Monday, October 20, 2014

Reminiscence Therapy

Reminiscence therapy is the use of life histories to improve a person's psychological health.  Using pictures, video clips, objects or the written word, an individual can evoke a deep memory from an individual with dementia.  In order to help trigger the memory, the stimulants should be representative of or from the time of the individual's younger years.  For example, while you may not have pictures of the person as a child, pictures taken in the area where and from when they grew up may be familiar enough to cause a memory to surface.  During a therapeutic period, the person may not talk about the contents of the stimulus; but may discuss other topics which are connected emotionally for that person.

Reminiscence therapy benefits a person by getting them communicating and focusing on positive associations.  Making a connection and sharing their thoughts helps the individual feel valued.  The conversation itself can be interesting and funny and who doesn't like a good conversation?

Lyn has several photo albums that she used to go through fairly regularly.  While she doesn't much anymore, she will go get one and sit with you to look through it.  Looking through pictures of Albuquerque from the time of Lyn's life makes me realize that despite the growth of the city, much of it still looks the same or has enough of the same flavor that picking out the age of a picture can be a bit of a challenge.  Sometimes, we have to look to the type of photograph to help us determine the age of the image.

When you sit with Lyn and go over her photos, I find she doesn't make the connections that other dementia patients may be able to make.  For example, she can't tell you what movie was her childhood favorite or tell you about the time that Mom took us to see Star Wars when it was in the theaters.  A picture won't cause her to think of a meal, a song or even the seasons.  She might, on rare occasions, think about someone who is not pictured.

This difference is really nothing new with her.  While she enjoys music, I cannot remember a song that she felt a strong emotional connection.  I really think her inability to express connected memories is a result of how her memories were stored through out her entire life and not a result of her Alzheimer's.

Friday, October 17, 2014

Thursday, October 16, 2014

A Question of Guilt

At some point, Lyn will no longer be able to tend to her personal needs.  She won't be able to change her clothes, feed herself or clean herself.  She won't be able to get up and may become bedridden.  All of these changes are common symptoms of the late stages of Alzheimer's.  When that time comes, Lyn will need care providers who are able to lift her, turn her, feed her, clothe and clean her.  Because of Lyn's size, Mom may not be able to do it all herself.

A comment on yesterday's post raised this concern and the very real possibility that Lyn will need to be placed in a care home.  The goal is to keep Lyn in her home environment for as long as possible.  Her case managers have spoken of making in home renovations such as a walk-in tub to make her care as easy as possible for as long as possible.  While that goal guides decisions about Lyn's in-home care, the reality is that Lyn will very likely need full-time nursing care.  Mom and I are cognizant of this need and are emotionally prepared to make the decision when the time comes.

The comment posited that we may feel guilt in placing Lyn in a nursing home.  It raises a good question.  Will we?  Mom and I discussed this topic last night as a result of the comment.

When my Grandmother's care exceeded the capacity for her to be cared for in-home, Grandma was moved to a small private nursing home where she lived until her death.  She received very good care.   It was the right place for Grandma and we'll always appreciate my Aunt suggesting the facility.  In thinking back on that time, I don't remember there being expressions of guilt in moving Grandma to a nursing home.  Mom confirms that there was no sense of guilt felt or expressed.

As we continued the discussion, we found we were both expressing much of the same sentiments.  When Lyn is placed in a nursing facility, it will be with the recognition and knowledge that her care has exceeded what can be provided to her in the home.  We will make sure she's in a good facility and Mom anticipates visiting her regularly if not daily.  Neither of us expect that we'll feel guilt or question the decision to move Lyn because our goal is to provide her with the best care we can provide.  If that means that others have to do the heavy lifting then we line up the resources Lyn needs.

If we were just placing Lyn in a nursing home because we were tired of caring for her, then we'd have reason to feel guilt.  If a nursing home was a matter of convenience and not need, then we'd have reason to feel guilt.  Moving her when her care exceeds our abilities is no reason for guilt.

Mom and I both have participated in Alzheimer's support groups.  Mom has attended in real life as well as on-line.  I participate on-line only at this time.  Neither of us have understood the feelings of guilt that are commonly expressed by other participants.  When we hear of the lengths to which others have gone to avoid a nursing home placement, we see nothing to fault with their decision to finally place their loved one in a nursing home.  The decisions are not easily or lightly made.  While it may not be an easy decision for us too, I do believe we will accept the decision peacefully and not beat ourselves up over it.

Wednesday, October 15, 2014

Walking Away

In today's news, a famous British sportsman, Ian Botham gave an interview in which he talks about his father's dementia and his decision to stop visiting his father months before his father died.  He states that it was horrendous to see his father's diminished capacity and behavior changes as a result of Alzheimer's.  He asks that no one judges him unless they've been in his shoes.

Lyn's not violent.  She can be a brat.  Lyn's capacity is diminishing on a daily basis but she's not yet "a shell" of a person.  It is painful to see the changes some days.  Her care is sometimes a heavy burden for Mom.  The changes in her are definitely having an emotional impact on us all.

Mr. Botham's father passed in 2005.  It is my hope that the care we provide dementia patients has improved some as our understanding of their experiences is improved.  His father's violence would be traumatic to experience.  His father was in a nursing home and being tended to by the staff there.  However, I'm not sure, even then, that I could just walk away and have no more contact with my loved one.  The thought of that just seems like abandonment to me.

Tuesday, October 14, 2014

Petri Alzheimer's

Rudolph E Tanzi is the Director of the Genetics and Aging Research Unit at MassGeneral Institute for Neurodegenerative Disease at Massachusetts General Hospital.  He and his staff have been researching the causes of Alzheimer's Disease.  This week, they announced that they have developed the ability to grow human neurons with the genes for Alzheimer's in petri dishes.

The neurons organize themselves in the grid-like structure found in the brain.  Those neurons with the Alzheimer's genes also form the plaque tangles which are a hallmark indicator of the disease.  The ability to grow neurons in a petri dish will hopefully allow researchers to test potential drugs for treating Alzheimer's more quickly.

Dr. Tanzi and his team are not the only ones growing neurons in petri dishes.  His team at MassGeneral worked with embryonic stem cells which have the ability to become any cell needed.  However, a team of stem cell scientists led by Tracy Young-Pearse have converted skin stem cells from individuals with early on-set Alzheimer's into neurons and grown them in petri dishes as well.  Both Tanzi and Young-Pearse teach at Harvard in addition to directing their respective labs.

The goal to create collections of human neurons to directly study or use in drug testing is not a new concept and has been under work for several years.  In 2012, the University of California, San Diego team led by Larry Goldstein had announced they had succeeded in converting skin cells to neurons for petri growth.  From how heavily Tanzi's team is receiving coverage this week, you'd be hard pressed to know that this announcement is not the first of its kind.

Will Tanzi's approach be substantively different or a game changer in ways that the findings by the labs run by Young-Pearse or Goldstein have not?  Only time will tell.

Monday, October 13, 2014

Clothing Issues

For the past couple of weeks, we've noticed that Lyn wants to wear the same thing again and again.  If Mom doesn't intervene, Lyn will wear the same pajamas every single night and the same clothing each day.  She gets irritated if Mom tells her to change into a fresh set of clothes.  Fortunately, if Mom can convince Lyn to put the dirty clothes in the hamper, she'll leave them there and get a different set.  However, each day, she asks about the set she wants, checking to see if they are available for use.

This is not unusual with Alzheimer's.  Making a decision is hard.  Patients will revert to the familiar as the easiest option when choices are at hand.

This is not a surprising change to see in Lyn.  At this point, she's still cooperative with changing even if she's not happy about it.  Additionally, she's still able to get dressed on her own for the most part.  She'll get upset if her bra strap is twisted as she puts it on.  When that happens, she asks Mom to help her because "It is faded!"  She now uses "faded" instead of "twisted."  We're honestly glad that she can still put on her own bra and get the rest of her clothes on independently.  We'll take that for as long as it lasts.

Thursday, October 9, 2014

Hilarity for Charity

Next Friday night, Seth Rogan will be hosting his third annual Hilarity for Charity event.  Hilarity for Charity is a fundraising comedy concert which supports the Alzheimer's Association.   Seth and his friends in the entertainment world put on a big show.  This year's theme is the Prom.  There's also an online fundraising component with Omaze this year.

If you enjoy Seth Rogan's work, you may want to check out some of the Hilarity for Charity videos.  While you're at it, consider supporting your preferred Alzheimer's charity.