Forget Me Not: November is National Alzheimer's Awareness Month

Dementia is a major issue for older people and their families. According to the Centers for Disease Control and Prevention, 47% of people age 85 and older have some kind of dementia. In my elder law practice, I find it helpful to have a working knowledge of the different types of dementia affecting our clients and their families. The major categories of dementia are as follows:

Mild Cognitive Impairment. This exists when a person has a complaint about memory loss that is corroborated by someone else. Neuropsychological testing will show that these patients have an objective memory impairment when compared to peers of similar age and educational background. At this stage, the person appears to have normal general cognitive function and can perform activities of daily living. Mild cognitive impairment is not in itself a diagnosis of dementia. However, many people diagnosed with mild cognitive impairment will progress to a diagnosis of Alzheimer's Disease.

Alzheimer's Disease. This may start with a loss of short-term memory. As it progresses, the patient will experience an impairment in executive function (the ability to make and carry out a plan) and judgment. He or she will have difficulty making appropriate choices. Social skills may be lost. Next, the patient may experience aphasia, or language impairment. Initially, this manifests as difficulty making word choices. As the illness progresses, the patient's verbal communication is very difficult to understand, and in late stages, the patient may not speak at all. Another symptom is called apraxia, which is motor memory impairment. This is where the person has difficulty with activities of daily living, such as bathing and dressing. The person may easily become disoriented as to time and place, and is at risk of getting lost. Finally, the person may experience symptoms of agnosia, which is the inability to recognize the purpose of an object. He or she may not know what to do with a toothbrush, or may take a cup of coffee and pour it on the floor. Approximately 10% of Alzheimer's Disease cases are so-called "early onset," with diagnosis prior to age 65. These cases tend to progress faster than "late onset" Alzheimer's Disease.

Vascular Dementia. This is a decline in cognitive ability that is usually the result of a stroke. It is the second leading cause of dementia. It occurs when brain tissue is damaged because of reduced flow of blood to the brain. The brain cells have difficulty working together to process information. Executive function is often affected, but memory impairment may be less severe than with Alzheimer's Disease.

Lewy Body Dementia. This is a progressive dementia characterized by a significant fluctuation in the person's cognitive impairment. There will be periods of acute confusion, and recurrent, detailed visual hallucinations. The person may show motor symptoms similar to Parkinson's Disease, such as changes in gait. He or she may shuffle or walk stiffly. There may be frequent falls. People with Lewy Body dementia are very sensitive to anti-psychotic medications, which can worsen cognition and motor control issues, and increase hallucinations. For this reason, it is very important that proper diagnosis is made and health care providers are educated about this form of dementia.

Frontal-Temporal Dementias. These are dementias of behavior rather than memory. The onset is more rapid than with Alzheimer's Disease. Symptoms include early and severe changes in personality, judgment, planning, and social function. Pick's Disease is an example of a frontal-temporal dementia.

One of the most important things a person with mild cognitive impairment or early
dementia/Alzheimer's can do is to develop a plan to insure good care and quality of life, and to make sure their legal affairs are in order. Alzheimer's Disease and Dementia Planning is one of our specialties. If you know someone affected by Alzheimer's Disease, please give him or her a copy of this article.

Geoff Bernhardt is an elder law attorney in Portland, Oregon. For more information on
his firm and on Medicaid planning, please see his website at www.elderlawpdx.com.

Dad's Odd Behaviors Don't Mean He Has Alzheimer's-He's Just Getting Older, Right?

By Jacqueline Marcell, Author, "Elder Rage"

For eleven years I pleaded with my elderly father to allow a caregiver to help him with my ailing mother, but after 55 years of loving each other--he adamantly insisted on taking care of her himself. Every caregiver I hired to help him sighed in exasperation, "Jacqueline, I just can't work with your father--his temper is impossible to handle. I don't think you'll be able to get him to accept help until he's on his knees himself."

My father had always been 90% great, but boy-oh-boy that temper was a doozy. He'd never turned it on me before, but then again--I'd never gone against his wishes either. When my mother nearly died from an infection caused by his inability to continue to care for her, I immediately flew from Southern California to San Francisco to save her life--having no idea that in the process it would nearly cost me my own.

EARLY SIGNS OF DEMENTIA?
I spent three months nursing my 82-pound mother back to relative health, while my father said he loved me one minute but then get furious over some trivial little thing and call me horrible names and throw me out of the house the next. I was stunned to see him get so upset, even running the washing machine could cause a tizzy, and there was no way to reason with him. It was so heart wrenching to have my once-adoring father turn against me.

I immediately had the doctor evaluate my father, only to be flabbergasted that he could act completely normal when he needed to! I could not believe it when the doctor looked at me as if I was crazy. She didn't even take me seriously when I reported that my father had left the gas stove on without it lighting, or that he had nearly electrocuted my mother. Luckily, I walked into the bathroom just three seconds before he plugged in a huge power strip, which was in a tub of water--along with my mother's soaking feet!

Much later, I was furious to find out that my father had instructed his doctor (and everyone he came into contact with) not to listen to anything I said because I was "just a (bleep bleep) liar"--and all I wanted was his money! (Boy, I wish he had some.)

Then things got serious. My father had never laid a hand on me my whole life, but one day he nearly choked me to death for adding HBO to his television--even though he had eagerly consented to it just a few days before. Terrified and shaking, I dialed 911 for the first time in my life. The police came and took him to a psychiatric hospital for evaluation, but I just could not believe it when they released him saying they couldn't find anything wrong with him. What is even more astonishing is that similar horrifying incidents occurred three more times.

CAREGIVER CATCH 22
I was trapped. I couldn't fly home and leave my mother alone with my father--because she'd surely die from his inability to care for her. I couldn't get healthcare professionals to believe me--because my father was always so darling and sane in front of them. I couldn't get medication to calm him, and even when I finally did--he refused to take it, threw it in my face, or flushed it down the toilet. I couldn't get him to accept a caregiver in their home, and even when I did--no one would put up with him for very long. I couldn't place my mother in a nursing home--he'd just take her out. I couldn't put him in a home--he didn't qualify. They both refused any mention of Assisted Living--and legally I couldn't force them. I became a prisoner in my parents' home for nearly a year trying to solve crisis after crisis, crying rivers daily, and infuriated with an unsympathetic medical system that wasn't helping me appropriately.

GERIATRIC DEMENTIA SPECIALIST MAKES RIGHT DIAGNOSIS
You don't need a doctorate degree to know something is wrong, but you do need the right doctor who can diagnose and treat properly. Finally, I stumbled upon a compassionate neurologist specialized in dementia, who performed a battery of blood, neurological and memory tests, along with CT and P.E.T. scans. He reviewed all of my parents' many medications and also ruled out all the many reversible dementias. And then, you should have seen my face drop when he diagnosed Stage One Alzheimer's in both of my parents--something that all of their other doctors had missed entirely.

TRAPPED IN OLD HABITS
What I'd been coping with was the beginning of Alzheimer's, which starts intermittently and appears to come and go. I didn't understand that my father was addicted and trapped in his own bad behavior of a lifetime and that his habit of yelling and pounding the table to get his way was now coming out over things that were illogical and irrational... at times. I also didn't understand that demented does not mean dumb (a concept that is not widely appreciated) and that he was still socially adjusted never to show his "Hyde" side to anyone outside the family. Even with the onset of dementia, it was amazing he could be so manipulative and crafty. On the other hand, my mother was as sweet and lovely as she'd always been.

BALANCING BRAIN CHEMISTRY
I learned that Alzheimer's is just one type of dementia (making up 65% of all dementias) and there's no stopping the progression nor is there yet a cure. However, if identified early there are medications that in most people can mask/slow the progression of the disease, keeping a person in the early independent stage longer--delaying full-time supervision and nursing home care. (Ask a Dementia Specialist about the FDA approved medications: Aricept, Exelon, Razadyne and Namenda.)

After the neurologist treated the dementia and then the depression (often-present in dementia patients) in both of my parents, he prescribed a small dose of anti-aggression medication for my father, which helped smooth out his volatile temper without making him sleep all day. (Boy I wish we'd had that fifty years ago!) It wasn't easy to get the dosages right and not perfect, but at least we didn't have to have police intervention anymore! And once my parents' brain chemistries were better balanced, I was able to optimize nutrition, fluid intake, and all their medications with much less resistance.

CREATIVE BEHAVIORAL TECHNIQUES
As soon as the medications started working, I was finally able to implement some creative behavioral techniques to cope with all the bizarre behaviors. Instead of logic and reason--I learned to use distraction, redirection and reminiscence. Instead of arguing the facts--I simply agreed, validated their frustrated feelings, and lived in their reality of the moment. I finally learned to just "go with the flow". And, if none of that worked, a bribe of vanilla ice cream worked the best to get my obstinate father into the shower, even as he swore a blue streak at me that he'd just taken one yesterday (over a week ago)!

Then finally, I was able to get my father to accept a caregiver in their home (he'd only alienated 40 that year-most only there for about ten minutes), and with the tremendous help of Adult Day Health Care five days a week for them, and a weekly support group for me, everything started to fall into place. It was so wonderful to hear my father say once again, "We love you so much, sweetheart."

ALZHEIMER'S / DEMENTIA OFTEN OVERLOOKED
What is so shocking is that no one ever discussed the possibility of Alzheimer's with me that first year. I was told their "senior moments" and intermittently odd behaviors were just old age, senility, stress, and a "normal part of aging". Since one out of every eight persons by the age of 65, and nearly half by the age of 85, get Alzheimer's Disease--I should have been alerted to the possibility. Had I simply been shown the "Ten Warning Signs of Alzheimer's", I would have realized a year sooner what was happening and known how to get my parents the help they so desperately needed.

If any of this rings true for you or someone you love, I urge you to seek early evaluation from a Dementia Specialist-immediately!

TEN WARNING SIGNS OF ALZHEIMER'S
(Reprinted with permission of the Alzheimer's Association)

1. Memory loss
2. Difficulty performing familiar tasks
3. Problems with language
4. Disorientation of time and place
5. Poor or decreased judgment
6. Problems with abstract thinking
7. Misplacing things
8. Changes in mood or behavior
9. Changes in personality
10. Loss of initiative

Expanded Descriptions: http://www.elderrage.com/alzheimers.asp

Jacqueline Marcell is a former television executive whose caregiving experience resulted in her first (bestselling) book "Elder Rage", a Book-of-the-Month Club selection being considered for a film. Over fifty endorsements include: Hugh Downs, Regis Philbin, John Hopkins Memory Clinic, and the National Adult Day Services Association who bestowed on her their Media Award. She also hosts the "Coping With Caregiving" radio program www.wsRadio.com/CopingWithCaregiving. Jacqueline is also an International speaker who has delivered over 150 keynotes, including to the Florida House of Representatives. She also writes a Q&A column for AgingCare.com, and Blogs for HealthCentral.com and ThirdAge.com. Jacqueline is also a breast cancer survivor who advocates that everyone (especially caregivers), closely monitor their own health.