Customized programs and new medicines for the millions of Americans who suffer from dementia-related illnesses are being used here to ease the process of irreversible memory loss, and dementia-care experts are expecting rising demand for those services as the number of people with such illnesses increases.


Facilities here are using memory boxes and personalized activities programs, such as making small carpentry projects, to help residents who are experiencing memory loss.


Dementia is the most resource intensive of all long-term care, says Joel Loiacono, executive director at Alzheimers Association Inland Northwest Chapter. Facilities are increasingly transitioning to having adequately trained staff and appropriate environments for people suffering from some form of dementia.


Elsewhere, Santa Clara, Calif.-based Intel Corp. is developing whats called caller ID on steroids for telephones that use a digital photo frame to display a picture of whoever is calling and list what the person talked about the last time he or she called, says the Wall Street Journal.


Dementia refers to a group of conditions that gradually destroy brain cells and lead to a progressive decline in mental function. The most common form of dementia is Alzheimers disease, which eventually destroys a persons memory and ability to learn, communicate, and conduct daily activities. It also can change a persons personality and behavior.


In the most recent statistics available, an estimated 4.5 million Americans have Alzheimers disease, the Chicago-based Alzheimers Association says. About 83,000 people in Washington state have Alzheimers, and that number is expected to grow by 81 percent, or to 150,000, by 2025. In Idaho, about 19,000 people have Alzheimers, and that total is projected to increase by 100 percent by 2025. Loiacono says about 8,000 to 10,000 people in Spokane County currently have the disease.


The resource-intensive nature of dementia care typically makes it more expensive than adult family homes or assisted-living facilities, Loiacono says.


I see a frightening trend happening, and that is that we dont have resources in residential care or in-home care to handle the coming tidal wave of Alzheimers disease, he says. Quality care is expensive, and a lot of families in the middle that cant afford to pay privately but dont qualify for Medicaid arent able to get into a dementia-care facility.


The Alzheimers Association and the National Institute on Aging, in Maryland, estimate that the direct and indirect annual costs of caring for people with Alzheimers total at least $100 billion. Spokane-area facilities that offer dementia-care services typically combine increased staffing and security with personalized programs to help residents cope with their illnesses.


Rockwood Retirement Communities Rockwood South, located at 2903 E. 25th, operates a 30-unit dementia-care wing, called The Courtyard, on the south end of its independent-living building. The Courtyard has increased security, a quieter atmosphere, and about a 1-to-6 staff-to-resident ratio, says Jaak Juhkentaal, Rockwood Souths vice president of operations.


A calm approach, quiet environments, and communicating face-to-face are the standard fundamentals for dementia care, Juhkentaal says.


The dementia wing is closed off from the rest of the building, and its outdoor courtyard is enclosed to minimize the potential risk of residents wandering away, he says. It has individual bedrooms and a living room where residents can sit by the fireplace.


We dont want them sharing bedroom space because often they dont understand who the stranger is in their room, he says, but we also wanted an area where people can sit on soft couches and smell the cookies baking in the kitchen to entice them out of their rooms.


The Courtyard doesnt have a public announcement system, because nothing is more confusing than for a resident to hear a voice and be unable to connect where the voice is coming from, Juhkentaal says. He says increased staffing levels also help residents get to know employees on a personal level, which is important because the amount of information they can remember changes frequently.


Arbor House, a three-building, 30-unit dementia-care facility thats part of Northpointe Retirement Community, at 1110 E. Westview Court, uses whats called a memory box to help its dementia patients. A box sits outside the door of each apartment to help the resident identify the apartment as his or her home, says Paula Tomlinson, executive director at Northpointe. It contains memorabilia, such as pictures or crafts or family heirlooms, and those items change with each stage of memory loss, Tomlinson says.


If in their brain theyre 30 years old, a picture of them at 90 isnt going to cut it, she says. They dont recognize themselves at that age, because theyre living in a world that was decades ago.


The roughly 22 employees at Arbor House notice changes in residents conditions quickly and adjust the contents of their memory boxes accordingly, she says.


Customized care


Residents at Alterra Clare Bridge of Spokane, located at 5329 W. Rifle Club Court, participate in their own customized activities program as part of the memory-care facilitys Life Enrichment Program, says Mark Scroggin, Alterras residence care director.


Each case is unique, Scroggin says. One of the most important things about programs for people who suffer from memory loss is that theyre tailored to each person.


Residents can garden, play music, paint birdhouses, do laundry, make photo collages, work with fabrics, or even make small carpentry projects using workbenches and tools, he says. The one-story, 46-unit building has studio apartments, two dens, two libraries, two kitchens, two courtyards, and a game room.


Alterra is located on a 3-acre site, where two streets converge into a town square that looks like Disneyland, he says. Its layout allows residents to feel as though theyre walking through a small town within the building, where they can wander without walking off the property, he says. Alterra currently has about 40 employees and roughly 40 residents.


Loiacono says dementia-care facilities require higher staffing levels than other types of facilities. Challenging behaviors associated with dementia, such as wandering, can be avoided when facilities are staffed adequately with people who can pay close attention to residents, he says.


The types of therapies used for people with dementia-related illnesses have changed over the years, he says. Caregivers in years past primarily used reality orientation as a way to help patients cope, but now are using validation therapy more often. For instance, a person may ask, Where is my husband? Someone using reality orientation would respond, Your husband is dead.


Someone using validation therapy would address emotions, such as loneliness, behind such questions, and would respond, You must miss your husband, to redirect a resident to a good memory, he says.


Loiacono says that in terms of clinical therapy, medicines have been developed to treat symptoms of dementia-related diseases or to slow the damage from them, but cant cure them.


Theres nothing technology-wise that I can point to you that can slow or stop the disease, he says. Medications can help with short-term memory loss and activities for daily living, but it doesnt delay the progress of the disease as the brain continues to die.


Memantine, sold under the trade name Namenda, was approved by the U.S. Food and Drug Administration in 2003 to treat the symptoms of moderate to severe Alzheimers disease, the Alzheimer Associations Web site says. It was the first Alzheimers drug of its type to be approved in the U.S. It appears to work by regulating the activity of glutamineone of the brains specialized messenger chemicals that plays an essential role in learning and memory.


Cholinesterase inhibitors are the second class of drugs approved by the FDA to treat cognitive symptoms of Alzheimers disease, the Web site says. They are designed to prevent the breakdown of acetylcholine, which is a chemical messenger in the brain thats important for memory and other cognitive skills. Three such drugs are commonly prescribed. Donepezil, under the name Aricept, was approved in 1996; Rivastigmine, under the name Exelon, was approved in 2000; and galantamine was approved in 2001 under the name Reminyl and was renamed Razadyne in 2005.


In terms of preventative memory-loss measures, its important to stay physically active, read, do puzzles, and participate in other mentally-challenging activities, Loiacono says.


Its a good thing for all of us to exercise our brain, he says. If its something that makes your gray matter work, then its something to use.