World Alzheimer’s Day on 21^st September 2020

Alzheimer’s disease (AD) is a neurodegenerative disorder of uncertain cause that primarily affects older adults and is the most common cause of dementia. The most common and earliest clinical manifestation of AD is selective memory loss. In early stages, memory impairment may be mild. The pattern of memory loss in AD is distinctive. Declarative episodic memory (memory of events occurring at a particular time and place) is usually profoundly affected in AD. Memory for recent events is prominently impaired in early AD. Memory deficits develop insidiously and progress slowly over time. 

Family members and coworkers may notice the patient getting less organized or less motivated; multitasking is often compromised. As the disease progresses, an inability to complete tasks typically emerges. It is common for patients to underestimate their deficits and offer explanations for them when they are pointed out. Interviewing an informant who has known the patient over time (usually a family member) is necessary; often it is the family member, not the patient, who brings the complaint of cognitive impairment to medical attention. Such loss of insight may be associated with behavioral disturbances.

Neuropsychiatric symptoms are common in AD, particularly in the middle and late course of disease. These can begin with relatively subtle symptoms including apathy, social disengagement, and irritability. More problematic in patient management is the emergence of behavioral disturbances, including agitation, aggression, wandering, and psychosis (hallucinations, delusions, misidentification syndromes). A concomitant medical illness, medication toxicity, and other causes of delirium should be considered whenever new behavioral disturbances arise.

COVID 19 and Alzheimer’s care

This is a challenging time for all of us, especially for patients with AD, their care providers, and the clinicians who care for people with AD. In particular, people with Alzheimer’s disease may have difficulty comprehending what’s going on around them. When we start talking about things like social distancing, wearing a mask, and frequent handwashing, they may not understand exactly why we’re doing this or whether they should be doing it. They may forget to continue to do it or take their mask off frequently.

Focus on Hand hygiene

Because patients with Alzheimer’s and other types of dementia may forget to wash their hands, caregivers need to be extra vigilant in helping individuals practice hand hygiene. Caregivers can help them do that either by setting up a schedule to do hand washing on a regular basis or having signs in the bathroom or by the kitchen sink to remind them to wash their hands for 20 seconds. Repetition can help encourage behavior changes in those with moderate dementia.

Plan for gaps in caregiving

As adult day care programs shut down and health services become less available due to public health containment strategies for COVID-19, less help and support may be available for patients with Alzheimer’s disease.

As quarantining is impossible due to dementia or physical complications requiring regular contact, it is preferable to limit the number of caregivers caring for the person. If continuous care is needed a ‘live-in’ caregiver should be considered, to avoid several caregivers coming in and out to do shift type work

 Communication and socializing with distancing

Patients can be introduced to group video chats that include other friends and family. They can be made part of a virtual dinner, someone’s birthday, graduation, or anniversary.

Rather than news, caregivers can try to get them to watch something more positive by streaming a show simultaneously so that they can watch with family. It is particularly important to turn to technology to connect with older adults who may be feeling lonelier than ever.

Seniors living in assisted-care and nursing homes have loss of critical social activities such as off-site trips, game nights, communal dining, and fitness classes. Confined to their rooms or apartments, these seniors are left with little to no social contact at all. Technology offers several ways for the isolated to still stay connected with the outside world.

Explain the pandemic in relatable terms

Talking to the patient about the pandemic in a way they can understand is very important. Depending on where they are in the course of the disease, it should be put in a context that they can understand and not to over explain if they are not able to grasp it.

I recommend saying something like, “We have to stay inside because that’s most safe for us, but we’ll do it together. I’ll be with you and we’ll be okay.”

Practice self-care

It is important for caregivers to practice self-care.

The Alzheimer’s Association suggests the following ways to reduce anxiety about the pandemic:

• Pay attention to your own level of stress.

• Stay present by engaging in activities in your home with the person you’re caring for, such as folding clothes or cooking.

• Stay off social media if it makes you anxious.

• Keep news to a minimum.

Engage other family members with your older adult if they are willing to sit by the computer and listen to a story or engage in conversation or a simple game.