How Technology Can Assist People with Alzheimer’s Disease and Dementia

Alzheimer’s disease is frightening and overwhelming for both the patients and their caregivers. While people with Alzheimer’s may experience grave difficulties due to illness, caregivers often feel pressured and exhausted with increased demands and responsibilities.

Technological advancement has provided promising solutions to ease the burden and anxiety of caregiving and to make people with Alzheimer’s disease and dementia feel safer and more comfortable.

The technology that is specifically designed to help people suffering from dementia do things in everyday life is known as assistive technology. This technology helps promote independence and autonomy among seniors, reduce stress, and manage potential risks at home.

Assisted technology includes a range of innovations such as ‘smart home’ systems (that you can instruct to switch off the lights or turn on the heating), electronic pill boxes (that remind you to take medication), and many more. Alternatively, general technology, such as mobile phone apps, may also help caregivers in their caregiving endeavors and Alzheimer’s patients in staying active.

The following are some of the helpful technologies for caregivers and dementia patients.

1. Memory Problems and Management of Daily Activities

There are a variety of devices that can assist if your patient’s memory loss is interfering with their daily life. Each device typically functions by providing a visual, verbal, or audible reminder to do something.

(i) Automated Reminders

Several devices are available for setting reminders, and you can customize them as per your needs. Some may include a voice recording of you, a family member, or a friend. You can record messages on the devices that set reminders and play them to remind the person to take medicine at the right time or perform other activities when you are not around. Others can detect motion and play a pre-recorded message upon sensing movement.

(ii) Clocks and Calendars

Automatic calendar clocks, specifically designed for dementia patients, are available to help them distinguish the day of the week and the time of the day. Talking clocks and clock and calendar apps are also available to assist caregivers in managing the memory issues of their patients.

(iii) Medication Aids

Medication aids may help people with dementia take their medicine at the right time. They can be simple, like a pillbox, or advanced, like automatic pill dispensers. Simple pillboxes have separate sections for days of the week and times of the day. Automatic pill dispensers, on the other hand, are pre-filled and locked. The dispenser sets off an alarm when it is the time to take medicine, and the right section opens so that you can have the right pills.

(iv) Locator Devices

People with Alzheimer’s disease may wander. GPS location and tracking devices may help caregivers cope with such situations. You can have your patient wear them so that their alert system lets you know if the person has left a particular area. Some locator devices can also help the patients find misplaced items. A small electronic tag is attached to the objects, which helps locate them.

(v) Vision and hearing aids

A wide range of devices is available to help people with Alzheimer’s disease and dementia with sight and hearing problems. For instance, handheld magnifiers and electronic magnifying video screens can be used for sight, while hearing aids and amplified phones (with louder speech volumes and ringtones) can be used for hearing issues.

2. Technology for Safety

Assistive technology encourages independence and helps make the home safer for Alzheimer’s patients. While assistive technology can help curtail risks, it does not entirely eliminate them. Technology that makes you feel safe can be a huge help and an essential part of living well with dementia. It could include the following:

  • Automatic lights that turn on upon sensing movement and turn off when the room has been empty for a set time.
  • Water isolation devices that automatically turn off the tap if left running.
  • Fall sensors automatically detect and get immediate assistance for the person susceptible to falls.
  • Automated shut-off devices that turn off a cooker or stop the gas supply if the gas is on.
  • Special plugs that let you keep the required water depth in a sink or bath. If the water level rises above a certain level, the plug opens and drains the water. They can also have heat sensors that change the plug color upon getting too hot, preventing burns.

(i) Telecare Systems

Telecare systems are another way of ensuring the safety of your patient. These systems allow people with Alzheimer’s disease or dementia to live independently, knowing that their family or friends will be notified if they run into a problem.

Telecare systems may include sensors, movement detectors, community alarms, and video calling. An alarm is linked to a particular person or a call center, who gets alerted when a sensor detects an issue and when the patients themselves press a panic button or community alarm. These systems require a telephone line or an internet connection to function.

Various telecare systems are available for different situations, including community alarms, monitored medication reminders, and sensors (for example, water, temperature, door, and movement sensors). Bed or chair sensors are put on the bed or chair and alert the family or friends if the patient gets up and does not return after a particular time or does not get up in the morning.

3. Socializing and Doing Things Your Patient Enjoy

Assisted technology can help your patients socialize, stay engaged, and do things they enjoy. A variety of apps are available for mobile phones and tablet devices to help the person remain active. Besides, other technological innovations, ranging from simple to sophisticated ones, can also assist them in achieving these goals. These include phones (pre-programmed with numbers), video chat, communication apps, social media, online forums or communities, sensory devices (that use touch, sound, and light to stimulate senses), and digital games and puzzles. Digital photo frames are also available that can make the patient reminisce about their life events by viewing a slideshow of photos.

Posterior Cortical Atrophy (PCA): Symptoms & Treatments

What is Posterior Cortical Atrophy?

Posterior cortical atrophy (PCA), also known as Benson’s syndrome, is a rare degenerative brain and neurological disorder caused due to a gradual and progressive deterioration of the cortex (the outer layer of the brain) at the back (posterior regions) of the brain. This ailment usually affects eyesight and the ability to process visual and spatial information.

What Causes PCA?

It is unclear whether posterior cortical atrophy is a distinct disorder or a possible variant of Alzheimer’s disease. In many people with PCA, the affected parts of the brain exhibit the presence of amyloid plaques and neurofibrillary tangles, which is similar to Alzheimer’s disease but in a different area of the brain. However, in some people, the brain changes are similar to other diseases like Lewy body dementia or a type of Creutzfeldt-Jakob disease. Alzheimer’s disease typically occurs at age 65 or above, while PCA occurs between 50 and 65.

According to researchers, approximately 5% of people diagnosed with Alzheimer’s have PCA. However, because PCA is not often recognized or diagnosed, the actual percentage may be as high as 15%.

Symptoms of PCA

The symptoms of PCA and its progression vary from individual to individual. The most common symptoms are related to the deterioration of the posterior cortex, the part of the brain involved in the processing of visual information. Neurological damage results in the gradual development of difficulties with visual tasks such as:

  • Trouble reading a line of text
  • Incorrectly judging distances
  • Disorientation
  • Difficulty differentiating between stationary and moving objects
  • Inability to distinguish more than one object at a time
  • Difficulty identifying and using everyday objects
  • Problem with spelling or mathematical calculations

Many people with posterior cortical atrophy may also experience the following behavioral symptoms:

People with PCA generally do not exhibit a considerably reduced memory in the early stages of the disease. However, it can affect the memory in later stages.

Diagnosis

Posterior cortical atrophy is an unusual and rare disorder and, therefore, misdiagnosis is common. Since the eyesight problems are the initial symptoms, most people with PCA seek the advice of an ophthalmologist, who may perform regular eye examinations with their usual tests. Cortical brain dysfunction is not initially considered to be the cause of the symptoms.

Currently, there are no diagnostic tests to precisely diagnose PCA. For diagnosis, doctors use a combination of tests, including blood tests, neuropsychological tests, neurological examinations, and brain scans (MRI and PET scans). They also conduct ophthalmology examinations to determine whether the eyesight and vision problems are due to any other condition besides PCA. Finally, the disease is diagnosed by ruling out other possible explanations for symptoms.

The gradual emergence of visual symptoms with retention of normal eye function and memory are characteristic features that the physicians occasionally observe for diagnosis. Furthermore, the age of onset of PCA (50 to 65 years) also provides a clue about the disease. The diagnosis should rule out the chance that the symptoms are due to a stroke, tumor, or other recognizable disorder.

Treatment of PCA

No treatments are currently known to slow the progression of posterior cortical atrophy. Since it resembles Alzheimer’s disease in some people, it is suggested that the medications used for temporary treatment of Alzheimer’s symptoms may be effective in treating PCA, but it is not proven. Some patients may temporarily treat symptoms such as anxiety or depression, but the overall risks or benefits of such treatments are unidentified.

Alzheimer’s Disease and Posterior Cortical Atrophy

Discussion is ongoing in the field to determine whether posterior cortical atrophy should be regarded as a subtype of Alzheimer’s disease or a separate disorder. Brain imaging suggests that the posterior cortex in PCA patients is thinner than in healthy people of the same age, indicating a decreased brain volume in the former. Moreover, although the diseases often overlap, the brains of PCA patients show degeneration in different portions than those of patients with typical Alzheimer’s disease.

Similar to Alzheimer’s disease, the cause of PCA is still not known. There are no known genetic factors or mutations that can cause PCA. It is also unclear whether the risk factors of PCA are the same as Alzheimer’s disease.

What is Parkinson’s Disease Dementia?

Parkinson’s disease is a progressive neurological disorder of the central nervous system that affects an individual’s mobility and ability to perform regular activities. It typically occurs in older adults over the age of 65. The disease impacts physical movements, but the patients can also exhibit impairment of mental functions, thought processes, and memory. This condition is known as Parkinson’s disease dementia and can develop in people living with Parkinson’s at least one year after diagnosis.

Parkinson’s disease initiates in a part of the brain involved in movement. Therefore, its early symptoms include muscle stiffness, tremors, stooped posture, a shuffling step, lack of facial expression, and problem initiating movement. As the disease advances, in the brain changes gradually spread and often start affecting cognitive functions such as memory, judgment, attention span and ability to plan steps for completing a task.

What causes Parkinson’s disease dementia?

The chief brain changes responsible for Parkinson’s disease and Parkinson’s disease dementia are the formation and abnormal deposition of Lewy bodies, the neuronal inclusions chiefly composed of alpha-synuclein protein. Alpha-synuclein protein is abundantly present in the brain, but its function is not fully understood.

Lewy Bodies are also the hallmark of Lewy body dementia (LBD) and may be present in other brain disorders, including Alzheimer’s disease. Research shows that LBD, Parkinson’s disease, and Parkinson’s disease dementia may be due to similar underlying abnormalities in alpha-synuclein processing in the brain. Researchers have also discovered the presence of plaques and tangles, the hallmarks of Alzheimer’s disease, in the brains of people with LBD and Parkinson’s disease dementia.

A recent study1 suggests that the problematic nature of Lewy bodies is because they pull out alpha-synuclein protein from the nucleus of brain cells. According to the study (which was performed on a mice model), these proteins carry out DNA repair in the cells, which may be pivotal in preventing cell death. The possible loss of this function in brain disorders like LBD and Parkinson’s disease dementia might be responsible for the widespread death of neurons.

What are the risk factors?

About 50 to 80% of Parkinson’s patients eventually develop dementia with disease progression. According to some studies, the patients develop dementia approximately 10 years2 after Parkinson’s disease onset.

Certain factors present at the time of Parkinson’s diagnosis may increase the risk of acquiring dementia in the coming years. These risk factors include aging, severe motor symptoms, and mild cognitive impairment (MCI). Experiencing hallucinations before manifesting other dementia symptoms and excessive daytime sleepiness may also indicate an increased dementia risk.

Another risk factor is a Parkinson’s symptom pattern called PIGD (postural instability and gait disturbance), which includes freezing mid-step, balancing problems, difficulty initiating movement, shuffling, and falling.

Symptoms of Parkinson’s disease dementia

Following are the most common symptoms of Parkinson’s disease dementia:

  • Changes in appetite and energy levels
  • Hallucinations, delusions, and paranoid ideas
  • Changes in memory, judgment, and concentration
  • Muffled speech
  • Depression, anxiety, and mood swings
  • Difficulty interpreting visual information
  • Loss of interest
  • Sleep disturbances such as rapid eye movement (REM) sleep disorder and excessive daytime drowsiness

How is Parkinson’s disease dementia diagnosed?

There is no single precise test or combination of tests for diagnosing Parkinson’s disease dementia. Following are the guidelines for making a diagnosis:

  • The diagnosis is Parkinson’s disease dementia if an individual is initially diagnosed with Parkinson’s disease due to the manifestation of movement-related symptoms, and dementia symptoms do not appear until a year or more.
  • If the dementia symptoms consistent with LBD develop first or present with movement-related symptoms or occur within a year after movement symptoms, the diagnosis is LBD.

What is the treatment?

Currently, no treatment is available to slow or stop the neuronal damage due to Parkinson’s disease dementia. However, improving the symptoms may help provide temporary relief to the patient. In the case of medications, remember to have a thorough conversation with a doctor to know which drugs will be most effective.

Doctors may prescribe drugs for treating the symptoms:

  1. Cholinesterase inhibitors drugs (used for treating cognitive changes in Alzheimer’s disease) may alleviate the symptoms of Parkinson’s disease dementia, such as sleep disturbances, hallucinations, and behavioral and cognitive changes.
  2. Carbidopa-levodopa may treat movement symptoms. However, it may cause complications such as aggravation of confusion and hallucinations in Parkinson’s dementia or LBD patients.
  3. Clonazepam and melatonin may be prescribed for the treatment of REM disorder.
  4. Selective serotonin reuptake inhibitors (SSRIs) can help treat depression.

Doctors usually avoid prescribing antipsychotic drugs. Approximately 60% of LBD patients exhibit worsening Parkinson’s symptoms, impaired swallowing, sedation, or neuroleptic malignant syndrome (NMS). NMS is a severe condition that may occur after exposure to traditional antipsychotics and is characterized by fever, rigidity, and muscle breakdown.

References

  1. Schaser, A.J., Osterberg, V.R., Dent, S.E., Stackhouse, T.L., Wakeham, C.M., Boutros, S.W., Weston, L.J., Owen, N., Weissman, T.A., Luna, E. and Raber, J., 2019. Alpha-synuclein is a DNA binding protein that modulates DNA repair with implications for Lewy body disorders. Scientific reports, 9(1), pp.1-19.
    https://www.nature.com/articles/s41598-019-47227-z
  2. Parkinson’s disease dementia. https://memory.ucsf.edu/dementia/parkinsons/parkinson-disease-dementia

What to do if dementia patients stop eating?

People with dementia may experience difficulty eating, swallowing, and drinking as the disease progresses. Although this behavior can occur at any stage of the disease, it tends to be most common in the late stages.

In late-stage dementia, the difficulty in swallowing limits the intake of food and drinks. This time can be difficult and emotional for the family or the caregivers of the patients as they have to figure out how to maintain the eating and drinking of their patients or loved ones.

What causes swallowing problems?

Eating and drinking is a complex procedure involving the brain’s control center and powerful muscles in the neck and throat. As dementia advances, it affects the brain regions that control swallowing. As a result, the patient exhibits symptoms, such as coughing or choking, clearing the throat, grimacing when swallowing, excessive motion of the mouth or tongue, refusal to swallow or keep food in their mouth, and even spitting food out. The caregiver usually notices these symptoms rather quickly.

Another reason for these problems is the weakening of swallowing muscles. Furthermore, due to changes in sensation and sensory perception, some people may feel the consumption of food becomes different and even unpleasant at times.

Having sensitive teeth or a sore mouth can also lead to swallowing problems. In this case, you should get your patient to visit a doctor and dentist as soon as possible for review.

If dementia patients do not eat, will they die of dehydration or starvation?

In late-stage dementia, the individual gradually develops swallowing problems and may stop eating. However, that does not imply that the patient will die due to starvation or dehydration. The food and fluid intake gradually decreases as the disease advances to the end, and the body slowly adjusts to it [1]. The brain regions responsible for basic functions start shutting down at this stage. The disease also seriously affects the brain regions that control hunger and thirst [2].

The movement and activity of the late-stage dementia patient also declines, and so does the calorie requirement. This observation can help the caregiver understand why not as much food or drink is required. A health care provider can examine the situation and make recommendations [2].

What is artificial nutrition and hydration (ANH)?

Artificial nutrition and hydration (ANH) refer to methods used to provide food and fluids to individuals who have impaired swallowing and can not eat through the mouth. Generally, ANH administration involves feeding with a tube. The tube either passes from the nose and into the stomach (nasogastric tube) or directly enters the stomach wall via a hole (gastrostomy). Another method is the intravenous (IV) or subcutaneous (SC) administration of fluids. ANH is often difficult for a person with dementia.

Is ANH a good decision?

A majority of health care professionals suggest that because patients with late-stage dementia are near the end of life, they should not be given ANH. It requires hospital admission that can be stressful for the patient, who might also try to pull out the tubes and drips, leading to infection and soreness at the insertion sites.

Some recent studies suggest that ANH can be more harmful than beneficial [3,4]. Giving food and fluids via tube does not stop choking or coughing, reduce chest infections, improve the healing of bedsores (pressure ulcers), improve the quality of life, or prolong life. Furthermore, the food can also get into the lungs, causing aspiration pneumonia. According to another study, the post-insertion mortality rate in late-stage dementia patients was 64.1%  with average survival of 56 days. About one-third of people with late-stage dementia died within a year after receiving a feeding tube [5].

Is the dementia patient suffering?

As a caregiver, you might be concerned if your patient or loved one is suffering. Caregivers or family members are often unaware of why their patients do not want to eat. Understanding that these eating problems are a normal part of the disease may help you feel assured that they are not suffering [2]. Most of the patients will not exhibit signs of hunger or thirst, but if they do, seek medical advice and get recommendations on what alternatives you can give in order to keep them comfortable.

Should you continue giving food and fluids through the mouth?

Yes. You should encourage your patient who can eat and drink, even if it is only a spoonful or sips of drink. Also, you should help them have fluids and foods that are as safe as possible. Examples would be soups, purees, etc.

Some helpful ideas for caregivers

If the patients want to eat or drink, despite having difficulty with swallowing, you can give them small amounts of food and drinks at a consistency that is manageable and safe. Always seek the advice of a healthcare professional, such as a general practitioner or speech therapist, who will assess the patient and suggest the most suitable consistency.

You should rule out physical problems that might make swallowing difficult, such as mouth sores, ill-fitting dentures, infections, or toothache. Changing the food or drinks may help. Consider soft and flavored food that requires minimal chewing, and avoid solid and mixed foods (such as cereals).

A balanced diet is not necessary at this point. Instead, focus on giving the patients food they desire and enjoy, or that they can swallow. A dietitian, however, can recommend nutrient supplements.

Before giving food or fluids, you should ensure that the person is in a good and comfortable position. Your patient should be fully awake and as upright as possible.

Lastly, give your patient some extra time and effort to make them enjoy the meal as much as possible.

References

[1] Gallagher, R., 2011. Swallowing difficulties: a prognostic signpost. Canadian Family Physician, 57(12), pp.1407-1409.

[2] Feeding Choices for Patients with Advanced Dementia.

[3] Ying, I., 2015. Artificial nutrition and hydration in advanced dementia. Canadian Family Physician, 61(3), pp.245-248.

[4] Feeding Tubes for People with Alzheimer’s.

[5] Kuo, S., Rhodes, R.L., Mitchell, S.L., Mor, V. and Teno, J.M., 2009. Natural history of feeding-tube use in nursing home residents with advanced dementia. Journal of the American Medical Directors Association, 10(4), pp.264-270.

[6] Eating and drinking at the end of life.

[7] The Decline of Tube Feeding for Dementia Patients.