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Deciding on dementia, Alzheimers treatment; Caregivers Corner

Capital - 7/22/2018

Dear Mary,

My dad has Alzheimer's and he also has cataracts. Should we put him through the cataract surgery?

Dear Reader,

Cataracts symptoms mirror many of dementia symptoms: difficulty in recognizing faces, reading facial expressions, finding objects, locating food on a plate, and managing in unfamiliar settings. Dementia alone can often isolate people; visual difficulty can further limit their activities, causing even more confusion and isolation.

The answer to your question depends a great deal on where he is in the progression of the disease and on your conversations with his neurologist, primary care doctor and ophthalmologist. According to a report by the Alzheimer's Association, a 2014 study indicated that "improved vision, resulting from cataract surgery can have a variety of benefits - both visual and non-visual - for people with dementia" when they were in the early stages of the disease. Keep in mind, however, that this study was conducted on a very small sample (28) of individuals with dementia.

Surgery during the earlier stages of dementia, when an individual can still cooperate with the pre-op tests and post-op procedures (such as eye drops, wearing dark glasses), may certainly be beneficial. However, if your dad's condition is more severe and he has difficulty following instructions, communicating and cooperating, I suggest you speak with both his neurologist and the ophthalmologist regarding your concerns.

Make sure that you address the question of what type of anesthesia will be used. For individuals who can cooperate, a local anesthesia is generally used. However, for those with a more advanced dementia, a general anesthesia might be required. Again, speak with the physicians as, oftentimes, general anesthesia can exacerbate the symptoms of dementia.

So the bottom line is that you don't have to make this decision alone. Gather other members of the care team together so you can make the best decision for your dad.

Dear Mary,

My 82-year-old mother recently came to live with me. She is in generally failing health, is in consistent pain from compression fractures in her spine and was recently diagnosed with dementia. She repeatedly says "I just want to die." I don't know how to respond to that.

Dear Reader,

It's not unusual for someone to be depressed after leaving their home, dealing with chronic health issues or receiving a diagnoses of dementia. Your mother is dealing with all three. It's important for you to validate what she is feeling. Sometimes, just a gentle hand on the shoulder and, "I'm sorry. This must be hard," will let her know you understand how difficult this is for her.

Address her pain issue. No one should have to live in constant pain if something can alleviate it. There is a feedback loop between pain and depression, so we need to look at a medical solution that can help with both. Check her current medications for a possible side effect of depression. Speak with her physician about palliative care options.

Let her know you are concerned about her. "Mom, it upsets me when you say that. Can you tell me why you feel this way?" Then listen. Ask her if she's considering suicide. (Don't worry; the question will not put the idea in her head.) Listen some more. Allow her to have her feelings. They are valid emotions.

Continue to provide updates to her physician regarding her mood and behavior. And in the meantime, take care of yourself. It would be quite easy to become so overwhelmed by your mother's depression that you become depressed yourself. Make sure you find a way to get away from your caregiving duties on a routine basis.

Dear Readers,

Registration for the Fall 2018 Caregivers Educational Workshop series will begin on Aug. 1. Topics include: "What is Dementia?," "When I Can No Longer Provide the Best Care," "Intimacy and Dementia," "Research Updates in Alzheimer's Disease," "Communicating through Behaviors: Part II," and "Sensory Stimulation and Activities for Those with Dementia." The registration brochure will available at www.aacounty.org/aging in late July. If you would like a copy mailed to you and to join the mailing list, call 410-222-4375 or email caregiver_support@aacounty.org.

Questions and comments can be sent to Mary Chaput at the Department of Aging and Disabilities, 7320 Ritchie Highway, Glen Burnie, MD 21061, or by contacting 410-222-4339 or agchap01@aacounty.org.

Credit: Mary Chaput - Questions and comments can be sent to Mary Chaput at the Department of Aging and Disabilities, 7320 Ritchie Highway, Glen Burnie, MD 21061, or by contacting 410-222-4339 or agchap01@aacounty.org.

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