Alice Williams, Libbie’s Place director; Andrea Wirt, UTMB Geriatrics nurse practitioner; Helen Appelberg, Center of Spirituality and Aging, University of Texas Medical Branch director; Krista Dunn, Alzheimer’s Association representative; and Adele Herzfeld, a social worker, answer questions about dementia.

Q: What happens when a person has dementia?

A: A person loses the capacity to make decisions. He or she forgets simple things like Did I eat breakfast? or Did I talk with you yesterday?

Progressively, they forget their family. They might recognize a familiar face or think of you as a friendly person. There comes a time when they stop remembering what a family is.

This can be crushing, especially to spouses. Some people wander. Some become combative. It’s a different journey for every person. Some people are never agitated. There are general perimeters we can tell the families.

We can say what typically happens but not all conditions apply to every person. Most people want predictability but specific answers about what happens next are not easy to give.

Alice Williams, Libbie’s Place director

Q: Does it help to identify dementia early?

A: Yes. There are medications that can slow the process down but there isn’t a cure.

When we identify dementia early, the primary goal is to keep as much function as possible.

Andrea Wirt, UTMB Geriatrics nurse practitioner

A: It’s better to meet the condition head on. A good evaluation by a geriatric specialist and sometimes a neurologist can help.

Mild cognitive impairment can be due to other, treatable conditions like a urinary track infection or uncontrolled diabetes. It’s important not to be in denial about dementia because quality of life can be extended by early treatment.

If you had a broken leg, wouldn’t you immediately seek help? Then your leg has a better chance to mend and you can better manage the pain.”

Alice Williams, Libbie’s Place director

Q: What are signs of early dementia?

A: An early sign might be that individuals start missing appointments. Maybe they’ve gone to play bridge every Thursday for 20 years and suddenly they forget. Or they forget to pay a bill. They may lose weight because they’ve forgotten to eat.

Also, a person may become repetitive and ask questions over and over. We suggest that people come in because there could be other causes besides dementia such as thyroid or anemia or uncontrolled diabetes.

At a later stage, the person may lose the ability to communicate. Maybe they can say yes or not but can’t string words together.

Andrea Wirt, UTMB Geriatrics nurse practitioner

Q: Why is there a stigma with dementia? How can it be overcome?

A: Growing up in Texas, watching, observing and listening to my generation, I people think if you’re not in your right mind, then you are mentally ill.

Mental illness has a terrible stigma. Educating, sharing and understanding dementia will help to make a change.

Helen Appelberg, Center of Spirituality and Aging, University of Texas Medical Branch director

Q: Why is dementia embarrassing for affected individuals and their families?

A: People with Alzheimer’s lose much of their ability to follow our social “rules” which can be embarrassing.

I know a caregiver whose Mom put all the laundry in the front yard, including his underwear, which was very embarrassing to him.

The stigma of the disease also causes embarrassment. Some people are not comfortable telling their friends that they have Alzheimer’s because they are afraid of how their friends will look at them. So much of the disease is not understood and the unknown is always scary.

In addition, Alzheimer’s disease is frightening because it ultimately takes the person you once knew and changes them. Many families fear what is still to come. They dread the day that the person will no longer remember them.

Krista Dunn, Alzheimer’s Association

Q: How can you best assist a person with dementia and the family?

A: Flexibility and patience are vital. For caregivers, it’s a lot of responsibility because they set the tone.

When everything is serious and stressed, it creates anxiety that can trigger agitation and problematic behaviors.

It’s important for the affected person to continue living. As long as possible, they should engage in the activities they have always enjoyed.

Social interaction with friends is encouraged. It can be difficult because friends may feel uncomfortable but more openness and understanding will help to ease that discomfort.

A: We really promote support groups. The more education you have about what you’re dealing with, the more you are empowered.

Individuals in a similar situation are helpful to you and you to them.

Andrea Wirt, UTMB Geriatrics nurse practitioner

Q: How important is it to share with other people in similar situations?

A: Support groups are critical. The members of the group share their successes and the lessons learned from interventions they have tried.

The support group members are in different places on the dementia journey, and it helps to see that other people have experienced the same emotions and events related to the disease.

Adele Herzfeld, social worker

A: I would say support systems are extremely important. The Alzheimer’s Association has over 50 support groups that caregivers can attend to talk with those going through similar issues.

It is therapeutic to talk through certain issues, but it may also provide practical help. For those diagnosed with the disease, the Alzheimer’s Association has a wonderful early stage program that brings together affected people and their caregivers.

This program is extremely helpful to engage those with dementia and give them purpose and support.

Krista Dunn, Alzheimer’s Association

Q: What causes Alzheimer’s?

A: Unfortunately, at this time, we do not know. We know that there are two hallmark proteins that accumulate in the brain of people with Alzheimer’s — beta amyloid plaques and tau tangles.

We do not know what causes the accumulation of these plaques and tangles in people with Alzheimer’s. We know that age is a risk factor and there is emerging research of a “brain-body” connection, suggesting that there may be a connection between heart health and brain health.

In addition, research is being done on the role that genetics play with developing Alzheimer’s. However, we still do not have the entire picture, which is why funding research remains a top priority.

Krista Dunn, Alzheimer’s Association

Q: How does the disease progress?

A: While there is some consistency between patients with dementia diagnosis, each patient progresses differently.

It is common for an Alzheimer’s patient to display a slow progression of the disease over a period of 20 years, but I have watched two patients with Alzheimer’s progress rapidly and die within a year of their diagnosis.

This is not the normal. It is also rare for a patient die from Alzheimer’s alone, there are usually other serious health problems that cause death such as heart disease, stroke or cancer.

Adele Herzfeld, Geriatric social worker

A: Every person progresses through Alzheimer’s differently. However, it is a progressive disease meaning it does get worse over time.

Some people progress very slowly through the disease and others quite rapidly. However, in the late stage of Alzheimer’s, the brain stem, which is responsible for basic functions like swallowing, is affected.

Many people are not aware that Alzheimer’s is eventually fatal.

Krista Dunn, Alzheimer’s Association

Q: Is there a genetic predisposition to dementia?

A: Having a family member with Alzheimer’s does increase one’s risk of developing Alzheimer’s, just as eating a diet high in saturated fat increases one’s risk of developing heart disease.

There is also research being done on apolipoprotein E4 gene. There appears to be an increased risk for those who have the ApoE4 gene and there seems to be a protective factor for those who carry the ApoE2 gene.

While genetics play a role in Alzheimer’s, there are many pieces to the puzzle and genetics is only one piece.

Krista Dunn, Alzheimer’s Association

Q: Are their medications that help?

A: There are no medications that cure the disease at this time. Current medications slow the progression.

More focus is being given to prevention and identifying in early stages so that medications can be employed to slow process.

It is also important to stay active physically and mentally. Maintaining a good circulatory system and learning new things are important.

Adele Herzfeld, geriatric social worker

Q: How can you help families to cope?

A: It’s better for the person and the family member if you meet them where they are. Stop for a moment and get into their world. Try to see into their reality.

Ask yourself, where did this behavior come from? Maybe mom is thinking of when she was 20 years old.

Also, stay in agreement to get through a difficult moment. You can say, “Yes, I hear what you’re saying”. Or “OK, I hear you.” This is easier said than done and it does take practice.

Alice Williams, Libbie’s Place director

Q: What can families do to bring spiritual comfort to their loved ones with dementia?

A: Those with dementia enjoy attending their place of worship and being part of their church family.

Most often they can recall the words and are deeply comforted by singing familiar hymns and religious songs they sang in their place of worship during their childhood.

It is also calming and nurturing to have someone say familiar prayers with them and read religious stories to them.

Helen Appelberg, Center of Spirituality and Aging, University of Texas Medical Branch director

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