Senior Issues

If you find yourself forgetting an appointment or a word here and there, then you have no need for alarm. Most of the aging population suffers from some senior issues related to memory loss and decreased brain function. By the time we reach 60, several changes take place in our brains that are beyond our control.

Just as our skin gets drier and our muscles grow weaker, the neurotransmitters in our brain slows down and the muscle mass shrinks slightly. This can be a confusing process, but it’s something we can cope with. We learn to make notes and write things down. We keep phone numbers next to the phone and arrange a designated “key spot.”

Alzheimer’s is a truly horrible disease because it robs a person of their ability to function. The disease is also damaging to family and friends as it is very difficult to watch a parent, brother, sister or friend progress to the point where they don’t recognize anyone. The burden of caring for a person suffering from Alzheimer’s is significant. At some point in time, a family will have to look for assistance with the care.

Most “board and care” and “assisted living facilities” are willing and capable of providing for a person suffering from Alzheimer’s. These facilities are similar to nursing homes, but with less of an institutional atmosphere. If, however, a senior becomes increasingly disoriented, perhaps even occasionally wandering away, they may require a facility with a dementia waiver.

The Early Signs Of Alzheimer’s

The early signs of Alzheimer’s and dementia often go unnoticed and are chalked up to the normal natural aging process that healthy older adults experience, such as forgeting someones name, or losing your keys.

The early symptoms are usually noticed by friends and family first, and the person who is having symptoms should consult a doctor. Some of these early signs of Alzheimer’s include mood and personality changes, such as depression, anxiety, paranoia, and childish behaviors.

You or your loved one might be experiencing some lapses in memory or other cognitive problems, but neither family nor friends are able to detect any changes. A medical exam would not reveal any problems either.

It is understood to include three sub-tests: rational relation, minimum impairment and balancing between the deleterious and the salutary effects of the law. In practice the courts concentrate on the second test. It is argued that in fact they often perform balancing when applying the minimal impairment test, but refrain from explicitly acknowledging it, because it appears less legitimate. The constitutional challenge in R. v. Sharpe to the child pornography legislation is used as an example to illustrate the argument.

Minimal Impairment Test

The Minimal Impairment Test is part of the Oakes Test used by the Canadian Supreme Court. The Oakes Test is used to determine whether legislation, which may infringe upon a right guaranteed under the Canadian Charter of Rights and Freedoms, is saved under Section 1 of the Charter. Goodwill and other intangible assets that have indefinite live are tested for impairment at each reporting date. These assets were recognised at fair value when Icelandair Group Holding hf. acquired the Company in October 2006.

Medical Malpractice

Ordinary negligence by a physician, or medical malpractice, is when the physician’s acts or omissions constitute a “departure from good and accepted medical practice” in the treatment of a patient. A physician may be found to have departed from accepted medical practice if s/he fails to treat the patient within the standard of care of his/her medical speciality. An investigation by OPMC for physician misconduct can be brought about on the basis of reports of two or more instances of departures from accepted medical practice.

Screening For Dementia

All currently available therapies for dementia rely on early diagnosis of the condition. Although no perfect screening test exists it is imperative that we improve on our current diagnostic rates. The 6CIT probably offers the best compromise between sensitivity, specificity and ease of use. Never delay referral for memory assessment on the basis that the results are only borderline-positive or where the patient appears to be coping well unaided - These are the group of patients who are likely to benefit most from intervention.

Pick’s Disease Causes

Less common etiologies include Alzheimer’s dementia, postconcussion syndrome, Rasmussen’s encephalitis, nonconvulsive status epilepticus, dissociative state, subdural hematoma, trauma, severe hypoglycemia, sedative-hypnotic drug intoxication, sensorineural hearing loss, herpes encephalitis, and tertiary syphilis.

Like Huntington’s Disease and Lewy Body Disease, Pick’s Disease is the result of a build-up of protein in the affected areas of the brain. The accumulation of abnormal brain cells, known as Pick’s bodies, eventually leads to changes in character, socially inappropriate behavior, and poor decision making, progressing to a severe impairment in intellect, memory and speech.

The exact cause of the abnormal form of the protein is unknown. A gene for the disease has not yet been found. Most cases of Pick’s disease are not passed down through families.

Pick’s disease is rare. It is more common in women than men. It can occur in people as young as 20, but usually begins between ages 40 and 60. The average age at which it begins is 54.

Pick’s disease is marked by the presence of abnormalities in brain cells called Pick’s bodies. These are found in the affected areas as well as elsewhere in the brain. Pick’s bodies are fibres that look very different from the neurofibrillary tangles found in Alzheimer’s disease. Pick’s bodies are straight rather than paired and helical.

Diagnosis of Pick’s Disease

Pick’s disease (Pick disease)is the best known form of Frontotemporal dementias. It results in the gradual loss of social skills and personality and may also include loss of language skills, impaired memory and judgment.

Brain cells are affected by abnormal deposits of the brain protein tau that damages cells in the frontal and temporal lobes of the brain.

Dementia Due to Pick’s Disease symptoms and diagnostic criteria follow below. While some of these Dementia Due to Pick’s Disease symptoms may be recognized by family, teachers, legal and medical professionals,  and others, only  properly trained mental health professionals (psychologists, psychiatrists, professional counselors etc.) can or should even attempt to make a mental health diagnosis.

The life span of patients with Alzheimer’s is generally reduced, although a patient may live anywhere from 3 to 20 years after diagnosis. The final phase of the disease may last from a few months to several years, during which time the patient becomes increasingly immobile and dysfunctional. Caregivers should understand the phases of this illness in order to help determine their own capacities for dealing with this painfully sad disease.

Identifying A Stage Of Alzheimer’s

Alzheimer’s disease is a medical issue that affects the mental faculties of individuals over time. The disease has been shown to progress in stages, which can be helpful in identifying for patients and families where things stand.

1. Normal function – this traditionally is seen as the stage of normality or “the calm before the storm”. Not really an actual symptom in itself, this stage of Alzheimer’s disease is often left off of most lists.

2. Very mild cognitive decline – this is the introduction of some mild memory loss. Individuals experiencing this stage of Alzheimer’s may have familiarity some lapses in memory as oppose to entire losses of it.

3. Mild cognitive decline - Severe cognitive impairment is associated with increased mortality, but the impact of mild cognitive impairment on survival remains unclear. Although there is doubt whether a simple test such as the mini-mental state examination has sufficient discriminatory power to detect mild cognitive impairment in elderly people, we determined the impact of borderline scores in this particular examination on survival in very elderly people.

4. Moderate cognitive decline - Half of the 183 patients in the Russian study received Dimebon; the other half were given a placebo or an inactive pill. Clinicians at the study sites then monitored the patients’ progress over the next year on five different outcomes. All of those in the study had mild to moderate Alzheimer’s disease.

5.Severe cognitive decline -  Cognitive decline was severe and occurred across a wide range of cognitive functions. The frequency of generalised tonic–clonic seizures was the strongest predictor of decline. Complex partial seizure frequency was associated with a decline in memory and executive skills but not in IQ. Seizure-related head injuries and advancing age carried a poor cognitive prognosis, whereas periods of remission were associated with a better cognitive outcome. Early age at onset was not implicated, and duration of epilepsy was a much less potent predictor of cognitive decline than has been reported in cross-sectional studies. No evidence indicated that a higher level of cognitive function protected against cognitive decline.

Symptoms of brain injury dementia

1. Dementia Due to Head Trauma symptoms and diagnostic criteria follow below. While some of these Dementia Due to Head Trauma symptoms may be recognized by family, teachers, legal and medical professionals,  and others, only  properly trained mental health professionals (psychologists, psychiatrists, professional counselors etc.) can or should even attempt to make a mental health diagnosis. Many additional factors are considered in addition to the Dementia Due to Head Trauma symptoms in making proper diagnosis, including frequently medical and psychological testing considerations.

2. Common symptoms of a subdural hematoma in infants include a disproportionate and enlarged head circumference, a swollen fontanel (the soft membrane-covered gap on an infant’s head) and disjointed sutures (the junction of bones in the skull).

3. Over time, people with dementia may begin to act very different. They may become scared and strike out at others, or they may become clingy and childlike. They may stop brushing their teeth or bathing. Later, they cannot take care of themselves. They may not know where they are. They may not know their loved ones when they see them.

4. The condition, which occurs in people who have suffered multiple concussions, commonly manifests as dementia, or declining mental ability, problems with memory, and parkinsonism, or tremors and lack of coordination. It can also cause speech problems and an unsteady gait. Patients with CTE may be prone to inappropriate or explosive behavior and may display pathological jealousy or paranoia. Individuals displaying these symptoms also can be characterized as “punchy,” another term for a person suffering from dementia pugilistica.

5. Many of us often experience forgetfulness. We may forget where we put the car keys or repeat the same story to a friend or family member. These behaviors are usually caused by the information overload of our busy, stressful lives - it doesn’t mean that we’re developing dementia. As people age, they may experience memory changes such as slowing of information processing. This type of change is normal. By contrast, dementia is progressive and disabling and not a normal part of aging.

6. Individuals experience different combinations of these symptoms depending on the part of the head injured, the force of the blow, the damage caused, and the person’s personality before the injury. Some symptoms appear rapidly, while others develop more slowly.

Symptoms of Alzheimer’s

1. Become confused, and frequently forget the names of people, places, appointments and recent events. Experience mood swings. They may feel sad or angry. They may feel scared and frustrated by their increasing memory loss.

2. Confusion about time and place (difficulty recognizing familiar neighborhoods or remembering how arrived at a location, confusion about months or seasons ). Impaired judgement (dressing inappropriately or making poor financial decisions)

3. Is it Alzheimer’s or just normal aging? We all forget things as we age. Mild forgetfulness is normal. More serious memory problems can make independent living difficult. Read about the steps you can take to help your memory.

4. When Alzheimer’s disease begins to destroy brain cells, no outward symptoms are evident.  After a while, small memory lapses appear and grow more serious.  The afflicted individual may forget the names of familiar people or places, the words to express what they want to say, or the location of everyday objects.

5. Researchers and doctors use a number of scales to measure the progression of symptoms over time, which may define as many as seven distinct stages of the disease. For general purposes, three broad phases are typically recognized: mild, moderate and severe. The symptoms commonly seen in each stage are summarized below, but it’s important to realize that there may be some overlap among the stages, and that people may not experience all of these symptoms.

Warning Signs

1. Memory loss. Forgetting recently learned information is one of the most common early signs of dementia. A person begins to forget more often and is unable to recall the information later.

2. Loss of judgment. Solving everyday problems, such as knowing what to do if food on the stove is burning, becomes increasingly difficult, eventually impossible. Alzheimer’s is characterized by greater difficulty in doing things that require planning, decision making and judgment. No one has perfect judgment all of the time but those with Alzheimer’s disease may dress without regard to the weather, wearing several shirts or blouses on a warm day or very little clothing in cold weather. Individuals with dementia often show poor judgment about money, giving away large amounts of money to telemarketers or paying for home repairs or products they don’t need.

Delirium may be caused by diseases of body systems other than the brain, by poisons, by fluid/electrolyte or acid/base disturbances, and by other serious, acute conditions. Infections such as urinary tract infections or pneumonia may trigger delirium in individuals with pre-existing brain damage (prior strokes, dementia).

Older adults are at significant risk of delirium if they are admitted to hospital, where 15-50% of over 65 year olds develop delirium. It is most prevalent (25-60%) in elderly patients admitted for hip fracture surgery. Delirium usually develops within the first two days of hospitalization, and rarely presents after the sixth day. It is associated with longer hospital stays and higher mortality rates. For those not already in long term care, older adults who develop delirium whilst hospitalised are more likely to be discharged to a RACF. Due to the trend for early hospital discharge, patients transferred to RACF may still have symptoms of delirium.

Treatment of Delirium

Treatment of delirium begins with recognizing and treating the underlying cause. Delirium itself is managed by reducing disturbing stimuli, or providing soothing ones; use of simple, clear language in communication; and reassurance, especially from family members. Physical restraints may be needed if the patient is a danger to himself or others, or if he insists on removing necessary medical equipment such as intravenous lines or monitors. Sedatives or anti psychotic drugs may be used to reduce anxiety, hallucinations, and delusions.

The delirious patient should never be left unattended. Physical restraint should be minimized to that required to gain initial control of an uncooperative patient and to undertake procedures and prevent self-harm prior to pharmacological sedation. When required, physical restraint is best accomplished by holding the patient with the assistance of several people.

The goal of treatment is to control or reverse the cause of the symptoms. Treatment depends on the condition causing delirium. Diagnosis and care should take place in a pleasant, comfortable, non-threatening, physically safe environment. The person may need to stay in the hospital for a short time. Stopping or changing medications that worsen confusion, or that are not necessary, may improve mental function.

Drug Therapy: Identification and correction of the etiologic condition may be sufficient to reverse delirium. However, some cases of delirium, especially in the elderly, are protracted and may take weeks to clear. Subclinical delirium lasting months has been associated with hepatic encephalopathy. Specific pharmacologic intervention may become necessary to help to reduce the intensity and duration of delirium. The medication of choice is a low-dose, high-potency neuroleptic.

Hospitalization: Being in the hospital, particularly intensive care units (ICUs), can contribute to or trigger delirium. In ICUs, people are isolated in a room that typically has no windows or clocks. Thus, people are deprived of sensory stimulation and can become disoriented. Sleep is disturbed by staff members who awaken people during the night to monitor and treat them and by loud beeping monitors, intercoms, voices in the hallway, or alarms.

Causes of Senile Dementia

1. Huntington disease, a progressive degenerative disease that causes dance-like movements and mental deterioration, Atherosclerosis, or hardening of the arteries.

2. Degenerative forms of dementia are long lasting (chronic) and typically involve a progressive loss of brain cell function. In disorders like Alzheimer’s and Creutzfeld-Jakob diseases, this can involve the presence of infectious agents that disturb the structure of proteins that are vital for cell function. Other forms of dementia are chemically based.

3. In some cases of dementia, it may be reversible or improved once the underlying cause has been treated. Unfortunately, when dementia is caused by conditions such as Alzheimer’s disease, brain injury, or simply aging (senile dementia), the changes that occur are irreversible.

4. Lack of neurotransmitters to perform brain function. Exposure to aluminum, manganese, and other light metals. Prion infections that can affect the brain and spinal cord.

5. Although adult personality traits have been shown to be stable with age, a recent study in the USA showed changes in a group of elderly people with memory disorders, as perceived by caregivers. The aim of this study was to replicate these findings in individuals suffering from senile dementia and to examine interactions with other emotional and physical stresses experienced by the carer.

6. Zinc deficiency has been reported in association with dementia and linked with its pathogenesis. A group of 45 elderly patients admitted to a mental hospital were given diagnoses in accordance with ICD-9, and their fasting plasma zinc levels were recorded. No difference was found in zinc levels between patients with diagnoses of senile dementia and those with other diagnoses.

Delirium Symptoms

1. The symptoms of delirium come on quickly, in hours or days, in contrast to those of dementia, which develop much more slowly. Delirium symptoms typically fluctuate through the day, with periods of relative calm and lucidity alternating with periods of florid delirium. The hallmark of delirium is a fluctuating level of consciousness.

2. One gentleman, who had already been in the hospital for three days, when asked if he knew where he was, stated the correct city and hospital. He immediately followed this by saying, “but I started out in Dallas, Texas this morning.” The hospital location was some 1,800 miles from Dallas, Texas, and as previously indicated, he had been in the same hospital for three days.

3. Specific behaviors, precipitating events (eg, feeding, toileting, drug administration, visits), and time the behavior started and resolved should be recorded; this information helps identify changes in pattern or intensity of a behavior and makes planning a management strategy easier. If behavior changes, a physical examination should be done to exclude physical disorders and physical abuse, but environmental changes (eg, a different caregiver) should also be noted because they, rather than a patient-related factor, may be the reason.

4. Attention and concentration are impaired in the delirious patient. This is evidenced by distractibility and poor focus on conversation or other activities. These disturbances are easily identified during bedside interview. Specific tests of attention include serial sevens, digit-span testing, spelling the word “world” backwards, and repeating the months of the year in reverse order.

5. Emotional disturbances, such as fear, anger, anxiety or irritability, Disruptive vocalization, such as screaming, cursing or muttering, Increased or decreased activity — constant hand movements (pulling at clothes or bedding), or, conversely, not moving, Disrupted sleeping and waking.

6. Mental confusion and impaired thinking. See free access online books about Confusion below. See detailed information below for a list of 415 causes of Confusion, including diseases and drug side effect causes.

7. Many additional factors are considered in addition to the Substance Intoxication Delirium symptoms in making proper diagnosis, including frequently medical and psychological testing considerations. This information on Substance Intoxication Delirium symptoms and diagnostic criteria are for information purposes only and should never replace the judgement and comprehensive assessment of a trained mental health clinician.

Vascular dementia is the second most common form of dementia after Alzheimer disease (AD). The condition is not a single disease; it is a group of syndromes relating to different vascular mechanisms. Vascular dementia is preventable; therefore, early detection and an accurate diagnosis are important.

Symptoms

1. Vascular dementia symptoms can vary, depending on the portion of the brain that’s affected. One of vascular dementia’s earliest symptoms typically involves a decline in the ability to organize thoughts or actions. This makes it difficult to keep track of more than one thing at a time or to communicate details in a sequential manner.

2. Onset can be gradual or dramatic. It appears that a prolonged period of TIAs leads to a gradual decline in memory, whereas a stroke can produce profound symptoms immediately. Regardless of the rate of appearance, vascular dementia typically progresses in a stepwise fashion, where lapses in memory and reasoning abilities are followed by periods of stability, only to give way to further decline.

3. Memory problems may or may not be a prominent symptom, depending on whether brain regions important in memory are affected. Confusion, which may get worse at night. Difficulty concentrating, planning, communicating and following instructions.

4. Unlike Alzheimer’s disease, vascular dementia may progress in steps. Symptoms may worsen suddenly, then remain the same (plateau). Months or years later when another stroke occurs, symptoms worsen again. Dementia that results from many small strokes progresses more gradually than that due to a few large strokes.

5. Vascular dementia affects different people in different ways and the speed of the progression varies from person to person. Some symptoms may be similar to those of other types of dementia. However, people with vascular dementia may particularly experience problems concentrating and communicating depression accompanying the dementia symptoms of stroke, such as physical weakness or paralysis memory problems (although this may not be the first symptom).

6. Serious forgetfulness, mood swings and other behavioural changes are not a normal part of ageing. They could be caused by poor diet, malfunctioning thyroid, lack of sleep or too many medicines. Feelings of loneliness and boredom or depression can also cause forgetfulness. These conditions can often be helped and medical advice should be sought. Sometimes, however, mental changes are caused by diseases that permanently damage the brain cells.

7. The condition often occurs with Alzheimer’s disease, which further complicates its progression. VaD causes similar symptoms to those associated with Alzheimer’s disease (AD), such as memory loss. However, memory problems caused by VaD are usually easier to overcome with cues and reminders.

8. In most cases, symptoms make it difficult to hold a job, carry out household responsibilities, or maintain social relationships. People with vascular dementia also experience neurological symptoms such as exaggerated reflexes, problems with walking and balance, and/or weakness in the limbs, hands, and feet. Depending on the individual and on the cause of the dementia, delusions, confusion, agitation, urinary problems, and/or depression can also accompany vascular dementia.