Taking a Team Approach to Fighting Alzheimer’s

There is no cure for Alzheimer’s disease. But, with the right unit of healthcare providers, Alzheimer’s patients can see their lives prolonged and improved.

My 32nd birthday was easily my worst. 

I lost my grandfather that day—January 25, 2005—to complications of Alzheimer’s disease. 

Alzheimer’s took my father not quite 12 years later, in the early afternoon of Dec. 31, 2016—by far the worst New Year’s Eve I’ve ever spent. 

My grandfather struggled with Alzheimer’s for roughly three years before succumbing to the disease. My Dad’s battle was about half as long, but every bit as gut-wrenching for all involved. 

This battle is one that too many families have to fight. According to Alzheimer’s Association figures, more than five million Americans are currently living with Alzheimer’s, with that number projected to grow to more than 14 million by the year 2050. 

Healthcare providers can and should be critical allies in this fight, of course. And the right team of healthcare professionals can help prolong and improve the quality of life for Alzheimer’s patients—and their families. 

Detecting and diagnosing

The team identifying and treating Alzheimer’s disease must be a multidisciplinary one, says Anjali Patel, DO, a memory and cognitive neurologist at the Atlantic Neuroscience Institute, Overlook Medical Center in Summit, N.J. 

“A typical care team for an Alzheimer’s disease patient should include the primary care physician, neurologist and/or a psychiatrist,” says Patel. “A social worker, care manager and psychologist may also be part of the team, depending on the needs of the patient.”

Each of these professionals has a specific role in the caregiving process. 

“The primary care physician will help manage the overall health and well-being of the patient, while a neurologist will diagnose and manage Alzheimer’s disease,” continues Patel, adding that a psychiatrist might also diagnose the disease and help manage any changes in mood or behavior. 

Along with short-term memory loss, decreased or poor judgment and withdrawal from work or social activities, such shifts in mood and behavior are just a few of the early symptoms of Alzheimer’s that providers should be looking for, she says. 

“A person may have difficulty planning or solving problems. They may have trouble completing tasks they were once able to do,” says Patel. “A healthcare provider can ask specific questions regarding memory and thinking during an office visit. A brief memory test can also be completed during an office visit.” 

Determining whether a patient is in progressive cognitive decline is critical to making an accurate diagnosis and effectively treating Alzheimer’s disease. 

Alzheimer’s is primarily a clinical diagnosis, meaning that there is no definitive blood test, biopsy or imaging study, for example, says Marian Schuda, MD, medical director of the Gerlach Center for Senior Health at OhioHealth. 

“Therefore, a physician should be involved to assure that other possibilities that might be treated differently are excluded. Also, the symptoms should be consistent with the course,” she says, adding that social workers are helpful in providing assistance to patients as well as their families. 

These and other healthcare professionals have many tools at their disposal to aid diagnosis. 

“While no test represents a gold standard, use of brief cognitive assessment tools with appropriate patients can aid in the early identification of [mild cognitive impairment] MCI and mild dementia,” according to Biogen, which provides a list of various screening assessments at www.identifyalz.com, a website intended to help healthcare providers detect and diagnose mild cognitive impairment due to Alzheimer’s disease. 

Most of these tests can be administered in 20 minutes or less, according to Biogen, and include the Mini-Mental State Examination (MMSE), the General Practitioner Assessment of Cognition (GPCOG), Test Your Memory (TYM) and the Memory Impairment Screen (MIS). 

By definition, Alzheimer’s patients lose the ability to function independently, says Schuda, who notes that support for these deficits can keep them living safely in the community and provide respite backup for the families. 

“Counselors are often very helpful. Mood disorders, i.e., depression, are common and respond well to treatment,” she says. “Occupational and physical therapists are wonderful at recommending modifications for homes that can make life much easier and safer—shower seats, hand-held shower heads, grab bars, toilet seat elevator, for example.” 

Improving quality of life

There is no cure for Alzheimer’s disease, and there’s not yet a known way to stop or slow down the disease’s progression. But, once Alzheimer’s has been identified, there are options available to help treat symptoms and improve patients’ quality of life, such as medications for memory and treatments for behavior, for example. 

The care team can also help set up cognitive activities for the patient, and care providers should play a role in helping Alzheimer’s maintain a healthy lifestyle, says Patel. 

“It is important to manage risk factors such as high blood pressure or high cholesterol with medications, diet and exercise.”

With regard to diet, research has shown a connection between a healthy diet and improved memory

Mealtimes also offer an opportunity to provide Alzheimer’s patients with needed familiarity and social interaction, as the National Institute on Aging points out

“Change can be difficult for a person with Alzheimer’s disease. Maintaining familiar routines and serving favorite foods can make mealtimes easier,” according to the organization. “They can help the person know what to expect and feel more relaxed.”

In terms of what early Alzheimer’s patients are eating, Schuda suggests five to seven daily servings of fruits, vegetables, nuts and grains, including adequate protein—a minimum of three to five ounces a day, such as a large chicken breast, for instance. 

Schuda also recommends modest aerobic exercise, such as walking 30 minutes a day, five days a week, and reducing medications as much as possible, including over-the-counter vitamins and supplements. 

“Some vitamins may be helpful; talk to a physician,” says Schuda, adding that adequate sleep is also crucial for Alzheimer’s patients. 

“Napping is very common, and might interfere with nighttime sleep,” she says. “This is best handled by adjusting activities and reducing napping, rather than by using medication.” 

References

  1. Alzheimer’s Association, Alzheimer’s Disease Facts and Figures, 2020. Accessed September 20, 2020. 
  2. Alzheimer’s Association, 2020. Accessed September 24, 2020. [https://www.alz.org/alzheimers-dementia/10_signs?utm_source=google&utm_medium=paidsearch&utm_campaign=google_grants&utm_content=alzheimers&gclid=CjwKCAjwh7H7BRBBEiwAPXjadvKaZwONT9EE7SoUlycS0HROQUCnCePGbfJlCx_JCOArCRHIZ8AD2BoCb7oQAvD_BwE]
  3. Biogen, 2020. Accessed September 25, 2020. [https://www.identifyalz.com/en_us/home/diagnosing-mild-cognitive-impairment.html?cid=PPC-GOOGLE-Testing_Diagnosis_Exact~S~PH~UB~NER~HCP~CON-alzheimers+screening-NA-p55516056324&gclsrc=aw.ds&&gclid=CjwKCAjwh7H7BRBBEiwAPXjaduQGga7RJao8leNlE7aJVBb9lKat_tKZbgjm8d3fPR4JMUZRSvSmqxoCj7oQAvD_BwE&gclsrc=aw.ds]
  4. Alzheimer’s Association, 2020. Accessed September 25, 2020. [https://www.alz.org/alzheimers-dementia/treatments?utm_source=google&utm_medium=paidsearch&utm_campaign=google_grants&utm_content=alzheimers&gclid=EAIaIQobChMIruuyvduB7AIVB4bICh2OaQ7LEAAYBCAAEgJpovD_BwE
  5. American Academy of Neurology, 2015. Accessed September 24, 2020. [https://www.aan.com/PressRoom/Home/PressRelease/1383]
  6. National Institute on Aging, 2017. Accessed September 24, 2020. [https://www.nia.nih.gov/health/healthy-eating-and-alzheimers-disease]

SIDEBAR

Alzheimer’s Caregivers: Tips for Daily Tasks

For family members serving as caregivers for Alzheimer’s patients, the duties that come with this role can seem daunting and, at times, overwhelming. The Mayo Clinic offers a number of tips to help family caregivers manage the load. For example:

Schedule wisely. Establish a daily routine. Some tasks, such as bathing or medical appointments, are easier when the patient is most alert and refreshed. Allow some flexibility for spontaneous activities or particularly difficult days. 

Take your time. Anticipate that tasks may take longer than they used to and schedule more time for them. Allow time for breaks during tasks.

Involve the person. Allow the person with dementia to do as much as possible with the least amount of assistance. For example, he or she might be able to set the table with the help of visual cues or dress independently if you lay out clothes in the order they go on.

Provide choices. Provide some, but not too many, choices every day. For example, provide two outfits to choose from, ask if he or she prefers a hot or cold beverage, or ask if he or she would rather go for a walk or see a movie.

Provide simple instructions. People with dementia best understand clear, one-step communication.

Limit napping. It’s important for individuals with Alzheimer’s to avoid multiple or prolonged naps during the day. This can minimize the risk of getting days and nights reversed.

Reduce distractions. Turn off the TV and minimize other distractions at mealtime and during conversations to make it easier for the person with dementia to focus.

Be flexible. Over time, a person with dementia will become more dependent. To reduce frustration, stay flexible and adapt your routine and expectations as needed. For example, if he or she wants to wear the same outfit every day, consider buying a few identical outfits. If bathing is met with resistance, consider doing it less often. 

References

  1. Mayo Clinic, 2019. Accessed September 22, 2020. [https://www.mayoclinic.org/healthy-lifestyle/caregivers/in-depth/alzheimers-caregiver/art-20047577]

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