Can you believe it is November already? Now put yourself in the shoes of someone who has Alzheimer's - your memory is impaired and waking up every morning may feel like how you feel when you ask that question rhetorically with your friends...times 100. The Alzheimer's Association has deemed November as Alzheimer's Awareness Month. So let's bring some awareness and explore how lifestyle therapy can help a person with AD.
According to the Alzheimer's Association and the CDC, AD is the most common form of dementia that causes changes in memory, thinking, and behavior, is not a normal part of aging, and progressively worsens. Individuals with AD experience a decline in cognition and in functioning. Currently there is no cure for AD, and treatment centers around the management of symptoms.
Case Study: Mary
Mary is a 65 year old grandmother who enjoys taking care of her grandchildren when they get off school. She plays tennis every day, tells stories to her grandchildren about her childhood, cooks dinners for her family, visits with friends, and volunteers as a board member for a non-profit organization that she was the CEO of before retirement.
Mary was not the first person to notice her forgetfulness. Her family was. Through their occasional questions, Mary realized that she was forgetting little things here and there with more frequency. She would misplace her keys sometimes when she went out. She became afraid that she would lock her keys in her car one day. She began having some trouble remembering the names of things. She had friends who had family members with dementia and AD, so she decided to check in with her PCP. Her PCP suspected dementia, and after a visit with a neuropsychologist, the diagnosis is confirmed as early stage AD.
As her PCP discussed this diagnosis with Mary, he also referred her to lifestyle therapy so that she could receive guidance in coping and learning more about her diagnosis, symptoms, treatments, and what she can do to maintain her independent and happy lifestyle for as long as possible.
Lifestyle THerapy for Mary
Initial Evaluation: Determining Priorities
During the initial visit, Mary is flustered, anxious, and sad. It is clear to the Lifestyle Therapist (LT) that Mary is a person who highly values her independence and has limited knowledge about her diagnosis and prognosis. She has done research on the internet, and she is feeling terrified about her inevitable decline. Mary and her LT narrow down her priorities to learning more about AD and her prognosis, how she can maintain her independence, and how to communicate with her family as the disease progresses.
Creating SMART Goals
- Mary will learn at least 3 ways to educate herself regarding AD, her prognosis, treatment options, and symptoms from viable sources.
- Mary will create a daily routine that allows her to maintain her independence.
- Mary will develop communication skills that will allow her to effectively speak with her doctors and family members regarding her health and wellbeing.
Mary decides that for now, she wants to work with the LTone time a week. During treatment sessions, the LT teaches Mary about reliable sources from which to gather information about her condition, such as avoiding ".com" sites and reading ".org" and ".gov" sites instead.
The LT analyzes each one of Mary's daily tasks, from playing tennis to socializing with friends, to the specifics of each task as a board member. The LT assesses Mary's physical, social, cognitive, emotional, cultural, environmental, and psychological factors to determine strengths and weaknesses. The LT and Mary work together to find solutions to everyday problems and streamline a routine that works for Mary and minimizes forgetfulness. For example, Mary learns to place a neon-colored sign for "KEYS" inside a bowl placed on the entry table by her front door and another one labeled "WALLET, KEYS, CELL PHONE" on her front door so that she won't forget any of those items. Mary learns to play around with the placement of both signs - e.g. placing the WALLET sign at eye level on the door did not help because she never looked there when she opened the door - she had to place is right next to the door handle instead.
Mary explains that when she visits her doctor, she gets nervous and forgets everything that she had wanted to discuss, only saying, "Yea, I'm fine!" Mary says that she usually thinks about things to speak to her doctor about when she is lying in bed, so LT suggests that she keep a pen and pad by her bed. Also instead of trying to find a way to remember putting that piece of paper in her purse, LT suggests that she takes a picture of it the night before the doctor's visit. Mary is also concerned about speaking to her family, who are very loving and caring, but tend to want to coddle her. The LT teaches her ways to be assertive and firm without being hurtful to her family, such as using "I statements" or inviting a family member to attend an LT session with her.
As Mary continues to work with her LT, new problems arise that they need to work together and come up with solutions for. To help Mary create an independent, meaningful, and happy lifestyle is a trial and error process coupled with the LT's clinical knowledge.
***Check out the post next week to see how Mary progresses and how lifestyle therapy continues to help her and her family.
Do you know someone who you notice has recently been more forgetful, is having difficulty with word-finding, or misplacing or misnaming items? Encourage them to get screened for dementia and AD with their primary care physician! An early diagnosis means earlier treatment, which means your loved one may learn to maintain his/her independence in living the life they want earlier.