causes of dementia mild cognitive impairment · •in later stages of the disease matters such as...

Alzheimers and Dementia

www.planetbenja.com © Benjamin W. Pearce

Many Faces of Dementia

A Changing Lifestyle

Dementia

•  Dementia is the loss of intellectual abilities (such as thinking, remembering, and reasoning) of sufficient severity to interfere with a person’s daily functioning. [i]

•  The most common form of dementia is Alzheimer’s disease.

•  The likelihood of developing Alzheimer’s doubles about every five years after age 65. After age 85, the risk reaches nearly 50 percent.

[i] Crystal HA. The diagnosis of Alzheimer’s disease and other dementing disorders. In: Aronson MK, ed. Understanding Alzheimer’s disease: What it is; How to Cope With It; Future Directions. Alzheimer’s Disease and Related Disorders Association. New York, NY: Charles Scribner’s Sons; 1988: 15-33.

Causes of Dementia

• There are more than 50 diseases that can cause dementia or symptoms similar to Alzheimer’s disease,[i]

• Tests designed to rule out other causes • Blood tests to identify some genes

associated with dementia.

[i] Davies P. Alzheimer’s disease and related disorders: An Overview. In: Aronson MK, ed. Understanding Alzheimer’s disease: What it is; How to Cope With It; Future Directions. Alzheimer’s Disease and Related Disorders Association. New York, NY: Charles Scribner’s Sons; 1988: 3-14.

Mild Cognitive Impairment

•  Mild cognitive impairment (MCI) a condition in which a person has problems with memory, language, or another mental function severe enough to be noticeable to other people and to show up on tests, but not serious enough to interfere with daily life.

•  Because the problems do not interfere with daily activities, the person does not meet criteria for being diagnosed with dementia.

•  Research has shown that individuals with MCI have an increased risk of developing Alzheimer’s disease over the next few years, especially when their main problem is memory.

•  Not everyone diagnosed with MCI goes on to develop Alzheimer’s.

•  There is currently no treatment for MCI approved by the FDA.

Other Causes of Dementia Vascular Dementia

• Occurs when arteries feeding the brain become narrowed or blocked.

•  The onset of symptoms usually is abrupt, frequently occurring after a stroke.

•  Some people have Alzheimer's and vascular dementia at the same time.

•  Vascular dementia often causes problems with thinking, language, walking, bladder control and vision.

• Also called multi-infarct dementia (MID)

Other Causes of Dementia Lewy Body Dementia

•  Abnormal round structures (alphasynuclein)— Lewy bodies — develop within cells of the midbrain, beneath the cerebral hemispheres.

•  Lewy body dementia shares characteristics with both Alzheimer's disease and Parkinson's disease. Like Alzheimer's disease, it causes confusion and impaired memory and judgment.

•  Often produces two distinctive physical signs typical of Parkinson's disease — a shuffling gait and flexed posture.

•  Lewy body dementia can also cause hallucinations. •  Lewy body dementia and Alzheimer's or Parkinson's

disease sometimes co-exist in the same person.



Other Causes of Dementia Frontotemporal Dementia

•  Affects the lobes of the brain that are responsible for judgment and social behavior.

•  Frontotemporal dementia can result in impolite and socially inappropriate or disinhibited behavior, distractibility, repetitive or compulsive behavior, agitation, blunted emotions, neglect of personal hygiene, loss of insight into the behaviors of oneself.

•  Symptoms of this form of dementia usually appear between the ages of 40 and 65. The disease seems to run in families.

•  Also known as Pick’s disease.

Other Causes of Dementia Huntington’s Disease

•  Symptoms of this hereditary disorder typically begin between the ages of 30 and 50, starting with mild personality changes.

•  As the disorder progresses, a person with Huntington's develops involuntary jerky movements, muscle weakness and clumsiness.

•  Dementia commonly develops in the later stages of the disease.

Other Causes of Dementia Parkinson’s Disease

•  People with Parkinson's disease may experience stiffness of limbs, shaking at rest (tremor), speech impairment and a shuffling gait.

•  Some people with Parkinson's develop dementia late in the disease.

Other Causes of Dementia Creutzfeldt-Jakob Disease

•  Extremely rare and fatal brain disorder belongs to a family of human and animal diseases known as the transmissible spongiform encephalopathies.

•  A new variety of Creutzfeldt-Jakob disease has emerged — particularly in Great Britain. It's believed to be linked to the human consumption of beef from cattle with mad cow disease (bovine spongiform encephalopathy).

If your cow sounds like this

may we suggest the fish.

If your cow sound like this

then fire up the barbecue.

Mad Cow Disease How to identify if your cow has mad cows disease..

Treatable Causes of Dementia Reactions to Medications

•  Some medications have side effects that mimic the symptoms of dementia.

•  A single medicine may trigger such a reaction in an older person or in someone whose liver fails to eliminate the drug properly.

•  Interactions among two or more drugs may lead to reversible symptoms of dementia as well.



Treatable Causes of Dementia Metabolic Abnormalities

•  Decreased thyroid function (hypothyroidism) can result in apathy, depression or dementia.

•  Hypoglycemia, a condition in which there isn't enough sugar in the bloodstream, can cause confusion or personality changes.

•  Pernicious anemia — an impaired ability to absorb vitamin B-12 — also can cause personality changes.

Treatable Causes of Dementia Nutritional Deficiencies

•  Chronic alcoholism can result in deficiencies of thiamin (vitamin B-1), which can seriously impair mental abilities. Also known as Wernicke-Korsakoff syndrome. Thiamine helps brain cells produce energy from sugar. When levels of the vitamin are too low, cells are unable to generate enough energy to function properly.

•  Severe deficiency of vitamin B-6 may lead to pellagra, a neurological illness with features of dementia.

•  Dehydration also can cause confusion that may resemble dementia.

Treatable Causes of Dementia Emotional Problems

•  The confusion, apathy and forgetfulness associated with depression are sometimes mistaken for dementia, particularly in older individuals.

Delirium

•  Disturbance in consciousness or change in cognition occurring within a relatively short (hours or days) onset.

•  Should be treated as a medical emergency – 65% mortality rate.

•  At Risk: Age, Dementia, Cancer, Stroke, Cardiovascular, Hospitalization, Acute Illness, Post operative, Intoxication, Infections, Medications.

•  Confusion Assessment Method (CAM)

Depression •  Newly diagnosed seniors commonly experience

depression. •  Symptoms of this are often associated with

withdrawal, crying, agitation, and changes in eating habits or sleeping patterns, feelings of worthlessness or acting out.

•  Depression can significantly lower a persons cogitative capabilities and their ability to fight-off illness.

•  Ultimately this is the single biggest factor that will influence their quality of life.

•  Depression is treatable with antidepressants but the best treatment for depression is socialization. Isolated people with dementia tend to focus on all the things that they can’t do anymore, their limitations. But in social situations such as day care or senior living homes their focus becomes directed outward toward their environment.

Differentiating Dementia, Depression, and

Delirium in the Elderly Characteristic Depression Dementia Delirium Onset Often abrupt Chronic, gradual Acute, subacute Progression Weeks-Months Months-Years Hours-Days Awareness Clear Clear Reduced Alertness Normal Generally normal Fluctuates Attention Minimal impairment Generally normal Impaired, fluctuates Orientation Some disorientation May be impaired Impaired, fluctuates Memory Selective impairment Recent, remote

impaired Recent, immediate

impaired Mood Consistent Labile Fluctuating Progression Resolves with

treatment Ongoing Resolves with

treatment Answers ‘Don’t know’ Response incorrect May be incoherent MMSE Fluctuates Stable, downward trend Severe fluctuations

Adapted from: Forman, M., Fletcher, K., Mion, L., & Trygstad, L.( 2003). Assessing Cognitive Function in Mezey, M, Fulmer T, Abraham I, (editors); Zwicker, D, (managing editor). Geriatric Nursing Protocols for Best Practice. 2nd ed. New York (NY): Springer Publishing Company, Inc.; p. 102-103.



Treatable Causes of Dementia Infections

•  Meningitis and encephalitis, which are infections of the brain or the membrane that covers it, can cause confusion, memory loss or sudden dementia.

•  Untreated syphilis can damage the brain and cause dementia.

•  People in the advanced stages of AIDS also may develop a form of dementia.

Evaluate First

• Dementia isn't always due to Alzheimer's. Before you conclude that a loved one's memory loss and confusion stem from an irreversible disease process, get a thorough medical evaluation.

•  Even if the evaluation uncovers no underlying condition that, with treatment, can reverse dementia, options may be available for easing its symptoms.

•  Knowing the likely cause of dementia, however, is the essential first step toward managing it.

Alzheimer’s 10 Warning Signs Normal Possibly Alzheimer’s

Temporarily forgetting a colleague’s name Not being able to remember the name or person later

Forgetting the corn on the stove until the meal is over

Forgetting a meal was ever prepared or served

Unable to find the right word, but use an acceptable substitute

Uttering incomprehensible sentences

Forgetting for a moment where you are going

Getting lost on your own street

Talking on the phone, momentarily forgetting to watch child

Forgetting there is a child

Having trouble balancing checkbook Not knowing what the numbers mean

Misplacing your watch until your steps are retraced

Putting your watch in the sugar bowl

Having a bad day Having rapid mood shifts

Gradual changes in personality with age Drastic changes in personality

Tiring of housework, but eventually getting back to it

Not knowing or caring that housework needs to be done

Alzheimer’s Association. Is it Alzheimer’s? Warning Signs You Should Know. Chicago: Alzheimer’s Assn. .)

Progression of Alzheimer’s

•  The patient may become increasingly dependant upon the caregiver for even the most basic tasks.

•  Daily activities once performed routinely may require assistance or supervision by the caregiver.

•  The caregiver may eventually need to reconsider the range of acceptable activities for the patient as their impairment progresses.

•  The management of financial affairs, and previously safe activities such as driving and preparing meals, taking medications or going for unaccompanied walks may become hazardous.

•  In later stages of the disease matters such as daily hygiene and dressing may be beyond the capabilities of the patient and will become the caregiver’s responsibility.

Stages of Alzheimer’s Disease

•  Stage 1: No Impairment •  Stage 2: Very mild Decline •  Stage 3: Mild decline •  Stage 4: Moderate decline (mild or early stage) •  Stage 5: Moderately severe decline (moderate or

mid-stage) •  Stage 6: Severe decline (moderately severe) •  Stage 7: Very severe decline (severe or late stage) •  People with Alzheimer’s live an average of 8 years

after diagnosis, but may survive anywhere from 3 to 20 years.

Source: Alzheimer’s Association

Early Stage 2-4 years

Symptom Example

Confusion May get lost in own, familiar neighborhood

STM loss May lose or misplace things

Poor judgment leading to bad decisions May burn food on stove or go out in cold without a coat

Numbers are confusing May have trouble managing money and paying bills

Increased need for security May be less likely to try new things

Mood or personality changes May seem anxious, sad, paranoid, withdrawn

Language problems May have trouble finding the right words to say

Taking longer to accomplish normal daily tasks May get confused while dressing, not knowing which task to do next to reach goal

Loss of spontaneity and initiative Unable to think of or carry out an unexpected or unplanned idea or event



Middle Stage 2-10 (or more) years

Symptom Example

Increasing memory loss and confusion; shortened attention span

Trouble with STM and with learning new things; LTM may still be intact; can talk about familiar things

Problem recognizing friends and family May not “know” people who visit

Suspicious of others; paranoid May accuse caregivers and family of stealing

Needs assistance with ADLs May require help with bathing, dressing, and toileting

Sundowning syndrome Increased restlessness, agitation, confusion, tearfulness in late afternoon and early evening

Language difficulties May have difficulty expressing thoughts, feelings, and needs

Cognitive impairment May have difficulty with numbers, reading, organizing thoughts, and logical thinking

Perceptual and perceptual-motor difficulties May have problems correctly understanding what one sees; may have difficulty with depth and distance

Motor difficulties May have difficulty dressing self, walking, and understanding depth and distance

Changes in behavior and mood May become more agitated when having difficulty completing simple and normal tasks; generalized restlessness, agitation, anxiety, tearfulness, wandering

Hallucinations, delusions, suspiciousness, paranoia, irritability

May “see” things and “hear” things that aren’t there and talk to people who are not present; may see those people as a threat to safety or personal belongings

Late Stage 1-3 years

Symptom Example

Severe language deficit May be unable to communicate with words

Incontinence (bowel and bladder) Will not be able to control BMs or urination

Total care for ADLs Cannot bathe, dress, ambulate, or eat without help

Difficulty swallowing May choke on food or drink

Increased need for sleep May nap several times per day

Severe memory loss All memory is damaged; no longer recognizes familiar things or people

Weight loss The body is shutting down

Seizures The brain is severely impacted by the disease process

Skin infections and breakdown Generally related to poor nutrition and immobility

Groaning, moaning, grunting The only means left to communicate discomfort

MMSE Scores Correlated with Functional Ability

Adapted from Galasko et al. Eur J Neurol. 1998;5:S9-S17.

Loss of Optimal (Independent) Performance

Progressive loss of function MMSE score

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Genetic Links to Alzheimer’s

•  Scientists have so far identified two Alzheimer risk genes called apoliprotein E-e4 (APOE-e4)& SORL1

•  APOE-e4 is one of three common forms of the APOE gene; the others are APOE-e2 and APOE-e3. APOE provides the blueprint for one of the proteins that carries cholesterol in the bloodstream.

•  Everyone inherits a copy of some form of APOE from each parent. Those who inherit one copy of APOE-e4 have a 30-40% increased risk of developing Alzheimer’s. Those who inherit two copies have an even higher risk, but not a certainty. Scientists do not yet know how APOE-e4 raises risk. In addition to raising risk, APOE-e4 may tend to make symptoms appear at a younger age than usual.

•  Linked to late onset – 90% of all cases of the disease.

Risk genes increase the likelihood of developing a disease but do not guarantee it will happen.


Genetic Links to Alzheimer’s

• Abnormal SORL1 genes promotes the production of amyloid plaque.

•  Big gene that contains as many as 500 variants, researchers focused on only 29.

• Also linked to late onset – after age 65. • Not everyone with a faulty SORL1 gene will

develop Alzheimer’s disease. • Alzheimer's is caused by a complex genetic

puzzle, finding out about SORL1 explains only a small piece of the puzzle.

Risk genes increase the likelihood of developing a disease but do not guarantee it will happen.


SORL1

Under the Microscope • Alzheimer tissue has

many fewer nerve cells and synapses than a healthy brain.

•  Plaques, abnormal clusters of protein fragments, build up between nerve cells.

• Dead and dying nerve cells contain tangles which are made up of twisted strands of another protein.



Plaques •  Plaques form when protein

pieces called beta-amyloid (BAY-tuh AM-uh-loyd) clump together. Beta-amyloid comes from a larger protein found in the fatty membrane surrounding nerve cells.

•  Beta-amyloid is chemically "sticky" and gradually builds up into plaques.

•  The most damaging form of beta-amyloid may be groups of a few pieces rather than the plaques themselves. The small clumps may block cell-to-cell signaling at synapses. They may also activate immune system cells that trigger inflammation and devour disabled cells.

Alzheimer’s Brain

•  The cortex shrivels up, damaging areas involved in thinking, planning and remembering.

•  Shrinkage is especially severe in the hippocampus, an area of the cortex that plays a key role in formation of new memories.

•  Ventricles (fluid-filled spaces within the brain) grow larger.

Amyloid Production and Accumulation

Oxidation, Excitotoxicity, Inflammation, Tau Hyperphosphorylation

Cholinergic Deficit

Neuronal Death Dementia with

Cognitive and Behavioral

Disturbances

The Amyloid Hypothesis (Simplified)

Cummings, JL. New Engl J Med 2004;351:56-67.

Medicines Used to Treat AD and its Symptoms

• Celexa® (Sa-LEKS-a) • Citalopram (SYE-tal-oh-pram) •  Used to reduce depression and anxiety

–  May take 4 to 6 weeks to work –  Sometimes used to help people get to sleep

•  Depakote® (DEP-uh-cote) •  Sodium valproate (so-DEE-um VAL-pro-ate) •  Used to treat severe aggression •  Also used to treat depression and anxiety

Medicines Used to Treat AD and its Symptoms These Drugs Should Be Taken with Caution Sleep aids •  Ambien® (AM-bee-un) •  Zolpidem (zole-PI-dem) •  Used to help people get to sleep and stay asleep

–  People with AD should not use this drug on a regular basis •  Lunesta® (lu-NES-ta) •  Eszopiclone (ess-ZOP-eh-klone) •  Used to help people get to sleep and stay asleep

–  People with AD should not use this drug on a regular basis •  Sonata® (SO-nah-ta) •  Zaleplon (ZAL-ee-plon) •  Used to help people get to sleep and stay asleep

–  People with AD should not use this drug on a regular basis

Medicines Used to Treat AD and its Symptoms Anti-anxiety •  Ativan® (AT-eh-van) •  Lorazepam (lor-AZ-eh-pam) •  Used to help people relax and calm their agitation

–  Can cause sleepiness, falls, and confusion •  Klonapin® (KLON-uh-pin) •  Clonazepam (KLO-naz-ee-pam) •  Used to help people relax and calm their agitation

–  Can cause sleepiness, falls, and confusion

Antipsychotics •  Risperdal® (RISS-per-dol) •  Risperidone (riss-PAIR-eh-dohn) •  Used to treat mental problems such as aggression, paranoia, hallucinations, or

agitation •  Seroquel® (SAIR-o-kwell) •  Quetiapine (KWE-tye-uh-peen) •  Used to treat mental problems such as aggression, paranoia, hallucinations, or

agitation •  Zyprexa® (zye-PREKS-uh) •  Olanzapine (o-LAN-zuh-peen) •  Used to treat mental problems such as aggression, paranoia, hallucinations, or

agitation



FDA-Approved Pharmacotherapy in Alzheimer’s Disease

• Cholinesterase Inhibitors –  Tacrine (Cognex®) – no longer used – Galantamine (Razadyne™) – Rivastigmine (Exelon®) – Donepezil (Aricept®) – Approved for use in mild to moderate AD

• N-Methyl-D-Aspartate–Receptor Antagonist – Memantine (Namenda®) – Approved for use in moderate to severe AD

FDA = US Food and Drug Administration.

Side Effect Profile for Cholinesterase Inhibitors

• Gastrointestinal side effects include nausea, vomiting, diarrhea, and abdominal pain –  Resulting in anorexia and weight loss

• Cardiovascular side effects include bradycardia, tremor, and dizziness –  Resulting in asthenia and fatigue

• Neuromuscular side effects include muscle cramps and weakness

• CNS effects include insomnia, nightmares, agitation, and a panic-like state

Is Drug Treatment Working?

Is the patient better, worse, or the same compared to the last assessment?

Alzheimer’s Facts •  Alzheimer’s Disease is the most common cause

of dementia (70%). •  One in 6 women and one in 10 men who live

longer than 55 years will develop Alzheimer’s disease in their remaining lifetime.

•  Alzheimer’s is the seventh-leading cause of death

•  The direct and indirect costs of Alzheimer’s and other dementias to Medicare, Medicaid and businesses amount to more than $148 billion each year.

•  10 Million baby boomers will develop Alzheimer’s in their lifetime.

•  22 percent of people with two parents with Alzheimer’s disease will develop the disease themselves vs. 13 percent in general population.

Source: Alzheimer’s Disease Facts and Figures, Alzheimer’s Association, 2008

Etiologies for Dementia

Source: Morris, JC. Clin Geriatrmed. 1994 May: 10 (2): 257-176

Americans with Alzheimer’s


Every 71 seconds someone in America develops Alzheimer’s disease by mid-century every 33 seconds

Currently 5.2 million 5 Million >65 200,000 < 65



Looking to the Future

•  In 2000, there were an estimated 411,000 new cases of Alzheimer’s disease. That number is expected to increase to 454,000 new cases a year by 2010, 615,000 new cases a year by 2030, and 959,000 new cases a year by 2050.

•  The number of people age 65 and over with Alzheimer’s disease is estimated to reach 7.7 million in 2030, a greater than 50 percent increase from the 5 million age 65 and over who are currently affected.

•  By 2050, the number of individuals age 65 and over with Alzheimer’s could range from 11 million to 16 million unless science finds a way to prevent or effectively treat the disease.

•  By that date, more than 60 percent of people with Alzheimer’s disease will be age 85 or older. Source: Alzheimer’s Disease Facts and Figures 2008. Alzheimer’s Association

Alzheimer’s Worldwide •  35 million people were living with the disease

in 2009 •  Researchers predict that global prevalence

of Alzheimer's will quadruple by 2050 to more than 100 million

•  1 in 85 persons worldwide will be living with the disease

• More than 40 percent of those cases will be in late stage Alzheimer's requiring a high level of attention equivalent to nursing home care

Source: Alzheimer's Association International Conference on the Prevention of Dementia

Alzheimer’s – Who is at Risk? •  Return from a regular walk or drive later than

usual? •  Try to fulfill former obligations like going to work? •  Try or want to “go home” even when at home? •  Act restless, pace or make repetitive

movements? •  Have difficulty locating familiar places like the

bathroom, bedroom, or dining room? •  Check the whereabouts of familiar people? •  Act as if doing a hobby or chore, but nothing

gets done? •  Appear lost in a new or changed environment?

Source: Alzheimer's Association Myths of Wandering.

Typical Dementia Symptoms

• Short-term memory loss • Word-finding problems • Asking the same question • Denial • Difficulty making decisions • Paranoia • Depression

Short-term Memory Loss

•  Short-term memory loss is normally the first symptom noticed.

•  Patients become forgetful, lose things and have trouble remembering most recent events.

•  Establish a routine and provide a written daily agenda such as notes or a special calendar.

•  Leave items in plain view that are used daily such as hearing aides, glasses so that they can take advantage of visual cues.

•  Avoid questions that test their memory such as “What did you eat for breakfast?” or didn’t you pay the credit card bill?” these serve only to make them more painfully aware of their loss.

Word-Finding Problems

• Common especially when they become fatigued or are emotional.

•  Supply the word if she can’t, if they lose their train of thought mid-sentence; tell them that they can come back to it later.

•  Preserving the patient’s self-esteem is critical. Some people may have difficulty following instructions or complex concepts.

•  Use short sentences, and visual cues. Never assume that they have understood everything you have just said.



Asking the same question

• Many people will ask the same question repeatedly.

• This is quite common and indicates that they are trying to remember something that is important to them.

• Be patient, and answer their question as if it was the first time you heard it.

•  If the information is critical, jot it down for them.

Denial

• Denial is a common coping mechanism and a natural way of self-preservation.

•  If you want someone with dementia to admit that they have it, they need to feel safe, supported, and that they have some control over their future.

•  Resist the temptation to convince them of their condition. They are more likely to respond to emotional support, and opportunities to talk about their fears.

Difficulty Making Decisions

• Changes in the brains of early stage patients cause impairments in memory, reason and judgment rendering it difficult for them to make decisions.

• Many feel overwhelmed when asked to make choices, causing them to feel ashamed of their condition.

•  Limit situations where choices are necessary.

Paranoia

• Common in the disease, results from damage to the part of the brain that separated fact from fiction.

•  It is also a way for the patient to avoid the painful realization that they have Alzheimer’s disease.

•  You will not convince an Alzheimer’s patient that someone didn’t take his wallet, so don’t even try. Respond to the feeling behind the paranoia. Help him look around for it.

• Avoid denying their reality.

Risk Reducers •  Intellectual stimulation (e.g., playing chess or doing

crosswords) •  Regular physical exercise •  Regular social interaction •  A Mediterranean diet with fruits and vegetables

and low in saturated fat, supplemented in particular with: B vitamins, Omega-3 fatty acids, especially Docosahexaenoic acid – Heart Smart is a preventative

•  Omega-6 fatty acids found in margarine, mayonnaise, and most processed and fried foods can cause brain inflammation.

•  Fruit and vegetable juice, Berries, cherries, kiwi, oranges, prunes and raisins.

•  Keep blood sugar levels steady – eating three smallish meals and two snacks daily helps keep blood sugar levels even.

Risk Reducers •  High doses of the antioxidant Vitamin E (in

combination with vitamin C) seem to reduce Alzheimer's risk in cross sectional studies

•  Cholesterol -lowering drugs (statins) reduce Alzheimer's risk in observational studies but so far not in randomized controlled trials

•  Female Hormone replacement therapy is no longer thought to prevent dementia based on data from the Women’s health Initiative

•  Long-term usage of non-steroidal anti-inflammatory drugs (NSAIDs), used to reduce joint inflammation and pain, are associated with a reduced likelihood of developing AD.

•  Recent medical research has found that cannabinoids, the psychoactive compounds in marijuana, "succeed in preventing the neurodegenerative process occurring in the disease."



Life as a Process •  Seniors who can learn to view changes in their life

as a process of life rather than an end to it will treat themselves to a happier, healthier life.

•  Families are often concerned that knowing what is causing their loved one’s memory loss may trigger them to panic, or become depressed and hasten the degenerative process, while for many the opposite may be true.

•  A patient who is kept in the dark about the source of their problems may tend to worsen because they desperately try to remember things and become frustrated, agitated and possibly depressed when they cannot.

•  They need to know that something is causing the problems that they are experiencing and that it is not normal or a part of getting old. This way they can learn to understand the disease and their prognosis and be more receptive to the adjustments in their changing lifestyle.

Grant me the senility to forget the people I never liked

anyway, the good fortune to run into the ones I do, and the eyesight to tell the difference.

THE SENILITY PRAYER

causes of dementia mild cognitive impairment · •in later stages of the disease matters such as...

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