Monday, October 18, 2010
It's normal for our loved ones to become a bit forgetful as they age. So how can we separate a harmless "senior moment" from a more serious problem like Alzheimer's disease? One in eight people 65 and older have this devastating form of dementia. In its first stages, Alzheimer's may not be obvious to friends and family. But there are some early warning signs to watch for.
In early Alzheimer's, long-term memories usually remain intact while short-term memories become sketchy. Your loved one may forget conversations you had. He or she may repeat questions that were already answered. The disease also disrupts speech, so patients may struggle to remember common words.
In addition to memory loss, Alzheimer's can cause confusion and behavior changes. Your loved one may get lost in familiar places. Mood swings and poor judgment are also common, as is poor hygiene. People who once dressed with style may resort to wearing stained clothes and unwashed hair.
While it's difficult to face the possibility that a loved one could have Alzheimer's, it's better to consult a doctor sooner rather than later. First, the diagnosis might not be Alzheimer's after all. The symptoms could be caused by a highly treatable problem, such as a thyroid imbalance. And if it is Alzheimer's, today's treatments work best when they are used early in the course of the disease.
There is no simple test for Alzheimer's, so the doctor will rely on you to describe the changes in your loved one. A mental status test, sometimes called a "mini-cog," or other screening tests can help evaluate the patient's mental function and short-term memory. In addition, neurological exams and brain scans may be used to rule out other problems, such as a stroke or tumor — and they can help provide other information about the brain.
Alzheimer's disease leads to nerve cell death and tissue loss throughout the brain. As the disease progresses, brain tissue shrinks and the ventricles (chambers within the brain that contain cerebrospinal fluid) become larger. The damage disrupts communication between brain cells, crippling memory, speech, and comprehension.
Alzheimer's disease takes a different path in every patient. In some people the symptoms worsen quickly, leading to severe memory loss and confusion within a few years. In others, the changes may be more gradual with the disease taking 20 years to run its course. The average length of survival after a diagnosis of Alzheimer's is three to nine years.
Because Alzheimer's affects concentration, patients may lose the ability to manage ordinary tasks like cooking or paying the bills. A study suggests difficulty balancing a checkbook is often one of the first effects of Alzheimer's. As the symptoms worsen, your loved one may not recognize familiar people or places. He or she may get lost easily, or use utensils improperly, such as combing hair with a fork. Incontinence, balance problems, and loss of language are common in the advanced stages.
Poor coordination, memory loss, and confusion make for a dangerous combination behind the wheel. If you feel your loved one should not be driving, explain why. If he or she won't listen, ask the doctor to step in. If the patient still insists on driving, contact the Department of Motor Vehicles for an assessment. Then make an alternate plan for your loved one's transportation needs.
Exercise can help people with Alzheimer's maintain some muscle strength and coordination. It also improves mood and may reduce anxiety. Check with your loved one's doctor to learn which types of exercise are appropriate. Repetitive activities, such as walking, weeding, or even folding laundry may be the most effective at promoting a sense of calm.
As the caregiver of someone with Alzheimer's, you will probably wear many hats — cook, chauffeur, accountant. While you may have to handle the meal planning and finances, encourage the patient to do some activities independently. It may help to label cabinets with their contents and put up sticky notes with reminders of daily tasks. Be sure to buy a weekly pill box for medications.
In the early stages of Alzheimer's, patients often understand what is happening and may be ashamed or anxious. Watch for signs of depression because this can often be managed with medication. In the more advanced stages, your loved one may become paranoid or violent and could even turn on you. Remember that the disease is responsible for this change. Alert the doctor about violent behavior promptly.
Some people with Alzheimer's become distressed when the sun goes down. This agitation tends to last through the evening and sometimes all through the night. The cause is not known, but there are some strategies to ease the tension. Keep the house well lit and close the drapes before sunset. Try distracting your loved one with a favorite activity or TV show. And restrict caffeine after breakfast.
Many people with Alzheimer's have trouble remembering names — even those of close family members. A temporary fix is to put up pictures of friends and relatives with names printed underneath. Eventually, the patient may no longer recognize faces and may react to loved ones as if they are strangers. This can be a distressing time for family members, especially the primary caregiver.
Caring for someone with Alzheimer's can be physically and mentally taxing. Signs of caregiver stress include:
• Anger, sadness, and mood swings.
• Headaches or back pain.
• Difficulty concentrating.
• Difficulty sleeping.
To avoid caregiver burnout, make sure you take at least a few minutes to do something you enjoy every day. Stay in touch with friends and keep up with hobbies whenever possible. Find a friend or relative to be your support person. You can also join an online or local caregiver support group through the Alzheimer's Association.
While your loved one is still able to make important decisions, contact an attorney about drafting advance directives. These are legal documents that spell out the patient's preferences for medical treatments and end-of-life care. The patient should designate someone to make health care decisions and manage finances on his or her behalf. This can avoid confusion when your loved one is no longer able to state his or her wishes.
Many patients express a desire to stay in their own homes as long as possible. Unfortunately, they may have trouble getting dressed or using the bathroom on their own as the disease advances. A home health aide can assist with personal hygiene and other daily tasks. You can also look into local services that deliver meals or provide transportation to the elderly. Most communities have an Area Agency on Aging that provides such services.
There may come a day when your loved one can no longer be cared for at home. If he or she does not need 24-hour nursing care, an assisted-living facility may be an appropriate choice. ALFs provide housing, meals, and activities, but are much less expensive than nursing homes. Look for a facility with an Alzheimer's special care unit, which delivers 24-hour supervision and personal care to meet the needs of people with dementia.
People with advanced Alzheimer's may lose the ability to walk, talk, or respond to others. Eventually, the disease can hinder vital functions, such as the ability to swallow. Patients in this stage may benefit from hospice care, which provides pain relief and comfort for the terminally ill.
Children may feel confused, afraid, or even resentful when a family member is affected by Alzheimer's. Let the child know these feelings are normal and answer his or her questions about the illness honestly. Help the child celebrate happy memories of the patient — for example, by creating a scrapbook.
If you're caring for a relative with Alzheimer's, you might be wondering if there's anything you can do to reduce your own risk. Research in this area is ongoing, but diet and exercise appear key. Studies indicate a lower risk among people who eat a Mediterranean diet rich in vegetables, fish, and nuts. Research also suggests those who are the most physically active are the least likely to get Alzheimer's.
Monday, October 11, 2010
1. Name the Beast – The first step in tackling any obsession: Identify the thought. What is my fear? What is my doubt? Describe it in one sentence, or in a few words. Name the fear: “I am afraid that if my co-workers find out that I was hospitalized with severe depression that they won’t respect me anymore, and they won’t assign me any projects.” There it is. There’s the beast. You named it, and by doing so, you can rob it of some of its power over you.
2. Find the Distortion – Once you have named the fear or doubt, try to see if you can file it under any of the forms of distorted thinking that Dr. David Burns describes in his bestseller “Feeling Good,” like all-or-nothing thinking, jumping to conclusions, magnification (exaggeration), or discounting the positive (ie “None of my accomplishments count”). Your obsession almost always involves at least three forms of distorted thoughts. So consider Burns’ ten ways of untwisting distorted thinking to help me to undermine my obsession.
3. Pencil It In – Simply tell yourself, “Sorry, it’s not time for that. You’ll have to wait until 8 in the evening, when I give you, My Head, 15 minutes to obsess your heart out.” Record in your journal everything you are dwelling on for 20 minutes every night: that you are a horrible mom, an inadequate writer, that no one likes you, and so on.
4. Laugh at It – Laughter can make almost any situation tolerable. And you have to admit, there is something a little funny about a broken record in your brain.
5. Snap Out of It – Literally snap out of it. Wear a rubber band around your wrist, and every time your thoughts turn to an obsession, snap the band as a reminder. Or, write your obsession on a piece of paper, then crinkle it up and throw it away. That way you have literally thrown out your obsession. Or you could try visualizing a stop sign. When your thoughts go there, remember to stop! Look at the sign!
6. Pull Over – One of the most helpful visualizations is to imagine that you are driving a car. Every time your thoughts revert back to an obsession, pull over on the shoulder, because your car is misaligned. It’s dragging right. Once you’ve stopped, ask myself: “Do I need to change anything?” Can I change anything? Can I amend this situation somehow? Do I have anything I need to do to find peace? Spend a minute asking the questions. Then, if you don’t have anything to fix, it’s time to get your car back on the road again. This is basically a visualization of the Serenity Prayer. Try to decipher between what you can’t change and what you can. Once you have made the distinction, it’s time to start driving again.
7. Learn the Lesson – We often obsess about our mistakes. I know I messed up, and I’m beating myself over and over again for not doing it right the first time, especially when I have involved other people and hurt them unintentionally. If that’s the case, ask yourself: What is the lesson here? What have I learned? Just like the first step – naming the obsession – describe the lesson in one sentence or less.
8. Forgive Yourself – After you take away the lesson, you have to forgive yourself. This is a hard one. Especially for perfectionists. And guess what? Perfectionists are natural ruminators. Julia Cameron writes about this in “The Artist’s Way:” “Perfectionism is a refusal to let yourself move ahead. It is a loop – an obsessive, debilitating closed system that causes you to get stuck in the details of what you are writing or painting or making and to lose sight of the whole. Instead of creating freely and allowing errors to reveal themselves later as insights, we often get mired in getting the details right. We correct our originality into a uniformity that lacks passion and spontaneity.” Forgiving yourself means concentrating on the insights gained from mistakes, and to let go of the rest.
9. Imagine the Worst – Imagining the worst can actually relieve the fear that’s triggering an obsession.
10. Put It on Hold – Sometimes we start to obsess about a situation for which we don’t have enough information. So it’s useless to worry. Therefore put your obsession “on hold,” like it was a pretty lavender dress at a boutique that you saw and wanted but didn’t have enough money to buy. So it’s there, waiting, when you get enough money – or enough data.
11. Dig for the Cause – So often the object of the obsession isn’t the real issue. That object or person or situation is masking the deeper issue we’re too afraid to face.
12. Reel It In – We all know how fast obsessions can take on a life of their own. A slight hitch in a project becomes a massive hurdle, a friendly gesture by a friend turns ugly and threatening, and a minor criticism from a colleague turns into a 150-page dissertation about your flaws and inadequacies – you know, everything that’s bad about you and why you shouldn’t get out of bed in the morning. Granted, buried within any obsession are usually pieces of truth. But other parts are way off in fantasyland – with about as much accuracy as there is in a juicy celebrity tabloid story: “Celine Dion meets ET for drinks.” That’s why you need some good friends that will help you separate fact from fiction.
13. Interrupt the Conversation – Here’s where a bad habit can come in handy. Are you always interrupting people? Can’t help it? You get curious about a detail in someone’s story, and you want to hear more about that, not the end of the story? That’s how an obsession works in your brain – like a conversation over coffee: “This is why he hates me, and this, too, is why he hates me, and did I mention why he hates me? I’m sure he hates me.” Practice some of your rude manners and interrupt. You don’t even have to say, “Excuse me.” Ask yourself a question or throw out another topic. By doing so, you catch the snowball as it’s accumulating matter, and you throw it back with momentum because, as most of us learned in physics, a body in motion stays in motion. Now your internal conversation goes something like: “These are the reasons he should like me, and this, too, is why he should like me, and did I mention that he probably likes me? I’m sure he likes me.”
14. Stay in the Present – When you are grounded in the moment, you’re not thinking of what bad things can happen to you in the future, or dwelling on the mistakes of your past. To get yourself into the present, start with your senses. Try to hear only the noises that surround tiy – cars, birds, dogs barking, church bells – because if you give yourself the assignment of listening to the actual sounds around you, you can’t obsess on a fear. Likewise, concentrate on seeing what’s in front of you. At the very moment. Not in the year 2034.
15. Give it Back to God – The last step is surrender, as usual. “Okay, God, I give up! Take the bloody obsession from me!” It’s acknowledging that the last 14 steps haven’t gotten you where you need to be, and so you don’t know what else to do but give your ruminating mind to God and let him deal with it. Obsessions are almost always rooted in our attachments. So if we can think of them as borrowed from God – that God alone is the owner of this thing about which we are obsessing – we tend to become less greedy and possessive with our gifts, material and otherwise. In this way, we are mere stewards of whatever God has graciously given us.