The Alzheimer's Answer Book: Professional Answers to More Than 250 Questions about Alzheimer's and Dementia

346 Pages·2008·1.23 MB·English

by  Charles Atkins

A
Q
Is Alzheimer’s disease hereditary? Are there memory exercises I THE
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should be doing now? Is all dementia Alzheimer’s, or are there other
forms? How do I make time for both my parent with Alzheimer’s and my Z
children? How long can someone live with this disease? H ALZHEIMER’S
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A All caregivers and families touched by Alzheimer’s and dementia E
The
face a seemingly overwhelming number of emotional decisions. I ANSWERBOOKTM
Alzheimer’s Answer Book M
serves as a much-needed resource for you
in this difficult time and is full of the sound advice and immediate
The Alzheimer’s Answer Book E
guidance you need. covers such topics as:
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What are the causes of How can I avoid “caregiver burn-
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Professional Answers to More Than
for a parent?
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S diagnosis? support in my community?
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Are there medications available What are the differences
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R the disease? Medicaid, and how do I know  What can I do to
what insurance will and will
B How can I tell if my parent is in E prevent Alzheimer’s?
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The Alzheimer’s Answer Book
K Written in an easy-to-read Q&A format, explains confusing treatment?
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TM medical lingo and provides straightforward answers to all of your most pressing questions.
O  H ow close are we to
Charles Atkins, MD,
is a K
finding a cure?
Health
board-certified psychiatrist
$12.99 U.S. TM
who began his career ISBN-13: 978-1-4022-2126-2
ISBN-10: 1-4022-2126-6  How do I know what
working in geriatrics.
level of care is right?
He maintains a clinical
faculty appointment at Yale
University and is an attending psychiatrist
at Waterbury Hospital. He is the author
Atkins
of several psychological thrillers as well
www.sourcebooks.com
as hundreds of articles and columns. Visit
his website at www.charlesatkins.com.
cHARlES ATKINS, Md
Susan Ashley, PhD
TM
CHARLES ATKINS, MD
Copyright©2008byCharlesAtkins
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LibraryofCongressCataloging-in-PublicationData
Atkins,Charles.
TheAlzheimer’sanddementiaanswerbook:professionalanswerstomorethan
250questionsaboutAlzheimer'sanddementia/byCharlesAtkins.
p.cm.
Includesbibliographicalreferencesandindex.
1. Alzheimer’sdisease—Popularworks.2. Seniledementia—Popularworks. I.
Title.
RC523.A8482008
616.8’31—dc22
2008018085
PrintedandboundintheUnitedStatesofAmerica.
UGI 10 9 8 7 6 5 4 3 2 1
To Ida Marks

Contents
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix
Chapter 1:WhatAreAlzheimer’s and Dementia? . . . . . . . . . . . .1
Chapter 2:Dementia Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Chapter 3:Getting a Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . .21
Chapter 4:The Dementia Evaluation . . . . . . . . . . . . . . . . . . . . .35
Chapter 5:Alzheimer’s and OtherTypes of Dementia . . . . . . . .45
Chapter 6:Treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59
Chapter 7:Taking Care of theWhole Person . . . . . . . . . . . . . . .73
Chapter 8:Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89
Chapter 9:Emotional and Behavioral Changes . . . . . . . . . . . . .107
Chapter 10:KeepingYour Loved One Safe . . . . . . . . . . . . . . .131
Chapter 11:Understanding Medicare . . . . . . . . . . . . . . . . . . . .153
Chapter 12:Understanding Medicaid . . . . . . . . . . . . . . . . . . . .171
Chapter 13:Advance Directives . . . . . . . . . . . . . . . . . . . . . . . .175
Chapter 14:Other Legal and Financial Issues . . . . . . . . . . . . . .191
Chapter 15:Nursing Homes and Extended-Care Facilities . . . .205
Chapter 16:Caring for the Caregiver . . . . . . . . . . . . . . . . . . . .223
Chapter 17:IfYou’ve Been Diagnosed . . . . . . . . . . . . . . . . . . .243
Chapter 18:The Family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .251
Chapter 19:Hope for the Future . . . . . . . . . . . . . . . . . . . . . . .261
AppendixA:Chapter-by-Chapter References . . . . . . . . . . . . . .273
Appendix B:Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .279
Appendix C:Geriatric Questionnaire . . . . . . . . . . . . . . . . . . . .283
Appendix D:State-by-State Guide to Resources and
Long-Term Care Ombudsman Programs . . . . . . .307
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .327
About theAuthor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .333
Acknowledgments
First, I need to acknowledge the many families I’ve met over the
years—both in my personal life and in my role as a psychiatrist—
who are dealing with a dementing illness.It is from them that I got
the inspiration for writing this book, and it is for them that I am
writing it.
I’d like to thank the many people who’ve helped me with this
book; their experience, expertise, and time are greatly appreciated:
Blanche Agostinelli, APRN; Sigrid Wiemers, APRN; Dianne Davis,
APRN;RajeshTampi,MD;AlbertZuckerman;ShanaDrehs;Doreen
Elnitsky, RN; Harvey and Cynthia Atkins; Margaret Munro; Judith
Hoberman;Lea Nordicht-Shedd;Gary S.Jayson;Judith Stein;Linda
Shaffer; Tracey Violette, OTR/L; Bridget Gallant, LPC; Lisa
Hoffman;VallrieFreeman,MSW;ThomasReinhardt,MD;Jeannette
Mitrukiewitz,LCSW;and MaryAnn Berube,RN.
I’m indebted to the superb medical librarians at Waterbury
Hospital Health Center, Linda Spadaccini and Kandace Yuen, for
pulling hundreds of articles and scanning the Internet for new
sources of information. I’d also like to thank my colleagues at the
Department of Behavioral Health of Waterbury Hospital and the
staff and administration of Yale’s Dorothy Alder Geriatric
Assessment Center.

Introduction
I think it’s impossible to write a book about Alzheimer’s disease and
other dementing illnesses without having it become personal. Like
many, or even most, Americans, my life has been touched by losing
someone I loved through dementia. For me it was my grandmother,
who was sharp as a tack through her mid-eighties and then began to
lose her memory and other abilities,likely through a series of strokes.
I watched as my mother and aunt became caregivers and took on ever
greater responsibilities as my grandmother’s condition deteriorated.
Other family members pitched in expertise and assistance for the
necessary financial planning,legal advice,help with moves—from her
own apartment, to assisted living, to a nursing home—and emotional
support. In the end, my grandmother couldn’t recognize her children
and required total care.
As my own family was going through this,I was working as a geri-
atric psychiatrist helping other families plan and strategize. As a
young doctor I was impressed by how different each family’s treat-
ment of Alzheimer’s and other dementias was. While the diagnoses
are relatively easy to make,what comes after them,and the layers of
planning and information that families and caregivers need, is enor-
mous. This is why I wanted to write this book—when I meet with
families in which the mother/father/husband/wife has been diag-
nosed with a dementia, what strikes me are the barrage of questions
they need answered. “How do you know it’s Alzheimer’s? How do we
handle it when she wanders? How does someone qualify for Medicaid?
How do I pick a Medicare D policy for Mom? I read in the paper that
substance X is a magic cure, is that true?”