Tag Archives: Dementia Live

The Depression-Dementia Link and What Caregivers Need to Know

Far too often I talk to family caregivers who are concerned about their loved one’s cognitive decline.  It is not uncommon to hear such explanations go something like this:

Mom just has not been on top of things lately.  She seems scattered.  Her house is messier than normal, and she can’t seem to get things in order.  What concerns me most is that it doesn’t seem to bother her, and that is so unlike her.”

Dad was always such a strong decision maker, and now he can’t decide something simple, like where to go for dinner.  It seems like he’s stuck in limbo with just about everything when it comes to making choices – not just about the big stuff but everyday things”.

My wife has no interest in meeting with friends, going to church, or even going out for a stroll.  This is so unlike her.  I know she is blue, but it seems to be affecting her memory.  The other day she asked me the same questions many times.”

All of these scenarios certainly look like potential dementia-like symptoms.  Being disorganized, not able to make decisions and social isolation are certainly cause for concern, especially with older adults.  What often goes unnoticed is the possibility of depression.

What is Pseudodementia?

There is a link between depression and dementia.  It actually has a name – it’s called pseudodementia. Pseudodementia is a term—not an official diagnosis— that is sometimes used to describe symptoms that resemble dementia but are actually due to other conditions, most commonly depression. Unlike true dementia, depression that is caused by depression is often reversible.

Why is the Depression-Dementia Link often Overlooked?

My non-clinical opinion (but based on years of working with family caregivers and my own caregiving story) is that far too often families and even primary caregivers are not tuned into their loved one’s risks for depression.  Older adults who have at least one chronic health condition and 50% have two or more.  Depression is more common in people who have illnesses that limit their normal daily activities.

Loss and grief are common denominators in the elderly, especially those who are living alone, lost loved ones, especially spouses, and because of illness have lost their independence.  If, for instance, a parent has recently lost a spouse, moved from a life-long home, been diagnosed with a significant illness, can no longer drive or has to have help with everyday tasks – ALL of these are precursors to the possibility of that person’s loss and grief lead to depression.

The domino effects that occur when illness strikes, depression sets in and cognitive decline is recognized are often confusing and shocking for families.

It’s very important that loved ones look at life circumstances, and begin to make notes of lifestyle changes (such as not wanting to go out), lack of ability to make decisions, unkempt dress or cluttered living conditions.  The importance of noting these things will make all the difference when visiting the doctor.  Since we have limited time to spend with busy health care professionals, it is more important than ever that older adults have a health care advocate (preferably a family member) accompany their loved ones’ to doctor visits.

More often than not depression is not going to be diagnosed during a doctor visit unless their advocate is there to share what has been observed.  If it is too uncomfortable to do this with a loved one present, then ask for a consultation visit or at the least leave a note that clearly outlines your concerns so the doctor can read this before visiting with your loved one.

Dementia caused by depression is often reversible by treating the depression.  Before loved ones jump to conclusions that their loved one has Alzheimer’s disease or another form of dementia, they should step back and make comprehensive observations, share this with their healthcare professional and see if treating depression first will reverse what looks like symptoms of dementia.

As the holidays’ approach and families come together, this is an important reminder to observe your loved one’s emotional health just as much, if not more than what is going on physically.  Be willing to talk to others and what they have observed, and even with your loved one should be on your to-do list.

And lastly, keep in mind that the oldest generation did not grow up in the era of “happy pills” so, talking about depression and the possibility of taking a medication to treat depression can often be considered an “off the table” topic.  I’ve found that approaching with empathy and kindness and being prepared to explain that depression is treatable –  just like high blood pressure is helpful.  Above, as the saying goes, use your finest kid gloves.

Pam Brandon is President/Founder of AGE-u-cate Training Institute and a passionate advocate for older adults and those who serve them.  A longtime family caregiver herself, Pam has guided thousands of care partners and their loved ones with complex  challenges.

 

 

 

Down Syndrome and Alzheimer’s – the Challenges of Diagnosis

Research confirms that by the age of 40, almost 100% of persons with Down syndrome who die have changes in the brain associated with Alzheimer’s disease (AD).  Understanding this link and the challenges of a diagnosis of AD in persons with Down syndrome is important for families and healthcare professionals.

Down Syndrome occurs when a person has three copies of the 21st chromosome instead of the normal two copies.  Studies show that one of the main genes responsible for AD is on the 21st chromosome and is more active in persons with Down syndrome.  Because of this extra copy of the Alzheimer gene, virtually 100% of people with Down syndrome will develop the plaques and tangles in the brain associated with AD, but not necessarily the same memory loss.  Although research is not complete, it is estimated that about 50% of persons with Down syndrome will develop the characteristic memory problems of AD before age 50.

Testing for AD in persons with Down syndrome is often challenging.  Diagnosis of AD is difficult for a number of reasons:

  • Persons with Down syndrome are susceptible to hypothyroidism and depression, which are both reversible conditions but often go untreated and can be mistaken for AD.
  • Side effects of medications taken for either of these conditions can also mimic AD.
  • Normal AD skills testing are often not applicable for persons with Down syndrome simply because of learning differences.
  • Communication skills of persons with Downs syndrome may affect the results of assessment testing.

Families need to watch for signs of AD, especially as their loved one reaches middle age years.  Diagnosis is important, but also education, resources, and support are especially critical for care partners.  Learning to better respond to surprising new behaviors will prepare families for AD symptoms, such as changes in judgment,  processing speed, memory recall, to name a few.

Care partners, either family or professionals, need to have access to new communication tools, understand that care processes will need to be adjusted as well as home or residential changes to their living environment.  Staff and family training will help care partners better serve their residents and loved ones.

Person-centered care approaches to help persons with Down’s syndrome who have developed AD is key to maintaining a loving, trusting environment, where they feel loved, valued and are treated as individuals.

Pam Brandon is President and Founder of AGE-u-cate® Training Institute and a passionate advocate for culture change, improving the quality of life of aging adults, and transformative training for professional and family care partners.  She is the creator of the internationally recognized Dementia Live® simulation experience and collaborated with expert Ann Catlin on the transformational Compassionate Touch® training.  

References:

http://Dementia.org.au

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Is it Delirium or Dementia – Learn the Differences

Delirium is an acute disorder of attention and global cognition, including perception and memory, and is treatable.  Learning the differences between delirium and dementia is important for professional and family caregivers, as the diagnosis is missed in more than 50% of the cases.

According to the Alzheimer’s Association, dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Memory loss is an example. Alzheimer’s is the most common type of dementia.

Persons who have dementia are at an increased risk of delirium, however, it is important to learn the differences.  Risk factors for delirium include dementia, pre-existing brain disease, medications, and age.

Delirium has serious implications for older adults, especially those who are at higher risks.  Sometimes referred to as hospital delirium or post-operative confusion, dementia-like symptoms can be alarming to families and often misdiagnosed by healthcare professionals.

Patients who experience hospital or post-operative dementia may exhibit symptoms such as agitation, experience hallucinations or delusions, and often extreme confusion.  Conversely, they may become extremely quiet.  Often this is accompanied by a rapid decline in one’s mental state.

Older adult patients in hospitals or in rehabilitation facilities who have undergone surgery, had an infection, experienced trauma, or spent time in ICU are more vulnerable to experiencing delirium.

Examples of delirium causes (or aggravators) may be untreated pain, dehydration,  constipation, fear, and anxiety of a changed environment (such as a hospital setting).   Unfortunately, delirium can be aggravated even more in older adults that are hospitalized, then moved to a skilled nursing facility, where they may be at higher risks of infection and other health complications.

Families must be diligent to note any changes in mental state and discuss these immediately with healthcare professionals.  Because families will be more familiar with their loved ones’ “normal” state (whether that includes any level of pre-existing dementia or not), sharing a baseline of that person’s behavior is important to determine changes that are not normal.

Non-pharmacological management of delirium should be the first approach in treatment.  This may include having someone sit with the person to aid in helping him/her feel secure, utilizing soft music and touch to provide reassurance and calm.  Bring in photographs of loved ones or special memories that may help the person divert attention from strange or new surroundings.

Families should always discuss non-pharmacological treatment before a loved one is administered medications.  If they have had any drug previously for such conditions, such as antipsychotic or sleeping aids and their loved one has had an adverse reaction, be sure to let healthcare professionals know this.  Your goal is to avoid aggravating the condition and potential side effects of withdrawal.

While dementia and delirium differ, it is important to note that behaviors may be similar and that proper communications tools for care partners will prove critical in responding to their unmet needs and determining a safe treatment plan with the best outcomes possible.

Pam Brandon is President/Founder of AGE-u-cate® Training Institute and a passionate advocate for older adults and those who serve them.  She is the creator of the internationally recognized Dementia Live® Simulation Experience and co-developer of Compassionate Touch® training for professional and family caregivers.   Pam may be contacted at pam@AGEucate.com.

References:

Johns Hopkins Medicine

https://www.hopkinsmedicine.org/gec/series/dementia.html#delirium

Ushering in a New Culture of Change at Pioneer Network

We are honored to be a part of the National Pioneer Network Conference kicking off today in beautiful Denver, Colorado.  Ushering in a New Culture of Change promises to be an enlightening and invigorating educational and networking event for participants and those serving the elder care industry.  AGE-u-cate® Training Institute will be offering it’s internationally acclaimed Dementia Live® Experience and Compassionate Touch® Program to innovators

Pioneer Network was founded in 1997 by a small group of prominent professionals in long-term care who were pioneers in changing the culture of aging. These forward thinkers developed the mission and vision, as well as the values and principles, that continue to guide their work to this day.  Today, Pioneer Network is a large, diverse group of passionate individuals from the entire spectrum of aging services. Most are engaged in some aspect of senior living or long-term care which includes nursing homes, assisted living, and other providers of services and supports for elders, as well as the generous supporters, including people that work, live in or visit these settings.

The goals of Pioneer Network have and continue to be a model of care that supports and makes possible for our elders these elements:

Life-Affirming, that is promoting a positive outlook that encourages optimism about life; one that is hopeful and ultimately enjoyable.

Satisfying, meaning that desires, expectations, and needs of the individual are being met so that the person has a sense of contentment.

Humane, which is characterized by tenderness, compassion, and sympathy for our elders and those who are suffering.

Meaningful, which simply is having a sense of purpose and a meaning in their lives.

Pioneer Network was started by pioneers and to this day continues to lead the way for a culture of change in elder care around the world.  We face many challenges ahead in meeting the needs of the fast-growing elder population,  but it is through the efforts of organizations such as this and many others, collaborating with passionate-life minded people that we have a future for elders that can usher in new opportunities for personal growth, improved care, and certainly a life worth living.  Thank you to the leaders at Pioneer Network for the hard work you do every day to improve the lives of our elders and those who serve them.

Pam Brandon is President/Founder of AGE-u-cate Training Institute and a passionate advocate for older adults and their caregivers.  Pam is the creator of the internationally acclaimed Dementia Live® Simulation Experience and other innovative dementia programs.  Pam may be reached at pam@AGEucate.com.