Questions and Answers Concerning Dementia and Alzheimer’s Disease

• What is Dementia? 
  Dementia is a progressive deterioration of the ability to think. The initial stage includes forgetfulness, an inability to learn new things and difficulty concentrating and persevering. Behavioral problems sometimes appear already at an early stage.
• Recently, my mother has frequently been forgetting simple things. For example, she forgets to turn off the stove, or asks the same question several times and does not remember that I have answered her. What should I do?
  It would be best to see her primary care physician for a diagnosis. If necessary, he can give a referral for further diagnosis from a specialist in the field (a geriatrician, neurologist or psychiatrist).
• A relative of mine is beginning to forget things. When should this be a concern, and when is it simply “old age”?
  Forgetfulness or not remembering everything is a familiar phenomenon, particularly for senior citizens. If you feel that the forgetfulness is affecting day-to-day functioning or impairing the execution of tasks, it’s best to consult the primary care physician.  
• Many people tell me that nothing can be done for my mother, who has Alzheimer’s disease, and I find it difficult to accept this. Is this really correct?
  It is true that Alzheimer’s disease is currently incurable. However, some things may be done for people suffering from it. Just like all of us, persons with dementia need contact with others, someone who will look them in the eye and communicate with them in a dignified manner. There is evidence that cognitive activities during the initial stages may help preserve the person’s abilities and slow down the disease’s progress. In the later stages, it is also possible to provide patients with positive experiences through contact and stimulation of the senses.  
• Why is it important to get a diagnosis if there is no cure for Alzheimer’s disease?
  It is worthwhile to diagnose changes in memory for a number of reasons: 
• There are quite a number of diseases that cause dementia. Alzheimer’s disease is only one of them (albeit the most common), and they don’t all have the same course and treatment.
• Sometimes, a decline in memory is not connected to dementia at all, but rather to another, treatable disease, such as depression, a problem with drug treatment, thyroid gland deficiency, or acute illnesses such as infection or dehydration. In these instances, timely diagnosis and treatment could bring about a marked improvement or cure. 
• For persons who are indeed suffering from dementia, relatively early diagnosis could enable appropriate drug treatment to ameliorate the disease’s symptoms.
• Diagnosing dementia helps the patient and his family know what they have to deal with and what the expected course is. Plans may be made for the future, since at an early stage of the disease the patient is still able to express his wishes regarding issues that are important to him. Knowing the diagnosis in advance may also help the family cope better.
• I see a drastic decline in my mother’s condition. She is anxious and wakes up at night from nightmares. What is going on?
  It’s advisable to consult with the primary care physician. Comprehensive medical testing should be done to pinpoint the cause and treat it accordingly: 
• Such behavior sometimes indicates an additional health problem (e.g., infection, pain, or other medical condition), which the patient may be unable to describe or interpret, with the pain therefore manifesting as agitation or detachment. 
• On the other hand, sleep disturbances are sometimes one of the disease’s symptoms (e.g., frightening hallucinations), and changes can be made in the daily schedule to ease the problem, or drug treatment may be added. 
• My father has been diagnosed as suffering from dementia, but the doctor said it is not Alzheimer’s disease, thank God!!! So what does he have?
  Dementia can be caused by a number of diseases. Alzheimer’s disease is the most common, the second most common is vascular dementia from the blockage of small blood vessels in the brain, and there are additional diseases. They all share some symptoms, such as difficulty with memory, communication, judgment and understanding external stimuli, and sometimes behavioral problems as well. On the other hand, there are also differences between the various diseases. Ask the physician regarding the disease that caused your father’s dementia, its expected course, and possible treatments. 
• How is long-term institutional care arranged for parents?
  The information included here is intended to help senior citizens and their families, particularly with the issue of long-term institutional care.   
• Where are support group meetings held? 
  Various bodies hold support groups for the families of people with dementia, such as: 
• EMDA - The Alzheimer's Association of Israel 
• The Ezer Mizion association
• Some of the HMOs (kupot cholim)
• Is Alzheimer’s a genetic disease?
  In many instances, there is no clear genetic factor in the disease. In rare instances, when Alzheimer’s disease commences at a young age, there is a connection to a specific gene.
• If one of my parents has the disease, is there a way of testing whether I will also have Alzheimer’s disease?
  No recommendation exists to perform routine genetic testing for dementia in family members. In the rare instances in which Alzheimer’s disease commences at a young age, the gene that causes the disease can be identified in family members, but the development of the disease cannot be prevented.  
• My mother has Alzheimer’s disease. She does not keep herself clean, and does not allow us to help her. I am at a loss as to what to do.
  The issue of bathing is a complex one for people with dementia, including Alzheimer’s disease; bathing is a task that consists of a number of stages, with many things to remember: undressing, turning on the tap, adjusting the water temperature... in short - it isn’t easy! 
• It sometimes helps to simplify the process by arranging clothes and bathing accessories in advance, using items that are easy to use and operate (such as the tap).
• The process can be made more pleasant by creating a calm atmosphere, comfortable room temperature (not too cold), undressing only in the bathroom, a stream of water that is not too strong and is at a pleasant temperature, directing the water at body parts and not from above, etc.
• It is sometimes possible to avoid fully wetting the entire body, with partial washing (e.g. limbs), shampooing hair at the hairdressing salon, etc. 

If there is strong resistance, a professional familiar with the subject, such as a nurse or occupational therapist, may be consulted.

• My husband has Alzheimer’s disease. He conducts conversations with people from his past, including people who died many years ago! He sometimes calls me “Mom,” even though his mother passed away long ago. How should I react?
  This is a complex issue. It is very common for persons with dementia and Alzheimer’s disease to turn inwards or to figures from the past, as a mechanism for detaching from the unclear and incomprehensible present. This phenomenon can be very difficult for relatives, who seek truth and reality.
  It’s best not to point out his error, but to relate to his connection with the figure from the past and reassure him that everything is okay. Afterwards, try to redirect his thoughts to another topic.
• My father frequently asks me how my brother is, and when he is coming to visit. My brother is a dedicated son, but he left the country a year ago. Every time I tell my father that my brother lives far away, he becomes angry and sad.
  Tell him that your brother is fine and busy working, but also put your father in touch with him by telephone or by sending him a letter or email. There’s no need to cause unnecessary disappointment and sadness.  
• My mother puts all sorts of things in her bag that don’t belong there, and then is convinced that we took them away. What should we do?
  Your mother is afraid things will get lost, so she puts them in her bag “just to be sure.” She blames you for taking them because she no longer remembers what she has done.
  The best reaction is not to confront her outright, but rather to find a tactful way of looking in her bag, saying, for example, “Mom, maybe I accidentally put it in your bag, let’s look there...” or “Sorry, my mistake.”  
• My wife gets up every morning convinced that it’s Shabbat. She asks to light candles and make the blessing for lighting candles, and I don’t manage to persuade her otherwise.
  So long as there is no issue of danger, try to allow her to do this. Let her light candles, and go out for a “Shabbat walk.” Maybe when you return home, she will forget that today is “Shabbat,” and you will be able to cook lunch.  
• My husband has been diagnosed with Alzheimer’s disease. He goes to the bank, withdraws large sums of money, and we don’t know what he does with all of it. What should we do?
  One of the first things impaired in dementia is the ability to manage one’s affairs, particularly financial affairs. A person with Alzheimer’s disease (or other dementia) undergoes a gradual process - from an independent person in control of all his affairs to a person in need of assistance with everything. This is a painful and frustrating process, both for the patient and for his family. 
• Somebody else, usually one of the children, should undertake management of the patient’s finances. 
• Speak with the bank manager and to ask him to be alert to unusual activity in the account. 
• It may be necessary to appoint a guardian for the patient’s assets, in order to give legal validity to the financial management. 
• Consult with professionals in this regard – a physician, social worker, lawyer (legal advice for senior citizens is provided by the Yad Riva association). 
• It is also important to make sure that the patient is always in possession of a small amount of money, to give him the sense that he is still in control. 

For more details, see information on the topic: Loss of Capacity.

• My husband has been diagnosed with Alzheimer’s disease, and the doctor said he cannot continue driving. He has been driving since the age of 18, and it will be quite a blow to him to have to stop. What should I tell him?
  Clearly, a revoked driver’s license significantly impairs one’s independence and self-image. On the other hand, dementia usually causes difficulty with orientation and a decline in judgment, and obviously one must not endanger other road users. It would be best to share this question with the primary care physician. If your husband’s driving is dangerous, the doctor is legally obliged to report this to the Licensing Bureau. It may be impossible to explain to a patient that he must voluntarily stop driving, and it is preferable for the notification to come from an official source.
  For more details, see information on the topic: Loss of Capacity.