By Rachel Galvin
Memory loss is an important concern as we age. Many younger people find themselves dealing with an older parent who is starting to forget things. The question is when does forgetting something here and there turn into dementia and what do you do if you or a parent has it? These are questions best answered by the experts.
At Broward Health North, they have a Memory Disorder Center where people can turn to get some answers. The best part is that having a memory test done is free and they keep the results on file for 10 years, so you can have it retaken in later years and see the difference. The test is simple and pretty quick. The social worker or counselor asks you some questions then has you conduct some tasks that involve following basic directions. You are given a score that helps them determine your memory.
What happens if the results are not normal? Well, then they can move onto determine the next course of action, including possible other tests that need to be taken, which may include an EEG, bloodwork, imaging of the brain, etc. There are different types of memory that they can further evaluate – Executive Functioning, auditory memory, visual memory, processing speed, concentration, attention and more.
Past age 75, everyone’s process of storing and recalling information takes more time. But dementia does not happen automatically as we age.
“As we age, the brain changes,” said neurologist Hazel Wiley, DO, who said it is proteins like Amyloid-beta and Tau that damage brain tissue over time. They are still researching the reason why proteins build up.
She added, “Just because you don’t have a problem now doesn’t mean you won’t have one later. High blood pressure, diabetes, kidney problems, tobacco use for years can cause brain changes and lead to a loss of neurons.”
The most common form of memory difficulty is dementia due to Alzheimer’s. One in 10 people over 64 have Alzheimer’s disease. But there are other types of dementia – Vascular Dementia, Dementia with Lewy Bodies and others.
“I don’t think there is someone who is not affected [by dementia in some way]. For Broward County, there are 41,000 people diagnosed with Alzheimer’s alone. Dementia is a broad category. Over 80 percent of dementia is Alzheimer’s. When you have high cholesterol, blood pressure, or drink or smoke too much, it causes damage to the arteries and you can develop vascular changes,” said Wiley.
It is important to be screened early for possible changes, something that most do not do. It isn’t until the senior starts making behavioral changes that family members or friends notice, and then an assessment is made.
Melina Cedeno-Oblinger, RN, SCRN, who is a coordinator at the center, said, “Sixteen percent of seniors get assessments [routinely]. Most probably never have. Now, there’s an issue with their finances. Now, the family is noticing. The person is living alone. There is mildewed food in the refrigerator. They can’t give themselves a proper diet…”
Wiley added, “We see a lot of people in crisis. But it is a slow decline. Most are not aware or not willing [to get tested]. If a test was more routine, like a check for cholesterol, then the person would get a diagnosis earlier. They could put in place a Power of Attorney, take care of finances, and get plans in place before there is a problem. We see a lot after the fact. What we want is awareness. We want to get the person in when the problem is first starting.”
In addition to making themselves available to test people who might be experiencing memory loss, they also are there for the families who act as caregivers. They offer a free 16 hour program to provide important information. It is a four day course.
“The Care Assistance Program experts volunteer to go over information with families, including disaster planning, when they start to wander … legal and financial planning is huge, care for the caregiver (you don’t want them to be burned out), living arrangements (some will require 24 hour assistance – nursing home and/or assisted living). We run three support groups here,” said Cedeno-Oblinger.
They offer their course 10 times per year. They have day and evening classes. The next one starts on Sept. 3 in the evening. After that, they have one on Sept. 16 during the day.
“[Partcipants] can share stories and realize they are not alone. A lot of others are suffering, grieving the loss of a spouse, [or parent],” said Wiley, who can see a change in the families who attend from feeling overwhelmed to feeling more empowered with information.
“Before they felt isolated. They leave empowered and feel their parent can age with dignity. We’re trying to put away the stigma. The [patients] need to be supported and included in the community rather than isolated. It is about how to create quality of life and keep them safe,” said Cedeno-Oblinger.
“It is very gratifying. We hear the thank yous. Patients come and bring their parents and later come back when they have an issue themselves to get the same great experience,” said Wiley, who said sometimes people come back and take the class again also because they need a refresher as their parents are in later stages.
“They didn’t have to listen to the later stage information because their parents were not at that stage yet, but now they are,” said Wiley.
She said there are things they can do to benefit patients, not only medication, but things like increasing socialization and mental activities. It could be getting them to read books or work on puzzles.
“If they’re sitting and staring at a TV, it’s not going to be helpful. Depression and dementia go hand-in-hand. Socialization is a big part of improving mood. In later stages, there are other behaviors [that emerge like] agitation, paranoia, wandering. It may limit their ability to go out. We can teach caregivers how to redirect patients,” said Wiley.
The center also offers other programs, including a safe driving assessment, which measures all aspects of what goes into driving – physical and mental. It also takes them through a road test and gives them a score that measure their risk to themselves and others for being on the road. If the test comes back saying they should probably not be driving, they can let families know of alternative transportation. The test has a fee but the counseling and also the memory screening is free.
The center, which has been around since 1986, is one of 16 of its kind in Florida. For more information, call 954-786-7392 or visit www.browardhealth.org/services/neurology.

(Part 3 in our series on Dementia)

The good news is that there are many advances being made in both the mental health and medical fields when it comes to dementia. Let’s examine some of these new advances.

Dementia and Mental Health advances:

The Dementia-Directive

Dr. Barak Gaster, an internist at the University of Washington School of Medicine, spent three years working with specialists in geriatrics and devised a dementia specific mental health advance directive (https://dementia-directive.org). This directive provides a map for mild, moderate and severe dementia and asks dementia patients to decide what medical interventions they want and do not want at each phase of their dementia.

It is estimated that between 20 to 30 percent of us at some point will develop dementia. As patients turn 65 and qualify for Medicare, which covers a visit to discuss advance care planning, the dementia- directive can be a useful tool that acts as a supplement to other directives.

The dementia-directive has many positive aspects. We know that many patients move into advanced stages of dementia prior to anyone identifying it and, therefore, being able to discuss with the patient what exactly is happening to them and asking them how they would like their dementia managed is beneficial. It is difficult for dementia patients to express their wants and needs as their dementia progresses and the dementia-directive can be a helpful tool for better management as the disease progresses.

Dementia and Medical advances:

Medical Devices

Neural Devices are electrodes that penetrate top layers of the brain and act as mini-microphones to record brain activity. Some neural devices are currently being tested to diagnose Alzheimer’s and Parkinson’s based on what is called a fingerprint or activity patterns recorded directly from the brain. It’s interesting to note that Facebook and Elon Musk’s company Neurolink are currently looking to invest in neural device companies.

Medications

Cholinesterase inhibitors, such Aricept, Exelon, Razadyne and Memantine or Namenda, are used to treat the common cognitive symptoms of Alzheimer’s, such as memory loss, confusion and problems with thinking and reasoning. There is also a Namzaric that combines one of the cholinesterase inhibitors Donepezil with Memantine.

As Alzheimer’s progresses, brain cells die and connections among brain cells are lost causing cognitive symptoms to worsen. Current medications cannot stop the damage Alzheimer’s causes to brain cells, but they may help lessen or stabilize symptoms for a limited time by affecting certain chemicals involved in carrying messages among the brain’s nerve cells.

Exercise

According to Neurology Times, a study of over 1,400 women over age 44 years were observed to determine a correlation between midlife cardiovascular fitness and the risk of developing dementia. It appears there was a 9.5 year delay determined by using an ergometer cycling test and this study supports research that exercise is a reliable strategy to prevent dementia.

Dementia Series summary:

We have explored dementia in our three part series over the past three months. Dementia is a complex condition with many possible causes, but what many people want to know is can dementia be cured? Recent developments and understanding of how the disease progresses have been encouraging. Researchers believe more effective treatments will continue to be realized.

Additional information is available to you online at www.Alz.org. This website will help you find your local Alzheimer’s chapter, direct you to a 24/7 helpline (800-272-3900) and provide you with access to a virtual library with over 5,000 library books, journals and other Alzheimer’s resources.

Dr. Julia Breur is a licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. Further information available at www.drjuliabreur.com.

Part 2 of a 3-part series on dementia

Today, there are more than 9.9 million people caring for someone with Alzheimer’s and other dementia. Last month, the initial column in our series on dementia discussed dementia as a progressive biological brain disorder that makes it difficult for those diagnosed to think and communicate clearly and to even take care of themselves. This month, in part two of our series, we discuss practical strategies for caregivers who manage others with dementia.

Many families find it difficult and frustrating to communicate with a loved one with dementia. It is important to remember that a person with dementia cannot control behavior caused by their dementia.

Here is a list of common dementia behaviors and helpful suggestions for caregivers:

• Eating and Nutrition: People with dementia forget their need to eat and drink, and complicating this may be dental problems, weight loss, irritability, disorientation, poor sleep and even bladder issues. Caregivers should consider serving meals away from a television and other distractions. Being flexible with food and beverage choices helps — a person with dementia may suddenly develop new food choices or reject ones that were liked in the past.

• Bathing: Forgetting proper hygiene, such as bathing, combing hair, brushing teeth and changing clothes are common among people with dementia. Being cleaned by another person can be frightening, embarrassing and humiliating to a person being cared for and frustrating to a caregiver. If your loved one is modest when it comes to bathing, acknowledge that by making sure doors and shower curtains are closed. Keep a towel over private body parts and have a robe ready after bathing. Never leave a person with dementia unattended in a bath or shower and have all necessary bathing products in place for ease of use.

• Sleeplessness: Restlessness and disorientation are troubling behaviors people with dementia experience and often it gets worse at the end of the day and throughout the night. Caregivers can increase daytime activities and discourage daytime naps, limit intake of sugar and caffeine and, if needed, consider speaking with patient’s physician about medication for sleeping issues.

• Hallucinations and delusions: Seeing or hearing things others do not and false beliefs may occur as dementia progresses. Caregivers can offer reassurance and acknowledge the thoughts and feelings relating to hallucinations and delusions and use distractions to help such as suggesting a walk or simply moving to another room.

Caregivers at times forget to focus on their own needs.

Here are self care practices to consider:

• Learn and use stress reduction techniques, such as exercise or yoga

• Get rest and proper nutrition

• Seek and accept support from others

• Talk to other family members and the dementia patient’s physician about new concerns and seek their guidance for suggestions on additional or alternative care-giving assistance

A caregiver cannot stop the impact of dementia for someone they care for, but there is a great deal they can do to take responsibility for their own well-being and to have their needs met. When a caregiver’s needs are addressed the person being taken care of will benefit as well.

Dr. Julia Breur is a licensed marriage and family therapist with a private clinical psychotherapy practice in Boca Raton. Further information available at www.drjuliabreur.com.

(Part one of a three part series) Dementia means “deprived of mind” and has been described in older adults since ancient times. Dementia is a term used for a wide range of symptoms that are severe enough to interfere with a person’s ability to perform everyday activities. These symptoms include the following:

• Decline in memory

• Language and communication confusion

• Difficulty focusing and paying attention

• Poor reasoning and
judgment

• Difficulty with visual perception

The most common type of dementia is Alzheimer’s and is named after Alois Alzheimer, a German physician who first described it. Today, Alzheimer’s accounts for approximately 70 percent of the dementia cases. It causes problems with memory, thinking and behavior. Alzheimer’s is not a normal part of aging. The majority of people with Alzheimer’s are 65 or older and it is interesting to note that up to 5 percent of people with Alzheimer’s are in their 40s and 50s.

The second most common form of dementia is Vascular and this can occur after a person experiences a stroke. There are numerous other conditions that have symptoms of dementia, even some that are reversible, and include thyroid issues and vitamin deficiencies.

There is not one test to determine if someone has dementia. Physicians take into consideration medical history, physical examination, laboratory tests, mental and memory testing, changes in thinking, daily functioning and behaviors in order to determine that an individual has dementia.

10 Early Symptoms of Dementia

1. Memory Changes: Forgetting where an item has been left, struggling to know the name of someone in the same room or forgetting what given tasks are to be attended to in a given day

2. Difficulty with Words: Difficulty explaining a situation

3. Mood Changes: Mood changes, such as depression or a shift in personality, such as normally being shy to being very outgoing

4. Apathy: Losing interest in a normal activities or hobbies. Choosing to be alone rather than being socially interactive

5. Difficulty with Tasks: Difficulty balancing a checkbook or understanding players or score of sports game. Struggle to learn new things or follow new routines

6. Confusion: Confusion may occur since an individual can no longer remember faces, find right words or properly interact with others

7. Difficulty with Conversations: Struggle with comprehension during a conversation

8. Direction Disruption: Spatial orientation and sense of direction deteriorate. Following step by step instructions becomes difficult

9. Repetitive Behavior: Repeats daily tasks, repeats same question even after an answer has been provided

10. Change in routine can be difficult: Fear from memory loss — going for a walk and not knowing where one is within minutes. This may create desire to stick with what is known and not trying new things

Some risk factors for dementia, such as age and genetics, cannot be changed. Researchers continue to explore the impact of other brain risk factors and the prevention of dementia. Some active areas of research are in risk reduction and prevention of dementia to include application of the Mediterranean diet that appears to help protect the brain and physical fitness to increase blood and oxygen flow to the brain. Cardiovascular factors also help, such as not smoking, keeping blood pressure stable, monitoring cholesterol, monitoring blood sugar and maintaining a healthy weight.

Research over the past 20 years has greatly improved our understanding of what dementia is and how it develops and affects the brain. This work is paying off with better diagnostic techniques, improved treatments and potential ways of preventing these diseases.

For the next part in my three part series on Dementia, I will be focusing on Dementia and caregivers.

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. Further information is available at www.drjuliabreur.com.