ALZHEIMER’S THROUGH TEARS AND LAUGHTER: DIARY OF A CAREGIVER


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Identifying Pseudobulbar Affect in Alzheimer’s Disease and Dementia

Your caring made a great difference. Thanks to the Tubbs family for their thoughtfulness in helping me deal with those moments when I was unable to help myself. To David and Nancy Bamberger who insisted on taking time from their moving day to take me to the hospital the day Lucy came down with pneumonia.

Thanks to Alfie and Ruthie for their tireless support, tenderness, vigilance and loyalty throughout our struggle with this dreaded disease. Thanks to the Doctors and Nurses, my sister, Mary Catalano among them, who not only assisted me physically, but gave me lessons in nursing as well. Thanks to the Medical Supplies companies who went the extra mile assisting me in finding the right equipment, diapers, bed clothing throughout our ordeal. Long before that study, there had been many elderly people who became forgetful and their behavior, so erratic they were often regarded as insane.

Where to get support

Those who had families were cared for at home because, in those early years, women did not work outside their home and could provide the care needed. Those who had no one to care for them were placed in an institution often referred to as the Crazy House. Most of these people were elderly, and I recall the conversations at home about becoming elderly and the possibility of ending up in an institution when they arrived at Old Age. It was then, that desperate families who had been floundering in their caring for their loved ones, found some reprieve.

No one knew it would become the worst threat to our health, and certainly not, a laughing matter. Today, we shrink from the thought that we can become an Alzheimer patient, as the number of patients continue to grow.

It is, in fact, a very frightening possibility because we do not know what causes it, and worse, no medication has been developed for its cure. The dictionary tells us dementia is a condition of deteriorated mentality often with emotional apathy, and does describe the Alzheimer patient.

Memories of the past, sometimes happy and sometimes very painful, surface, causing the patient to become frightened or to break out in laughter. Their ability to remember is not so much lost as it is scrambled and very confusing.

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The changes that ensue, come one at a time and last anywhere between eight and ten years. The disease attacks the body in phases. It usually begins with the Incontinence of urine, followed by Incontinence of bowel. As the patient worsens, diet becomes a major problem because their inability to recognize a fork or spoon or food makes it difficult to feed them, and they must be watched carefully. Me, my sister and mother had lived in the city hospital […].


  1. Family caregivers of people with dementia.
  2. tackleesmohyder.ga: alzheimer-s-through-tears-and-laughter-diary-of-a-caregiver-by-edwina-marino-pap.
  3. Identifying Pseudobulbar Affect in Alzheimer’s Disease and Dementia.

Time flies and I keep myself busy. This reminds me of my own battle […]. Today I have been living with my diagnosis for one year. Still I started crying, mostly because I […]. We're not around right now. But you can send us an email and we'll get back to you, asap. Summer in Sweden June 3, Spring cleaning April 26, Happy Birthday to me January 28, The X-men December 27, A weekend whit tears and laughter July 23, Fifteen years as married May 14, Approval from Sam the dog April 25, One year has past.

January 25, Contact Us. I consent to Womens Brain Project collecting my details through this form. We use cookies to ensure that we give you the best experience on our website. However, it is important to note that frequent crying spells do not automatically indicate depression and that tearfulness is not a necessary or sufficient criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition DSM-V for diagnosing major depressive disorder MDD.

They found that crying was no more likely in the depressed than in the control group, who, surprisingly, showed greater crying-related emotional activity than the MDD group. Also, using patient self-reported episodes of crying to compare depressed versus non-depressed elderly individuals, Hastrup and colleagues 11 found only a weak link in increased frequencies of crying episodes among elderly adults with depression, and concluded that crying could not be interpreted as a symptom or sign of depression.

Establishing if a patient with AD also has depression is further complicated by the overlapping features of the two conditions. For example, apathy and poor concentration are common symptoms found in dementia; anhedonia and nihilism also commonly occur in depression. Behavioral Disturbances Behavioral disturbances are common in people with AD and other forms of dementia. Essential Crying Essential crying is an uncommon disorder and is included for completeness. Patients with the condition do not necessarily have an underlying neurological disorder. Pseudobulbar Affect PBA is a disorder of regulation of emotional expression, caused by neurological disease or injury affecting the brain.

Caregiver Training: Repetitive Questions - UCLA Alzheimer's and Dementia Care Program

PBA is characterized bysudden, uncontrollable episodes of crying, laughing, or both. The former will be familiar with clinicians who have experience caring for people with dementia, but what exactly is PBA and how can it be identified and managed? In particular, inappropriate crying and laughing have been variably described and not uniformly classified, leading to inconsistency in terminology and descriptions in the literature.

This lack of standardization may be a result of the same disorder occurring in multiple neurological conditions, but being called different things by different specialties.

Alzheimer's Through Tears and Laughter: Diary of a Caregiver

Despite being described in several neurological conditions, PBA is thought to have common manifestations and neuropathophysiology in these settings. Initially it was described as a disinhibition syndrome. A more recent theory proposes that PBA is related to dysfunction in circuits that involve the cerebellum, 24 while others suggest it is caused by lesions in the descending motor pathways of the cerebral cortex, basal ganglia, or brainstem. Due to their cognitive and memory deficits, patients with AD may be unable to accurately recall or report their symptoms, or may use crying to communicate physical symptoms, such as pain.

Additionally, other neuropsychiatric disturbances may be present that could also be associated with crying. To avoid such outcomes, understanding the clinical presentation and distinguishing features of PBA is essential. The most widely cited diagnostic descriptions or clinical criteria are summarized here:.

Criteria of House and Colleagues House and colleagues used the term emotionalism to describe symptoms of inappropriate crying and laughing in stroke patients and included the following three sets of questions into a standardized psychiatric assessment for patients suspected of having the condition:. Criteria of Kim and Colleagues Kim and colleagues conducted a study on diagnosing inappropriate and excessive laughing and crying following stroke in which they included relatives in the patient interview and subsequently developed diagnostic criteria that incorporated responses from relatives.

Diagnostic Criteria of Cummings and Colleagues Cummings and colleagues published the following diagnostic criteria for what they termed involuntary emotional expression disorder IEED : These authors described supportive observations and descriptive characteristics.

Summary of Diagnostic Features While these diagnostic recommendations differ somewhat in language and detail, they emphasize four common attributes:. How to Differentiate Pseudobulbar Affect It is important to try to establish the pervasive mood of the patient with frequent crying episodes, particularly to assess the likelihood, or confirm the presence, of depression.

Getting a complete history may be difficult if depression in a patient with AD is itself producing symptoms of dementia, 37 creating problems in eliciting the mood of the patient during the crying episode. This may have a particular bearing where a patient is able to describe that episodes of crying do not reflect their mood 18,33 —as did PJ. In some cases, the crying is triggered by a physical event e. Given their etiology, nature, and high prevalence, these behavioral disturbances could account for frequent episodic crying in patients with dementia.

It is frequently helpful to note the absence of labored breathing, negative vocalization, groaning, tense body language, and other items from the Pain Assessment in Advanced Dementia PAINAD scale 38 in order to help distinguish PBA from pain. Also, outbursts of laughter may be a prominent sign that PBA is the underlying neurological condition or, possibly, that the patient has witzelsucht a rare condition in which the affected individual inappropriately finds situations funny that others do not.

ALZHEIMER’S THROUGH TEARS AND LAUGHTER: DIARY OF A CAREGIVER ALZHEIMER’S THROUGH TEARS AND LAUGHTER: DIARY OF A CAREGIVER
ALZHEIMER’S THROUGH TEARS AND LAUGHTER: DIARY OF A CAREGIVER ALZHEIMER’S THROUGH TEARS AND LAUGHTER: DIARY OF A CAREGIVER
ALZHEIMER’S THROUGH TEARS AND LAUGHTER: DIARY OF A CAREGIVER ALZHEIMER’S THROUGH TEARS AND LAUGHTER: DIARY OF A CAREGIVER
ALZHEIMER’S THROUGH TEARS AND LAUGHTER: DIARY OF A CAREGIVER ALZHEIMER’S THROUGH TEARS AND LAUGHTER: DIARY OF A CAREGIVER
ALZHEIMER’S THROUGH TEARS AND LAUGHTER: DIARY OF A CAREGIVER ALZHEIMER’S THROUGH TEARS AND LAUGHTER: DIARY OF A CAREGIVER
ALZHEIMER’S THROUGH TEARS AND LAUGHTER: DIARY OF A CAREGIVER ALZHEIMER’S THROUGH TEARS AND LAUGHTER: DIARY OF A CAREGIVER
ALZHEIMER’S THROUGH TEARS AND LAUGHTER: DIARY OF A CAREGIVER ALZHEIMER’S THROUGH TEARS AND LAUGHTER: DIARY OF A CAREGIVER

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