People tend to use “Alzheimer’s” as a catchall term for memory loss in older adults, but Alzheimer’s disease (AD), first identified by neuropathologist Aloysius Alzheimer in 1901, is only one form of dementia.
Dementia is the umbrella category of brain diseases that cause a gradual decline in the ability to think, remember, and function day-to-day. It refers to a cluster of symptoms such as short-term memory loss, language deficits, poor judgment, and changes in behavior. Alzheimer’s disease is the most common form of dementia, comprising 50 to 70% of all dementia diagnoses.
The Difficulty with Diagnosis
Part of the confusion around dementia and Alzheimer’s arises from the challenge in diagnosing Alzheimer’s disease with complete accuracy while someone is alive. The “markers” for AD — sticky plaques that accumulate in the brain from abnormally folded proteins, causing inflammation and cellular damage — can only be positively identified on autopsy. Thus, doctors generally make an Alzheimer’s diagnosis by testing for and eliminating other possibilities.
After AD, the second most common cause of dementia results from high blood pressure, high cholesterol and diabetes. All of these conditions block the arteries and impede blood flow to the brain, creating what is known as vascular dementia. If blood can’t reach the brain easily, parts of the brain die. This is called an infarct, and is similar to what happens in a heart attack, or myocardial infarction. When brain tissue dies, the person begins to exhibit signs of cognitive impairment.
In some cases, what looks like dementia may actually be a vitamin or mineral deficiency, since absorption of nutrients declines with age. Because loss and loneliness tend to increase with age as well, depression can be a major factor in dementia. One study found the effect of loneliness is equivalent to smoking fifteen cigarettes a day! Loneliness, and the lack of mental stimulation and emotional connection, increases the risk of heart disease and other physical and mental health problems. It’s a downward spiral in which dementia is an effect, rather than cause.
Finally, Parkinson’s disease, a long-term degenerative disorder of the central nervous system, can cause dementia symptoms. While dementia only becomes widespread in advanced stages of Parkinson’s, depression and anxiety are more common complications, and can also escalate mental decline.
Reducing the Risk
Although Alzheimer’s disease is not currently reversible or curable, its progression can be slowed — and other forms of dementia, such as vitamin deficiency or depression, can be treated, halted, and usually reversed.
Some of the best ways to reduce an older adult’s risk of developing non-Alzheimer’s dementia are surprisingly simple, yet many people ignore them. To brighten your brain, or that of a senior loved one:
- Exercise regularly
- Quit smoking
- Learn something new; challenge your mind
- Get enough sleep
- Eat a healthy diet
- Stay socially active
- Get a health check-up, especially for blood pressure and cholesterol
- Protect your head. Over half of those 80 and older fall every year. If you’re unsteady on your feet, use a walking stick, and make sure your home has bathroom handrails and non-skid floors throughout.
When to Place a Loved One in Memory Care
Though most people want to age in place (remain in their own home as they grow older), as dementia progresses this may no longer be feasible, even with a caregiver. These seven questions can help you evaluate whether it’s time for Memory Care:
- Inattention: Do they forget to turn off the stove?
- ADL: How well does he/she handle activities of daily living (eating, dressing, bathing)?
- Personality: Is your loved one suspicious of others, fearful of taking medications, or of eating certain foods?
- Medication: Is your loved one taking medications on schedule, following correct dosages, and willing to use an organizer/reminder device if necessary?
- Short-term memory: Has your loved one gotten lost on a walk, or while running errands? Can he/she remember personal information such as address, phone number, contacts, that enable them to return home?
- Do you have additional support to care for your loved one at home?
- Is the amount of home care assistance needed likely to become so great that it is no longer affordable for your family?
Options Beyond Memory Care Facilities
Dementia care can be expensive, because Medicare and Medicaid do not pay for “custodial care”, meaning day-to-day care that does not require skilled nursing.
However, there are options beyond memory care facilities. One is adult day care. Adult day care programs provide care during the day for individuals who are unable to live at home alone, but don’t need full-time nursing care. If you or another person is available to care for your loved one during evenings and weekends, adult day care may be an excellent resource to delay or avoid memory care placement.
At adult day care programs, trained individuals care for those with dementia in a setting that provides interaction and stimulation, which help keep people’s minds sharper, longer.
Another possibility is a residential care home, also known as RCFE (residential care facility for the elderly), adult day home, board-and-care home, or personal care home. These small group settings provide basic services (usually meals and light assistance) at a much lower cost than typical assisted living communities or nursing homes. Medicaid may also pay some of the cost for residents who meet eligibility requirements.
Dealing with dementia can be very difficult for everyone involved. The more information you have, the better equipped you’ll be to support your loved one in making the best choices for the road ahead.