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Is it delirium, depression, or dementia?

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Known as the 3 D’s these three can be mistaken for each other and inappropriately treated or ignored. A person can have more than one D and it is important to determine which one is causing the person’s change in behaviour as some are treatable and reversible.
Delirium is a medical emergency which is characterized by an acute and fluctuating onset of confusion, disturbances in attention, disorganized thinking and/or decline in level of consciousness.
Depression is a term used when a cluster of depressive is present on most days, for most of the time, for at least 2 weeks and when the symptoms are of such intensity that they are out of the ordinary for that individual.
Dementia is a gradual and progressive decline in mental processing ability that affects short-term memory, communication, language, judgment, reasoning, and abstract thinking.

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Are there any strategies to help me deal with challenging behaviours?

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Create a calm environment: get rid of triggers in the home that could set off anxiety, such as machines that make abrupt or unusual noises and bright lights.
Make sure the person is comfortable: check to see if the person is feeling pain, hunger, or thirst. Ensure a comfortable temperature and that the bathroom is easily accessible.
Simplifying potentially frustrating tasks and routines: Assist with bathing, dressing and chores that loved ones find harder to do
Give them a chance to burn off excess energy: accompany your loved one on walks, or have them attend your local Adult Day Program.
Other helpful strategies may include:
-Distraction or redirecting the individuals attention
-Avoid becoming confrontational or over excited
-Allow rest and quiet between potentially stressful activities, and ensure there is adequate light to reduce the potential for confusion
-Structured activities can be calming
-Listen to your loved one as they express frustration, they may provide you with clues to upsetting behaviour
-Provide reassurance that you are there to provide love, help and comfort
-Provide simple, clear and positive answers
-Provide plenty of supervised activity to channel their energy and reduce the frequency of wandering. Often wandering may be goal directed e.g. loved one may think they are going to work

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Can someone with dementia experience pain?

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People with dementia experience pain the same as anyone else. Individuals with a dementia diagnosis are often at a higher risk for events that cause pain such as falls and injuries. We should not assume a person with dementia is not experiencing pain especially if they have physical conditions indicative of aches and pain such as arthritis or a past surgery.
The difference is that a person with dementia may have lost the ability to communicate that they are in pain. They may express their discomfort in atypical ways such as by displaying responsive behaviours. There are a number of pain assessments that look at pain symptoms and signs beyond verbal expressions of pain such as facial grimacing, sleep patterns, appetite, and mood.

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How can I be better prepared when bringing my loved one to the hospital?

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Ensure that you have the proper documents:
•Health card and list of previous medical history
•Copy of legal documents (POA, advance directives, DNR)
•List of all current medications including vitamins and herbal supplements and over the counter medications
•List of physician names and contact information
•List of allergies or bad reactions to medication
•Key contact numbers (family, friends)
•Documented information for the health care team on concerns, behaviours and recent changes you have noticed

A hospital visit can often take several hours, it is also important to bring items that will allow you to redirect and calm your loved one down if needed. Some examples are:

•Personal security items
•Pictures
•Special blanket or pillow
•Spiritual objects
Meaningful activity
•Music
•Change of clothing
•Extra incontinence products
•Snacks and drinks

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How do I help support a person with dementia when they lose a loved one?

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A person with dementia can experience grief and can mourn actively as anyone else depending on the stage of the disease they are in. Supporting a person in the early stage may involve telling the person with dementia that their loved one has died, helping them understand the nature of the death and providing time and comfort for them to grieve in their own way. This may entail allowing them to plan the funeral or memorial or be part of the ceremony in some way. It may also include them in any culturally or religious rituals that provides them with comfort. Over time the person with dementia may ask about the loved one and in the early stage telling them what happened may be part of the family's plan. Preparing a photo album with pictures of the loved one during happy occasions may help the person with dementia focus on these happy times.
For a person with dementia in the middle to later stages of the disease, often their memory may not be long enough to 'hold' the details of the death and the loss. They may experience a change in behaviours, appearing more confused, sad, or disoriented especially if the loved one was a full time caregiver. The suggestions above will also help this person to grieve the loss. In the middle to later stages the person with dementia may often ask repeatedly where their loved one is. If is often suggested that 'reminding' the person with dementia that their loved one is dead is beneficial. This can increase anxiety and prolong the grieving process as each time they are told of the death the person with dementia will acutely grieve as if the event just happened. This can not only be traumatic for the person with dementia but also for the family to continue to tell the story of the death. As a suggestion, asking the person what they remember about their loved one, reminiscing a happy event or looking at a photo album is a better choice.
For a person in the later stages telling them of the loss of a loved one may not even register or be retained. It is often the feelings of the family that they 'need' to tell the person with dementia of this loss. As a suggestion, keeping the message very short and very clear and not repeating it again is a better way for the person with dementia to hear the information. They may not show any emotion. This is normal. Allowing time to reflect, telling stories, showing photos, and allowing ritual to be part of the person with dementia's life is recommended for healing for the whole family.

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How do I prepare for my doctor's appointment?

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When a memory problem is discovered the first step is usually making an appointment with a general practitioner. Using this work sheet will help you as well as your health care provider specifically look at the symptoms you are experiencing and will also help you remember what to ask the doctor once you have the appointment.

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How do we plan for the different stages of the dementia journey?

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With the diagnosis of a medical condition like dementia often there needs to be planning for the future stages as the disease progresses as well as for times when you may not be well enough to speak for yourself. This chart can help you see what decisions need to be made and when.

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How do we plan for the future?

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It is recommended that once a diagnosis of any disease has taken place that the family have a conversation about planning for the future. This may include: financial planning, future planning for care needs, legal planning. There are some steps that must take place in the early stages of this disease as it can affect the reasoning, thinking, and decision making skills of the person who has the disease. Allowing them to put their own plans in place, and document them with a lawyer and or accountant can help lessen the confusion in the future about what will be required. The Alzheimer Society can help either through the counselling department or through our many free educational seminars in helping sort out these complex issues.

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How is Alzheimer's disease diagnosed?

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There is no single clinical test that can be used to identify Alzheimer's disease. A comprehensive patient evaluation includes a complete health history, physical examination, neurological and mental status assessments, and other tests, including analysis of blood and urine, electrocardiogram, and an imaging exam, such as CT or MRI. While this type of evaluation may provide a diagnosis of possible or probable Alzheimer's disease with up to 90 percent accuracy, absolute confirmation requires examination of brain tissue at autopsy.

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How to deal with grief and loss?

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I am experiencing problems with my memory. What's my first step?

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The first step would be to make an appointment with your family doctor in order to be assessed. Typically an assessment for memory problems would include a full physical, collection of blood and urine, a full medical history and a memory test. There is no formal diagnosis of Alzheimer's disease or related disease, but these other tests can help your doctor eliminate other possible reasons for your memory loss.

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I am having difficulty in providing care for my person living with dementia. There have been so many changes that bathing has become more and more difficult. Plus the bathroom is not big enough. The bathtub is too deep and my person with dementia is having difficulty in getting in and out of the tub. What community supports are available to help with bathing?

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Personal care, bathing, grooming, dressing and toileting can be more difficult as the disease progresses. Often the person with dementia experiences changes in mobility and this prevents them from using a bathtub safely. Also there can be changes in the communication abilities of the person with dementia and so dressing and personal grooming can become difficult as the person with dementia cannot understand instructions and or becomes resistive to bathing and personal care routines.

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I am not sure if I want to tell my family and friends.

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Receiving a diagnosis for any health care issue can be a confusing time. At first you may want to keep the information to yourself as you may be unsure of what the diagnosis means for your future. Having a support network that may include family and close friends may be necessary for helping you to sort out questions and concerns about your future as well as having someone to talk to. You may also be still working and active in your community. Having a support network in your community will also be helpful as those around you may have noticed some changes in you. These individuals may also have questions. Perhaps your employer can set up some accommodates in your job or in your work day so that you can continue to work and be productive. Often people think that a diagnosis of dementia means that they will have to stop everything in their lives now. This is not the case. What will work for you will need to be discussed either with the family or a counsellor if you do not feel comfortable in advocating for yourself. There is also a stigma around this disease that can only be lessened the more we learn about the disease and help you to advocate for your needs.

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I am noticing some changes in memory of a friend who is only 55. Is dementia not a disease of the elderly?

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Alzheimer's disease or a related dementia is most often found in the elderly with symptoms usually appearing in the 60's. Early onset occurs in people age 30 to 60 and represents less than 5 percent of all people with Alzheimer’s. Most cases are caused by an inherited change in one of three genes, resulting in a type known as early-onset familial Alzheimer’s disease, or FAD. For others, the disease appears to develop without any specific, known cause, much as it does for people with late-onset disease.

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I am noticing some changes in the person with dementia's ability to understand simple instructions. Often when I am attempting to help them in the bathroom the person will not sit down. Is there a strategy to help them understand how to sit down?

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Dementia causes changes in the brain in the centres in charge of movement and language. This can cause difficulties as the disease progresses for simple tasks like sitting, getting up from a chair, or using the toilet. This video can help you better understand the strategies needed to help the person with dementia sit down.

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I am noticing some mood and memory changes in someone I care about. What do I do?

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The first step would be to help the person get to their family physician for a full physical in order to determine the reason for the changes. If this is a family member often there can be resistance to going to the doctor. If this is the case a short call to the doctor and expressing your concerns may encourage the doctor to call the patient in for a full physical. If this is not a family member then getting into contact with a family member and expressing your concerns would be the first step.

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I am only 55 years old and am experiencing some memory changes. Am I not too young to get dementia?

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There is a form of dementia that can start before the age of 65. It is called Early Onset or Younger stage dementia. Making an appointment to speak to your doctor, getting a proper diagnosis and connecting early to the Alzheimer's Society can help ease the worry about memory loss. Getting a full physical will also help in eliminating other possible causes of memory loss. For example: stress, depression, sleep deprivation, vitamin deficiencies, substance abuse, some medications can change memory as well. Once these have been ruled out then a referral to a neurologist may be the next step in finding out why there is a memory loss.

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I am providing care for a person with dementia in the middle stages. What are some of the community supports that I can suggest to the family?

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There are many community supports that can provide in home care for the person living with the disease, bathing or personal grooming support, respite care, adult day programs and recreational programming, transportation options and many more. Here are some fact sheets or use the First Link referral form to refer the family to the Alzheimer Society and an outreach counsellor can make these connections and referrals for the family.

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I am supporting a person in the middle to late stage of the disease. How can best support the caregiver as they seem to be burnt out?

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Often the middle stage of the disease progression brings many changes for the person with dementia and caregiver. There may be behaviours present, sleepless nights as the person with dementia may be up and wandering at night. Often this stage also requires 24/7 supervision and taking the person out of the home is sometimes not possible as they are more confused when outside their familiar surroundings. There may also be other health issues that are complicating the care. In addition the caregiver may have their own health issues and may also have been providing sole care for many years up to this point. Caregiver burn out is a concern at this stage and helping the caregiver understand the stress and help them to accept community supports will benefit the person with dementia and allow them to stay in their familiar surroundings longer. These information sheets may help or please use the First Link program and refer your clients to the Alzheimer Society for more in depth support.

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I can no longer leave my person alone. What are my options?

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At some point in the disease progression, and often during the middle stage the person with dementia either gets so anxious when left alone or that they can begin to wander outside of the home when left alone that for safety reasons leaving the person is no longer an option. The caregiver has some options. A private home care provider can be hired to provide short term respite in the home so that the care partner can do groceries, other errands or take care of their own doctor’s appointments. Another option is to ask a friend, family member or volunteer to stay with your person. Depending on how anxious they become this can be provided at the family or friend’s home. Another option is to access the many Adult Day Programs in the community. These programs can provide a safe and secure place for the person to stay during the day while the caregiver takes a break or does some errands. Please connect with the Alzheimer Society Peel’s outreach counsellors to discuss these options.

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I have a caregiver who is experiencing stress from caregiving for a person with dementia. What can I do?

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If you are a health care professional we have a program to help you support your patients who are caregiving for someone with Alzheimer’s disease or a related dementia get connected to community supports and services. By using the First Link Program the Alzheimer society peel will connect patients to an outreach counsellor within 3-5 business days. The program will enable you to feel secure in knowing that your patient will receive timely support, counselling, referrals and ongoing support throughout the disease process.

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I have a neighbour that gets pick up everyday and goes to a recreational program. What are these programs and are there programs for the person with dementia?

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There are many recreational based adult day centres in our communities. They can cater to older adults, the general public, and there are some that are specific to the person living with dementia. These programs are based on recreational and leisure programs to help seniors and the person with dementia to get out of the home, socialize, participate in brain stimulating activities, decrease isolation and increase mobility by providing exercise programs. These programs often have individualized programs based on the person's past history and hobbies, group programs like exercise, and outings. Often there are guest speakers who are invited to perform entertainment, or there are specialized therapies offered like Music therapy, Horticultural therapy, Pet therapy. Some programs also offer hairdressing, foot care and bathing programs in order to provide the most support in one place as possible. Most programs also offer snacks and a hot lunch and can accommodate many dietary and nutrition needs. Medications can also be managed on site. These programs offer respite for the family and allow them to know that their person is safe, stimulated and well taken care of so they can go to work or take care of their own needs.

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I have been diagnosed with a dementia. Does this mean that my children will get it?

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At this time scientists have not clarified the cause of Alzheimer's disease and related dementias. Over the years scientists have focused on many possible causes including the environment, other diseases like viruses, and genetics. At this time they know that genes do play a role in this disease but fewer than 7% of the cases are associated with this genetic link. At this time there is also no way of testing for a genetic link. Prevention is the most important aspect of life, and we encourage everyone to adopt a healthy lifestyle or make changes to your lifestyle now in prevention of any disease that may affect you in the future and as you age.

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I have been told to put my person with dementia on a wait list for a nursing home. I have heard that the wait lists are years long. What is long term care and how do I access it?

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Nursing homes are called Long Term Care homes. They follow a medical model in that they provide needed medical care for a person the is eligible for this type of care and can no longer care for themselves or be care for by another due to the excessive care needs. In the past these homes would be just for the elderly. Now these homes have a broader mix of people but they all require medical care of some type. In order to access the long term care system a family needs to connect with the Community Care Access Centre. They will be required to undergo a full assessment of the care needs, medical history and current diagnosis. Often the CCAC will suggest that the family tour the homes first to make sure that they are ready to make this decision and know what the homes look like and what they can provide. The homes can be very modern with many amenities and services or more 'hospital' like with ward style rooms. All of the long term care homes are Ministry run and inspected. There are no 'private' long term care homes. The Ministry of Health also sets the fees for these services. Please connect with your local Alzheimer Society and they can discuss this decision at greater length with you and help you connect with the CCAC.

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I have heard that the government has a program to help with seniors and person's with dementia. I am finding that I need more care but don't know who to call. What is the CCAC and what do they provide.

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The Community Care Access Center is the Ministry of Health's community support program for extended health care needs. If you are in hospital and need some nursing care when discharged, this organization can provide this type of short term support. If you are caring for a person with dementia and needs some bathing support, there are personal support workers that can be sent into the home to provide this care. If you need an adult day program or are considering long term care then the CCAC is the organization that assesses, determines eligibility, and manages the application and paper work for these types of services. This assessment can be done in the home. Care provided is often limited but free to the family. This brochure may answer some of your questions. Please call your local Alzheimer Society and they can help you get connected to the CCAC by putting a referral in on your behalf.

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I have heard that wandering can be a problem. My person has mobility issues and doesn't like the heat or the cold. Should I be worried?

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Wandering or becoming disoriented while away from home is a very common symptom of the disease and at some point 6 in 10 persons with dementia will become lost. They can become lost while out walking, driving, or when in a mall, or while travelling. It can happen at any point in time and whether or not they are with someone or alone. It can also happen at any time of day or night. Having a plan in place in prevention of the person getting lost is one strategy that can be put into place early on in the disease progression. Purchasing a Medial Alert bracelet will help identify the person and provide contact information in the event that they cannot speak for themselves. Carrying an identification card in a purse, wallet, pocket, or fanny pack may help as well. In the region of Peel registering the person on the Vulnerable Person's Registry will be invaluable to the policy when the person goes missing so that they can save time in gathering information about the person's description. Some families enquire about GPS tracking devices. There are many on the market and cost is often a factor in making the decision. Additional locks on doors, door alarms and safety locks on basement doors, garage doors and pool access gates are always recommended for safety. Please connect with the Alzheimer Society outreach counsellor so that we can help you find some strategies that work best for your situation.

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I have heard that wandering can be a problem. My person has mobility issues and doesn’t like the heat or the cold. Should I be worried?

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Wandering or becoming disoriented while away from home is a very common symptom of the disease and at some point 6 in 10 persons with dementia will become lost. They can become lost while out walking, driving, or when in a mall, or while travelling. It can happen at any point in time and whether or not they are with someone or alone. It can also happen at any time of day or night. Having a plan in place in prevention of the person getting lost is one strategy that can be put into place early on in the disease progression. Purchasing a Medial Alert bracelet will help identify the person and provide contact information in the event that they cannot speak for themselves. Carrying an identification card in a purse, wallet, pocket, or fanny pack may help as well. In the region of Peel registering the person on the Vulnerable Person’s Registry will be invaluable to the policy when the person goes missing so that they can save time in gathering information about the person’s description. Some families enquire about GPS tracking devices. There are many on the market and cost is often a factor in making the decision. Additional locks on doors, door alarms and safety locks on basement doors, garage doors and pool access gates are always recommended for safety. Please connect with the Alzheimer Society outreach counsellor so that we can help you find some strategies that work best for your situation.

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I have noticed some changes in the person with dementia's mobility and they are stumbling more. I am afraid that if they fall I won't know how to help them get up. Is there a safe way to help a person with dementia get up off the floor?

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When there are changes to mobility due to the disease or past physical injuries or a medical illness the person with dementia may have difficulty getting up if they fall. The brain changes due to the disease also effects their ability to understand instructions like, turn around, bend your knees, lift your foot etc. This video will help you to understand how to best help a person with dementia get up when they fall down.

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I have noticed that my person is very confused and paces in the late afternoon and well into the night. Several times they have gotten quite angry when I have attempted to comfort them. What’s happening?

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When the person with dementia becomes more confused, disoriented to time and place, agitated and often anxious and sometimes angry in the late afternoon and evening hours this is called Sundowning. This is a term that is used to describe this set of symptoms. At this point in time there is no known cause for this rapid change in behaviour except for the declining light at the end of the day. This is why it has been termed “sundowning.” The person may be more tired at the end of the day. Remember their brains are working harder than ours. They may have been over stimulated by their day. Or they may be hungry or thirsty. Regardless of the cause some specific tips are suggested. Offer the person a quiet place to be. Turn on all the lights, and close the drapes to the outside windows. Offer some small refreshments. Do not over stimulate them with questions, assurances, or comfort measures. What they need is a quiet and peaceful time. Be observant from another room if possible but don’t hover. Make sure the person is safe and there is no risk to them harming themselves but keep your distance. Our natural reaction when we see someone we care about being upset is to attempt to provide support and comfort. For a person with dementia this can be overwhelming and overstimulating. If the person is showing anger in their body language or in their speech then it is best not to engage them in any conversation. Agree with them, and walk away. Many more suggestions can be discussed with our outreach counsellors at the Alzheimer Society Peel.

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I need help with my patients who are experiencing memory loss. What questions should I be asking?

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This fact sheet can help you determine the questions to ask your patients so that an accurate diagnosis can be made. Often in the early stages the symptoms can be fleeting and assumed to be part of 'normal aging.' If after a preliminary assessment you are unsure of your next steps please make a referral using the First Link referral form to connect these families to our supports and services. A referral as well to a specialist at a local health centre may also help clarify the symptoms and an accurate diagnosis.

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I need to make some decisions and don't know where to start.

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When the disease progresses to another stage or when different services need to be added to help you and your person living with dementia continue to live in comfort often this is a time of confusion, indecision and grief. Connecting to your local Alzheimer Society can help you understand the changes, put strategies in place, and get more support. You are not alone and we can help you find what suits your family the best.

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I thought this disease only affects memory. Why is my person having difficulty finding words or recognizing common household items?

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Alzheimer's disease and related dementias is a global brain disease that begins in the memory centres of the brain. As this disease progresses it can and will affect decision making, sight, perception, mobility, hearing and sound perception, reflexes, language and speech abilities, ability to manage all tasks of daily life, follow a sequence and will affect their attentional abilities. These symptoms will appear gradually and will appear and disappear making it very difficult for the care partner, family and friends to "believe" that the person is suffering from a memory disease. Sometimes the person in front of you will appear "normal" and then some times will have great difficulty in managing. This can happen when we introduce a new task to the individual, take them away from their familiar environment (like when travelling), or when they are in a large group. At these times more support is needed and helping to reassure the person that help is available. Remembering that the brain is actively changing even though there seems to be no pattern or consistency and that the person with the disease is not purposely trying to be difficult. There are many strategies that can be learned and adopted with the help of an Alzheimer's counsellor or though one of our many educational seminars.

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I'm noticing some changes and need some help.

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As the disease progresses changes may occur very quickly or very slowly depending on the type of dementia and/or on other health issues. Being prepared for changes, putting care into place, connecting with community organizations before changes occur can help to minimize the effects of those changes on everyone. Your local Alzheimer Society can help you understand the common changes that can and do occur and what would need to be put into place. Having a Plan B will help minimize crisis plans and help keep options open.

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I've been diagnosed with dementia. What now?

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This can be a frightening and confusing time. Connecting with friends and family can help with the confusion of this diagnosis. Having the doctor connect you to the Alzheimer Society in your area can help make sure that you are well connected to the supports, education, and community agencies that you may need now and in the future.

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I've been given some "memory" pills, how will they help me?

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At the present moment the most common way to treat Alzheimer's disease and related dementias is through medication to enhance memory, thinking skills, language and mood. How these medications work is through their ability to preserve the functions of the nerve endings in your brain cells to transmit messages from one cell to the next. There has been much success for some people in the early stages with taking medication. Being active and staying physically and mentally active in addition to taking medication has shown positive results in slowing the progression of the disease. At this time there is no known cure for dementia but researchers are actively pursuing many positive studies in hopes for a cure in the future.

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My family and friends have suggested that I place my person into a ‘nursing home.’ How do you know when its time?

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Thinking about and making the decision to put the person with dementia into a nursing home or long term care environment can be a time of extreme stress for the caregiver. There can be emotions of sadness, grief and guilt and often anger at the person with dementia at “putting you in the position” of making this decision. Knowing the ‘right’ time is based on two main aspects. One is the caregiver’s own physical and mental health. Has the caregiver’s heath declined? Have they expressed that they can no longer provide care? Has the caregiver been treated in hospital lately? Has the caregiver been treated for stress, depression or anxiety? Is the caregiver not sleeping and having trouble managing the care needs of the person with dementia? Are you noticing changes in the caregiver like they have lost weight or they have a ‘chronic’ cold. The other is looking at the care needs of the person with dementia. When those needs become physical, for example physically helping them to walk, get up and down from chairs, or onto the toilet or in and out of the bath. Is the caregiver providing all care needs like feeding, toileting, bathing, dressing, along with other chores like laundry, cooking, grocery shopping, and driving to and from appointments? Is the person with dementia sundowning, up several times during the night, wandering during the day? These can all be signs that it may be time for the person with dementia to be assessed for a nursing home environment. This assessment is done by the Community Care Access Centre and there can be lengthy wait times. Speaking to an Alzheimer Society outreach counsellor to discuss these complex issues is a recommended plan of action.

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My friend turned 80 and has to take the driving re-test. I have been diagnoses with dementia and I am worried that they will take my license away. What can I do?

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Driving is a complex skill and we use it for keeping us active and independent. The prospect of losing your license and subsequently possibly losing your independence can be a frightening thought. The diagnosis of dementia for some people means that they will automatically lose their license. Perhaps this is due to other health related issues or medication side effects. Perhaps there was an accident and this is how a diagnosis of dementia was found. For some people with dementia they can continue to drive for a short period of time after a diagnosis as long as they make changes to their driving. For example not driving at night or in bad weather; and not driving alone to unfamiliar or new places. For some people a diagnosis of dementia means that they voluntarily give up their driver’s license saying that the risk out ways the benefits of driving. For each individual the decision is personal and connecting with the Alzheimer Society outreach counsellor so that we can help you to connect to other transportation supports or to education around driving and dementia so that you can better understand the process.

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My loved is experiencing increased anxiety, what can I do to help?

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It is important to try and identify the cause of the behaviour. Often an individual may be reacting to the Alzheimer’s diagnosis, and the course of the disease. Anxiety may involve fear of being alone or particular stresses, such as financial worries. Change is often a problem, such as a new caregiver, hospitalization, or travel. Parts of the daily routine, such as bathing or changing clothes, may induce anxiety.
The key to managing challenging behaviors is to accept the brain-behavior relationship so that the behaviors can be viewed through a compassionate lens and with a non-judgmental attitude. Once you have identified the possible sources of the anxious behaviour you can try to minimize their impact with Behaviour Management and the A-B-C Chain.
Antecedent- what occurred before a challenging behaviour or what “set the stage” for it to occur?
Behaviour- what is the problematic action?
Consequence- what happened directly after the behaviour?
For example: Does your loved one wander or become agitated when in a chaotic place such as a grocery store, when normally they are calm? How do you react after the behaviour? Do you stay calm or become defensive?
It is important to look at several instances over time to see if a particular antecedent or consequence has a trigger reinforcing the behaviour. After you have tracked and analyzed the behaviour try to develop new ways to deal with it. The key is to change the antecedent and/or consequence.
REMEMBER: Your loved one cannot control or prevent behaviours on their own; it is up to you to change what happens.

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My partner has been diagnosed with dementia. How will this impact our marriage?

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Often a serious health change can and will change aspects of the marital relationship. The diagnosis of a dementia can impact both the relationship, the retirement plans of the couple, the financial aspects of the marriage, ways in which the couple communicates and the sexual and intimacy needs of the relationship. As this is most often a disease of the older generation marriages have a tendency to be long and enduring relationships based on more than 5 or 6 decades of patterns of communication and behaviours. Suddenly you are both living with a new person or there has been an addition of an ‘unexpected’ and unwanted stranger into the relationship- called dementia. Intimacy needs still exist for each partner in the relationship. The need for love and belonging, touch, and sexual needs. These will still continue regardless of the dementia diagnosis. For the person with dementia sometimes the brain is not able to access the ‘mechanics’ of the act of sexual intercourse and as a couple, changes will have to be explored to satisfy both of their needs for intimacy. Perhaps a back rub, hand holding, kissing, and soft words of love may not only enhance the relationship but add a quality to life that was perhaps forgotten. For the caregiver your changing roles from spouse to caregiver can be an exhausting time as well as a confusing time. Are you the “wife/husband” or the “cook?” Are you “still married” or not if the person does not remember who you are? Dementia often requires the caregiver to live in a time of ambiguity between life that was and a new life that hasn’t been figured out yet. Connecting with the Alzheimer Society outreach counsellor to discuss these complex issues can help clarify the ambiguity for both partners in a marriage.

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My person is in the 'moderate' phase of the disease process. What do I need to know about this stage?

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The person in the moderate stage of dementia may be experiencing more confusion and difficulties with everyday tasks. This stage is progressive and may last several years. The person may begin to have difficulties with beginning a task, staying on task and finishing the task. The role of the caregiver increases from supervisor to coach to full care partner. For the person with dementia their short term memory may go from several minutes long to several seconds long and their long term memory may also begin to be affected. It is not unusual for the person to resist going out, resist any changes, resist help, and have difficulty understanding their everyday life. Repetitive questioning can be frustrating for the caregiver at this time and questions like; Where are we going? When is lunch? Why are we here? can be asked and require an answer multiple times a day. Often the changes in mood can be surprising to the caregiver and expressions of anger and quick temper can lead to conflict and arguments between the care partner and the person with dementia. Often this stage also brings with it a feeling on the part of the person with dementia and the care partner that they are prisoners. Often the care partner does not feel secure in leaving the person at home alone during this time. Sometimes the person with dementia, as changes occur and they are being asked to do many things, feel that they are living with a jailor and have lost control over their lives. Often there are physical changes in the person with dementia and this will require the care partner to be more physically supportive which can cause decreases in their own physical wellbeing. There are many strategies and supports that can be put into place to help in this phase. Please connect with the Alzheimer Society outreach counsellor so that we can help to direct your needs to the best supports available.

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My person with dementia has been hospitalized three times this month with an infection that doesn’t seem to get better. The doctor has suggested that we consider palliative care. What is this and what does this mean?

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At some point in this disease progression the disease becomes terminal and decisions will have to be made around the extension of life. The brain is in control of the body’s ability to manage illnesses though our immune system and the disease in the end stages will affect the person’s ability to fight off infections and recover from infections. Sometime more medication is not appropriate as the medication cannot be absorbed or used by the body to fight of the infections. The doctor may begin to have the conversation with the care partner and family members about withdrawing active ‘treatments.’ This is not to mean that the person will not be treated for pain, or be made to feel comfortable. Sometimes decisions around the late stage will also include decisions whether to provide a feeding tube, ventilation and other active tests and supportive surgeries. These decisions are all very difficult and stress producing. Having access to a spiritual advisor, trusted and unbiased family friend, a counsellor, or the palliative team at the hospital are all good supports to have at this time. Palliative care can be accessed at any time in the disease process but most often after several visits to the hospital for severe infections or other health events the decline the person with dementias abilities even more. At this stage the person with dementia will no longer be eating, speaking, or moving on their own. They may sleep for most of the day. They may not respond to visitors or may not recognize close family members. All their care needs are being provided for. At this point in time the person with dementia may also stop eating or refuse to eat or may be incapable of swallowing food that is presented. Palliative care is symptom management and care and support at the end of life for both the person with dementia and the care provider.

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Someone I know has been diagnosed with dementia. How can I best support them?

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As a care partner supporting a person with dementia who has just been diagnosed can be a difficult and confusing time. Many emotions about the diagnosis and what this will mean for your future as well as how you will support them can include: sadness, anger, confusion, grief, worry and stress. You may have many specific disease related questions as well as questions about how this will affect you future as a care partner as well as how this will affect the person you will be caring for. Getting as much information as possible, attending a support group or accessing counselling all through the Alzheimer Society will help you to sort out these confusing emotions and to also help you put an action plan in place for now and for the future. Often the diagnosis and the emotions can be overwhelming and having a support network of family, friends and the Alzheimer Society can reduce the stress felt at this time.

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Someone I know who has dementia is still driving. Should I be worried?

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The diagnosis of dementia does not automatically mean that they will lose their driving license. During the early stages of the disease progression the person may be capable of still driving. The care partner can offer support to the person with the disease by offering to drive them to unfamiliar places, driving in bad weather, or if they need to go out at night. These tend to be the environments that make driving more difficult. If the care partner or friends notice driving difficulties of the person with the disease, for example driving more slowly and more cautiously; asking directional questions, failing to notice road signs; hesitating in making decisions at intersections or getting lost going to familiar locations; new dents or scrapes on the car. These are signals that changes may need to be made. This can be a difficult time for the person as it can impact the independence of the person living with dementia as well as the care partner. Letting them know that there are community supports for when driving can no long be done safely often is one strategy that can be helpful. Please connect with the Alzheimer Society outreach counsellor so that we can help to direct your needs to the best supports available.

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The family doctor has suggested that that we use an Adult Day centre. What is it and how do we access this service?

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An adult day program is similar to a community centre or older adult centre. It is a place to go to participate in social and leisure activities in order to keep healthy and strong. Dementia specific day centres provides guided programing for all stages of the disease specializing in programs to stimulate the brain. Activities like music, exercise, gardening, baking, pet therapy, discussion groups, arts and crafts are programs that the person with dementia can continue to participate well into the disease process. Often the day program staff also take members out on day trips to the zoo, science centre and museums. A hot lunch is provided as well as snacks and refreshments. Most of the centres are open Monday to Friday and have extended hours from 7:00pm to 7:00pm. These programs are accessed through assessment by the Community Care Access Centre who determines accessibility and needs. These programs are also a way for the caregiver to get a break from the role of care taker for a few hours each day. Transportation can also be provided to and from the program. Please contact your Alzheimer Society Peel outreach counsellor to find out more about these programs and for a referral to the Community Care Access Centre to get the application and assessment process started.

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The person I am caring for is experiencing incontinence and having some bathroom accidents. How can I help them?

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At some point in the disease progression the brain begins to either not receive the messages from the bladder and bowels that they are full or the brain misunderstands the messages received. Keeping the person that you are caring for on a strict bathroom schedule, restricting liquids, in addition to perhaps medication changes can help with this personal issue. This video can help explain the steps to help a person living with dementia be most successful in using the bathroom and help them preserve their dignity as their body mechanics change.

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The person with dementia has become increasingly suspicious, how to I respond?

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A combination of memory loss and disorientation can cause the person with dementia to perceive situations in atypical ways. They may become suspicious of others, including you, and make accusations of theft, infidelity, or other offensive behavior.
As hard as it may be to be accused of something you did not do, try not to become offended. Remember that the behavior is due to the way the disease is affecting your person with dementia's brain. Don't try to argue with your relative or convince him or her of your innocence. Instead, share a simple answer or response, such as, "I see that you're upset about your missing wallet, so I'll do my best to find it for you." Avoid giving wordy or complicated explanations. Redirection to another activity can be very effective in these situations. It's also helpful to store "back-ups" of items that are frequently misplaced (e.g., baseball caps, purses).

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The person with dementia is experiencing Hallucinations, how should I respond?

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Hallucinations are sensory experiences that seem real to people with Alzheimer's disease, yet they are not really happening. The most common hallucinations are visual (seeing something that isn't really there) and auditory (hearing something that isn't really there), but hallucinations can also occur in regard to taste, smell, and touch.
Because hallucinations seem so real to those with Alzheimer's, it is not helpful to try to convince them that they are imagining things. Instead, acknowledge your loved one's feelings, try to reassure her that you are there to help, and redirect her to a pleasant activity.
Another thing to consider is whether the hallucination is actually bothering your relative. If it's a pleasing hallucination, for example, your loved one sees birds and flowers outside a window that are not really there, then there may be no benefit in trying to discourage or minimize the behavior

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The person with dementia is experiencing some behaviours and I would like to learn some strategies on how to help.

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At some point in the disease process the person living with dementia may not be able to communicate with their words as they once did. Instead they begin to communicate in other ways, for example with behaviours. Learning how to respond appropriately to these behaviours will help the person living with dementia stay calm and reassured that some one is there to care for them. It can be a scary time for the person living with dementia and using reassuring words, and a calm manner will help. Long detailed responses, logical answers, shouting or telling the person "Don't worry" will not ease their already agitated state. This brochure will help you learn the appropriate responses.

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There are changes to the person with dementia's mobility and they are having difficulty getting into and out of a vehicle. How can I help them?

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When there are changes to mobility due to the disease or past physical injuries or a medical illness the person with dementia may have difficulty getting into and out of a vehicle. The brain changes due to the disease also effects their ability to understand instructions like, turn around, bend your knees, lift your foot etc. This video will help you to understand how to best help a person with dementia get into and out of a vehicle.

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What are Alzheimer's disease symptoms?

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Most common type of dementia; accounts for an estimated 60 to 80 percent of cases.
Symptoms: Difficulty remembering recent conversations, names or events is often an early clinical symptom; apathy and depression are also often early symptoms. Later symptoms include impaired communication, poor judgment, disorientation, confusion, behavior changes and difficulty speaking, swallowing and walking.

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What are my resources for dealing with loss?

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Grief for the professional that is dealing with individuals living with dementia is a very real issue that can lead to burnout. The Alzheimer Society has prepared an information booklet to help deal with this topic for you to share with staff.

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What are some of the community supports and services for someone with dementia?

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1. Getting a diagnosis. Support a referral to a geriatrician, geriatric psychiatrist, neurologist, or Geriatric Outreach Team to assist with a diagnosis, cognitive assessments, and medication review and management.
2. Education and Support. Referral for the person or their friends and family to the local Alzheimer Society for education, counselling, support groups, and respite options.
3. CCAC. For community supports for activities of daily living, physiotherapy, occupational therapy, speech and language pathology.
4. Engagement for the person with dementia/Respite for the caregiver. Look into options for day programs, short-term respite, 24 hour respite care or homemaking support.

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What are some of the treatment options for a person with Alzheimer's disease or a related dementia?

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At this point in time there are four medication options for the management of Alzheimer's disease and related dementias. There is no know cure and the medications are not considered a treatment they are used to slow the progression of the disease. This brochure will help you understand the medications that are currently available.

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What are some of the treatment options?

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Your person has just been diagnosed with a dementia and has probably been given some medication. At this time there is no cure and no treatment for this disease. The medication works on the nerve endings of the brain cells in helping them to work more efficiently at sending and receiving information. The most success has been documented for these three medications in the early stages of the disease. Making the decision to take the medication must be balanced with the risks and the benefits to the person's quality of life. As will all medication there can be side effects. Medication management is a very early support skill that can be offered to the person diagnosed. They are experiencing memory problems and remembering to take their medication can be a complex task even in the early stages. Putting some strategies in place can help the person manage their medication successfully. Keeping a watchful eye that they are managing this task is very important as medication errors can disrupt the person's health, independence, and quality of life. Please touch base with the Alzheimer's Society in order to access tips and strategies to help.

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What are some quick tips when providing care to someone with dementia?

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Approach from the front.
Minimize distractions. Background noise, bright lights.
Introduce yourself: name, profession, and the task you are there to complete.
Speak clearly with a friendly tone.
Use simple statements or questions.
Be at the same physical level as the person.
Make appropriate eye contact.
Allow the person time to comprehend and answer.
Do not argue or correct.

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What are the First Steps?

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First Steps is a 4 week educational program for carepartners and those diagnosed with a dementia. You will be introduced to the changes in the brain, strategies for coping, community supports and financial and legal considerations. It is a great first step to being connected to the programs and supports through the Alzheimer Society in your community.

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What are the next steps after a diagnosis?

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There are several things that you can do now that you have been diagnosed. Learning as much about your diagnosis together with your care partner will ease some of the confusion and emotions around the diagnosis. Talking to a trusted friend about your diagnosis, and reach out to the Alzheimer Society to speak to an outreach counsellor. There are also some practical planning items that can be started and put into place for your future. These may include updating or creating a will, preparing a Living Will, putting in place your powers of attorney for both your finances and your health care decisions. This disease can impact your ability to make decisions in the future and you want to make sure that how you would like to live your life in the future has been discussed with your loved ones and formally documented with an accountant and a lawyer. The Alzheimer Society Peel can direct you to our many educational seminars to help guide you in this process and answer any questions you may have. Planning early and having these discussions can help you and your family make plans in the future.

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What are the other causes of memory loss?

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Some other causes of memory loss could be:vitamin deficiencies, delirium, stroke or other vascular issues, concussion, medication side effects among other things.

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What are the other types of dementias?

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The other types of dementias are neurological disease such as Parkinson’s disease and Huntington’s disease, Vascular dementia, Posterior Cortical Atrophy, Wernicke-Korsakoff (alcohol related dementia), Mixed, Frontotemporal, Creutzfeld-Jakob ( CJD), Normal pressure hydrocephalus, dementia with Lewy Bodies. Each of these dementias have different symptoms and causes. Some of the treatments are similar but others need specific treatments. Formal diagnosis is important in order to best direct treatment.
- Alzheimer’s disease
- Vascular dementia
- Dementia with Lewy bodies
- Mixed dementia
- Parkinson’s disease
- Frontotemporal
- Creutzfeld-Jakob
- Huntington’s disease
- Wernick- Korsakoff
- Posterior Cortical Atrophy

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What are the supports and services that are available in the community?

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At some point during the disease you and the person with dementia may require some help in the home, help with personal care, or may require a more stimulating environment. These are some of the supports that are offered to you through the community agencies in your community. If you require some light housekeeping, perhaps some meal preparation and medication management; this can be offered through private nursing companies at a cost. For a more stimulating environment there are adult day programs available at a small fee. They operate social, and leisure activities to help with keeping the person with the disease active, healthy and stimulated. If you are needing some support in the home with personal care which can include bathing support this can be provided through your local Community Care Access Centre. A personal support worker will come to the home to provide this support. There are also many adult day centres that offer bathing support in their programs as well as hairdressing and foot care for both men and women. For some extra caregiving support like respite care or short term home support these can also be provided for a limited time. Please connect with the Alzheimer Society outreach counsellor so that we can help to direct your needs to the best supports available. We can also make those connections for you through a referral process. We can also clarify the costs and benefits to the programs.

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What are the symptoms of Alzheimer’s disease?

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Most common type of dementia; accounts for an estimated 60 to 80 percent of cases.

Symptoms: Difficulty remembering recent conversations, names or events is often an early clinical symptom; apathy and depression are also often early symptoms. Later symptoms include impaired communication, poor judgment, disorientation, confusion, behavior changes and difficulty speaking, swallowing and walking.

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What can I do to keep my brain healthy?

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There are many things that can be done to help our brains stay healthy and functioning. A good healthy diet following Canada's Food Guide is a great place to start. A diet high in fruits, vegetables, low in fat and starches helps keep our heart functioning at full capacity in order for our circulatory system to provide much needed oxygen to our brains. Exercise is also recommended with at least 30 minutes a day of brisk walking. This can be done in 10 minute intervals throughout the day. Another brain healthy activity is being socially active. Join a club, volunteer, go out with friends, go to the local community centre or older adult centre to take part in activities every day. If you are not able to go out brain 'games' are another way of keeping your brain active: crosswords, puzzles, word searches, reviewing your basic math and language skills, learn a new language or practice an old one. Anything that keeps us engaged in life and stimulated every day is a great way to stay health and age well!

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What does the end stage of dementia look like?

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The late stage and end stage of dementia is also a progressive and declining in ability model. In late stage dementia the person may still be able to stand for short periods of time with support, may be able to take a few steps with support. May be able to sit up right for a few short minutes. The person with dementia may respond in short words or verbalizations when spoken to and may still be able to respond to simple commands. Person with dementia can still eat but meal must be soft pureed foods; liquids may have to be thickened to prevent choking. Person with dementia can no long recognize friends and family and may only recognize the care provider sometimes. The person will not be able to speak. The person will be fully incontinent of bowel and urine. All care needs are being provided for by the care provider. The person may be in a long term care home. Safety precautions must be taken for falls during transfers in and out of chairs and in and out of beds and baths as the person with dementia’s mobility is severely impaired. Often it will require two people to provide support to the person with dementia to keep them safe from falls. Often the person with dementia will have infections that require visits to the hospital, longer stays in the hospital and longer treatment courses of antibiotics. Please connect with an outreach counsellor at the Alzheimer Society Peel to discuss strategies and supports that can be offered at this stage in the disease process.

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What does the middle stage of dementia look like?

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The middle stage of dementia can be the most difficult stage for the care partner. This stage can include behaviours like wandering, suspicions, resistance to care. It will require the care partner to supervise the person living with dementia 24/7 due to the fact that the person is not safe being left alone. This stage is where the care partner may consider community supports like home care, day programs, and bathing support. It is also a time where the care partner may need to reach out to others in order to gain support and strategies for the many changes that are occurring at this time.

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What is a Living Will?

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Living Wills are directions or instructions left for a designated person like a family member, friend, or Power of Attorney that describes the care that you would like to be provided to you in the event that you cannot speak for yourself. This document is one of several that can be found on the internet that can be filled out and kept in a safe place with your Will and Powers of Attorney. The Powers of Attorney are the people who will make these decisions and the Living Will describes to them the decisions and care that you would like for your future.

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What is a Medical Alert bracelet?

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The Medical Alert Bracelet is a bracelet that is worn by any one that has a health concern, takes multiple medications or perhaps has a medical apparatus for example a pace maker. This way if the person cannot speak for themselves during a health event the emergency personnel can access their health records in order for them to provide care. If the person has a memory problem and gets lost the Medical Alert bracelet can be used to contact family and get the person back home safely.

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What is Alzheimer's?

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Dr. Alois Alzheimer first identified the disease in 1906. He described the two hallmarks of the disease: "plaques", which are numerous tiny, dense deposits scattered throughout the brain that become toxic to brain cells at excessive levels, and "tangles", which interfere with vital processes, eventually choking off the living cells. When brain cells degenerate and die, the brain markedly shrinks in some regions.

The image below shows that a person with Alzheimer's disease has less brain tissue (right) than a person who does not have the disease (left). This shrinkage will continue over time, affecting how the brain functions.

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What is Creutzfeld-Jakob disease (CJD)?

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CJD is the most common human form of a group of rare, fatal brain disorders affecting people and certain other mammals. Variant CJD (“mad cow disease”) occurs in cattle, and has been transmitted to people under certain circumstances.
Symptoms: Rapidly fatal disorder that impairs memory, coordination and causes behavior changes.


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What is Dementia with Lewy Bodies?

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People with dementia with Lewy Bodies often have memory loss and thinking problems common in Alzheimer's, but are more likely than people with Alzheimer's to have initial or early symptoms such as sleep disturbances, well-formed visual hallucinations, and muscle rigidity or other Parkinsonian movement features.

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What is First Link for Caregivers

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First Link is a program of connecting care partners and the person living with dementia to the Alzheimer Society in order for them to be quickly link to supports, information and education. After a diagnosis there may be many questions and emotions. The Alzheimer Society has professional Outreach Counsellors that can help guide you in this journey. You are not alone; we can help.

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What is First Steps for families?

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First Steps for families is a psycho-educational program for families that have just been diagnosed with a dementia. It is attended by the carepartner and the person living with dementia. The program consists of education on the disease, planning for the future, safety planning and understanding the community supports that are available. It is the first step for many families.

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What is Frontotemporal dementia?

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Frontotemporal dementia includes dementias such as a behavioral variant FTD (bvFTD), primary progressive aphasia, Pick's disease and progressive supranuclear palsy.
Symptoms: Typical symptoms include changes in personality, behavior, and difficulty with language. Nerve cells in the front and side regions of the brain are especially affected.

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What is Huntington's disease?

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Huntington’s disease is a progressive brain disorder caused by a single defective gene on chromosome 4.
Symptoms: Include abnormal involuntary movements, a severe decline in thinking and reasoning skills, and irritability, depression and other mood changes.

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What is Mixed dementia?

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In mixed dementia abnormalities linked to more than one type of dementia occur simultaneously in the brain. Recent studies suggest that mixed dementia is more common than previously thought.

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What is Normal Pressure Hydrocephalus (NPH)?

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Normal Pressure Hydrocephalus is a rare neurological condition caused by the build up of excess amounts of cerebrospinal fluid in the ventricles or cavities of the brain. This causes the surrounding brain tissues to be damaged.
Symptoms include difficulty walking, memory loss and inability to control urination.
Brain changes can sometimes be corrected with surgical installation of a shunt in the brain to drain excess fluid.

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What is Parkinson's disease?

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As Parkinson's disease progresses, it often results in a progressive dementia similar to dementia with Lewy bodies or Alzheimer's.
Symptoms: Problems with movement are common symptoms of the disease. If dementia develops, symptoms are often similar to dementia with Lewy bodies.

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What is Posterior Cortical Atrophy disease?

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Posterior cortical atrophy (PCA) refers to gradual and progressive degeneration of the outer layer of the brain (the cortex) in the part of the brain located in the back of the head (posterior). It is not known whether PCA is a unique disease or a possible variant form of Alzheimer’s disease. In many people with PCA, the affected part of the brain shows amyloid plaques and neurofibrillary tangles, similar to the changes that occur in Alzheimer’s disease but in a different part of the brain. In other people with PCA, however, the brain changes resemble other diseases such as Lewy body dementia or a form of Creutzfeld-Jacob disease. Most cases of Alzheimer’s disease occur in people age 65 or older, whereas the onset of PCA commonly occurs between ages 50 and 65.

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What is the difference between Alzheimer's disease and dementia?

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Alzheimer's and dementia are still a mystery in many ways. This is why the two similar diseases are often mixed up in every day conversation and understanding. According to the National Institute on Aging (NIA), Dementia is a brain disorder that affects communication and performance of daily activities and Alzheimer's disease is a form of dementia that specifically affects parts of the brain that control thought, memory and language.

Read on to discover more particulars on how the two diseases vary and why there's still a lot of scientific research needed as well as public awareness around these worldwide epidemics.

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What is the First Link program?

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The First Link program is a referral service that connects families and the person living with Alzheimer's disease and a related dementia directly to the Alzheimer Society in their location. This connection will provide the family with much needed supports, counselling and education to help on their journey. Referrals can be made through a health care professional.

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What is the Power of Attorney for Personal Care?

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There are two Powers of Attorney that exist in Canada. One for financial decisions and one for health care decisions. A Power of Attorney is a designated person who will make decisions on behalf of the person who cannot speak for themselves due to a health event or medical condition prior to death. Powers of Attorney are legal documents that every person should have as part of their important papers including the Will. Powers of Attorney are directions that need to be made prior to death and Wills are directions for decisions after death. This document will explain the Powers of Attorney for Personal Care. Please reach out to your local Alzheimer Society if you have any questions.

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What is the Vulnerable person registry?

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The Peel Police have developed a way to register vulnerable persons including seniors with memory issues so that they can quickly begin to search for a senior that may have gone missing. This fact sheet explains the program. Please register with the Peel police to help keep vulnerable persons safe and independent in their communities.

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What is Vascular dementia?

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Previously known as multi-infarct or post-stroke dementia, vascular dementia is less common as a sole cause of dementia than Alzheimer’s, accounting for about 10 percent of dementia cases.
Symptoms:Impaired judgment or ability to make decisions, plan or organize is more likely to be the initial symptom, as opposed to the memory loss often associated with the initial symptoms of Alzheimer's. Occurs because of brain injuries such as microscopic bleeding and blood vessel blockage. The location, number and size of the brain injury determines how the individual's thinking and physical functioning are affected.

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What is Wernick- Korsakoff's disease?

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This syndrome is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1). The most common cause is alcohol misuse.
Symptoms: Memory problems may be strikingly severe while other thinking and social skills seem relatively unaffected.

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What is"Last Steps"?

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Last Steps is an educational program offered through the Alzheimer Society Peel. It is a three part series offered to caregivers and professionals that describes the late and end stages of the disease process, the decisions that may need to be made, and the emotions like grief that are triggered during this stage. Please call the Peel chapter to find out when the next presentation is scheduled. If you are a health professional and would like this presentation to be offered at your next health fair or meeting please call the Peel chapter to book. Last Steps is also a toolbox of informational resources that are available dealing with dementia specific grief, end of life, and death that can be accessed for your professional practice and information.

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What would be the benefits to investigating memory loss?

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No all memory loss is the beginnings of a dementia so making sure that all memory loss is investigated is an important first step. Getting a diagnosis early on in the dementia journey can help you get connected to the appropriate supports in your community as well as make preparations in your life for a time in the future where you may not be able to care for yourself or make decisions. This may include writing a will to settle your estate as you wish. Establishing a Power of Attorney for your financial decisions while you are still alive but cannot make those decisions. And establishing the Power of Attorney for Health care Decisions for those decisions that will arise in the future regarding who will care for you and how they will do this. An early diagnosis can also help with a treatment plan of proper medication for the type of dementia as well as life style changes that can enhance health. A change of diet, adding an exercise regime and connecting with a local social club or group will help to establish healthy behaviours for now and the future. There are also many programs at your local Alzheimer Society to participate in that will help you maintain and stimulate your brain.

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Where do I start in getting a diagnosis?

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Your first step would be to discuss the issues that you may be experiencing with your general practitioner. He or she may do some preliminary testing and then refer you to a specialist. This fact sheet will help you to prepare for this appointment.

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Where do we go from here?

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After completing a Getting Started seminar and our the First Steps for Families program through our education department, families can now access our many support groups. There are support groups for carepartners, a specialized support group for persons living with dementia in the early stages, an early onset group for those younger than 65 and many more. Or perhaps you would like to speak to an outreach counseller for some one to one support or to help you get started with connecting to other community supports. Please contact your local Alzheimer chapter to find a program that best fits your needs.

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Why do some people with dementia have responsive behaviours?

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People with dementia are facing challenges with making sense of the world around them. Someone will display responsive behaviours for many reasons such as:
An unmet need. ie. Temperature, hunger, boredom, loneliness
Physical health issues. ie. Delirium from an infection, arthritis pain
Cognition changes ie. Unable to understand or process information, unable to communicate
Emotional or mood changes ie. Depression, agitation, frustration.
Changing capabilities. ie. Unable to dress/bathe.
New or unfamiliar environment. ie. Hospital or long-term care.
Social changes. ie. Family/friends, interests, likes/dislikes.

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