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About Alzheimer's & Dementia

Video: Most Common Questions with Dr. Eric Smith

Video: Other Common Questions

Video: Most Common Questions with Dr. Eric Smith

Video: Other Common Questions

Common first questions (FAQs)

 
What is the difference between Alzheimer’s disease and dementia?
 
Dementia is a general term that describes acquired challenges with memory, thinking, reasoning, judgment and behaviour that have a significant impact on a person’s daily life. Alzheimer’s disease is one particular cause of dementia - and the most common. Find more information about dementia and Alzheimer’s disease on our website.
What different types of dementia are out there?
  • Alzheimer’s disease (most common)
  • Vascular dementia (from a series of mini strokes)
  • Mixed dementia (from a combination of causes)
  • Lewy body dementia (a multi-system disease affecting cognition, movement and emotions)
  •  Frontotemporal dementia (behaviour changes and language problems are more prominent than memory loss)
  • Other causes of dementia include Parkinson’s disease, Huntington’s disease, normal pressure hydrocephalus, alcohol abuse, substance abuse, depression, delirium and head injury.
You can find more information inside the Types of Dementia section on our website.
 
Do I need a diagnosis or a physician's referral to access help and support?
Not at all. Any person can contact the Alzheimer Society of Calgary, whether it's regarding a concern for yourself or a person you care about. You do not require a referral. We provide helpful information, support, care and community resources. If you're discussing your concerns with a physician, health care provider or other professional, please ensure they take advantage of the First Link® program. This will help ensure continuity of service and proactive follow up for you. Click here for more information on the First Link® program in Calgary and area.
 
Can dementia be treated with medication?
Occasionally dementia can occur because of Vitamin B 12 deficiencies, nutritional deficiencies, thyroid disease, depression or delirium. If these types of dementia are diagnosed promptly and corrected, the person may be able to recover almost completely. Some cases of normal pressure hydrocephalus are also responsive to treatment.
 
Is Alzheimer’s disease hereditary? Is there a genetic component?
Only a small portion of cases (5-7%) of Alzheimer's disease are hereditary; the majority of cases are not. Dementia with a genetic predisposition is typically the young (or early) onset type appearing before the age of 65 years.
 
Can genetic testing be done to assess a person’s risk of getting Alzheimer’s disease?
Genetic testing can be done but it is generally not recommended except in more rare cases where there is a family history of diseases contributing to dementia.
 
How is Alzheimer’s disease diagnosed?
There is no single test available to diagnose Alzheimer’s disease. A diagnosis is usually based on a combination of information obtained from a person’s medical history, thorough physical examinations, lab tests, imaging procedures and cognitive assessment. When a person presents with a history of memory loss or other symptoms suggestive of dementia, a detailed history is obtained from the person and from a family member, if available. At least two of the following core mental functions – memory; communication and language; ability to focus and pay attention; reasoning and judgment; and visual perception – must be significantly impaired to be considered for potential dementia. Following a thorough physical exam, the person is sent for blood tests, CT and MRI scans to rule out other causes of dementia.

The family physician may refer the person to a specialist such as a neurologist, geriatrician, psychiatrist or a geriatric psychiatrist. The person will often undergo cognitive assessments including tests to assess memory, recall, orientation and thinking. A diagnosis of probable Alzheimer’s disease is made after excluding all other potential causes. When a diagnosis of probable Alzheimer’s disease is given, the physician is typically 85-90% certain of the diagnosis. The plaques and tangles in the brain that are the physical features of Alzheimer’s disease can only be seen in a biopsy of the brain at autopsy. For this reason, a physician can really only make a diagnosis of probable Alzheimer’s disease. 
 
What is the course of the disease? Can a person die of Alzheimer’s disease?
As Alzheimer’s disease progresses, the cognitive challenges (issues with memory, reasoning and judgment) will grow and the person’s abilities to communicate and care for themselves will progressively decline. Behaviour changes may become more challenging, but vary from person to person. The average life span is eight to 12 years from the time of diagnosis, but can vary from four years to 20 years. The duration depends on the age and health of the person among other conditions. One out of three older individuals typically pass away from Alzheimer’s disease or a related dementia. A smaller proportion of people will pass from complications resulting from Alzheimer’s disease (immobility, challenges with swallowing, malnutrition or pneumonia.)
 
Can Alzheimer’s disease be treated and cured?
Currently, there is no known cure for Alzheimer’s disease. Medications are available that can control symptoms for a variable length of time. These medications cannot stop or slow the progression of the disease. They alter the level of neurotransmitters - chemicals in the brain - that help the nerve cells communicate with each other. These medications are effective in the earlier stages of the disease, and typically stop working after a period of time.
 
Are there any alternative medications/supplements to treat or prevent Alzheimer’s disease?
No alternative medication or supplement has been shown to be extremely effective in treating, slowing the progress of, or preventing Alzheimer’s disease. There are some concerns regarding the use of alternate medications, such as unknown ingredients, unknown effectiveness, safety and side effects due to interaction with prescribed medications.
 
Is coconut oil an effective alternative to medication in Alzheimer’s disease?
No long-term study has been completed to-date that confirms the benefits of coconut oil in people with Alzheimer’s disease. The proposed benefit of coconut oil is based on it being a source of ketone bodies which can be a source of energy for the brain. In Alzheimer’s disease, utilization of glucose by nerve cells has been found to be diminished in affected areas of the brain. The proponents of coconut oil claim that the brain is able to utilize the ketone bodies from the oil as a source of energy in such circumstances. More research is required to establish the benefits, if any, of coconut oil in people living with dementia.
 
Does coffee help to reverse the symptoms of dementia?
To date, no conclusive study has proven this claim. Cocoa has been shown to have some beneficial effect on cognitive health in some trials. More research is needed to confirm this.
 
Is there a correlation between alcohol or drug use and dementia?
Heavy and long-term alcohol consumption can cause alcohol-related dementia. Mild to moderate intake of alcohol is not associated with any increased risk of dementia and may help reduce your risk to some extent. This means no more than two standard drinks per day for men and one standard drink for women. A standard drink includes a bottle of beer, glass of wine one and a half oz of liquor (either straight or in a mixed drink).
Smoking is associated with an increased risk of dementia. Long-term use of a group of medications called benzodiazepines has also been associated with a higher risk of cognitive decline. The impact of other drugs on dementia is not very clear, but excess drug use is believed to adversely impact cognitive functioning.
 
Does alcohol have an effect on behaviour change in dementia?
It is not advisable for a person with dementia to consume alcohol since alcohol is neurotoxic (toxic for the brain). It can aggravate the symptoms of dementia and aggravate behaviour changes.
 
The person’s behaviours are changing. What are some ways to help manage aggression, delusions and other behaviours?
Behavioural changes are common in people living with dementia and are often distressing for caregivers.
All behaviour has meaning and should be interpreted as a form of communication, though it is often unclear what the person may be trying to communicate. It helps to try and understand what is happening to the person before the behaviour, during the behaviour and after the behaviour. This will help you identify the triggers for some of these behaviour changes. By removing these triggers, you might avoid the resulting undesirable behaviours.
Behaviours can sometimes indicate an unmet need. Any sudden change in behaviour may be due to a health condition such as a urinary tract infection, pain or discomfort, rather than due to the progression of dementia.
Non-pharmaceutical approaches should be tried first. These include providing reassurance and personal comfort, validating the expressed emotions of fear, anger or sadness and trying gentle distraction through favourite activities. Some suggested strategies:
  • Check for pain, hunger, thirst, constipation, full bladder, fatigue, infections and skin irritation
  • Look for reasons behind the behaviour and do not take the behaviour personally
  • Validate and acknowledge the emotion and respond to the emotion
  • Make sure the environment is calm and comfortable - lighting, temperature, noise level, and not too crowded
  • Try and avoid arguments or confrontations
  • Allow adequate rest between periods of activity and stimulation
  • Redirect the person’s attention to a favourite activity or object
Drug therapy may used if these strategies don’t work and/or if the behaviours are severe. Read more about managing behaviour changes on our website.
 
What is the role of statins in dementia?
Statins are groups of drugs prescribed for people at risk of coronary artery disease. They have no proven effect in preventing Alzheimer's disease or related dementias. Very rarely in some users, these medications can lead to memory loss, forgetfulness and confusion. These symptoms are not severe and are typically reversible within a few weeks of discontinuing the medication. We recommend discussing the consequences of discontinuing this medication with your physician before making the decision on your own.
 
What are some strategies for preventing or delaying the onset of dementia?
We recommend risk reduction strategies to help maintain the health of your brain. Here’s how:
  • Keep active - physically, mentally and socially
  • Stimulate the brain through a variety of challenging activities like doing puzzles, learning a new skill, activity or language.
  • Stick to a Mediterranean or heart-healthy diet. People who consume plenty of fruits and vegetables, high-fibre foods, fish and omega-3 rich oils and eat less red meat and dairy may reduce their risk for the onset of dementia
  • Wear head protection when engaging in sports
  • Monitor your health and control risk factors such as high blood pressure, diabetes, high cholesterol and obesity
  • Identify and treat depression
  • Reduce your stress. It can be harmful to the brain causing shrinkage of the hippocampus (the part of the brain concerned with memory and learning).
 
 Is it important to disclose the diagnosis to the person with dementia?
We advocate for person-centered care and the Best Friends™ Approach which outlines that every person has a right to be informed of their diagnosis. The manner of disclosing this information will depend on the unique needs of the individual and the situation. If the person is anxious about their situation and might find some measure of explanation and relief in a diagnosis, it may be fine to inform them.  If the person is likely to be very upset, you could suggest that the physician conveys the news to them gradually. Contact us or your physician to discuss in further detail. Read more about what a diagnosis means and what resources are available to you.
 
I’m worried about telling family members about the diagnosis. What should I do?
Sometimes family members are somewhat relieved to have a diagnosis as it helps them understand why a loved one has demonstrated changes in behaviour, personality or is having difficulties with their memory. At the same time, it can be overwhelming for the family when they understand the implications of the diagnosis. We advocate for person-centered care and the Best Friends™ Approach which advocates for honesty and transparency, and the importance of disclosing the diagnosis to family members. It will help them understand the changes and learn how they can provide support. Speaking to our social workers or going for counselling will help the family deal with their emotions and cope with the diagnosis. Contact us for information, guidance and support.
 
How should I respond when asked repetitive questions by a person with dementia?
A person living with dementia is experiencing changes within their brain that create difficulties with short term (and sometimes long term) memory. They simply aren’t able to recall the answer you just provided. Try to understand the reason behind their questions. Could they have any unmet needs, fear, loneliness or frustration? Acknowledge and validate the emotion and then respond to the emotion.You can also try gentle distraction or redirection to a favourite activity or object.
 
The person with dementia is asking for someone who has passed away. Should I tell them the bad news? I know the answer will upset them.
Try to understand the reason behind their behaviour. For instance, if they are asking to see a parent who died long ago, they may be feeling afraid, lonely, or sad. Validate the emotion that is expressed and instead of reminding them that their parent has passed on, you could respond with something like, “It seems like you are missing him/her. I am sure he/she is a wonderful person. I would like to meet him/her.” Try and redirect the conversation or distract the person to focus on something else.
 
How do you determine that a person with dementia should move into a care facility? What are the signs that it is time for placement?
As dementia progresses, care needs increase and the person with dementia will need supervision and care both during the day and at night. It can become difficult for the caregiver to meet the increasing care needs in advanced stages of dementia. Some individuals with dementia tend to leave home if they are unsupervised, leading to concerns about the safety of the individual and wandering. Other factors to consider are the caregiver’s physical and mental health and their stress load in addition to the behavioural changes and sleep disturbances experienced by the person with dementia. These things can make it very challenging to care for the person at home. The time to move the person to a care facility varies based on the individuals involved and the situation. The decision is best made by the family. Contact us for further information, or to register for the "Considering Care Options" workshop.
 
My father gets upset because he can't recall our last visit but I see him regularly. Should I remind him that I have been there recently?
He is missing you. Validate that feeling. Respond to that emotion and spend time with him doing his favourite activities. Do not try to correct him or argue with him. He will not be able to remember your last visit because of the impact of dementia on short-term memory. Do not take the behaviour personally and try to understand that it is simply the nature of the disease.
 
How should I respond when my family member repeatedly asks to go home from the care facility?
Wanting to go home is one of the most common reactions for a person with dementia living in a care facility. Provide simple explanations to why they are there and try to redirect them by finding another activity or going for a walk. Here are some additional strategies:
  • Validate and acknowledge the emotion and respond to the emotion
  • Check for pain, hunger, thirst, constipation, full bladder, fatigue, infections and skin irritation
  • Look for reasons behind the behaviour. Do not take the behaviour personally
  • Make sure the environment - lighting, temperature, noise level - is calm and comfortable
  • Allow adequate rest between stimulating periods
  • Avoid arguments or confrontations
  • Redirect the person’s attention to a favourite activity or object
Are routines helpful for someone with dementia?
For a person with dementia, the world is constantly changing. This is complicated by the losses they experience as the disease advances. Having routines and a structured schedule will help to establish a sense of normalcy for the person. Many people find it helpful to have a routine for the person with dementia as well as the caregivers - and to stick to the routine as closely as possible.
 
Do all people with dementia become aggressive?
Changes in behaviour and personality are common in dementia because of the changes happening in the brain. Some people with dementia can become aggressive, whereas others may become more docile. It is good to keep in mind that dementia affects each person differently.
 
 

Video: Most Common Questions with Dr. Eric Smith

Video: Other Common Questions