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It’s Never “Just” Dementia

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You may recall nearly two decades ago a George Clooney movie came out that revolved around some men who made their living as fishermen.  It was called “The Perfect Storm,” and the title drew upon what happens when not just one storms hits a ship at sea, but two storms.  It was quite dramatic.  Well, Alzheimer’s disease is like that Perfect Storm, but it is not just two storms.

Those with dementia who are 65 years or older have not just two storms; they have an average of four chronic conditions – what doctors call comorbidities – along with the dementia.  An average 65+ year old individual has about two comorbid chronic conditions.  The most common comorbidities for Alzheimer’s patients are diabetes, urinary infections and depression, but there are also other cognitive aspects to dementia that impact more than memory.

We often refer to the manifestations of Alzheimer’s disease as “cognitive impairment.”  But cognitive impairment isn’t just about memory issues.  If you have a loved one who has had the diagnosis, there is another facet to cognitive impairment called apraxia, and it is the most common manifestation of cognitive impairment.

The healthy brain is a complex data processor that routinely connects things.  It knows what a fork is and it knows food on a dinner plate when it sees it and it also knows how to use the fork to transport the food to the mouth.  Rinse and repeat.  But apraxia can put up a significant road block between those two cognitive processes.  The brain sees the fork and it sees the food and the brain then comes to a halt…at least until someone helps to move the fork with the food to the dementia sufferer’s mouth.  Clearly the apraxia can take on a number of basic forms, and understanding what your loved one is now unable to do can help in getting assistance as well as treatment for your loved one with dementia.

Health care providers categorize apraxia along these three lines:

  • “Ideational apraxia” describes the cognitive deficit of the person unable to process what an object is for…they see a car key, but don’t know how that enables driving a car.
  • “Ideamotor apraxia” describes the kind of activity for which a person with dementia needs to be “primed” to do. They recognize a hair brush, but need to be prompted in how to use that brush for their hair.
  • “Dressing apraxia” describes all the roadblocks in what used to be a taken for granted process. Think about seeing buttons, but not remembering how they align with button holes…or how a zipper zips, etc.

These are all important for the caregiver, because if you understand the deficit you can help your loved one and you to minimize the frustration of what have become mind boggling tasks.  It will help you in asking for the appropriate assistance in respite or residential care.  You can explain that “mom needs help dressing in the morning,” and the staff will understand and be proactive.  Or “dad will need help with dinner and cutting meat,” and they can help dad do as much as possible on his own and with the least embarrassment.  Within all of this it is about maintaining quality of life for your loved one with dementia, and that takes patience.  And your patience can come from knowing what to expect and how to respond.  Here are a couple resources on how to address apraxia:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4341309/

https://medlineplus.gov/ency/article/007472.htm.

Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago.  She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.

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