Monthly Archives: April 2014

Last week we looked at the early symptoms of Alzheimer Dementia – this week we look at the more serious symptoms showing signs that the disease is advancing.

TROUBLE UNDERSTANDING VISUAL IMAGES

When people start having difficulty identifying images or even start having difficulty reading, then this could be another indicator that dementia is advancing.

Now logically, any vision problem should be checked for impaired vision first, there could be a cataract developing.  But if that is not the case and the person is having trouble reading or determining colour and contrast, then you should test for Alzheimer’s.

Quite a few people will also have impaired judgment of distances.  When that happens it is important that they no longer drive cars or motorbikes.  I know that is a drag on the family – but increased care is now essential.

SPEAKING OR WRITING

It is quite common for people in the middle stages of Alzheimer’s symptoms, to have trouble following or joining into a conversation.  Again – you need to be careful in diagnosing symptoms.

I have had it myself, when I am suffering from jet-lag, and when I am really tired, that the mind more or less goes to sleep – and even in the middle of a conversation – you completely lose your train of thought.  That is NOT a symptom of Alzheimer’s.

But when people who are not tired – and they stop halfway through a conversation – and cannot complete the conversation – or when they start to ramble a bit – or when they start repeating themselves – then these are common Alzheimer’s symptoms.

MISPLACING OR LOSING ITEMS

Last week we looked at forgetfulness as an early symptom.  However, when people start to regularly lose items or put them away in unusual places, then this could easily be another symptom of Alzheimer Dementia.

For example, when you need to look for the car keys in the fridge, or cups and saucers in the linen press, then you know something is not right.  I have seen quite a few cases where people accuse others (even their carers) of stealing things, like purses, wallets and handbags.

Please do not take it personally – these people genuinely cannot find their items and start to think that someone has taken them – and since you are there more often than others – you are the likely suspect.  Reassure them and help them look for the lost items – and expect to find them in the weirdest places.  Remember, any recent events are difficult for them to retrace, so they cannot remember where they placed the items.

MOTOR SKILLS

When people start to have difficulty with simple tasks – like tying shoelaces – getting dressed – going to the toilet – making a cup of tea – then you are getting into the advanced stages of Alzheimer Dementia.

Making a cup of tea appears to be a very simple act, but when you break it down into individual steps: walk to the kitchen – getting the kettle – taking it to the sink/tap – placing the kettle underneath the tap – turning on the tap – turning off the tap when you have enough water – (what is enough water) – taking the kettle back and putting it down – plugging it into the power – turning it on – getting a cup from the cupboard – getting the teabags – getting the sugar – getting the milk – getting a teaspoon – waiting for the water to boil – filling the cup with hot water – placing the teabag into the cup – picking up the cup and bringing it to you.

These are tasks that you and I take for granted – but for a dementia patient – this is a huge lists of individual tasks.  So do not be surprised if you get a cup of hot water – because the patient forgot the teabag.  If you really want to complicate it – just ask for a piece of cake or a biscuit.

TOTAL CARE

In severe cases of Alzheimer Dementia, the patient will have trouble walking, eating, talking, toileting and even sitting.  I have experienced several of my half brothers and sisters who lost the ability to do anything by themselves and were total care patients.  One of my sisters spend the last months of her life curled up in a fetal position.  One of my brothers did not recognize me – I was just this pleasant visitor who occasionally came to visit him with his wife.

When they have reached this stage – they require total care which is often impossible in the home. The best solution is often a place in a nursing home or something similar where trained nurses can take care of them.  Since they have difficulty walking, they are at high risk of falling and suffering breakages.  Consequently they become less mobile and may pick up other illnesses as a result.

So total support around the clock is needed for these dementia patients.  When this phase has been reached life expectancy is really determined by the quality of the care provided.  So it is wise to check out care givers and nursing homes before you send your loved one there.

In the coming weeks I will focus on how to cope with Alzheimer patients – here is a link to a short introduction.

This is a really great question.  Alzheimer Dementia usually does not show any symptoms until a person is well in her/his 70’s or 80’s.  Sure – there are cases of early onset dementia – but they are less common.

FORGETFULNESS

So when an elderly person does become a little forgetful – it is easy to become concerned about the person – thinking that he or she is starting to suffer from dementia.  However, sometimes forgetfulness in old age is exactly that – nothing more.

It usually starts with not remembering where the keys are, or going to the shops without a list and only bringing back half the things you need, or forgetting an appointment.   If that is all it is – there is no need for concern.

But when this forgetfulness becomes regular, then you need to be concerned.  My mother-in-law started asking me if I take sugar in my coffee (I don’t and she always knew that).  So now she does not ask but simply puts a spoon of sugar in my coffee.  When my wife comes along as well she neatly places the sugar pot on the table – so that she does not have to ask and show that she forgets all the time.

When people constantly forget their passwords, phone numbers, what day of the week it is, then it is time to start testing.

CONFUSION

Following the forgetfulness phase – I find that people start to show different levels of confusion.  They now regularly forget what day of the week it is, cannot remember if they took their medication in the morning, cannot answer some simple questions – then the confusion level has set in.

At the same time, many elderly people start to recognize that they are becoming a little forgetful – but often laugh it of and suggest that this is just a part of becoming a little older.  Laugh along with them – it is best to reassure them.  I remember visiting my mother every week, who would often sort of recognize me.  Most of the time I was her son from Australia, but often I was her brother or even her pastor and that is also how she would introduce me to anyone else in the room.

A friend of ours bought their mother a “complete large display clock”, one that tells the time, the day of the week, the date and year and so on.  She loves it – and that is a great example of minimizing the confusion.

During this phase lots of people need extra support.  They often get taken advantage of by dishonest people.  My mother would go to the florist to buy a bunch of flowers.  While she was chatting with the sales person, he would let her pay 3 or 4 times for that same bunch of flowers and she was non the wiser.  This happens all too often.

My brother-in-law tested my mother on this issue.  He suspected that this was happening based on her spending habits.  So one day he went to buy a take-away lunch that she was paying for.  He took the money, bought the lunch, came home and they ate.  Five minutes later she said – “oh I better pay you for the lunch”.  This happened 4 times in 20 minutes.  Fortunately he gave her the money back – but many others don’t.

The sad part is that now quite a lot of brain cells have already died off and the disease will progress.

SECLUSION

By now, many elderly people recognize themselves that something is wrong.  They know they are forgetful and quite a few do not want others to know that they have this condition.  So they accept fewer invitations to events or dinner parties etc.  They tend to become a little reclusive and only attend events where they are less likely to be “found out”.

I witnessed this both with my mother and now with my mother-in-law.  They much prefer to mind their own business in their own little apartment.  In the early stages my mother loved to go out and see things but progressively this declined and the same in happening now with my mother-in-law.

My mother-in-law is happy to come to church – but  does not come to our place for lunch or dinner as often as before.

AGGRESSION

As the disease progresses you will see mood changes developing.  Many people become aggressive in their tone of voice and often towards their loved ones or primary care givers.  Please recognize this is not because of you or anything you have done.  This is often a case of frustration being expressed.

Patients do become frustrated that they are confused so often.  They do not know why this is happening.  They probably look for a reason.  So when you ask a very innocent question, like “How are you today?” they may interpret that totally different.  They may think that you are testing their ability or their memory and that is threatening to them.

That is why you may get a snappy answer or often an unfriendly reaction.  My sister was the primary care giver to my mother and she was often verbally abused by my mother.  I often found that indirect questions are less threatening or simple discussion about the weather are a better way to start a conversation.

More to come in my next post.

I welcome any experiences that you want to share.