is memory loss, especially forgetting recently learned information. Others include forgetting important dates or events; asking for the same information over and over; relying on memory aides (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own.

What's a typical age-related change? Sometimes forgetting names or appointments, but remembering them later.

 

Challenges in planning or solving problems

 

Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before.

What's a typical age-related change? Making occasional errors when balancing a checkbook.

 

Difficulty completing familiar tasks at home, at work or at leisure

 

People with Alzheimer's often find it hard to complete daily tasks. Sometimes, people may have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favorite game.

What's a typical age-related change? Occasionally needing help to use the settings on a microwave or to record a television show.

 

Confusion with time or place

 

People with Alzheimer's can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there.

What's a typical age-related change? Getting confused about the day of the week but figuring it out later.

 

Trouble understanding visual images and spatial relationships

 

For some people, having vision problems is a sign of Alzheimer's. They may have difficulty reading, judging distance and determining color or contrast. In terms of perception, they may pass a mirror and think someone else is in the room. They may not realize they are the person in the mirror.

What's a typical age-related change? Vision changes related to cataracts.

 

New problems with words in speaking or writing

 

People with Alzheimer's may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a "watch" a "hand-clock").

What's a typical age-related change? Sometimes having trouble finding the right word.

 

Misplacing things and losing the ability to retrace steps

 

A person with Alzheimer's disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time.

What's a typical age-related change? Misplacing things from time to time, such as a pair of glasses or the remote control.

 

Decreased or poor judgment

 

People with Alzheimer's may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean.

What's a typical age-related change? Making a bad decision once in a while.

 

Withdrawal from work or social activities

 

A person with Alzheimer's may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced.

What's a typical age-related change? Sometimes feeling weary of work, family and social obligations.

 

Changes in mood and personality

 

The mood and personalities of people with Alzheimer's can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone.

What's a typical age-related change? Developing very specific ways of doing things and becoming irritable when a routine is disrupted.

 

Misplacing things and losing the ability to retrace steps

 

A person with Alzheimer's disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time.

What's a typical age-related change? Misplacing things from time to time, such as a pair of glasses or the remote control.

 

Decreased or poor judgment

 

People with Alzheimer's may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean.

What's a typical age-related change? Making a bad decision once in a while.


Withdrawal from work or social activities

 

A person with Alzheimer's may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced.

What's a typical age-related change? Sometimes feeling weary of work, family and social obligations.

 

Changes in mood and personality

 

The mood and personalities of people with Alzheimer's can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone.

What's a typical age-related change? Developing very specific ways of doing things and becoming irritable when a routine is disrupted

Risk Factors

Scientists have identified factors that increase the risk of Alzheimer's. The most important risk factors—age, family history and heredity—can't be changed, but emerging evidence suggests there may be other factors we can influence.

Age

The greatest known risk factor for Alzheimer's is advancing age. Most individuals with the disease are age 65 or older. The likelihood of developing Alzheimer's doubles about every five years after age 65. After age 85, the risk reaches nearly 50 percent. One of the greatest mysteries of Alzheimer's disease is why risk rises so dramatically as we grow older.

Family history

Another strong risk factor is family history. Those who have a parent, brother, sister or child with Alzheimer's are more likely to develop the disease. The risk increases if more than one family member has the illness. When diseases tend to run in families, either heredity (genetics) or environmental factors, or both, may play a role.

Genetics (heredity)

Scientists know genes are involved in Alzheimer's. There are two types of genes that can play a role in affecting whether a person develops a disease—risk genes and deterministic genes. Alzheimer genes have been found in both categories.

1.  Risk genes increase the likelihood of developing a disease, but do not guarantee it will happen. Scientists have so far identified several risk genes implicated in Alzheimer's disease. The risk gene with the strongest influence is called apolipoprotein E-e4 (APOE-e4). Scientists estimate that APOE-e4 may be a factor in 20 to 25 percent of Alzheimer cases.

APOE-e4 is one of three common forms of the APOE gene; the others are APOE-e2 and APOE-e3. Everyone inherits a copy of some form of APOE from each parent. Those who inherit APOE-e4 from one parent have an increased risk of Alzheimer's. Those who inherit APOE-e4 from both parents have an even higher risk, but not a certainty. Scientists are not yet certain how APOE-e4 increases risk. In addition to raising risk, APOE-e4 may tend to make Alzheimer symptoms appear at a younger age than usual.  

2.  Deterministic genes directly cause a disease, guaranteeing that anyone who inherits them will develop the disorder. Scientists have discovered variations that directly cause Alzheimer's disease in the genes coding three proteins: amyloid precursor protein (APP), presenilin-1 (PS-1) and presenilin-2 (PS-2).

When Alzheimer's disease is caused by these deterministic variations, it is called "autosomal dominant Alzheimer's disease (ADAD)" or "familial Alzheimer's disease," and many family members in multiple generations are affected. Symptoms nearly always develop before age 60, and may appear as early as a person's 30s or 40s. Deterministic Alzheimer variations have been found in only a few hundred extended families worldwide. True familial Alzheimer's accounts for less than 5 percent of cases.  

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