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Alzheimer's Answers is an educational forum where caregivers can connect with
professionals and clinicians to understand Alzheimer's Disease. This Chat Room provides
general information that is for educational purposes only and should not be considered as
offering medical advice. The information that is made available by this Chat Room should
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the diagnosis or treatment of any medical or health condition. ElderCare Online, the
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VALUE, USEFULNESS, COMPLETENESS OR ACCURACY OF ANY OF THE INFORMATION THAT IS MADE
AVAILABLE BY THIS CHAT ROOM.
Dr. Edward Zamrini
is an assistant professor in the Department of Neurology at the University of Alabama at
Birmingham. He is head of the Information Transfer Core in the UAB Alzheimer's Disease
Research Center, one of the leading institutions of its kind. His primary clinical
interest is early detection of Alzheimer's Disease and its treatment, although he has a
great interest in the way that knowledge is shared by professionals with families. Before
joining UAB, Dr. Zamrini served as associate professor of neurology and psychiatry at the
Medical College of Georgia, as well as acting chief of the dementia/Alzheimer's program
and director of the geriatric neuropsychiatry program at the Veterans Affairs Medical
Center in Augusta. You can read more about Dr. Zamrini and the University of Alabama at
Birmingham at http://www.health.uab.edu/show.asp?durki=29851&site=46&return=9885?
For additional chat transcripts, visit the Alzheimer's Answers Home Page.
Hello Mr. OBoyle, I'm trying to get myself oriented to the chat page.
I really appreciate the time and effort you are taking for this.
JeffDavis (This user has entered ElderCare Chatroom)
Hello Jeff and welcome
We are just getting settled in
Waiting for a few more attendees before we get started.
nico (This user has entered ElderCare Chatroom)
Hello Nico and welcome
Hello Dr. Zamrini!
I'm a counselor just starting a new job in senior services at Mental Health Center of
Greater Manchester in New Hampshire.
Do you work primarily with people with AD?
Caseload will certainly include clients with dementias of all sorts, but is not pre-sorted
Rich had quite a few questions so expect people to show up....
Jeff if you have a question to get us started, why don't you share it...
June (This user has entered ElderCare Chatroom)
Current caseload is 4 clients (but will grow rapidly i'm assured) one is early stage Alz
and one vascular dementia. One Dysthymia, and one is Bipolar II
Hello June and welcome
Hello, sorry to be late.
We are just getting started, so please get comfortable
One member wrote in advance: Her mother has been diagnosed with early stage AD, but has
not been told of her diagnosis. She has no friends or family, so she has limited
socialization. How can her daughter convince her to attend a local day care center?
therevera (This user has entered ElderCare Chatroom)
Hello theravera and welcome
We are just getting started.
You are next in line if you want to prepare/type in your question
darlene (This user has entered ElderCare Chatroom)
Hello Darlene and welcome
I don't have a question but wanted to observe if I may?
I usually try to enlist the patient in that decision (with the help of some leading
questions and by limiting options provided to her.) For instance, I may ask her if she
feels lonely sometimes, or if she would like to accompany me to a social event, etc. while
there may be reluctance at first, often patients are ultimately agreeable to trying a new
place. I would also encourage you to be there with her the first few times to help her
feel more comfortable.
By the way, what do you think about the issue of whether to tell someone that he or she
has Alzheimer's. As this first questioner says, her mother may suspect that's what she
has. So by not telling her, might that not feed feelings of paranoia?
What is the value of socialization for an individua with AD, or for any elderly person in
I am new at this and at being a caretaker. How do you tell you friends about the condition
of your spouse?
SR (This user has entered ElderCare Chatroom)
Hello SR and welcome... we just got started, so please get comfortable
I find that most patients have some awareness that something wrong is going on, and I have
had a number of patients tell me they think they have Alzheimer's disease or ask me flat
out if that is what I think. I believe in being honest and sensitive. If the patient asks
for a diagnosis name, I provide it. If on the other hand I tell them that they have memory
loss, that it is not normal but due to a disease, and that we should treat it, and they
ask no further I leave it at that.
Darlene, were you getting more speficially at how to tell friends about your husband's
diagnosis? Does HE know of the actual diagnosis?
Re socialization: I believe socialization is helpful. It stimulates brain activity and is
associated with less depression.
re telling friends: This depends on the friends and your relationship to them.
Yes, he is very aware of his diagnosis but is very uncomfortable in social situations. He
is afraid he will say the wrong things or forget the right words.
Could you try it out on some close friends first?
Perhaps it will ease your husband's concerns if others knew... then they would understand
why he may not have the social finesse he used to.
I find it easier to discuss memory loss in general and the prevalence of AD and the hope
for new medication and the fact it is not contagious with close friends and relatives that
one trusts. With others I would just be very matter of fact about it.
Do any of the caregivers here have their own experiences or input on this matter?
Would it also help Darlene's husband if he could find helpful coping strategies in social
situations, to help defuse any embarassment and help him feel less anxious?
We have told a few friends, but he is still uneasy even when I reasure him that he is
doing quite well socially. He does better when people do not know.
Darlene, your husband appears to be relatively high functioning. When going out with
friends who know his diagnosis, try to focus more on being social and enjoying the company
and less about being perfect. If they have a good sense of humor it helps not to focus too
much on any "slip-ups" and just treat them as very normal.
Thank you. I thank this will be a help to him and myself.
One of our members wrote in advance that she is concerned with preventing
"catastrophic behaviors." Can you explain what types of negative behaviors may
arise, and how to prevent them in the first place?
The trouble with trying to teach Darlene's husband coping strategies is that it is much
easier for others to adapt to his needs than for him to adapt to their desires.
I think you have to know the people you are dealing with and how much they know about AD.
Catastrophic behaviors can take on many forms. This reminds me of a "Cathy"
cartoon strip I once read. Cathy came home with a load of Christmas gifts, but looking at
her list realized she had much more to do and so got very upset.
The "normal" relationship between your husband and his friends will be changing,
his friends may need some support in understanding the changes that are happening and
learning ways to deal with the shifting relationship.
Catastrophic reactions are usually a sign that the patient is overloaded (for them). I
would start by remaining calm and listening and validating their concern. I would also try
to limit their decision-making needs. I would give them a lot of reassurance. I would try
to avoid the situations that lead to catastrophic reactions.
One member writes that her mother has disrupted sleep patterns. She sleeps about 18 hours
a day and would sleep longer if allowed. She has been diagnosed with mild dementia and
bipolar disorder. Are the prescription and non-prescription approaches to improving her
How do you deal with the agitation that sometimes comes with Ad? My husband gets very
frustrated and then becomes agitated or angry at something I have said.
Patients with AD and related disorders may have sleep changes. An increase to 18hrs due to
the disease would be unusual. Please check the medications she is on and if any of them
can cause excessive drowsiness.
This sleep pattern may also be attributable to depression. She should have a visiti with
her psychiatrist to assess efficacy of any anti-depressant and euthymic medications
While we're on the topic of sleep, several caregivers have asked us at the Alzforum about
sleep apnea among AD patients. Is that common? Is it related to the AD, or not?
Agitation in the AD patient can be very frustrating. Try to avoid the situations that
result in agitation. Remain calm. Try to find out if he is in pain or discomfort. Reassure
him. Avoid arguing. If the agitation is frequent consider an discussing antidepressant use
with his physician.
Thank you Jeff.
Our elder law attorney told us that sometimes people with AD have killed or injured
others. He gave an example of a woman who tried to cut off her husband's arm with a knife.
Are these kinds of reactions common, and are they predictable so that one can head them
off before something terrible happens? (I'm new at caregiving -- my husband was diagnosed
with AD only last July.)
I am not aware that sleep apnea is any more common in AD that in people who do not have
AD. It is a common condition and in some instances may result in some memory loss. Some
medications can disrupt sleep and result in sleep disorders.
One member asks: Does the Alzheimer's patient realize the changes they are going through?
When they lose their temper, do they realize that they are screaming, cursing, etc.?
There are occasional stories of violent acts by AD patients. Fortunately, these are not
very common. They are not predictable. However, if the person has a history of violent
behavior, that should be addressed.
some patients realize that some change is going on. Often, they deny the change or
minimize it. Generally, those who lose their temper are in a stage where they are less
aware of that.
Loss of temper, screaming, cursing etc. sometimes respond to calming and redirecting.
Their frequency may decrease when they are placed on Cholinesterase inhibitors or
emjay (This user has entered ElderCare Chatroom)
An an individual's personality traits change drastically with the onset of AD? For example
on member wrtites that her mother has become increasinglky suspicious and dwells on
painful past events. Can this be alleviated?
Hello emjay and welcome
Hello & thank you.
Lynne (This user has entered ElderCare Chatroom)
Hello Lynne and welcome
Personality change is one of the features of AD (and more so in frontotemporal dementia).
Degree and severity of change depend more on the area of the brain that is involved than
on past personality.
It is hard to deal with the changing relationship that accurs with AD. I sometimes feel
resentful that dicisions are up to me now. How do I deal with these feelings?
Suspiciousness and dwelling on past events may be eased by "going with the
flow". E.g. if the patient complains of losing their wallet, telling them 'let's go
look for it'. When suspicousness is of delusional intensity (does not respond to
validation or redirecting or evidence to the contrary) low doses of antipsychotics may
help. I prefer to try antidepressants which may or may not work, first.
Darlene, more than ever, you will need to use and develop support systems for yourself.
Mutual support groups, and, if needed, group and individual counseling should be available
in your community.
Find a caregivers group in your area
kworstell (This user has entered ElderCare Chatroom)
Thank you to all -- this has been helpful.
Hello kworstell and welcome
Thankyou. Glad I could make it.
Darlene, neither you nor your husband have chosen his AD. Your best bet is to recognize
that the disease is there. Your husband cannot stop the relationship from changing. It
seems he has made many of the decisions. Now it is your turn. this is your new role.
Consider it as a act of love (towards him). A gesture of gratitude ofr all the decisions
he made that you have appreciated.
One change in my mother that I've had trouble dealing with is her increasing
"neediness". She was always a strong independent person and a caregiver herself.
Now the more she tries to cling to me, the more the urge I have to withdraw from her. Any
I also agree with Jeff's recommendations.
Thank you for your suggestions and help.
I have had AD for 4 years now.I lose things too.My husband&I laugh alot about the
goofy things i do.We are in this together 100%.Which is as i should be
We go with the flow
We talk to everyone we can about AD.
It takes a while to get there, but it is getting easier.
Lynne... can you share some more insights on your condition... many of our members are
caring for someone with AD... your perspective is so helpful... what are the top 3 things
a caregiver should know?
Emjay, as the roles reverse, you may have resentment for the lack of nurturing that your
mother used to provide. Please be sure that you are getting your own needs for nurturance
emjay, see response to Darlene re her husband (above). Consider thinking of your actions
to comfort your mother as a "thank you" for all she has done. attend support
groups. If necessary, consider a sitter or some other pleasant socialization for her.
Don't argue,while you are still steamed,they have turned the corner,going a different
Take time out for you,95% of caregivers died before the LO does
Lynne, thank you very much for your insight and sage advice.
My final question from a member who could not be here: What are some tips and suggestions
for helping an individual with AD when going to the doctor, especially the eye doctor or
the dentist. Good eyesight, hearing and oral hygine are essential for quality of life. How
can the doctor visit be improved?
Thanks bunches, Lynne!
We both go to caregivers meetings every week
Lynne, you make a strong case for laugher being powerful medicine. And the importance of
acceptance of the experience you are going through. You sound like a wondeful couple!
We are both nuts,not really,but it helps at times....LOL
Make sure the doctor knows the patient has AD and what the patient likes and dislikes that
may be related to the visit. Chances are the doctor will try to adapt to the patient's
Should the CG and patient do any advance preparation for themselves? time of day? distance
I am still able to see the Dr.alone,but if i feel the need i have my hubby go too
Advance prep that we do - I write things out so I don't have to talk to the doctor as if
Mom is not there. She is still aware of being "talked about" and it gets the
appointment off to a bad start.
Yes, it is easier if the visit is in the morning rather than the afternoon. The patient
should be told they are going for a check-up and reassured that the cg will be right there
with them. Chances are the patient will be anxious about the visit. Reassurance helps.
In the office, I usually try to ask the patient questions first and when they cannot
answer, ask their permission to ask their caregiver.
Laughter is the best medicine in most cases
Thank you Rich for organizing this.
kworstell has just asked a quick question...
Thank you Lynne for your insight and advice.
Her mother sleeps 17hours a day. Is this normal?
Thank you Jeff for pitching in. I have to go to clinic now.
Dr. Zamrini, million thanks from all of us!
This goes back to our earlier question. But I wonder if Dr. Zamrini can suggest a healthy
timeframe for sleep... a target to shoot for
Rich, sleeping 17 hrs is not normal. Please check re depression and meds.
Dr. Zamrini, thank you very much from the Alzheimer Research Forum!
I find up to 12 hrs acceptable if above factors have been explored.
Thank you Dr. Zamrini. The transcript of this session will be edited (to remove MY typos)
and posted to the website later today.
Remove my typos too, Rich! : )
Thank you. Signing out.
I've enjoyed chat . thankyou all
I was on Zoloft,had to stop it,i slept all the time while on it
even on just 25mg
Kworstell... you may ask her doctor if any of her medications can be causing drowsiness.
Some professionals suggest setting up a rigid sleep, exercise, toileting schedule.
thank you all
Thanks - this was helpful.
thanks everyone and see you later.
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