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alzheimer's disease and care

Posted by tzul at 2020-03-21
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Summary

Alzheimer's disease (AD) is a disease that can cause abnormal changes in the brain, mainly affecting memory and other mental abilities. Alzheimer's disease is a disease, not a normal manifestation of natural aging. Memory loss is a common first symptom. With the development of the disease, reasoning ability, language ability, decision-making ability, judgment and other key skills are gradually lost, making it impossible to carry out daily life without the help of others (usually family members or friends). Personality and behavior sometimes change, but this is not necessarily a symptom.

Alzheimer's disease is the most common form of dementia in the elderly. The terms "Alzheimer's" and "dementia" are often used interchangeably, but in different conditions. "Dementia" describes a disease in which a person no longer has the ability of self-care because of the long-lasting damage to a variety of mental abilities that affect memory, attention and reasoning. Dementia can be caused by many different medical conditions, such as severe head injury or major stroke. Other common types of dementia include Lewy body dementia, frontotemporal dementia, vascular dementia and Parkinson's disease dementia (Dementia: Is This Dementia and What Does It Mean?)）。

Although the etiology and progression of AD have not been fully understood, more and more evidences show that the initial changes of brain occur 15 years before dementia symptoms in people with AD. Some brain scans can detect these changes. However, the work is not advanced enough to predict who will develop Alzheimer's disease in the future.

The prevention of Alzheimer's disease is a hot topic in the media. The media recommends non-medical life practices as they may help prevent Alzheimer's disease, build healthy ways to manage disease and achieve the health that peers deserve. There is evidence that mental stimulation (brain games), exercise (such as walking, swimming, yoga), social activities and a healthy diet (fruits, vegetables and antioxidant rich foods) may be helpful, but these are not clearly documented.

However, there is a great deal of evidence that small strokes are common in Alzheimer's patients, which only aggravates the symptoms of AD. Given our knowledge of stroke prevention, maintaining healthy blood pressure, avoiding diabetes or managing diabetes, lowering cholesterol and non-smoking are four key risks.

It occurs as early as 30, but is usually diagnosed after 60, and the risk increases with age. Up to 40% of the population is likely to be affected by the age of 90. The inheritance of ad is very complex, and the related knowledge is changing with each passing day. In addition to a small number of families with the disease caused by a single gene, a family member suffering from ad will only increase your risk to a certain extent. Alzheimer's disease is reported to be the sixth leading cause of death in the United States.

Symptom

AD patients may show symptoms of the disease three to five years before diagnosis. The stage of ad is called "mild cognitive impairment", or MCI. It is important to understand that not everyone with MCI will continue to develop ad. In fact, as many as 40 – 50% of people may never get the disease. (refer to FCA reference book MCI.) Early problems are often seen as normal changes due to aging; only when looking back can caregivers see that symptoms have been present for years. Although people usually live four to eight years after diagnosis, it's not unusual to live 20 years. In order to understand the changes in the course of disease development, ad is generally divided into three stages: early, middle and late. However, individual symptoms will vary from person to person, and the development of symptoms will vary.

Diagnosis and science of Alzheimer's disease

At present, no single detection can realize the diagnosis of AD. Doctors first need to make sure that memory loss is abnormal, and that the symptom pattern matches ad, which sometimes requires a special memory test. Doctors then need to rule out other diseases that may cause the same symptoms. For example, similar symptoms may also be caused by depression, malnutrition, vitamin deficiency, thyroid and other metabolic disorders, infections, drug side effects, drug and alcohol abuse or other conditions. If the symptoms are typical of AD and no other cause is found, a diagnosis can be made. The diagnosis made by a skilled doctor is very accurate.

Requests to assess Alzheimer's are usually made by family members or friends who find memory problems or abnormal behavior. When doctors begin this assessment, they usually obtain a health history, perform physical examinations, and assess the patient's cognitive abilities (psychological processes of perception, memory, judgment, and reasoning). This method can help doctors determine whether further tests are needed. The primary care physician may recommend to the patient a more extensive examination by a designated Alzheimer's diagnostic center or by a neurologist, dementia or geriatric specialist. This examination may include a comprehensive medical assessment and medical history, blood tests and brain scans (MRI or PET), as well as a wide range of neurological and neuropsychological assessments. Dementia assessment should include interviews with relevant persons, who can be family members or other persons with close contact with the assessed.

Rapid scientific progress is being made in the identification of "biomarkers" of AD. Biomarkers are abnormal findings of ad markers in blood or cerebrospinal fluid (CSF) or on brain scans. There is strong evidence that specific detection of CSF may be helpful in diagnosis. Now, PET scans can also be used to see amyloid (the main abnormal protein in AD) in the brain. With the development of knowledge, these tests may be used in clinical practice. However, even now, they are obviously not enough to be the full basis for diagnosing ad. Diagnosis will still depend on a skilled and comprehensive assessment.

Treatment after diagnosis

No one is fully aware of the causes of Alzheimer's disease, and there is no cure. However, researchers have made considerable progress in recent years, including the development of several drugs for early AD, which can temporarily improve cognitive ability.

It has been proved that donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl), three main drugs, can improve memory, with limited side effects, usually manifested as gastrointestinal discomfort. Ace can be provided in the form of patch, which is very helpful for people who have difficulty swallowing pills. However, these drugs are not effective for everyone, and their effects are limited to early and mid-term ad. Another prescription drug, memantine HCl (namenda), is also helpful in delaying the progress of AD and is usually used in combination with the above drugs. Doctors can also prescribe drugs to help reduce restlessness, anxiety and unpredictable behavior, as well as improve sleep patterns and treat depression.

New drugs should be tested regularly after development. Those interested in participating in clinical trials should discuss the pros and cons with their doctors and family. Information about clinical drug trials and other studies can be obtained from the Alzheimer's disease education and referral center (adear) and the FCA's research registry.

Regular visits are important. Sudden and significant changes in mental state may be the main symptom of major treatable diseases such as UTI, pneumonia and even fractures. If the doctor knows the patient's condition, he can quickly see the change of mental state. But if they're dealing with a dementia patient they haven't seen for years, it's hard to know if anything has changed and may not be able to initiate the right tests.

Nursing of patients with Alzheimer's disease

Alzheimer's disease is known as a family disease because watching a loved one's physical condition slowly deteriorate can cause constant stress on each family member. Effective treatment will meet the needs of the entire family. Caregivers must focus on their own needs, take time to focus on personal health, and receive regular support and temporary rest during the care so as to maintain their own health during the care process. Emotional support, practical support, counseling, resource information, and education programs for Alzheimer's can all help caregivers provide the best care for their loved ones.

For caregivers, the easiest thing to say and the hardest thing to accept is to take care of yourself. As one caregiver said, "caring for yourself is caring for your loved ones." It's often difficult to foresee waiting for your care every morning.

Through training, caregivers can learn how to manage challenging behaviors, improve communication skills, and ensure the safety of Alzheimer's patients. Studies have shown that caregivers are less stressed and healthier when they learn skills through caregiver training (online or in person) and participate in support groups. Participation in these groups allows caregivers to provide home care for their loved ones for longer periods of time.

When you start as a caregiver, it's hard to know where to start. Perhaps you have only recently realized that a relative needs help. He or she is no longer as independent as before. Or maybe their health suddenly changed.

It's time to take action and inventory the people, services and information that can help you provide care. The sooner you get support, the better for you.

The resources listed at the end of this resource book will help you find local training courses and support groups. (please refer to FCA's two reference books: caregiver's Guide to understanding dementia behaviors, dementia, nursing, and controlling frustration, and ten real-life strategies for dementia nursing.).

The role of caregivers varies with the needs of AD patients. The following table summarizes the stages of AD, the expected types of behavior, and the care information and recommendations associated with each stage of the disease.

Early Stage Alzheimer's Disease

Early care

Can't remember recent events or conversations, months or days of the week

Ask the same questions over and over again

Loss of financial management ability, error in issuing check

Can't remember recent events or conversations, months or days of the week

Ask the same questions over and over again

Loss of financial management ability, error in issuing check

Early on, caregivers and AD patients will want to spend time adapting to the diagnosis and planning for the future:

Learning: the more you know about AD, the easier it is to take care of it. Learn as much as you can about early and mid-term ad; don't worry about late issues. Talking to other caregivers is also a good way to understand and understand personal experience. One of the hardest things to learn is to distinguish the disease itself from your loved ones. Especially in the early days, caregivers may find themselves thinking, "he did it to make me difficult!" Or "she's just slacking off." In these cases, behaviors that upset caregivers are usually the result of the disease process, rather than AD patients trying to hurt or defeat caregivers.

Emotional support: the diagnosis of ad can be a heartbreaking experience for both the diagnosed and the caregiver. AD patients may not remember or admit to suffering from the disease, or have been told they have Alzheimer's disease. Trying to persuade them is futile and frustrating for caregivers. Caregivers need appropriate emotional support through counseling, support groups, or other family members. The goal is to build an emotional support system that grows and changes as your caregiver role and emotional challenges change. Depression is common in caregivers of AD patients and should be addressed.

Family role: with the development of the disease, it will be more difficult for AD patients to fulfill the role they usually play in the family. For example, if an AD patient is the only driver in the family, family members need to find alternative means of transportation (for example, learning to drive, recruiting volunteer drivers from family and friends, using public transport or auxiliary transport). If in the past it was usually for AD patients to prepare all the meals, now caregivers are going to learn to cook. If in the past it was the AD patients who were in charge of family finance, then others would have to play that role. Paying attention to these issues as early as possible will allow AD patients to help caregivers prepare for the future.

Finance: ad can be an expensive disease to treat. Strategies need to be developed to cope with the increasing financial burden on families as the disease progresses. Financial planning should include checking your coverage, such as health, disability, long-term care. Please note that Medicare does not pay for long-term care or guardianship. Medicaid is the safety and security of people living on a limited income, providing coverage for eligible people. The elderly can get health insurance consultation services free of charge. To find help in your community, see the eldercare locator website: eldercare.acl.gov (external link).

Metaphase Alzheimer's disease

Medium-term care

Behaviors that are difficult to deal with often occur, but not always. Common examples include anger, suspicion, overreaction, and paranoia (for example, thinking that a family member stole money or a spouse had an affair)

More repetitive questions or conversations

Trance or sunset syndrome (i.e. restlessness or agitation in the afternoon and evening)

Fear of bathing

Food problems, poor table manners

Involuntary urinary leakage (incontinence) or "accident"

Hoard goods, especially paper

Inappropriate sex

Violence - beating, shouting, armed self-protection

Will move from need to help select clothes and remember to change clothes to need to help wear clothes

From the need for personal care reminders to the need to help bathe, take medicine, brush your teeth, shave, comb your hair, go to the toilet, etc

Greater difficulty in language expression and understanding, especially when trying to name an item

Space issues (e.g., no way to find, sometimes even at home)

Loss of reading, writing, and arithmetic skills; inability to keep up with the storyline of a television program

Lack of coordination often leads to a tardy footstep or gait problem

Will require care or guardianship; may be 24 hours a day

Sometimes you may lose the ability to recognize your family and friends

Behaviors that are difficult to deal with often occur, but not always. Common examples include anger, suspicion, overreaction, and paranoia (for example, thinking that a family member stole money or a spouse had an affair)

More repetitive questions or conversations

Trance or sunset syndrome (i.e. restlessness or agitation in the afternoon and evening)

Fear of bathing

Food problems, poor table manners

Involuntary urinary leakage (incontinence) or "accident"

Hoard goods, especially paper

Inappropriate sex

Violence - beating, shouting, armed self-protection

Will move from need to help select clothes and remember to change clothes to need to help wear clothes

From the need for personal care reminders to the need to help bathe, take medicine, brush your teeth, shave, comb your hair, go to the toilet, etc

Greater difficulty in language expression and understanding, especially when trying to name an item

Space issues (e.g., no way to find, sometimes even at home)

Loss of reading, writing, and arithmetic skills; inability to keep up with the storyline of a television program

Lack of coordination often leads to a tardy footstep or gait problem

Will require care or guardianship; may be 24 hours a day

Sometimes you may lose the ability to recognize your family and friends

In the mid-term of AD, the role of carer will be extended to full-time. To ensure the safety of AD patients will become the primary task. Both AD patients and caregivers need help and support.

Dealing with challenging behaviors: we often use intuition to help us decide what needs to be done. However, dealing with Alzheimer's and other dementia is counterintuitive; that is, often the right thing to do is the opposite of what seems right. (see FCA article: ten real life strategies for dementia care.)

Safety: it's important to create a safe and comfortable environment. Occupational therapists or physical therapists can provide advice and help to make families safer for caregivers and caregivers. Ask your doctor, local Alzheimer's association or area agency on aging to recommend a professional with experience in home improvement and assistive equipment. For AD patients who are likely to get lost outside, the local police should be informed and the person should be registered with the Alzheimer's Association's safe return program.

The pressure of care can affect your health. Be sure to take good care of yourself and get regular medical care. If you need to be hospitalized or take time out of your care responsibilities, you can arrange emergency temporary care. A caregiver whose health is seriously affected may need to consider other options for the family (such as residential care facilities).

Planning for the future: many caregivers want to keep their loved ones at home as long as possible. However, compared with the care that can be provided at home, if more care is needed or different types of care are needed, residential care is often the best choice for the second. Many assisted care facilities have programs designed specifically for people with dementia. Hiring home care workers is an alternative to placing your loved ones in a care facility. (for more information on these follow-up steps, please refer to FCA's materials, home away from home: relocating your parents and hiring in home help.)

Advanced Alzheimer's disease

Late care

Loss of communication skills

Inability to identify people, places and objects

Need full assistance in all personal care activities

Loss of walking ability

Loss of smiling ability

Muscles may atrophy

May lose swallowing ability

Epilepsy may attack

Lose weight

Sleep most of the time

May show a need to suck

incontinence

Loss of communication skills

Inability to identify people, places and objects

Need full assistance in all personal care activities

Loss of walking ability

Loss of smiling ability

Muscles may atrophy

May lose swallowing ability

Epilepsy may attack

Lose weight

Sleep most of the time

May show a need to suck

incontinence

Placement: if a family needs to care for a loved one with advanced Alzheimer's, it should be considered for placement in a professional care facility or dementia care facility, where adequate management and care can be provided.

Hospice care: hospice care services are designed to support the dying individual. These services may include support groups, visiting nurses, pain management and home care. Hospice care services are usually arranged by treating doctors, usually when doctors expect a person to live less than six months. There are several organizations dedicated to helping families cope with the challenges of hospice care. (please refer to FCA's reference book making choices about every day care and hospice reference book, including holding on and letting go; for more information, please refer to the resources section at the end of this reference book.)

Placement: if a family needs to care for a loved one with advanced Alzheimer's, it should be considered for placement in a professional care facility or dementia care facility, where adequate management and care can be provided.

Hospice care: hospice care services are designed to support the dying individual. These services may include support groups, visiting nurses, pain management and home care. Hospice care services are usually arranged by treating doctors, usually when doctors expect a person to live less than six months. There are several organizations dedicated to helping families cope with the challenges of hospice care. (please refer to FCA's reference book making choices about every day care and hospice reference book, including holding on and letting go; for more information, please refer to the resources section at the end of this reference book.)

Resources

The family caregiver Alliance (FCA) is committed to improving caregivers' quality of life through education, services, research and advocacy. FCA, through its national center on caregiving, provides information about current social, public policy and care issues, assists in the development of public and private programs for caregivers, and provides free call centers nationwide for home caregivers and professionals. FCA provides direct family support services for adults with Alzheimer's disease, stroke, ALS, head injury, Parkinson's disease, and other brain diseases who live in the bay area.

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