02.18 Dementia and Alzheimers

Today we’re going to be talking about Dementia and Alzheimer’s Disease.

In this lesson, we will cover the difference between dementia and Alzheimer’s disease, what Alzheimer’s disease looks like and most importantly, how to care for someone who suffers from Alzheimer’s disease.

Let’s start by talking about dementia. When we talk about dementia we are talking about abnormal brain changes which means they are not associated with the aging process. These changes are due to damage to brain cells which causes difficulty or inability to communicate. Often times what we’ll see in dementia patients is a slow decline in their cognitive abilities and changes in their behavior and feelings. Remember no two people are exactly alike, so this means not everyone will have the same symptoms. This is important to remember because the treatments and care that work on one person may not work on the other and we have to understand that as healthcare providers.  The one thing that is the same across the board is that someone who suffers from dementia will be forgetful, and this is not the normal “I forgot what I was in the kitchen for”. It’s going to become pretty significant as the disease progresses. There are several different types of dementia so it’s important to know that the area where the damage first occurs is the type of dementia that person has, frontal lobe for instance. This is very similar to how we name cancer despite the spread. Dementia is also a progressive disease. There is no cure for it however with the right interventions, we can slow the progression and treat the symptoms.

We already said this is not a normal aging process issue, but most of the people suffering from dementia are elderly or have a family history of it.  Risky lifestyle behaviors and choices like alcoholism can increase the risk of developing dementia as well. Please know there is a such thing as alcohol induced dementia, and this strikes at earlier ages. Your personal medical history can have a bearing on your risk for dementia as well. If you’ve had head trauma or suffer from heart disease, your risk is greater. Why? Because they can both cause damage or destruction to brain cells. AIDS patients sometimes suffer from AIDS related dementia, which again, can happen despite age.

Let’s talk Alzheimer’s disease, the most common form of dementia. The hallmark of Alzheimer’s disease is what we call “plaques and tangles” in the brain. As the brain deteriorates, this plaque which is really just abnormal clumps of protein, builds up in between nerve cells. Think about the plaque on your teeth and how your dentist uses that tool to scrape.  Protein fiber bundles get tangled inside the nerve cells, which is where your tangles come from. Here we have a picture of a healthy brain and then an Alzheimer’s brain. The big thing to remember is that with Alzheimer’s disease, the brain actually shrinks, which is what’s happening on this side. You can see the differences between the two brains: the ventricles are huge, the hippocampus and cerebral cortex are both really shrunken. These are characteristics we can’t see until autopsy. Also just FYI, early onset Alzheimer’s can start anywhere between ages 30-60. Late onset starts around the mid-60s.  So remember I just pointed out the hippocampus shrinks? That’s the part of our brain that forms memories so you should be able to visualize now why memory loss is such a big issue.

These are some of the risk factors for Alzheimer’s disease. This doesn’t mean that you can’t be the picture of health and not end up with it. You are just more at risk if any of these relate to you. Remember, this is a form of dementia and we discussed those risk factors earlier. Some of the factors overlap, others don’t, but don’t exclude them from the picture.

Symptoms for Alzheimer’s start small and can very easily be mistaken for aging. People suffering from dementia slowing begin having problems performing everyday tasks like personal care, paying bills and cooking. Usually, the skills that leave later are the personal care. They lose things and will sometimes accuse other people of stealing or moving them. You will notice that the person you used to know isn’t the person you know now because their behaviors and emotions change. Someone that used to be nice and sweet can now be rude and agitated or vice versa. The anxiety and aggravation behind losing your skills and memory is enough to make anyone’s mood change. I would be angry or depressed too if I woke up one morning and couldn’t remember how to put my clothes on too. Some Alzheimer’s patients sleep habits change, sometimes drastically, because they don’t have a concept of time all the time. Eventually they will lose control of their bowel and bladder as well. So, what we are seeing with Alzheimer’s is essentially a regression to infancy when you think about it.

The truest diagnosis of Alzheimer’s comes only after autopsy, but there are some things we can do to find out if there are any changes or damage to the brain that may be consistent with dementia of some form. Here we have the CT scan, the MRI and the PET scan. These are all used to rule out other issues when memory impairment and cognitive issues start to occur. Outside of these tests, we can perform cognition exams like the Mini Mental Status Exam where we test the functions of memory, problem solving skills and counting.  We use these exams to establish a baseline so that if a person’s cognitive abilities do continue to decline, we will see how far of a decline it’s been and what supports we need to put in place for it.

We said earlier that Alzheimer’s and dementia are progressive diseases and can’t be reversed, but here we are talking about medication as treatment. Understand we are not treating the condition or trying to reverse it, but what we are doing with medications is slowing the progression, controlling behaviors and targeting symptoms. Dependent on where in progression the patient is will determine what kind of medication they receive. Cholinesterase inhibitors like Aricept or Exelon are used to treat mild to moderate cases, while NMDA antagonists like Namenda are used for moderate to severe cases. You will also find that antipsychotics and antidepressants are used to control moods and behaviors as well. Also helping control moods and behaviors is the psychosocial approach where we use music and pet therapy as an alternative means to provide behavioral supports. We are not trying to change the behavior because we understand we can’t, but we want to minimize the negative or harmful ones. Safety and support are the most important things we can do to keep these patients safe. It is important to understand that cognitive impairments and the loss of independence is scary and frustrating. We want to make our dementia and Alzheimer’s patients as comfortable within themselves as we can and we do that by avoiding their triggers and avoiding confrontation when we can, and providing consistent routines along with a calming environment. These all help maintain some sense of normalcy and can decrease negative behaviors and outbursts. Redirection is necessary at times, particularly when we are looking at those negative behaviors we are trying to avoid and we also try to provide security objects. You will find sometimes that the things we take for granted can sometimes hold great value to others and this is no different for dementia and Alzheimer’s patients. If there is one thing that we know will give them comfort and it’s not harmful, we provide it.

Let’s review some key points. Remember dementia is an umbrella term for a group of diseases that occur from abnormal changes to the brain. It is not a normal part of aging! The hallmarks of Alzheimer’s disease are the “plaques and tangles” and the shrinkage of brain tissue, although they are only found in autopsy. Medications are not used for reversal of the disease or for curative purposes. We are only slowing the progression and controlling behaviors and symptoms. Despite the medication we use to treat, first and foremost we provide safety and support to our patients.

We love you guys! Go out and be your best self today! And as always, Happy Nursing!