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Originally posted by: Starling
RevShasha, most stage 4 patients still work, still drive and have not been diagnosed. Pretty hard not to leave them alone if they have a paying job.
Are you certain your LO is at stage 4, because I'm amazed that you have found this forum that early in the game.
When my husband was at stage 4 he took a trip from the US to Australia in March by himself (major Northeast Snowstorms going, major Western Ice storms coming back). I realize he was in stage 4 NOW, but at the time I was clueless about dementia. I did have this vague feeling something wasn't quite right, but didn't even ask about his being assessed for another 18 months.
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Originally posted by: Starling
Actually the discussion involved more than one person and more than one time period.
I agree that leaving a stage 5 person alone for a week is a bit much, but early in stage 5 is one thing. Late in stage 5 is another. I won't judge.
Most of the conversation was about someone leaving a stage 5 patient for under an hour to run some errands and give the caregiver a bit of relief when it was too early to hire a caregiver.
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Originally posted by: Cathy J. M.
My partner was still in stage 4 when she could no longer be left alone. She'd get very frightened and confused. So it seems like a very individual thing.
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Originally posted by: RevSasha
Wow! I don't even leave my stage 4 DH alone for any more than a few minutes. If ANYTHING happened he would not know how to call for help. He had a monitor, but he never figured out what it was. Our neurologist told me well over a year ago that someone needs to be with him 24/7.
Besides all that the time he was left alone while I was working, he had no stimulus. He would stare into space or go back to bed. I felt he was slipping faster than necessary. I finally have him enrolled in day care. I am not working now, but he needs the social stimulus of going to day care 3 times a week.
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Originally posted by: Starling
Dave, I tried to quote your quotes but it got too confusing, so I'll try to answer this way.
I just knew he was afraid, the way you would recognize that you had given a child too much responsibility and that the child was afraid, and pull back. I can't explain better than that.
You can use the 7 stages or not. Whatever works. But we were discussing things here using the 7 stages. The problem with the 3 stage system is that no one ever sees Mild Dementia. Moderate Dementia can include anything including my husband who is now totally bedridden and can't talk because he is not yet actively dying. And I've got no clue as to what Severe Dementia includes because his last mini-mental had him as Profoundly Demented when he was in early Stage 5 according to the stages here.
It just worked better for me to be aware of the 7 stages and where he fit in them. He is currently in stage 7.
As for the "obsession with Stages" I'm just trying to be clear about what I was talking about in earlier posts.
As for "speaking Alzheimer's" it might be useful in earlier stages, but it is pretty useless when the person with the disease can't talk and doesn't interact with anyone even when he is awake. Understanding why he can't talk or take care of anything for himself and what needs to be done to keep him as comfortable as possible is what is useful right now.
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Originally posted by: RevSasha
Starling...I started coming to this site as soon as he was diagnosed. I am one to start researching things early. He was plagued with panic attacks and other than forgetfulness (that I attributed to his being a husband)had no other symptoms. During an MRI they discovered plaque formations in the brain. He quit driving the first time he got confused behind the wheel. He came home and handed me the keys. As I reviewed the stages of ALZ yesterday he is now clearly stage 5, that has come about in the past few months. What is remarkable about him is his awareness of the disease and ability to talk about it with me. His neurologist told me that he is doing so well because of his high level of intelligence. That being said, my primary concern was his inability to use the telephone early on. I think the lines are blurred between the stages, they are more fluid than static and helpful non the less.
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Originally posted by: Starling
Cathy, yes, being afraid makes it all different. When my husband got afraid, I stopped leaving him alone even though he continued to leave the house on two hour walks every day for at least a year longer. His doctor knew about the walks and had no problems with it. And he always knew how to come home. His wandering happened quite a few months after the walks had stopped and was a totally different kind of thing. I had no problems knowing the differences. And he was "going home" so he had no intention to come back the day he took off.
JAB, yes, his dementia is event driven. But he has had the classic stage symptoms almost always in the same order as with Alzheimer's. This is pretty typical of Vascular Dementias. The drugs work and the stages are the same, although the sub-stages can be a bit out of order. However, from what nurses in the nursing home have said, the sub-stages are frequently out of order towards the end of the disease with almost everyone.
I'll stick with what I said. Most patients are not diagnosed until stage 5. Most patients are still working if they are young enough in stage 4. And looking back now he was in stage 4 when he made the Australia trip. Looking back he had some anxiety during the trip home during the massive Western ice storm that had his plane on the runway for close to an hour before it could take off. But only a bit more than he would have had with no dementia.
We disagree on how the stages work, I think. I believe that the stages are a range. A patient is in a stage when they get the first symptom of that stage until they get the first symptom of the next stage. So people I would call stage 5 are sometimes called stage 4 because they don't have all the stage 5 symptoms yet.
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Originally posted by: JAB
Starling, I thought your husband had an unusual type of dementia ... event-driven, isn't that what you've said? Caused by his heart stopping and being restarted several times. Maybe that's why your experience is so different.
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Originally posted by: DLMifm
quote: Originally posted by Starling:
Cathy, yes, being afraid makes it all different. When my husband got afraid,
What did he do to make you aware that he was afraid?
quote: Originally posted by Starling:
I'll stick with what I said. Most patients are not diagnosed until stage 5. Most patients are still working if they are young enough in stage 4.
I hate broad generalities.
quote: Originally posted by Starling:
We disagree on how the stages work, I think. I believe that the stages are a range.
What's with the obsession with Stages?
IMHO Alzheimer's is an disease afflicting unique individuals individually. There seems to be a lot of debate/discussion as to which stage our LO's fit. As if there were some magic to being classified.
I'll stick to the swag ranges of early, mid, late. IMHO for carers it is more important to learn to speak Alzheimer's and develop awareness of what is going on moment to moment.
Long Live: "Correlation confusion"
Dave
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Originally posted by: lurk
quote: Originally posted by RevSasha:
forgetfulness (that I attributed to his being a husband). . . I think the lines are blurred between the stages, they are more fluid than static and helpful non the less.
Rev, you needed a  after that first thought.
I like the seven stages. I use Starling's approach when I describe my husband. I describe him as stage five as he does not need help dressing (choosing clothes, yes), eating, etc. For me it is very helpful to know the seven stages--three won't cut it. (Broad generalities.) Whatever works.
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Originally posted by: yy
quote: .
When the spouse or partner gets Alzheimer's -- it's my belief that our expectations have to adjust to reduce as much stress on them as possible -- which means lowering our own stress enough so we can be relaxed and caring and loving toward them without expecting the same thing in return. The whole dynamic of the relationship is new and different -- not bad, necessarily, but very different.
hi, Cathy. thanks you said so.
it is so true. When i am so depressed,your words make me feel much better. I learn a lot from here.
Thanks!!
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Originally posted by: DLMifm
quote: Originally posted by Starling:
[quote]Dave, I tried to quote your quotes but it got too confusing, so I'll try to answer this way.
quotes and atributions of posts are not my strong suite.
quote:
You can use the 7 stages or not. Whatever works.
My difficulties following the 7 stage approach: 1, I haven't studied them and absorbed the criteria. 2. How do you classify when the disease is unique to the individual and we're dealing with a continium of charactersitics accross the board. 3, I'm comfortable with broad categories since to me it is subjective system at best. 4. Does it really matter? Imho I find at my level of caring it doesn't matter to me. My LO's symptoms change on a irregular pattern. How I react and what she needs changes moment to moment in her current "stage".
The subject of death and dying is one that I am just not strong enough right now to discuss without getting emmotional and personal.
quote:
It just worked better for me to be aware of the 7 stages and where he fit in them. He is currently in stage 7.
With all on your plate I can't image how I will handle it. I appreciate that 7 stages helps and works for you.
quote:
As for the "obsession with Stages"
My sincere appologies for a bad choice of words. I did not intend it to be personal.
quote:
As for "speaking Alzheimer's" it might be useful in earlier stages, but it is pretty useless when the person with the disease can't talk and doesn't interact with anyone even when he is awake. Understanding why he can't talk or take care of anything for himself and what needs to be done to keep him as comfortable as possible is what is useful right now.
You have learned to speak Alzheimer's. I'm certain you understand how your words work even if he can't react or interact.
DLM
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Originally posted by: lurk
My husband was going to buy bananas. I said, "Good, you can buy wasp spray. I told him where to find it and what it looked like. He said that he didn't want to do it, and I recognized that he wasn't able. Not afraid, maybe, but not able to do that task. I think the fear will come later as a natural progression from what I've learned.
(Oh, yes, I said over and over, "Okay then, I will buy the bananas also. Don't buy bananas. I'll buy them on the way back from the doctor's." I bought one bunch; he bought two. More banana bread for all the neighbors. 
As for stages, of course they won't work if a loved one doesn't fit into the mold, but they are still a good guide for most of us. I've "studied" (read through) them over and over, and am content to see what happens, but when it does, not to be surprised or dismayed. Love the discussions.
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Originally posted by: JAB
quote: Originally posted by Starling:
JAB, yes, his dementia is event driven. But he has had the classic stage symptoms almost always in the same order as with Alzheimer's. This is pretty typical of Vascular Dementias. The drugs work and the stages are the same, although the sub-stages can be a bit out of order.
Actually, cholinesterase inhibitors are not recommended for patients with vascular dementia. Per guidelines such as the 2008 Updated Criteria for Use: Cholinesterase Inhibitors to Treat Dementia:
"None of the [cholinesterase inhibitors] has FDA labeling for vascular dementia. Systematic reviews and practice guidelines have not found a consistent or clinically significant treatment effect. At least one trial has raised safety concerns and the potential for increased mortality in this patient population."
The trial that raised safety concerns to which the guidelines refer was a Phase III to evaluate Aricept for treating vascular dementia. Out of 648 patients who took Aricept for 24 weeks, 11 died, while none of 326 patients in the placebo group died.
The progression of AD and VaD differs, too. One of the major differences is that AD tends to progress fairly steadily, whereas most VaDs progress in a series of steps, with plateaus in between sharp declines. (One exception to that rule of thumb is that step-wise progression may or may not be seen in lacunar state VaD.) VaD onset can be very abrupt; AD onset is slow and insidious. The life expectancy of VaD is shorter than that of AD.
The prevalence of various symptoms, and the order in which they appear, differs substantially between the two dementia syndromes, as well. For example, severe depression is more common in VaD than in AD; in fact, mood and behavioral changes may be more prominent than intellectual deficits in VaD. Executive functioning deficits are seen prior to severe memory loss in the early stages of VaD. Gait problems frequently are noticed in the beginning stages of VaD, unlike AD. See, e.g.:
http://alzheimers.boomja.com/V...%28VaD%29-26299.html
especially the Medscape article.
One study which compared VaD and AD at different stages concluded:
"VaD can be clinically distinguished from AD by criterion-related features that span across all stages of dementia. We also identified non-criterion-related features that differed according to dementia severity. In the CDR 0.5-1 stage, VaD patients demonstrated increased reading difficulty, loss of insight, apathy, and greater impairment in executive function compared with delayed and recognition memory. Unique distinguishing features for VaD in the CDR 2-3 stage included higher Geriatric Depression Scale scores, lower Barthel scores, gait apraxia and parkinsonism." (Barthel's index for basic activities of daily living looks at 5 basic, self-care functions.)
http://www.ncbi.nlm.nih.gov/pubmed/19052451
I have the full paper and would be happy to send it to anyone who would like it.
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