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Defining Dementia and Alzheimer's (icarevillage.com)

Making the Holidays Count for You and Your Relative with Alzheimer's or Dementia

Caring for Alzheimer's Relative During the Holidays

Holidays are often a time for families to be together, for sharing and carrying on traditions that have long been a part of a family's history. But for families affected by Alzheimer's disease or other forms of dementia, holidays can be a time when a person with memory loss may not be able to participate as she (or he) once did in activities or conversations. The question then becomes "How can we best get through the holidays with minimal upset and frustration for all of us?"

Holidays can be a time of heightened activity, sounds, and get-togethers.By adjusting your expectations and doing some planning ahead of time, holidays can be an enjoyable time. Here are some suggestions for getting your family ready for and through the holiday season.

Recognize that holidays may not be the same as they have been in the past. Adjusting your expectations and schedule ahead of time may help you. Common feelings of loss, sadness, and anger at the disease may be heightened at this time of the year. Talk with other family members who are likely to be experiencing some of these same feelings and may have some suggestions of how to cope.

Give yourself permission to do only what you can manage. Ask other family members and friends to help you with decisions, celebrations and events. You may be surprised how willing others are to help you, but you have to accept help when help is offered, or ask for help when you need it.

Discuss with family and close friends how the holidays will be celebrated: What traditions will you observe? What traditions or events will you not do this year?

Help prepare visitors for their visit with your relative. Family members and friends, who have not seen your relative in a while, may be surprised at the changes your relative has experienced. Tell them what to expect, in either a letter email or a phone call.

" While I am looking forward to your visit, I thought it might be helpful for you to know what to expect and how mom is doing before you arrive. Mom is having more problems remembering and recognizing people. Although she may not recognize you, I am confident she will appreciate your company and so will I. Please do not think it is strange when I introduce you, sometimes this helps mom be more relaxed. I have some old photos of our vacations at the cabin that I thought we would enjoy looking at together%u2026.. "

Think through where your relative is most comfortable celebrating the holiday: in her home or your home? Some people with memory loss are more relaxed being in their own home. Many families find that taking the holiday celebration to their relative is better than taking their relative to a holiday celebration. Too much noise and activity, and too many people can be hard for some people with memory loss to tolerate no matter where they are.

Try several celebrations rather than one large celebration. If your relative lives in a residential care home, find out when the holiday activities are scheduled and plan to visit during those times. Participate in the sing-a-long with other residents; bring a favorite holiday food, etc.

Consider celebrating with your relative before or after the holiday. Many families with a relative in the middle - late stages of Alzheimer's disease, find that celebrating a holiday a few days before or after the actual holiday, may be more manageable for them and less stressful for their relative. Separate celebrations may be easier for everyone. A holiday is still a holiday wherever and whenever you celebrate it with your relative.

Maintain your relative's routine as much as you can to avoid increased confusion. Schedule holiday activities around rest times and meal times as much as possible.

Be alert to signs of agitation, fatigue and increased confusion. Facial expressions such a furrowed brow or tense mouth, pacing, increased tapping fingers or slapping hands on table, and loud outbursts may indicate the person with memory loss may be overwhelmed or over stimulated and needs to get away from a noisy or crowded room.

Try altering traditions, not eliminating them. Most people with Alzheimer's disease, or other types of memory disorders, can enjoy the spirit of the holidays, especially if this time of year was important to them in the past. Holiday baking, holiday cards, sing-along, gift wrapping, being with grand children, etc. can be adapted to your relative's abilities, length of attention span or your relative's best time of day.

Enjoy the moments when meaningful activities and conversations occur, even if they are not as long as you might wish.

Keep it simple. Keep in mind it is not how much you do, but the enjoyment your relative receives from doing things and being with family and friends, if even they are different from past holidays.
Biography

Laurie White, MSW, is well versed in the complexities families face as they move their relative from a family home to an assisted living or board and care community. For 20 years Laurie has helped countless families with making the decision, planning the move and adjusting to having a relative in a more supervised setting. She is also one of the authors of "Moving a Relative with Memory Loss".

Q & A on Caring for Alzheimer's and Dementia

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Experts Answer Your Questions on Alzheimer's and Dementia

1. Is memory loss a normal part of old aging?

Memory loss is not limited to aging, but has greater significance when we are older and we forget. Although memory changes begin in our 40s, the changes are so gradual and so small that people hardly notice. By the time people are in their 60s and 70s memory changes have continued and are much more noticeable to ourselves and perhaps to others.

The most common and normal changes in age-related memory loss are:

~ It takes us longer to recall names of people, places and things. Some call it a "senior moment" or the "it's on the tip-of-my tongue" syndrome.

~ It takes us longer to learn. This is because it takes us longer to process new information. But the adage "You can't teach an old dog new tricks" is just not true.

~ It is harder for us to screen out distraction. When we are young, we can do multiple things at the same time, but when we grow older, distractions are harder to screen out, making it harder to focus on the task at hand.

~ Keeping track of events, dates, phone numbers, and appointments is more challenging. Occasionally forgetting appointments or a birthday is normal as we grow older. Forgetting the phone number we have had for 25 years is not normal.

~ "What am I here after?" syndrome. Most of us do it: go into a room for a specific reason, stop in our tracks and ask "Why did I come here? What am I here after?"

There are various degrees of age-related memory loss. If you are concerned whether your loved one's memory loss is within the normal range, schedule an appointment with their doctor.

2. My mother was diagnosed with dementia. Is that the same thing as Alzheimer's disease?

I am asked this question frequently. The reason for the confusion is because dementia and Alzheimer's disease are used interchangeably. Dementia is not a disease; it is a syndrome that describes a number of signs and symptoms that are indicative of one or more diseases. Memory loss, shortened attention span, changes in personality, abilities and behavior are a few of the characteristics of dementia. There are hundreds of different types of dementia that produce similar symptoms.

Alzheimer's disease is the most common form of progressive dementia, meaning it gets worse over time. Other types of dementia are Lewy Body dementia, vascular dementia, Frontal Temporal Dementia and Parkinson's disease with dementia. Although the symptoms are very similar in the different types of dementia, they can also be very different because of the part of the brain that is affected.

It may help to think of dementia this way: Everyone with Alzheimer's disease has dementia but not everyone with dementia has Alzheimer's disease.

3. My dad who is 76 years old, has become very forgetful over the past couple of years. I am afraid he may have Alzheimer's disease. I don't know where to start or who to talk to about getting a diagnosis. Can you help me?

When a parent or a loved one begins to show signs of increased memory loss, it is normal and common to think the worst. It is important to get a thorough work-up to determine what the cause of his memory loss is.

The first place to start is with your relative's primary care physician. Ask for a memory screening. The Mini Mental Status Exam (MMSE) is an 11 question screening tool that evaluates memory, language, attention and calculation, recall and registration.

Someone who scores 30 points (maximum number of points) is considered within the normal range. A score of 24 or lower indicates cognitive impairment. The question then becomes "what is causing the changes?" The MMSE is a screening tool, not a diagnostic tool.

When a patient scores in the 24 point range, a doctor will usually order further testing to determine what the cause of his patient's cognitive impairment might be. These tests may be ordered by the primary care physician or the patient may be referred to a specialist such as a geriatrician, neurologist, or gero-psychiatrist.

A thorough work-up includes:

~ Blood tests to rule out vitamin deficiencies, thyroid functioning, infections, and other possible causes.

~ A thorough physical exam.

~ A psychiatric exam. It is often difficult to know if a person suffers from depression or dementia. Depression is often referred to as 'pseudo-dementia' because the symptoms look very much like dementia: loss of memory and initiative; changes in mood, personality and behavior are associated with both disorders.

~ A complete medical, social, occupational, and medication history given by the patient and also by family members, friends and other caregivers, if involved.

~ An evaluation of behaviors, usually given by family members.

~ CAT scan or MRI to see if there is any evidence of strokes or brain tumors.

Family members observations are very important in the diagnostic process because a person with cognitive impairment might not be able to accurately report changes in abilities, behaviors, and cognitive functioning.

After all these tests are performed and the results are reviewed, a diagnosis can be given. The only way to confirm a diagnosis of Alzheimer's disease is to perform a brain autopsy after death, but a diagnosis that includes careful evaluations in the above areas is 80-90% accurate.

If you are concerned, call your doctor today and ask for a memory assessment.

4. My husband refuses to admit he has a memory problem, when in fact, he was diagnosed with Alzheimer's disease 6 months ago. Why is he denying that he has a problem? He has always been pretty straightforward talking about himself in the past, but not now. Why?

It is often hard to know if a person is in denial about his memory loss or just forgets that he has a problem. It may help to think of it this way: denial is a refusal to admit that there is a problem. Denial is more of a conscious or sub-conscious decision that something exists.

Denial can protect a person with Alzheimer's disease (AD) as well as family members until they are ready to accept the diagnosis and the losses that AD causes. But this is usually not the case with people with Alzheimer's disease and probably is not the case with your husband. Your husband just simply forgets that he forgets. Keep in mind that memories are stored in the brain and when the memory center of the brain is damaged, memories can be lost.

Another part of our brain-likely in the right hemisphere-is responsible for giving a person insight into him or her self. If this part of your husband's brain is damaged, then he may not have self awareness or insight into himself and what he can and can't do.

5. I have heard that Aluminum causes Alzheimer's disease. Should I stop drinking out of aluminum cans and throw away my aluminum pots and pans.

The theory that aluminum causes AD has been controversial for the past 40 years. Early studies found a higher level of aluminum in the brains of people with Alzheimer's upon autopsy. But other studies did not. Some early research studies found a higher rate of AD in people who used antiperspirants and antacids, while other studies do not confirm this theory. Studies have found that people who worked around aluminum in their jobs are not at an increased risk of getting AD.

Aluminum can be found in the air we breathe, the water we drink and the food we eat. It can be found in cosmetics and added to some medications to make them more effective. And we all have aluminum in our bodies.

The aluminum in pots and pans or in soda cans does not leak into the foods at a high enough level to cause a risk. And some foods we eat do have aluminum in them.

The current thinking is that there is not enough convincing evidence that aluminum increases a person's risk of developing AD.