Alzheimer’s Care refers to the Medical and Non-Medical Care needs for individuals with Alzheimer’s Disease and or Dementia often requiring 24hr care & supervision. Alzheimer’s and Dementia not only have a significant impact on the individual with Alzheimer’s but the family caregivers, spouses and children who are also significantly impacted by the disease. Many find it difficult to find high quality, reliable Alzheimer’s care. Unfortunately, Alzheimer’s is chronic disease and as such, there is no single treatment or cure. The course of the illness is expected to get worse and progress over time, but there are many treatments and interventions that can improve quality of life, slow the decline, maximize function & improve the quality of life for BOTH the individual and the family who help care for a person with Alzheimer’s disease or other dementia.
There are many Alzheimer’s Care options, but they are not one size fits all. Who you choose is a significant factor in determining the quality of care you and your loved one receive. Choosing the right care team can make to all the difference. Tender Loving Care Senior Residence is unique in that they have Geriatrics trained MD & RN who are highly knowledgeable and experienced in managing Alzheimer’s and Dementia patients. The MD & RN provide hands on care to each resident on a regular basis. They personally oversee & train their staff & are available day & night to assist with un expected issues or emergencies. They have daily communication with the staff and provide the needed support to the staff and families which promotes continuity and improves quality of care. TLCSR is a great value and provides the needed skill, training & leadership of a geriatrician in a small, personal, community Residential Care Home setting.
DEFINITION Alzheimer’s is a progressive disorder of the brain that negatively impacts memory, problem solving skills and behaviors. The symptoms progress over time impacting the ability to perform daily activities. Alzheimer’s Disease is only one type of Dementia. Dementia is a general heading that includes; Alzheimer’s type Dementia, Pic’s Type Dementia, Dementia with Lewy bodies, Alcohol Dementia, and Parkinson-Dementia and what might be the most common type of Dementia, Vascular Dementia which is from TIA’s or Strokes.
The fact is they all share the same clinical signs and symptoms; progressive cognitive impairment, memory loss, paranoia, delusions and or lack of insight and judgment. There are some pathologic differences in how the brain is affected but, in most cases, the cause is multi factorial with many types of brain pathology occurring as people age. Young people tend to have single type pathology, but in general, seniors tend to have a mixed picture which makes any one label-less reliable.
Some say Alzheimer’s type Dementia with beta amyloid, along with plaques and tangles is the most common form of Dementia. It is interesting to note that much of that data was acquired before CT scans and MRI’s of the head were available. If this advanced technology had been available, the number of cases with vascular dementia or small strokes would have increased. If you were to include UBOs (unidentified bright objects) as the defining characteristic then most “normal” people would be considered to have dementia, since many “normal” people have UBO’s on MRI’s if you look for them. While the diagnosis and label are interesting from a research stand point, the focus should be on the best therapy for the individuals’ symptoms of any Dementia label. The best therapy is having a staff or care team that provides continuity of care and who have well developed social and interpersonal skills to know how to provide the most effective care & support to a person with dementia, as well as, their family and friends.
While academics have created various systems of staging for Alzheimer’s, no one staging system provides a consistent predictive model for what a family can expect in the progression of Alzheimer’s Disease or any dementia. While these staging scales are useful in a research setting, they typically oversimplify the very complicated nature of Dementia and the related chronic illnesses that are typically associated with it. They are useful as a teaching tool for a Geriatric doctor or Primary Care Provider to use in educating individuals and their caregiving team to prepare them on the types of behaviors, issues, and changes in care needs that are likely to occur.
Stages of Alzheimer’s Disease
The three-stage model for Alzheimer’s includes Early (mild Alzheimer’s), Middle (moderate Alzheimer’s) and Late (severe Alzheimer’s). and is the most basic.
Early Stage In this stage an individual may still be functioning at a high level. They may still be driving working & socializing but may start having some difficulties with memory. Forgetting familiar words losing or misplacing objects, not remembering what one just read or discussed, difficulty with planning & organizing are common finding s in the early stage.
Middle Stage- the symptoms are usually more pronounced. They may have more difficulty performing tasks like taking their medications or paying bills. They may become frustrated or agitated more easily, neglect their own personal care needs like bathing, have issues with incontinence, forget events or parts of their own personal history, forget their address or phone number, have difficulty sleep, increased risk of wandering and have personality and behavior changes like becoming more suspicious, repetitive behaviors, paranoia or delusions. When a loved one starts to show behaviors associated with sundowning and night time awakenings that wake the family caregiver and affect their sleep or the need assistance with incontinent care it often requires a family to move their loved one to a 24-hr care setting. The middle stage is often referred to as the longest stage lasting over several years and requiring a higher level of care & supervision.
Late Stage is considered the most severe. In this stage individuals start to lose the ability to speak or hold a conversation, lose control of body movements, may lose ability to feed themselves, walk, are unaware of where they are, who they are and often cannot recognize their own family members on visits. This can be very difficult for families to manage & cope with. Individuals in this stage need 24hr care and supervision and it is often tough for families to provide the needed care on their own.
It is important not to get too fixated on an individual’s ‘stage”, as symptoms can vary widely. There are many factors that cause an individual to progress from one stage to the next. Some people skip entire stages. The seven-stage classification is a more specified breakdown of the 3 general stages of Alzheimer’s. In all cases, the label of a stage does not predict treatment or ways to improve the quality of life for the individual or their family.
Alzheimer’s Life Expectancy
Alzheimer’s disease is a chronic disease that can take 10—15 years to run its course or in some cases can be as short as a few years or as long as 20 years. Because Alzheimer’s and dementia are often present for a significant amount of time before symptoms appear it is difficult to really determine a specific time frame. Life expectancy varies based on the number of co morbid chronic illnesses, variations in social supports, and other resources. It is still unclear if medications designed to slow the progression of dementia like Aricept and Namenda are effective, but medications that treat the symptoms (antipsychotics), along with the appropriate behavioral therapies can improve quality of life not only for the individual but for the for the family caregivers as well.
In all cases, the best care requires ongoing monitoring and adjustments to the care plan and are best managed by an experienced Geriatrician who has the knowledge, skills and Geriatric Psychiatry training needed to effectively manage the medical and non-medical elements related to Alzheimer’s Care and has consistent hands on involvement with the patient, the caregivers and family.
There is not one specific Dementia test or Alzheimer’s test used to diagnosis Alzheimer’s. An Alzheimer’s Diagnosis is commonly determined by a doctor (preferably a Geriatrician) performing various cognitive, physical & functional tests to evaluate memory, judgment, and physical condition, as well as, other diagnostic & lab tests to rule out other causes
Signs of Alzheimer’s
Recognizing the signs and symptoms early on, can help one to slow or maintain function for longer periods of time and give family time to plan for the future and address any financial or legal issues that may arise as a result of this diagnosis. Early signs of Alzheimer’s Disease include memory loss, forgetting events, misplacing items, not remembering the time or place, difficulty finding words or writing, lack of insight & judgment, difficulty concentrating or planning, changes in mood, personality or behaviors, withdrawing from social events. You may find your loved one using adaptive memory aids, like taking notes and or staying in more familiar territory. In general, early Alzheimer’s symptoms affect short term memory more than long term memory. It is important to evaluate how any of the above-mentioned impairments may be impacting one’s ability to perform actives of daily living (ADL’s) or mange in day to day life. The doctor should gather information from family and friends about changes to overall health, diet or behaviors they may have observed. Continuity of care with your doctor and your team is important to accurately assess and monitor changes and adjust treatment if needed. It is important to rule out other causes or types of Dementia that can present similar symptoms and behaviors as Alzheimer’s like Multi Infarct Dementia (MID), Vascular Dementia, Parkinson Disease, Lewy Body Dementia, Anxiety Disorders, Clinical Depression and Psychosis which are also common and overlap with the diagnosis and treatment of an individual with Alzheimer’s.
Diagnostic Criteria for Alzheimer’s
The diagnostic criteria guidelines require that your doctor or Geriatric Medical doctor (Geriatrician) rule out all other possibilities that may present similar symptoms as Alzheimer’s. This makes it very difficult, practically speaking, to diagnosis Senile Dementia of the Alzheimer’s Type (SDAT). Many, if not most seniors will have several of these “normal” aging effects including vascular narrowing, reduced vascular circulation in legs or brain, related neuropathic findings including wide based gait, mild tremor, and other abnormal or reduced reflexes which often make it difficult to accurately diagnosis Alzheimer’s Disease. Moreover, potentially treatable conditions like clinical depression, dysthymia or reduced mood are common in a group of people who are seeing their memory, cognitive, physical and social choices reduced over time. That is a co morbid aspect one needs to consider before making the diagnosis of SDAT. Additionally, while other late onset mental illness labels are less likely, one can also raises those as possible co morbid factors. The only conclusive way to diagnosis Alzheimer’s Disease requires a brain biopsy which rarely occurs while a person is alive, so doctors are left with a suggestion that is it Alzheimer-type Dementia.
Fortunately, Alzheimer’s research is progressing and the diagnosing according to the DSM-5 seems to be moving away from the old labels and staging, to criteria that describes two categories; Major Neurocognitive Disorders and Mild Neurocognitive Disorders. According to the DSM-5 criteria, those with Major Neurocognitive Disorder present with symptoms or decline that interferes with one’s independence while people with Mild neurocognitive disorder retain their ability to be independent. The new terminology is an attempt to reduce the stigma associated with a dementia label and focuses more on a decline in function as opposed to a deficit and considers more variables. The APA reports, the addition of the new criteria that is designed to help with early detection and treatment of cognitive decline. In that regard they also introduced another label of mild cognitive impairment (MCI). We caution people not to over emphasize any one label, given the expected wide variation and overlapping issues. It is important for the doctor to consider all of the chronic illnesses a person may have and be sure to develop a treatment plan that addresses all of the chronic care issues which typically results in the highest quality of life and function possible for each individual in their unique financial, social and life styles.
Never the less, the best therapy for a person with Dementia, Alzheimer’s or any chronic diseases is having a care team who have the qualifications, training, skills and experience required to guide the care. That team should consist of a Geriatric doctor who can provide leadership, continuity of care, education, communication and support to the staff, the patient and their family. This is best accomplished in a small, personal, family-like, community setting of a Residential Care Home where there is continuity & consistent staff to allow for ongoing, trusting, long-term relationships to be developed and add great value when caring for those with Alzheimer’s.