Understanding Dementia Professor Ramos Blog

Understanding Dementia Allison Hepburn 10/10/2018 English 010 3pm                                                                 Understanding Dementia Dementia is characterized by progressive global deterioration of cognitive abilities in multiple domains, including memory, and at least 1 additional area- learning, orientation, language, comprehension, and judgment- severe enough to interfere with daily life (Daviglus 176) .Different forms of dementia, including vascular disorders (multiple strokes), dementia with Lewy bodies, Parkinsons dementia, and normal pressure hydrocephalus would be grouped among the non-Alzheimer disorders (Dementia). Alzheimer disease is the most common cause of dementia it accounts for 60% to 80% of all dementia cases, and as many as 5.1 million Americans may currently have the disease; the prevalence of mild cognitive impairment is even higher (Daviglus 176). Furthermore, the number of persons affected by Alzheimer disease or mild cognitive impairment is expected to increase considerably with the aging of the baby-boom generation (Daviglus 176). About 5 percent to 8 percent of all people over the age of 65 have some form of dementia, and this number doubles every five years above that age (Dementia). It is estimated that as many as half of people 85 or older suffer from dementia (Dementia). Although dementia has always been common, it has become even more common among the elderly in recent history. It is not clear if this increased frequency of dementia reflects a greater awareness of the symptoms or if people simply are living longer and thus are more likely to develop dementia in their older age (Dementia). The cognitive or behavioral impairment involves a minimum of two of the following domains: Impaired ability to acquire and remember new information––symptoms include: repetitive questions or conversations, misplacing personal belongings, forgetting events or appointments, getting lost on a familiar route (McKhann., et al). Impaired reasoning and handling of complex tasks, poor judgment––symptoms include: poor understanding of safety risks, inability to manage finances, poor decision-making ability, inability to plan complex or sequential activities (McKhann., et al). Impaired visuospatial abilities––symptoms include: inability to recognize faces or common objects or to find objects in direct view despite good acuity, inability to operate simple implements, or orient clothing to the body (McKhann., et al). Impaired language functions (speaking, reading, writing) ––symptoms include: difficulty thinking of common words while speaking, hesitations; speech, spelling, and writing errors (McKhann., et al). Changes in personality, behavior, or comportment––symptoms include: uncharacteristic mood fluctuations such as agitation, impaired motivation, initiative, apathy, loss of drive, social withdrawal, decreased interest in previous activities, loss of empathy, compulsive or obsessive behaviors, socially unacceptable behaviors (McKhann., et al). Diabetes mellitus, ApoE gene variation, current smoking, and depression are associated with increased risk for Alzheimer disease and cognitive decline (Daviglus., et al 180). Several cardiovascular risk factors have been consistently associated with increased risk for cognitive decline (Daviglus., et al 180). High blood pressure has been most consistently associated with cognitive decline, and particularly with severe cognitive decline (Daviglus., et al 180). Diabetes also has been associated with an increased Risk for cognitive decline, but this association is modest and less consistent (Daviglus., et al 180). The metabolic syndrome, a cluster of metabolic abnormalities, has been consistently associated with a modest risk for cognitive decline (Daviglus., et al 180). A large randomized trial of cognitive training (consisting of memory, reasoning, and speed) over 5 to 6 weeks with a subsequent booster period showed modest benefits on cognitive functioning and a small, statistically significant effect on reducing the extent of age-related cognitive decline at 5-year follow-up (Daviglus., et al 180). This trial also showed a very small significant benefit on instrumental activities of daily living- for example, managing finances, managing medications, and keeping house- and, in a subgroup analysis, benefit on driving performance in elderly persons (Daviglus., et al 180). However, these findings need to be replicated to confirm the benefits of cognitive engagement on preventing cognitive decline over a longer period and in persons with varying levels of baseline cognitive abilities before firm recommendations can be made (Daviglus., et al 180). Currently, no evidence of even moderate scientific quality exists to support the association of any modifia ble factor (such as nutritional supplements, herbal preparations, dietary factors, prescription or nonprescription drugs, social or economic factors, medical conditions, toxins, or environmental exposures) with reduced risk for Alzheimer disease. Numerous modifiable factors have been reported to show association with risk for Alzheimer disease across multiple studies, but the overall scientific quality of the evidence is low. I interviewed Nancy Hepburn who had a grandmother with dementia and is currently taking care of her mother who also had dementia. â€Å"The hardest thing to go through is them not remembering who I am and the times we had together† (Hepburn). My grandmother started having abnormal behavior and accused me of stealing her perfume, but I later found out she was hiding them (Hepburn). Nancy Hepburn also says, â€Å"My mother still remembers who I am but has short term memory loss, I have noticed while taking care of her, one thing that gets me frustrated and is also a very hard thing to do is have a conversation with her†. â€Å"We will start talking about a topic and then she will ask me the same thing that she did seconds before, or she gets it all mixed up and loses the point of what we were talking about† (Hepburn). You need to have a lot of patience and understanding for their circumstances and no matter how bad it gets, it’s your family member and you ha ve to understand they weren’t like that before the disease (Hepburn). As the disease progresses, these activities can enhance the person’s sense of dignity and self-esteem by giving more purpose and meaning to his or her life. Activities also structure time. They can make the best of a person’s abilities and facilitate relaxation. Being active can also provide a sense of engagement, usefulness and accomplishment, which can help reduce behavior like wandering or agitation. Both a person with dementia and his or her caregiver can enjoy the sense of security and togetherness that activities provide. Consider the person’s likes and dislikes, strengths and abilities, and interests. As the disease progresses, be ready to make adjustments (Alzheimer’s Associations 2).   Daily routines may include:  » Chores: Dusting, sweeping, doing laundry.  » Mealtime: Preparing food, cooking, eating.  » Personal care: Bathing, shaving, dressing. Other activities may include:  » Creative: Painting, playing the piano.  » Intellectual: Reading a book, doing puzzles.  » Physical: Taking a walk, playing catch.  » Social: Having coffee, talking, playing cards.  » Spiritual: Praying, singing a hymn.  » Spontaneous: Visiting friends, going out to dinner.  » Work-related: Making notes, fixing something (Alzheimer’s Associations 2). To determine if the daily plan is working, consider the person’s response to each activity (Alzheimer’s Associations 8). The success of an activity can vary from day to day (Alzheimer’s Associations 8). In general, if the person seems bored, distracted or irritable, it may be time to introduce another activity or take a break (Alzheimer’s Associations 8). Structured and pleasant activities often can reduce agitation and improve mood (Alzheimer’s Associations 8). The type of activity and how well it’s completed is not as important as the joy and sense of accomplishment the person gets from doing it (Alzheimer’s Associations 8). Cited page Alzheimer’s Associations. â€Å"Activities at Home Planning the Day for a Person with MIDDLE- OR LATE-STAGE DEMENTIA Middle- or Late- Stage Dementia† (2017) 1-12 This article explains daily activities to plan with a dementia patient. I believe this source is credible because it is written by the Alzheimer’s Association. I will use this information in my research to find different activities that will better help the dementia patient along with the caregivers. Daviglus, Martha L., et al. National Institutes of Health State-of-the-Science Conference statement: preventing alzheimer disease and cognitive decline. Annals of internal medicine 153.3 (2010): 176-181. This article researched the reduction of risk factors for Alzheimer’s disease. I find this article credible because state-of-the-science statements were prepared by independent panels of health professionals and public representatives by the National Institutes of Health (NIH). I will use this source in my report to better understand the risk factors and preventions of Alzheimer’s Disease. Dementia. (2014) my.clevelandclinic.org/health/diseases/9170-dementia. This source is credible because it is information from a clinic. I will use the information in the article to better understand dementia and what its symptoms are. Hepburn, Nancy, Personal interview. 2 Oct. 2018 This source is credible because she has a mother and had a grandmother who both have and had dementia. I will use this information to better understand what it is like taking care of an Alzheimer’s patient. McKhann, Guy M., et al. The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimers disease. Alzheimers dementia 7.3 (2011): 263-269. This article explains the different behavioral impartments on Alzheimer’s disease. I believe this to be a credible source because it is information from the National Institute on Aging-Alzheimer’s Association. I will use this source to the impairments that dementia causes.

Dachauâ€The First Nazi Concentration Camp

Dachau- The First Nazi Concentration Camp Auschwitz might be the most famous camp in the Nazi system of terror, but it was not the first. The first concentration camp was Dachau, established on March 20, 1933, in the southern German town of the same name (10 miles northwest of Munich.) Although Dachau was initially established to hold political prisoners of the Third Reich, only a minority of whom were Jews, Dachau soon grew to hold a large and diverse population of people targeted by the Nazis. Under the oversight of Nazi Theodor Eicke, Dachau became a model concentration camp, a place where SS guards and other camp officials went to train. Building the Camp The first buildings in the Dachau concentration camp complex consisted of the remnants of an old World War I munitions factory that was in the northeastern portion of the town. These buildings, with a capacity of about 5,000 prisoners, served as the main camp structures until 1937, when prisoners were forced to expand the camp and demolish the original buildings. The â€Å"new† camp, completed in mid-1938, was composed of 32 barracks and was designed to hold 6,000 prisoners. The camp population, however, was usually grossly over that number. Electrified fences were installed and seven watchtowers were placed around the camp. At the entrance of Dachau was placed a gate topped with the infamous phrase, Arbeit Macht Frei (Work Sets You Free.†) Since this was a concentration camp and not a death camp, there were no gas chambers installed at Dachau until 1942, when one was built but not used. First Prisoners The first prisoners arrived in Dachau on March 22, 1933, two days after the acting Munich Chief of Police and Reichsfà ¼hrer SS Heinrich Himmler announced the camp’s creation. Many of the initial prisoners were Social Democrats and German Communists, the latter group having been blamed for the February 27 fire at the German parliament building, the Reichstag. In many instances, their imprisonment was a result of the emergency decree that Adolf Hitler proposed and President Paul Von Hindenberg approved on February 28, 1933. The Decree for the Protection of the People and the State (commonly called the Reichstag Fire Decree) suspended the civil rights of German civilians and prohibited the press from publishing anti-government materials. Violators of the Reichstag Fire Decree were frequently imprisoned in Dachau in the months and years after it was put into effect. By the end of the first year, there had been 4,800 registered prisoners in Dachau. In addition to the Social Democrats and Communists, the camp also held trade unionists and others who had objected to the Nazis rise to power. Although long-term imprisonment and resulting death were common, many of the early prisoners (prior to 1938) were released after serving their sentences and were declared rehabilitated. Camp Leadership The first commandant of Dachau was SS official Hilmar Wckerle. He was replaced in June 1933 after being charged with murder in the death of a prisoner. Although Wckerle’s eventual conviction was overturned by Hitler, who declared concentration camps out of the realm of the law, Himmler wanted to bring in new leadership for the camp. Dachau’s second commandant, Theodor Eicke, was quick to establish a set of regulations for daily operations in Dachau that would soon become the model for other concentration camps. Prisoners in the camp were held to a daily routine and any perceived deviation resulted in harsh beatings and sometimes death. Discussion of political views was strictly prohibited and violation of this policy resulted in execution. Those who attempted to escape were put to death as well. Eicke’s work in creating these regulations, as well as his influence on the physical structure of the camp, led to a promotion in 1934 to SS-Gruppenfà ¼hrer and Chief Inspector of the Concentration Camp System. He would go on to oversee the development of the vast concentration camp system in Germany and modeled other camps on his work at Dachau. Eicke was replaced as commandant by Alexander Reiner. Command of Dachau changed hands nine more times before the camp was liberated. Training SS Guards As Eicke established and implemented a thorough system of regulations to run Dachau, Nazi superiors began to label Dachau as the â€Å"model concentration camp.† Officials soon sent SS men to train under Eicke. A variety of SS officers trained with Eicke, most notably the future commandant of the Auschwitz camp system, Rudolf Hà ¶ss. Dachau also served as a training ground for other camp staff. Night of the Long Knives On June 30, 1934, Hitler decided it was time to rid the Nazi Party of those who were threatening his rise to power. In an event that became known as the Night of the Long Knives, Hitler used the growing SS to take out key members of the SA (known as the â€Å"Storm Troopers†) and others he viewed as being problematic to his growing influence. Several hundred men were imprisoned or killed, with the latter being the more common fate. With the SA officially eliminated as a threat, the SS began to grow exponentially. Eicke benefited greatly from this, as the SS was now officially in charge of the entire concentration camp system. Nuremberg Race Laws In September 1935, the Nuremberg Race Laws were approved by officials at the annual Nazi Party Rally. As a result, a slight increase in the number of Jewish prisoners at Dachau occurred when â€Å"offenders† were sentenced to internment in concentration camps for violating these laws. Over time, the Nuremberg Race Laws were also applied to Roma Sinti (gypsy groups) and led to their internment in concentration camps, including Dachau. Kristallnacht During the night of November 9-10, 1938, the Nazis sanctioned an organized pogrom against the Jewish populations in Germany and annexed Austria. Jewish homes, businesses, and synagogues were vandalized and burned. Over 30,000 Jewish men were arrested and approximately 10,000 of those men were then interned in Dachau. This event, called Kristallnacht (Night of Broken Glass), marked the turning point of increased Jewish incarceration in Dachau. Forced Labor In the early years of Dachau, most of the prisoners were forced to perform labor related to the expansion of the camp and the surrounding area. Small industrial tasks were also assigned to make products used in the region. But after World War II broke out, much of the labor effort was transitioned to create products to further the German war effort. By mid-1944, sub-camps began to spring up around Dachau in order to increase war production. In total, over 30 sub-camps, which worked more than 30,000 prisoners, were created as satellites of the Dachau main camp. Medical Experiments Throughout the Holocaust, several concentration and death camps performed forced medical experiments on their prisoners. Dachau was no exception. The medical experiments conducted at Dachau were ostensibly aimed at improving military survival rates and bettering medical technology for German civilians. These experiments were usually exceptionally painful and unneeded. For example, Nazi Dr. Sigmund Rascher subjected some prisoners to high altitude experiments using pressure chambers, while he forced others to undergo freezing experiments so that their reactions to hypothermia could be observed.  Still, other prisoners were forced to drink saltwater to determine its drinkability. Many of these prisoners died from the experiments. Nazi Dr. Claus Schilling hoped to create a vaccine for malaria and injected over a thousand prisoners with the disease. Other prisoners at Dachau were experimented on with tuberculosis. Death Marches and Liberation Dachau remained in operation for 12 years- nearly the entire length of the Third Reich. In addition to its early prisoners, the camp expanded to hold Jews, Roma and Sinti, homosexuals, Jehovah’s Witnesses, and prisoners of war (including several Americans.) Three days prior to liberation, 7,000 prisoners, mostly Jews, were forced to leave Dachau on a forced death march that resulted in the death of many of the prisoners. On April 29, 1945, Dachau was liberated by the United States 7th Army Infantry Unit. At the time of liberation, there were approximately 27,400 prisoners who remained alive in the main camp. In total, over 188,000 prisoners had passed through Dachau and its sub-camps. An estimated 50,000 of those prisoners died while imprisoned in Dachau.