Current theory holds that Alzheimer’s begins to manifest itself in a region of the brain called the hippocampus.  It is made up of two curved structures that lie towards the center of your head.  Some people believe that these structures look like sea horses, and so that’s where it gets its name from the Greek words for curved horse. The hippocampus helps us to filter and organize information, and it helps us to form new memories.

When we walk down a city sidewalk filled with strangers, the hippocampus is busy making decisions on whether we need to remember all the new faces that we are seeing.  In this situation, the hippocampus determines that they are unimportant to us, and so we don’t remember every single person we encounter on the street.  However, in a situation where we meet a new boss, or our future in-laws, our hippocampus determines that these are people worth remembering, and so we commit them to memory.

In the fall, when the trees turn gold and the air turns crisp, our thoughts may turn to the upcoming holiday season.  For some, this will be a time to visit loved ones who have recently been diagnosed with Alzheimer’s.  Families may even plan reunions right after a diagnosis, in the hopes of making the most of the time they have together.  Interaction with family is important.  If you have a large extended family, you might wish to modify your plans.   Alzheimer’s is typically a slow, progressive disease, and it’s not contagious.   Overtime, your interactions with your loved one will change as the disease progresses, but appropriate and purposeful interaction is essential to maintain a high quality of life.In a person with Alzheimer’s, the hippocampus starts to have problems filtering out information.  It gets distracted by unimportant facts and it misses essential details.  Researchers have shown that proper mental and emotional stimulation is essential to people with Alzheimer’s.  In fact, it’s important for all people whether you have dementia or not.  In patients with Alzheimer’s, the nature and level of this stimulation is critical.

As was mentioned, the hippocampus helps us to filter out stimulation coming at us, and in Alzheimer’s that part of the brain is under attack.  This creates a situation that I call the Goldilocks effect, where an Alzheimer’s patient can be easily under-stimulated and easily over-stimulated.  While each person is different, it’s possible to see this effect in a family reunion situation—too many people attempting to interact at the same time.  The person can become overwhelmed emotionally and mentally.

As an alternative to a single, large family gathering, you might consider spreading the visits out over an entire day or a weekend.  Instead of one holiday meal and party, split into smaller groups over multiple meals.  This will create a longer period of more moderate levels of stimulation.  If this is done, you might find that the person has better recall and more enjoyment.

Alzheimer’s is a disease not of just one person, but a condition that affects the entire family.  There may be hard times and challenges, but with some small changes you can add quality to this time of life and make new, special memories that you might not have thought possible.

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Know What to Look For

Some changes are barely noticeable, and not all changes are reason for concern.  Once-in-a-while we all forget details or put things off, but if a pattern of depression, neglect or confusion develops and persists, it may be serious, it might even possibly indicated dementia (a decline in cognitive functions due to disease or trauma).  So, for the benefit of your loved-one–and to improve their quality of life–sharpen your observational skills, and look for patterns of consistent neglect or deterioration within the following contexts:

Basic tasks – difficulty in walking, dressing, talking, eating, cooking, climbing steps, or managing medications.

Hygiene – infrequent bathing, unusually sloppy appearance, foul body and/or mouth odor.

Dressing – seasonally inappropriate dress, mismatched clothing (shoes, socks), multiple layers of clothes

Responsibilities – mail is unopened, papers are piled up, checkbook is unreadable, bills are unpaid, bank account overdraft notices are accumulating, prescriptions are unfilled, phone calls aren’t returned, cooking pots and pans look burned, refrigerator interior has foul odor, food supply is low, home interior and/or exterior is unkempt, laundry is piling up, automobile has new dents.

Health – weight loss, changes in appetite, problems swallowing, fatigue, burns, black and blue marks (possible signs of falling), hearing loss (look for signs of lip reading and talking loudly), seems withdrawn without reason, incontinence (bed-wetting), spilling and dropping things (check carpet for stains), complaints of muscle weakness, insomnia or excessive sleeping, dehydration.

Isolation – lack of interest in outside friendships, activities, or hobbies, keeps curtains drawn day and night (if this is atypical).

Attitude – sadness, display of verbal or physical abuse, talk of being depressed and feelings of despair, abuse of alcohol or drugs, paranoia, refusal to communicate, unusual argumentativeness, a recent emotional or medical crisis.

Cognitive functions – consistent forgetfulness about where things are, getting lost while walking or driving, confusion, loss of reasoning skills, difficulty answering questions, inability to find the right word, use of repetitive words or phrases, severe personality changes, wandering, inability to recall names of familiar people or objects, inability to complete a sentence, forgetting how to use simple, ordinary things such as a can opener, forgetting to close windows, turn off the stove, and lock doors, loss of sense of time.

Open Up a Dialogue

If some of these warning signs are present, and you may begin to question your loved-one’s ability to make choices and decisions, do not scare yourself and other family members into thinking that these are the early stages of dementia.  Overreacting and jumping to conclusions create communication friction and unfounded anxiety.  Many conditions can cause the outward symptoms described above, only a qualified medical exam can determine the underlying cause.  In many instances, the causes may be simple and easily treatable.

However, if a diagnosis of dementia is received, this should not be seen as an immediate death sentence.  Each day new discoveries are made to improve the treatment and care of individuals with dementia.  With most individuals, there are years of quality life ahead for the individual and their family.  The best action is to seek help and start all forms of recommended treatment as promptly as possible.  Evidence shows that delayed treatment only serves to increase the total cost of care and to increase other life altering affects.

Based upon your observations, if you have concluded that issues demand immediate attention, it’s time to take the next step and talk about it.  But beware, you are about to enter a sensitive a realm.  Without knowing the most effective ways to initiate these very sensitive conversations with your elderly family members, the probability of them telling you to mind your own business, or telling you everything is fine when it is not, is almost guaranteed.  You may wish to seek guidance from a Geriatric Doctor, Care manager, Social Worker, or mental health provider.

There are definite signs that indicate some kind of assistance may be necessary.  Failing eyesight, memory lapses, confusion, fatigue, sadness, drug and other substance-abuse and appetite changes can account for a diminished ability to manage a home.  As spouses and family caregivers, we might want to deny the need for help and hope for the best, but when observed objectively the need for action and increased care is usually undeniable.

On the following page is a simple observational checklist.  You may wish to use it to objectively assess your loved-one’s current condition and their ability to safely function independently.  When completed, you may wish to talk to your loved-one’s Doctor, caregiver, spouse and—with help, patients, persistence and love—with your loved-one.

Observational Checklist

Inadequate Meals and Nutrition

• Does there appear to be a loss of interest in preparing well-balanced, nutritious meals?
• Are there unusual amounts of spoiled food in their refrigerator?
• Have food dates expired on staple foods such as dairy and meat?
• Are there many packages and cans of the same thing?
• Are food products stored in unsafe or unusual places (lunch meat stored outside the refrigerator or cereal boxes kept in the refrigerator)?

Unopened Mail, Unusual Mail, or Piled Up Bills

• Is mail piled up unopened?
• Are there new or usual magazine subscriptions coming to the house?
• Do some of the bills come from unrecognizable sources?

Recurring Memory Lapses

• Are they missing doctor appointments or forgetting to make them?
• Are they making mistakes with their medication?  Too much?  Forgetting to take their pills? Confusing medications in original containers with those laid out on a daily basis?  Repeat prescriptions from more than one doctor or pharmacy?
• Are foods left to burn or overcook on the stove?
• Have pots been burned?

Lack of Interest or Feeling “Sort of Down”

• Have there been many peer losses recently?
• Has there been sadness or depression present for a long time (more than two weeks) without signs of improvement?
• Have they decreased or stopped social activities outside the home?

Driving

• Have you noticed a change in their driving capabilities?
• Do they get angry when you bring up a discussion about driving?
• Have you noticed changes in their agility, reflexes and eyesight?
• Have there been recent accidents?
• Has there been new reluctance to drive to new areas or areas less frequently visited?

A Marked Change in Behavior Patterns

• Is the home as neat and spotless as it used to be?
• Have they stopped attending church services or keeping beauty or barbershop appointments?
• Are they more irritable or otherwise moody, teary, sad?
• Are there unusual levels of paranoia or unexpected accusations towards friends and loved-ones?
• Have abnormal levels of obsession with items become apparent?
  • Repeatedly organizing purses or wallet
  • Checking calendars multiple times a day
  • Fixation on missing appointments
  • Repeatedly counting money in wallet or purse

Other Observations

• Do they repeatedly bring up the same issues of concern for discussion that might be indicative of areas they need help with but are reluctant to ask for outright?
• Have neighbors or other relatives spoken to you of their observations?
• Have there been sudden or new signs of dizziness or loss of balance?
• Are they refusing to use a new prescription (cane, walker, medication)?
• When was the last time of a complete physical?  Have you talked to the doctor?

Many life-alterations may require attention and support.   An active care plan can lessen the impact and improve quality of life.  Things may seem normal on the outside, but under the surface nothing is as it should be.  The only way to truly know is to be open and honest with yourself and the clues you are seeing.  If you have concerns about your loved-one, seek help.  Talk to advisors.  Ask for assistance.  It might be scary or over-whelming, but delaying action out of fear will only delay the inevitable, and may make matters much worse.  You are not alone, there are professional and volunteer support groups to help you with information and services.

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This document is not intended to diagnose any disease or condition.  Its purpose is to make the reader aware of areas of observation that may indicate a need to have further discussions with your loved-one or their medical professional.

If you are concerned about changes in memory or mental capacity, you may wish to ask your loved-one’s Doctor about Brain Activation Therapy, or ask them to visit aWiserMind.com to learn more.  Our services are based on over 100 peer-reviewed studies. They have shown success at improving quality of life, increasing confidence and slowing the long-term mental decline associated with dementia. Our services are covered by Medicare Part B for those individuals with appropriate coverage and diagnosis.