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July 23, 2009
Early Indicators, Warning Signs of Alzheimer's Disease


July 9, 2009
And Now, for the Rest of the Story!


June 4, 2009
Is It a Senior Moment -- or Dementia?


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Posted: June 17, 2009

Caregiving Lessons Learned

Differential Criteria: Normal Aging vs Dementia

I recently used this space to explore the differences between normal forgetfulness, mild cognitive impairment, and dementia (of which Alzheimer's disease is the most common type). Because I will use today’s column to dig deeper into the topic, you may want to first review the previous column, Is It a Senior Moment -- or Dementia?.

Today, I would like to explore the criteria recommended for physicians by the American Medical Association in Diagnosis, Management and Treatment of Dementia: A Practical Guide for Primary Care Physicians, published in late 1999.

Every day in their practices, physicians encounter elderly patients who suffer from some type of dementia. But how do these physicians make their diagnosis -- and how does the patient and their caregiver (or family member) come to grips with this diagnosis? According to the guide, dementia is an illness that has tremendous impact in this country, affecting millions of individuals and their families. Although some patients develop dementia in their 50's (sometimes even earlier), the incidence increases with age. It is estimated that as many as half of all people over age 85 suffer from a dementing disorder -- often Alzheimer's disease.

To emphasize the importance of an early and accurate diagnosis, the AMA states in this book, "Many physicians are used to thinking of cancer, congestive heart failure, and chronic obstructive pulmonary disease (COPD) as conditions for which palliative and hospice referral may be appropriate; most do not think about dementia in the same way." 

The AMA goes on to say, "Alzheimer's disease and other progressive dementias are life-altering and eventually fatal conditions for which curative therapy is not available. Thinking of dementia as a terminal illness from which people are dying over years instead of months allows one to focus explicitly and aggressively on a palliative care plan." 

People afflicted with the end stages of dementia of the Alzheimer's type, and their families, endure many sources of suffering. Alzheimer's patients in the end stages often have moderate to severe pain, profound weakness, muscle spasms and contractures, choking and difficulty swallowing, incontinence of urine and stool, inability to empty bladder or bowel, weight loss, severe agitation, and severe skin breakdown. The ability to reason and relate to loved ones is lost.

Their loved ones suffer chronic grief at the loss of the person they once knew, physical and emotional exhaustion from the burdens of caregiving, distress at witnessing the suffering of the patient, and depletion of income and personal resources. Family caregivers are at increased risk of significant illness and death -- sometimes before the patient dies. The cost to family caregivers and to society are staggering.

End-stage Alzheimer's, and other dementing illnesses and neurodegenerative diseases, can be thought of as “brain failure" -- analogous to kidney failure or liver failure. Failure of a vital organ without possibility of recovery or replacement of the organ function leads to death. The brain is the most vital organ, so conditions that cause "brain failure" are indeed terminal illnesses. People suffering from these illnesses deserve -- and indeed are entitled to -- the option of palliative and hospice care. Hospices have long accepted persons with dementing illnesses and other neurodegenerative diseases into their programs.

Have I now gotten your full attention? If so, then let's explore what the AMA has recommended as criteria for determining the differences between normal aging and dementia. It is important to remember that these criteria were published in late 1999 and much has changed in the clinical evaluation process. However, if you find that your loved one is experiencing any of these "symptoms" of potential dementia, make sure that you talk to their physician about the situation sooner than later. Discuss with the physician your "findings" based upon these criteria -- it will help them to help you with an early and accurate diagnosis for your loved one.

Normal Aging    Dementia
Preserved independence in daily activities.   Critical dependence on others for key daily living activities.
The person complains of memory loss but can provide considerable detail regarding incidences of forgetfulness.   The person complains of memory problems only if specifically asked; can not recall instances where memory loss was noticeable.
The individual is more concerned about alleged forgetfulness than close family members are.   Close family members are much more concerned about incidents of memory loss than the individual.
Recent memory for important events, affairs, and conversations is not impaired.   Recent memory for events and ability to converse are both ability to converse are both noticeably impaired.
Occasional word-finding difficulties.   Frequent word-finding pauses and substitutions.
Person does not get lost in familiar territory; may have to pause momentarily to remember the way.   Person gets lost in familiar territory while walking or driving; may take hours to return home.
Individual operates common applicances even if unwilling to learn how to operate new devices.   Person can not operate common appliances; unable to learn to operate even simple new devices.
No decline in interpersonal social skills.   Loss of interest in social activities; socially inappropriate behaviors.
Normal performance on mental status examinations, relative to the person's education and culture.   Below-normal performance on  mental status examinations in ways not accounted for by educational or cultural factors.

Source: Diagnosis, Management and Treatment of Dementia: A Practical
Guide for Primary Care Physicians (American Medical Association, 1999). 

As many readers of this column know, I was the family caregiver for my wife, Carol, who died in June 2008, after her 14-year battle with Alzheimer's disease. As mentioned above, end-stage Alzheimer's is -- in fact -- "brain failure." As the brain starts to shut down, many of the indications discussed above begin to occur. And then, other body systems start to fail as well ultimately resulting in death. The burden on the family caregiver becomes often unbearable. I know -- I have "been there and done that."

The bottom line: an early and accurate diagnosis is critical for both you and your loved one if you encounter any of the above indications!

Please e-mail me at ASKBill@caregivershome.com with your comments and/or reactions. I will include them in a future column with your permission. Please provide your full name and address. In the column, I will only use your first name and the initial of your last name as well as your city and state. Thank you.

WORDS TO CARE BY . . .

"Delay not . . .swift the flight of fortune's greatest favors."

Seneca (5BC-65AD)

 


Bill Andrew identifies himself as a former “nutritionally-empowered Alzheimer’s caregiver” who attributes the slow-down in the progression of the Alzheimer’s Disease in his wife, Carol – and the growth of his own personal emotional, mental, physical, and spiritual capability and strength to provide quality 24/7 care for her in their own home – to the targeted nutritional supplements they both took on a daily basis. Carol went to her Heavenly reward on June 9, 2008 – Bill continues on to advocate for family caregivers. Contact Bill with your caregiving questions and comments via email at ASKBill@caregivershome.com.

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