rtb2008-02

Dementia: What Are the Common Signs?

 

What is dementia?

Dementia is a problem in the brain that makes it hard for a person to remember, learn and communicate. After a while, this makes it hard for the person to take care of himself or herself.

Dementia may also change a person's mood and personality. At first, memory loss and trouble thinking clearly may bother the person who has dementia. Later, disruptive behavior and other problems may start. The person who has dementia may not be aware of these problems.

 

What causes dementia?

Dementia is caused by the destruction of brain cells. A head injury, a stroke, a brain tumor or a problem like Alzheimer's disease can damage brain cells. Some people have a family history of dementia.
 

What are some common signs of dementia?

Dementia causes many problems for the person who has it and for the person's family. Many of the problems are caused by memory loss. Some common signs of dementia are listed below. Not everyone who has dementia will have all of these signs.

 
  • Recent memory loss. All of us forget things for a while and then remember them later. People with dementia often forget things, but they never remember them. They might ask you the same question over and over, each time forgetting that you've already given them the answer. They won't even remember that they already asked the question.
  • Difficulty performing familiar tasks. People who have dementia might cook a meal but forget to serve it. They might even forget that they cooked it.
  • Problems with language. People who have dementia may forget simple words or use the wrong words. This makes it hard to understand what they want.
  • Time and place disorientation. People who have dementia may get lost on their own street. They may forget how they got to a certain place and how to get back home.
  • Poor judgment. Even a person who doesn't have dementia might get distracted. But people who have dementia can forget simple things, like forgetting to put on a coat before going out in cold weather.
  • Problems with abstract thinking. Anybody might have trouble balancing a checkbook, but people who have dementia may forget what the numbers are and what has to be done with them.
  • Misplacing things. People who have dementia may put things in the wrong places. They might put an iron in the freezer or a wristwatch in the sugar bowl. Then they can't find these things later.
  • Changes in mood. Everyone is moody at times, but people with dementia may have fast mood swings, going from calm to tears to anger in a few minutes.
  • Personality changes. People who have dementia may have drastic changes in personality. They might become irritable, suspicious or fearful.
  • Loss of initiative. People who have dementia may become passive. They might not want to go places or see other people.

 

 

What if I have any of these signs of dementia?

Talk with your doctor. Your doctor can do tests to find out if your signs are caused by dementia. The sooner you know, the sooner you can talk to your doctor about treatment options.
 

What if a family member has signs of dementia?

If your family member has some of the signs of dementia, try to get him or her to go see a doctor. You may want to go along and talk with the doctor before your relative sees him or her. Then you can tell the doctor about the way your relative is acting without embarrassing your relative.
 

Dementia: Info and Advice for Caregivers

 

What is dementia?

Dementia is a brain disorder that makes it hard for people to remember, learn and communicate. These changes eventually make it hard for people who have dementia to care for themselves. Dementia may also cause changes in mood and personality. Early on, lapses in memory and clear thinking may bother the person with dementia. Later, disruptive behavior and other problems can create a burden for caregivers and other family members.

Dementia is caused by the damage of brain cells. A head injury, stroke, brain tumor or disease (such as Alzheimer's disease) can damage brain cells and lead to dementia.

 

How is dementia treated?

Some causes of dementia can be treated. However, once brain cells have been destroyed, they cannot be replaced. Treatment may slow or stop the loss of more brain cells. When the cause of dementia can't be treated, the focus of care is on helping the person with his or her daily activities and reducing upsetting symptoms. Some medicines can help people who have dementia. Your family doctor will talk with you about treatment options.

 

Why do people who have dementia become agitated?

The agitation can have many causes. A sudden change in surroundings or frustrating situations can cause people who have dementia to become agitated. For example, getting dressed or giving the wrong answer to a question may cause frustration. Being challenged about the confusion or inability to do things caused by the dementia may also make the person agitated. As a result, the person may cry, become irritable, or try to hurt others in some way.

 

How can I deal with agitation?

One of the most important things you can do is avoid situations in which your loved one might become frustrated. Try to make your loved one's tasks less difficult. For example, instead of expecting him or her to get dressed alone, you can just have your loved one put on one thing, such as a jacket, on his or her own.

You can also try to limit the number of difficult situations your loved one must face. For example, if taking a bath or shower causes problems, have him or her take one every other day instead of every day. Also, you can schedule difficult activities for a time of day when your loved one tends to be less agitated. It's helpful to give frequent reassurance and avoid contradicting him or her.

 

What should I do if hallucinations are a problem?

If the hallucinations are not making your loved one scared or anxious, you don't need to do anything. It's better not to confront people about their hallucinations. Arguing may just upset a person who has dementia. If the hallucinations are scary to your loved one, you can try to distract the person by involving him or her in a pleasant activity.

 

What if my loved one will not go to sleep at night?

Try one or more of the following if your loved one is having trouble sleeping:

 
  • Try to make the person more aware of what time of day it is. Place clocks where he or she can see them.
  • Keep curtains or blinds open so that he or she can tell when it is daytime and when it is nighttime.
  • Limit the amount of caffeine he or she consumes.
  • Try to help your loved one get some exercise every day.
  • Don't let him or her take too many naps during the day.
  • Make your loved one's bedroom peaceful. It is easier to sleep in a quiet room.
  • At night, provide a night light or leave a dim light on. Total darkness can add to confusion.
  • If your loved one has arthritis or another painful condition that interrupts his or her sleep, ask your doctor if it is okay to give your loved one medicine for pain right before bed.

What if wandering becomes a problem?

Sometimes very simple things can help with this problem. It is all right for your loved one to wander in a safe place, such as in a fenced yard. By providing a safe place, you may avoid confrontation. If this doesn't work, remind your loved one not to go out a certain door by placing a stop sign on it or putting a piece of furniture in front of it. A ribbon tied across a door can serve as a similar reminder. Hiding the doorknob by placing a strip of cloth over it may also be helpful.

An alarm system will alert you that your loved one is trying to leave a certain area. Your alarm system may just be a few empty cans tied to a string on the doorknob. You might have to place special locks on the doors, but be aware that such locks might be dangerous if a house fire occurs. Don't use this method if your loved one will be left home alone. Make sure your loved one wears a medical bracelet, in case he or she does wander away from home.
 

Depression and Older Adults: What It Is and How to Get Help

 

What is depression?

Sometimes when people feel sad, they say they are "depressed." But depression is more than just feeling sad. It's a medical illness. Someone who has "major" depression has most or all of the symptoms listed in the box below nearly every day, all day, for 2 weeks or longer. There is also a "minor" form of depression that causes less severe symptoms. Both have the same causes and treatment.
 

What causes depression?
 

Symptoms of depression

  • No interest or pleasure in things you used to enjoy, including sex
  • Feeling sad or numb
  • Crying easily or for no reason
  • Feeling slowed down or feeling restless and irritable
  • Feeling worthless or guilty
  • Change in appetite; unintended change in weight
  • Trouble recalling things, concentrating or making decisions
  • Headaches, backaches or digestive problems
  • Problems sleeping, or wanting to sleep all of the time
  • Feeling tired all of the time
  • Thoughts about death or suicide
 
 
Your body contains chemicals that help control your moods. When you don't have enough of these chemicals or when your brain doesn't respond to them properly, you may become depressed. Depression can be genetic (meaning it can run in families). Abusing drugs or alcohol can also lead to depression. Some medical problems and medications can lead to depression.

Depression is not a normal part of growing older, but it is common in adults age 65 and over. Retirement, health problems and the loss of loved ones are things that happen to older adults. Feeling sad at these times is normal. But if these feelings persist and keep you from your usual activities, you should talk to your doctor.
 

Why is depression in older adults hard to recognize?

It can be hard to tell the difference between depression and illnesses such as dementia. Also, older adults may not talk to their doctor about their sad or anxious feelings because they are embarrassed. But depression is nothing to be embarrassed about. It is not a personal weakness. It's a medical illness that can be treated.

How is depression diagnosed?

Sometimes depression is first recognized by friends or family members. If you're having symptoms of depression, be sure to tell your doctor. Don't assume he or she will be able to tell that you are depressed just by looking at you. Your doctor will ask you questions about your symptoms, your health and your family's history of health problems. He or she may also give you an exam and do some tests. It is also important to tell your doctor about any medicines that you are taking.

 

How is depression treated?

Depression can be treated with medicine or counseling, or with both. These treatments are very effective. Medicine may be particularly important for severe depression. Talk to your doctor about the right treatment for you.

What if my doctor prescribes medicine?

Medicines used to treat depression are called antidepressants. They correct the chemical imbalance in your brain that causes depression. These medicines usually work very well, but they may have some side effects. The side effects typically decrease with time. Antidepressants can start to work right away, but it may take 6 to 8 weeks before you see the full benefit. Don't stop taking the medicine without checking with your doctor first.

 

What about suicide?

Thinking about suicide can be part of depression. Anyone with depression, including older adults, may be at risk for suicide. If you have thoughts about hurting yourself, tell your doctor, friends or family right away, or call your local suicide hot line (listed in your phone book). The thoughts of suicide will go away after the depression is treated.

 

Depression and Alzheimer's Disease

 

Do people who have Alzheimer's disease become depressed?

Yes. Depression is very common among people who have Alzheimer's disease. In many cases, they become depressed when they realize that their memory and ability to function are getting worse.

Unfortunately, depression may make it even harder for a person who has Alzheimer's disease to function, to remember things and to enjoy life.

 

How can I tell if my family member who has Alzheimer's disease is depressed?

It may be difficult for you to know if your family member is depressed. You can look for some of the typical signs of depression, which include the following:

 
  • Not wanting to move or do things (called apathy)
  • Expressing feelings of worthlessness and sadness
  • Refusing to eat and losing weight
  • Sleeping too much or too little
 
Other signs of depression include crying and being unusually emotional, being angry or agitated, and being confused. Your family member who has Alzheimer's disease may refuse to help with his or her own personal care (for example, getting dressed or taking medicines). He or she may wander away from home more often.

Alzheimer's disease and depression have many symptoms that are alike. It can be hard to tell the difference between them. If you think that depression is a problem for your relative who has Alzheimer's disease, talk to his or her family doctor.

 

How can the doctor help?

The doctor will talk with your relative. The doctor will also ask you and other family members and caregivers whether the person has any new or changed behaviors. The doctor will check your relative and may wish to do some tests to rule out other medical problems. He or she may suggest medicines to help your family member feel better. The doctor may also have some advice for you and other family members and caregivers on how to cope. He or she may recommend support groups that can help you.

What medicines can help reduce depression?

Antidepressant medicines can be very helpful for people who have Alzheimer's disease and depression. These medicines can improve the symptoms of sadness and apathy, and they may also improve appetite and sleep problems. Don't worry--these medicines are not habit-forming. The doctor may also suggest other medicines that can help reduce upsetting problems, such as hallucinations or anxiety.
 

What can I do to help my family member?

Try to keep a daily routine for your family member who has Alzheimer's disease. Avoid loud noises and overstimulation. A pleasant environment with familiar faces and mementos helps soothe fear and anxiety. Have a realistic expectation of what your family member can do. Expecting too much can make you both feel frustrated and upset. Let your family member help with simple, enjoyable tasks, such as preparing meals, gardening, doing crafts and sorting photos. Most of all, be positive. Frequent praise for your family member will help him or her feel better--and it will help you as well.

As the caregiver of a person who has Alzheimer's disease, you must also take care of yourself. If you become too tired and frustrated, you will be less able to help your family member. Ask for help from relatives, friends and local community organizations. Respite care (short-term care that is given to the patient who has Alzheimer's disease in order to provide relief for the caregiver) may be available from your local senior citizens' group or a social services agency. Look for caregiver support groups. Other people who are dealing with the same problems may have some good ideas on how you can cope better and on how to make caregiving easier. Adult day care centers may be helpful. They can give your family member a consistent environment and a chance to socialize.

 

Where can I learn more about caring for my family member who has Alzheimer's disease?

A book called The 36-Hour Day explains Alzheimer's disease and gives information about resources for caregivers. It gives ideas about things you can do to deal with behavior problems in an Alzheimer's patient. One chapter discusses mood disorders and depression in these patients.

Depression After a Heart Attack

 

What does depression have to do with my heart attack?

As many as 1 out of every 3 people who have a heart attack report feeling depressed. Women, people who have been depressed before, and people who feel alone and without social or emotional support are at a higher risk for feeling depressed after a heart attack.

Being depressed can make it harder for you to recover. However, depression can be treated.

 

What is depression?

Depression is a medical illness, like diabetes or high blood pressure. The symptoms of depression can include the following:

 
  • Feeling sad or crying often (depressed mood)
  • Losing interest in daily activities that used to be fun
  • Changes in appetite and weight
  • Sleeping too much or having trouble sleeping
  • Feeling agitated, cranky or sluggish
  • Loss of energy
  • Feeling very guilty or worthless
  • Problems concentrating or making decisions
  • Thoughts of death or suicide

How will I know if I am depressed?

People who are depressed have most or all of the above symptoms nearly every day, all day, for 2 or more weeks. One of the symptoms must be depressed mood or loss of interest in daily activities.

If you have some or all of the above symptoms, see your family doctor. Your doctor will ask you questions about your symptoms, your health and your family's history of health problems.

 
 

How is depression treated?

Depression can be treated with medicine, counseling or both.

Depression can be caused by a chemical imbalance in the brain. Medicines called antidepressants can correct this imbalance. If your doctor prescribes an antidepressant medicine for you, follow his or her advice on how to take it. These medicines can take a few weeks to start working, so be patient. Also, be sure to talk to your doctor before you stop taking any medicine or if you have any unusual symptoms.

How you think about yourself and your life can also play a part in depression. Counseling can help you identify and stop negative thoughts and replace them with more logical or positive thinking. Many people who are depressed, and their families, benefit from counseling.

 

What else can I do to help myself feel better?

Many times people feel depressed because they are inactive and aren't involved in social and recreational activities. You may find that participating in a hobby or recreational activity improves your mood. Interacting more with other people or beginning an exercise program can also help you feel better. Many people who have had a heart attack benefit physically and mentally from a cardiac rehabilitation program. Talk to your doctor about what kinds of activities and exercise programs are right for you.

 

Does treatment for depression usually work?

Yes. Treatment helps between 80% and 90% of people with depression.

Grieving: Facing Illness, Death and Other Losses

 

What is grief?

Grief is a normal, healthy response to loss. One of the greatest losses that can occur is the death of someone you love. Other losses include the loss of your health or the health of someone you care about, or the end of an important relationship, such as a marriage. Healing from a loss involves coming to terms with the loss and the meaning of the loss in your life.

 

What are the normal feelings of grief?

Symptoms of grief

  • Anger
  • Blaming yourself
  • Crying spells
  • Diarrhea
  • Dizziness
  • Fast heartbeat
  • Feeling like there's a lump in your throat
  • Feeling like what's happening around you isn't real
  • Headaches
  • Hyperventilating -- sighing and yawning
  • Nausea
  • Not being able to get organized
  • Not feeling hungry or losing weight
  • Restlessness and irritability
  • Sadness or depression
  • Seeing images of the dead person
  • Shortness of breath
  • Tightness in your chest
  • Tiredness
  • Trouble concentrating
  • Trouble sleeping
As you face a loss, you may have different feelings at different times. These feelings include shock, denial, anger, guilt, sadness and acceptance. You may find yourself going back and forth from one feeling to another. For example, right when it seems that you're starting to accept your loss, you may find yourself feeling sad or guilty again. Your grief may never completely go away. But the pain you feel will lessen with time as you work through these feelings.

What usually happens first?

In the first hours or days after the loss, you may feel shocked, numb and confused. You may not remember what people have said to you. You may think and act as though the loss hasn't occurred. This is called denial.

As the shock wears off, reality will slowly break through. You'll begin to realize that the loss has happened. It's normal to feel abandoned and angry. You may direct your anger toward God, religion, doctors and nurses, the one who has died or other loved ones, or even yourself.

 

What happens after the anger wears off?

After you get through some of the anger and denial, it's normal to pretend things are like they used to be. If someone you love has died, you may play memories over and over in your mind. You may also feel the presence of your loved one, think you see him or her, or think you hear his or her voice.

You may also find yourself talking to your loved one as though he or she were in the room with you. As you begin to realize that your loved one is gone and won't be back, you'll begin to feel the full impact of your loss. These feelings may be scary because they're so strange and so strong. They may make you feel like you're losing control.

 

What happens then?

When you begin to realize the full impact of the loss on your life, you may feel depressed and hopeless. You may also feel guilty. You may find yourself thinking things like "if only" or "why me?" You may cry for no apparent reason. This is the most painful stage of healing, but it won't last forever. In normal grief, the depression will begin to lift with time.

What is the first sign of relief?

You may start to feel better in small ways. For example, you may find it's a little easier to get up in the morning, or you may have small bursts of energy. This is the time when you'll begin to reorganize your life around your loss or without your loved one.

What is the final stage?

Tips on dealing with a loss

  • Talk about how you're feeling with others.
  • Try to keep up with your daily tasks so you don't feel overwhelmed.
  • Get enough sleep, eat a well-balanced diet and exercise regularly.
  • Avoid alcohol. Alcohol can make you feel more depressed.
  • Get back into your normal routine as soon as you can.
  • Avoid making major decisions right away.
  • Allow yourself to grieve--to cry, to feel numb, to be angry or to feel however you're feeling.
  • Ask for help if you need it.
The last stage of accepting a loss is when you begin to reinvest in other relationships and activities. During this time, it's normal to feel guilty or disloyal to your loved one because you're moving on to new relationships. It's also normal to relive some of your feelings of grief on birthdays, anniversaries, holidays and during other special times.

How long does grief last?
You'll probably start to feel better in 6 to 8 weeks. The whole process can last anywhere from 6 months to 4 years.

If you feel like you're having trouble at any point, ask for help. People who can help include friends, family, clergy, a counselor or therapist, support groups and your family doctor.

Be sure to talk with your family doctor if you have a lot of trouble eating, sleeping or concentrating for more than the first couple of weeks. These can be signs of depression. Your family doctor can help you with depression so you can start to feel better.
 

 

Depression After a Heart Attack

 

What does depression have to do with my heart attack?

As many as 1 out of every 3 people who have a heart attack report feeling depressed. Women, people who have been depressed before, and people who feel alone and without social or emotional support are at a higher risk for feeling depressed after a heart attack.

Being depressed can make it harder for you to recover. However, depression can be treated.

 
 

What is depression?

Depression is a medical illness, like diabetes or high blood pressure. The symptoms of depression can include the following:

 
  • Feeling sad or crying often (depressed mood)
  • Losing interest in daily activities that used to be fun
  • Changes in appetite and weight
  • Sleeping too much or having trouble sleeping
  • Feeling agitated, cranky or sluggish
  • Loss of energy
  • Feeling very guilty or worthless
  • Problems concentrating or making decisions
  • Thoughts of death or suicide

How will I know if I am depressed?

People who are depressed have most or all of the above symptoms nearly every day, all day, for 2 or more weeks. One of the symptoms must be depressed mood or loss of interest in daily activities.

If you have some or all of the above symptoms, see your family doctor. Your doctor will ask you questions about your symptoms, your health and your family's history of health problems.

 
 

How is depression treated?

Depression can be treated with medicine, counseling or both.

Depression can be caused by a chemical imbalance in the brain. Medicines called antidepressants can correct this imbalance. If your doctor prescribes an antidepressant medicine for you, follow his or her advice on how to take it. These medicines can take a few weeks to start working, so be patient. Also, be sure to talk to your doctor before you stop taking any medicine or if you have any unusual symptoms.

How you think about yourself and your life can also play a part in depression. Counseling can help you identify and stop negative thoughts and replace them with more logical or positive thinking. Many people who are depressed, and their families, benefit from counseling.

 

What else can I do to help myself feel better?

Many times people feel depressed because they are inactive and aren't involved in social and recreational activities. You may find that participating in a hobby or recreational activity improves your mood. Interacting more with other people or beginning an exercise program can also help you feel better. Many people who have had a heart attack benefit physically and mentally from a cardiac rehabilitation program. Talk to your doctor about what kinds of activities and exercise programs are right for you.
 
 

Does treatment for depression usually work?

Yes. Treatment helps between 80% and 90% of people with depression.