Types of Dementia you should be aware of
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August 29, 2016
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Dementia is a general term for loss of memory and other mental abilities severe enough to interfere with daily life. It is caused by physical changes in the brain.

Learn more about dementia, what it is, symptoms and treatments

Alzheimer’s disease

Alzheimer’s disease
Vascular dementia
Dementia with Lewy bodies (DLB)
Mixed dementia
Parkinson’s disease
Frontotemporal dementia
Creutzfeldt-Jakob disease
Normal pressure hydrocephalus
Huntington’s disease
Wernicke-Korsakoff Syndrome

Most common type of dementia; accounts for an estimated 60 to 80 percent of cases.

Symptoms: Difficulty remembering recent conversations, names or events is often an early clinical symptom; apathy and depression are also often early symptoms. Later symptoms include impaired communication, poor judgment, disorientation, confusion, behavior changes and difficulty speaking, swallowing and walking.

Revised criteria and guidelines for diagnosing Alzheimer’s were published in 2011 recommending that Alzheimer’s be considered a slowly progressive brain disease that begins well before symptoms emerge.

Brain changes: Hallmark abnormalities are deposits of the protein fragment beta-amyloid (plaques) and twisted strands of the protein tau (tangles) as well as evidence of nerve cell damage and death in the brain.

 

Vascular dementia

Previously known as multi-infarct or post-stroke dementia, vascular dementia is less common as a sole cause of dementia than Alzheimer’s, accounting for about 10 percent of dementia cases.

Symptoms: Impaired judgment or ability to make decisions, plan or organize is more likely to be the initial symptom, as opposed to the memory loss often associated with the initial symptoms of Alzheimer’s. Occurs from blood vessel blockage or damage leading to infarcts (strokes) or bleeding in the brain. The location, number and size of the brain injury determines how the individual’s thinking and physical functioning are affected.

Brain changes: Brain imaging can often detect blood vessel problems implicated in vascular dementia. In the past, evidence for vascular dementia was used to exclude a diagnosis of Alzheimer’s disease (and vice versa). That practice is no longer considered consistent with pathologic evidence, which shows that the brain changes of several types of dementia can be present simultaneously. When any two or more types of dementia are present at the same time, the individual is considered to have “mixed dementia” (see entry below).

Dementia with Lewy bodies (DLB)

Symptoms: People with dementia with Lewy bodies often have memory loss and thinking problems common in Alzheimer’s, but are more likely than people with Alzheimer’s to have initial or early symptoms such as sleep disturbances, well-formed visual hallucinations, and slowness, gait imbalance or other parkinsonian movement features.

Brain changes: Lewy bodies are abnormal aggregations (or clumps) of the protein alpha-synuclein. When they develop in a part of the brain called the cortex, dementia can result. Alpha-synuclein also aggregates in the brains of people with Parkinson’s disease, but the aggregates may appear in a pattern that is different from dementia with Lewy bodies.

The brain changes of dementia with Lewy bodies alone can cause dementia, or they can be present at the same time as the brain changes of Alzheimer’s disease and/or vascular dementia, with each abnormality contributing to the development of dementia. When this happens, the individual is said to have “mixed dementia.”

Mixed dementia

In mixed dementia abnormalities linked to more than one cause of dementia occur simultaneously in the brain. Recent studies suggest that mixed dementia is more common than previously thought.

Brain changes: Characterized by the hallmark abnormalities of more than one cause of dementia —most commonly, Alzheimer’s and vascular dementia, but also other types, such as dementia with Lewy bodies.

 

Parkinson’s disease

As Parkinson’s disease progresses, it often results in a progressive dementia similar to dementia with Lewy bodies or Alzheimer’s.

Symptoms: Problems with movement are common symptoms of the disease. If dementia develops, symptoms are often similar to dementia with Lewy bodies.

Brain changes: Alpha-synuclein clumps are likely to begin in an area deep in the brain called the substantia nigra. These clumps are thought to cause degeneration of the nerve cells that produce dopamine.

Frontotemporal dementia

Includes dementias such as behavioral variant FTD (bvFTD), primary progressive aphasia, Pick’s disease, corticobasal degeneration and progressive supranuclear palsy.

Symptoms: Typical symptoms include changes in personality and behavior and difficulty with language. Nerve cells in the front and side regions of the brain are especially affected.

Brain changes: No distinguishing microscopic abnormality is linked to all cases. People with FTD generally develop symptoms at a younger age (at about age 60) and survive for fewer years than those with Alzheimer’s.

Creutzfeldt-Jakob disease

CJD is the most common human form of a group of rare, fatal brain disorders affecting people and certain other mammals. Variant CJD (“mad cow disease”) occurs in cattle, and has been transmitted to people under certain circumstances.

Symptoms: Rapidly fatal disorder that impairs memory and coordination and causes behavior changes.

Brain changes: Results from misfolded prion protein that causes a “domino effect” in which prion protein throughout the brain misfolds and thus malfunctions.

Normal pressure hydrocephalus

Symptoms: Symptoms include difficulty walking, memory loss and inability to control urination.

Brain changes: Caused by the buildup of fluid in the brain. Can sometimes be corrected with surgical installation of a shunt in the brain to drain excess fluid.

Huntington’s Disease

Huntington’s disease is a progressive brain disorder caused by a single defective gene on chromosome 4.

Symptoms: Include abnormal involuntary movements, a severe decline in thinking and reasoning skills, and irritability, depression and other mood changes.

Brain changes: The gene defect causes abnormalities in a brain protein that, over time, lead to worsening symptoms.

Wernicke-Korsakoff Syndrome

Korsakoff syndrome is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1). The most common cause is alcohol misuse.

Symptoms: Memory problems may be strikingly severe while other thinking and social skills seem relatively unaffected.

Brain changes: Thiamine helps brain cells produce energy from sugar. When thiamine levels fall too low, brain cells cannot generate enough energy to function properly.

New study finds dementia more common in African-Caribbean people
August 27, 2016
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New study finds dementia more common in African-Caribbean people

RCPsych release

A UK study shows dementia is more common in older African-Caribbean people than in White people – and tends to affect African-Caribbean people at a younger age. The study, published online today by the British Journal of Psychiatry, is the largest study of dementia in the UK African-Caribbean population to date.

 

Researchers from UCL (University College London) studied 436 people over the age of 60 living in the north London borough of Haringey. Of these, 218 had migrated to the UK from a Caribbean island or Guyana. The remaining 218 participants were White and had been born in the UK.

All the study participants were screened to test if they showed signs of cognitive impairment. Those that did were invited for a longer interview, to see if they met the full diagnostic criteria for dementia.

The researchers found that the prevalence of dementia was significantly higher in the African-Caribbean group than the White group, when corrected for age and socioeconomic status. 9.6% of the people in the African-Caribbean Group (21 out of 218) were diagnosed with dementia, compared to only 6.9% (15 out of 218) of people in the White group. In addition, those African-Caribbean people who had dementia were nearly 8 years younger than those from the White group (they had a mean age of 79.1 years compared to 86.9 years).

The most common type of dementia among the participants was Alzheimer’s disease, which was diagnosed in 69% (25 out of the 36). 28% (10 out of the 36) had vascular dementia. Of the 10 people with vascular dementia, 9 were from the African-Caribbean population.

Lead researcher Dr Simon Adelman said: “Our study shows there is an increased prevalence of dementia in older people of African-Caribbean country of birth who are living in the UK. It also suggests that dementia affects African-Caribbean people at younger ages.”

Dr Adelman points out that their study does not explain why rates of dementia are higher in African-Caribbean people – further research is needed to investigate the risk factors. However, he believes the study does have important implications for how we provide care for people with dementia.

Dr Adelman said: “Older Black people in the UK are generally first-generation immigrants, and the largest of these groups are people of African-Caribbean descent. For the first time, many of this group have now reached retirement age. Healthcare staff working in both primary and secondary care need to be aware than dementia may occur more commonly, and at younger ages, in African-Caribbean people than White people. Our study also supports the move towards providing health and social care services based on people’s needs – not just on their age.”

Alzheimer’s Caregivers Face Unanswered Questions
August 25, 2016
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Hindsight may be 20/20 but, when it comes to being an Alzheimer’s caregiver, foresight is essentially non-existent. There are many things that seem obvious after you’ve gone through them with a loved one who has the disease, but that you’d never have considered, prior to experiencing them. What do most caregivers wish they’d known when they began their journey with their loved one? An illuminating AgingCare.com surveyoffers some insight:

I wish I’d known…     how to wave my magic wand and have family understand what’s happening to Mom.” how to place Dad in a home without them taking him to the cleaners.” how difficult taking care of an Alzheimer’s patient really is. Had I really known what I stood to lose, I never would’ve taken this on.”how to find the right doctor.”that I’d soon miss the days when Dad would tell the same story over and over again; now he can’t even talk.” that a loved one doesn’t have to be put in a nursing home if

they don’t want to be.” how to keep him healthy and engaged as his mobility and memory declines.”how hard it really is to be a caregiver.

What 24/7 really meant. How to deal with the day-to-day craziness.”

what’s the best medicine to help them sleep through the night.” how to ease their anxiety and frustration.” when it’s time to move them into a facility, and how to get them to go if they don’t want to.”that I’d have to eventually accept that, no matter how active and alert and precise Mom used to be, this is her now. ” how to get him to take a shower.”

what to expect as Alzheimer’s progresses.”

how to get help.”how long this will last.”Some of these questions have answers; some don’t. Some answers are

simple; others are complex. Even the world’s leading experts in Alzheimer’s don’t know everything there is to know about the disease. In fact, very little is certain when it comes to the ailment’s causes and underlying pathology

Standing Tall Against the Stigma of Dementia

We fear Alzheimer’s. We fear becoming the stereotypical dementia patient: slumped in a wheelchair, staring out the window, our minds as blank as our gaze.From this fear, a powerful and pervasive stigma is born. A stigma fueled by a lack of legitimate knowledge about the realities of the disease. A stigma with a crippling ripple effect that contributes to the isolation of those with Alzheimer’s and their families. Even long time friends can vanish when an individual is diagnosed with Alzheimer’s. They may feel uncomfortable in the presence of a personwith cognitive impairment, they may not know what to say, or be worried that they might do something to upset them. This abandonment, benign or not, can take a toll on family caregivers:

My ‘friends’ have pretty much disappeared. No phone calls, not even an email. It’s a lonely life. Now that Mama lives with me, I have to initiate gatherings with my friends—they seldom call me anymore.”Friends are hard to find, or they act like they don’t even know me—it’s as if my entire life is a stigma and they don’t want tobe seen with me.”These are the typical laments of family members of those with Alzheimer’s; and the situation is no less frustrating for those diagnosed with the disease.

Number of people with dementia in minority ethnic groups could rise seven fold by 2051
August 1, 2016
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Number of people with dementia in minority ethnic groups could rise seven fold by 2051 and yet awareness and support is lacking

Estimated numbers of people with dementia in Black, Asian and Minority Ethnic (BAME) groups in England and Wales are far higher than previously thought yet their needs are often being overlooked.

This is according to a new report published today (Tuesday 2 July 2013). The All-Party Parliamentary Group on dementia’s inquiry ‘Dementia does not discriminate’ reports that there are nearly 25,000 people with dementia from BAME communities.

This number is set to increase seven-fold to over 170,000 by 2051. This is a significantly bigger leap than the two-fold increase expected amongst the rest of the population, as people who moved here between the 1950s and 1970s are reaching their 70s and 80s. Despite this increase, awareness of the condition in minority ethnic groups is low and current provision of appropriate support is lacking.

The APPG is now calling for Public Health England to raise awareness of dementia amongst minority ethnic groups by funding a pilot awareness campaign to inform communities about the condition whilst challenging existing stigma. ‘Dementia does not discriminate’ also urges commissioners to ensure appropriate dementia support services are provided in minority ethnic communities.

The APPG commissioned Ethnos – specialist in minority ethnic research – to interview carers, people with dementia and service providers to create new evidence which explores the experiences of people with dementia from BAME communities. ‘Dementia does not discriminate’ found that many did not receive a diagnosis of dementia, preventing them from having access to support and treatments that could help them live well with the condition. In addition to this, stigma surrounding the condition meant people with dementia and their families face social isolation, feeling unable to reach out for support. Amongst those who did seek help, there is generally felt to be a lack of culturally-sensitive dementia services. One Indian carer talked about their negative experience of visiting a local support service, feeling like they couldn’t relate to the activities and were unable to talk to people because of language barriers.

Gloria Bailey who runs the Make a Difference African Caribbean support group in Streatham said:

‘Having cared for my own husband when he had dementia, I understand the need to support both the person with dementia as well as the carer. In my group, I show tenderness and sensitivity towards people in my community affected by the condition, it can often be difficult to talk about dementia, but I encourage people to brave, I hope that other people will take the plunge and get help with the condition so as to improve their standard of living.’

In order to raise awareness and improve existing services for people from minority ethnic groups, the report also recommends:

  • Commissioners ensure local services meet the needs of people with dementia from minority ethnic groups, ensuring that specially designed services are provided locally to suit people from a diverse range of backgrounds
  • Public Health England should lead preventative work to protect people from BAME communities who are at greater risk from developing dementia
  • It’s important for ethnic community groups and specialist dementia services to share knowledge and expertise to improve the quality of services

The APPG on Dementia sought evidence from a range of people, including those with dementia and their carers, health and social care providers and practitioners, and experts in dealing with challenges that can arise for people living in minority groups. Commissioners and providers of dementia support services gave examples of services that have been tailored for people in minority groups.

Baroness Sally Greengross Chair of the APPG on Dementia, said:

‘Ageing populations in BAME groups in the UK mean dementia is a growing challenge. It’s frightening to think that dementia is set to affect thousands more people from ethnic minorities and yet society isn’t geared up to deal with this.

‘Our focus now should be on ensuring high quality dementia support is available to all once they’ve received a formal diagnosis. Making sure more services are tailored to meet the needs of people with dementia from ethnic minorities is the key to helping them achieve the best possible quality of life.’

Meers Syal

Actress and comedienne Meera Syal, who recently became an Alzheimer’s Society ambassador, is supporting the report. She said:

‘It was a shock when I found out a loved one had dementia, but what really made that time difficult was finding such a lack of appropriate care and support that caters for the needs of people from Asian communities. It’s vital that services are tailored to be meaningful and effective for people from all walks of life. Everyone wants the person that they love to have access to support that works for them.’

For more information about the inquiry and to read the findings in full, visit here alzheimers.org.uk/appginquiry

Guide to Dementia Care at Home

Even though most dementia develops from irreversible causes, there is still much that families can do to help their loved ones continue to function as well as possible for as long as possible. Creating a safe, comfortable and supportive environment for someone with dementia can be achieved through the below standard practices.

General Dementia Care Techniques

Researchers, doctors and eldercare professionals are still discovering and refining what works and what doesn’t when it comes to dementia care, but the following tactics have proven effective over time:

  • Develop a Daily Routine
    Assess your day to see if there are routines you can put in place to help things go more smoothly. Most people like to have a sense of what’s coming next, and a daily rhythm can be especially helpful for those dealing with general confusion. If there are times of day when your loved one is less confused or more cooperative, plan major activities for those times.
  • Encourage Independence
    Studies have found that a technique called “graded assistance,” combined with daily practice and positive reinforcement can go a long way to maintaining functional independence. Graded assistance is a method of helping someone accomplish a task with the least amount of aid possible, using a spectrum of assistance from verbal prompts to physical demonstration, physical guidance, partial physical assistance and complete physical assistance.
  • Use Music
    Studies have shown that music soothes and can help reduce problem behaviors, such as agitation and aggression (especially during mealtimes and bathing). However, it’s important to note that the music should be something that the person with dementia prefers, not necessarily what the caregiver thinks would be nice to listen to. Playing your loved one’s favorite types of music is typically the most effective form of dementia therapy.

Here are some more tips from the National Insitute on Aging (NIA):

Communication

  • Minimize Distractions: When you’re preparing to have a focused conversation, turn off the TV and radio.
  • Get Your Loved One’s Attention: Call him by name, and make sure he’s looking at and listening to you before speaking.
  • Speak Simply and Directly: Choose simple words and short sentences and use a gentle, calm tone of voice. Make sure to treat the person with dementia like an adult; avoid taking a condescending tone.
  • Be Patient: Allow enough time for a response. Be careful not to interrupt. If she is truly struggling to find a word or communicate a thought, gently try to provide the word she is looking for.

Bathing

Dementia can make bathing a frightening, confusing experience. Advance planning can help make bath time better for both of you.

  • Limit Bathing: Try replacing some showers with sponge baths. Depending on how active your loved one is, he or she may not need a full shower every day.
  • Plan Ahead: Gather everything you need ahead of time, including a towel and change of clothes. Get the water going and set to the right temperature.
  • Warm the Bathroom: Undressing can be especially unpleasant when it’s cold. Turn up the heat as needed.
  • Narrate What’s Happening: Tell him what you are going to do, step by step, and allow him to do as much as possible.
  • Minimize Safety Risks: Use a handheld showerhead, shower bench, grab bars, and nonskid bath mats. Never leave the person alone in the bath or shower.

Dressing

For those with dementia, getting dressed presents a series of challenges, from choosing what to wear, to figuring out how to properly take things off and put other things on, to manipulating buttons and zippers. Here are some things you can do to simplify the process:

  • Encourage Independent Choice: Allow the person to choose from a limited selection of outfits. If she has a favorite outfit, consider buying several identical sets.
  • Arrange Clothes in Order: Elimintate the need for decision-making by laying clothing items out in order they are to be put on.
  • Provide Instructions if Needed: If the person needs prompting, provide clear, step-by-step instructions.
  • Choose Convenient Clothes: Clothing for dementia patients should be comfortable and easy to get on and off. Elastic waists and Velcro closures minimize struggles with buttons and zippers.

Eating

  • Limit Distractions: Ensure a quiet, calm atmosphere for eating. Limiting noise and other distractions may help the person focus on the meal.
  • Serve Small Meals and Snacks: Dementia patients may have limited appetites and attention spans. Plan on serving small portions and supplementing these with snacks.
  • Make Eating Easy: Use straws or cups with lids to make drinking easier. Serve finger foods if the person has trouble with utensils. Using bowls instead of plates may also help encourage independent eating.
  • Visit the Dentist Regularly: Maintaining a healthy mouth and healthy teeth is key to helping dementia patients eat appropriately.

Activities & Exercise

Incorporating physical and mental stimulation into daily routines is important for both caregivers and their charges. Here are some tips for making regular exercise and other activities a part of daily life:

  • Find Mutually Enjoyable Activites: From daily strolls around the neighborhood, to game nights and regular outings, activities should be simple and fun for everyone.
  • Keep Expectations Reasonable: You may need to modify favorite activities to suit current abilities. Go slowly, take things step by step, and avoid frustration and overexertion.
  • Take Advantage of Organized Programs: Local senior centers often offer classes and activities suitable for those with dementia. You may also want to check into adult day services, which can be a good source of daily socialization for those with dementia and relief for caregivers.

Incontinence

As the disease progresses, many people with dementia begin to experience incontinence. Sometimes incontinence is due to physical illness, so be sure to discuss it with the person’s doctor. Beyond that, here are some tips for managing bathroom care:

  • Develop a Schedule: Take the person to the bathroom at regular intervals. Don’t wait for her to ask.
  • Watch for Signs of Discomfort: Is he unusually restless or pulling at his clothes? Take him to the bathroom.
  • Prevent Accidents When Possible: Take steps such as avoiding fluids after a certain time of night. If you are going to be out with the person, plan ahead. Know where restrooms are located, and have the person wear simple, easy-to-remove clothing.
  • Stay Calm and Positive: When accidents occur, minimize embarassment by dealing with them matter-of-factly.

Sleep Problems

Getting enough rest can help ensure optimal mental functioning for those with dementia. Try the following techniques to increase the likihood of everyone getting a good night’s sleep:

  • Keep Evenings Peaceful: When it’s getting close to bedtime, dim the lights and avoid stimulating activities such as watching television. You may find that playing soothing music or reading to your loved one helps him or her relax.
  • Make Bedtime Consistent: Help your loved one develop an effective internal clock by keeping bedtime within 15 minutes of the same time each night.
  • Maintain an Exercise Routine: Getting enough physical activity each day is key to sleeping deeply at night.
  • Avoid Caffiene: Limit coffee, tea and soda, especially after lunch and into the evening.

Hallucinations & Delusions

As the disease progresses, a person with dementia may experience hallucinations and/or delusions. The following techniques can be used to help manage episodes:

  • Avoid Arguing: Don’t disagree with the person about what she sees or hears. Try to respond to the feelings she is expressing, and provide reassurance and comfort.
  • Offer Distractions: Suggest a change of topic or activity. Sometimes moving to another room or going outside for a walk may help.
  • Turn Off the TV: Dark, moody or violent programming can be especially unhelpful for those who have difficulty distinguishing fantasy from reality.
  • Ensure Safety: Make sure the environment is free of objects that could be used to cause harm.

Home Safety & Wandering

Creating a safe environment is one of the most important aspects of caregiving and can prevent many stressful and dangerous situations. Caregivers of people with dementia often have to look at their homes through new eyes to identify and correct senior home safety risks.

  • Install Locks on Possible Exits: All windows and doors should be appropriately secured to prevent wandering. This may involve installing new and unfamiliar locks, or placing new locks where the person can’t reach them.
  • Remove Interior Locks: Avoid allowing your loved one to lock him- or herself into any room, including the bathroom. He or she may not remember how to unlock
  • Remove Dangerous Objects: This includes anything that could create a tripping hazzard and anything that could be used to cause harm.
  • Install Childproof Latches: Secure kitchen cabinets, linen closets and other storage spaces.
  • Ensure Proper Identification: Make sure that the person carries some kind of identification or wears a medical bracelet. If he gets lost and is unable to communicate adequately, this will alert others to his identity and medical condition. In addition, keep a recent photograph or videotape of the person with dementia on hand.

Driving

Driving generally isn’t safe for those in all but the earliest stages of dementia. Here’s how you can handle the transition:

  • Be Firm: Don’t allow your loved one to drive on “good days” but forbid it on “bad days.” Offer sympathy when he or she expresses unhappiness with the situation, but don’t give in.
  • Get a Doctor’s Help: The person may view the doctor as an “authority” and be willing to stop driving. The doctor also can contact the Department of Motor Vehicles and request that the person be reevaluated.
  • Take the Car Keys: If just having keys is important to the person, substitute a different set of keys.
  • Move the Car: If all else fails, disable the car or move it to a location where the person cannot see it or gain access to it.

Visiting the Doctor

Here are some tips for handling medical appointments:

  • Schedule Wisely: Try to schedule the appointment for the person’s best time of day. Also, ask the office staff what time of day the office is least crowded.
  • Give Short Notice: Don’t tell the person about the appointment until the day of the visit or even shortly before it is time to go. Be positive and matter-of-fact.
  • Bring Snacks and Activities: Bring along something for the person to eat and drink and any activity that he may enjoy.
  • Bring a Helper: Have a friend or another family member go with you on the trip, so that one of you can be with the person while the other speaks with the doctor.
How Far We’ve Come in Alzheimer’s Research
Developments in Alzheimer Research

A worldwide quest is under way to find new treatments to stop, slow or even prevent Alzheimer’s. Because new drugs take years to produce from concept to market—and because drugs that seem promising in early-stage studies may not work as hoped in large-scale trials—it is critical that Alzheimer’s and related dementias research continue to accelerate.

Currently, there are five FDA-approved Alzheimer’s drugs that treat the symptoms of Alzheimer’s — temporarily helping memory and thinking problems in about half of the people who take them. But these medications do not treat the underlying causes of Alzheimer’s.

In contrast, many of the new drugs in development aim to modify the disease process itself, by impacting one or more of the many wide-ranging brain changes that Alzheimer’s causes. These changes offer potential “targets” for new drugs to stop or slow the progress of the disease. Many researchers believe successful treatment will eventually involve a “cocktail” of medications aimed at several targets, similar to current state-of-the-art treatments for many cancers and AIDS.

In this video, past and present members of the Alzheimer’s Association Medical and Scientific Advisory Council explore the progress we’ve made since Dr. Alois Alzheimer first described the disease more than a century ago.

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