Osceola Woman Newspaper
Article written by Dr. Lucy Ertenberg, MD
Vice President, Chief Medical Officer of Cornerstone Hospice
Alzheimer’s disease is a form of dementia associated with a progressive and predictable loss of both cognitive function (ability to think and reflect) as well as physical function. The progression of decline with Alzheimer’s is well documented and begins with memory deficit. Although normal aging has similar changes such as remembering names and the location of objects, the Alzheimer’s patient, will gradually have more problems functioning in social situations including work. The disease causes further memory deficits such as knowledge of current events. Executive functions such as managing finances and driving become more problematic, while daily activities including dressing, feeding and toileting will require assistance.
The final stage of Alzheimer’s disease is 7. The patient reaches this stage when he/she cannot walk independently or cannot say six meaningful words. At Stage 7, the patient is a candidate for hospice services which provide more support to the patient and family. Ultimately, the patient loses the use of all words and becomes unable to smile. The patient has to be lifted to be moved and requires propping to keep his/her body and head in a good position. If other disease processes such as heart failure or pneumonia do no intervene, the patient will finally lose the ability to take in food and swallow.Approximately 70% of dementia patients have Alzheimer’s disease. Recognizing that there are other forms of dementia is important because they progress in their own ways causing different burdens for the patient and family. These forms include Vascular, LewyBody, Parkinson’s and Frontotemporal Dementia. Vascular Dementia, the second most common form, is caused by problems with the blood supply to the brain. Instead of a steady decline, the patient often has sudden, stepwise progression of loss of function. Vascular Dementia can be seen in conjunction with the other forms of dementia.
Lewy Body Dementia is more often associated with fluctuations in ability to process thoughts and attention. Patients commonly have various forms of hallucinations and symptoms often associated with Parkinson’s disease such as falls. Parkinson’s disease, itself, has been recognized to cause dementia in about 30% of patients afflicted with this.
Frontotemporal Dementia, which affects the frontal and temporal lobes of the brain, can be very distressing for the families because the patient becomes socially inappropriate. This includes the use of inappropriate language or inappropriate sexual actions. The family needs to remember that the disease, not the patient, causes the symptoms.
Some forms of dementia have the potential to be reversed such as dementia due to Hypothyroidism or Normal Pressure Hydrocephalus. Therefore, the symptoms of dementia should be medically evaluated and not ignored. Even if the symptoms are not reversible, medications are available to temporarily stabilize the progression. Ultimately, as the dementia progresses, hospice care can help keep the patient comfortable in the setting most appropriate for optimal care while also providing support for the family and caregivers.
Cornerstone Hospice and Palliative Care, a not-for-profit community-based healthcare organization, has provided care and services since 1984 to central Florida patients and families experiencing life-limiting illnesses. To learn more, call (352) 343-1341 or toll-free (888) 728-6234 or visit www.cornerstonehospice.org.