Alzheimer’s Disease

What is Alzheimer’s disease?

Alzheimer’s is a disease of the brain. It is the leading cause of dementia. Dementia is a broad term for symptoms showing a decline in a person’s ability to think. About 5 to 10 percent of people over age 65 have dementia.

Symptoms of dementia include:

  • Forgetfulness
  • Poor judgment
  • Disorientation
  • Difficulty learning
  • Loss of language skills
  • Decline in the ability to do day-to-day tasks

People with dementia can also experience personality changes and behavior problems.

What causes Alzheimer’s disease?

Alzheimer’s is caused by chemical changes in the brain that kill brain cells. As the brain cells die, a person slowly loses the ability to think and care for him or herself. This is why Alzheimer’s is referred to as “progressive.”

Researchers are learning more by studying brain chemistry. This has resulted in medicines that can help some symptoms of Alzheimer’s. The medicines can improve functioning and enhance quality of life as well. However, there is still no cure for this disease.

Alzheimer’s disease usually occurs in people over 65. The risk of getting it increases with age. Family history can also be a risk factor. But the most common form of the disease has no obvious family link.

What are the symptoms of Alzheimer’s disease?

In general, people with Alzheimer’s:

  • Forget recent events
  • Have problems starting and completing tasks
  • Have problems learning new information
  • Have problems doing usual tasks correctly as the disease progresses
  • Have problems using words correctly
  • Get mixed up about time and place (disorientation)
  • Make poor decisions
  • Lose things
  • Have changes in mood, such as depression or anxiety
  • Have changes in behavior

A psychiatric exam can help diagnose the mental health symptoms of depression and anxiety. Also, people with Alzheimer’s often have behavior problems. It is important to have these problems treated since they can make caring for your loved one more difficult.

Behavior problems may include:

  • Not sleeping at night
  • Becoming angry easily
  • Seeing things that are not there (hallucinations)
  • Having false ideas about what is going on (delusions)

The rate at which Alzheimer’s progresses differs from person to person. At first, there is a decline in memory and thinking skills. Later, other abilities are affected. Eventually, the person suffering from this disease will need full-time care.

How is Alzheimer’s diagnosed?

The only sure way to diagnose Alzheimer’s is to look at the brain tissue once the person has died. But there are doctors with special training and experience who can diagnose Alzheimer’s disease correctly in living people about 90 percent of the time.

A diagnosis is made after a careful evaluation. A medical history is taken, and blood, urine, and other tests are done. Brain scans help to see if other types of brain changes are causing symptoms. The tests will help rule out other causes of symptoms. These may include a thyroid condition, heart disease, stroke, or a brain tumor. Special interviews are used to find out how a person thinks and solves problems. The sooner a diagnosis is made, the sooner treatment can start.

A person with Alzheimer’s disease should continue to see his or her doctor for regular check ups. This will ensure that other medical conditions don’t cause more problems. Family members caring for a loved one should come to each doctor’s appointment. That way, they will hear the doctor’s instructions, and can ask questions. It is not safe to count on the person with Alzheimer’s to understand and remember instructions.

Tips for Caregivers

Family members are usually the main caregivers for people with Alzheimer’s. This can be very stressful. Families should stay in touch with doctors and other health care and mental health care providers. As the disease progresses, they can provide information about helpful resources. They can also give guidance on ways to manage care and plan for the future.

Interactions and Communication

You may need to change the way you communicate with your loved one as the disease progresses. It is helpful to make eye contact before touching or speaking to the person.

Use short, simple sentences in a calm voice. Directions should be given one step at a time using short statements. Use familiar words. Give the person time to understand and respond. Do not offer too many choices. Most importantly, speak adult-to-adult. Avoid making statements that call attention to your loved one’s problems or the things they can’t do. Try to focus on the positives in their life.

Day-to-Day Living

Having a daily routine can help the person with Alzheimer’s function better. Some people with Alzheimer’s function better in the morning, so the morning may be a better time for going to appointments or to the store. Some people with this disease become more confused at the end of the day, so a quiet activity should be planned. Planning a routine will require experimenting with different ideas and will require frequent adjustments.

Bathing

A person with Alzheimer’s may resist help with bathing and dressing. This can be a real challenge to caregivers because the reason for the resistance is not always clear. A caregiver will need to gradually increase directions to a person as the disease progresses.

Try the following:

  • Make the bathroom warm. Have everything ready – towels, soap, and shampoo.
  • Be gentle.
  • A sponge bath can replace a daily shower or tub bath.
  • Respect the person’s dignity by using a light blanket or towel for privacy and warmth.
  • Provide for safety by using a tub seat, hand rails, anti-skid mats, and hand-held shower heads.
  • Help your loved one wash and dry himself or herself.

Grooming

  • Provide grooming items. Label them and keep them in a personal box.
  • Provide enough time for your loved one to complete the activity.
  • Keep hair in an easy-to-care-for style.
  • Use an electric razor for shaving.
  • Encourage brushing teeth twice daily.

Dressing

  • Use a gentle tone of voice and positive suggestions while helping.
  • Provide simple choices in clothing.
  • Clothing that can be pulled on or slipped on is easier to handle.
  • Fasteners such as Velcro are easier to use than buttons, zippers, and shoelaces.

Toileting

Helping a person use the bathroom can be a difficult and upsetting process for the caregiver and the person with Alzheimer’s. Here are some tips to make things easier:

  • Make sure your loved one can find the bathroom and can walk there safely.
  • Leaving the door open may help.
  • Set up a regular routine to use the bathroom. Don’t focus on an exact time – just try at regular intervals.
  • Various types of products can help protect your loved one from leakage (for example, pads, disposable underwear, and adult diapers).
  • Make sure your loved one is cleaned properly after using the bathroom. Use a wet, warm washcloth.

Eating

  • Locate a comfortable place to eat.
  • Encourage the person to do as much as possible for himself or herself.
  • If your loved one has difficulty handling utensils, finger foods may be easier.
  • Use utensils with thicker handles, plate guards, and sippy cups for those having difficulty with utensils.
  • Allow enough time for the person to finish the meal.
  • Watch how much the person eats. Take note if he or she begins to eat less.

Getting Around Safely

  • Do not rush.
  • Keep areas well lit and free of clutter.
  • Provide proper footwear such as athletic shoes.
  • Help your loved one when walking. If unsteady, he or she may need a walking device, such as a cane or walker.
  • Encourage your loved one to walk several times daily to keep up strength and endurance.
  • Your loved one may not be able to see as well as before. A change in floor covering from carpet to tile may look like a hole in the floor. Provide reassurance that you are by their side.

Safety

  • Consider alarms or bells on doors.
  • Consider a safety ID bracelet or necklace.
  • Bright-colored clothing will make the person more visible when outdoors.
  • Keep keys out of sight.
  • Never leave your loved one alone in a car.
  • Avoid leaving your loved one home alone.
  • Remove stove knobs when the stove is not in use.
  • Keep a night light in the hallway and bathroom.
  • Get rid of throw rugs.
  • Keep hallways free of clutter.
  • Lower the temperature on the hot water tank.
  • Keep all medicines, poisons, and toxic substances locked up.
  • Keep a list of emergency phone numbers by the phone.
  • Place a stop sign on exit doors.
  • Ideas for day-to-day activities
  • Have your loved one help with simple household chores.
  • Do easy craft projects together.
  • Have your loved one help with simple food preparation, like baking muffins or brownies.
  • Ask your loved one to help in the garden or with flower beds.
  • Fold laundry.
  • Go for a walk together.
  • Have your loved one help you rake leaves.
  • Do word search puzzles together.
  • Go for a car ride.
  • Make a photo album together.
  • Tell stories to one another.
  • Listen to music.
  • Watch a favorite video or movie.
  • Make a keepsake box.

Driving

Families need to look for warning signs that a person can no longer drive safely. A gradual change from driver to passenger is best. People with mild memory decline can still use public transportation alone if they are already in the habit of using a bus.

Find out if there is a door- to- door service for seniors in your area. Your loved one may be able to use this instead of the bus or driving. Escorting a person with Alzheimer’s to the store and to appointments is the best way to be sure the person arrives safely.

Watch for:

  • Scrapes or dents on the car, garage, or mailbox
  • Incorrect signaling
  • Parking inappropriately
  • Confusing the brake and gas pedals
  • Stopping in traffic for no apparent reason
  • Getting lost when traveling to familiar places

Driving evaluations are available. Your doctor or health care professional may be able to provide more information.

Sundowning

Many people with Alzheimer’s disease become more confused or agitated later in the day. This is called “sundowning.” It may be that caused by being overly tired. It may that the appearance of a familiar room changes as the day gets darker and shadows appear. If you notice sundowning in your loved one, have the doctor check for possible medical causes, which may contribute to this problem. Some ways to deal with sundowning are:

  • Make sure your loved one is well rested. Have him or her take an afternoon nap or do a quiet activity.
  • Try to schedule activities for the morning.
  • Provide a quiet, restful environment later in the day.
  • Make sure that your loved one is comfortable. Keep him or her clean, warm, and dry.
  • Watch for things that trigger agitation (loud noises, bright lights). Reduce or eliminate them if possible.
  • Keep the living area as simple as possible.

Caregiver Coping

While caring for your loved one, it is normal to have feelings of loss. It is normal to experience feelings of denial, anger, and guilt. You may also have physical symptoms such as headaches, upset stomach, or muscle tension. Everyone goes through grief in his or her own way. It is important to pay attention to your feelings.

Some symptoms that you may have are:

  • Denial that your loved one is ill
  • Periods of depression and despair
  • Anger and frustration with your loved one
  • Changes in your appetite and sleep
  • Withdrawal from social activities, family, and friends

Caregivers often have guilt. They may feel they should have done more to help their loved one. Caregivers need to know that the illness is out of their control.

The following may help you cope with the grief process:

  • Accept guilt as a normal part of the grief process.
  • Find ways to forgive yourself.
  • Share your feelings with a friend, therapist, spiritual leader, or support group.
  • Learn to accept and celebrate the good things in life.
  • Find time to exercise.
  • Get enough rest.
  • Find time to continue some of the activities that you enjoy.
  • Try to find humor — even in difficult situations.
  • Schedule regular periods every week away from your loved one. Be sure to provide adequate care for your loved one at that time.

If you find that your grief is overwhelming, seek help from your doctor, counselor, or therapist. Often family members have serious symptoms of depression and anxiety that will need treatment.

Family Issues

A diagnosis of Alzheimer’s disease greatly affects all family members. It may cause feelings of fear, anger, sadness, and denial. Family members may disagree over responsibilities.

To lessen stress:

  • Meet often as a family to talk about problems and feelings. This can ease tension.
  • Explain the disease to children on their level. They may be afraid of their loved one or embarrassed by his or her actions. Involve children in the care as much as they wish.
  • Avoid criticism of other family members, especially if they provide direct care.
  • Divide responsibilities according to abilities, preferences, and resources.
  • The intimate relationship shared by a husband and wife may change when a spouse has Alzheimer’s. Sexual interest can increase or decrease. Hugging, touching, and patting can help fill the need for physical contact.

Legal Concerns

The early stage of Alzheimer’s disease is the best time to meet with a lawyer to provide or review legal documents. All adults over age 60, if they have not done so already, should get legal advice on a will, power of attorney, medical directives, and a health care proxy.

For More Information and Treatment

UPMC has one of the best centers in the United States for research and treatment of Alzheimer’s disease and other dementias.

For more information on this topic, visit the University of Pittsburgh’s Alzheimer Disease Research Center website or UPMC Institute on Aging website.

Resources

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