What is wandering? Wandering is a common behavior for people with dementia…
Dr. Cheryl Alvarez, Psy.D. is the Program Director at the Mind & Memory Program at Mission Hospital, an Intensive Outpatient Program for patients with both memory loss and a mental condition.
Tell us about your role as Program Director at Mission Hospital?
I’ve been serving as the Program Director for the Mind and Memory program since we opened this last January 2018. The program is a joint venture between Alzheimer’s Family Center in Huntington Beach, and Mission Hospital in Mission Viejo. We are very proud of the program, as it’s the first of its kind in the nation serving patients who have both a memory and a psychiatric disorder.
Tell me about the focus of the Mind and Memory program at Mission
Mind and Memory is an intensive outpatient program that serves patients who have both memory loss and a psychiatric condition, such as PTSD, depression, or an anxiety The focus of the Program is to treat the psychiatric problems which are impacting their ability to function and enjoy life and may be contributing to worsening memory loss or confusion. The program is a half day and provides therapy, treatment planning, and medication and nursing oversight, but also, importantly, provides structure, support, and socialization- and a cohort of peers that help normalize the unique challenges our patients face. We work to help our patients access services and keep their cognitive faculties for as long as possible despite a memory loss condition, such as Alzheimer’s.
How common are co-occurring dementia and psychiatric conditions?
Dementia and psychiatric conditions are very common to occur together. Individuals who are diagnosed with memory loss may experience depression as a result of the diagnosis, the loss of control, or the changes that occur in life. That being said, it’s a dangerous combination to have depression and Alzheimer’s. The research has shown us that patients who have depression are more likely to progress faster in their memory loss than those who don’t. For this reason, it’s really important to treat the depression quickly. The geriatric population is often dealing with a lot of grief, loss, and life changes. Moving from their homes, changes in their independence and freedom, and increased physical health issues. While it’s normal to have feelings of sadness at times, long standing or chronic depression can take a serious toll on a person’s memory and cognitive abilities.
How is the care for those patients different than care for people with Alzheimer’s?
Patients who attend our program are often times in the early stages of Alzheimer’s Disease or another type of Dementia. They are, like many patients with dementia, struggling with changes, depression, loss, anxiety, or another mental health condition, and have chosen to participate in a program where they are with peers who are having similar experiences. In this program, they are focusing on how to increase their coping skills, manage their depression or negative thought patterns, improve their communication and relationships, and improve their quality of life.
What is your advice to anyone seeing changes in behavior in their loved one? Where do you start?
It’s a scary thing for a lot of people to think about losing their memory, but it is critical to take action as soon as you start seeing changes. Confronting the problem from a place of care and concern is often helpful, then taking steps such as getting a memory assessment, seeing a neurologist, and following through with the diagnostic process in order to get a clear picture of what’s happening. There are several reasons why a person could be experiencing memory loss, so getting the right information and then being able to proceed and make educated and informed decisions is. In addition, the earlier the diagnosis, the more treatment options that are available. We are blessed with a health system with so many resources, neurologists, and diagnostic tools- but both the patient and family have to be good advocates for themselves to act quickly.
What is the treatment plan for someone who is facing this?
The best treatment is a combination of services that provide comprehensive care. We need to treat and attempt to delay the Alzheimer’s disease, but also treat the psych issues and improve their functioning. This will have an impact on their day to day activities. The more active and social they are, the better chance they can stay active longer. Isolation is a critical issue for these patients- they may get a diagnosis, feel embarrassed, lose their driver’s license and stop socializing and doing the things they used to enjoy- this is going to have a negative impact on their physical and mental health. Our treatment plans often focus on issues such as increasing their ability to cope with changes and stress, and reducing symptoms of depression that keep them from interacting and being
What do you tell people who ask about advice for maintaining brain health as they age?
Brain health is a combination of so many factors, but the most important:
- Managing other health conditions- preventing or treating diabetes/hypertension/cholesterol
- Exercise of course, but social activity is incredibly important for our brain function
- Intellectual challenges and pleasure. Doing things that are challenging. Watching TV and doing the same easy crossword puzzles will not contribute to brain health- we have to challenge ourselves, learn new things, and have fun- doing things that are fun and pleasurable have a reward impact in our brain that offers some protection against disease and decline.
Our attitudes about aging may have an impact on how well we age. Studies show that people who have healthy feelings about getting older tend to be healthier than those who have negative attitudes. While we can’t control everything that happens to us, we can control how we respond to it.
-Lastly, understanding risk factors, and understanding what normal aging is. Often patients either miss the signs of a memory problem or get stressed about something they are experiencing that is completely normal. The stress associated with worrying about something that isn’t there isn’t worth it! On the other hand, we need to be educated about the signs, so we can recognize them early in ourselves and others.
Questions From Social Media
Sam on FB asks, what are some options for younger people to do to prevent Alzheimer’s – do brain games work?
There is some mixed evidence on brain games. Some studies show no impact and others show a modest change, but we simply don’t know enough about who could benefit from these, or how long we need to do them, or what kind of games will have the most impact to be effective or The best bet to prevent Alzheimer’s is to stay active- physically, mentally, and socially. These will have a much more profound impact on your overall health than anything we can do on the computer now. Of course, if you smoke, stop smoking, and prevent or manage other health conditions, such as high blood pressure, diabetes, and high cholesterol.
Harry on FB asks, do head injuries lead to Alzheimer’s?
People who have suffered a head injury statistically do have an increased risk of developing Alzheimer’s or another Moderate to severe head injuries, and those that happen later in life are associated with greater risk, but the greatest risk is when you have repeated head injuries overlapping, or a history of head injury as well as other risk factors. It’s important to note that many people who sustain a severe head injury never develop Alzheimer’s or another dementia, and we still have research to do to better understand the link between the two.