At the beginning of the presentation, assess your audience and determine why they are attending this talk: Caregiver or family member of someone with dementia Worried about dementia Just curious Slides 34 – 38 are specific to caregiving. Include these slides if caregivers are present in your audience.
Let the audience know the importance of this topic. Here are some relevant facts about dementia that can be used with this slide: Dementia is a leading cause of memory impairment and disability among older adults. With the aging of the population, dementia is a large problem now that will continue to have a larger impact in the future. It is difficult to accurately determine the number of people with dementia at any one time and the number of new cases that is diagnosed yearly.
During this presentation, we are going to cover several topics: The definition and most common types of dementia How dementia is diagnosed and treated Useful facts related to coping with dementia and Alzheimer’s disease, such as caregiving and depression Specific questions you can use when talking with your healthcare provider about dementia If you have any questions, don’t hesitate to stop me and ask them.
Dementia is a broad term that is used to describe loss of mental abilities. Most commonly, this term refers to memory loss, which is the most prominent symptom of dementia. Other symptoms that individuals with dementia commonly experience include: Confusion about place and time Asking the same question over and over Trouble remembering recent events Impaired judgment or speaking
Another symptom is having an impaired ability to perform everyday tasks, such as using the telephone or following a recipe. Additionally, changes in personality, mood, or behavior can occur.
Dementia is caused by a variety of different conditions. The two most common types of dementia are Alzheimer’s disease and vascular dementia. It is important to see your healthcare provider as soon as you think you or the person for whom you provide care is having problems. Some forms of dementia are reversible if detected early.
First, let’s talk about Alzheimer's disease. Alzheimer’s disease is the leading cause of dementia, and the cause that we probably hear most about. About 50% to 75% of dementia cases will be Alzheimer’s disease. Stated another way, out of 10 people with dementia, about 5 to 7 of them will have Alzheimer's disease. The picture in this slide illustrates the fact that out of 10 people with dementia, approximately 6 of them will have Alzheimer’s disease. Here are some statistics about Alzheimer’s Disease: Currently, there are over 4 million individuals in the United States with Alzheimer’s disease. Approximately 266,000 new cases of Alzheimer’s disease are diagnosed each year. 1 in 10 individuals aged 65 and older and perhaps as many as 1 out of 2 individuals aged 85 and older have Alzheimer’s disease. These numbers are expected to grow with the projected 50% growth in the elderly population over the next 30 years.
What is Alzheimer’s disease? Basically, Alzheimer’s disease begins when certain cells located in the part of the brain controlling memory start to die and are not replaced. Usually, this onset is slow and gradual, and the affected person will experience forgetfulness and will have trouble remembering recent events and performing usual everyday tasks.
As the disease progresses, damage from increased cellular death spreads from the area that is responsible for memory into neighboring brain structures. This causes an increase in the number of symptoms that are being experienced and a worsening of those that are already present. Other symptoms of dementia that may occur as Alzheimer’s disease progresses are confusion, personality and behavioral changes, impaired judgment, and/or impaired communication. For most people, this disease occurs after age 65 and has a slow progression. However, people in their 30’s, 40’s, and 50’s have been diagnosed with Alzheimer's disease, although this earlier onset occurs in less than 10% of all Alzheimer’s disease cases. Although there is no cure for Alzheimer’s disease currently, the slow progression experienced by most people with Alzheimer’s disease provides time for treatment. Treatment can slow the rate of decline. Also, certain medications may be used to decrease behavioral symptoms, such as depression, sleeplessness and agitation. These symptoms may be problematic in individuals with more advanced Alzheimer’s disease. On average, individuals with Alzheimer’s disease live an additional 8 to 10 years after the diagnosis.
What causes Alzheimer’s disease? That is the big question. Currently, the cause of Alzheimer’s disease is not known. There are some risk factors, however, which may increase your chances of developing this disease.
What are risk factors? Risk factors are certain characteristics that, if present, may increase the chance of developing a disease, in this case Alzheimer’s disease. Not everyone with a risk factor for a disease will develop that disease. Risk factors simply increase your chance of developing the disease in the long-run. Conversely, some people without risk factors for a disease end up getting the disease anyway. There are 2 types of risk factors – those that you cannot change and those that you can change.
Two of the currently identified risk factors for Alzheimer’s disease cannot be changed. One unchangeable risk factor for Alzheimer’s disease is having a family history. For example, if your mother, father, brother or sister has had Alzheimer’s disease, you are more likely than someone without a family history to get Alzheimer’s disease.
Increasing age is another known risk factor for Alzheimer’s disease that cannot be changed. As you age, your risk of developing Alzheimer’s disease increases. It is estimated that 10% of individuals over age 65, or 1 in 10 people, have this disease. As many as 1 out of 2 individuals (50%) over 85 have been estimated to have Alzheimer’s disease.
The second most common type of dementia is vascular dementia. This type of dementia results from damage to the brain due to a stroke or series of strokes. Between 10% and 20% of individuals with dementia have this type. In other words, out of every 10 people with dementia, 1 or 2 of these people have vascular dementia. The picture in this slide illustrates the fact that out of 10 people with dementia, approximately 2 of them will have vascular dementia. Although Alzheimer’s disease and vascular dementia are the two most common types, they are very different in how they first appear and how they progress.
Vascular dementia is caused by a stroke or a series of strokes occurring in the brain. A stroke occurs when there is impaired blood circulation in the brain and the cells are deprived of oxygen.
Unlike Alzheimer’s disease, which begins slowly in the portion of the brain specific to memory, a stroke : Occurs suddenly, Impairment occurs almost immediately, and The types of impairment that result depend upon the location in the brain that was affected by the stroke. Symptoms of the mental impairment/dementia caused by stroke include disorientation, confusion, and behavioral changes.
There are certain risk factors that increase the chances of a stroke: High blood pressure High cholesterol Diabetes Certain heart conditions If you have one of these conditions, you need to manage it appropriately with your healthcare provider’s supervision. How do you manage these conditions?
If you have high blood pressure, certain prescription medications or lifestyle changes can help to reduce your blood pressure to acceptable levels. In turn, this will lessen your risk of having a stroke by approximately 36%.
Managing cholesterol at acceptable levels is important for heart health and reducing the risk of stroke. A varied diet with fruits, vegetables, grains, and fish or chicken is an excellent way to keep cholesterol low. Also, baking, broiling, poaching, steaming, and boiling (not frying) foods and avoiding fatty sauces are helpful. Speak with your healthcare provider about the diet that is best for you.
If you have diabetes, controlling your blood sugar is important for a variety of reasons, one of which is to reduce the risk of stroke. Speak with your healthcare provider about how best for you to test and control your blood sugar. Important steps include diet, exercise and possibly prescription medication.
Earlier in this talk, in our discussion of Alzheimer’s disease and stroke, we accounted for 60% to 90% of the people with dementia. The remaining cases of dementia not caused by Alzheimer’s disease or stroke may be caused by other factors. Many of these causes can be reversed or slowed with proper treatment. Examples of reversible causes of dementia are: alcohol use, depression, medication side effects or drug interactions, nutritional deficiencies, such as Vitamin B12 deficiency, and thyroid dysfunction. Other diseases that cause dementia may not be affected by treatment. They include: Parkinson’s disease, Huntington’s disease, and AIDS, among others. In order to determine the presence and cause of dementia, a thorough evaluation by a healthcare provider is necessary.
Seeing a healthcare provider as soon as symptoms are noticed is very important to determine if there is a problem with dementia, what its cause may be, and the appropriate method of treatment. The earlier a diagnosis is made, the more value treatment can offer. The evaluation will include: Thorough medical history Complete physical exam Neurological exam Blood tests Mental status exam The evaluation may include psychological testing and a brain scan, such as an MRI or CAT scan. While the basic examinations most likely will be done by a general practitioner, referral to a medical specialist is common. The purpose of this screening is to determine if the person has dementia and the underlying cause of the dementia, if possible.
There is no single test currently available for diagnosing Alzheimer’s disease. Using results from the battery of tests just described, healthcare providers can diagnose the presence of Alzheimer’s disease with 80% to 90% accuracy.
Now that dementia, Alzheimer’s disease, and stroke have been discussed, we will review some tips for managing dementia, dealing with depression, and being a caregiver. These are outlined in the Dementia Facts for Older Adults brochure.
The importance of seeing a healthcare provider for a thorough evaluation as soon as symptoms are noticed cannot be stressed enough. As we saw earlier, there are several physical conditions which can cause dementia. Early identification of a reversible condition can result in more rapid treatment and a return to normal functioning.
If Alzheimer’s is diagnosed, it is very important to begin treatment as soon as possible. Medications known as cholinesterase inhibitors have been shown to improve memory and other types of thinking and functioning among individuals with mild to moderate Alzheimer’s disease. Additionally, medications may diminish some of the behavioral symptoms caused by this disease, such as loss of interest in activities, family, and friends. With these medications, individuals obtaining treatment in the early stages of this disease may be able to continue participating in the activities that they find enjoyable for a longer period of time.
Certain strategies can be used to help someone manage dementia and/or Alzheimer’s disease. A few of the easier-to-implement strategies will be discussed now, but this topic should be discussed thoroughly with a healthcare provider to fully benefit both the person with dementia as well as the caregiver.
One of the best strategies for both the person with dementia and his/her caregiver is to make life less complicated by establishing daily routines that will organize the day. Have a daily schedule that includes: Routine activities – personal care, mealtime, household chores Other activities – social events, physical activities, or other activities that are of interest to the individual Establishing a routine offers several benefits to someone with dementia: Reinforcement of existing abilities Maintenance of self-esteem through active participation in daily life Reduction in wandering and agitation, which are 2 symptoms of dementia experienced in the later stages
Because of changes in physical ability, behavior, and judgment that result from dementia, a careful review of the home environment should be performed, and appropriate modifications should be made to make the environment safer. Each room should be checked for potential hazards that an individual with dementia could encounter. Kitchen – Remove access to hazardous utensils or cleaning supplies; remove knobs on stovetop and oven. Bathroom – Install grab bars; remove electrical appliances; remove potentially dangerous medications. Walking Areas – Keep clear by moving furniture and removing or securing throw rugs to reduce the chance of injury from bumps or falls. Keeping the environment safe will provide long-term benefits for both the person with dementia and his/her caregiver. These are examples of only a few of the many safeguards to be made. It is important for caregivers to discuss this important topic further with the healthcare provider.
Continuing to participate in favorite activities is important, as long as the individual with dementia can continue to perform them and obtain satisfaction from them. This may help to improve function and reduce the chance of depression. “Activities” does not necessarily mean group activities. While group activities like playing cards, going to religious services, or getting together with friends may be fun for some, other people may get equal enjoyment from individual activities such as reading, gardening, walking, listening to music, or doing crossword puzzles. Overall, remember that for individuals with dementia, enjoyment of activities is key.
Finally, being physically active is important, whether it is through involvement with a group or individually.
Some of the early symptoms of Alzheimer’s disease, such as a decreased ability to think clearly and accomplish everyday tasks, may bring about symptoms of depression because of the reduced ability to do usual activities. This depression may increase the rate of mental decline, which may prompt the individual to feel more depressed – quickly turning into a vicious cycle. Additionally, depression may cause uncharacteristic behavior such as aggression. Symptoms of depression include sadness, inactivity, and feelings of hopelessness, among others.
Treatment for depression is available. Individuals treated with prescription antidepressant medication often show improvement with the agitation and aggressive behavior that are associated with Alzheimer’s disease. If you suspect depression may be occurring, see the healthcare provider as soon as possible. Your healthcare provider may refer you/your family member to a specialist.
The full-time responsibility of caring for someone with dementia or Alzheimer’s disease will greatly increase the responsibilities of the caregiver, who may also be caring for children and/or maintaining a full-time job. By planning ahead and having a strong support network, the stress associated with these additional demands can be controlled. It is important as a caregiver to be aware of how you are feeling, both mentally and physically, and mindful of when you need to take a break and when you need to get further help. All too often, the caregivers of individuals with Alzheimer’s disease become victims of poor health themselves. Symptoms of caregiver stress and ways of dealing with the increased responsibility of being a caregiver will be discussed.
Often, the additional demands on a caregiver’s time and energy begin to take their toll, and symptoms of stress can arise. Keep in mind that not every caregiver will experience all of these symptoms all of the time. If you notice any of these symptoms, however, it is important that you take action. Common symptoms of caregiver stress include: fatigue, stomach problems, headaches, difficulty sleeping, and lack of concentration. Additionally, caregivers may experience some of these emotional symptoms: depression, tension, anger, guilt, grief, denial, anxiety, irritability, and feeling overwhelmed. Physical symptoms can also occur in the form of blurred vision, stomach irritation, and high blood pressure, as well as physical strains on joints and muscles.
Finally, other changes that may occur are: Changes in relationships with others Financial changes, due to increasing responsibility and possible lost days from work Less time for yourself, which could lead to a feeling of isolation and social withdrawal
As a caregiver, you must take care of yourself both physically and mentally to avoid developing depression, which is very common among caregivers. How do you do that? First, go to a healthcare provider for a routine annual physical exam. Discuss with him/her any physical concerns as well as any symptoms of stress and/or depression that you may be having. Also, take time for yourself to relax and unwind. Do something just for you at least once every 1 to 2 weeks…more if you are able to. In order to get this needed relaxation time: Have another family member fill in for you for an afternoon Arrange for home-care services Enroll the person with dementia in an adult day program. While this will provide you with needed relaxation time, the program can be beneficial for your family member. Adult day programs are designed to promote interaction with others, and can offer opportunities for exercise and simple, fun activities.
Be proactive and get the education and support that you need. Seek out information from healthcare providers. Find out what resources are available in the community and whether there are any local support groups. Join a support group. You are not alone. Many other caregivers are struggling with the same feelings that you are. A support group will give you an outlet to discuss your concerns and get ideas and opinions from individuals who may have already been there. One-on-one counseling with a specialist might also be beneficial for you, particularly if you are feeling overwhelmed by stress. It is important to get financial and legal advice from a qualified professional as soon as possible, both for yourself and for the individual with Alzheimer's disease. Doing so now can reduce the need for rushed decisions in the future. Some issues to be addressed include durable power of attorney, advanced directives for healthcare, paying for care, and estate planning. Caregiver burden is a common reason that individuals with Alzheimer’s disease are placed in nursing homes or assisted living facilities. With appropriate education, support, and counseling, many family caregivers are able to cope better and maintain a significantly improved quality of life. Research shows that with this support, many caregivers are able to provide care at home for an additional year before placement of their family member is necessary.
Let’s review the important points from today’s discussion. Dementia is progressive, but with adequate and timely treatment it can be slowed, if not completely reversed. Alzheimer’s disease, the most common cause of dementia, can now be diagnosed by healthcare providers with 80% to 90% accuracy using a battery of evaluations and tests. The current quality of life of the affected individual can be maintained by incorporating treatment and certain behavioral changes into everyday life. Remember that as a caregiver, you are not alone. Caregiver support is widely available from support groups and educational programs.
It is helpful to speak with your healthcare provider about the issues presented in this talk. The Dementia Facts for Older Adults brochure lists several questions you can use to break the ice and start a conversation with your healthcare provider about yourself or a family member. The next slide is a catch-all slide inserted for you to highlight useful ‘ice-breaking’ questions for the healthcare provider. The questions are grouped in sections related to different topics. While question numbers should not be mentioned to the audience, the following numbers will help you to group the questions by topic. In your own copy, please number the questions in order and note: Introductory question to start a discussion of dementia—Q1 Questions on screening and evaluation—Q2, 3 Questions on medication and treatment—Q4, 6, 7 Questions on behavioral therapy and daily routines—Q5, 8 Question on depression—Q9 Question on caregiving information—Q10
When discussing the questions, here are some lead-ins you can use: Helpful questions to break the ice are listed on the last few pages of the brochure, and there is also space to make notes if you would like. A good introductory question to start a discussion of dementia might be… (Q1) Screening is important, especially since diagnosis is possible and treatment is often available. Find out whether you or a family member has ever been screened or if further testing should be done. (Q2, 3) If Alzheimer’s disease is diagnosed, learn what treatment options are available and whether they are necessary. Also, ask what to look for to identify improvement, and whether anything else should be tried. (Q4, 6, 7) Well-being can be maintained for individuals with dementia or Alzheimer’s disease using certain behavioral therapies and daily routines. Ask your healthcare provider about such strategies. (Q5, 8) Be concerned about depression. It is common among individuals of all ages, not just older adults, and it is treatable once recognized. (Q9) Being a caregiver for someone with dementia or Alzheimer’s disease is a substantial responsibility. Be open about needing support yourself. Your healthcare provider can give you a variety of references of where to obtain information on dementia and Alzheimer’s disease as well as where to obtain support from other caregivers. You only need to ask. Without asking, he or she won’t know that you are in need. (Q10)
This is the time to take any remaining questions and comments. Also, this may be a good time to pass out the Dementia Facts for Older Adults and the Screening and Prevention Facts for Older Adults brochures, if you have not already done so.
Dementia An illness that worsens over time
Dementia – a leading cause of memory impairment and disability