Depression vs. Dementia

We had another great Town Hall Forum on dementia diagonses yesterday at Lake San Marcos Resort's Convention Center in North County. In case you missed it, we'll be providing highlights in the next few posts.

Today's topic is recognizing the symptoms (and differences) of depression and dementia.

"Sometimes a very depressed individual will present as if they have serious memory loss, and sometimes people with Alzheimer's disease will get depressed," explained neurologist Michael Lobatz, who is the medical director of the Rehabilitation Center at Scripps Memorial Hospital in Encinitas. He's featured in the photo above from the all-morning forum.

Here are just some of the differences:

The onset of depression is abrupt.
The onset of dementia is gradual.

The person with depression is usually aware something's wrong.
The person with dementia at least initially is unaware.

Memory impairment in depression is due to lack of motivation and concentration.
Memory impairment in dementia is due to an inability to remember, no matter how hard someone tries.

Someone with depression appears emotionally sad.
Someone with dementia appears emotionally "shallow."

The depressed person shows no concern for appearance.
The dementia person is interested, but dresses inappropriately.

Early signs someone may be starting to experience the early stages of dementia include impairment of their:

• language


• short-term memory


• visual perception

They also may experience:

• signs of depression, anxiety or agitation


• changes in their behavior or personality


• obsession with a subject

Up Next: Recognizing the early stages of Alzheimer's Disease

A Must Read: Help for Alzheimer's Caregivers

Today the Los Angeles Times rolled out a package of articles on Alzheimer's disease, including one on help for Alzheimer's caregivers. It explains various options and includes adult day care centers such as those operated by the Glenner Alzheimer's Family Centers.

"Most people are going to need some help at home with the person they're caring for at some point," Kennedy says. Adult day services are one resource. They provide Alzheimer's patients with a safe environment in which to spend the day and caregivers some much-needed respite. Some programs are paid for by Medicaid, while others accept only private pay. Medicare does not cover the cost of adult day services.

The benefits of adult day health care services are many, including allowing a caregiver to continue working to support the family, resting to stay healthy themselves and providing their loved one quality care that keeps them active and mentally engaged so they return home at the end of the day with a sense of accomplishment and renewed friendships.

This is a must-read for anyone currently or expecting to care for a loved one with Alzheimer's. Taking action now can extend the quality of life for everyone in a family.

Article: Help for Alzheimer's caregivers

Article: Resources for Alzheimer's patients and their caregivers

Article: Alzheimer's Disease: The Best Bets for Prevention, So Far

Photo above originally appeared on latimes.com.

Principles for a Dignified Diagnosis

Our center manager in Encinitas, Sheila Meyer Argeanton, recently passed this along for our Glenner Alzheimer's Family Centers blog.

In the 2008 report Voices of Alzheimer’s Disease: A Summary Report on the Nationwide Town Hall Meetings for People with Early Stage Dementia, the Alzheimer’s Association identified diagnostic challenges and dissatisfying interactions with the medical community as two major challenges articulated by people living with the disease. These principles are their insights on how to make that experience better.

o Talk to me directly, the person with dementia. I am the person with the disease, and though my loved ones will also be affected, I am the person who needs to know first.

o Tell the truth.
Even if you don’t have all the answers, be honest about what you do know and why you believe it to be so.

o Test early.
Helping me get an accurate diagnosis as soon as possible gives me more time to cope and live to my fullest potential and to get information about appropriate clinical trials.

o Take my concerns seriously, regardless of my age. Age may be the biggest risk factor for Alzheimer’s, but Alzheimer’s is not a normal part of aging. Don’t discount my concerns because I am old. At the same time, don’t forget that Alzheimer’s can also affect people in their 40s, 50s and 60s.

o Deliver the news in plain but sensitive language. This may be one of the most important things I ever hear. Please use language that I can understand and is sensitive to how this may make me feel.

o Coordinate with other care providers.I may be seeing more than one specialist — it is important that you talk to my other providers to ensure you all have the information so that changes can be identified early on and that I don’t have to repeat any tests unnecessarily.

o Explain the purpose of different tests and what you hope to learn.Testing can be very physically and emotionally challenging. It would help me to know what the purpose of the test is, how long it will take and what you expect to learn from the process. I would also appreciate the option of breaks during longer tests and an opportunity to ask questions.

o Give me tools for living with this disease.
Please don’t give me my diagnosis and then leave me alone to confront it. I need to know what will happen to me, and I need to know not only about medical treatment options but also what support is available through the Alzheimer’s Association and other resources in my community.

o Work with me on a plan for healthy living. Medication may help modify some of my neurological symptoms, but I am also interested in other recommendations for keeping myself as healthy as possible through diet, exercise and social engagement.

o Recognize that I am an individual and the way I experience this disease is unique.
This disease affects each person in different ways and at a different pace. Please be sure to couch your explanation of how this disease may change my life with this in mind.

o Alzheimer’s is a journey, not a destination.
Treatment doesn’t end with the writing of a prescription. Please continue to be an advocate — not just for my medical care but for my quality of life as I continue to live with Alzheimer’s.

Excuses, Excuses

Yesterday we "tweeted" about an article by the editor in chief of Elderlink.com on how elders can be quite good at covering for memory lapses. We wanted to share some of the information here too because it taps a touchy subject: when you suspect someone's not being completely honest -- even with themselves.

When someone fills in memory gaps, whether it's completing another's sentences or turning off an unattended stove burner, it may delay a medical diagnosis that could confirm or cancel an early diagnosis of dementia. Why is that early diagnosis so important?

As author Carol Bradley Bursack, who wrote Minding Our Elders: Caregivers Share Their Personal Stories, notes in her piece:

While accepting a dementia diagnosis is very difficult, knowing that something can be done to help stave off the worst symptoms is helpful. Also, when people know the name of the monster they are facing, they can better prepare to fight it, and also to plan for a time when they know they will lose that fight. They can better help themselves and their families if they find out the truth early on.

Adult children should watch their aging parents for signs that one is continuously covering for the other when it comes to memory gaps. Do they still pay bills on time? Is the house still kept clean? Are they maintaining good hygiene? Food regularly eaten and bad food disposed? Are appliances kept on when they should be shut off? Water kept running from faucets beyond what's normal?

Article: Elders Can Be Adept at Covering Memory Problems

Will Alzheimer's Trump Obesity by 2030?

A ZDNet.com blog post today predicts that Alzheimer's disease will become an epidemic much like obesity is today in the United States. The author, whose grandfather died of Alzheimer's, believes the morbidly obese in the next 20 years will largely have passed away or changed lifestyles to regain their health. In the meantime, Alzheimer's disease will continue to claim more and more baby boomers.

Just as with the obesity epidemic, you can expect an Alzheimer’s gold rush, as new therapies are passed by the FDA and a fading baby boom generation (that’s me, folks) begs for anything claiming to offer relief.

Article: Alzheimer's Epidemic Will Follow Obesity One

New Diagnostics for Alzheimer's Could Have Significant Impact

A CNN report published this morning says medical doctors are considering a new way to diagnose Alzheimer's disease, and if the new guidelines go into effect, the number of those found to have the memory-impairment disease could double or even triple.

The advances that Alzheimer's research has seen since 1984 include the recognition of changes in the brain driven by Alzheimer's - but also that some people don't show symptoms of dementia even though they have these brain changes, the Alzheimer's Association said. Also, scientists did not have a good understanding of non-Alzheimer's dementia in 1984; today, there is greater knowledge of other kinds of dementia.

The article also provides a link to a Web site outlining the new guidelines under consideration and asking for feedback.

The New York Times also wrote about the new scanning system and its potential impact. Currently, doctors look for signs of plaque on the brain to confirm an earlier Alzheimer's diagnosis.

Doctors do not wait for a brain autopsy to diagnose Alzheimer’s. They use memory tests and evaluations of patients’ reasoning and ability to care for themselves. Yet with autopsy, even doctors at leading medical centers have been wrong as often as 20 percent of the time: people they said had Alzheimer’s did not have plaque.

CNN Article: How Alzheimer's Gets Diagnosed May Change
New York Times Article: New Scan May Spot Alzheimer's

USA Today: Consider Paid Help in Your Care Plan

USA Today today published a piece in which experts encouraged Alzheimer's caregivers to seek paid help.

About 70% of families coping with Alzheimer's and other dementia have loved ones who live at home, the Alzheimer's Association says. Most of those families do not have any assistance from paid health workers; family members and friends do all the care.

This week, a study will be reported from the annual Alzheimer's Association International Conference on Alzheimer's Disease meeting in Honolulu on the influence of diagnosis and care management on health care costs. Experts say having no outside help can take a toll on caregivers and patients alike.

The article also outlines options for assistance, including in-home care, adult day care, assisted living and skilled nursing facilities. It's a good read, and one that many caregivers trying to go it alone will want to read.

Article: Alzheimer's experts: Don't hestitate to get paid help

Study: Big Head Helps With Alzheimer's

An article in today's Los Angeles Times reports a new study showing a connection between physical brain mass and Alzheimer's disease. Apparently, the bigger the brain, the more room for cognitive functionality, even as the brain starts to wither.

From the article:

Studies show that brains reach 93% of their maximum size when they are only 6 years old. Bigger brains have more neurons, as well as more connections between them. Genetics plays a role, but so do external factors such as nutrition, central nervous system infections and brain injury early in life. The upshot is that Alzheimer's prevention efforts should be geared toward the preschool set, the German researchers suggested.

Article: Big heads help patients withstand Alzheimer's disease
Study abstract: Head circumferernce, atrophy and cognition: Implications for brain reserve in Alzheimer's disease

More on Driving with Dementia

In our last post, we outlined warning signs it may be time for a loved one with dementia to stop driving. We also mentioned the huge psychological toll it can take since the loss of driving often is seen as a loss of independence.

Still, for everyone's safety, sometimes we need to take action, starting with a conversation about taking away the keys. The National Institute on Aging has some recommendations we're republishing here from its Caregiver Guide:

• Be sensitive to the person’s feelings about losing the ability to drive, but be firm in your request that he or she no longer do so. Be consistent—don’t allow the person to drive on “good days” but forbid it on “bad days.”
• Ask the doctor to help. The person may view the doctor as an authority and be willing to stop driving. The doctor also can contact the Department of Motor Vehicles and request that the person be reevaluated.
• If necessary, take the car keys. If just having keys is important to the person, substitute a different set of keys.
• If all else fails, disable the car or move it to a location where the person cannot see it or gain access to it.
• Ask family or friends to drive the person or find out about services that help people with disabilities get around their community.

When to Take Away the Keys

People with mild dementia often continue to drive for a number of reasons, most importantly for fear of losing a major source of independence. But as the dementia becomes more serious, caregivers must eventually decide when and how to take away the car keys for everyone’s safety.

The Hartford Financial Services Group and MIT AgeLab provides guidelines to help families find that balance between independence and safety. Today we’re exploring warning signs for drivers with dementia. Consider the following driving behaviors as you deliberate, including how often you observe or hear about these incidents.

Does your loved one with dementia:

Have less confidence while driving?
Have difficulty turning to see when backing up?
Ride the brake?
Becoming easily distracted?
Get honked at by other drivers?
Use incorrect signaling?
Find it difficult to park within a defined space?
Hit curbs?
Have scrapes or dents on the car or on the garage?
Become agitated when driving?
Fail to notice traffic signs? Important roadside activity?
Fail to stop at stop signs or traffic lights?
Drive at inappropriate speeds?
Show bad judgment making lefthand turns?
Move into the wrong lane?
Confuse exits?
Receive moving violation tickets?
Get lost in familiar places?
Get into an auto accident?
Confuse the gas and brake pedals?
Stop for no apparent reason?

Diagnosed with Alzheimer's-Type Dementia. Now What?

Join us on Thursday, July 29, at the Lake San Marcos Resort Conference Center for a Town Hall Forum for caregivers and health care professionals titled "Diagnosis: Probable Alzheimer's-Type Dementia...Now What?"

The event kicks off with a complimentary breakfast at 8:30 a.m. and runs until 12:30 p.m. Medical experts and an attorney will discuss the following topics:

• Most common forms of dementia


• Treatment options at various disease stages


• Legal decisions following a dementia diagnosis


• Determining your loved one's end of life preferences and values

To R.S.V.P., call 858-565-4424. Free adult day care will be offered at the Glenner Alzheimer's Family Center in Encinitas. You must reserve a spot one week prior to the event. To schedule a reservation, call 760-635-1895.

Postcards from South Bay

Today concludes are postcards from participants of our Glenner Alzheimer's Family Centers. As mentioned in previous posts, these we interviewed people about their memories of the beach to feature at our annual signature event last week in La Jolla.

These three come from our center in South Bay, located on the edge of the Fredericka Manor campus. You can click an image and enlargen to read it in bigger print.

Postcards from Encinitas

Today we continue to feature postcards we created for "Postcards from the Pacific: Oceans of Memories," our annual fundraiser. These showcase beach memories of some of our Glenner Alzheimer's Family Centers participants and were made into posters at the actual event.

Today's post features participants from our n Encinitas center in North County.

If you have trouble reading them, just click on an image and it should enlarge.

Postcards from Hillcrest

Over the next few days, we're featuring postcards we created for our big event, "Postcards from the Pacific: Oceans of Memories," that showcase beach memories of some of our Glenner Alzheimer's Family Centers participants. These appeared as posters at the actual event.

Today's post features participants from our center in San Diego's Hillcrest neighborhood.

If you have trouble reading them, just click on an image and it should enlarge.