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Dementia affects 4-5 million people in the United States today and up to 50% of people aged 85 or older will be diagnosed with some form of dementia. Dementia is the leading reason for placement of patients in nursing homes and greatly affects a persons’ quality of life. Home health care therapists treat many patients diagnosed with dementia. Understandably, most of these individuals are considered poor rehabilitation candidates since many forms of dementia are progressive and symptoms are not reversible. Home health clinicians have an advantage of observing their patient in their natural surroundings with their everyday schedules and activities. They are more inclined to pick up on certain aspects of mind lapses that would give clues to other forms of dementia which may be treatable.

Treatable Memory Conditions

Normal Pressure Hydrocephalus (NPH) has dementia symptoms but can be treated and the symptoms, reversed. Unfortunately, many clinicians are unfamiliar with NPH and it is often overlooked as a potential diagnosis. It is estimated that 5 – 10% of patients diagnosed with dementia actually have NPH. NPH can occur at any age, but is most common in adults over 60 years old. The symptoms of NPH can be similar to Parkinson disease and Alzheimer disease, which may lead to misdiagnoses. There are three primary symptoms of NPH which home health clinicians would have an advantage in diagnosing given their involvement with the patient in their normal surroundings. The three symptoms are: abnormal gait, urinary incontinence, and dementia. The lower extremities, the bladder, and mental processes such as memory, speech and problem solving are most often affected. The walking problems that occur with NPH occur often as a shuffling gait. The symptoms develop slowly with the walking problem occurring first and the confusion occurring later.Hydrocephalus is a condition where the ventricles enlarge and press on parts of the brain due to an excess cerebral spinal fluid (SCF). CSF circulates around the brain and spinal cord, cushioning and bringing nutrients to the cells of the brain and spinal cord. Normally, excess CSF drains into the bloodstream and fresh CSF is produced. NHP presents similar to hydrocephalus with a slower onset and lower CSF pressure than many forms of hydrocephalus. There is an increase in subarachnoid space volume, but this does not accompany an increase in ventricular volume. Distortion of the central portion of …The dementia from NPH results from the distortion of the periventricular limbic system There are several tests that can be used to determine the diagnosis of NHP. A test including an MRI, CT scan lumbar puncture and cisternography. It is still difficult to diagnosis and a consultation with a neurologist is recommended.Dementia is a general term used to describe a decrease in mental ability. There are a wide range of symptoms associated with the decline in memory or thinking skills, and most are serious enough to affect the person’s daily life. Functions affected include memory, communication, language, perception, judgment, and the ability to focus. There are many conditions that can cause symptoms of dementia, including Alzheimer’s, vascular dementia, thyroid problems and vitamin deficiencies. Dementia is a progressive condition that becomes more severe over time, and most forms of the disease can not be cured. Treatment of dementia may help slow or lessen the development of symptoms making it easier for the patient to maintain independence and a good quality of life. The AT Home Care in home medical team can help you manage symptoms with a variety of treatments, therapies and lifestyle changes. AT Home Care offers a variety of treatment and management approaches to those suffering from dementia. Medications such as cholinesterase inhibitors and memantine, as well as other drugs to help control mood, behavior and sleep disorders are oftentimes prescribed to patients with dementia. Occupational therapy is another treatment option available from AT Home Care. Our therapists work with patients in their homes by teaching coping mechanisms, and establishing ways to better manage symptoms and the affects dementia has on daily life. Through medication, therapy and modifications to the home environment, patients suffering from dementia can lead fairly normal, independent lives. The AT Home Care team of nurses, therapists and staff can offer guidance in all of these areas and help patients better manage symptoms, and adapt their lifestyles to coordinate with the slow progression of the condition. Dementia Statistics:

A Family’s Guide to Understanding Dementia Behaviors

Living with and caring for a loved one with dementia is challenging. It is hard for family members and friends to understand the behaviors associated with dementia, Alzheimer’s and other progressive brain disorders. This is especially true because these conditions gradually worsen over time, so it can be difficult to keep up with mental and behavioral changes as they fluctuate. For people with symptoms of dementia, their memory, communication, thought process and ability to care for themselves are all affected. Being aware of these behaviors is the key to understanding how to help the person maintain a dignified, quality life. Below are some of the most common behaviors of someone experiencing dementia. Discussed are the characteristics of these behaviors, and how family members and friends can help their loved ones through the difficult challenges associated with dementia. Aggression/Mood Swings: These behaviors aren’t intentional and are always triggered by something. Triggers could be the environment, discomfort or simply a symptom of miscommunication. Sometimes aggressive behavior and mood swings occur out of fear. It’s important to not get argumentative, and understand that the aggression is not deliberate. Make sure the person is not putting themselves, or others, in harms way before trying to redirect their attention to something else in an attempt stop the behavior. Repetitive Behaviors: For people with dementia, memory decline encourages them to repeat actions and behaviors over and over again, not remembering they’ve already done it once. This behavior can mean a number of things. The person may be suffering from boredom, seek the feeling of purpose, or feel anxious. Try to be patient and encourage a new activity that you can do together, explaining each step in a simple manner. Poor Judgment/Cognitive Difficulties: Deterioration of brain cells is the cause of judgment and cognitive problems. Be encouraging, reassuring and do your best to respond without making the person feel embarrassed. Offer to help with things that the person is experiencing difficulty, like finances, appointments and other day-to-day tasks. Communication Issues: Losing the ability to communicate effectively and clearly is one of the most difficult symptoms of dementia. The inability to express themselves and understand what others are saying is very frustrating for the senior, as well as their loved ones. Be patient and caring, not condescending. Pay close attention to the body language you exhibit, and use appropriate bodily cues. Adjust the environment for better communication. Turn off the TV and avoid any unnecessary background noise. Paranoia/Suspicion: These feelings arise due to declining memory, an inability to recognize people, and the desire to decipher and understand what is happening in the environment. Suspicions are unintentional and can be directed at anyone, like a neighbor, the mailman, or the most caring and supportive family members. Remember not to dismiss the person’s accusations or suspicions until you’ve deemed them untrue. Then, try to reassure the person and redirect their attention elsewhere. For more information on caring for a loved one with dementia, contact AT Home Care.One of the most difficult, challenging aspects of dementia is the gradual decline in one’s ability to communicate. Just like signs of dementia develop, symptoms do too. Initially the person may seem able to converse and share stories quite well. Slowly as dementia symptoms progress, patients often find themselves stumbling to find locate a word or share a simple sentiment. Over time, trivial forgetfulness turns into severe mental impairment. Not only is the inability to effectively communicate difficult, but the ability to expressing emotion is very difficult for a person in any stage of dementia. Families have an especially hard time understanding how to care for and support their loved ones with dementia. Fortunately, there are some simple strategies to promote better communication.
    1. Focus on non-verbal cues: Body language, facial expressions and other bodily signals are oftentimes easier to read than spoken language. Pay attention to the body language you put forward. Focus on the person’s cues to understand better how they’re feeling.
    2. Set up the environment: A successful conversation is dependent on the right setting. Eliminate background noise or sights. Turn off the TV or radio and put away cell phones. Maintain good eye contact and an appropriate talking distance.
    3. Practice patience: Give your loved one extra time to process what you are saying. Don’t rush into a new topic of conversation, as this can cause confusion. Even if you don’t understand what they are saying, don’t be condescending or use harsh emotions. Let delusions and misstatements go.
    4. Each day is a new day: The general trend of dementia sufferers is a downward decline, but like everyone, they will have ups and downs. Just because one day they’re more fluid and expressive doesn’t mean the next day will be the same. Having an overall understanding of the challenges helps you accept and prepare for the wavering nature of the disease.
    5. Be encouraging: Always responding, no matter what, shows the person that they’ve been heard. If you find a topic they are more communicative about, take it a step further by asking them to tell you more.
Communicating with your loved one may be challenging, especially as the disease reaches more severe stages. It’s painful to see them change as their symptoms become more prominent. One of the best reminders is that the person can’t control what is happening to them. Reminding yourself what you’re up against helps you not take things so personally or be too hard on yourself. All you can do is be patient, understanding and supportive as it helps the person feel more safe and secure.Tests that focus on memory and thinking are some of the main components to evaluating people for dementia and symptoms of Alzheimer’s disease. However, there is no single assessment that will accurately diagnose Alzheimer’s. It is through a series tests, scans and a comprehensive symptom evaluation that doctor’s can begin to even identify a diagnosis. These methods may still only determine that a person has dementia, or if the dementia is a sign of Alzheimer’s disease. Unfortunately, the disease itself can actually not be diagnosed with complete accuracy until after death. Various tests are available that challenge cognitive brain function and specifically look for the signs and symptoms of early Alzheimer’s disease. Recent data and studies suggest that there is a new assessment available that can efficiently test people for decline in cognitive abilities. This test is called the Self-Administered Gerocognitive Examination, or SAGE. There are many differences between SAGE and tests controlled by doctors in an exam room. SAGE is self-administered, so anyone can complete the evaluation on their own time, in the comfort and convenience of their home. The 22 question test takes about 10 to 15 minutes to complete, and draws on a variety of mental skills. The test includes, but it not limited to, areas of focus like problem solving, verbal fluency, reasoning and visual perception. Once complete, the participant can take the test results to their doctor and review the findings. Although SAGE will not identify early Alzheimer’s, it does accurately recognize symptoms that can lead to dementia, and can open lines of communication about early intervention. This is significant for several reasons. First, very early signs of cognitive decline are oftentimes overlooked in an exam room. Secondly, it enables doctors to intervene with appropriate treatments before degenerative brain disease develops. Cognitive decline and symptoms of dementia are far easier to control when caught early. Research suggests that SAGE will identify nearly 80% of people who have memory issues. Other studies conclude that the results of SAGE correlate well with more intense, detailed testing methods. This isn’t to say that the test supersedes all other brain imaging testing measures typically used to diagnose cognitive conditions. However, it is an easy, non-medical way to ease into a dialogue with a doctor and a loved one about the potential serious medical problems that can result from not catching signs and symptoms early enough.

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