Dementia and Alzheimer’s Disease – Latest Report on Alzheimer’s Disease

Dementia is an age-associated condition, causing a reduction in mental or intellectual functioning.  The most common cause of dementia is Alzheimer’s disease. It accounts for 60 to 80% of all irreversible dementias, and is characterized chiefly by difficulty remembering names and recent events, and, very often, apathy and depression in the early stages. Later stages are marked with reduced judgment and reasoning, confusion and disorientation, behavior difficulties, and communication.

This month, the Alzheimer’s Association released its latest report on this disease, 2010 Alzheimer’s Disease Facts and Figures, the latest collection of statistics on its prevalence in different racial and ethnic groups, costs of care, and mortality. The full document can be found and downloaded from Alzheimer's report.

Some of the major highlights of this report include:

• Alzheimer’s disease was the 7th leading cause of death in the U.S. for 2006, across all ages, and the 5th leading cause of death for those over age 65. Deaths from this disease increased approximately 46% from 2000 thru 2006, in contrast with reductions in other diseases (stroke, down 18%, prostate cancer, down 8%, heart disease, down 11%, and HIV, down 16%).
• African-Americans and Hispanics are at greater risk than Caucasians, with the former group being about twice as likely, and the latter group being 1.5 times as likely as Caucasians to develop the condition. Though there is no known genetic factor that would account for these racial differences, other conditions, such as high blood pressure and diabetes are being studied as increased risk factors.
• Another significant finding is that African-Americans and Hispanics are less likely to be given the diagnosis, even though the rate of the disease is higher, reflecting that diagnoses will occur later in the course of the disease than for Caucasians.
• More women than men have dementia, because women live longer, and not due to any gender differences.
• Almost 11 million people in the U.S. provide care for a person with Alzheimer’s disease or related dementia.

The full report and other valuable information can be found on the website of the Alzheimer’s Association.

The CoHealth website endeavors to provide helpful educational programs for all caregivers working with older adults, from professionals, to home care providers, to family members. See the entire range of educational programs at http://www.cohealth.org/. Two especially useful programs are the CoHealth courses on differentiating among depression, dementia, and delirium, and understanding sensory losses that occur with aging. Continuing education credit is available for many health care disciplines.

Principles of Behavior Management and Reality Orientation with Dementia – Principle 8

The information in this blog series is intended to help paid and unpaid caregivers manage problem behaviors caused by dementia. The slow insidious decline that we see in dementia is characterized by losses in mental, emotional, behavioral, and self-care capacities. The recommended interventions offered are considered milieu-based, or environmentally-based because they help to create an environment that is structured and anxiety-reducing, settings that reinforce appropriate behaviors while avoiding interactions that trigger unwanted behaviors.

This blog describes the need for extraordinary structure, explanation, and cues to make up for what is missing due to the loss of general awareness and information that accompanies dementia. This loss is manifested in little or no awareness of everyday events, like holidays, important facts, seasons, local or world events, anything that you and I may take for granted. Because the person with dementia is unaware of these facts, it is essential to communicate these to the patient, and repeating as often as necessary. This is referred to as reality orientation, and should take place whenever interacting with the person. We want to communicate what’s happening to the individual: explain what is going to happen, what just happened, what the daily schedule is, what the day and date and seasons and upcoming holidays are, when the next meal is, even what we’re having for the next meal or had for the last meal, and so on. We see this on the activity boards in the nursing home, though the verbal interaction between caregiver and patient is much more effective.

We take this information all around us for granted, but for the confused, disoriented person, it is necessary to replace this missing information. And, the need for this information sharing is not short term or temporary, but permanent. The term “prosthetic environment” is used to describe the permanent, extraordinary atmosphere that we want to create: multiple cues and reminders, continually offering explanations, facts, everyday information, in short, anything and everything that helps to orient the person, and helps her feel safe and secure. This is called a prosthetic environment for good reason: a prosthesis is a device used to replace a missing part of the body, such as a leg. And, just as a prosthetic leg is needed permanently, a prosthetic environment is also needed permanently for those with brain impairment to minimize confusion, disorientation, anxiety, and distress. Whatever structure, communication, and reality orientation we can provide, the better. In the absence of this, the person gets more anxious because she cannot tolerate uncertainty, ambiguity, or the unknown. The more the anxiety level escalates, the more likely she is to engage in problem behaviors.

As we learn the many ways that dementia impairs a person’s functioning, we can be better prepared to anticipate, make up for, or replace some of the losses that the patient experiences. This means better management of potential behavior problems, and helping the person function at her highest possible level.

Many of these concepts can be found in the caregiver educational programs on our website, http://www.cohealth.org/. Some of the titles include behavior management, understanding Alzheimer’s disease, nursing home placement, and end of life decision making.