According to the National Institute of Mental Health (NIMH) over five million Americans are living with Alzheimer's disease or a related dementia. Countless others are affected by their illness. Because these diseases are so prevalent, everyone must raise their awareness of the diseases themselves, the persons being treated, drugs used for treatment, and known effective behavior management strategies of others. In order to have a successful encounter, a person must also have ingenuity, creativity, flexibility and patience. The goal is to keep dementia folks at their highest level of physical and mental functioning.
Understanding Alzheimer's disease and related dementias
Dementia is a declin in cognitive function. This decline often impairs the ability to carry out everyday activities such as driving; household chores; and even personal care such as: bathing, dressing, and feeding. It is primarily a condition that affects the elderly. In some cases it is reversible.
It is not an inevitable part of aging. Instead, dementia is caused by specific brain diseases. Alzheimer's disease is the most common cause, followed by vascular or multi-infarct dementia. Often there is a combination of Alzheimer's disease and some other type of dementia. Other types of dementia are frontotemporal lobe dementia (FTD) and Lewy Body disease.
The most common form of dementia is Alzheimer's disease which is a brain disorder named for German physicist Alois Alzheimer, who first described it in 1906. The hallmark of the disease is the development two abnormal structures called plaques and tangles which kill brain cells causing a decline in mental functioning. It is not reversible and eventually causes death. No matter what the cause of the dementia, there is a slow gradual loss of short term memory and always long term memory with a great deal of confusion. Frequently there are personality changes and changes in mood and behavior because of anxiety, depression delusions or hallucinations. Because of this, a dementia person is often uncooperative.
Understanding those with these diseases
Since these diseases can have such varied symptoms, it is important to know the person you are dealing with. You need to know favorite pastimes, likes, dislikes, strengths, weaknesses, hobbies etc. You will also need to know problem behaviors and triggers for these behaviors. You need to know his daily routine and sleep- wake pattern. You will need to know what medications he is on and possible side effects.
Most diseases that cause dementia are progressive. Unfortunately, there is no cure. Current treatment medications however, can temporarily improve symptoms and functioning and may slow the progress of the basic disease process.
There are several types of medications that are used to treat the dementias. Some slow the progress of the diseases and some improve the behaviors associated with the diseases.
There are currently four medicines, tacrine (Cognex), donepezil (Aricept), rivastigmine tartrate (Exelon) and galantamine (Reminyl), which are used to slow the intellectual decline in some people with mild to moderate Alzheimer's disease for periods up to 18 months . These drugs (called cholinesterase inhibitors) increase the brain's levels of acetylcholine, which helps to restore communication between brain cells.
Another medication, memantine (Namenda), has been shown to stabilize memory in people with moderate to severe Alzheimer's disease. It is the first in a new class of medications called NMDA receptor antagonists.
Unfortunately all these drugs can have side effects which may limit or preclude their use.
Estrogen and nonsteroidal anti-inflammatory drugs may also protect individuals from developing Alzheimer's disease. Antipsychotic medications may be used to treat psychosis and agitation in those with dementia. Other medications such as sleep aids may also be used.
Understanding successful strategies
There are certain approaches that have worked well in communicating effectively with dementia folks.
Remember, Keeping the mind active is key for those affected by this disease because it allows them to hold onto their remaining cognitive skills longer and enhances their mood, states Dr. Paul Raia of the Massachusetts Alzheimer's Association
The carer, whether it is a loved one, home health aid, nurse, CNA, social worker, activity professional or another health care provider, must be upbeat animated and excited about the interaction. As these diseases progress, interactions will get shorter until they may only last a moment. The dementia person takes his lead from the carer. He can sense when someone is not enthusiastic about being there.
Since you as the carer know about the dementia person, you will focus on things he likes to do. However getting anyone to laugh or smile is a good thing no matter what. Also giving out compliments and hugs will put most dementia folks in a good mood. In addition babies and pets lift the spirits of a dementia person. If you can not arrange for visits with live babies or animals, large colorful photographs of either are almost as good. It will also give them an opportunity to reminisce.
Now that they are in a good mood, proceed to what tasks need to be accomplished. Make sure you give them ample time to respond to a question by being patient and helping them find the right word if they have trouble. Never argument. The days of reality orientation are over. Trying to do this will most often agitate dementia persons. Enter their reality. Also allow those with dementia to express their feelings. Emotion is one of the last things to go.
Make sure you nip agitated behavior in the bud. Then divert and redirect him to something pleasant. You may have to use the therapeutic fiblets (an untruth told to a person with dementia to make him feel better) Often when this troubled behavior escalates, there is no stopping it except with medication.
Finally, you as the carer must take care of yourself. Attend a support group. There are many online if you do not want to leave home. Make sure you eat right and get enough sleep.
At least one of the 5 million people with Alzheimer's disease or a related dementia is counting on you to have an Alzheimer's encounter of the best kind