A Guide to Assisted Living and Nursing Homes for Alzheimer's Care

Symptoms of Alzheimer's Disease

Alzheimer’s disease (AD) begins in late middle age or old age. General symptoms include impaired memory, impaired communication, disorientation and a decline in everyday living skills.

Health care providers describe Alzheimer’s as having three stages: mild, moderate, and severe. Researchers have also identified a pre-clinical period, which can last years or decades before any symptoms are evident. Even though symptoms aren’t apparent in the pre-clinical stage, brain changes might be evident on an MRI scan.

Mild stage

Independent living is possible with mild Alzheimer’s symptoms. For example, symptoms might be limited to:

• Having trouble making plans or performing a work task
• Being unable to remember the names of new acquaintances
• Misplacing items and being unable to retrace one’s steps

Moderate stage

The moderate stage of Alzheimer’s can last for several years or longer. During this time, the most common symptoms include:

• Changes in mood and personality
• Restlessness
• Insomnia
• Fidgeting and/or wandering

Becoming lost when wandering is a common danger to patients, so Alzheimer’s assisted living centers and nursing homes equipped for memory care have especially secure perimeters. Eventually, patients may require 24-hour supervision.

Severe stage (late stage)

Individuals in the late or severe stage of Alzheimer’s lose the ability to carry conversations, respond to their immediate environment, and control their movements/basic motor skills.  They require personal care support and need to be monitored for their own safety and the safety of others.

Alzheimer's Symptoms

Alzheimer's is manifested differently in each patient. Listed here are common symptoms in several categories.

Cognition
Impaired memory and jumbled thinking are classic symptoms of Alzheimer's disease. Examples include:

• Memory loss that disrupts daily life and activities
• Inability to follow plans (e.g., can no longer balance a checkbook or follow a recipe)
• A decline in judgment or critical thinking
• Disorientation (confusion about the time or place)
• General confusion (often strongest in the evening)
• Confabulation (making things up)
• Difficulty holding a conversation (e.g., forgetting words, forgetting one's point, or being repetitive)
• Inability to recognize loved ones and acquaintances
• Inability to understand speech

Behavior

• Decline in personal care
• Aggression
• Irritability
• Lack of restraint
• Restlessness
• Wandering

Mood and Psychology

• Anger
• Apathy
• Anxiety
• Depression
• Paranoia
• Hallucinations

Whole Body

• Loss of appetite
• Inability to control muscles

Watch our video below with geropsychologist Abby Altman, Ph.D to learn more about the warning signs of dementia.

Diagnosing Alzheimer's Disease

A certain diagnosis of Alzheimer's disease can only be made with an autopsy that includes examining brain tissue with a microscope. Therefore, to determine whether a patient might have Alzheimer's, doctors will attempt to rule out other causes of dementia. There are dozens of possible causes, so many tests might be recommended. Some common diagnostic tests are described below.

Mini Mental Status Exam

Also called the Folstein test, the Mini Mental Status Exam is a 30-point test that helps doctors understand whether a person has trouble with attention span, problem-solving, counting, and memory.

Some questions on the Mini Mental Status Exam are:

• What is the year? Season? Date? Day? Month?
• Spell WORLD backward.
• Make up and write a sentence about anything.

A person's score on this exam should be interpreted with caution. For instance, a person might score poorly because the test is given in their non-native language or because they have a lifelong learning disability. Still, based on the test score and the patient's education level, the doctor can generally render an informed opinion about whether the person has cognitive impairment and how much senior care they likely need.

CT Scan

CT stands for “computer tomography.” A CT machine takes X-rays from many different angles. A computer combines these images to produce what look like slices of the body. The composite images could show brain changes that are common with moderate and severe Alzheimer's.

MRI

MRI stands for “magnetic resonance imaging.” An MRI machine uses a magnet, radio waves, and a computer to produce pictures of the brain. Doctors study the pictures for tumors and signs of a stroke. Also, like a CT scan, an MRI may also show brain changes that are linked to Alzheimer's disease.

PET Scan

A PET or “positron emission tomography” machine uses radioactive tracers to make images of the brain. It can be used to show amyloid plaque accumulation. Amyloid plaque buildup is present in all Alzheimer's patients. However, some people have this plaque without symptoms of dementia.

Alzheimer's Care

No Alzheimer's disease cure is known, but medications and other therapies can help maximize quality of life. Along with skilled caregiving medication can slow the progression of the disease and ease symptoms. If you are looking for Alzheimer's care, you can call our Alzheimer's helpline to find local care near you today.

Drugs to Support Cognition

For treating the cognitive symptoms of Alzheimer’s disease — memory loss, confusion, and trouble reasoning — the US FDA has approved two kinds of medications:

1. Cholinesterase inhibitors (three types with the brand names Aricept, Exelon, Razadyne)
2. Memantine (known by the brand name Namenda)2

Doctors may prescribe one or more of the above drugs to support the brain's chemical messaging; the drugs reduce the breakdown of the neurotransmitter acetylcholine. Alternatively, doctors could prescribe Namzaric, which is a combination of a cholinesterase inhibitor and memantine.

These drugs may be especially helpful during early and mid-stage Alzheimer's. Later, because more neurons are lost, improving the levels of chemical messengers is less helpful. Different drugs are approved for use at different stages though, and some are beneficial even with severe Alzheimer's. You can learn more about these drugs at alz.org.

Treatments for Behavioral Changes

Changes in mood and behavior, such as feeling anxious or being hostile toward loved ones, are common with moderate and severe Alzheimer's disease. Many Alzheimer's patients take medications to manage these psychological changes. As explored below, it's also critical to ensure that symptoms aren't partially or fully explained by other medical problems or the caregiving environment.

Medications for Behavioral Changes

Antipsychotic medications, such as those for paranoia and hallucinations, may be toxic to people with dementia. However, Alzheimer’s patients might take mainstream medications for depression and anxiety.

Antidepressants are prescribed to lift mood. Among the commonly prescribed drugs and their brand names are:

• Bupropion (Wellbutrin, Zyban)
• Citalopram (Celexa)
• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

Anxiolytics can help relieve anxiety and restlessness. They may also help reduce verbally disruptive behavior and resistance to requests.

• Lorazepam (Ativan)
• Oxazepam (Serax)

All of the above may bring different side effects, and the correct dosage might not be set for a few months. An advanced blood panel might help a physician or psychiatrist determine which drugs are most likely to be helpful.

Antipsychotic medications can be deadly for older adults with dementia. They bring an increased risk of stroke and death. In younger adults these drugs are prescribed to help control hallucinations, delusions, and extreme aggression or uncooperativeness. The following are among those that the FDA warns against for Alzheimer's patients: aripiprazole (Abilify), clozapine (Clozaril), haloperidol (Haldol), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal) and ziprasidone (Geodon).

Medical Check-Up About Behavioral Changes

Before drugs are prescribed for psychological problems, it’s important to rule out other medical causes for the symptoms. For example:

• Physical pain might cause irritability, and the patient might be unable to describe their pain. A thorough medical examination can check for possible contributing factors such as urinary tract infections, ear infections, and slipped discs.
• Sleep disorders are common in all stages of Alzheimer's disease. Poor sleep contributes to irritability and may be remedied without medications.
• Drugs prescribed for Alzheimer's can cause uncomfortable side effects. Possibly different drugs could be prescribed.
• Vision or hearing might be in decline. Eyeglasses and hearing aids help alleviate feelings of frustration and loneliness.

Modified Caregiving to Reduce Behavioral Symptoms of Alzheimer's

Everyday caregiving decisions can significantly shape a patient’s physical and psychological comfort. Simply keeping the thermostat in the person’s preferred setting could have a noticeable effect on their mood. Caregivers are also advised to:

1. Create a calm environment. Busy environments can trigger anxiety in anyone. Alzheimer's patients may feel strained by lots of sensory input. Caregivers should minimize noise, keep lighting natural (not glaring), and keep the living area clutter-free. In-home help with homemaking is often available for free or at very low cost.

2. Support sensory experiences. Maintaining a calm environment is critical to peaceful Alzheimer’s care. Still, rich sensory input is important for mental health. Caregivers can provide opportunities for patients to play simple musical instruments, knead dough, smell flowers, and otherwise engage their senses in ways that support well-being. Some of the best memory care facilities design rooms specifically for calming sensory experiences. First developed in the Netherlands, these rooms are sometimes called snoezelen (pronounced snooze-lin). Caregivers can create sensory rooms with budgets of all sizes.
3. Avoid arguing about facts. Arguing about facts can trigger negative moods in anyone. The best Alzheimer's caregivers accept that patients' comfort matters more than setting the record straight. They respond pleasantly without making corrections. For instance, if an Alzheimer's patient states that Richard Nixon is president, ideally the caregiver would avoid giving a political update. Examples of non-confrontational responses are, “Did you vote for Nixon?” and “We live in interesting times!”
4. Redirect the person's attention. Alzheimer's patients sometimes fixate on imagined problems. Again, contradicting the person's reality could introduce stress. A caregiver could say, “Let me think about a solution,” then redirect the person's attention to something positive.
5. Provide consistency. Abrupt changes can trigger difficult behavior in Alzheimer's patients, but caregivers can ease transitions or avoid them altogether. With consistency in mind, for example, the best Alzheimer's home care agencies assign two caregivers to each senior, alternating their shifts. One caregiver is a fallback in case the other misses work, so the patient won't be startled by an unfamiliar substitute. Another example is easing the transition to an Alzheimer's nursing home or memory care center by decorating the new bedroom with familiar paintings and photographs from home. Keeping a regular schedule is part of consistency too.

Treatments for Sleep Problems

People with Alzheimer’s, more than the general population, have sleep problems. Generally, Alzheimer’s patients should avoid sleep drugs because these medications bring an increased risk of disorientation, falling down, and being less independent. In this section, we consider different medications, other medical issues to consider, and tips for naturally healthy sleep.

Medications for Sleep Problems

Sleep medications have proven dangerous for people with Alzheimer's. Here are just a few cautions to keep in mind:

• Sleep medications can increase the risk of disorientation and the risk of falling.
• Antipsychotic medications (which are sometimes prescribed for sleep disorders) can be fatal to people with Alzheimer's disease and other forms of dementia.
• Benzodiazepines (also commonly prescribed for sleep trouble) may contribute to memory problems.

The least risky medications for this patient population might be mild antidepressants. Melatonin, which is available without a prescription, might be more effective. Melatonin is a natural regulator of the sleep cycle, and melatonin production is impaired in Alzheimer’s patients.3

Remember that diet may help promote sleep. Foods with tryptophan, for example, bring on drowsiness. (Turkey, eggs, tofu, nuts and pineapple are some tryptophan sources.) Camomile and other herbal teas can promote sleep as well.

Medical Check-Up

Various treatable medical conditions cause insomnia and other sleep problems. Some conditions to rule out:

• Anxiety
• Depression
• Restless legs syndrome
• Sleep apnea

The timing of medications can influence sleep too. Cholinesterase inhibitors (common medication to support memory in Alzheimer's patients) shouldn't be given before bedtime. Drugs prescribed for anxiety and depression might also be best taken at a certain time of day.

Caregiving to Reduce Sleep Problems

The following tips can help anyone, including Alzheimer's patients, achieve healthy sleep.

1. Maintain regular times for arising, eating meals, and going to bed.
2. Get morning sunlight exposure to help regulate your body.
3. Exercise daily, but not within four hours of bedtime.
4. Avoid caffeine, nicotine, and other stimulants.
5. Have an inviting sleep area. This includes a comfortable mattress and soft bed linens of the proper weight for the season. The room temperature shouldn't be too cold or too warm. A night light could be soothing.

With sound sleep, dementia patients (and their caregivers) are best able to handle stressors and appreciate life's everyday gifts.