Dementia is an umbrella term that encompasses a group of disorders characterized by misperception, memory problems, disorientation, mental confusion and in some cases, behavioral problems. Dementia is not just a normal sign of aging, but it does play in outsized role in how we think about caring for our aging or elderly parents.
According to researchers, there are more than 50 underlying causes of dementia, including diseases such as stroke, head injuries and Alzheimer’s disease. While each dementia type – based on the different causes – has its own unique features, they all cause brain cells to die quicker than normal. As a result, dementia patients often suffer from judgment, personality and memory problems.
Dementia typically progresses slowly in three stages (early, middle and late). As it slowly damages the brain, it causes substantial impairment in cognition and thinking, interfering with a patient’s ability to live independently. Accordingly, dementia is one of the leading causes of dependency in seniors.
Types of Dementia
The most common types of dementia include:
Alzheimer’s Dementia: Caused by the accumulation of a snipped protein called amyloid beta in the hippocampus, the area of the brain responsible for memory, Alzheimer’s dementia is a neurodegenerative condition that damages brain cells, leading to cognitive decline and memory loss. Alzheimer’s dementia starts mild and gets progressively worse. More than 6.7 million Americans currently have some type of Alzheimer’s disease, making it the most common type of dementia in the US.
The main causes of Alzheimer’s disease include stroke, head injuries, brain tumor, infections to the brain, lifestyle and environmental factors. Alzheimer’s symptoms generally depend on the stage of the disease, with the early stage of the disease typically characterized by confusion and short-term memory loss, the middle stage featuring constant questioning, slurred speech, communication and language difficulty, tremors and difficulty performing regular tasks, and the final stage bring characterized by long-term memory loss, emotional and physical instability and major personality changes.
Vascular Dementia: Caused by both large and small strokes in the brain, this is the second most common type of dementia after Alzheimer’s dementia. In essence, this condition occurs when the blood vessels that supply the brain with oxygen-rich blood are damaged, depriving the brain of enough oxygen. This means that brain injuries, tumors, and brain infections can also cause vascular dementia.
Diagnosis typically involves MRI screening as well as assessments of a patient’s cognitive functions. The risk factors for vascular dementia include age, gender, heart disease, stroke and vasculitis. Some of the common symptoms of vascular dementia include communication and language difficulty, confusion, disorientation, trouble understanding speech, emotional instability and partial vision loss.
Diagnosis of vascular dementia typically involves MRI screening as well as assessments of a patient’s cognitive functions. The risk factors for vascular dementia include age, gender, heart disease, stroke and vasculitis. Some of the common symptoms of vascular dementia include communication and language difficulty, confusion, disorientation, trouble understanding speech, emotional instability and partial vision loss.
Parkinson’s Dementia: Caused by the accumulation of a protein called alpha-synuclein, Parkinson’s dementia manifests symptoms similar to Alzheimer’s dementia and can occur after years of having Parkinson’s disease. According to the National Parkinson’s Foundation, about 1 million Americans are currently living with Parkinson’s disease. Out of those, 50 to 80% will develop Parkinson’s dementia.
The risk factors for Parkinson’s dementia include gender, ethnicity, age, genetics, head injuries and environmental factors, such as exposure to toxins. Common symptoms of Parkinson’s dementia include declining memory functions, tremors, slow shuffling gait, muscle rigidity, gait disturbance, bradykinesia, hallucinations, depression, anxiety, trouble interpreting visual information, sleep disturbances, and personality and behavioral changes.
The diagnosis of Parkinson’s dementia involves MRI screening and lab tests and a thorough physical examination. There is no specific treatment for this condition currently. However, certain medications including cholinesterase (acetylcholinesterase) inhibitors, L-opa, antidepressants (SSRI) and Clonazepam can help stop the progression of the disease and the symptoms.
Lewy Body Dementia: Lewy body dementia is a Parkinson’s-like condition that often causes hallucinations, balance problems, and confusion. This condition is characterized by the presence of Lewy bodies in the cerebral cortex. Lewy bodies are essentially small clusters of proteins, mainly alpha-synuclein protein, which occurs naturally in the brain and other body tissues and organs including the heart and muscles. In nerve cells, alpha-synuclein protein plays a role in the release of neurotransmitters, allowing nerves to communicate with each other effectively. Although it is perfectly normal to have small amounts of alpha-synuclein in your body, when this protein is deformed due to mutation or damage, it clumps together, forming Lewy bodies, which eventually cause Lewy body dementia.
Similar to other types of dementia, there is no current cure for Lewy body dementia. Moreover, Lewy body dementia patients tend to have a severe sensitivity to most antipsychotic drugs, which are used to manage hallucinations.
Huntington’s Disease: Huntington’s disease is a genetic disease that causes progressive brain damage, causing the loss of physical, intellectual and memory abilities.
Some of the common symptoms associated with Huntington’s disease include slurred speech personality changes, significant weight loss, mood swings, depression, forgetfulness and impaired judgment, anxiety, depression, myoclonus, and difficulty swallowing. It is worth noting that these symptoms typically appear between the ages of 30 and 50 and get progressively worse over a 10-to-15-year period. Moreover, the common causes of death from Huntington’s disease are an inability to swallow, slip-and-fall injuries and pneumonia.
Because Huntington’s disease is a hereditary disease, a child born to two parents with Huntington’s disease has a 50% chance of inheriting the disease. To diagnose Huntington’s disease, doctors typically review a patient’s family medical history, perform a neurological and psychiatric exam, as well as ask the patient certain questions in order to judge the patient’s mental status, coping skills, reflexes, mood, and memory.
Frontotemporal Dementia: This disease affects the temporal and frontal lobes of the brain. These are the parts of the brain responsible for processing sensory input and memories, as well as cognitive skills, such as problem-solving skills.
Patients with Frontotemporal Dementia often exhibit antisocial behavior, impulsiveness, speech impairment and memory problems. To lessen the undesired behaviors associated with Frontotemporal Dementia and ease symptoms, doctors often use behavior modification therapy and antidepressants.
Confusing Signs and Symptoms
Many of the symptoms of early onset dementia are, in fact, common to other health problems, as well. Most commonly, the side effects of a new medication can induce confusion, weight loss and other symptoms that closely resemble those of dementia. Depression, poor nutrition, or disorienting changes in a senior’s life, such as the loss of a friend or loved one, may also present similarly. Only a doctor can tell for sure what is going on after a complete neurological work up.
Whether it is truly dementia, or something mimicking it, the person’s ability to care for themselves adequately and safely may be seriously compromised. The family will need to come up with either a short-term solution, long-term remedy, or both. A useful first step is to provide some in-home care through either Medicare Home Health or non-medical home care. The latter will provide companionship, assistance with personal care and maintaining or routine household chores such as shopping, cooking and laundry.
Home Safety Tips for Aging Parents with Alzheimer’s & Dementia
For those caring for aging parents or older relatives with Alzheimer’s or Dementia, it is important to realize that there is a higher risk that these seniors will injure themselves in their own homes if the proper safety precautions aren’t made against to safeguard them against certain home hazards.
There are number of things you can do to make the home of your aging parent or relative under your care, safe and secure without breaking the bank. The important thing to understand is how the disease has affected your aging loved one and the best way to compensate for those changes.
Here are a few tips that you can use when caring for an older parent with Alzheimer’s or Dementia:
Increase the Lighting – There is a chance that there may be changes in the vision of these older adults and adding additional lighting will help compensate for some of the acuity they may have lost.
Secure Walkways – Make sure that all walkways remain clear of obstructions (including cords, rugs, etc.). Some home safety assessments recommend using reflective tape to outline walkways, so they can be more visible to the older adults.
While you are in the process of securing the walkways, it is also helpful to place covers over electrical outlets, lock doors leading to basements, garages, cabinets, closets, pool areas, etc.
Reorganize the Kitchen – Making the kitchen safer for your aging parent or loved one could include anything from removing electrical appliances, cutting off gas stoves and garbage disposals, putting away knives and utensils that may cause injuries, picking up rugs, removing flammable liquids. No kitchen is the same, so it is important to look at the kitchen critically to assess what may pose a risk to your loved ones.
Decluttering The Bedroom – The same critical evaluation must be applied to the bedroom. Some hazards may include rugs, space heaters or radiators, scattered cords or furniture. Another consideration is the bed; you may want to look into adding rails to prevent falls or mats on the floor near the bed to minimize injuries in case a fall happens.
Accessorizing The Bathroom – Consider installing hand rails, raised toilets, plastic shower stools (if there is no bathtub), hand-held shower heads and slip mats, etc. It is also important to lock the medicine cabinets and remove any medication that may be lying around (along with electrical razors, blow dryers, etc.).
Wandering As a Major Concern
A large number of people with this disease tend to walk around aimlessly. There are many reasons for this, but they do not realize that they are doing it. They could be looking for someone, be hungry, need to find a toilet, it could be medically related, or simple boredom. Whatever the reason, it is vital to ensure their safety. Tips that may limit wandering without entirely infantilizing the aging individual include:
- Set times for regular exercise that consumed energy and doesn’t leave the elderly individual feeling cooped up.
- Change your loved one’s locks and keep the key with you.
- Use a barrier like a curtain in front of the door. You can even put a STOP sign up to remind them to not continue walking.
- Placing child safety covers on the doorknobs is another idea that works for some sufferers.
- GPS bracelets have also proven to be beneficial in keeping track of people with this illness.
- Get your loved one to wear a bracelet that can help others identify who they are and where they live, in case they wander off.
- Inform their neighbors and relatives about their condition, and make sure that they know how to contact you in the event that they come across your loved one wandering around.
- Keep a current photo of them close by, should the worst happen and you need to report them missing to your local police department.
Communicating When a Loved One Has Dementia
Because dementia gradually diminishes a person’s mental and cognitive abilities, a dementia patient typically has difficulty understanding others, as well as expressing thoughts and emotions. Here are some tips to help you communicate with a loved one suffering from dementia:
- When communicating with your loved one, always ensure you create a “kind voice.” To do this, speak gently and smile while you talk. At the same time, be sure to talk slowly and clearly.
- To orient your loved one and get his/her attention, always call your loved one by his/her name. To avoid startling your loved one, always approach your loved one from the front. Additionally, always tell your loved one who you are, even if your child or spouse.
- Ask him/her one question at a time. At the same time, use short phrases and simple words, refrain from using reason and logic and more importantly, avoid asking, “Do you remember when…?” type of questions. Additionally, do not get impatient if your loved fails to respond to your questions immediately. Instead, be patient and allow him/her extra time to process your question. If he/she fails to respond after a reasonable amount of time, you may repeat your question, but be ensure to use a gentle voice and friendly tone.
- When having a conversation with your loved one, don’t interrupt, criticize, correct or argue with him/her. At the same time, let your loved one know you are listening and trying to understand the message. To do this, always maintain good eye contact and show the person you care about what he/she is saying.
- In case your loved one says something mean to you, do not take it personally. Instead, focus on your loved one’s feelings, not the negative information. You should understand that dementia may cause your loved one’s personality to change, causing him/her to be emotionally unstable and exhibit antisocial behavior. Because of this, your loved one might say some hurtful things to you. When this happens, simply let it go.
- Always allow your loved one to think about and describe whatever he/she wants. If he/she uses the wrong word or cannot find a word, try guessing what he/she wants. If you’re unable to understand what your loved one wants, ask him/her to gesture or point.
Some of the things you should avoid when caring for your loved one with dementia include:
- Avoid overstimulating your loved one. This could be in the form of too much physical activity without rest breaks or other activates such as quizzing. Overstimulation is a problem because it could easily overwhelm your loved one’s ability to cope, causing your loved one to become combative and more resistant to you. Additionally, it makes your loved one more prone to accident, including slip-and-fall accidents.
- As a caregiver, you should avoid being overprotective of your loved one. In fact, unless it’s a big safety issue, allow your loved one to do what he/she wants. This is particularly important because your loved-one may have lost his ability to make good judgment. However, if you treat your loved one as a child, he/she may see you as the unreasonable and become argumentative, combative, or resistant to you.
- Do not force your loved one to do things that he/she does not want to do.
- Avoid giving your loved one multiple choices. This is important because your loved one may have lost his/her ability to make decisions, as well as intellectual and cognitive abilities.
Caring for a loved one with dementia is stressful and draining. Facing the responsibilities alone, day after day, requires a superhuman and most of us are not in that category. There is no shame and does not diminish your love for the dementia victim to get help so that you can recharge. Hire a home care aide with experience helping client with dementia, at least part-time, to assist you. Even if only for periodic respite care, hiring a professional home care aide will give you the time to recuperate to remain at your strongest for this daunting task.
Of course, individuals with debilitating dementia often need round-the-clock care to ensure their safety. Consider a live-in caregiver or two 12-hour shifts if you think your loved one needs more constant support.
A geriatric care manager can also assist with coordinating care. A local expert at all things related to aging, they will be able to recommend resources for both your loved one and yourself that make the task of caring for someone with dementia a little bit easier.