DEMENTIA VERSUS DEPRESSION

All of us experience a small lapse in memory periodically. It is also not unusual for us to feel “out of so rts” from time to time. We have good and bad days. However, when these problems plague us or our loved ones, on a continuous basis, then it is time to seek professional advice. There are many similar symptoms bet ween the conditions of Dementia and Depression. There are also s ubtle differences. Here are some guidelines which will improve your recognition of these problems. Keep in mind that the treatments and medications are very different for these two illnesses. Specialists, such as psychiatrists or neurologists, are your best bets for help.

Social Inhibitions – Alzheimer’s is infamous for erasing inhibitions, allowing the victim the freedom to say and do things that are socially unacceptable. Depression does not do this, but can promote feelings of “Who cares anyway?”

Onset – Dementia occurs slowly over the years. Depression is noticed quickly.

Progression – Dementia gradually becomes worse over time. Depression is rapid.

Memory Loss – Dementia starts with recent memory loss and progresses to long-term memory loss over time. Depression can create bot h types of memory loss right away.

Noticeable Changes in Personality – Dementia has a generally slow affect, but can also vary from day to day. Depression creates a dramatic change immediately.

Response to Questions – Dementia patients try very hard to answer correctly and to conceal their inability to understand or remember . Depressed patients admit when they do not know the answer.

Awareness of Disability – Dementia patients are convinced t hat there is nothing wrong with them. Depressed patients emphasize their losses.

“Sun-Downing” – This is common in Dementia patients, but does not affect Depression patients.

Mood Swings – Occur in both Dementia and Depression patients.

Uncooperative Attitude – Appears in both Dementia and Depression patients from time to time, but for different reasons. The Dementia patient generally says, “No!” to any request that they cannot understand or feel threatened by. The Depression patient is lackadaisical.

Ability to Concentrate – Dementia disrupts the attention span. Depression usually does not change this.

Speech – Dementia can severely impair a person’s ability to effectively speak. Depression usually does not effect language skills.

Depth Perception – Dementia can severely diminish this skill, but Depression does not.

Alzheimer’s disease

We know that it can be devastating and difficult. A person with Alzheimer’s disease or another dementia can live in the comfort of their own home. The abilities and needs of a person with dementia will change as Alzheimer’s disease progresses. Our caregivers can adapt a daily routine to support these changes with some creativity and flexibility.

Our caregivers make sure that your loved one feels supported and is living a full life while providing respite care for as long as it is needed.

Alzheimer’s disease and related dementia’s can cause a person to act in different and unpredictable ways. Some individuals with Alzheimer’s become anxious or aggressive while others repeat certain questions and gestures. Many misinterpret what they see or hear. These types of reactions can lead to misunderstanding, frustration and tension, particularly between the person with dementia and the caregiver. It is important to under stand that the person is not acting that way on purpose. Our caregivers improve the quality of life not only for the people with Alzheimer’s disease but also for their loved ones.

MENTAL EXERCISES FOR DEMENTIA PATIENTS

We all need brain stimulation, even when our brain function is impaired and reduced. It is a basic human need to seek entertainment, thrills, fun, accomplishments, humor, and other activities. All of these goals engage an individual in “mental exercises.” Dementia patients have these needs, but also need a “coach” or “partner” to guide them. Most of us, with fully functioning brains, are good at entertaining ourselves. Dementia patients cannot successfully complete solo mental exercises. They unfortunately get “lost” along the way in an activity, due to memory loss interruptions and lack of concentration due to attention diversion to a competing stimulus. Normal brains have similar disruptions during completion of a task or project. The difference is, we can control them, and get our brains back on track. A dementia patient needs one-on-one supervision from a “friend” to help him or her stay on track.

The benefits of mental exercises include com bating boredom and increasing a personal sense of accomplishment and self-worth. Mental games create suspense while playing, and potentially the thrill of winning. If you are the “coach,” please re member that the dementia patient does NOT have to follow the set rules. The goal is to have FUN! Help the dementia patient “win” and then make a big production out of helping him or her “celebrate” the victory! At the same time, you are helping your patient AVOID negative feelings that lead to behavioral problems, such as agitation. This is a win-win for both of you!

Examples of “in-home” mental exercises:

• Board games (checkers, backgammon, monopoly).
• Busy hands” crafts (cutting, gluing, drawing, sewing, stringing, stuffing).
• “Busy at the office” (talk about t he position the Pt. once had at the o ffice, act it, set up desk with simple office supplies).
• “Busy in the kitchen” (prepare simple meals toget her, polish silverware, sort cabinet contents).
• Crossword puzzles. – Flash cards (pick a category: spelling, counting, pictures).
• “Let’s have a party” (invite a neighbor, plan a simple snack, set the table, decorate).
• Playing cards (solitaire, bla ck jack, concentration, go fish).
• Puzzles (100 pieces or much less, depending on the patient).
• Reading & discussing articles of interest to the patient.
• Reviewing picture books, such as travel, history, gardening.
• Reviewing family albums and photos. Reminiscing on names, places, events of the past.
• Watch and discuss appropriate TV shows, such as Discovery channel.
• Watch and laugh together at vintage cartoons and comedies (“I Love Lucy,” “The Honeymooners”
• Watch and listen together to vintage musicals, can combine with singing and dancing!
• Write letters to family, or type and e-mail.

SAFEGUARD VALUABLES OF ALZHEIMER’S PATIENTS

* Are you the caregiver or the responsible family member of an Alzheimer’s patient?

* Are you frustrated by how often the Alzhei mer’s patient loses things of importance?

* Are you concerned about this person’s inabili ty to keep track of important documents?

* Are you afraid to make any changes or take control because the Alzheimer’s victim will be angry with you?

Please understand that you are not alone. This type of dilemma is both common and inevitable. You cannot avoid dealing with these concerns. This article offers proven solutions to safeguard the valuables of an Alzheimer’s patient.

The mind set of an Alzheimer’s patient prevents hi m/her from believing that he/she “lost” an item. The patient usually thinks that someone else “stole or took” the item. Your best response is to help the patient search for the missing item and not argue over why it is missing.

It is not unusual for the patient to lose the same item frequently. Favorite lost items include: keys, wallet, purse, jewelry, cash, cr edit cards, checks, I.D., eye gl asses, hearing aids, dentures, in- coming mail, bills to be paid, dividend checks, and medications.

In addition to helping the Alzheimer’s patient reco ver missing items, you need to plan in advance to help prevent a future catastrophe.

KEYS : have duplicates made. Give the Alzheimer’s pat ient only one set at a time. A responsible adult, who lives close by, should keep the other sets. Make a telephone list of a local locksmith and a car dealership, for car keys.

PURSE, WALLET : buy duplicates when possible. Cont rol and limit the contents to the bare minimum. Remove I.D. and medical cards and gi ve them to the responsible, local adult.

CASH, CHECKS, CREDIT CARDS : limit value of cash in wallet. Change checking account to joint account with the responsible adult. This person then controls available funds in the account. Have all bank statements mailed to the responsible ad ult. Limit credit cards to one multi-purpose type, such as Visa. Reset available credit to low limit. Have all statements sent to responsible adult.

JEWELRY : Remove all items not being worn continuo usly and lock up in home safe or bank box. Only the responsible adult should have the key. For jewelry, such as wedding rings, that are habitually worn, consider having a jeweler make up a low value copy, and then switch the rings. Offer a simple excuse, such as “Your ring needs professional cleaning,” or “Your stone is loose and needs repair.”

MEDICAL AIDS : If the vendor offers replacement insurance on eye glasses, hearing aids, dentures, etc.,

BUY IT!!! IN-COMING MAIL : You could have all the mail rerouted to the address of the responsible adult by notifying the post office. A better method is to i ndividually contact creditors to reroute bills and financial institutions to reroute monies. This way, the Alzheimer’s patient can still receive pleasant mail, such as cards from the family.

MEDICATIONS : Utilize a pill box system. Have the respons ible adult fill up the pill box each week. At the same time, that person can check to see if the patient remembered to take all the pills from the previous week. When compliance becomes a pr oblem, a responsible adult must be present to watch the Alzheimer’s patient take the medicati ons, every time a dose is due to be taken.

DRIVING AND DEMENTIA DO NOT MIX! The number of drivers in South Fl orida who have cognitive impairment is frightening. As part of my job in home health care I meet with families who are facing the problems associated with the care of a dementia patient. (I use the term dementia to cover the s pectrum of Alzheimer’s, memory loss or confusion) I frequently find that the family allows the impair ed person to drive, even though they acknowledge the cognitive losses.

Here are some “horror stories” which may help educate and convince families that driving and dementia do not mix.

“Culpable Negligence”:

An elderly gentleman was sentenced to 15 years in prison due to a car accident. He killed the mother of two small children when he lost control of his car. His defense was that he had an epileptic seizure while driving. The court found him guilty of culpable negligence – driving even though he knew that he shouldn’t. This scenario could also apply to an Alzheimer’s patient, especially when the family is fully aware of t he diagnosis. A person with memory loss could easily confuse the gas pedal with the break pedal, especially when reacting to an emergency.

“Risking the Life of the Spouse”:

The healthy spouse is motivated to allow the dementia patient to drive out of necessity. One wife recently explained, ‘My husband always did the driving. I never learned to drive. Now he doesn’t know where to turn, so I direct him while he drives. We only drive locally.” The sad part of this lifestyle is that both spouses are at risk.

“Litigation Can Destroy Your Estate”:

I know of one Alzheimer’s patient that was sued for causing an auto accident. She was driving down the wrong side of the road when she hit an on-coming car. The size of her estate is the primary reason she is being sued. Her adult children wish they had taken away the car sooner. The only levity in her situation was during her deposition when she said, “What accident? I’ve never been in an accident! I’ve been driving since before you were born and my record is perfect!”