2014 Bulletin

Bulletin vol. 28 no. 2 | 5 Patient Corner Dementia and Helping Families Overcome Uncertainty When Caring for a Loved One with Dementia and the accompanying changes, patients and families need ongoing help and support to cope successfully and to maintain a high quality of life. Dementia Care The rate that the disease advances and the types of symptoms experienced vary depending on factors including the age of the individual, personal health factors and the type of dementia. Thus, if you're caring for someone with dementia, there isn't a one-size- fits-all guidebook; the type and timing of care differs from Carol Manning, Ph.D. UVA Memory and Aging Care Clinic, University of Virginia, Charlottesville, VA What is Normal and What is Dementia? Mild memory decline is a normal part of aging. Memory changes can be expected and frequently become noticeable by midlife. Decreased memory for names and problems with word finding are normal even in healthy older people. Normal age-related memory decline does not indicate a disease process. However, when memory decline is greater than expected and significantly affects daily life, this may indicate a dementia such as Alzheimer's disease. Dementia is a general term that describes changes in mental abilities including memory, attention, concentration, language and organizational abilities. Dementia is an umbrella term that does not identify a particular disease process or cause. Diagnostic assessment is required to determine the specific cause of dementia. Alzheimer's disease is the most common cause of dementia and significant memory decline is the hallmark of the disease. The risk of Alzheimer's disease increases with age, is more common in women than men and the average duration of disease is around eight years from diagnosis. The decline in Alzheimer's disease is typically gradual and progressive. Although minimal at first, the decline eventually can impact the ability to recognize familiar people and affect activities of daily living including dressing and bathing. Although Alzheimer's disease is the most common cause of dementia, a few other causes of dementia include: Fronto- Temporal dementia, Vascular dementia and Dementia with Lewy Bodies. These diseases have different brain changes and associated profiles of cognitive loss. They also have different patterns of progression and treatment. Diagnosis of these disorders typically involves a neurological examination, neuropsychological testing and imaging of the brain through MRI and/or PET Scan. Diagnosing the type of dementia is particularly important because some dementias are reversible and some have treatments that may minimize or slow the rate of decline. Do not assume that the dementia is Alzheimer's disease just because of memory loss. Correct diagnosis is important to provide the best treatment and accurate planning for patients and family members. In addition to appropriate diagnosis, ongoing treatment is essential to maximize good health, and minimize decline. Although the initial focus is often on memory, people with dementia can experience a range of symptoms, in addition to cognitive difficulties including personality changes, depression, irritability and anxiety. All of these symptoms can be difficult for patients and caregivers. Due to the progressive nature of dementia problems, difficulty completing daily tasks), a visit to his or her primary care physician should be the first step, but not the last. Ask for a referral to a memory care clinic, which offers multidisciplinary services including neuropsychological testing, blood tests and advanced imaging of the brain to pinpoint a diagnosis of Alzheimer's or another type of dementia. These tests also rule out other common disorders that may appear very similar to dementia. For example, depression in older adults can be misdiagnosed as dementia. A memory care specialty clinic has the expertise to evaluate each patient individually, provide an accurate diagnosis and establish a baseline that is critical for monitoring disease progression. Getting an accurate diagnosis and establishing the current stage of decline will increase understanding of the person with dementia's current strengths and weaknesses, and plan care accordingly. Collaborate on a Care Plan Occasionally families decide not to tell a loved one about his or her dementia diagnosis. However, patients are typically aware that something isn't normal; educating them on the cause of their symptoms can alleviate their worry and help make them a partner in their care. It also allows the patient to have a voice in their care preferences and indicate how they would prefer their family to handle financial and personal affairs should they be unable to make these types of decisions at a later time. one person to the next. To help patients and families navigate the phases of dementia and provide the best care possible along the way, here are some general recommendations. Seek Out a Specialist If a loved one is showing signs of dementia (e.g., disorientation, memory

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