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Category Archives: Dementia
A Dutch village dubbed "The Truman Show" for dementia patients is getting praise from Alzheimer's experts in the U.S.
The tree-lined streets of Hogewey, a tiny village at the edge of Amsterdam, boast shops, restaurants, a movie theater and a hairdresser. Its 23 apartments are carefully crafted to feel like home to 152 residents.
But Hogewey is not a real village; it's a nursing home.
"Our director compared it to a theater," said Isabel van Zuthem, Hogewey's information officer. "The frontstage is what all the residents experience as a normal way of living, their normal home. But backstage, we are a nursing home. Everything is arranged to give all residents all the care they need. But they feel like they're living a normal life, and that's what we think is very important."
The supermarket cashier, the restaurant manager: all staff who work incognito, specially trained to care for people with dementia. Most of the residents think it's a real village.
"We wouldn't lie about it, of course. If asked, a staff member would say they're living somewhere where they get the care and support they need," said van Zuthem, adding that most residents will forget the response 15 minutes later. "People with dementia, they go back in time. They live in a different world."
Alzheimer's disease is the most common cause of dementia, affecting 5.4 million Americans. The disease swiftly robs patients of their memories and other brain functions, forcing most to live out their final years in a nursing home.
"Many times, a nursing home is very institutional: nurses walk around in white clothes; people sit together in big rooms to eat meals. We decided that's not how we would like to live when we get old," said Van Zuthem, adding that Hogewey residents are more at ease and need less medication because they feel at home.
While Hogewey has been criticized for creating a fantasy world where nurses pretend to be neighbors, experts say eldercare in the U.S. could benefit from a little improv.
"I'm personally fascinated by the concept of a self-contained village," said Marianne Smith, assistant professor of nursing specializing in dementia care at the University of Iowa. "I don't think it is living out a fantasy as much as it is accommodating the person's desire to live a normal life in a community-like environment. The program is surely better than the usual nursing homes that can resemble hospitals."
Smith said the village design allows dementia patients to experience the world as they currently understand it, even if it's in the past.
"That's the kindest, most compassionate way to care for them," she said. "The village allows them to do be comfortable where they are, and it plays to their strengths. They can still walk, they can still talk, and they can still be with other people."
But the approach isn't cheap. Hogewey cost roughly $25 million dollars to build.
"You can imagine this is not exactly a low-budget solution to a problem that is widespread and increasing daily," said Dr. Richard Caselli, professor of neurology at the Mayo Clinic in Scottsdale, Ariz. "But heck, if you can provide a safe surrogate environment where patients who cannot really think clearly can wander about enjoyably, that would seem to have many advantages."
The freedom to walk outside, shop, visit with friends or just relax can make patients happier and less agitated, meaning fewer mood-altering medications.
"Environmental approaches to reducing both cognitive and behavioral problems associated with dementia are really the key to improving quality of life for these patients without excess medication," said Dr. Paul Newhouse, director of Vanderbilt University's Center for Cognitive Medicine.
Newhouse agreed Hogewey's approach may be the kinder way to care for people with late-stage dementia.
"In fact, I would argue that ethically this is a better solution than what we currently do, namely putting patients in 'mini hospitals' and pretending that this is an appropriate care environment," he said.
Hogewey's frontstage-backstage set-up has earned it comparisons to 'The Truman Show," the Jim Carrey movie about a man unknowingly living on an elaborate film set.
"I doubt that there is any effort in the Netherlands facility to 'fool' the residents into thinking they are not being taken care of for dementia," said Dr. Mark Tuszynski, director of University of California at San Diego's Center for Neural Repair. "Instead, it sounds as though they are trying to create the most naturalistic environment possible for patients. Sounds like a great place."
Dr. Murali Doraiswamy, chief of biological psychiatry at Duke University Medical Center in Durham, N.C., said the idea could be "a game changer" in Alzheimer's care.
"The old saying, 'Treat the person and not the disease' is particularly true in end-stage dementia," he said. "All of us might actually then look forward to getting old!"
While Hogewey might be the most elaborate village-inspired nursing home, it's not the first. In fact Towsley Village Memory Care Center in Chelsea, Mich., is home to 100 dementia patients living in four distinct neighborhoods, complete with 50s-style coffee shops.
"Facilities in the U.S. have had these villages since the mid-1980s," said Geri Hall, a clinical nurse specialist at the Banner Alzheimer's Institute in Phoenix, Ariz. "The biggest practical challenge is that it requires space and special construction, potentially increasing the cost of care. I can't see many American facilities using nurses at a cash register. There are so few [registered nurses] in long-term care, they are pretty busy."
But even small-scale adjustments, like having furniture and entertainment from the familiar decades, can help Alzheimer's patients feel more at home.
"The 'deception' is really adjusting our reality to allow the person with dementia to be in a place that is comforting and safe," said Cynthia Barton, a nurse practitioner at the University of California at San Francisco's Memory and Aging Center. "It is unrealistic to think that they will be able to retain new information or remember our repeated attempts to correct them, so we emphasize strategies to make people feel safe and well cared for."
Barton said she wishes there was a place like Hogewey for her aunt, who currently lives in a nursing home in Connecticut.
"I'd love for her to be able to live in a facility like this that would so much more appropriately meet her needs," she said.
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Alzheimer's dementia - ABC News
What is Dementia?
Dementia is a decline in cognitive function. It may affect memory, thinking, language, judgment, and behavior. To be considered dementia, mental impairment must affect at least two brain functions. It may also cause personality changes.
Dementia is not a disease. It may be caused by a variety of illnesses or injuries. Mental impairment may range from mild to severe. Some dementias are progressive, which means they get worse over time. Some dementias are treatable or even reversible. Some experts restrict the term dementia to irreversible mental deterioration.
Dementia can be caused by degeneration of neurons (brain cells), or by disturbances in other body systems that affect how neurons function.
Several conditions can cause dementia, including diseases of the brain. The most common such causes are Alzheimers disease and vascular dementia.
Neurodegenerativemeans that neurons gradually degenerate (cease to function or function inappropriately and eventually die). This impacts the neuron-to-neuron connections, calledsynapses, which arehow messages are passed along in your brain. This disconnect can result in a range of dysfunction.
Some of the more common causes of dementia include:
Another cause is frontotemporal lobar degeneration, which is a blanket term for a range of conditions that cause damage to the frontal and temporal lobes of the brain. They include:
Dementia may also be caused by
Some of these dementias may be reversible. This is one of the many reasons why it is important to see your doctor and get a medical workup as soon as symptoms develop.
Its absolutely normal to forget things once in a while. Memory loss by itself does not mean you have dementia. However, there is a difference between occasional forgetfulness and forgetfulness that is cause for serious concern.
Potential red flags for dementia include:
Seek medical attention if you experience any of the above.
Getting lost in familiar settings (driving to the supermarket, for example), is often one of the first signs of dementia.
The Merck Manual states that approximately five percent of people aged 65 to 74 years and 40 percent of people older than 85 years have some form of dementia.
The number of people diagnosed with and/or living with dementia is increasing. This is at least in part due to increasing life expectancy. By 2030, the size of the population 65 years of age and older in the U.S. will have increased from 37 million people (in 2006) to an estimated 71.5 million, according to the U.S. Census Bureau.
Scientists all over the world are working hard to gain a better understanding of the many different aspects of dementia. This might help to develop preventive measures (such as a vaccine), improved early detection diagnostic tools, better and longer-lasting treatments, and even cures.
For example, a vaccine known as a bapineuzumab jab is currently in its final phase of testing.Though it cannot cure dementia or related disorders, this vaccine has been shown to prevent, and in some cases reverse, the buildup of amyloid plaques in the brain.Amyloid plaqueswhich are the hallmark of Alzheimers diseaseare dense, mostly insoluble (not dissolvable) clumps of protein fragments that deposit a highly damaging gunky substanceoutside and aroundthe brains nerve cells.
Scientists are also investigating genetic factors, various neurotransmitters, the role of inflammation, factors that influence programmed cell death in the brain, the roles oftau (a protein found in neurons of the central nervous system), and the possible roles of oxidative stress (i.e., chemical reactions that can damage proteins, DNA, and lipids/fats inside cells) in the development of dementia. Such research can help doctors and scientists better understand what causes dementia, and in turn, how best to treat and possibly prevent the disorder.
There is also increasing evidence that lifestyle factors, such as getting regular exercise and maintaining social connections, may be effective ways to decrease the risk of developing dementia.
Dementia - Cognitive Impairment Disorder Symptoms & Signs ...
Type of Dementia
Most common type of dementia; accounts for an estimated 60 to 80 percent of cases.
Symptoms: Difficulty remembering recent conversations, names or events is often an early clinical symptom; apathy and depression are also often early symptoms. Later symptoms include impaired communication, poor judgment, disorientation, confusion, behavior changes and difficulty speaking, swallowing and walking.
Revised criteria and guidelines for diagnosing Alzheimers were published in 2011 recommending that Alzheimers be considered a slowly progressive brain disease that begins well before symptoms emerge.
Brain changes: Hallmark abnormalities are deposits of the protein fragment beta-amyloid (plaques) and twisted strands of the protein tau (tangles) as well as evidence of nerve cell damage and death in the brain.
Learn more about Alzheimer's disease.
Previously known as multi-infarct or post-stroke dementia, vascular dementia is less common as a sole cause of dementia than Alzheimers, accounting for about 10 percent of dementia cases.
Symptoms:Impaired judgment or ability to make decisions, plan or organize is more likely to be the initial symptom, as opposed to the memory loss often associated with the initial symptoms of Alzheimer's. Occurs because of brain injuries such as microscopic bleeding and blood vessel blockage. The location, number and size of the brain injury determines how the individual's thinking and physical functioning are affected.
Brain changes: Brain imaging can often detect blood vessel problems implicated in vascular dementia. In the past, evidence for vascular dementia was used to exclude a diagnosis of Alzheimer's disease (and vice versa). That practice is no longer considered consistent with pathologic evidence, which shows that the brain changes of several types of dementia can be present simultaneously. When any two or more types of dementia are present at the same time, the individual is considered to have "mixed dementia" (see entry below).
Learn more about vascular dementia.
Dementia with Lewy bodies (DLB)
Symptoms: People with dementia with Lewy bodies often have memory loss and thinking problems common in Alzheimer's, but are more likely than people with Alzheimer's to have initial or early symptoms such as sleep disturbances, well-formed visual hallucinations, and muscle rigidity or other parkinsonian movement features.
Brain changes: Lewy bodies are abnormal aggregations (or clumps) of the protein alpha-synuclein. When they develop in a part of the brain called the cortex, dementia can result. Alpha-synuclein also aggregates in the brains of people with Parkinson's disease, but the aggregates may appear in a pattern that is different from dementia with Lewy bodies.
The brain changes of dementia with Lewy bodies alone can cause dementia, or they can be present at the same time as the brain changes of Alzheimer's disease and/or vascular dementia, with each abnormality contributing to the development of dementia. When this happens, the individual is said to have "mixed dementia."
Learn more about dementia with Lewy bodies.
In mixed dementia abnormalities linked to more than one type of dementia occur simultaneously in the brain. Recent studies suggest that mixed dementia is more common than previously thought.
Brain changes: Characterized by the hallmark abnormalities of more than one type of dementia most commonly, Alzheimer's and vascular dementia, but also other types, such as dementia with Lewy bodies.
Learn more about mixed dementia.
As Parkinson's disease progresses, it often results in a progressive dementia similar to dementia with Lewy bodies or Alzheimer's.
Symptoms: Problems with movement are common symptoms of the disease. If dementia develops, symptoms are often similar to dementia with Lewy bodies.
Brain changes: Alpha-synuclein clumps are likely to begin in an area deep in the brain called the substantia nigra. These clumps are thought to cause degeneration of the nerve cells that produce dopamine.
Learn more about Parkinson's disease.
Includes dementias such as behavioral variant FTD (bvFTD), primary progressive aphasia, Pick's disease and progressive supranuclear palsy.
Symptoms: Typical symptoms include changes in personality and behavior and difficulty with language. Nerve cells in the front and side regions of the brain are especially affected.
Brain changes: No distinguishing microscopic abnormality is linked to all cases. People with FTD generally develop symptoms at a younger age (at about age 60) and survive for fewer years than those with Alzheimer's.
Learn more about frontotemporal dementia.
CJD is the most common human form of a group of rare, fatal brain disorders affecting people and certain other mammals. Variant CJD (mad cow disease) occurs in cattle, and has been transmitted to people under certain circumstances.
Symptoms: Rapidly fatal disorder that impairs memory and coordination and causes behavior changes.
Brain changes: Results from misfolded prion protein that causes a "domino effect" in which prion protein throughout the brain misfolds and thus malfunctions.
Learn more about Creutzfeldt-Jakob disease.
Normal pressure hydrocephalus
Symptoms: Symptoms include difficulty walking, memory loss and inability to control urination.
Brain changes: Caused by the buildup of fluid in the brain. Can sometimes be corrected with surgical installation of a shunt in the brain to drain excess fluid.
Learn more about normal pressure hydrocephalus.
Huntingtons disease is a progressive brain disorder caused by a single defective gene on chromosome 4.
Symptoms: Include abnormal involuntary movements, a severe decline in thinking and reasoning skills, and irritability, depression and other mood changes.
Brain changes: The gene defect causes abnormalities in a brain protein that, over time, lead to worsening symptoms.
Learn more about Huntingtons disease.
Korsakoff syndrome is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1). The most common cause is alcohol misuse.
Symptoms: Memory problems may be strikingly severe while other thinking and social skills seem relatively unaffected.
Brain changes: Thiamine helps brain cells produce energy from sugar. When thiamine levels fall too low, brain cells cannot generate enough energy to function properly.
Learn more about Wernicke-Korsakoff syndrome.
Alzheimers Dement.2015 Jun 15. pii: S1552-5260(15)00194-6. [Epub ahead of print] MINDdietslowscognitivedeclinewithaging. Morris MC1,Tangney CC2,Wang Y3,Sacks FM4,Barnes LL5,Bennett DA6,Aggarwal NT6. Abstract Background The Mediterranean and dash diets have been shown to slowcognitivedecline; however, neitherdietis specific to the nutrition literature on dementia prevention. Methods We devised the Mediterranean-Dietary [Read More...]
PLoS One. 2015 Mar 12;10(3):e0118333. doi: 10.1371/journal.pone.0118333. eCollection 2015. Smoking is associated with an increased risk of dementia: a meta-analysis of prospective cohort studies with investigation of potential effect modifiers. Zhong G1, Wang Y1, Zhang Y2, Guo JJ3, Zhao Y2. 1The Second College of Clinical Medicine, Chongqing Medical University, Chongqing, China. 2School of Public Health and Management, Chongqing [Read More...]
Neurobiol Aging. 2014 Sep;35 Suppl 2:S74-8. doi: 10.1016/j.neurobiolaging.2014.03.033. Epub 2014 May 14. Dietary and lifestyle guidelines for the prevention of Alzheimer's disease. Barnard ND1, Bush AI2, Ceccarelli A3, Cooper J4, de Jager CA5, Erickson KI6, Fraser G7, Kesler S8, Levin SM9, Lucey B10, Morris MC11, Squitti R12. Abstract Risk of developing Alzheimer's disease is increased by older age, genetic factors, and several medical [Read More...]
Alzheimers Dement. 2015 Jun;11(6):718-26. doi: 10.1016/j.jalz.2015.05.016. Epub 2015 Jun 1. Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective. Baumgart M1, Snyder HM2, Carrillo MC3, Fazio S4, Kim H1, Johns H5. Abstract An estimated 47 million people worldwide are living with dementia in 2015, and this number is projected to triple by 2050. In the absence of a [Read More...]
Get my dad to go to a dementia friends class by nicola Whittam
I am going to be more patient with people with dementia, and embrace their world more openly. I will also share the knowledge I now have with as many people as posssible x by samantha quinnell
Share facts and articles about dementia and latest news on social media, hoping to bring awareness to friends. Blog about nursing dementia patients, and the lessons that come with. by Alexandra Wong
Support my friend with his comndition and show understanding. by Ian Barnes
To tell my friends and family about what I have learned about dementia and to wear my dementia friend badge where ever I go by Lisa Chaffey
Tell friends about dementia and why it is important to have patience and look out for anyone who may be struggling to do a task. by Lauren Mackintosh
Attended first session and told family about what I had learned by Graham Hart
I am a student OT and I will wear my dementia friend badge on my uniform when on placement. by Donna Moy
To continue to raise awareness at my sons school and in the local area ... by Kelly Fraser
Teach my mother about dementia by JOANNE GRIFFITHS
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* I run a private FTD Patient Support Group on Facebook. Thegroups for FTD Patients Only and is open to those with a firm FTD diagnosis. The support group is a place where those with FTD can gather in a positive environment and realize there not alone. It's also a source of accurate information which is rare in the quick changing world of FTD. The director of AFTD, Sharon Denny is a permanent guest member. AFTD has been kind enough to open up there medical board to answer member questions. Please email me firstname.lastname@example.org join.
10 years ago FTD entered my life. Forced to leave work on disability being misdiagnosed as bipolar I just disappeared from the 17+ year career I had. My career started in NYC and culminated in Seattle. Then I just disappeared. Never returned calls from friends or associates. My absence was a mystery to many.
Some months ago I was contacted by an old colleague and close friend Dave Ashcraft who had looked me up on the web. I used to manage a string of independent dealerships in North America for a Japanese business equipment manufacturer. Dave is now the VP of of the largest independent dealership in the country, Witt Company, that has dealerships across the Western US including Phoenix. A few weeks ago I was contacted by the President and owner of the company Bill Witt. Bill wanted to come visit me in Phoenix. We met at the Starbucks I frequent. I worked closely with Bill for years and years. You couldn't find a fairer, more honest and astute businessman anywhere. He was also a huge handful to work with. Complicated, but you'd be hard pressed to find a finer individual.
Bill entered Starbucks and his first words were, "Howard Glick, the last time I was with you was March 2x, 200x at the Metropolitan Grill in Seattle. You took me and Gail (wife) out for dinner and bought us a bottle of Jordan wine. Told us you were sick and had to leave Riso. Then I was gone.
Bill rehashed mutual colleagues and friends across the country that I've not thought of in years. Some I remembered, some I didn't. Everyone I used to know was doing well in one form or another. It was good to hear. Bill also discussed the years I worked with him. Told me I was the best manufacturers rep he had from the company I worked for and that I always had his companies interests in the forefront - even if it caused me to have problems with my company. I broke down a couple of times. Tried to explain FTD. Tried to explain how I rarely leave my apt., curse out old ladies without realizing I'm doing anything wrong, frequently eat spoiled food and make inappropriate sexual remarks. Also that I now have frequent swallowing/choking issues and balance issues. Explained how I lost my disability from Unum because I was misdiagnosed which has me living now on the poverty line. Bill asked about longevity. I sort of lied and told him I'll be around for a long time. No one has a crystal ball with FTD, but FTD is marinating nicely and I know my time has become limited at best. At least I'm hoping to move on soon.
Bill told me if there was an emergency and I needed some financial help, not to hesitate to call and actually called someone at the company in front of me to let them know if I called to send out help. I was deeply moved at the gesture, but anyone who knows me knows that I'd be homeless before I'd make that call. Bill said he would visit me on his periodic trips in. There are no words to describe how much Bill's visit meant to me. It's soul shaking what I've lost since we worked together. Sitting here at Starbucks crying as I type. 10 years ago I had a consistent six figure income, kids, and a woman I was madly in love.
Yesterday I received an email from Dave Ashcraft from the same company in Seattle saying he would be visiting me in 4-6 weeks. You were one of the best salesman I've ever known. I'm looking at my schedule and I'm going to plan on coming down to Phoenix for a long weekend in the next 4 - 6 weeks. I'll let you know the exact dates."
Was recently contacted by a childhood friend. I haven't seen Peter Herzog since I left for college 35+ years ago. Peter came from Boca Raton, Fl. last week to look and possibly move to AZ. Peter's son was amazed how we just sort of clicked again like many of us NYC Washington Heights alum do. While we were in the car I pointed to a girl and mentioned what a great ass she had. Both Peter and his 23 yr. old son berated me that she looked really young. Age just didn't click, didn't cross my FTD corroded mind. Of course I'm aware now that she was just a kid and am once again on the edge of tears as I'm typing.
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FTD/Dementia Support Blog