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The Stages of Alzheimer’s Disease

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Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks. Named for Dr. Alois Alzheimer who in 1906 noticed changes in the brain tissue of a woman who had died of an unusual mental illness. Her symptoms included memory loss, language problems, and unpredictable behavior. After her death, Dr. Alzheimer examined her brain and found many abnormal clumps (not called amyloid plaques) and tangled bundles of fibers (not called neurofibrillary, or tau tangles).

These plaques and tangles in the brain are considered some of the main features of the disease along with the loss of connections between nerve cells in the brain.

Mild Alzheimer’s Disease

As Alzheimer’s disease progresses, people experience greater memory loss and other cognitive difficulties. Problems can include wandering and getting lost, trouble handling money and paying bills, repeating questions, taking longer to complete normal daily tasks, and personality and behavior changes. People are often diagnosed in this stage.

Moderate Alzheimer’s Disease

In this stage, damage occurs in areas of the brain that control language, reasoning, sensory processing, and conscious thought. Memory loss and confusion grow worse, and people begin to have problems recognizing family and friends. They may be unable to learn new things, carry out multi-step tasks such as getting dressed, or cope with new situations. In addition, people at this stage may have hallucinations, delusions, and paranoia and may show impulsive behavior.

Severe Alzheimer’s Disease

Ultimately, plaques and tangles spread throughout the brain, and brain tissue significantly shrinks. People with severe Alzheimer’s cannot communicate and are completely dependent on others for their care. Near the end of life, the person may be in bed most or all of the time as the body shuts down.

Research suggests that a host of factors beyond genetics may play a role in the development and course of Alzheimer’s disease. There is a great deal of interest, for example, in the relationship between cognitive decline and vascular conditions such as heart disease, stroke, and high blood pressure, as well as metabolic conditions such as diabetes and obesity. Ongoing research will help us understand whether risk factors for these conditions may also reduce the risk of Alzheimer’s.

A nutritious diet, physical activity, social engagement, and mentally stimulating pursuits have all been associated with helping people stay healthy as they age. These factors might also help reduce the risk of cognitive decline and Alzheimer’s disease. Clinical trials are testing some of these possibilities.

Beginning treatment early in the disease process may help preserve daily functioning for some time, even though the underlying disease process cannot be stopped or reversed. An early diagnosis also helps families plan for the future. They can take care of financial and legal matters, address potential safety issues, learn about living arrangements, and develop support networks.

In addition, an early diagnosis gives people greater opportunities to participate in clinical trials that are testing possible new treatments for Alzheimer’s disease or other research studies.

Alzheimer’s disease is currently ranked as the sixth leading cause of death in the United States, but recent estimates indicate that the disorder may rank third, just behind heart disease and cancer, as a cause of death for older people. Estimates vary, but experts suggest that more than 5.5 million Americans may have Alzheimer’s. By 2050, this number is projected to rise to nearly 14 million.

Want to get involved and raise awareness and money to fight Alzheimer’s?

The 2018 Wilmington Walk to End Alzheimer’s will be held on November 3 at Wrightsville Beach Park. They will also be hosting a kick off party at Waterman’s Brewing on Thursday, October 4 for an evening of fun, food, and inspiration. Visit their website for more information on how you can participate.

Sundowning: How to help your loved one

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Have you heard of Sundowner’s Syndrome? Sometimes it’s called Sundowning, and it’s usually associated with people who have Dementia or Alzheimer’s. For those people, sundowning can be a time of increased memory loss, confusion, agitation or even anger. For the family members who care for them, it can be a painful and exhausting experience.
What causes Sundowning?

  • Too much activity towards the end of the day can trigger sundowning. Even shift changes can lead to anxiety and confusion for those in a memory care facility.
  • Fatigue is also a common factor. Perhaps they are tired from the activities of the day, or even the sudden lack of activity after dinner can be a contributor.
  • Too much sleeping during the day and inactivity can also disrupt a good night’s sleep.
  • When the sun goes down, shadows may increase and the amount of available light makes already challenged vision that much more difficult to see.
  • Hormonal imbalances can cause disruption in the internal biological clock. This imbalance can lead to confusion between waking and sleeping hours.
  • Even wintertime and its shorter days can make sundowning worse for some people. This is also an indicator that the syndrome may have something to do with Seasonal Affective Disorder, a common type of depression caused by lack of exposure to natural sunlight.

How can you help reduce Sundowning symptoms?

  • Sticking to the same schedule every day can help your loved one feel more calm and oriented. If a routine much change, try to adjust them gradually and with as small of an impact as possible.
  • Adjusting the lighting in their room or home could also help with sleep and wake cycles if their circadian rhythm gets out of sync. According to the a research review published in Psychiatric Investigation, some studies suggest light therapy to reduce agitation and confusion in people with dementia.Placing a full-spectrum fluorescent light a few feet away from your loved one for a couple of hours each morning could help with sundowning symptoms. Even brightening the lights may help. when they feel confused or agitated.
  • Walking in the park and other activities during the day might improve their sleep at night and reduce sundowning symptoms.
  • Consuming large meals, caffeine, and alcohol can also interrupt the sleep patterns of someone with Sundowning symptoms. Limiting evening food to a healthy snack or a light meal might help them rest easier, too.
  • Encouraging evening activities that aren’t too stressful can help reduce confusion and irritability. If they have mid-stage or advanced dementia, watching television or reading a book could be too difficult. Try playing soft music to calm and soothe them. Snuggle time with a family pet could also help reduce stress.
  • If a loved one has moved into a hospital or assisted living facility, furnishing their space with some of their treasures like a favorite blanket, and family photos, can help ease the transition and help with sundowning symptoms.
  • Medication may be helpful in some cases of sundowning, especially when it’s associated with depression or sleep disorders. Consulting a physician is important since some medications may actually disrupt sleep patterns that can make symptoms worse.

Looking for patterns of sundowning in your loved one can help you identify the triggers.Track behaviors and activities with a journal or smartphone app to learn what makes symptoms worse or better. Once you know which activities or environments are triggers, it’s easier to avoid those situations and events.
Managing a loved one’s symptoms can be exhausting for the caregiver, so it’s important to take good care of yourself. Be sure to eat a well, get regular exercise, and get plenty of sleep every nights. It’s okay to rely on other family members or seek respite care so you can take regular breaks.

The Behaviors of Alzheimer's

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There are three stages to Alzheimer’s and many behaviors that go along with the disease. As a caregiver, it’s important to understand what these behaviors are so that we can know what to expect as the disease progresses.
Aggression and Anger
This can be a reaction caused by frustration due to not being able to communicate effectively about their needs, or perhaps, they are in pain or experiencing physical discomfort. A person with Alzheimer’s also can have irregular sleep patterns and they may be tired, which can in turn, make a person more quick to anger. Sometimes an over stimulating situation such as loud noises or crowds can cause aggression. A possible side effect of medication can also be to blame.
As a caregiver,  try to identify the immediate cause of the behavior. Did something happen just before the outburst? Is the person in pain? Urinary tract infections are not uncommon in Alzheimer’s patients, so it’s important to rule this out as a cause of the stress.
Anxiety and Agitation
A direct result of Alzheimer’s is the inability to process new information.So, when their normal routine is interrupted and situations change, a person may experience profound anxiety and agitation. For example, there will most likely come a time when the patient must be moved out of their own home and into a home with a caregiver or a nursing home. This can cause fear as they are trying to understand and process the new routine. Caregivers may also change, or if new visitors or house guests arrive, they may experience anxiety with these changes.
It’s important listen to the patient and talk with them to help them understand what is going on. Again, don’t be dismissive of their feelings. Create a calm environment for them and tell them that they’ll be safe. Taking them outside for a short walk can also help calm their nerves.
Depression
Depression is very common among people with Alzheimer’s, especially during the early and middle stages. However, it can be difficult to diagnose. Symptoms such as withdrawing from friends, social activities and hobbies are common.
Caregivers can assist by creating a normal routine based on the best interest of the patient. For example, exercising early in the morning, celebrate special occasions and small successes, prepare their favorite food and let them help prepare for as long as they are able. Alzheimer’s patients, dare I say like everyone, want to feel like they are contributing to something and need to be reassured that they won’t be abandoned.
Hallucinations

When individuals with Alzheimer’s have a hallucination, they see, hear, smell, taste or even feel something that isn’t really there. They usually occur in later stages of Alzheimer’s.
If a loved one is hallucinating, it’s important to evaluate the situation. Will it lead to dangerous behavior and cause harm to you or themselves? What is causing the person be afraid? Try to reassure them that they are safe and acknowledge their feelings.Distracting them by turning on lights, changing the conversation or listening to their favorite music can also help.
Memory Loss and Confusion
The beginning stages of Alzheimer’s brings a mild case of memory loss and confusion such as difficulty recalling events and understanding full conversations. The later stages brings greater memory loss including names and faces of family members, and the purpose of basic utensils such a pen or a fork. These more severe changes are some of the most difficult for family members and caregivers to witness.
Caregivers can help by remaining calm in a given situation, sharing photos and not being condescending when the patient doesn’t recognize someone or doesn’t know what a fork is used for. Even going back in time with them when they think they are somewhere else, can having a calming effect on them.
Repetition
A person with Alzheimer’s may say or do something over and over. They may ask the same question that you just answered. People with dementia who ask questions repeatedly may be trying to express a specific concern, ask for help, or cope with frustration, anxiety or insecurity.
They may be trying to communicate with the family member or caregiver about something. If they do ask the same question repeatedly, you may need to answer the question over and over. Or, if they are still able to read, you can try writing down the answer so they can be reminded of whatever it is that they are nervous about. They may also be bored. If so, you can try a change of scenery for them or go for a short walk.
There is an old saying that goes something like, “You may not remember what someone said, but you’ll never forget how they made you feel.” Your support and understanding of a person with Alzheimer’s will always be appreciated.
 

June is Alzheimer's Awareness Month

Memory loss? Confusion? Problems with thinking and reasoning? These are symptoms of declining cognitive health and a sad reality for many people right here in our community. Dementia is a term that describes the decline in cognitive health that’s severe enough to interfere with daily life and Alzheimer’s is the most common type of dementia.
Though the greatest known risk factor of Alzheimer’s is increasing age, it’s not just a disease for the elderly. About 5% of cases are early onset which often appears in someone who is in their 40s or 50s.
In its earliest stage, memory loss is mild, but as the disease progresses, it worsens over time. A person will usually lose the ability to have a conversation and respond to their environment.
Depending on the overall health and age of the individual a person with Alzheimer’s lives on average eight years after their symptoms become noticeable to others, but the range is about four to 20 years.
Facts:

  • More than 5 million Americans are living with Alzheimer’s
  • It’s the 6th leading cause of death in the U.S.
  • 1 in 3 seniors die from Alzheimer’s or another form of dementia
  • It kills more than breast cancer and prostate cancer combined
  • In 2015 15 million caregivers spent more than 18.1 billion hours of unpaid care
  • It’s estimated that family caregivers spend $5,000 annually specifically for someone with Alzheimer’s

There is no cure for Alzheimer’s though researchers are working everyday to find new treatments to change the course of the disease and improve the quality of life for those affected.
As Alzheimer’s progresses, brain cells die and connections among cells are lost, causing cognitive symptoms to worsen. While current medications cannot stop the damage Alzheimer’s causes to brain cells, 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.
The FDA has approved two types of medications to treat the cognitive symptoms of the disease:
Memantine: (Namenda)

  • Regulates the activity of glutamate, a different messenger chemical involved in learning and memory.
  • Delays worsening of symptoms for some people temporarily. Many experts consider its benefits similar to those of cholinesterase inhibitors.
  • Can cause side effects, including headache, constipation, confusion and dizziness.

Cholinesterase Inhibitors (Aricept, Exelon, Razadyne)

  • Prevent the breakdown of acetylcholine, a chemical messenger important for learning and memory. This supports communication among nerve cells by keeping acetylcholine levels high.
  • Delay worsening of symptoms for 6 to 12 months, on average, for about half the people who take them.
  • Are generally well tolerated. If side effects occur, they commonly include nausea, vomiting, loss of appetite and increased frequency of bowel movements.

Oftentimes, doctors prescribe both types of medications together. Plus, some doctors also prescribe high doses of vitamin E for cognitive changes of Alzheimer’s disease.
Source: alz.org
 

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