Long term care and Alzheimer’s disease

 Long term care and the experience of Alzheimer’s disease: 

Alzheimer’s disease is by far the most common type of dementia present in long-term care facilities.  The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) lists two different times of Alzheimer’s disease: early-onset, which starts prior to age 65, and late onset, which starts after 65 years old.  The late onset type is much more common for residents in long-term care facilities as well as for the community-based elderly. As an individual gets older they’re more likely to contract Alzheimer’s disease.  While only about 2% to 4% of seniors over 65 have Alzheimer’s disease, the rate increases to about 20% for those over 85 years old.  A diagnosis of Alzheimer’s disease is made by establishing that the individual meets the criteria for dementia and by ruling out all other medical and psychiatric conditions which may have a causative affect. 

The course of Alzheimer’s disease is relatively consistent with one of the first signs of the disease being an impairment in recent memory and some mild impairment in long-term memory.  As time goes on, more and more cognitive abilities are lost in each successive year.  Some of the early stages include the first stage (possible pre-Alzheimer’s stage) in which there are minor impairments which result in mild to moderate difficulty in one’s life.  This stage may last for up to seven years.  These stages progress on to the most severe stage in which there is pervasive, severe cognitive impairment which affects every aspect of an individual’s life, and ability to think and manage their affairs. 

There are a variety of other mental disorders that accompany Alzheimer’s disease with about 50% of Alzheimer’s disease patients displaying delusions during the course of their disease.  Some experts believe that it is doubtful that an increased rate of depression accompanies Alzheimer’s disease.  A recent study of community dwelling Alzheimer’s disease patients found that very few have a diagnosis of major depression.  However, these conclusions are subject to controversy.  Alzheimer’s disease patients often appear depressed because some of their symptoms such as decreased energy, sleep disturbance, lack of interest, and poor concentration, seem to overlap with the symptoms of depression. These symptoms may lead caregivers to believe that relatives are depressed when in fact they are observing the “pseudo depressive syndrome” of Alzheimer’s disease.  Of course this does not mean that Alzheimer’s disease patients never get depressed, just that Alzheimer’s disease does not appear to be a risk factor as a result of severe depression. 

Additional information and web page by Paul Susic M.A. Licensed Psychologist Ph.D. Candidate (Health Psychology)

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