What is dementia?
People who have dementia have a problem in the brain that
makes it hard for them to remember, learn and communicate.
These changes eventually make it hard for them to care for
themselves. Dementia may also cause changes in mood and
personality. Early on, lapses in memory and clear thinking
may bother the person with dementia. Later, disruptive
behavior and other problems can create a burden for
caregivers and other family members.
Dementia is caused by the damage of brain cells. A head
injury, stroke, brain tumor or disease (such as Alzheimer's
disease) can damage brain cells.
How is dementia treated?
Some causes of dementia can be treated. However, once
brain cells have been destroyed, they cannot be
replaced. Treatment may slow or stop the loss of more brain
cells. When the cause of dementia can't be treated, the
focus of care is on helping the person with his or her daily
activities and reducing upsetting symptoms. Some medicines
can help people with dementia. Your family doctor will talk
with you about treatment options.
Why do people with dementia become agitated?
The agitation can have many causes. A sudden change in
surroundings or frustrating situations can cause people who
have dementia to become agitated. For example, if he or she
can't get dressed without help or gives the wrong answer to
a question it may cause frustration. Being challenged about
his or her confusion or inability to do things may also make
the person agitated. As a result, the person may cry, become
irritable, or try to hurt others in some way.
How can I deal with agitation?
One of the most important things you can do is avoid
situations in which your loved one might become frustrated
because he or she fails to remember something or forgets to
do something. Try to make your loved one's tasks less
difficult. For example, instead of expecting him or her to
get dressed alone, you can just have your loved one put on
one thing, such as a jacket, on his or her own.
You can also try to limit the number of difficult
situations your loved one must face. For example, if taking
a bath or shower causes problems, have him or her take one
every other day instead of every day. Also, you can schedule
difficult activities for a time of day when your loved one
tends to be less agitated. It's helpful to give frequent
reassurance and avoid contradicting him or her.
What should I do if hallucinations are a problem?
If the hallucinations are not making your loved one
scared or anxious, you don't need to do anything. It's
better not to confront people about their hallucinations,
because you will not be able to convince them that there are
no voices or people. Arguing may just upset your loved one.
If the hallucinations are scary to your loved one, you can
try to distract the person by involving him or her in a
pleasant activity.
What if my loved one will not go to sleep at night?
First, try to make the person more aware of what time of
day it is. Place clocks where he or she can see them. You
can also keep curtains or blinds open so that he or she can
tell when it is daytime and when it is nighttime.
Limit the amount of caffeine he or she consumes. Try to
help your loved one get some exercise every day. Don't let
him or her take too many naps during the day. Be certain
that the bedroom is peaceful, since it is easier to sleep in
a quiet room. At night, provide a night light or leave a dim
light on, because total darkness can add to confusion. If
your loved one has arthritis or another painful condition
that interrupts his or her sleep, ask your doctor if it is
okay to give your loved one a medicine for pain right before
bed.
What if wandering becomes a problem?
Sometimes very simple things can help with this problem.
It is all right for your loved one to wander in a safe
place, such as in a fenced yard. By providing such a safe
place, you may avoid a confrontation. If this doesn't work,
remind your loved one not to go out a certain door by
placing a stop sign on it or putting a piece of furniture in
front of it. A ribbon tied across a door can serve as a
similar reminder. Hiding the doorknob by placing a strip of
cloth over it may also be helpful.
An alarm system will alert you that your loved one is
trying to leave a certain area. Your alarm system may just
be a few empty cans tied to a string on the doorknob. You
might have to place special locks on the doors, but be aware
that such locks might be dangerous if a house fire occurs.
Don't use this method if your loved one will be left home
alone. Make sure your loved one wears a medical bracelet, in
case they do wander away from home.
Other Organizations
American Psychiatric Association
http://www.psych.org
888-35-PSYCH (888-357-7924)
National Institute of Mental Health
http://www.nimh.nih.gov
800-421-4211
National Institute on Aging Information Center
http://www.nih.gov/nia
800-222-2225
Alzheimer's Association
http://www.alz.org
800-272-3900
What is depression?
Sometimes when people feel sad, they say they are
"depressed." But depression is more than just
feeling sad. It is a medical illness. Someone with
"major" depression has most or all of the symptoms
listed in the box below nearly every day, all day,
for 2 weeks or longer. There is also a "minor" form
of depression with less severe symptoms. Both have
the same causes and treatment.
What causes depression?
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Symptoms of depression
- No interest or pleasure in things
you used to enjoy, including sex
- Feeling sad or numb
- Crying easily or for no reason
- Feeling slowed down or feeling
restless and irritable
- Feeling worthless or guilty
- Change in appetite; unintended
change in weight
- Trouble recalling things,
concentrating or making decisions
- Headaches, backaches or digestive
problems
- Problems sleeping, or wanting to
sleep all of the time
- Feeling tired all of the time
- Thoughts about death or suicide
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Your brain has chemicals that help control your
moods. When you don't have enough of these chemicals
or when your brain doesn't respond to them properly,
you may become depressed. Depression can be genetic
(meaning it can run in families). Abusing drugs or
alcohol can also lead to depression. Some medical
problems and medications can lead to depression.
Depression is not a normal part of growing older,
but it is common in adults age 65 and over.
Retirement, health problems and the loss of loved
ones are things that happen to older adults. Feeling
sad at these times is normal. But if these feelings
persist and keep you from your usual activities, you
should talk to your doctor.
Why is depression in older adults hard to
recognize?
It can be hard to tell the difference between
depression and illnesses such as dementia. Also,
older adults may not talk to their doctor about
their sad or anxious feelings because they are
embarrassed. But depression is nothing to be
embarrassed about. It is not a personal weakness.
It's a medical illness that can be treated.
How is depression diagnosed?
Sometimes depression is first recognized by
friends or family members. If you're having symptoms
of depression, be sure to tell your doctor. Don't
assume he or she will be able to tell that you are
depressed just by looking at you. Your doctor will
ask you questions about your symptoms, your health
and your family's history of health problems. He or
she may also give you an exam and do some tests. It
is also important to tell your doctor about any
medicines that you are taking.
How is depression treated?
Depression can be treated with medicine or
counseling, or with both. These treatments are very
effective. Medicine may be particularly important
for severe depression. Talk to your doctor about the
right treatment for you.
What if my doctor prescribes medicine?
Medicines used to treat depression are called
antidepressants. They correct the chemical imbalance
in your brain that causes depression. These
medicines usually work very well, but they may have
some side effects. The side effects typically
decrease with time. Antidepressants can start to
work right away, but it may take 6 to 8 weeks before
you see the full benefit. Don't stop taking the
medicine without checking with your doctor first.
What about suicide?
Thinking about suicide can be part of depression.
Older adults with depression are at risk for
suicide. If you have thoughts about hurting
yourself, tell your doctor, friends or family right
away, or call your local suicide hot line (listed in
your phone book). The thoughts of suicide will go
away after the depression is treated.
Other Organizations
National Alliance for the Mentally Ill
http://www.nami.org
800-950-NAMI
National Mental Health Association
http://www.nmha.org
800-969-NMHA
American Psychiatric Association
http://www.psych.org
888-35-PSYCH
National Institute of Mental Health
http://www.nimh.nih.gov
800-421-4211
National Institute on Aging Information Center
http://www.nih.gov/nia
800-222-2225
Do people who have Alzheimer's disease
become depressed?
Yes. Depression is very common among
people who have Alzheimer's disease. In many
cases, they become depressed when they
realize that their memory and ability to
function are getting worse.
Unfortunately, depression may make it
even harder for a person who has Alzheimer's
disease to function, to remember things and
to enjoy life.
How can I tell if my family member who
has Alzheimer's disease is depressed?
It may be difficult for you to know if
your family member is depressed. You can
look for some of the typical signs of
depression, which include the following:
- Not wanting to move or do things
(called apathy)
- Expressing feelings of worthlessness
and sadness
- Refusing to eat and losing weight
- Sleeping too much or too little
Other signs of depression include crying
and being unusually emotional, being angry
or agitated, and being confused. Your family
member who has Alzheimer's disease may
refuse to help with his or her own personal
care (for example, getting dressed or taking
medicines). He or she may wander away from
home more often.
Alzheimer's disease and depression have
many symptoms that are alike. It can be hard
to tell the difference between them. If you
think that depression is a problem for your
relative who has Alzheimer's disease, talk
to his or her family doctor.
How can the doctor help?
The doctor will talk with your relative. The
doctor will also ask you and other family
members and caregivers whether the person
has any new or changed behaviors. The doctor
will check your relative and may wish to do
some tests to rule out other medical
problems. He or she may suggest medicines to
help your family member feel better. The
doctor may also have some advice for you and
other family members and caregivers on how
to cope. He or she may recommend support
groups that can help you.
What medicines can help reduce
depression?
Antidepressant medicines can be very
helpful for people who have Alzheimer's
disease and depression. These medicines can
improve the symptoms of sadness and apathy,
and they may also improve appetite and sleep
problems. Don't worry--these medicines are
not habit-forming. The doctor may also
suggest other medicines that can help reduce
upsetting problems, such as hallucinations
or anxiety.
What can I do to help my family member?
Try to keep a daily routine for your
family member who has Alzheimer's disease.
Avoid loud noises and overstimulation. A
pleasant environment with familiar faces and
mementos helps soothe fear and anxiety. Have
a realistic expectation of what your family
member can do. Expecting too much can make
you both feel frustrated and upset. Let your
family member help with simple, enjoyable
tasks, such as preparing meals, gardening,
doing crafts and sorting photos. Most of
all, be positive. Frequent praise for your
family member will help him or her feel
better--and it will help you as well.
As the caregiver of a person who
has Alzheimer's disease, you must also take
care of yourself. If you become too tired
and frustrated, you will be less able to
help your family member. Ask for help from
relatives, friends and local community
organizations. Respite care (short-term care
that is given to the patient who has
Alzheimer's disease in order to provide
relief for the caregiver) may be available
from your local senior citizens' group or a
social services agency. Look for caregiver
support groups. Other people who are dealing
with the same problems may have some good
ideas on how you can cope better and on how
to make caregiving easier. Adult day care
centers may be helpful. They can give your
family member a consistent environment and a
chance to socialize.
Where can I learn more about caring for
my family member who has Alzheimer's
disease?
A book called The 36-Hour Day
explains Alzheimer's disease and gives
information about resources for caregivers.
It gives ideas about things you can do to
deal with behavior problems in an
Alzheimer's patient. One chapter discusses
mood disorders and depression in these
patients.
Other Organizations
National Institute on Aging Information
Center
http://www.nih.gov/nia
800-222-2225
National Mental Health Association
http://www.nmha.org
800-969-6642
National Alliance for the Mentally Ill
http://www.nami.org
800-950-6264
Alzheimer's Association
http://www.alz.org
800-272-3900
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