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Examining the effects and treatments of Dementia

Watching a loved one suffer through any kind of pain or disease is never easy for any family, and for those struggling with Dementia or its most common form,  Alzheimer’s Disease, here is information to help you understand this malady.

brain
Steve McAlister, Getty Images

In order to fully understand some of the aspects of the disease as it progresses, we’ve broken up our research into five parts: Early Symptoms, Physical Symptoms, The Sufferer’s Internal Struggle, The Caregivers Role, and Current Treatments and Research toward a cure.

“An estimated 5.4 million Americans of all ages have Alzheimer’s disease in 2016. This number includes an estimated 5.2 million people age 65 and older, and approximately 200,000 individuals under age 65 who have younger-onset Alzheimer’s,” according to the Alzheimers Association 2016 Facts and Figures.

Part One: The Early Signs and Recognizing Them

“If there are some subtle changes in their personality, they’re asking the same questions, or they are repeating themselves,” it’s a warning flag, explains Dr. Sanjiv Sharma, a physician at Geriatric Medical Center.

Sharma adds blame shouldn’t be put on getting older, because there’s no correlation between getting old and becoming forgetful, which is the time to consult a doctor.

“To diagnose Dementia is a 100% clinical diagnosis, based on what you say as a patient, what your family members have to say and what I’m seeing as a clinician,” said Sharma.

It’s ordinary for anyone over 65-years-old to experience symptoms of dementia, and while there are different forms, Alzheimer’s is the most common.

“It typically will present memory impairment,” said Dr. Zeeshan Khan, a Geriatric physician. “You can also have some language impairment, and visuo-spatial limitations, impaired ability to interact with the world around you.”

As Alzheimer’s climbs into the later stages, Khan explains more of how visuo-spatial deficits come into play.

“You may not even recognize your own reflection in the mirror,” said Khan. “That can result in you not even recognizing who you are and thinking that there could be people after you.”

Stroke Medical Director for Meridian Neuroscience Dr. Stephen Martino, explains forgetting things is a commonality when we get older.

“We don’t know what triggers the brain itself to start degenerating in such a manner where it goes beyond, ‘where’d I put my keys?’ to ‘I’m in my own house and I don’t know what room I’m in’,” said Martino.

While Alzheimer’s is the most common or recognizable form to most people, there are more forms as well.

“There are some forms of Lewy bodies disease, where people get so agitated and hallucinating, it’s harder on the families then it is on the patient,” said Martino.

Part Two: Physical Symptoms 

Dementia progresses slowly, according to Martino who adds, “you have pathological changes in the brain which makes it age quicker, degenerate, and not be able to function.”

“People don’t really get diagnosed with Dementia or Alzheimer’s disease before it becomes noticeable to other people,” explained Khan.

But when we fall, how long does it take to get back up? For some the length of time varies but injuries tend to be one of the physical symptoms of the disease.

“It may be that it could of been there but it could of been in the early stages,” explains Khan. “That injury happened as a result of the progression of the disease.”

“This disease is present in your brain, three to four to five years before experiencing the first symptom,” said Sharma.

While being on multiple medications at once could cause these symptoms, Khan says there are other things to look out for.

“The big thing to think about is making sure this is something that is gradual and is happening over a long period of time, and not something that’s sudden” said Khan.

If it is sudden, Khan says it may be delirium and not Dementia, which progresses over the course of eight to ten years.

Each form of Dementia presents different sets of challenges, including the vascular form. “That’s typically people that have issues with heart disease, blood pressure, or cholesterol and causes these types of small almost strokes that are going on inside the brain,” said Khan.

Part Three: The Sufferer’s Internal Struggle

“In the early stages, the patient starts realizing there is something going on with them,” said Dr. Lina Shihabuddin, Chief Medical Officer for RWJ-Barnabas Health Network and a Gerio-Psychiatrist. “That’s when they have the most emotional turbulence.”

“Most of the time I see people are just getting aggravated at the situation they’re in or at themselves because they can’t do what they used to do,” said Martino.

It is at this time that grief begins setting in Shihabuddin says, “those patients aren’t only struggling with their memory loss, they start struggling with major depression and anxieties.”

But as the disease continues to progress into later stages she says, “they lose the ability to even recognize that they have a memory problem.”

Martino explains in later stages comes, “personality changes, when the degeneration may go into the frontal lobe,” adding that, “we could see dis-inhibition or aggravation…beyond normal aggravation.”

About 30% of patients who are diagnosed with Alzheimer’s disease in the early stages, will meet criteria for a major depressive episode according to Shihabuddin who explains the mild phase.

“That’s when we intervene with the anti-depressants because it does help,” said Shihabuddin. “You want them to stay well as long as possible.”

During moderate to severe stages, patients tend to become even more confused and deny they have a memory problem, says Shihabuddin.

Dr. Sharma adds memory loss is more than just remembering today’s date, it is the core of how we live. So things like learning how to walk or use the bathroom, become things patients forget as the disease advances.

“Their behavior changes, their orientation to time is gone, and their awareness of environment is gone,” said Sharma.

Part Four: The Caregiver’s Role

Helping a loved one soften the burden of their struggle can often take a toll on the caregiver, and family and friends tending to the patient should ask them questions to determine what’s bothering them, says Dr. Khan.

Other ways are a change in environment, Khan adds, “you can use supportive strategies like making sure there are clocks in every room, and making sure there are calendars with different to-do-lists.”

Presenting visual clues can also help, along with keeping them active with activities suitable for them.

“Physical activity helps in slowing the progression of the disease and social interaction helps with the underlying depression that can be going on,” said Khan.

Shihabuddin says that the early stages are when patients, “recognize things are going to get bad, ‘I’m not going to be able to drive anymore, I’m not going to be able to do my banking or live alone’.”

“Hopefully,” she adds, “the patient and the family, together with social workers and resources from the community can sit down and say, ‘how are we going to plan for all this?’.”

While there is no one-size-fits-all solution to solving conflict with dementia patients who’ve reached an advanced stage, Shihabuddin urges not to fight with them, whether it’s over getting into car accidents or losing their eye glasses.

“They don’t remember doing any of those things, so fighting with them and trying to rationalize with them isn’t going to work,” said Shihabuddin.

She adds caregivers should speak with them in the moment, because that’s all they can remember. While long term memory is there, short term memory is when they become more forgetful.

Another option for caretakers to learn more about the advancement of the disease and how to plan ahead with those suffering with Alzheimers, will take place at the Ocean County Library Jackson Branch at 2 Jackson Drive on October 19 at 10 am.

Inside this hour-long program named, “Communication Tips and Techniques in Alzheimer’s Disease,” ideas for more enhanced communication methods as well as what to do if you recognize this behavior in a loved one will be discussed.

Part Five: Treatments and Research Towards a Cure

On average Martino says, the disease takes about 10 years between the diagnoses and when someone passes away, but remains hopeful for a curable treatment.

“Dementia by nature is when the brain starts deteriorating, it’s a sad process and hopefully one day we’re going to have more of a grasp of how to treat it and different options for prevention,” said Martino.

Dr. Khan explains there’s been numerous studies into possible genetic components of dementia, and results concluded with a couple potential factors in causing Alzheimer’s.

“These are genetic markers that increase your probability,” said Khan. “One of them is the APOE E4 gene and that’s just one of the genetic markers.”

It’s a problem in how the brain is wired and Khan explains, “all of your nerves are coated in this type of substance that allows for good conduction,” says Khan who adds, “It’s kind of like a fiber-optic cable, and sometimes these coatings become an issue.”

However, there are some things that everyone, both young and old can do to potentially delay dementia from entering in. One way is staying as healthy as possible.

“We do know that people who have higher blood pressure, uncontrolled blood pressure or uncontrolled diabetes have a higher chance of getting dementia,” said Martino. His recommendation for younger adults is, “don’t smoke, moderate your alchohol use, make sure your blood pressure is under control, your sugars are under control, and get regular exercise.”

By doing these things, Martino adds your chances for developing dementia go down but so does the risk for a heart attack or stroke.

Keeping mentally alert can help sharpen our vision, but for patients with Dementia, doing things like a word search game or sudoku along with physical activities are a benefit as well.

“We don’t want people sitting at home, sitting on the couch and watching TV all day,” said Martino. “Get up, play bridge with your friends, go for a walk, talk to your friends, read or do crossword puzzles.”

He says the disease tends to slow down more often for those who are more mentally and physically active, then in those who aren’t.

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