Spring Arbor Living Blog

Behavioral and neuro-psychiatric symptoms of dementia can be extremely challenging and distressing for patients and their caregivers. Antipsychotic medications may be the only option if the patient's behavior is potentially harmful to him- or herself or to others.

Antipsychotic medications are often prescribed for dementia patients in nursing homes to alleviate the agitation, aggression or psychotic behavior that is either distressing to the patient or makes the patient a danger, but the Food and Drug Administration (FDA) has not approved any drugs for the treatment of behavioral symptoms of dementia. What's more, antipsychotics carry an FDA black box warning that older patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death.

Drugs versus alternatives

There are ways to deal with difficult dementia patients that don't involve the use of drugs. Once a medical cause has been ruled out, the nursing and medical staff should look for environmental triggers that can be avoided or minimized.

• Changes in the environment might include increasing contact with caregivers, switching roommates, adjusting the temperature in the room or providing stimulating activities.
• Simply paying attention to a patient can often ease disruptive symptoms.
• In some cases, difficult behavior can be safely managed by reducing boredom -- providing intellectual and physical stimulation, exercise, calming music or pet therapy.

However, if someone is in psychological agony and nondrug approaches have failed, medication might help. The risks and benefits of prescribing antipsychotics to people with dementia need to be carefully considered. While dementia patients are difficult to care for, even when drugs are administered, the practice of overmedication to make patients "manageable" is certainly not acceptable. Advocating for your loved one with dementia

When someone with dementia is cared for in an Alzheimer's care facility, the support of family and friends is still critical, since the person can't adequately advocate on his or her own part. Family members must learn about the medications that are being dispensed, the reasons for their use, proper dosages and possible side effects.

If you notice that your loved one seems to be showing greater confusion after starting a drug, say something. Bring this to the attention of the doctor who prescribed the medication and discuss what steps can be taken to improve his or her quality of life. By maintaining this dialogue, you will be doing everything you can to ensure the best care for your loved one.

Comments (0) | Trackbacks (0) | Permalink |

Elaine Vlieger is making some concessions to Alzheimer's. She's cut back on her driving, frozen dinners replace elaborate cooking, and a son monitors her finances. But she lives alone and isn't ready to give up her house or her independence.
 
Some 800,000 people with Alzheimer's, roughly 1 in 7 Americans with the disease, live alone, according to data from the Alzheimer's Association. It's a different picture from the constant Alzheimer’s care giving that they'll eventually need.
 
Many cope on their own during early stages of dementia with support from family and friends who keep in close contact.
 
But with support or not, living alone with a disease that gradually strips people of the ability to know when they need help brings concerns, and loved ones agonize over when to step in.

There's no easy answer, and it's a challenge that will only grow. About 5.4 million people in the United States have Alzheimer's or similar dementias. That number is expected to reach up to 16 million by 2050 with the population aging so rapidly.

Most older people want to stay in their homes as long as possible, and developing cognitive impairment doesn't automatically mean they can't initially, says Beth Kallmyer of the Alzheimer's Association. The association's new analysis illustrates the balancing act between a patient's autonomy and safety. People with dementia who live alone can do so initially while they are less impaired, as the disease progresses dementia and Alzheimer’s patients need caregivers. Studies also show that those who live alone have a greater risk of injuries or accidental death than those who don't live alone.
 
The first National Alzheimer's Plan, due this month, may help. It aims to increase screening to catch dementia earlier and urges doctors to help plan for Alzheimer's care.

Do you have a loved one who needs constant Alzheimer's Care? Contact Spring Arbor.

Newsday

Comments (0) | Trackbacks (0) | Permalink |

When family members become caretakers of loved ones who suffer from Alzheimer's disease and dementia, they often study up on the condition.

"The more you can learn the better you're going to be and you better understand the disease."

Often used interchangeably, both dementia and Alzheimer's are forms of mental degradation. In many ways they seem the same but are actually two different medical terms.

"I tell people that it’s sort of like dementia is the team and Alzheimer's is one of the players," says Dr. Michael Raab, a geriatrician with Lee Memorial Health System.

Dementia covers a number of disorders; Alzheimer's is most common.

Alzheimer's has physical characteristics in the brain, which most other forms of dementia don't have.

"When you look at the brain, there are tangles and plaques. The Lewy Body dementias, the vascular dementias, the front dementias, none of them really have any plaques or tangles," says Dr. Raab.

What's more, Alzheimer's progression is gradual and can begin in middle age. General dementia is usually found in advanced years.

Finally, various conditions can affect different parts of the brain. Only a specialist can give you proper diagnosis.

"It takes very sophisticated testing which is what we do with our neuropsychologists, to try and differentiate the areas of thinking that have been lost," says Dr. Raab.
 
NBC2.com

Comments (0) | Trackbacks (0) | Permalink |

If you have Parkinson's disease, your body fails to produce enough dopamine, a substance necessary for smooth and coordinated movements. This loss of dopamine leads to the signature symptoms of Parkinson's disease: rhythmical shaking (tremor), stiffness, shuffling, slowness of movement, balance problems, small or cramped handwriting, loss of facial expression and soft, mumbled speech.

Although Parkinson's disease is a neurological disorder affecting movement, it is also associated with an often overlooked psychological condition known as cognitive impairment. Cognitive impairment can affect your memory and attention span as well as your ability to plan and organize. Many patients already have some degree of cognitive impairment when first diagnosed with Parkinson's disease.
 
As Parkinson's disease advances, the ability to recognize people and objects and communicate with others becomes increasingly difficult, especially in the later stages. Some experts believe that nearly all patients with Parkinson's disease will ultimately develop some degree of cognitive impairment.
 
The challenge of diagnosing cognitive impairment: Diagnosing cognitive impairment in Parkinson's disease patients is difficult because it’s often hard to tell whether certain symptoms are due to Parkinson's disease or another form of dementia. For instance, significant cognitive impairment could arise from Lewy body dementia rather than Alzheimer's or Parkinson's disease.

Lewy body dementia is associated with the abnormal accumulation in the brain of alpha-synuclein -- a protein whose function in healthy brains is still unknown. Alpha-synuclein is of great interest to researchers because it is a major constituent of Lewy bodies, the protein clumps that are a hallmark of Parkinson's. Scientists now believe that Lewy body dementia -- not Alzheimer's disease -- is responsible for most cases of dementia in Parkinson's disease patients.

Caring for patients with Parkinson's disease when there are no signs of cognitive impairment is already a complex task. But caring for Parkinson's patients when evidence of cognitive impairment is present is even more complicated. Some medications commonly used to treat classic Parkinson's disease, such as levodopa, can worsen cognitive impairment and trigger bizarre behavior. Other drugs, such as anti-psychotics (neuroleptics), can paradoxically increase hallucinations, delusions and agitation in Parkinson's disease patients who also have dementia.
 
Original article – Johns Hopkins Health Alert

Comments (0) | Trackbacks (0) | Permalink |

As our population ages, people with chronic cardiovascular disease, including atrial fibrillation (or irregular heartbeat), are living longer. In a study reported in the journal Heart Rhythm (Volume 7, page 433) researchers reported that atrial fibrillation may be associated with an increased risk of developing dementia and Alzheimer's disease.

Over 37,000 people, average age 60, from the ongoing Intermountain Heart Collaborative Study database were evaluated for signs of atrial fibrillation and for Alzheimer's disease or vascular, senile or nonspecific dementia. During an average of five years' follow-up, 4 percent developed dementia and 27 percent developed atrial fibrillation.

Atrial fibrillation was associated with each of the four types of dementia, independent of other cardiovascular diseases. The youngest group with atrial fibrillation (under age 70) had the highest risk of dementia; dementia is linked to older age, so this finding suggests the relationship between atrial fibrillation and dementia is particularly strong. Atrial fibrillation was also linked with the highest risk of death.

Take away: Because subjects with atrial fibrillation were identified as having higher risks of dementia and death, people with cardiovascular diseases -- who are urged to consider measures like diet, exercise, medication and avoiding tobacco for their heart disease -- might want to take these steps also to prevent or delay the development of Alzheimer's.

All the facts you need to make informed decisions if you have to confront Alzheimer's disease -- the most common cause of dementia

Written by Dr. Peter V. Rabins, director of the Division of Geriatric and Neuropsychiatry at the Johns Hopkins School of Medicine and Medical Editor of the Johns Hopkins Memory Bulletin, Diagnosing and Treating Alzheimer's Disease is an indispensable resource for anyone concerned about Alzheimer's disease. This new report provides all the facts you need to make informed decisions if you have to confront Alzheimer's disease. You'll learn how Alzheimer's is currently diagnosed ... the existing drugs that are used to treat it ... and various new therapies that may someday provide better treatment.

Comments (0) | Trackbacks (0) | Permalink |