Dr. Powers is a gereopsychiatrist and neuropathologist and is a leading authority in the state of Alabama on Alzheimer's and other dementias.

Definition of dementia - slow, progressive loss of intellectual functions
de (from out of ) mens (mind) - de mens - Latin for out of mind.

Top causes of dementia in the elderly:
1. Alzheimer's
2. Vascular
3. Alcohol
4. Lewy Body Disease

Dr. Alois Alzheimer first described the disease in 1906. Not until the late 1960s and early 1970s was Alzheimer's recognized.

Clinical manifestations (1st four are 4 A's of Alzheimer's):
1. amnesia - loss of memory function
2. aphasia - loss of ability to understand the written or spoken work or inability to speak.
3. apraxia - loss of ability to perform remembered motor tasks
4. agnosia - loss of ability to remember what things look like
Psychiatric:
1. depression - 25%
2. psychosis (hallucinations and delusions) - 30-40%
3. poor judgement, irritability, inappropriate behavior
4. major personality changes

"Think of what it would be like if every fourth word was stuck on the tip of your tongue and you just couldn't think of the word."

Management strategies:
1. recognize patient deficits
2. use simple statements and words
3. speak slowly, calmly, patiently
4. gesture, point
5. structure activity and schedule

"Snack them or nap them--don't zap them." Take care of their needs --make sure they are not hungry, tired, or bored before giving them drugs to control their behavior.

Feeding is very important--don't let them lose weight--feed them what they will eat--don't get into food fights--if all they will eat is sweets, feed them sweets.

Causes of Alzheimer's:
1. Genetic disorder
2. Inflammatory disease
3. Neurotoxic substances
4. Hormonal/endocrine
5. Apoptosis

Aricept is a good medication but doesn't stop Alzheimer's. Aricept seems to be safer and more effective than Cognex, but Dr. Powers doesn't recommend switching if Cognex is working. Don't expect big changes from either-- only slow the progression of the disease.

Women receiving estrogen replacement seem to have less risk for Alzheimer's. Questions were asked about NSAIDs and Vitamin E. Dr. Powers is not convinced about Vitamin E and does not recommend taking NSAIDs for the prevention of Alzheimer's because of the risks involved.

Carol Mosely is the Executive Director at The Village at Cook Springs, just east of Birmingham on I-20, a 270 person capacity home including a 96 bed assisted living facility.

The facility is pleasantly designed, with paintings from songs on the walls. Music therapy is important there--upbeat music earlier in the day and soothing later.

Use pet therapy: birds, cats, dogs, and other animals. The residence is in the country, and there are also horses, goats, and other farm animals.

Validation therapy works--"fib therapy"--whatever world they are in--that is ok.

Medication: If it is a struggle to get them to take it, consider whether it is worth the struggle. Trim the medication down to only what is necessary.

Mealtimes are important. Those who lose weight tend to fall and to get injuries more.

They have added finger foods to the menu. All activities revolve around snacks and finger foods. Patients are fed one course at a time and given only what they need to eat it.

Recommendations to family: If you can keep them safely in the home, do. But whenever the family can no longer care for them or when it become unsafe, then it is time for a decision to place them somewhere.

It is important to get on a waiting list early. One doesn't have to say yes when an opening comes and can stay on the list. Waiting periods for nursing homes can be two months to two years and at least six months for assisted living.

Connie L. Glass is a partner in the Elder Law Firm of Glass & Wallace, P.C. in Huntsville, Alabama.

Living trust - assets put into a trust, with a person designated who would take over management of affairs - to avoid probate process.

Power of attorney - Need to make sure it is a Durable power of attorney, which will last even if the person becomes incapicated.

Springing or conditional powers of attorney are harder to use.

Guardianship - to care for a person
Conservatorship - to manage their business affairs
These are something done to a person, whereas a Power of Attorney is something someone gives to someone.

Durable power of attorney for health care includes health care decisions. Different people can be named for making financial and health care decisions. The issue of the feeding tube must be included in the document.

Paying for long-term care:
There are 22,000 patients in Alabama nursing homes. Medicaid is often the only option. A bed in a semi-private is around $3,500 a month. Medicare pays sometimes for a limited time after a hospital stay. Medicaid pays long-term.

Criteria for Medicaid benefits:
1. medical - needing 24 hr. care
2. income - $1,452 a month limit in patient's personal income. Spouse never has to contribute.
3. resources - $2,000 limit on countable resources - home is now excluded for spouse to keep.

Tamara Johnson is an Occupational Therapist with Reflections, a Geropsychiatric unit at Hartsell Medical Center.

Any change will affect function, so there should be a routine for everything.

Stress reducers: deep breething, squeeze balls, pocketsful of "interesting things"

"Go Fishing!"-- when the patient is hallucinating or having delusions. Don't try to change their minds, but "go fishing", talking about what they are talking about--for example, if they are seeing angels, start asking questions like "What do you think angels are like?", "Where do they live?", etc., or if they are talking about someone having a gun, start talking about kinds of guns. Eventually they will forget what they were seeing/thinking.

Keep a list of what works. Quickly abandon anything that doesn't work. Take one step at a time.

Choose your battles. As yourself "Is this behavior harmful to the patient or to others?" If not, don't worry about it!

Things you must know about the person with dementia:
1. Have to know personality, history, and experiences that make them who they are.
2. Dignity must be maintained.
3. Remember they are not crazy, they are not mean, and they are not children.
4. Everyone is different.
5. Everyone has potential.
6. Offer loving acceptance, respect, humor.