As the disease advances, the cognitive decline becomes associated with behavioral manifestations. What are these behavioral manifestations of dementia?

by: Michael G. Rayel, MD

Behavioral syndromes in Alzheimer’s can be grouped into two categories: psychological and behavioral. Major psychological syndromes consist of depression, anxiety, delusions, and hallucinations.

Depression in dementia is very common. Up to about 87% of patients develop some form of depression. It is characterized by tearfulness or crying episodes, feelings of sadness, and neurovegetative signs and symptoms such as inability to sleep, lack of appetite, poor energy, and thoughts of death. Irritability is also common. Depression can occur even in the early or mild phase of the illness.

About 50% of demented patients show delusions or false fixed beliefs. Such delusions include beliefs that a relative is stealing, that a spouse is just an impostor or is having an affair with a neighbor, or that friends and relatives are conspiring to cause trouble.

Moreover, many patients with dementia may experience hallucinations. Most of these hallucinations are visual — seeing strangers in the house, an animal or insects in the living room, people in the bedroom or on top of the TV set. Occasionally, auditory hallucinations may be experienced — hearing footsteps or knocking on the door or even people singing church hymns.

Regarding major behavioral syndromes associated with dementia, these problems include agitation, verbal outbursts, repetitive behavior, wandering, and aggression or even violence. Agitation can be manifested by pacing back and forth, restlessness, and inability to sit still.

Verbal outbursts consist of day-long screaming or occasional yelling at someone. Repetitive behavior is manifested by closing and opening a closet or a purse or a drawer. Asking questions repetitively for instance about a relative’s visit is very common.

Wandering can happen especially at the late stages of the illness. If doors are left unlock, some patients wander away from the house. Hence, safety level becomes an issue.

Aggression likewise may occur. Hitting the caregiver or throwing things are some complaints. Destroying things although rare can also ensue. A gentleman for example hit the wall with a cane and broke the window by smashing a chair.

Although difficult to deal with, most of these behavioral consequences of dementia can be treated especially if recognized and addressed early.

About The Author

Copyright © 2004. All rights reserved. Dr. Michael G. Rayel – author (First Aid to Mental Illness–Finalist, Reader’s Preference Choice Award 2002), psychiatrist, and inventor of Oikos Game: A Personal Development and Emotional Skills Game. To receive free newsletter, visit www.drrayel.com. For more information about Oikos Game, visit www.oikosgame.com. His books are available at major online bookstores.

mike@drrayel.com

As a clinician, my answer to queries is that Alzheimer’s dementia is only one type of dementia and that not all dementias are Alzheimer’s. Aside from Alzheimer’s disease, other dementias exist such as Dementia with lewy body, Vascular dementia, Parkinson’s disease with dementia, and dementias due to various neurologic and medical conditions.

How will you know if a person is suffering from Alzheimer’s dementia? What is Alzheimer’s dementia?

by: Michael G. Rayel, MD

Alzheimer’s dementia is a neurologic disorder characterized by a progressive and irreversible cognitive decline associated with impairment in functioning. The cognitive deterioration consists of memory impairment. Initially there is recent memory impairment but as the disease progresses, even the long term memory is affected.

In addition to memory impairment, a patient with dementia has impairment in one of four cognitive areas: aphasia, apraxia, agnosia, and impairment in executive functioning. Aphasia is a problem in language characterized by inability to express oneself, repeat words or phrases, or understand what is being said. Apraxia is inability to adequately perform a usual motor activity such as combing the hair or brushing the teeth despite no paralysis or musculoskeletal abnormality.

Agnosia is inability to recognize objects or things despite intact sensory functions. For instance, a demented patient cannot recognize a key or a pen placed in his or her hands without looking at it.

Impairment in executive functioning is characterized by difficulty in abstract reasoning and in organizing things, schedule, and activities. Patients with this problem give concrete meaning to proverbs. For example, when a patient is asked what “don’t cry over spilled milk” means, the patient responds, “It’s easy. Just wipe it!” Moreover, knowing the specific similarities and differences of certain things (e.g. apple versus orange) is a struggle for some patients.

What are the possible causes of Alzheimer’s?

The cause of Alzheimer is still unknown. However, several risk factors have been identified. One major risk factor is age. The risk of developing dementia increases as our age advances. Older individuals therefore are more at risk. Having said this, Alzheimer’s can also happen to young individuals.

Other important risk factors include the presence of apolipoprotein E4 allele, the predominance of plaques and tangles in the brain, and the brain’s impaired cholinergic system.

Is there any successful treatment for Alzheimer’s?

Alzheimer’s disease is irreversible so current medications are only geared to slow down the deterioration. These acetylcholisterase inhibitors, namely galantamine, rivastigmine, and donepezil, are aimed at improving the cholinergic functioning in the brain by inhibiting the cholinesterase enzyme. Although initially indicated for mild to moderate dementia, some recent evidence shows that some of these drugs may also benefit patients with moderate to severe dementia. Further studies are warranted to determine its efficacy in this group.

About The Author

Copyright © 2004. All rights reserved. Dr. Michael G. Rayel – author (First Aid to Mental Illness–Finalist, Reader’s Preference Choice Award 2002), speaker, workshop leader, and psychiatrist. Dr. Rayel pioneers the CARE Approach as first aid for mental health. To receive free newsletter, visit www.drrayel.com. His books are available at major online bookstores.

mike@drrayel.com

• Does your loved one ignore your feelings?
• Is he disrespectful?
• Does he withhold approval, appreciation or affection?
• Does he walk away without answering you?
• Does he criticize you, call you names or yell at you?
• Does he humiliate you in public or in the privacy of your home?
• Does he tell you that you are too sensitive?
• Does he destroy furniture or punch holes in the walls?

by: William Hammond, J.D.

These are some of the signs, but there are many more that may be observed. Abuse is difficult to deal with if the abuser has Alzheimer’s disease since the abuser can’t really control it.

If a person with Alzheimer’s becomes verbally abusive, it may be because he is suffering from depression or aggressive behavior caused by the disease. In this case you might want to involve your doctor and let him know the situation. He may be able to prescribe an anti-depressive medication or simply change the current medication. You may want to take a break from your loved one, as sometimes caring all the time for the same person can be exhausting. Or you can try to place your loved one in an adult day care, or hire some professional help. Make sure that substitute caregivers are knowledgeable about Alzheimer’s disease and know how to handle patients with dementia.

One way to deal with the situation before it becomes a big problem is to try humor. You cannot control how your loved one is acting but you can decrease the feelings of frustration by controlling how you respond. Try to validate your loved one’s feelings; it will definitely help him. Many times, people with Alzheimer’s are so frustrated that they act it out through verbal abuse and aggression. Put yourself in his place. It is very frustrating!

The most important thing you have to remember is not to talk “down” to your loved one because he is still a person with an entire life history of success and independence. If you see that what you are trying to do or say to him is not working, just let it go for a while, step out of the room and come back later. Let your loved one calm down and relax. You may want to try music. Studies have shown that Alzheimer’s patients often find music relaxing.

Finally, if you still feel overwhelmed, join a support group that specifically deals with verbal abuse and learn how to cope with it. Many times other people in the group will have experienced the same ordeal with their loved ones. Group members may be able to counsel you on how they coped or dealt with this kind of behavior.

This group will also help you to deal with your emotions and frustrations. They will tell you how to control them, and once you are able to deal with your own feelings, then you will be more effective coping with your loved one’s behavior.

About The Author

William G. Hammond, JD is a nationally known elder law attorney and founder of The Alzheimer’s Resource Center. He is a frequent guest on radio and television and has developed innovative solutions to guide families who have a loved one suffering from Alzheimer’s. For more information you can visit his website at www.BeatAlzheimers.com.

For Scientists the largest concern is what causes Alzheimer’s and how can it be eradicated. For possible victims and their families it is how do we prevent the dreaded affliction or stop it in its tracks once it is diagnosed.


by: Aaron Cummings

Scientists are in agreement and have narrowed down the contributing factor causing Alzheimer’s disease. Most researchers agree that Beta-amyloid is one of the agents thought to cause damage to the brain in Alzheimer’s disease. The research is attempting to find a deterrent and is recognizing antioxidants to be significant in protecting at risk patients.

According to the Harvard Medical Center, continuing research and studies are being conducted with some positive results. Even though some studies by the French point to wine as a protectant, the results are considerably controversial. The component in the wine that was indicated to be responsible for the protectant agent is still somewhat ambiguous.

Recent studies, including the study on wine, point to antioxidants for Alzheimer and Dementia risk reduction.

In an Italian study conducted by A. Russo, et.al., it was found that black grape skin extract protected cells in a test tube from oxidative damage and DNA fragmentation when exposed to beta-amyloid. An even more recent study by E. Savaskan, et.al, examined the red wine ingredient resveratrol, and found it to be neuroprotective against beta-amyloid oxidative stress, again supporting an antioxidant mechanism.

What these studies point to is, red wine may have an effect that could provide some protection against Alzheimer’s disease, but indication says it is the antioxidant factor that is the hero. This is consistent with the fact that other antioxidants, most notably vitamin E, are being studied with great interest as potential protective agents against Alzheimer’s disease. According to Dr. Steve Seiner, of Harvard Medical School, “While the results of these studies do not necessarily suggest that people should drink wine in order to lower their risk of Alzheimer’s disease, they do support the potential role of antioxidant treatment in preventing or delaying Alzheimer’s disease.

In another study by Robert P. Friedland, MD chief of the neurogeriatrics laboratory at Case Western Reserve University School of Medicine, “If antioxidants prove to protect against Alzheimer’s disease, it is probably because they reduce what is called ‘oxidative stress’ in cells.” He went on to say that his team believes free radicals are the culprit of oxidative stress in cells caused by the inappropriate consumption of some foods such as those in high fat content. In this study Friedland is recommending a “to-do” list for those who want to improve their chances of maintaining a healthy brain. He suggests:

* Eat a diet high in antioxidants

* Eat fish

* Take vitamin E

* Take B vitamins

* Take folic acid

* Be mentally and physically active throughout life

* Avoid head injuries

When addressing the reduction of free radicals it is essential to recognize the importance of Oligomeric Proanthocyanidins (OPC’s) as the most powerful antioxidant known in scientific studies. OPC’s are products commonly derived from a combination of grape seed extract, red wine extract and/or pine bark extract. They are very powerful bioflavanoids used as a natural food supplement ready to be absorbed into the body and begin to attack the free radicals.

OPC’s are safe and have been used for over 20 years throughout Europe. Extensive studies and laboratory testing reveal no evidence for human toxicity, allergic reactions, birth defects, or carcinogenicity. OPC’s work synergistically with other antioxidant vitamins, regenerating the antioxidant properties of vitamin C and vitamin E.

However, Bill Thies, PhD, vice president of medical and scientific affairs for the Alzheimer’s Association says although Friedmand’s recommendations are probably useful and that he agrees with all of them, he wants to “be very clear that the association is not making any recommendations about ways to prevent Alzheimer’s. Thies is, however, involved in reading and learning about all studies concerning Alzheimer’s Disease.

A study conducted in Rotterdam, Netherlands, Dr. Monique Breteler with the Eras UM Medical Center, found the antioxidants beta-carotene, vitamin C, and vitamin E appear to be equally protective as a reducing factor in the fight against Alzheimer’s. Her results of the 5,000 volunteers over the past 14 years, confirmed some earlier studies that point to antioxidants as a way to lower risk of dementia. She also said the protective effect of antioxidants was “more pronounced among smokers and among those who are carriers of the Alzheimer’s gene.”

It was also pointed out that diets rich in antioxidants are helpful, but in order to consume the necessary requirements, a person would have to triple, or more, their current consumption, which Breteler says, is most unlikely. Recommendations for proper amounts of ingestion are through antioxidant supplements including OPC’s, vitamin E and vitamin C.

About The Author
Editor of the OPC Antioxidant Reference Guide. www.opc.cc
http://www.elderly-advocates.com/articles/behavioral-manifestations-of-alzheimer%e2%80%99s-dementia Alzheimer’s Dementia has a combination of cognitive and behavioral manifestations. Cognitive impairment is the core problem which includes memory deficits and at least one of the following: aphasia or language problem, agnosia or problems with recognition, apraxia or motor activity problem, and impairment in executive functioning (e.g. planning, abstract reasoning, and organizing).

As the disease advances, the cognitive decline becomes associated with behavioral manifestations. What are these behavioral manifestations of dementia?

(by: Michael G. Rayel, MD)
Behavioral syndromes in Alzheimer’s can be grouped into two categories: psychological and behavioral. Major psychological syndromes consist of depression, anxiety, delusions, and hallucinations.

Depression in dementia is very common. Up to about 87% of patients develop some form of depression. It is characterized by tearfulness or crying episodes, feelings of sadness, and neurovegetative signs and symptoms such as inability to sleep, lack of appetite, poor energy, and thoughts of death. Irritability is also common. Depression can occur even in the early or mild phase of the illness.

About 50% of demented patients show delusions or false fixed beliefs. Such delusions include beliefs that a relative is stealing, that a spouse is just an impostor or is having an affair with a neighbor, or that friends and relatives are conspiring to cause trouble.

Moreover, many patients with dementia may experience hallucinations. Most of these hallucinations are visual — seeing strangers in the house, an animal or insects in the living room, people in the bedroom or on top of the TV set. Occasionally, auditory hallucinations may be experienced — hearing footsteps or knocking on the door or even people singing church hymns.

Regarding major behavioral syndromes associated with dementia, these problems include agitation, verbal outbursts, repetitive behavior, wandering, and aggression or even violence. Agitation can be manifested by pacing back and forth, restlessness, and inability to sit still.

Verbal outbursts consist of day-long screaming or occasional yelling at someone. Repetitive behavior is manifested by closing and opening a closet or a purse or a drawer. Asking questions repetitively for instance about a relative’s visit is very common.

Wandering can happen especially at the late stages of the illness. If doors are left unlock, some patients wander away from the house. Hence, safety level becomes an issue.

Aggression likewise may occur. Hitting the caregiver or throwing things are some complaints. Destroying things although rare can also ensue. A gentleman for example hit the wall with a cane and broke the window by smashing a chair.

Although difficult to deal with, most of these behavioral consequences of dementia can be treated especially if recognized and addressed early.

About The Author

Copyright © 2004. All rights reserved. Dr. Michael G. Rayel – author (First Aid to Mental Illness–Finalist, Reader’s Preference Choice Award 2002), psychiatrist, and inventor of Oikos Game: A Personal Development and Emotional Skills Game. To receive free newsletter, visit www.drrayel.com. For more information about Oikos Game, visit www.oikosgame.com. His books are available at major online bookstores. mike@drrayel.com

]]> http://www.elderly-advocates.com/articles/behavioral-manifestations-of-alzheimer%e2%80%99s-dementia/feed http://www.elderly-advocates.com/articles/bath-time-for-your-alzheimer%e2%80%99s-patient http://www.elderly-advocates.com/articles/bath-time-for-your-alzheimer%e2%80%99s-patient#comments Sat, 26 Mar 2005 19:45:41 +0000 Administrator http://www.elderly-advocates.com/articles/bath-time-for-your-alzheimer%e2%80%99s-patient Caring for an Alzheimer’s patient is one of the most difficult things you can do. It involves a lot of energy, time and patience. It can be very frustrating. People with Alzheimer’s may refuse help from caregivers. This is a sign that they are actually trying to communicate with you. Refusal to accept care is a sign that something is missing or not right. It’s up to the caregiver to assess the situation.

(by: William Hammond, J.D.)
If your loved one refuses to take her bath or shower, this might be a clue that something is bothering her. It may be embarrassment. Remember that your loved one used to do all these things alone before she had Alzheimer’s and now she has to depend on another person. It is very frustrating. You may have to limit bath time. Approach the situation one step at a time in a non-threatening manner. While you help your loved one undress, use a smooth calming voice. As you bathe her, you can talk about old memories you used to share. It will make the process more enjoyable and pleasant for both of you.

If this does not work and your loved one still resists your help, then you might need try again later. When people with Alzheimer’s do not like to bathe, it often stems from fear. Make sure the lighting in the bathroom is adequate for your loved one to see. If she cannot see well, her fear will increase. Let the shower or bath run for a while to warm up the room. It will make it more comfortable. No one likes to undress in a cold room. If your loved one is using a shower, you might want to put a chair in it so she can sit down. You can purchase one of those at a medical supply store or drug store. Use a hand held shower head. This will take the water up to her level and will be less threatening.

Music is a good way to help as well. It can be good therapy. Studies have shown that some Alzheimer’s patients react very well to music. They may feel less stress. Music can decrease emotions of agitation or aggressive behavior. You can play soft music; add some fragrance in the bathroom. It will make it more inviting. You can try to use the same rituals your loved one used before when taking a bath or a shower. Routine is extremely important for persons with Alzheimer’s.

If you feel there is still tension and resistance, you can always choose another option. You can hire some professional help just for the bathing time. If you decide to get someone to help you, make sure that person has experience with Alzheimer’s disease and knows how to handle patients with dementia. You can hire someone on your own or go through an agency. They have qualified people and will be able to assist you in this situation. Sometimes, the individual with dementia will respond better to a third party rather than a family member. Put yourself in her shoes, it can be really embarrassing having someone from your family bathe you. A disinterested, but gentle, third party may help greatly.

The main thing is to handle bath time in a loving manner. Your loved one will appreciate it and it will lower her stress level, as well as yours.

About The Author

William G. Hammond, JD is a nationally known elder law attorney and founder of The Alzheimer’s Resource Center. He is a frequent guest on radio and television and has developed innovative solutions to guide families who have a loved one suffering from Alzheimer’s. For more information you can visit his website at www.BeatAlzheimers.com.

]]> http://www.elderly-advocates.com/articles/bath-time-for-your-alzheimer%e2%80%99s-patient/feed http://www.elderly-advocates.com/articles/as-the-primary-caregiver-should-i-journal-my-feelings-about-alzheimer%e2%80%99s-disease http://www.elderly-advocates.com/articles/as-the-primary-caregiver-should-i-journal-my-feelings-about-alzheimer%e2%80%99s-disease#comments Sat, 26 Mar 2005 19:43:44 +0000 Administrator http://www.elderly-advocates.com/articles/as-the-primary-caregiver-should-i-journal-my-feelings-about-alzheimer%e2%80%99s-disease Being a caregiver is stressful and difficult. It involves contradictory feelings, thoughts and frustrations. When you have to care for a loved one who has Alzheimer’s, you have to be patient, talk with a calm voice and never “talk down” to your loved one.

(by: William Hammond, J.D.)
Journaling your thoughts and feelings will definitely help you cope with the situation. Write in your journal all that comes through your mind and your heart; nobody but you will read it. It is between you and your journal. Let your pen guide you through the pages. You may want to do some extra research on Alzheimer’s disease to better understand the process and stages your loved one will pass through. If you are a little bit knowledgeable about the disease, the process of caring will be easier on both you and your loved one.

You can keep daily notes on your loved one, such as bathing or eating changes, whether she becomes agitated, and so on. It can also help you remember things to discuss with the doctor.

The good thing about a journal is that it is handy and you can write whenever you feel like it, day or night. It will never contradict you. On the contrary, it will aid you in dealing with your internal emotions; it will relieve your mind and your soul. If you are uncomfortable about writing, then it may be easier for you to express your feelings by recording them on a tape recorder. If you like, you can recall some family gathering you all had together, a camping trip or fishing trip where your loved one caught a BIGGGGG fish! You can read this part to him and it might trigger some memory in your loved one…a memory that was lost to Alzheimer’s.

Journaling will also help you release the burden of care giving you may have. Releasing the burden through the pen will definitely ease the pain. But journaling should not be the only way out for these strong feelings you have. You may want to enroll in a support group. You can check through the Alzheimer’s Association if there is such a group in you area. Speaking to other people will help in getting all these negative emotions out. And most of the participants are dealing with exactly the same emotions because they have to care for a loved one who has dementia. Sometimes, speaking out loud and getting out these feelings will do you a lot of good and you will feel much better after. You may even make friends through these groups, friends that will be able to support you as time goes on.

Remember, you are not alone. You have friends and family to talk to. Maybe you can ask a family member to help with your loved one. It will ease the burden and give you more time to yourself, to journal and to recharge your batteries.

About The Author

William G. Hammond, JD is a nationally known elder law attorney and founder of The Alzheimer’s Resource Center. He is a frequent guest on radio and television and has developed innovative solutions to guide families who have a loved one suffering from Alzheimer’s. For more information you can visit his website at www.BeatAlzheimers.com.

]]> http://www.elderly-advocates.com/articles/as-the-primary-caregiver-should-i-journal-my-feelings-about-alzheimer%e2%80%99s-disease/feed http://www.elderly-advocates.com/articles/as-the-primary-care-giver-for-an-alzheimer%e2%80%99s-patient-how-can-i-get-a-break http://www.elderly-advocates.com/articles/as-the-primary-care-giver-for-an-alzheimer%e2%80%99s-patient-how-can-i-get-a-break#comments Sat, 26 Mar 2005 19:38:50 +0000 Administrator http://www.elderly-advocates.com/articles/as-the-primary-care-giver-for-an-alzheimer%e2%80%99s-patient-how-can-i-get-a-break Taking care of a loved one who has Alzheimer’s is a huge responsibility and very time consuming. It can bring a lot of stress, frustration and more. You devote all your time to your loved one and not have time for yourself anymore. You always wonder: when can I take a break from her? It is not an easy decision, but sometimes it has to be made for your own well being.

There are different options to consider. If your loved one is in early/mid stages of Alzheimer’s you can consider private duty home care. Many agencies throughout the nation and in your community provide this service. A list of providers can be obtained in the phone book, from the local Alzheimer’s Association, Area Agency on Aging, or any case management and referral source. The private duty home care can include services like bathing, sitting, taking to appointments, shopping, meal preparation and other day-to-day essentials. This assistance will definitely help you in getting more free time.

(by: William Hammond, J.D.)

You might also try adult day care. The centers usually operate from 8.00 am to 5.00 pm. It is a good environment for socialization. Your loved one will be able to interact with others, but she knows she will be back home for the night. If you decide to look for an adult day care, you will want to make sure the staff is experienced in caring for Alzheimer’s patients.

Another solution is hiring an independent in-home care giver yourself. This person will take care of your loved one while you are away. You may be able to obtain names and information about experienced caregivers from places such as your church, Alzheimer’s Association, Area Agency on Aging.

Make sure you check the references. Meet and talk with the prospective caregiver and see how the person interacts with your loved one. Touching is very important. It could be a pat on the back or gently rubbing the hand. You can even ask your loved one for input about the person. People with dementia are often perceptive and intuitive.

And don’t forget! You have family members as well that can help you. A loved one who has Alzheimer’s affects all family members. So if family members offer to help, take advantage of it.

Remember, help is available. Do not feel guilty because you want to take a break. You deserve it.

About The Author

William G. Hammond, JD is a nationally known elder law attorney and founder of The Alzheimer’s Resource Center. He is a frequent guest on radio and television and has developed innovative solutions to guide families who have a loved one suffering from Alzheimer’s. For more information you can visit his website at www.BeatAlzheimers.com.

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