See a social worker and a lawyer to gather information on future legal, financial, and medical needs. This includes creating a durable power of attorney for a trusted family member or friend. Because Alzheimer's disease will eventually result in the loss of the ability to make decisions, during the early stages of the disease the person with the condition should designate a durable power of attorney for financial and health care decision-making.
Establish daily routines to provide a consistent environment for a person with Alzheimer's disease. Modifications can be made to the home environment to reduce confusion, disorientation, and agitation. Consistent routines and regular use of calendars, clocks, television, and newspapers can help maintain orientation. Changes in the physical environment or schedule should be avoided, as they can cause confusion and agitation. In addition, a person with Alzheimer's should not have access to potentially dangerous appliances or tools in the home. Make access to toilet facilities as convenient as possible.
Monitor and test the ability of a person with Alzheimer's disease to drive safely. Alzheimer's will eventually affect a person's ability to drive safely. Therefore, driving skills, including orientation, judgment, reaction times, and visuospatial abilities need to be monitored frequently. At some point, the physician and caregiver will need to restrict and eventually take away driving privileges.
Make sure that the patient eats well and drinks enough fluids. Alzheimer's disease patients are at increased risk for nutritional imbalance, dehydration, and weight loss as a result of the condition. For example, problems with memory and judgment can lead to difficulties with grocery shopping, preparing food, planning meals, and even remembering to eat. Depression often accompanies dementia, and may result in loss of appetite. Occasionally a patient with Alzheimer's disease will gain weight as a result of forgetting that they have already eaten a meal, or as a result of loss of self-control.
Encourage exercise to improve mental and physical functioning, social interaction, sleep, general well-being, and morale. These steps would benefit any person, but given that these are the types of activities that those with Alzheimer's disease neglect, make every effort to engage the patient socially and physically. Day programs geared towards persons with Alzheimer's disease can be particularly helpful.
Maximize function by moving the patient to an assisted living or other appropriate facility early. Although some people with Alzheimer's disease are able to continue living at home with the help of family or other caregivers, many are not able to. Moving patients to an appropriate facility early, when they are still able to form some new memories, is helpful for reducing confusion and maximizing self-care. For example, if the move is made when the person is in the moderate stage of the disease, they may never learn where the bathroom is, and will thus be more likely to be incontinent.
Maintain good oral hygiene. Oral care is often overlooked in patients with Alzheimer's disease, and can result in cavities, gingivitis, and tooth loss. Even at the mild stage of Alzheimer's, the patient may need supervised mouth care and more frequent visits to the dental hygienist or dentist.
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Education, counseling, and support can help the family of an Alzheimer's patient cope with the disease. Family members who know what to expect and how to effectively communicate with someone with Alzheimer's disease are better able to cope with challenging behaviors. Caregivers need to be aware of the warning signs of their own “burnout” and depression, and should seek help when needed.
Planned activities may improve the quality of life of the person with Alzheimer's disease. Planned activities can help a person with Alzheimer's disease feel independent and needed. Daily chores within the capability of the patient can be turned into productive activities. Leisure activities such as painting, singing, or reading may relieve depression and reduce agitation. For some people, the attention offered by a pet can be a soothing and pleasurable.
Paying close attention to the needs of the person with Alzheimer's disease can reduce agitation and outbursts. People with Alzheimer's disease may appear to become agitated or aggressive for no apparent reason, but behavioral symptoms often result from treatable problems that the person may not be able to communicate, such as pain, discomfort, thirst, or hunger. Paying attention to the needs of the patient may reduce the frequency of agitation or outbursts.
Because conventional medicine can offer no cure for Alzheimer's disease, many people seek out alternative treatments. Alternative treatments for Alzheimer's disease are continually promoted through advertisements in newspapers, magazines, television, and the Internet. Many of the treatments are advertised as herbal or natural, but because few of them have undergone clinical trials, it is difficult to evaluate either their safety or effectiveness.
Unproven alternative treatments for Alzheimer's disease include gingko biloba, huperazine A, coenzyme Q, and phosphatidyl serine. Huperazine A is an extract from a moss used in traditional Chinese medicine. Although rigorous controlled trials are lacking, huperzine A has anti-acetylcholinesterase activity similar to donepezil and rivastigmine. Anecdotal reports suggest that it is less potent than these FDA-approved medications. Gingko biloba has mild stimulant properties, and, like a cup of coffee, can improve attention and concentration. It can also interfere with sleep if taken late in the evening. While many claims have been made for phosphatidyl serine and coenzyme Q, there is no compelling evidence from well-controlled trials that either has any beneficial effect on either the symptoms or the course of Alzheimer's disease.
Alzheimer's is an incurable disease. Although the disease progresses differently in different individuals, a person with Alzheimer's can expect progressive deterioration of memory and mental functioning. Medical researchers in the past decade have made great strides in unraveling the genetic roots and biochemistry of Alzheimer's disease. Continued research holds the promise of halting, or at least delaying, the degeneration of brain function that occurs in Alzheimer's.
Careful monitoring of the person diagnosed with Alzheimer's disease is important in terms of ensuring he or she has care appropriate to the progression of the disease.
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