Alzheimer's Disease

WHAT YOU SHOULD KNOW:

• Alzheimer's (ALTZ-heye-merz) disease may also be called AD. It is a long-term brain problem that slowly gets worse over time. It is a type of dementia (de-MEN-shah), which is a gradual loss of thinking ability. With AD, brain cells die and do not come back. There are also fewer amounts of the normal chemicals in the brain. These chemicals carry messages back and forth between the nerve cells throughout the body. This causes problems with how you think, behave, and remember things. It is not known for sure what causes AD. Many tests may be done to make sure your problems are caused by AD and not a different medical problem.
  
  
• There is no known cure for Alzheimer's disease. Treatment includes keeping a good quality of life, for as long as possible. Your caregivers may give you medicine to help memory and thinking problems. Medicine may also help behavior problems such as anxiety, nervousness, sleep problems, or depression. Exercise, good nutrition, and social activity are important to help you keep active as long as possible. In the later stages of AD, you may need 24-hour care for feeding, personal care, and bathroom needs.

AFTER YOU LEAVE:

Medicines:

• Keep a current list of your medicines: Include the amounts, and when, how, and why you take them. Take the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency. Throw away old medicine lists. Use vitamins, herbs, or food supplements only as directed.
  
  
• Take your medicine as directed: Call your primary healthcare provider if you think your medicine is not working as expected. Tell him about any medicine allergies, and if you want to quit taking or change your medicine.
  
  
• Types of medicines: Scientists are currently studying the best way to treat AD. Ask your caregiver for more information about the most current medicines available. Your caregiver may give you one or more of the following kinds of medicines to treat AD and the problems it may cause.
  
  
  • Cholinesterase inhibitors: Cholinesterase inhibitors are a group of medicines that help increase the amount of normal chemicals in your brain. They may help you think better and may make it easier to do every day activities. They work the best in the early to middle stages of Alzheimer's disease.
    
    
  • NMDA receptor antagonist: This medicine may help decrease the number of dead brain cells. It may be used in the moderate to severe stages of Alzheimer's disease.
    
    
  • Antidepressants: This medicine may be given if your Alzheimer's disease causes you to feel sad or depressed. It may take a little while before this medicine starts to work.
    
    
  • Antianxiety medicine: This type of medicine may help you feel less nervous and restless in the later stages of Alzheimer's disease. It may also help you sleep better.
    
    
  • Incontinence medicine: You may need this type of medicine to help you have more bladder control. Incontinence (in-KON-ti-nens) means loss of control over urinating and having bowel movements. This problem may happen in the later stages of Alzheimer's disease.
    
    
  • Anticonvulsants: This medicine may be used if you are easily angered, and are very restless.
    
    
  • Antipsychotics: This medicine may be used to control delusions (false fixed beliefs), hallucinations (seeing or hearing things that are not there) or violent behaviors (actions).
    
    
  • Other remedies: "Miracle drugs" to treat or cure diseases like Alzheimer's are talked about, but they have not been proven to work. Many of these are herbs and claim to be "all natural" but this does not mean they are safe. Some have harmful side effects, or cause problems with other medicines you may be taking. It is very important to talk to your caregiver before trying other remedies or treatments.

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

Caring for someone who has Alzheimer's disease:

• Activities: People with Alzheimer's disease do best with daily routines. Try to keep activities the same from day to day. Doing familiar activities and taking breaks often may work best. Save difficult activities for when the person seems the most alert. Choose activities that the person can do and is interested in doing. Help the person get started and try to break difficult activities into small steps.
  
  
• Depression: In the early stages of AD, depression is common. It may cause the person to want to be alone more than usual. Counseling for the person with AD and the person caring for them at home may be helpful. There are many different kinds of counseling and therapy. Ask caregivers which kind of counseling and support is right for you and the person with AD.
  
  
• Eating: Mealtime should be at the same time and in the same place each day. There will be less confusion if there are few food choices. Eating patterns may change in people with AD. They may gorge themselves (binge eating) and then cause themselves to vomit. They may also not eat at all. Eating small meals and snacks may help. Ask caregivers about giving vitamins if you do not think the person is eating enough.
  
  
  • Serving one food at a time may help decrease confusion. Select foods that are soft to chew and cut the food into small pieces. Remind the person to open his or her mouth and chew the food. Give the person healthy finger foods if he or she will not sit down to eat. Offer the person a few different types of foods in case he or she can handle one better than another. Too much caffeine may excite the person and cause him or her to be more active. Limit soft drinks, chocolate, coffee, and tea to decrease caffeine intake.
    
    
  • Try to have the person drink six to eight (8-ounce) cups of water each day. This will keep the person from getting dehydrated, or too dry. Swallowing and drinking liquids may be a problem for some people with AD. Gelatin, pudding, soup, and ice cream are good food choices for people who have trouble drinking enough liquids.
  
  
• Exercise: Both the mind and the body benefit from regular exercise. It may help decrease anxiety and depression, and improve their sleep. Exercise may also bring more oxygen and food to the brain cells. Walking is a good way to get exercise for the AD person. Check local senior centers for information about group exercise activities.
  
  
• Recognizing pain or discomfort: It may be hard to know if a person with Alzheimer's disease is having pain or discomfort. Noisy breathing or rigid body movements may be a sign of pain. A sad or scared facial look may also mean the person is having discomfort. The person may also constantly make certain noises when he or she is in pain.
  
  
• Personal care: It may be hard to get someone with AD to shower or bathe. Carefully watch the person during bathing so the water does not burn them. They may dress without noticing the color or pattern of their clothes. It may help to choose and lay out clothes each night for them to wear the next day. Hair care or other personal care may not interest them. Make sure to brush the person's teeth or dentures daily. Do not forget to take the person to the dentist for check-ups.
  
  
• Safety:
  
  
  • Making the house safe is very important to prevent accidents. Go through the house and remove things that could cause accidents. Put out of reach or lock up things such as drain cleaners, paint, or medicines. You may need to remove the stove burner knobs and hide matches and lighters to prevent fire and injury.
    
    
  • Avoid falls by making sure that the house has good lighting. Add extra light if needed, especially in entries, areas between rooms, bathrooms, and stairways. Use night lights to help the person see if they get up at night. Also check whether the person cannot see well out of their eyeglasses.
    
    
  • Smoking is dangerous because the person may forget to put out his or her cigarette. Hot water and electrical machines may cause injury. Remove loose rugs to prevent falls. Keep doors and windows tightly closed to prevent wandering or other injuries.
    
    
  • Keep a list of emergency numbers (police, fire, ambulance, and poison control) handy.
  
  
• Sleeping: Try to keep the person with AD awake during the day. Limit how much liquid the person drinks in the evening. This may help him or her sleep through the night. Make sure that the person goes to bed at the same time every night. Warm milk, soothing music, and dim lights at bedtime may help the person sleep.
  
  
• Talking:
  
  
  • Call the person by name and speak slowly, clearly, and calmly. Try to decrease noise in the background. Use short words and sentences. Do not give too much information at once. The tone of your voice and how you look when you talk are important. Stand where you can have eye contact and be seen by the person. To get the person's attention, you may want to touch their arm, elbow, or shoulder or hold their hand. You may want to put your arm around their waist.
    
    
  • Use the same words if you have to repeat yourself. Do not ask very many questions, because not knowing the answer is hard for the person. It may take a while, but wait for the person to respond. Questions that need a yes or no answer may be easiest for them to answer. The person may say one thing and mean another. You may need to repeat the answer, and then ask the person if you understood them correctly.
    
    
  • Give directions one step at a time. It may be easier to write down simple directions. Limit the number of choices because it may be hard for the person to make decisions. Talk only about things that are real to the person. If the person has a hard time talking, you may finish the rest of the sentence. Do not argue with the person.
    
    
  • Ask caregivers if hearing aids could help the person with AD.
  
  
• Toileting:
  
  
  • In early AD, it may help to try to have the person on a toileting (bathroom) schedule. This may mean reminding the person to urinate every four hours. Be aware of the person's bowel movement routine, and keep it the same.
    
    
  • With time, the person may not be able to tell you when they need to the bathroom. You may notice that he or she is picking at their clothes when they need to go. The person may touch their genital (between legs) area and seem restless. Sometimes the person may forget where the bathroom is located. Post bright signs to tell the person where to find the bathroom. Take the person to the bathroom often.
  
  
• Wandering: New locks may be needed on the outside of doors. This may keep the person from going outside alone. You could then open the door, but the person could not. An alarm system near doors may tell you if the person wanders out. Secure a necklace or bracelet with the person's name and phone number on it around their neck or wrist. This may be helpful if the person wanders away from you, and is found by someone else.

Caring for the family caregiver:

• Alzheimer's disease affects more than just the person who has it. It also affects the family and friends who care for that person. As the disease gets worse with time, family and friends may feel frustrated and resentful no matter how much they love the person. AD may cause financial (money) problems, which adds more stress to those caring for the person. Be sure to visit your caregiver if you are feeling overwhelmed when caring for a person with AD.
  
  
• People with AD may be cared for at home instead of at a nursing home, especially in the early and middle stages of the illness. It is important for the family caregiver to be trained so that they can understand what is happening and learn ways to help. There are support services available that help the person with AD stay at home longer. Ask your caregivers about training to learn how best to care for someone with AD. Also, ask caregivers for more information about support programs. Examples of support programs that may help include the following.
  
  
  • Adult day care: This is a program where the person with AD goes for a part of every day to a center with other adults that have AD.
    
    
  • Respite care: This is a temporary service where patients may stay in a nursing home type of place for a limited number of days. This service is especially helpful if the family caregiver needs to go away for a few days. It can also be used when the family caregiver needs a break from caregiving.

Where can I go for support?

Accepting that you or a loved one has AD is hard. You and those close to you may feel angry, depressed, or frightened. These are normal feelings. Talk to your caregivers, family, or friends about your feelings. You may also want to join an AD support group. This is a group of people who are living with AD and may help you work through your feelings. For more information, contact the following organization.

• Alzheimer's Association
  225 N.Michigan Ave, FL 17
  Chicago , IL 60601-7633
  Phone: 1- 800 - 272-3900
  Web Address: http://www.alz.org
  

• Alzheimer's Disease Education and Referral Center
  P.O. Box 8250
  Silver Spring , MD 20907
  P.O. Box 8250
  Silver Spring , MD 20907
  Phone: 1- 800 - 4384380
  Web Address: http://www.alzheimers.org
  

CONTACT A CAREGIVER IF:

• You have a fever.
  
  
• Your skin is itchy, swollen, or has a rash. Your medicine may be causing these symptoms. This may mean you are allergic to your medicine.
  
  
• You or your caregiver feel depressed or are having trouble coping.
  
  
• You have questions or concerns about Alzheimer's disease, treatment, or medicine.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Alzheimer's Disease (Discharge Care)