Caregiver preparedness will be critical (2)

This is the Truth, Lies and Alzheimer's Show, brought to you by Passionate World Talk Radio and Global Media Network, LLC. Passionate World Talk Radio is a wholly owned subsidiary of Global Media Network, LLC. Our motto is to educate, enlighten, and entertain. I'm Ken Poglia. I'm here to introduce your host. She is an Alzheimer's and dementia expert. She is a best-selling author. She is a world-renowned public speaker. She is Lisa Skinner, and we have a fantastic episode planned for you today. In today's episode, Lisa talks about why caregiver preparedness will be critical to having more positive outcomes in caregiving for those living with Alzheimer's disease and dementia. She shares one of her own true personal stories to illustrate how possessing the power of knowledge can make such a tremendous difference to the caregivers, the family members, and the folks with dementia. She'll provide you, the listener, with a list of many of the most challenging behaviors that caregivers have identified in their role and explain why understanding and recognizing these behaviors is the first step to help alleviate The Caregiver Burden. And in Lisa's What's New segment, she'll discuss a study that finds that the first signs of Alzheimer's disease may appear in the eyes and that they might be a reflection of a person's cognitive health. And with that, I'm very happy to turn it back over to our host, Lisa Skinner, for today's show.

Woo-hoo! Thanks again, Ken. Welcome everybody. So happy to have you with us again for another episode of The Truth Lies: An Alzheimer's Show. You know, throughout the episodes that we've had so far, I've shared my tips, approaches, and strategies that can help you manage the many challenging behaviors and situations that do arise as a result of living with Alzheimer's disease and dementia. Keep in mind that many of these occurrences will happen unexpectedly. So the more resources you have safely tucked away in your toolboxes, the more prepared you will be to address just about any situation that surfaces. It is so important to note that not every strategy will work every situation every time. But the more things you have to pull from your toolbox, the better chances you will have for success for each individual occurrence that happens. Also, I recommend that you keep a log or a journal of what has worked for each circumstance and what has not worked. But again, I've said this before, nothing is a guaranteed hit. If something did not work previously, you can always try it again and see if it works that time. The point is, you will eventually learn what tends to trigger certain behaviors in your loved one and will also learn the most effective effective ways to tackle these situations. So again, the more methods you have to choose from, the more prepared you will be to change the course of each episode as they occur. So, that said, I am now going to share with you a story I wrote called Stranger in the Mirror. This is a true story. Based on an actual experience of mine, and it's really going to illustrate this point that I just made about being prepared with methods and strategies and knowledge. Here we go. When a person with Alzheimer's or other dementia hallucinates, they may see see, hear, smell, taste, or feel something that isn't there. Some hallucinations may be frightening, while others may involve ordinary visions of people, situations, or objects from the past. Now, according to the Alzheimer's Association, hallucinations are false perceptions of objects or events Evolving the Senses. These false perceptions are caused by the changes within the brain that result from Alzheimer's disease, usually in the later stages of the disease. The person may see the face of a former friend in a curtain or may see insects crawling on his or her hand. In other cases, a person may hear someone talking and may even engage in conversations with the imagined person, like we will hear in the story Stranger in the Mirror. Harold had been diagnosed with Alzheimer's disease and lived with his wife Nancy, who was his primary caregiver. One day, Nancy was sitting in the living room watching the TV when she noticed him ambling down the hallway. He paused as he passed the hallway mirror, nodded at his reflection, and continued into the living room. "Who's that guy?" he asked Nancy. "What guy?" she replied. "That older guy in the hallway." Nancy looked down the hallway and saw the mirror. "Oh, oh, that's Harold," she said. "Oh," Harold said, shrugging his shoulders. As he headed into the kitchen. Over the next several months, Nancy watched Harold's relationship with his new friend blossom. She overheard him discussing a variety of subjects with his friend, including sports, aviation, and Harold's favorite kind of cookie, the Lorna Doones. "You gotta try these," Nancy overheard Harold saying to the mirror one night. And then the next morning, she found two smashed-up Lorna Doone cookies on the floor just underneath the mirror. On another day, Harold came dashing into the living room and demanded to know where his reading glasses were. "I didn't take your glasses," Nancy said without even looking up from the TV. Well, moments later, she heard Harold's voice from the hallway. Nancy said, "You didn't take them, did you, buddy?" "Nah," he said to the mirror, "you're not that kind of guy. I think you're my friend." A few days later, Nancy caught her husband looking at his feet in the full-length mirror. He turned to her and said, "Harold and I must be getting really close because apparently I gave him my shoes." Nancy mentioned her husband's imaginary friend at an Alzheimer's support group that she attended regularly. She learned that Harold's behavior was a common phenomenon called stranger in the mirror. She joked to the group that Harold's new friend wasn't a stranger, it was actually her husband that she no longer recognized. As Alzheimer's disease progresses, she learned, the short-term memory diminishes, and the person with dementia believes they are a younger version of themselves. So when Harold looked in the mirror, he saw an older man that he believed could not possibly be him. So the group's recommendation was that she cover up the mirror, remove it altogether, or continue to join his reality like she'd been doing by continuing to go along with his story. Nancy went home that evening and covered up the mirror. Mirror Harold must have found a new place to hang out because Harold never mentioned him again. The phenomenon of stranger in the mirror is an example of a hallucination. Which is a very common behavior seen with dementia. For Harold, the behavior ended up being relatively harmless, and his wife Nancy did find the situation entertaining because Harold was clearly having fun with his new imaginary friend. However, in other cases, people can be frightened by the hallucination or even perceive it as a threat. I cannot emphasize enough the importance of being aware of the stranger in the mirror phenomenon. So as caregivers, you too will know what signs and behaviors to look for to put your loved ones at ease if this situation were to arise. The brain is at the center of our thought processes and is essential to our lives. It takes in information from our daily experiences and enables us to make sense of our world. Our memories become the threads that sew our lives together in sequence and in continuity. But when our memory begins to fail, the tie to our life unravels, as we heard with Harold in the Stranger in the Mirror story when he did not recognize his own— in reflection in the mirror. When dementia is present, it breaks that link that connects the people with the world as they knew it, and therefore it will have a profound effect on their ability to process information in the same way they did before the brain disease developed. These losses in brain function will inevitably change the person afflicted with it, but it will also vary from person to person. The first memory problems with Alzheimer's disease typically occurs with recent or short-term memories. The person will have difficulty recalling the events that have happened most recently. However, their long-term memories can remain intact far into the disease, sometimes all the way through the disease. A person experiencing lost memories may feel confused when the world as they knew it starts disappearing and their past and present collide. This can elicit feelings of fear and anger as well as unveil uncharacteristic behaviors of that person. So, as you kids have learned, the Stranger in the Mirror story is a prime example of a situation arising unexpectedly for what seems to be no explainable reason. So, if a caregiver was not aware that a person living with dementia may not recognize themselves in the mirror and subsequently triggers a negative behavior, then of course, how would they know that this situation could easily be rectified? And that's why I can't emphasize enough why knowledge will end up being your power. And the more knowledge you possess regarding what triggers these behaviors, the more power you will have to resolve these issues. I'm going to read to you a list of what many caregivers have identified as being the most challenging behaviors for them. This is not an exhaustive list. So, these are just some of the most challenging behaviors that they have identified. Agitation or aggression, wandering or restlessness, hallucinations, delusions, refusal to bathe, refusal to take their medications, having incontinence or constipation, experiencing late-day confusion or sundowning, sleeplessness, refusal to eat, repetitive speech or repetitive actions, and paranoia. Now again, these are just some of the many, many behaviors that you can expect to encounter while caring for a loved one. And again, I can't emphasize enough that understanding the behaviors and challenges of Alzheimer's disease and dementia for the caregivers really is the first step to help alleviate the caregiver burden. And then, secondly, being prepared with the effective tools and best practices for responding to these behaviors as they come up. So, let's move on to what's news. In my What's New segment on today's episode, I found a really interesting study at CNN Health called Alzheimer's First Signs May Appear in Your Eyes. It was written by Sandy Lamotte of CNN, and it was published on March 24, 2023. The eyes are more than a window to the soul. They're also a reflection of a person's cognitive health. The eye is the window into the brain, says ophthalmologist Dr. Christine Greer, Director of Medical Education at the Institute for Neurodegenerative Diseases in Boca Raton, Florida. You can see directly into the nervous system by looking back into the back of the eye toward the optic nerve and retina, she says. Research has been exploring how the eye may help in diagnosing Alzheimer's disease before symptoms begin. The disease is well advanced by the time memory and behavior issues are affected. Alzheimer's disease begins in the brain decades before the symptoms of memory loss, says Dr. Richard Isaacson, an Alzheimer's preventive neurologist who is also at the Institute for Neurodegenerative Diseases. One day doctors may be able to use eye tests to identify cognitive decline soon after it begins. If doctors are able to identify the disease in its earliest stages, people could then make healthy lifestyle choices and control their modifiable risk factors like high blood pressure, high cholesterol, and diabetes, Isaacson says. The I know. Just how early can we see signs of cognitive decline? To find out, a recent study examined donated tissue from the retina and the brains of 86 people with different degrees of mental decline. Our study is the first to provide in-depth analysis of the protein profiles and the molecular, cellular, and structural effects of Alzheimer's disease in the human retina, and how they correspond with changes in the brain and cognitive function, said senior author Maya Koronohamoai, a professor of neurosurgery and biomedical sciences at Cedars-Sinai in Los Angeles, in a statement. These changes in the retina correlated with changes in parts of the brain called the entorhinal and temporal Cortices is a hub for memory, navigation, and the perception of time, she said. Investigators in the study collected retinal and brain tissue samples over 14 years from 86 human donors with Alzheimer's disease and mild cognitive impairment, which is the largest group of retinal samples ever studied, according to the authors. Researchers then compared the samples from the donors with normal cognitive function to those with mild cognitive impairment and those with later-stage Alzheimer's disease. The study, which was published in February in the journal Acta Neuropathologica, found significant increases in beta amyloid— a key marker of Alzheimer's disease in people with both Alzheimer's and early cognitive decline. Microbial cells did decline by 80% in those with cognitive issues, the study found. These cells are responsible for repairing and maintaining other cells, including clearing beta amyloid from the brain and retina. Markers of inflammation were also found, which may be an equally important marker for disease progression. The findings were also apparent in people with no or minimal cognitive symptoms, which suggests that these new eye tests may be well positioned to aid in early diagnosis The study researchers found higher numbers of immune cells tightly surrounding amyloid-based plaques, as well as other cells responsible for inflammation and cell and tissue death. Tissue atrophy, or shrinkage, and inflammation in cells in the far periphery of the retina were most predictive of cognitive— the study did find. So these findings may eventually lead to the development of imaging techniques that allow us to diagnose Alzheimer's disease early— earlier and more accurately, Isaacson said, and also monitor its progression noninvasively by looking through the eye. So, gosh, they're making some really exciting and positive advances. Just recently, because last week I shared with you the FDA approving the new drug treatment, Lekembi, that also tends to clear the amyloid proteins, and now with this a study that claims that they can possibly determine if somebody is developing Alzheimer's disease by looking into the back of the eye. This is all really, really encouraging news. So that's what I have for you on today's episode. I will be back in a minute after Ken— provide you with a few announcements.

Thank you, Lisa. I never get tired of hearing Stranger in the Mirror, and I really appreciate you always providing us with the latest news on Alzheimer's and dementia research. For our listeners, thank you for listening to The Truth, Lies Alzheimer's Show with your host Lisa Skinner. This program can be found on our website at passionateworldtalkradio.com under the shows tab, and you can also search for us on YouTube. You can find Lisa on Facebook by searching for Lisa Skinner Author, and if you're interested in Lisa's books or training programs, go to truthlivesalzheimer's.com. Her books are also available on all major platforms, including Amazon and Apple Books. And with that, let's bring it back to Lisa to take us home.

All righty. I want to thank everybody again for listening today. I always have so much to cover, especially in the upcoming episodes. I really want to provide everyone with information that you'll find helpful and valuable throughout your journey. Remember, dementia awareness happens every day. Kindness is the ability to speak with love, listen with compassion, and act with patience. And these are all very necessary attributes to have in order to outlast Alzheimer's disease. One last note: This show is about you and how my experiences, expertise, and strategies will be able to help you and your loved one have an easier time while struggling through this disease, I know firsthand how difficult it is. Therefore, I would really love it if you'd send me your comments and suggestions on what topics you'd like me to cover on this weekly show. You can send them to my personal email address, which is dementiawhisperer1@gmail.com. Also, if you're listening to this on YouTube or if you got here through our social media page, go ahead and leave your comments or questions and I'll do my very best to address them. So again, I genuinely look forward to receiving your thoughts and ideas. And in the meantime, take care of you. Talk to y'all next week. Bye-bye.