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by Germaine L. Odenheimer, M.D.
Darryl Wieland, Ph.D.
Most of us have had times when we forgot
the name of someone close to us or misplaced our car keys
or even our car. So how do we know when we or someone we love
is developing dementia?
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Q. What is dementia?
A. Dementia
is a condition of declining mental abilities, especially memory.
The person will have problems doing things he or she used
to be able to do, like keep the check book, drive a car safely,
or plan a meal. He or she will often have problems finding
the right words and may become confused when given too many
things to do at once. The person with dementia may also change
in personality, becoming aggressive, paranoid, or depressed.
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Q. Isn't dementia just
old age or senility?
A. As we get
older, it takes us longer to remember things or to find the right
word to say. But this is NOT dementia. Dementia keeps us from
doing the things we used to do because of the mental changes.
Although dementia is more common in old age, it is not "normal"
and should be evaluated. Aging alone does not interfere with our
abilities to function.
Q. What causes dementia?
A. There are
many causes of dementia, including strokes, low vitamin B 12 levels,
thyroid conditions, depression, AIDS, and other infections. Medications
and some illnesses can cause confusion (delirium) in older people
that may look like dementia. But Alzheimer's Disease is the most
common type of dementia. We are not sure what causes it.
Q. What is Alzheimer's
disease?
A. We don't
know why it happens, but certain cells in the brain stop working
and finally die. These cells produce important chemicals [Acetylcholine
and others] needed for memory, language and other thinking functions.
As the chemicals decrease, so do the person's abilities to remember
and think clearly. Alzheimer's disease usually sneaks up on the
person and family because it gets worse slowly over several years,
before the changes are noticed. Over time (usually 5-8 years),
it progresses to a point where the person can no longer care for
even the most basic needs.
Q. How do you get Alzheimer's
Disease?
A. We know
that as we get older we have a greater chance of getting Alzheimer's
disease. At the age of 65 +, about 1 in 15 people has the disease.
At the age of 85 and older, about 1 out of every 3 people has
this disease. We also know that some families carry genes that
place them at risk for developing the disease. We think that there
are triggers in our environment that can make the disease appear.
But we don't yet know, for sure, what those triggers are.
Q. Is there any point
to seeing my doctor?
A. There are
a number of reasons to get an evaluation. First, there are other
causes of dementia and confusion that can be very easily treated.
People with confusion may return to normal once the medications
are changed or the illness is treated. Second, new treatments
available for Alzheimer's disease seem to improve the symptoms
and slow their progress. Third, the doctor should be able to refer
you to community resources for information, support groups and
other help at home.
Q. What can we expect
from the doctor?
A. Your doctor
should do a careful medical examination and medication review.
There should be tests of memory. Blood work will be done and sometimes,
a CT scan or MRI scan of the brain will be obtained. Referral
for detailed mental testing may be made. Finally, the doctor should
provide care throughout the illness.
Q. How can I convince
my loved one to go to the doctor?
A. Often,
your loved one already knows there is something wrong and may
be very frightened. It would be helpful to emphasize that many
things can be treated and that there are new medications available
even for Alzheimer's disease.
Q. How do I know when
my loved one should stop working or banking or driving or living
alone?
A. These are
very difficult questions that will need to be addressed by your
doctor and other specialists. In general, the potential for harm
to your loved one or to others usually forces us to consider stopping
certain activities. The doctor is very dependent on your observations
when making recommendations about such major life changes and
can be supportive in reinforcing your concerns.
Q. What else can I
do as a caregiver?
A. You are
so important in taking care of the demented person, that you must
take good care of yourself. Caregivers can get very depressed
and often become sick because they are neglecting their own health
needs. You need breaks from caregiving. You need to get help at
home. You need to eat, sleep and exercise regularly. You need
to forgive yourself for feelings of anger and guilt. This is where
a support group can get you through some very tough times.
Q. Is a nursing home
really necessary?
A. This is
a very individual matter. Often families feel guilty about placing
a loved one in a nursing home. And with adequate help at home,
safety measures [such as removing the knobs from stoves], and
day care options, the person can stay at home for a long time.
But a good nursing home can provide safety and social interactions
that may actually give your loved one a great deal of pleasure
and security as well as giving you a chance to sleep and do your
daily tasks with some peace of mind.
Q. Where do I go for
more information or support?
A. The National
Alzheimer's Association is a wonderful resource and can be reached
at: 1-800-272-3900, or on the World Wide Web at: http://www.alz.org.
The Alzheimer's Disease Education and Referral Center can be contacted
at: 1-800-438-4380 or by email at: adear@alzheimers.org.
Your local Alzheimer's Association Chapter will help you find
local resources and support groups.
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