As we get older, it is normal to experience mild forgetfulness. Sometimes, it may take longer to learn new things or you may misplace things from time to time. But when does normal, age-related forgetfulness become a serious memory problem, like Alzheimer’s disease?
Contrary to popular belief, cognitive diseases like Alzheimer’s disease are not simply the result of aging. Rather, Alzheimer’s is a degenerative brain disease and the most common form of dementia. People often refer to dementia as a specific illness. However, it is a general term used to describe a group of symptoms.
Early warning signs of Alzheimer’s include Mild Cognitive Impairment (MCI), which refers to people experiencing mild memory and thinking problems compared to others of the same age. While losing your memory is worrying for individuals and their families, certain cognitive impairment treatments can help, including the Stronger Memory Program, which, according to its creator, Rob Liebreich, will soon be made accessible to all. Liebreich, the president and CEO of Goodwin House, a non-profit senior living community-based in Virginia, recently joined the LTC Heroes podcast to discuss the Stronger Memory Program’s origins, its evolution, and its future expansion.
What Are the Most Severe Complications of Dementia?
It is difficult to pinpoint the exact reason for the onset of Alzheimer’s disease because there is no one cause. Research shows that it usually develops through a combination of factors such as genetics, lifestyle, and environment. While there are many forms of dementia, the most common is Alzheimer’s disease, which accounts for sixty to eighty percent of dementia cases. The majority of cases are in older adults aged sixty-five years or older.
Being a degenerative disease, the symptoms of Alzheimer’s worsen over time with mild memory loss in the early stages and severe cognitive impairment in later stages. The latter includes losing the ability to hold conversations and function in everyday activities.
The disease is highly destructive for both those afflicted and their loved ones. One of the biggest complications of dementia is the high financial burden for individuals, their families, and the government. In fact, dementia is one of the most costly diseases in America, putting a greater financial burden on the country than even cancer or heart disease. A recent study found that the average cost for a person with dementia in the last five years of their life is $287,000. This is significantly higher than the costs for people with heart disease ($175,000) or cancer ($173,000).
It is expected that Alzheimer’s disease will increase dramatically as the Baby Boomer generation advances in age. So, too, will Medicare and Medicaid expenses. In 2010, the monetary cost of dementia was between $159 and $215 billion, with Medicare contributing $11 billion towards this cost. By 2019, individuals with Alzheimer’s disease and dementia incurred approximately $290 billion in costs. Half of these costs ($146 billion) were covered by Medicare, with Medicaid covering $47 billion.
Sensing the growing concern for dementia, in 2011, under the administration of President Barack Obama, the National Alzheimer’s Project Act was passed in order to help the federal government track dementia-related costs incurred by individuals and government programs, like Medicare and Medicaid. It also aimed to change the trajectory of Alzheimer’s disease and dementia by providing better resources to improve the health outcomes of people with dementia.
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Still, figures continue to rise, and it will develop into a national crisis based on current prediction models. In the United States, there are currently 6.2 million seniors aged sixty-five years or older who have been diagnosed with Alzheimer’s. These figures are expected to double to 12.7 million by 2050, a staggering 278% increase, requiring $584 billion in Medicare funding. This means that one in every three Medicare dollars will be spent towards Alzheimer’s disease.
Death rates for heart disease and cancer are falling while the death rates for Alzheimer’s and dementia are on the rise. In the United States, Alzheimer’s is the sixth-leading cause of death among adults, with the average person living between four to eight years after diagnosis. Of course, being an unpredictable disease with no known cure, it affects every sufferer differently. Therefore it is also common for some people to live significantly longer depending on their situation.
The symptoms of dementia
Another challenge of dementia is identifying the symptoms. As stated earlier, dementia is not a disease but rather a series of symptoms. Therefore, the early signs of dementia are subtle and vague, especially to the untrained eye. Still, while the signs are not obvious, there are some key signs to observe:
- A failing memory, particularly about recent events
- Confusion in familiar surroundings
- Shortened attention span
- Behavioral changes (e.g., mood swings and anxiety)
- Social withdrawal
- Difficulties with Activities of Daily Living (ADLs)
The problem with identifying these early signs of dementia is that they can develop over a long period. Therefore, for people, who are living with mild cognitive impairment, it is easy to mistake such behavior as normal and part of the aging process. There will also be some people who choose to live in denial, refusing to address the problems despite knowing there is something wrong. As the symptoms continue to worsen, though, they will begin impacting function and cause further complications.
In the later stages of dementia, there will be more apparent signs of a person’s physical and cognitive health. Physically, people will lose the ability to walk, sit, and even hold their heads up. They may also experience problems with bladder control, bowel movement, and the ability to swallow food. Cognitively, they will lose the ability to communicate, have conversations, and perform ADLs. During this stage, a person with severe memory deficits will require full-time care support, usually in a memory care facility designed to assist while still allowing for some sort of independence. These are specialized units that provide specific services, like:
- Around-the clock care for ADLs
- Secure and safe surroundings to prevent wandering
- Specially trained staff
- On-hand medical professionals
- Structured dementia care plans, programs, and activities
Memory care facilities use nursing home EHR or long term care software to customize care plans and cater to their residents’ needs. Such nursing home software also facilitates communication with families, giving them some respite knowing their loved ones are being cared for appropriately, alleviating them of the burden of full-time home care. The transition to a memory care facility may not be easy, but it is necessary, especially as dementia conditions worsen.
How to test for dementia
Physicians conduct a series of cognitive tests to determine the severity and particular type of dementia. These measure and evaluate a person’s cognitive functions such as memory, concentration, language skills, problem-solving, visual-spatial awareness, and counting. The most common types of testing include:
Mini-Mental Status Examination (MMSE) – A short five-minute screening with a physician. This assesses a person’s reading, writing, short-term memory, and orientation.
Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-Cog) – This is a follow-up test from the MMSE. It is more thorough, consisting of eleven sections that can determine the mild symptoms of dementia. It usually takes thirty minutes to conduct and measures a person’s memory and language skills. If the results show mild signs of dementia, the physician will likely refer the person to a psychologist for further testing.
In addition to the MMSE and ADAS-Cog, physicians will also use computerized tests to gain a clearer view of cognitive issues. Structural imaging—like magnetic resonance imaging (MRI) or computed tomography (CT) scans—are frequently used to eliminate possible conditions that require alternative treatment, like tumors, strokes, or head trauma. These computerized tests are especially beneficial for tracking the degeneration of the brain and Alzheimer’s and dementia symptoms.
The Goodwin House Stronger Memory Program
Once dementia symptoms are diagnosed, those with Mild Cognitive Impairment (MCI) can refer to memory programs to improve their brain health. The Goodwin House, Stronger Memory Program, for example, is designed to stimulate the brain by practicing three activities daily. The program was started in 2012, after Liebrich’s mother was diagnosed with MCI and began displaying telltale signs: repeating her speech, forgetting everyday items, and getting lost in familiar areas.
At the time, Liebreich knew of no tools, advice, or actionable steps he could recommend, despite working in long term care for a decade. Frustrated, he began searching for better options. After a chance encounter at a Leading Age Conference in 2012, he developed his Stronger Memory program by borrowing the primary and logical concepts of a Japanese model.
The Stronger Memory program can be reduced to three simple steps: reading out loud, practicing handwriting, and doing simple math quickly. According to Liebreich, it is by combining these activities that one “engages the prefrontal cortex of the brain,” which governs the ability to retrieve memories.
The program requires participants to practice the activities every day for twenty to thirty minutes. Liebreich and his team have designed a series of workbook exercises that are to be practiced each day. Participants must complete one math sheet, one writing prompt, and spend time reading out loud, after which they can track their progress using the provided calendar.
Liebreich found that his mother’s symptoms quickly subsided. “Her forgetfulness was no longer apparent, her repeating of sentences was no longer apparent,” he said. “And within a month, she certainly wasn’t getting lost in common areas anymore.”
But Liebreich did not suffice himself with treating his mother. He knows that losing your memory and forgetting the names of your primary caregivers or relatives is heartbreaking for others as well. And the emotional impact of losing your memory is frustrating and upsetting for both seniors and their families. That is why he rolled out the Stronger Memory Program in his assisted living and memory care community, Goodwin House. And he has seen strong results among the residents who have participated.
Liebreich’s breakthrough program has allowed participants to bypass some complications of dementia. Further, he observed that the program participants had improved sleeping patterns and appetites, therefore improving their physical health. The most noticeable difference, though, was in their psychological state. The program significantly improved participants’ quality of life by removing “that sense of fear and anxiety out of the equation, and ultimately replacing it with hope and purpose,” he said.
During his interview, Liebreich spoke about the encouraging progress he has observed in residents. One man displayed symptoms of dementia, not being able to remember his sister’s name, and then, “just a few weeks into doing this kind of work, consistently, the recall came back.” Such outcomes drive Liebreich to continue developing and improving the program, thus “impacting as many people as possible, from coast to coast.”
What To Do When Losing Your Memory
It is not always easy to identify the early symptoms of dementia. If you suspect you are losing your memory or fear that fate for a loved one, it is advisable to seek medical advice as soon as possible. Early detection of dementia is vital in knowing when to adopt healthier lifestyle choices, like eating a more nutritious diet, not smoking, participating in regular exercise, and cognitive stimulation, all of which help to prolong cognitive decline and dementia. When one’s memory has declined significantly, it is time to begin to think of long term care of memory care. The Stronger Memory Program is one of the more forward-thinking options in memory care and has produced tangible results for the residents of Goodwin House. Similar programs are likely to follow in the near future.