What are the symptoms of Alzheimer’s Disease?

Alzheimer’s Disease starts as simple forgetfulness, which is normal in the ageing process. It is when people repeatedly forget names, misplace things and forget recent incidences that it becomes a matter of concern.

Mild cognitive impairment

In the early stages the person is not able to learn new skills like a recipe. They may not be able to negotiate a new route while driving or perform a challenging task at work. There may also be a change in their personality. The person becomes depressed, apathetic or quite the opposite; they become excitable with irritability and agitation.

Mild AD

In this stage, a person is unable to handle bank affairs, shop independently or plan a dinner for friends. But they can carry out daily activities like bathe and dress. As AD progresses, the forgetfulness worsens. They may not get the right words for things, people or places. They may misplace things frequently and keep household items in odd places. They could, for example, keep shoes in the fridge instead of the shoe rack.

Moderate AD

The person forgets recent events, conversations and becomes irritable when this is pointed out. They may get lost in their usual surroundings or even in their own house. They may not be able to dress appropriately and may be unable to give out their correct address when asked. At this stage the person is unable to live independently.

Moderately-severe AD

The person is unable to carry out basic activities like brushing, bathing, dressing, using the toilet or having a meal independently. They get confused with people and may recall dead people as still being alive. They are not able to remember the names of their parents, children or grandchildren or hold  meaningful conversations.

Severe AD

The person needs assistance for all their daily activities. Speech is limited to a few words and there may be repetition of a particular word. Later, the person becomes speechless. The person cannot walk and is wheelchair bound. With further progression of AD, the person is unable to sit with their head held upright and is then confined to bed. They cannot swallow and need a feeding tube. Their control over urination and defecation is lost. The body becomes rigid and limbs get contractures and are in a fixed posture. The person involuntarily grasps objects with their hands and sucks on anything brought near the mouth due to primitive reflexes.

Is there a cure for Alzheimer’s Disease?

Currently there is no cure for AD. In the early stages, medications can improve memory to some extent and may even slow memory decline.

Educating caregivers of persons with Alzheimer’s Disease is important as they are prone to chronic stress and burnout is common. A good caregiver support programme improves the quality of life of AD patients and their families and delays placing AD patients in nursing homes.

Can we prevent Alzheimer’s Disease?

While there is no definite way to prevent AD, there are some precautions one can take. Eating dark green leafy vegetables, tomatoes, fish, walnuts, nuts, black berries and foods rich in omega-3 fatty acids helps to protect against AD. Dairy products, red meat and butter are high in saturated fats and are considered unhealthy for the brain. Learning to play an instrument or a speak a new language, doing crossword puzzles or other activities like solving Sudoku that require the brain to exercise may help reduce the risk of Alzheimer’s Disease. Remaining socially active and mentally engaged may delay cognitive decline.

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With Alzheimer’s, it becomes emotionally very difficult for family members who are involved in the daily care of the patient. Here are a few tips to help family members manage their dear ones with Alzheimer’s disease:

Avoid generalising the memory loss

Alzheimer’s patients tend to not remember most things, due to which family members or care givers may tend to assume that they remember nothing. Such assumptions can be detrimental in the care of the patient as it further alienates them from the people around them and may set back their treatment and worsen prognosis.

Support them in retrospection and recollection

The ability of Alzheimer’s patients to remember diminishes with age, therefore patients tend to forget recent events more readily. Though they tend to remember cherished memories which are deeply engraved in their minds, talking about the old times helps them in recollecting those memories. Going through family photos, videos or reminiscing about events may help them to jog their memory in a relaxed manner without them feeling pressurised to recall something that they may have forgotten. Allow them to take the lead in a conversation.

Address them by their name

Based on the patient-caregiver relationship, it is important to call the patients by their name. This helps in keeping the relation in perspective and they become more acceptable of the people around them.

Create eye contact and sit at the same level

It is important to make the patient feel that they are being cared for. Eye contact plays a very important role in comforting them and creating a sense of belonging. Maintain eye contact with them. Instead of standing over them, sit at their level, as this helps in reducing the feeling of skepticism they may feel about your actions.

Help them understand

While speaking, keep the pace slow and talk to them in short sentences so they can comprehend better. Alzheimer’s impacts their capability to understand many different things at a time. If introducing a new person, activity or a change in their routine, be extra patient with them as they may have many questions or may take time to comprehend you.

Be patient with them

Many a times Alzheimer’s patients ask questions that can irritate and frustrate family members or caregivers. Therefore, the situation needs to be handled with patience. Talking to them like they are children may not work either. Also, one should not force them to recall anything during conversations as they may feel embarrassed and insulted. From time to time you can have a discussion with them, and get them to agree that they can just ask for answers when they are unable to recall something.

Build involving and consistent experience

It is not easy to involve Alzheimer’s patients in social activities at home. But the patient can be involved with other family members by engaging them through pictures and music. It is advisable not to shift their rooms or living place frequently as they take more time to adjust to the surroundings.

Take safety measures

Use anti-slip mats at home which can be replaced for the safety of the patient. Leave the lights switched on at night as they might lose direction at home or trip while walking. Make sure that the doors are locked to avoid the patient from wandering out. Inform neighbours about the patient’s condition, so that help can be sought quickly in case of an emergency or when the patient is alone at home. Keep the home—or at least the patient’s room—clutter free and devoid of any sharp objects or plastic bags, in order to avoid risk of injury or suffocation.

The post 8 Things You Can Do to Support a Loved One With Alzheimer’s appeared first on Complete Wellbeing.

Reduced sense of taste and smell

While everyone else is enjoying their meal, you’re the only one asking for a multitude of condiments to be passed. Or you notice that the foods that you’ve always loved don’t excite you anymore. Ageing may reduce your sensitivity to taste, because as you age, the number of taste buds on the tongue decreases. Also, your sense of smell plays a role in how you taste your food. The aroma of the food sends a signal to your taste buds to secrete more saliva. If this is not happening, your mouth produces less saliva and this causes dry mouth, which in turn can affect your sense of taste.

People who experience diminished taste and smell often get depressed, as food no longer has the joy it once held. The most appetising foods seem unappealing; and if you add excessive salt or sugar to compensate for the loss of taste it may wreak havoc with your blood sugar levels and blood pressure too [if you have hypertension]. Loss of taste can also cause a nutrition deficiency as you no longer have the desire to eat. Besides, you become unable to detect if the food has gone bad.

How you can beat it

• Get regular flu shots to keeps respiratory infections away
• Your medication might be altering your sense of taste; have your doctor adjust the dose or substitute it with something else
• Avoid allergens like pet dander, grass, dust and others
• Stopping or reducing smoking can significantly restore your sense of taste
• Instead of adding more salt or sugar, use herbs and natural sweeteners to add more flavour to your food
• Certain foods taste better when they are eaten either hot or cold; have your food warmer or cooler for enhanced taste
• Maintain impeccable oral hygiene and give immediate attention to any dental problems.

Emotional problems

It is fairly common for older people to have emotional problems [which can often be mistaken for dementia]. As people gear up to face retirement, some of them believe that their remaining years will be an unending saga of gloom and doom. They may get upset, melancholic, lonely or bored. Also, as their children move to other cities or the grandchildren get busier with their school and college schedules, seniors may get a feeling of being redundant or may experience the empty nest syndrome.

Depression is worse still for people who are grieving over the loss of a loved one or who have been given a serious medical diagnosis.

How you can beat it

• Stay social; emotional problems can be eased by the support of the people around you. If possible, live close to your family
• Visit friends regularly
• Join a book club or dance class. Many communities have a senior-citizens group, which organises weekly events, classes and other activities for seniors
• Get professional help from a doctor or counsellor if you feel the need

Slow reflexes, reduced alertness and dullness of memory

As we age, we find it difficult to articulate our thoughts and might say “toasted peanuts” when we mean “roasted peanuts”. But if you say “purple curtains” when you really mean “roasted peanuts”, then that is a sign to watch out for, as it can indicate memory decline at best or a stroke at worst.

The recall ability in old age is affected because of the decreased blood flow to the brain. Also our bodies become less efficient at absorbing brain-enhancing nutrients, which leads to changes in cognitive skills. You may notice that you’re dropping things more often while working in the kitchen or that driving has become a problem for you.

How you can beat it

• Challenge your brain with crosswords, Sudoku or other puzzles
• Play games like chess, Jenga, scrabble or others that involve strategy
• Learn a new language, an instrument, driving route or recipe
• Read books, newspapers and magazines
• Work on projects that require you to plan and design them. Quilting, knitting clothes, starting a terrace garden are just a few ideas for you.

Urinary incontinence

This is a fairly common but very embarrassing problem for both men and women. Incontinence can range in severity from passing urine when sneezing, coughing or laughing to getting the urge to urinate so badly that you can’t get to a toilet in time. Most underlying causes are simple and easily treatable.

How you can beat it

• You can learn to re-train your bladder: Make a note of the timings when you urinate and when you leak and see if there’s a pattern. Accordingly you ‘train’ your bladder by emptying it before an incident can occur
• Do Kegel exercises to strengthen your pelvic floor
• Your doctor might prescribe a device called a pessary to reposition the urethra
• Injections, medication and surgery are some of the other ways to rectify this.

Loss of balance/dizziness

Our sense of balance is something that we take for granted. Constant falling is often due to a loss of balance, which is brought about by lack of co-ordination between eye-sight and hearing. Light-headedness, dizziness and a mild to violent spinning sensation [vertigo] are some of the symptoms you need to look out for.

Loss of balance can have a variety of causes: inner ear disorders, central nervous system disorders, low blood sugar, side effects of medication, infection, cardiac problems [including low or high blood pressure], or a poorly balanced diet. If you have difficulty walking or standing on soft or uneven surfaces, it could be the result of age-related, weakened inner ear function. Falling should not be dismissed as just another effect of ageing, but should be looked into as it can be cured.

How you can beat it

• Practise balancing exercises like yoga and T’ai Chi
• Regular walks are also beneficial to maintain balance
• Ensure that the floors of your house are free of clutter
• Put in a good lighting system and fit handrails around the house
• Place anti-skid mats in your bathroom and keep it as dry as possible
• While getting up from a lying down position, avoid doing so with a jerk or with haste.

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The presentation of illnesses is very different at this age which makes a definite diagnosis difficult. Thus there are more chances that in spite of the best possible attention given by the caregiver, the early signals can be missed and very often attention is given only when there is a crisis. Visits to the doctor at this point become need-based and very often the preventive aspect, nutritional needs and drug review are not addressed due to the urgency of the situation and a lack of time.

The IMPACT of old age

The question arises—how can we attend to the needs of this important and ever increasing population within the framework of our country’s health care system? Let’s see what the parameters are and the challenges that need to be addressed at this age and whether we are doing them right.

To understand and remember this let’s remember the important points as an Acronym “ IMPACT”—Where I stands for Independence, M for Mood, Memory and Mobility, P for Prevention, A for Appetite, C for control over urine and T for treatment including on-going medications.

Independence

The independence of a person is the first thing that is impacted as one grows older. However, it is not necessary that just because you are older, all your faculties will be impacted. There would be some responsibilities such as grooming, washing, bathing and eating that the person would be able to manage but other tasks such as using phones, shopping, travelling, cooking and managing money could become an issue. Assessment of these aspects acts as a reference point for further evaluation and can tell a lot about the physical and mental ability of the individual.

Mood Memory Mobility

• Mood—The older population often experience a low or depressed mood due to loneliness, feelings of worthlessness, troubled relationships at home or some chronic medical condition and pain. Often these aspects are overlooked by the person and the family as well. A careful observation during a consultation can provide invaluable insights with regard to the person’s mood. A well accepted tool called the Geriatric Depression Scale [a questionnaire] helps the clinician to make a decision to offer treatment for depression.
• Memory loss—Dementia is one of the most common and challenging problems of the geriatric population the world over. It is a condition with impairment in cognitive function [memory, reasoning abilities, language skills, forgetting learnt skills like how to eat, dress etc]. This may be accompanied by behavioural changes, personality changes, hallucinations and delusions. The symptoms can be very subtle initially and so they are easily missed. During a visit to a geriatric clinic, clinicians often use a MMSE scale—a 30-point questionnaire which helps a clinician to objectively diagnose and assess the level of dementia.
• Mobility—One of the biggest challenges in the elderly is to prevent a fall. Like children, the elderly population is very prone to falls and since they are more likely to have weak bones, they are at a higher risk of fractures as well as head injuries due to smaller brain mass. Mobility is tested with simple bedside tests like the “Get up and go test”. If an individual suffers from problems related to balance, physiotherapy exercises may be recommended to resolve the problem. The home environment plays an important role in fall prevention. Employ simple measures such as the use of anti-slip flooring in bathrooms and toilets, provide support handles in areas that have steps or a slope, avoid the use of carpets and bathtubs and leave a night light on to minimise the risk of a fall.

Prevention

When you are over the age of 60, prevention is a much better bet. There are two aspects to prevention:

• Annual health check ups which are specific to old age such as blood tests thyroid, sugar, lipid, scan to know the bone strength, mammography and stool tests. These tests are more or less standardised the world over and are based on common geriatric health problems.
• Vaccinations for flu must be taken annually and for pneumonia every five years apart from other vaccinations.

Appetite

With age, appetite may decline but a very rapid weight loss of 5 per cent in 6 months or 10 per cent in 12 months should always be investigated for the presence of an illness.

Control over urine

Often, the control over urine is a common problem with the elderly. In men, this can be due to prostate problems; in women it is due to stress incontinence. It can also occur as a symptom of an illness like pneumonia. A quick discussion during the doctor’s visit regarding this is very important to prevent medical emergencies such as the acute retention of urine.

Treatment

All the drugs that the individual is taking for various illnesses should be reviewed periodically for any possible side effects and  drug-to-drug interaction. Chances of drug side effects are higher at this age even with a normal or low dose, so a careful drug review is of the utmost importance.

To really have a positive IMPACT on the health of the Geriatric population, the most important tool required is time. Sometimes more than one visit to the doctor becomes necessary to address all issues at least in the initial stages. A clinic specially dedicated for the care of the elderly is doubtless as important as any other speciality.

Sir Richard Steele, the great writer, says, “There are so few who can grow old with a good grace”. I strongly feel that modern medicine should help every person to grow old and live with a good grace—that is the challenge awaiting the doctors in India today.

This was first published in the March 2015 issue of Complete Wellbeing.

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My mother is angry about her diagnosis. More than anything it’s that she’s caught something my father has not. “Don’t come into my MRI appointment with me,” she sneers in my dad’s direction. “They may figure out that you have it too.”

My father has never been a patient man. He ignores her and heads towards the garage.

“I may outlive all of you,” she says as he closes the back door. She flips through a pamphlet on dementia from her doctor. She says to me, “Sometimes it’s better for old people not to know all this stuff.” She recently turned 73. After a year of mom’s absent mindedness, my dad made an appointment for her with their family doctor.

Now I look over her shoulder at the description of ’cognitive decline’. She pronounces the words slowly: cog-NITE-ive. I read moderate dementia, a label I suspect may anger her the most. Like saying ‘half pregnant’—you know what’s coming.

After a week on Alzheimer’s medication, her disposition seems to improve. “Dad even cuddled me,” she tells me one day. “And I get two kisses: morning and night.”

One day I show up at my parents’ house when they’re in the middle of an argument. I take a spot at the dining room table. Lately my mom is angry at my dad much of the time. “You shut up,” she yells at him. “You don’t know.”

When we were kids none of us was allowed to say “shut up.” I’m still shocked every time I hear it come out of my mother’s mouth. Until recently, I’d never heard her yell.

My dad clears his throat the way he does before he cries.

She says to me, “People keep saying I have something, but I don’t. What is it called again?” Part of me wants to burst out laughing: the Alzheimer’s patient can’t remember the name of her disease. “Mom,” I say gently. “You have Alzheimer’s.” It’s the first time I’ve used that word with her.

“No, I don’t,” she says. “My doctor said I have memory loss. Not Alzheimer’s. Dad forgets things too, you know.” How happy she’d be if he was also afflicted, and she wasn’t alone.

“He does forget some things, but you’re the one on Alzheimer’s medication.” I’m not sure where this is going. My mother has never been reasonable.

“For memory loss,” she says. “And I’m going to start to take more pills.”

“And why do you want to take more?” “To stop the memory loss.”

“Because it’s getting worse?” I ask. I want her to admit what she’s said to my sisters and forgotten: that she thinks she can actually feel the blood vessels in her head bursting and she can’t remember anything anymore.

I know she uses 20 dollar bills for book marks and that my dad doesn’t leave her alone when they go to a grocery store or the casino. I know her arms are often covered in burns from the oven. I suspect that by tonight she’ll forget I was here today.

She says, “Because if I take one pill, then two would be much better.”

This was first published in the July 2014 issue of Complete Wellbeing.

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