Tag Archive | psychosis

Lifestyle Dementia: Underdiscussed, Overlooked, But a Very Real and Present Danger

Today’s post will discuss lifestyle dementia. Many of the people, especially the elderly and very elderly, suffering from dementias and Alzheimer’s Disease today either have the genetic markers for it or – and this is my opinion, but I see strong evidence to support it with the precipitous explosion of dementias and Alzheimer’s Disease – are suffering from the effects of living on a toxic earth, eating toxic food, and breathing toxic air.

However, another group of dementia sufferers is emerging.

They are younger and have very different lifestyles than their elderly and very elderly counterparts with whom they share the same commonalities of dementia. This group of people has dementia that is directly related to lifestyle.

How we live our lives is a series of choices that we make consciously or unconsciously along the way. That is what becomes our lifestyle. Our lifestyle – all of those choices – has short-term effects and long-term effects. 

The long-term effects of those lifestyle choices are beginning to be seen in the growing number of people suffering with lifestyle dementia. One of the generations most noticeably – and disproportionate to the incidence in the expected populations of the elderly and very elderly – affected is the Baby Boomer generation (people born between 1943 and 1960, according to William Strauss and Neil Howe in their book The Fourth Turning, which I highly recommend that everyone read).

I strongly suspect that one of the lifestyle choices, which I’ll discuss later, that was prevalent with this generation during the 1960’s and early 1970’s is a key contributor to the development of the lifestyle dementia we see emerging among this age group today.

Before we proceed with describing lifestyle choices that could lead to lifestyle dementia, it’s important to understand what the word dementia describes. Any loss of function of and/or damage to the internal components of the brain (neurological, chemical, or physical) falls under the broad category of dementia when describing the brain’s condition.

(Inset note: Alzheimer’s Disease is the shrinkage of the size of the brain from the outside in, brought on by a specific condition that occurs in the nerve cells of the brain. Therefore, it’s important to remember that all people suffering from dementia don’t necessarily have Alzheimer’s Disease, while all people suffering from Alzheimer’s disease have a very specific kind of dementia, commonly called tangles and plaques.)

So dementia is a condition – or  state – of the brain. Like many nouns, this condition or state has adjectives that describe where the loss of function or damage is or specific identified abnormalities of the brain that affect function and cognition. Therefore, when we see the term vascular dementia, for example, the loss of function and/or damage to the brain is related to the blood vessels in the brain. 

So what kind of lifestyle choices can lead to lifestyle dementia?

diabetes-insulin-dementiaIn the last twenty to thirty years, the western world has adopted a supersized fast-food diet, a very sedentary lifestyle, and an “ignorance is bliss” attitude toward taking care of their health with regular medical checkups and changes in their lifestyles to address health issues like diabetes and high blood pressure.

Unchecked or uncontrolled, both high blood pressure and diabetes directly affect the health of the blood vessels in the brain, leading to widespread blood vessel damage and neurological cell death, which is the cause of vascular dementia. 

alcoholAnother lifestyle choice that can lead to lifestyle dementia is alcohol abuse. While it’s generally believed that alcohol doesn’t directly kill brain cells, alcohol abuse creates key vitamin deficiencies that adversely affect the brain and adversely affects the liver’s ability to remove toxins from the body. Research shows that women who abuse alcohol begin to exhibit the adverse effects in half the time that men who abuse alcohol do.  

This article from the National Institute of Health gives a very clear and understandable explanation of how alcohol abuse results in long-term damage to the brain. The specific type of dementia that occurs with alcohol abuse is Wernicke-Korsakoff syndrome, which occurs because of a thiamine (B1) deficiency.

A third lifestyle choice that can lead to lifestyle dementia is drug abuse. I noted earlier that one lifestyle choice seems to point to why there is such a high incidence of older Baby Boomers showing signs of dementia at earlier ages than their elderly and very elderly counterparts do. I believe that this phenomenon has a direct correlation to the pervasive and unabashed drug experimentation within this age group in the 1960’s and early 1970’s.

A few years ago, I watched a documentary entitled The Drug Years on the History Channel (it was originally produced by the Sundance Channel and VH1). If you have not seen it, you should (Netflix and Hulu subscribers will find it in the Documentaries section). It’s shocking in some ways, but very informative in others. If you’re like me, you’ll watch it shaking your head a lot. But there’s a lot of history that explains things before some of us (like me) were born or cognizant and it also explains our continuing prevalent and unabashed drug culture in the U.S. today.

The series had a lot of commentary by Martin Torgoff, who wrote 2005’s Can’t Find My Way Home: America in the Great Stoned Age 1945-2000. Intrigued by the title (the first part of the title is the mind-altering drugstitle of one of my favorite songs by the band Traffic), I read the book after watching the documentary. I don’t believe that any book I’ve ever read scared me as much as Torgoff’s book did. And as much head-shaking as I did during the documentary, I did even more reading this book.

As Torgoff described the drug abuse of the 1960’s and early 1970’s and quoted well-known and not-so-well-known people about their own drug use and abuse, it became evident that there was an uninhibited desire to find, use, and abuse any substance that substantially altered the brain. The more altered the brain was, the “better” the experience.

With the psychedelic agents in LSD, acid, psilocybin mushrooms, and peyote, perceptions became altered, hallucinations occurred, and illusions became real.  In short, this generation liberally sought every possible means of chemically inducing the manifestations of dementia. In the process, neurological damage occurred and now, with age, the effects of that damage are becoming more evident with the emergence of lifestyle dementia.

To be clear and to be fair, I’m not saying that every case of early-onset Alzheimer’s Disease and dementia or other types of dementia occurring at a younger-than-usual age is the result of drug abuse. That’s much too broad a brush stroke to paint with. But a recent study showed a pretty strong link between dementia and teenage/young adult lifestyle choices for people without a family history of the diseases.

And the neurological damage from this lifestyle choice continues with the use of more modern drugs like Ecstasy, Adderall, and “bath salts,” which are psychoactive and which stimulate the brain beyond its normal capacity and can produce hallucinations, seizures, and even death.

Bath salts, which have become popular in the last couple of years, permanently create irreversible neurological damage because of the simultaneous and voluminous suckerpunch all at once to the brain with the chemical effects of amphetamines and cocaine.

It remains to be seen, although it certainly will occur, what lifestyle dementias develop among the Millennials using these drugs today.

Some things happen to us in life through no fault of our own. However, we have choices in how we live our lives, and we can make positive lifestyle choices that, while they may not preclude any of us from developing Alzheimer’s Disease and dementias down the road, will ensure that we’ve done every within our power to ensure that our choices and actions haven’t contributed to it.

Delusions, Suspicions, and Fears in Alzheimer’s Disease and Dementias

Today’s post will discuss the psychotic manifestations of the brain damage that occurs in dementias and Alzheimer’s Disease. These, in my opinion, are the ones that are the hardest for us, as loving caregivers, to understand, anticipate, and manage.

I think part of the reason delusions, suspicions, and fears resulting from dementias and Alzheimer’s Disease are so difficult to be on the receiving end of is because they often can be sudden, random, and transitory, so they have the effect of keeping us, as family, friends, and caregivers constantly off-balance.

And that’s not comfortable for anyone as a constant state-of-being, since a sort of everpresent anticipatory anxiety is a common side effect for those of us on the receiving end.

For several months in 2010, as my mom was experiencing these in full-throttle, it seemed like my heart was constantly about ready to beat out of my chest as we went through this together. Sometimes it was because I didn’t know what I was walking into and other times it was because of what I’d just experienced. But it was nonstop for the duration.

One of my mom’s biggest fears after my dad died was that I would die before she did and she’d be left, in her mind, alone. Although I constantly reassured her that she didn’t need to worry, there were times in 2010 when I thought her fears might just come true.

Before we identify some of characteristics of the common psychoses associated with dementias and Alzheimer’s Disease, it’s important to understand what they are.

Delusions and hallucinations are not the same thing. Hallucinations are part of the visuoperception disorders that were discussed in “‘I See Dead People’ – Vision, Perception, and Hallucinations in Alzheimer’s Disease and Dementias.”

dementia Alzheimer's Disease delusionsDelusions, on the other hand, are persistent untrue beliefs not substantiated by facts or evidence. In our loved ones suffering from dementias and Alzheimer’s disease, these delusions often are accompanied by paranoia. And, frustratingly, there is no amount of logic, evidence, persuasion, or proof that is effective to counteract the delusions.

It’s important to note, though, that the influence of delusions waxes and wanes with our loved ones, and sometimes may not be present at all. I found with Mom that hers were worsening and more pervasive as her sleep patterns got more and more disrupted

The most common negative (not all delusions are negative) delusions among our loved ones suffering from Alzheimer’s Disease and dementias are:

  • that everyone is stealing their money, valuable items, and important documents
  • that everyone is lying to them
  • that everyone is abandoning them
  • that everyone is against them
  • that everyone hates them

These delusions actually create the other two psychoses of malignant suspicions and irrational fears.

Mom exhibited all of these before medication (SeroquelXR was a life-saver for her and me until the tardive dyskinetic effects related to her Lewy Body dementia prevented her from being able to take it anymore), and the belief that people were stealing things from her was the first to emerge.

It’s interesting to note that some delusions have a factual foundation in our loved ones’ pre-dementia and pre-Alzheimer’s Disease lives.

Mom actually had experienced theft of money (an insurance policy her dad had left to pay for her college was stolen by the aunt who was her guardian after his death) and a chest of items he and her mother had left to her (by the same person).

So, even before the dementias and Alzheimer’s Disease started taking their toll on her brain, Mom had a heightened fear of people stealing from her and taking advantage of her.

So when she began moving things – and this moving things got more frenetic as the damage from these diseases increased, so it just exacerbated everything and was a losing battle for me to try to keep up with – and then forgetting where she moved them, she immediately started accusing people of stealing them.

At first, her accusations were against other people, but eventually, she became convinced that I was the thief of everything, including her money (which I had no access to) and everything she misplaced.

I will never forget a Sunday afternoon a few weeks before her psychiatric hospitalization when my sister called to tell me Mom said she’d been at the hospital all the night before. I knew it wasn’t true, but my sister urged me to go back for a third time that day to Mom’s apartment and check on her.

I pulled into the parking lot next to a police car that was running and my gut told me that Mom had called 911 and the police were there because of her. Someone met me at the entrance and said that she’d called the police to have them arrest me for stealing her money.

suspicionsFortunately, the policeman just sat and talked with Mom and realized what was going on and got her calmed down and by the time I saw her, she was out of the delusional episode and tearfully welcomed me and said she loved me and asked me to forgive her.

Her tears always broke my heart and there was nothing to forgive, because I knew it wasn’t her fault, but my reaction was more a sense of helplessness to do anything about what was happening to her brain and the realization that it was bigger than both of us.

(Fields of Gold: A Love Story and Going Gentle Into That Good Night are two books I’ve written that detail different aspects of the details of how this unfolded. 

Fields of Gold: A Love Story is the history of my dad and mom [much of what explains my mom’s background that led to her behavior and thinking as vascular dementia, Lewy Body dementia, and Alzheimer’s Disease affected her brain] and us, me included, as kids and our lives together. It is a story of love, of commitment, and of endurance. For all of us. I recommend it because I chronicle so much of the last years of Mom’s life, and for all caregivers, this will resonate, but more importantly, hopefully it will help you.

Going Gentle Into That Good Night is the big-picture overview of caregiving for loved ones who are suffering from Alzheimer’s Disease and dementias and my general offering of the lessons I learned in the process with Mom. This blog is a direct result of that book, so I can fill in the specifics, the details, and hopefully encourage and help you.)

After that Sunday, though, the delusions took over and every day until her hospitalization was like a siege. There were moments – and even a morning after a week of pure hell that I’ll never forget – of love and lucidity, but they were few and far between.

She was convinced I was stealing from her, that I hated her, and that I was purposefully hiding things in her apartment so she couldn’t find them.

Some days I spent hours trying to find things – sometimes successfully and sometimes not – and give her proof that nothing was missing and that I loved her.

But Mom simply, because of the dementias and the Alzheimer’s Disease and the ravaging effects that they were having on her brain, was unable to be persuaded that what she believed wasn’t true.

The one thing that always stung me most, however, was when I’d tell her that I loved her and she’d angrily say “Don’t tell me that! You don’t love me! It’s not true!”

And although she seemed to be doing everything she could – again, she wasn’t aware of nor was she responsible for this – to push me away or to push my buttons so that my behavior would validate her delusions, all I could see was the scared little girl who had been left all alone at the age of six and, instead of being angry or quitting her, compassion and mercy took over and all I wanted to do was protect her and love her and make it all okay.

fearsAnd here is where I’ll offer some advice from my experience with delusions, suspicions, and fears. I’m not saying I always handled it with grace, but that was always my intent, and, most of the time, I did okay.

The first thing is to not take it personally. The reality is that delusions are the product of damage to the brain and mixed up memories of a lifetime and, as hurtful as the accusations and the strong negative reactions can be, they’re not really about us in the present.

The second thing is to remain calm. Reacting emotionally to or arguing with our loved ones suffering from delusions, suspicions, and fears actually heightens the suspicions and fears and in a strange way validates, for them, that their delusions are true.

It’s hard to stay calm, but it’s absolutely essential that you do. An even, reassuring tone of voice, deliberate and smooth movements and gestures, and supportive and encouraging words will not stop or change the delusions, suspicions and fears, but they will help.

If the situation escalates because of your presence, leave.

But not without being sure to tell our loved ones that we love them and we’ll see them later. I don’t care what kind of reaction that elicits – because it usually is negative – but it lets our loved ones know we’re not abandoning them.

And, then come back later, and start over. Repeat as often as is necessary.

The most important things, in my opinion, that we can do is to be loving, be patient, be merciful, and be compassionate. You and I have no idea of the tumultuous mental landscape that our loved ones with dementias and Alzheimer’s Disease are living with.

It’s beyond comprehension.

There’s a sense, for our loved ones, of the knowledge that they’re “going crazy,” and yet doing anything about that is beyond their control. It’s sad, it’s scary, it’s depressing, and it’s lonely.

Love, patience, mercy and compassion given and expressed unconditionally and continually will not change the reality of what these diseases are taking from our loved ones, but they will be the greatest gifts that we are able to give and will ensure that our loved ones can count on us to be there and give them these things, no matter what else happens, as they and we walk this journey together to its natural conclusion.