A woman drives into a parking garage and parks on the third floor by the elevator. She goes to a meeting and returns four hours later to find the space empty.
The person with a healthy brain says to herself, “Now wait a minute. Let me think back and make sure I parked on this floor.”
She is able to process the thought and she realizes she is on the wrong floor, but a person with dementia will think someone has stolen her car, Dr. Macie Smith said.
Smith, a native of North, is a nationally recognized gerontologist and author who recently spoke at an Alzheimer’s/dementia symposium at Cornerstone Church. It was sponsored by Longwood Plantation.
In another scenario, a lady forgets where she parked at Walmart, said Smith. A person with normal brain activity will find the car, get in it and drive off. A person with dementia is unable to figure out what to do.
Dementia is not a disease, she said. It’s a set of symptoms that result from a medical condition and causes a loss of intellectual abilities.
The number one cause of dementia is Alzheimer’s, which affects more than 5 million Americans.
Women are more likely to have it than men, with some 3.2 million victims. It is progressive and incurable and is the fifth-leading cause of death in those over 65, Smith said.
Every 65 seconds, someone is diagnosed with the disease, which causes a plaque buildup outside and protein tangles inside the nerve cells. It cannot be prevented and there is no cure, she said.
It’s diagnosed by looking at the individual’s medical history, physical and neurological exams and questionnaires and cognitive tests.
Normal aging versus dementia
The person with a healthy brain can get their days mixed up and possibly go to church on Saturday instead of Sunday, Smith said. But when no one else shows up, they’ll process their thoughts and realize they went on the wrong day. On the other hand, the person with dementia starts calling around to see why everyone is missing church.
Perhaps your sister looks like your mother, and you realize that. But someone with dementia may eventually come to actually believe the sister is his or her mother.
There’s something in the normal brain that helps people control the things they say, but that part of the brain is fading in the dementia patient.
For example, Momma may say, “I don’t like that necklace. I don’t know why you wear it every day.”
“What they think is what they’re going to say,” Smith said. “They may say things you’d like to say but can’t because you don’t want to hurt someone’s feelings.”
Her grandmother, who had Alzheimer’s, loved to cook, Smith said.
When it reached the time of day she normally prepared dinner for her family and she couldn’t find her pots and pans, she’d think someone had stolen them. She could still read, Smith said. She’d look up the number and call the police.
Caring for the Alzheimer’s patient
Dementia patients have the same feelings and reactions that you do, Smith said.
“We all have major outbursts to small stresses with a fully functioning brain,” she said. “So what makes us think that a person with dementia can’t respond the way we do?”
They’re just unable to process information and deal with things normally because the part of the brain that controls reactions is damaged, and they often respond like toddlers, she said.
For example, Mary may hate being wet. She spills water on her shirt in a restaurant. Her reaction is like yours and she wants to change it. But she’ll pull it off right there in Shoney’s if you don’t stop her.
However, it’s necessary to treat them with tact and respect, according to Smith.
“Treat them like the person they were,” she said. “The problem is, with our fully developed cognitive brain cells, we focus on the condition and not the person.
“We think, ‘I have to feed Momma. I have to dress Daddy. I have to tell them what they can’t do because they don’t know they’ve got dementia,’” Smith said.
Don’t go into the situation assuming what they can’t do, she said. Go in assuming they can do it until they give you reason to believe they can’t.
There’s often a lot of stress between caregivers and patients, Smith said. One thing that causes it is the failure to treat them like adults.
They are not children. They’ve just reverted back to a place where they can’t make good decisions, she said.
“They need help with decisions – not you telling them what to do. That’s where the fighting begins – the mental battle,” she said.
Give them choices about the things they do, like the clothes they wear, Smith said.
Most of these patients have realized for years that something is going wrong with them, she said. This illness comes on very gradually, and they’re trying to hold on to their last show of independence.
In addition, you should never try to force reality on dementia patients.
For example, Momma may tell you she spent the whole afternoon visiting with Aunt Lucy. Aunt Lucy’s been dead for years, but you don’t tell her, “Momma you know that’s not true. You know it didn’t happen,” Smith said.
If you tell them that, you’re making them feel like something is wrong with them. You have to realize that the lie is their reality. You should say something like you’re glad they had a good afternoon.
Daddy may spend hours talking to that friendly man in the bathroom mirror. He’s always smiling and talks back to him.
You don’t say, “Daddy, you ain’t in there talking to anybody,” because that man in the mirror is his reality.
Stages of Alzheimer’s
The early stages of Alzheimer’s include short-term memory loss, problems finding words, decreased concentration, poor decision making and disorientation with time and place, depression and misplacing things.
Losing things may be a serious problem, Smith said. The individual never considers that he or she lost the item. Instead, someone stole them.
As the disease develops, there are problems with increased memory loss, mood disturbances, communication and repetitive behaviors.
Visual-spatial perception problems can lead to falls, and the patient may start putting inappropriate things in their mouths. For example, cotton balls might remind them of marshmallows. It might be a good idea to keep things like that out of sight because it’s awfully hard to take candy from a baby, Smith said.
Later signs of the disease include difficulty completing simple tasks, incontinence, limited communications, loss of inhibitions, agitation, paranoia, hallucinations and wandering.
Fragile skin may be very painful and cause the patient to pull away from the caregiver or others.
Other causes of dementia and treatment
“We don’t know what causes Alzheimer’s (or) who’s going to get it,” Smith said. “What we do know is that one-third of non-Alzheimer’s dementia could be prevented or delayed with a healthy lifestyle.”
Mini-strokes, vascular problems, Parkinson’s disease, urinary tract infections, HIV/AIDS, syphilis and alcohol can cause dementia, but some of these can be treated. There’s also a possibility that the onset of Alzheimer’s could be delayed.
Managing blood pressure, cholesterol and stress and following a low-fat diet are important. It’s also helpful to get enough rest and exercise. Challenging your brain by learning new things and being involved socially are also important, Smith said.
Eating “brain foods,” antioxidants like red wine, green tea and blueberries are preventive and salmon, dark chocolate and eggs improve brain function.
Medications like Aricept are used to treat the symptoms of Alzheimer’s but cannot prevent or cure it.
Help for the caregiver
Various groups offer help for the caregiver when the job becomes overwhelming. The Alzheimer’s Association provides many services, including grants that offer respite for the caregiver. More information is available at www.alz.org.
A number of hospice services provide aid, including Grove Park Hospice, which took part in the symposium. This care is paid for by the patient’s insurance.
The caregiver may eventually decide to place his or her loved one in a nursing home or health care facility.
Longwood Plantation/Magnolia Place sponsored the symposium and provide care for the dementia patient. Smith trains their caregivers. Help is also available at other nursing homes and health care facilities.
The Office of Veterans Affairs will help pay for care of a war veteran or his or her spouse. Information about this aid is available at 803-533-6156 or at the local VA office.