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A key word that you will see:

Fragmentation: a mental process where a person becomes intensely emotionally focused on one aspect of themselves, such as “I am angry” or “no one loves me,” to the point where all thoughts, feelings and behavior demonstrate this emotional state, in which, the person does not or is unable to take into account the reality of their environment, others or themselves and their resources. This is a term that my therapist and I use and is on the continuum of dissociation.

Wednesday, September 22, 2010

World Alzheimer's Disease Awareness Day!!

Okay, this wasn't meant to be a joke, but the World Alzheimer's Disease Awareness Day was actually yesterday and I forgot.  You can stop laughing now!!  This disease is devastating for the person with it and for the friends and families of those who have this disease.  During the course of my career, I have helped families and clients of loved ones and also clients (who were developmentally disabled and already had difficulties in the same areas)  with coping and managing Alzheimer's Disease.  My eyes water now as I think of how difficult a disease it is...I have a heavy heart.  Please watch the videos and read this post.  If it hasn't effected you yet, it will eventually.

September 21st was World Alzheimer’s Day, and the Alzheimer’s Association asks people in the United States to join those around the world in turning their attention to this disease and joining the fight against it. The Alzheimer’s Association’s commitment to raising awareness on World Alzheimer’s Day is part of an accelerating worldwide effort to find better ways to treat the disease, delay its onset, or prevent it from developing.

Think about combing your hair and break down the tasks and movements that are actually involved.  Some lists may be long and some shorter.  I tend to be detailed, so mine gets long.  Look in mirror, deciding if I want a comb or brush, opening drawer, selecting among other items which one is it that I want to use, grab the item, look in mirror again, decide how I want to brush it (forward, back, side to side), then complete that task, grab the brush, put it back in the drawer, shut the drawer, etc..

It is something that we all do without thinking about it much, but it is actually quite a complicated action if you think of all the things that you need to remember.  For someone with memory problems, it can become problematic.  Think about all the decisions that you have to make everyday if taking care of your hair every morning actually requires this much memory.

Alzheimer's disease is a type of dementia and neither is a normal part of aging.  Yes, older adults will have some memory loss and other symptoms that my look like a much less significant normal part of growing older.

Dementia is the loss of ability to talk, remember, reason properly, affects everyday functioning.  The risk increases as one ages. 5.3 million Americans have Alzheimer's. It is America's seventh leading cause of death. It costs 7.2 billion in costs annually. 10.9 million are unpaid care providers.

African-Americans and Hispanics are at greater risk.  Although there appears to be no known genetic factor for these differences, the report examines the impact of health conditions like high blood pressure and diabetes, conditions that are prevalent in the African-American and Hispanic communities and how these conditions also increase Alzheimer risk.

Other types of dementia are vascular dementia (high blood pressure, stroke, heart disease), Parkinson's disease, Pick's disease, Creutzfelt-Jacobs disease, Huntington's and others.  Alzheimer's disease. is the most common type of dementia.  Other things that might look like dementia include sleep deprivation, stress, influenza, thyroid disease, eating disorder, urinary tract infection and others.

Alzheimer's disease can only truly be diagnosed when a person passes when a complete look at the internal tangles and plaques can be examined.  However, there are groups of symptoms for dementia in general such as gradually memory loss, repetitive questions, forgetting to eat, misplacing objects in unusable locations, having difficulty naming everyday objects, behavioral changes (aggressive behavior, depression), and physical changes (incontinence).  In difficulty with naming objects, the first to go are nouns, so they become descriptive such as "the thing I write with."  Remember there are other causes for this...I do this frequently, but do not have any form of dementia.  Their seems to be a small genetic link and early onset such as 40s and 50s can occur. 

The following is from the Alzheimer's Association:

Stage 1:
No impairment (normal function)
The person does not experience any memory problems. An interview with a medical professional does not show any evidence of symptoms.

Stage 2:
Very mild cognitive decline (may be normal age-related changes or earliest signs of Alzheimer's disease)
The person may feel as if he or she is having memory lapses — forgetting familiar words or the location of everyday objects. But no symptoms can be detected during a medical examination or by friends, family or co-workers.

Stage 3:
Mild cognitive decline
Early-stage Alzheimer's can be diagnosed in some, but not all, individuals with these symptoms

Friends, family or co-workers begin to notice difficulties. During a detailed medical interview, doctors may be able to detect problems in memory or concentration. Common stage 3 difficulties include:

•Noticeable problems coming up with the right word or name

•Trouble remembering names when introduced to new people

•Having noticeably greater difficulty performing tasks in social or work settings

•Forgetting material that one has just read

•Losing or misplacing a valuable object

•Increasing trouble with planning or organizing

Stage 4:
Moderate cognitive decline
(Mild or early-stage Alzheimer's disease)
At this point, a careful medical interview should be able to detect clear-cut problems in several areas:

•Forgetfulness of recent events

•Impaired ability to perform challenging mental arithmetic — for example, counting backward from 100 by 7s

•Greater difficulty performing complex tasks, such as planning dinner for guests, paying bills or managing finances

•Forgetfulness about one’s own personal history

•Becoming moody or withdrawn, especially in socially or mentally challenging situations

Stage 5:
Moderately severe cognitive decline
(Moderate or mid-stage Alzheimer's disease)
Gaps in memory and thinking are noticeable, and individuals begin to need help with day-to-day activities. At this stage, those with Alzheimer’s may:

•Be unable to recall their own address or telephone number or the high school or college from which they graduated

•Become confused about where they are or what day it is

•Have trouble with less challenging mental arithmetic, such as counting backward from 40 by subtracting 4s or from 20 by 2s

•Need help choosing proper clothing for the season or the occasion

•Still remember significant details about themselves and their family

•Still require no assistance with eating or using the toilet

Stage 6:
Severe cognitive decline
(Moderately severe or mid-stage Alzheimer's disease)
Memory continues to worsen, personality changes may take place and individuals need extensive help with daily activities. At this stage, individuals may:

•Lose awareness of recent experiences as well as of their surroundings

•Remember their own name but have difficulty with their personal history

•Distinguish familiar and unfamiliar faces but have trouble remembering the name of a spouse or caregiver

•Need help dressing properly and may, without supervision, make mistakes such as putting pajamas over daytime clothes or shoes on the wrong feet

•Experience major changes in sleep patterns — sleeping during the day and becoming restless at night

•Need help handling details of toileting (for example, flushing the toilet, wiping or disposing of tissue properly)

•Have increasingly frequent trouble controlling their bladder or bowels

•Experience major personality and behavioral changes, including speciousness and delusions (such as believing their caregiver is an impostor), or compulsive, repetitive behavior like hand-wringing or tissue shredding

•Tend to wander or become lost

Stage 7:
Very severe cognitive decline
(Severe or late-stage Alzheimer's disease)
In the final stage of this disease, individuals lose the ability to respond to their environment, to carry on a conversation and, eventually, to control movement. They may still say words or phrases.

At this stage, individuals need help with much of their daily personal care, including eating or using the toilet. They may also lose the ability to smile, to sit without support and to hold their heads up. Reflexes become abnormal. Muscles grow rigid. Swallowing impaired.

All of these stages can is individual and can occur from 6-20 years.  (Remember that these symptoms represent a change behavior, such as, I've always had difficulty with remembering the day of the week. But, since this is normal it should not be considered as a symptom of any type of dementia.

There are medications to slow the process down which generally is most effective in the initial stages.  A person with Alzheimer with difficulty with walking can manifest as not wanting to walk or choosing not to do so. This may occur due to loss of this task or a change in perception and vision.  If their are changes in the floor such as carpeting to tile, curb to pavement and many others. They see it as a hole in the ground, so would you want to step into a hole. It may help to accompany them or to step off first. 

Also there is a term called "sundowning."  When their are changes light, it makes it harder to see and will be scary, loose sense of safety and steadiness.  Shadows appear as holes and they will have difficulty with spatial ability and interpretation of shapes and become more tired.  Their are some things that you can do such as minimize glare, shadows and reflections by removing mirrors and cover windows.  Hand rubbing also calms a person.

If you are a care giver, utilize some of community resources and make sure that you take breaks and contact services that can help you.  Adult day care centers are a good community resource.  There they should have therapeutic socialization, activities, exercise which helps decrease "behavior.", increases self-esteem and sense of worth.

There is much more significant information that I have not covered. For more comprehensive information, complete a Google search on Alzheimer's Association.  This is the link for the Los Angeles chapter.  There are many chapters throughout the world.


Dr. Deb said...

I also forgot to post about the awareness day.

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