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More evaluations may be needed to confirm dementia; Caregivers Corner

Capital - 10/14/2018

Dear Mary, My mother's primary care physician recently diagnosed her with Alzheimer's disease. But when I came to the September workshop, Dr. Ann Morrison discussed different kinds of testing that my mother has not had. Now I'm confused. Does she have dementia or not?

Dear Reader, There is no single test that diagnoses Alzheimer's disease or any other dementia. I suggest you speak to your mother's physician to find out how that diagnosis was made.

Medicare now pays for an evaluation for cognitive impairment during a routine wellness visit or check-up. Many physicians use the Mini-Mental State Exam, which can establish a baseline for comparison in subsequent visits. It is not, in itself, a diagnostic tool but, rather, a screening tool.

The MMSE takes about 10 minutes to administer and assesses orientation to time, word recall, attention and calculation, language abilities and visual-spatial ability. While the MMSE has shown to be a valuable screening tool, it is not meant to substitute for a thorough neurological workup.

Ask your mother's doctor if blood work was done to rule out other causes of cognitive impairment, such as drug interactions, a vitamin B-12 or vitamin D deficiency, or a thyroid condition.

If there is reason to be concerned she is dealing with a cognitive impairment, a visit to a neurologist, neuropsychologist, or geriatric psychiatrist would be in order. Further testing, which could include brain imaging, can not only help determine if your mother is dealing with dementia but also the severity and type of dementia she has.

Dear Mary, I have been taking care of my husband who has frontal temporal lobe dementia for more than 10 years now. We didn't have children so I don't have any help and I still work full time. He is so nasty and he lies all the time, telling our neighbors that I don't feed him and that I am mean to him. When I am home, he always yells at me and sometimes pushes me so hard I fall. Some days, I don't even want to leave work. How can I get him to stop?

Dear Reader, If you have not spoken with your husband's physician, you need to do so immediately. Explain to him what is happening, question whether medication needs to be changed and whether it is safe for him to be home alone during the times you are at work.

Before you can "stop" his aggressive behavior, you must first determine the triggers. His behavior could be a result of physical factors (pain, illness, medications, fatigue), environmental factors (overstimulation or changes in routine), social/emotional factors (isolation, fear, boredom, frustration). Psychological factors (hallucinations, delusions and depression) and cognitive factors (trouble interpreting the world around them and language difficulties) can also contribute to aggressive behaviors. No matter the cause, this type of behavior is not safe for either one of you.

Memory care experts, such as those at the Alzheimer's Association, suggest the following responses to aggressive behavior:

*Identify the cause: What happened right before the individual became aggressive or violent? Is there a pattern to this behavior? Look for the feelings behind the words or actions.

*Rule out pain: Pain can trigger aggressive behavior especially when the individual cannot recognize it or verbalize it.

*Stay calm and never argue: Often, a person with dementia will become agitated when someone tries to make them do something they don't want to do. Unless the situation is serious, back down from your request. Do not shout back at an aggressive person with dementia, as this can escalate the situation. Use a calm tone of voice as you speak. Often, they will mirror your calm demeanor and start to relax.

*Eliminate environmental distractions and shift activities: Eliminate triggers in the environment (noise, glaring lights). Aggressive behavior may wane as the person with dementia loses track of why they are upset. Change the subject or scenery or try to engage them in an activity they enjoy

*Take a break: If your husband is in a safe environment and you are able, walk away for a moment to gather and calm yourself.

*Ensure safety: In cases where either you or your loved one is not safe, call 911. If your loved one is acting violent because they feel threatened, seeing a person in uniform may help them feel safe as well as mitigate the scene. If you do call 911, make sure to tell first responders the person has dementia, which causes them to act aggressively. We are fortunate here in Anne Arundel County to have all of our police officers complete the Communicating through Behaviors dementia training so they have the necessary tools to deal with these situations.

Again, I urge you to speak with your husband's physician to determine if his medications need to be adjusted and to help you determine if, for both of your safety, the home setting is appropriate for his level of care needs.

I also urge you to speak with your physician. Caregiving is exhausting and you are trying to do it all alone - while working full-time! Somewhere in the midst of all this chaos, you need a supportive environment, whether it be individual counseling or a support group. As the saying goes, "You can't pour from an empty cup."

Keep in mind that, like all symptoms of dementia, your husband is acting a certain way because of the disease. Individuals with dementia are struggling to live in a world that ceases to make much sense to them, and aggression might be their instinctual way to defend themselves.

Dear Readers, If you, too, are caring for someone who has been diagnosed with a dementia, please join us for one of the upcoming sessions of Communicating through Behaviors with Dementia Live. Our next session will be held from 1:30 to 3:30 p.m.Oct 22. Space is limited, so call 410-222-4375/4339 to register.

Questions and comments can be sent to Mary Chaput at the Department of Aging and Disabilities, 7320 Ritchie Highway, Glen Burnie, MD 21061, or by contacting 410-222-4339 or agchap01@aacounty.org.

Credit: Mary Chaput - Questions and comments can be sent to Mary Chaput at the Department of Aging and Disabilities, 7320 Ritchie Highway, Glen Burnie, MD 21061, or by contacting 410-222-4339 or agchap01@aacounty.org.

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