In the early stages of Alzheimer’s, caregivers can take the simple approach, placing clothes in plain view at the end of the bed or on a chair.  This will generally be all that is needed to prompt your patient to dress.  As Alzheimer’s progresses, you may have to use a combination of verbal and physical cues to prompt your loved one to start dressing.  In the latter stages of the disease, it is usually the caregiver who will be responsible for dressing the Alzheimer’s patient.

There are some basic tips that can be used when dealing with daily living tasks such as dressing:

• Keep things simple
• Be social, talk to your loved one first, concentrating on the task of dressing second
• Plan things in advance
• Ensure that your patient is paying attention to you before you start and if you’re speaking to them, do it at eye level, and not from above.

If as a caregiver you are experiencing problems dressing your patient, you may find this could be caused by a number of reasons.  The Alzheimer’s patient may find they have too many items of clothing to choose from.  Their closet may be packed with a variety of clothes and they may have an inability to choose something appropriate.  Limit the selection available in the early stages of the disease to avoid confusion and allow them a greater opportunity of remembering where certain items are located.

As Alzheimer’s progresses, you may find your patient forgetting the proper order for putting on their clothes.  You can assist by providing verbal cues and passing them the clothes in the order they are to be worn.  This can also help minimize distraction from other sources.  As a caregiver, you may also notice your patient struggling to select appropriate clothing for both the weather and occasion.  Planning ahead and providing their clothing in advance can be a simple solution for this.

Be aware that some people suffering from Alzheimer’s will want to wear the same clothes every day.  This may be caused by them having a certain familiarity with a particular outfit.  They may also have difficulty in telling dirty from clean clothes.  Planning the outfits to be worn in advance can minimize the confusion for the Alzheimer’s patient when it comes to dressing.

Some Alzheimer’s patients become embarrassed when dressing, especially if they have to do it in front of the caregiver.  Remember, as the disease progresses they have difficulty remembering who people are and identifying objects.  Ensuring some degree of privacy during dressing can help alleviate the feeling of embarrassment.

Be careful of the clothes being selected for Alzheimer’s patients.  Motor skills become inhibited as the disease progresses and Alzheimer’s patients will have difficulty with zippers, buttons and other fasteners.  Be prepared to lend assistance when required and never rush the Alzheimer’s patient who is struggling fastening their clothes.  This can be simple as holding out the clothing item, putting a hand into a sleeve and starting to fasten the item.  This could then cause the Alzheimer’s patient to start the process themselves.

Some caregivers also struggle with their loved one undressing in public.  If this occurs, it could be possible that the Alzheimer’s patient may be uncomfortable in their clothes or it no longer fits.  Assess the clothing being worn and determine if there is a problem the Alzheimer’s patient may be having difficulty communicating about.

Never forget the basics of providing the Alzheimer’s patient the best care possible.  Provide lots of encouragement and lots of praise.  This will not only make the atmosphere more pleasant for the person with Alzheimer’s but make the caregiver’s life just a little easier when it comes time to dress those they care for.

While studying the brains of two groups of mice that had diabetes, researchers noted one group aged faster than the other.  Both groups were infected with type 1 diabetes and changes in their brains were observed.  Proteins were allowed to develop on their own to allow the researchers to gain a better understanding as to how the interactions were happening.

Both groups aged more quickly after being infected with diabetes which could have major implications for people who are predisposed to Alzheimer’s disease.  These individuals could potentially experience worsened conditions associated with Alzheimer’s especially if they also suffered from diabetes.

Researchers also noted there was an increase in both amyloid beta and tau protein in the brain cells.  Other studies have found a relationship to these two proteins and the onset of Alzheimer’s.  Excessive levels of amyloid beta can result in neural connections becoming inflamed and result in the death of neurons.

The results published could mean that people with diabetes may be encouraged to undergo screening for Alzheimer’s at an earlier age to help lead to both early detection and treatment before any significant symptoms of Alzheimer’s appear.  As research continues, research may continue to find relationship between other diseases and Alzheimer’s, resulting in better methods for assessing Alzheimer’s risk and detection.

The new Alzheimer’s wonder drug known as LMTX works by blocking the accumulation of tau protein in the brain.  This protein forms twisted fibers in brain cells and is believed to be one of the proteins contributing to the development of Alzheimer’s.   LMTX specifically targets these tau proteins, dissolving them and in doing so halts their effects on brain cells.

This is one of the first drugs to reach this phase of testing that targets the tau protein.  Most other pharmaceutical companies have focused on targeting beta amyloid plaques, shown to also contribute to the onset and progression of Alzheimer’s disease.

An earlier study testing an early form of LMTX showed a 90 percent reduction in Alzheimer’s progression over a two-year period.  Researchers hope that this drug can be administered to anyone, regardless of their symptoms.  Additionally, if administered early enough once Alzheimer’s symptoms have started showing, LMTX may be able to restore people to normal, perhaps slowing the disease enough to allow them to remain independent or prevent institutionalization.

Even if clinical trials show this drug is not able to reverse the disease but slow its progression, it could be a major advancement in providing effective treatments for Alzheimer’s patients that could have major implications on health care costs.

Using predictor models, it is possible to isolate metabolic information and pinpoint the progression of Alzheimer’s, allowing for early detection of the brain disease.  Early results show that using such models is 90 percent accurate at predicting early stage Alzheimer’s.

With data collected from the hippocampus region of the brain, researchers were able to isolate 50 genes that were most predictive of Alzheimer’s.  The hippocampus region was used because this is the most common are damaged as the disease progresses.  The results of their study showed that these genes were either over or under expressed, meaning there were too few or too many.

This has allowed the researchers to isolate and potentially identify biomarkers that may be able to be used to detect Alzheimer’s early with a simple blood test.  Researchers plan to indentify which biomarkers in the blood are associated with these metabolic changes and its progression, allowing for a simple, non-invasive blood test to be used.

In a study published in the Lancet Neurology, it was shown that Alzheimer’s disease begins much earlier than anyone would notice.   Usually the disease is only detected when enough brain cells have died to affect the patient and allowing signs of dementia to appear.  However, it has been shown that this is when a person may have lost up to 20 percent of their brain cells, making it too late to effectively treat the patients.

By examining a family predisposed to early onset Alzheimer’s, researchers were able to compare the differences in the brains of those who were not destined to develop early Alzheimer’s.  It was shown that the fluid surrounding the brain and spinal cord also had higher levels of the protein beta-amyloid.  Researchers have indicated they could detect these differences almost 20 years before any symptoms would appear in these high-risk patients.

One of the lead scientists in the study, Dr. Eric Reiman indicated “These findings suggest that brain changes begin many years before the clinical onset of Alzheimer’s disease.  These raise new questions about the earliest brain changes involved in the predisposition of Alzheimer’s and the extent to which they could be target by future prevention therapies.”

Being able to detect Alzheimer’s disease earlier than was previously thought is a major advancement for intervention therapies.  It could also allow new drugs to be used to treat Alzheimer’s disease well before any visible symptoms.

This has enabled researchers to develop a predictor model that can be used to target the progression of Alzheimer’s and enable them to get a better understanding in determining which stage of the illness people are entering.  This model may be the first step in identifying biomarkers that will allow earlier detection of Alzheimer’s.

Scientists hope that in studying the metabolism of the brain that they can develop new therapeutic strategies and provide a better understanding of the brain disease.

Researchers will publish their findings in the journal Neurobiology of Aging.

The following story was submitted by “Cameron” from the United Kingdom about his experience when his dad was diagnosed with Alzheimer’s and put into a protective care unit when he and his family were unable to provide the necessary care for his dad.

The day my dad was diagnosed with Alzheimer’s was the day both his and my life changed forever.

I wasn’t surprised.  I had noticed his deterioration and we joked about his inability to find his shoes, forgetting his car at the local coffee shop and his many colourful outfits he donned each day while dressing.

It had become a ritual to watch for him each evening pacing the streets in front of our house, confused about where he was and what was happening about him.  I know now it was his Sundowning and as pleasant as he was throughout his “episodes” as we called them, I knew there would come a time things would change.

When the inevitable happened and our family was forced to institutionalize him, I struggled with this transition more than he did.  He was jovial and happy to have company throughout the day and joined the other patients each day pacing more and more as the evening progressed.

Things suddenly changed.

I noticed each evening as I visited what the health authority called the “Protective Alzheimer’s Unit” my dad was being isolated more and more from the other patients.  His pleasantness was gone.  I thought he was fading quickly into a world I wasn’t prepared for.  The dad I knew and loved was gone.

Nursing staff assured me it was the progression of the disease.  This was “normal” and to be “expected”.

Was it the progression of his Alzheimer’s or was it something else.  He cowered when I approached him.  He whispered “Please take me home, I don’t like this place” each time I bent to kiss him good-bye.  My heart grew heavy each time I heard those words but I was reassured by the nursing staff “You’re dad is doing okay.  He’s settled into a routine and this is normal.  He’ll have moments.”

Moments?

When another family approached me wanting to know how my dad was doing, I first thought it was ‘normal’.  We all had one thing in common, our loved ones suffered from Alzheimer’s.  I said “He’s doing okay, but it’s difficult to watch the disease progressing.”

“Oh you don’t know?” someone said.

“Don’t know?” I asked.

They went on to explain that for about a month, my dad was being medicated and physically restrained.  Other patients were becoming overly agitated by my dad’s pacing, his singing and his laughing.  The staff apparently took the easy way out and removed the “threat” (my dad) from the situation by knocking him off his feet with drugs and restraining him in a chair.

My heart sank.

My visits to the “Protective Alzheimer’s Unit” became more frequent and at more random times.  I witnessed my dad sitting in a chair, a pool of urine at his feet.  I noticed more and more bruises on his body.  I noticed he had lost the ability to speak and the ability to feed himself.  He became incontinent.  He developed infection after infection, some that went untreated for days.

The more I advocated for better care, the more the staff pushed back.  The more I complained the more frequent his “incidents” and the more I realized there was a direct correlation to the quality of his care and my level of complaining.

I noticed patterns of what I classed as elder abuse.  I noticed it was more predominant when certain staff worked and these were the same staff I had complained about.

It took almost 2 years to resolve the issues with the health authority and establish a policy of personalized care for all Alzheimer’s patients.  Sweeping changes were brought into the unit with some staff retrained, others disciplined and others terminated.

I realized there is nothing “normal” about elder abuse.  I realized there was nothing “normal” about Alzheimer’s disease.

To all the loved ones out there struggling with this terrible disease, be aware of what is happening to your family member.  Advocate for them.  Stand up for their rights and for their care.  Hold the organizations you entrust with the care of your loved ones accountable for their actions.

How is my dad doing now?

His disease has progressed to a point where he no longer recognizes me or any of my family.  He still paces in the evening, laughs at nothing and sings the same song over and over.  He is still the same dad I know and love and when I kiss him good-bye each evening and tell him I love him he says “I love you too”.  He no longer asks me to bring him home but I’ve now realized, I’ve made the place he lives, a home that he is happy with.

This is a bold statement to make and is not meant to diminish the important role that nurses play in providing healthcare.  However, most nurses are trained to provide general care and are for the most part, unfamiliar with how to provide specialized care for Alzheimer’s patients.

Nurses are the core of our healthcare system.  They are the men and women who are the backbone of everything that is good when it comes to providing care.  When it comes to their role in providing care for Alzheimer’s patients, nurses must lead the way, being both care provider and advocate for those suffering from this disease.

Nurses must be provided with the skill set required to assess patients and recognize the impairments in thinking and functioning unique to each person with each patient.  There can be no general care plan for dealing with Alzheimer’s patients because each individual case is different requiring individual care plans.  It becomes essential for the nurse to recognize complications associated with general care and how the progression of Alzheimer’s Disease impacts both the physical and mental well-being of their patients.

As front-line staff most familiar with their patients’ lives, nurses will be the first to notice changes and must have the necessary skills to reassess their patients and coordinate possible treatments with other healthcare professionals.  It goes beyond having a cursory understanding of Alzheimer’s and its symptoms.  It means having a more personal relationship with patients and their families.

Because Alzheimer’s patients will at times lack the ability to describe how they feel or communicate effectively about what is happening to them, nurses caring for these patients must have a keen sense of observation.  They must be capable of performing cognitive tests, assessing the mental abilities of their patients and obtain critical information at times when most patients would consider situations embarrassing or intrusive.

The role of nurses in caring for Alzheimer’s patients has to become an area of specialty supported by their nursing associations, care facilities and hospitals.  It has to be recognized these individuals play a more active role in personal, hands-on care.  It can never be about meeting just the general care of these patients.  It has to be about providing quality care without exception.

To put this in context, here are some statistics showing the impact of dementia:

• More than 5 million people have dementia in the USA alone
• More than 28 million people worldwide have dementia
• Approximately 7% of people age 65 experience dementia
• Approximately 16% of people aged 75-85 experience dementia
• At the age 85, approximately 50% experience dementia

Unfortunately, health care systems have yet to advance care or adjust to this changing demographic.  It continues to be reactive, not proactive, failing to meet the needs of dementia patients or provide the necessary support for those family members caring for loved ones.

Dementia has a major impact on our health care system, especially with compared to providing care for the elderly in general.  Aging adults diagnosed with this mental disorder are:

• More than 3 times more likely to be admitted to the hospital
• Incur more than 3 times more home health care costs
• More than 3 times the length of hospital stay
• Result in more than 21 times higher hospital costs

The impact of this disorder can no longer be ignored.  It is time for governments to recognize that dementia is an area of health care that has to be addressed in order to provide quality care for those patients.

We would laugh at some of the things he did and make jokes about him being forgetful.

Somehow things were always okay in those early days.  He knew me.  He would call me by name and always looked at me in his special way.  I was his little girl.

As his Alzheimer’s progressed, I could see the distance between us growing.

The laughing stopped.  The jokes stopped.  I was familiar to him but when he looked at me I could see him trying to remember who I was.  I wasn’t his little girl anymore.  I was “that lady” who lived upstairs.  “You know the one …” he would say.  “… the one that makes supper and takes us out for a donut sometimes.”

I would tell him my name, and remind him I was his daughter.  He would laugh and smile in his own special way.  He humoured me but I could tell he really wasn’t sure of anything.

He didn’t see me as his daughter because in his mind, he had no daughter.

Alzheimer’s had stolen my father, taken away his laughter, the special way he looked at me and turned his little girl into “that lady”.

There’s not a day that goes by I don’t miss his smile or the way he used to look at me.  There’s not a day that goes by that I don’t miss my dad.

Sure, the person I visit each day looks like and sounds like dad but I know it’s only a shell.  Alzheimer’s has destroyed his being and left him alone.  He’s in a dark place and I’m powerless to help him, to be that little girl for him, to offer him comfort and to bring back his laughter and his smile.

On certain days dad looks alive.  He walks and sings, oblivious to the dark place his disease has brought him.

It’s these days I look forward to.  Those are the good days.  Dad almost remembers me.  I close my eyes and listen to his happy tunes, his whistling and the happiness in his voice.

Those are my good days as well and if I look hard enough, I can catch a glimpse of him staring at me and in his eyes I know he sees his little girl.