Recognizing Symptoms of Dementia

The Brown family reunion has always been an event everyone looks forward to. Family visits, games, stories and everyone’s favorite foods are always on the agenda. On the top of the menu is Grandmas Lemon Coconut Cake. Grandma always makes the traditional cake from her old family recipe. This year, however, the cake tasted a little on the salty side, perhaps a half cup full of salty.

Though the family was disappointed over the cake, of more concern was Grandma’s confusion with the recipe and her similar confusion about the loved ones around her. Could something be wrong with grandma's mental state?

One might say that for an elder person a little forgetfulness or confusion is normal, but when do you know if there is a serious problem, such as dementia?

An online article from FamilyDoctor.org outlines some common symptoms in recognizing dementia.

"Dementia causes many problems for the person who has it and for the person's family. Many of the problems are caused by memory loss. Some common symptoms of dementia are listed below. Not everyone who has dementia will experience all of these symptoms.

• Recent memory loss. All of us forget things for a while and then remember them later. People who have dementia often forget things, but they never remember them. They might ask you the same question over and over, each time forgetting that you've already given them the answer. They won't even remember that they already asked the question.
  
  
• Difficulty performing familiar tasks. People who have dementia might cook a meal but forget to serve it. They might even forget that they cooked it.
  Problems with language. People who have dementia may forget simple words or use the wrong words. This makes it hard to understand what they want.
  
  
• Time and place disorientation. People who have dementia may get lost on their own street. They may forget how they got to a certain place and how to get back home.
  Poor judgment. Even a person who doesn't have dementia might get distracted. But people who have dementia can forget simple things, like forgetting to put on a coat before going out in cold weather.
  
  
• Problems with abstract thinking. Anybody might have trouble balancing a checkbook, but people who have dementia may forget what the numbers are and what has to be done with them.
  
  
• Misplacing things. People who have dementia may put things in the wrong places. They might put an iron in the freezer or a wristwatch in the sugar bowl. Then they can't find these things later.
  
  
• Changes in mood. Everyone is moody at times, but people who have dementia may have fast mood swings, going from calm to tears to anger in a few minutes.
  Personality changes. People who have dementia may have drastic changes in personality. They might become irritable, suspicious or fearful.
  
  
• Loss of initiative. People who have dementia may become passive. They might not want to go places or see other people."

Dementia is caused by change or destruction of brain cells. Often this change is a result of small strokes or blockage of blood cells, severe hypothyroidism or Alzheimer’s disease. There is a continuous decline in ability to perform normal daily activities. Personal care including dressing, bathing, preparing meals and even eating a meal eventually becomes impossible.

What can family members do if they suspect dementia? An appointment with the doctor or geriatric clinic is the first step to take. Depending on the cause and severity of the problem there are some medications that may help slow the process. Your doctor may recommend a care facility that specializes in dementia and Alzheimer’s. These facilities offer a variety of care options from day care with stimulating activities to part or full-time live-in options. Sometimes if patients tend to wander off, a locked facility is needed.

In the beginning family members find part time caregivers for their loved one. At first, loved ones need only a little help with remembering to do daily activities or prepare meals. As dementia progresses, caregiving demands often progress to 24 hour care. Night and day become confused and normal routines of sleeping, eating and functioning become more difficult for the patient. The demented person feels frustrated and may lash out in anger or fear. It is not uncommon for a child or spouse giving the care to quickly become overwhelmed and discouraged.

Family gatherings provide an excellent opportunity to discuss caregiving plans and whole family support. It is most helpful if everyone in the family is united in supporting a family caregiver in some meaningful way.

"The first step to holding a family meeting, and perhaps the most difficult one, is to get all interested persons together in one place at one time. If it's a family gathering, perhaps a birthday, an anniversary or another special event could be used as a way to get all to meet. Or maybe even a special dinner might be an incentive.

The end of the meeting should consist of asking everyone present to make his or her commitment to support the plan. This might just simply be moral support and agreement to abide by the provisions or it is hoped that those attending will volunteer to do something constructive. This might mean commitments to providing care, transportation, financial support, making legal arrangements or some other tangible support." The Four Steps of Long Term Care Planning

Professional home care services are an option to help families in the home. These providers are trained and skilled to help with dementia patients. Don’t forget care facilities as well. It may be the best loving care a family member can give is to place their loved one in a facility where that person is safely monitored and cared for.

The National Care Planning Council supports caregiving services throughout the country.
www.longtermcarelink.net

Can Fosamax and Other Osteoporosis Drugs Contribute to Bone Fractures?

What you need to know

by: Katharine Greider | from: AARP Bulletin | May 28, 2010

For years women, especially postmenopausal women, have been prescribed osteoporosis medications called bisphosphonates (a group of drugs that includes Fosamax, Boniva, Actonel and Reclast) to strengthen their bones. But recent reports have raised questions about whether long-term use of these drugs might be linked to an unusual fracture of the thighbone.

Two studies presented this spring at the annual meeting of the American Society of Orthopaedic Surgeons added to that concern as they pointed to changes in bone quality among women taking bisphosphonates for several years.

Doctors stress, though, that these medications do prevent fractures—especially hip fractures—in large numbers of women who have osteoporosis, and that the thighbone fractures are relatively rare.

Here’s what we know so far.

What did the new studies show?

These small studies were designed to explore whether prolonged use of these osteo drugs changes bone quality in ways that might promote thighbone fractures.

In one study, researchers at Columbia University Medical Center examined 111 postmenopausal women to measure the strength of their thighbones. About half of the women were not taking the drugs, and the other half had taken them for at least four years. The study found that for those on the medicines, bone strength improved during the first four years of drug therapy. But as they continued to take the drugs beyond four years, those improvements deteriorated, although not all those gains disappeared.

In the other study, researchers at the Hospital for Special Surgery in New York examined samples from the thighbones of 21 postmenopausal women; 12 had taken bisphosphonate drugs for an average eight-and-a-half years. The age of the bone tissue from women taking the drugs showed less range—there was more old bone and less soft, flexible newer bone—compared with women not on the drugs.

What do these findings mean?

Bisphosphonates work by suppressing the natural process in which bone tissue is removed and replaced with new bone. In osteoporosis, bone removal outstrips replacement and results in light, fragile bones. It’s possible, the studies’ authors suggest, that long-term drug therapy sometimes produces bone that’s thick and hard but harbors tiny flaws from accumulated damage or structural irregularities, which reduce the bone’s resistance to cracking.

Why did doctors first begin to be concerned about these drugs?

Certain kinds of bone fractures are considered typical for those who have osteoporosis. These include fractures in various places on the hip and spine.

But over the last several years physicians have published a series of reports of cases where women taking bisphosphonate drugs for a number of years experienced unusual breaks or cracks in the thighbone several inches below the hip.

Joseph M. Lane, M.D., an orthopedic surgeon at the Hospital for Special Surgery and NewYork-Presbyterian Hospital and a coauthor of one of the studies presented in March, says that in past decades this kind of break was so rare that few of his colleagues had ever encountered it. Since about 2000, he says, that’s changed. It’s still unusual, representing about 1 in 100 to 1 in 50 hip fracture cases treated at NewYork-Presbyterian Hospital between 2002 and 2007, says Lane. But, it’s a serious, hard-to-treat problem that seems to affect mainly younger, active postmenopausal women.

I’ve been taking a bisphosphonate for years. Should I stop?

Both the American Society of Orthopaedic Surgeons and the Endocrine Society have issued statements urging patients with osteoporosis not to stop taking their medications without consulting their physicians. To do so could expose them to the potentially disabling and even deadly fractures the drugs are meant to prevent in the first place.

“What we have to keep in mind,” says Elizabeth Shane, M.D., a Columbia University endocrinologist and co-chair of a major professional task force reviewing these thigh fractures, “is that garden variety fractures can be just as devastating as this type of fracture, but much, much, much more common—and these drugs do a pretty good job of preventing those types of fractures.”

If you treat 10,000 women with osteoporosis for longer than five years, research shows, you’ll prevent about 100 of these common fractures, says Shane, while perhaps—if bisphosphonates are indeed promoting the thighbone breaks—leading to two of these more unusual fractures. Two very small studies have followed women taking these drugs for up to 10 years, without uncovering serious problems.

Do I have to take the drugs indefinitely to maintain stronger bones?

Not necessarily. An important study published in late 2006 in the Journal of the American Medical Association compared results among women who discontinued Fosamax after five years versus women who continued taking the drug. Up to five years later, those who had gone off medication had roughly the same risk for most types of fractures as those who kept taking it.

“From the studies it would appear that once you’ve taken Fosamax for five years, if you stop for a year, probably nothing much changes,” says Ethel Siris, M.D., a past president of the National Osteoporosis Foundation who directs the Toni Stabile Osteoporosis Center at Columbia University Medical Center. The benefit appears to continue, she says, “probably because you’ve accumulated enough drug in your system. Once you’ve been off for two years, there’s a slight reduction in the hip density. It’s as if the effect is starting to wear off.”

Given these results, some physicians recommend a drug “holiday”—stopping the medications temporarily—to avoid unnecessary expense and inconvenience, if nothing else.

Who’s most at risk for the femur fractures? What can I do to avoid this problem?

Experts suspect that a small, specific group of women may be more at risk for unusual thighbone fractures. Perhaps these women have other conditions besides osteoporosis, have taken additional medications or have a genetic vulnerability. Unfortunately, no one can say at this point just what those risk factors are.

What doctors do know is that many women who suffered this type of upper-thigh fracture complained of thigh pain beforehand, sometimes for months.

“Since these cases have been published, I routinely ask all my patients if they have pain in their thighs,” says Shane. Such pain in osteoporosis patients taking bisphosphonates should prompt an x-ray of both thighs, and, if the images indicate a problem, referral to an orthopedic surgeon.

Are we certain osteoporosis drugs are causing these unusual fractures?

No. Studies haven’t been done to confirm that these unusual fractures are on the rise, nor is it clear that they are caused by Fosamax and other bisphosphonates.

In response to news reports on the studies, the U.S. Food and Drug Administration released a statement saying the agency would continue to investigate this “potential safety signal,” but so far hadn’t found evidence that women taking the osteoporosis medicines are at an increased risk.

Katharine Greider lives in New York and writes about health and medicine.