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Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Early Alzheimer's Disease and The Outdoors

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As clinicians, it seems that we are increasingly encountering Alzheimer’s disease and other forms of dementia, certainly in elders and sometimes in persons at an earlier age. It’s hard to know the exact reasons for this seeming epidemic, but I suspect it’s mostly a combination of more awareness, the fact that people are living longer, and improved support and medical care.

From a safety perspective in the outdoors, that means heightened attention to lost persons and accidents that occur because people lose visual-spatial orientation, suffer memory loss, have impaired judgment, or ignore safety warnings and procedures. The more we understand the risks at different stages of dementia, the better prepared we can be to support impaired people in their outdoor activities and to assist them in their times of need.

Alzheimer’s disease, like many other diseases, begins with an early stage and progresses to a more advanced form. The time course of progression is variable, but there is a fairly common clinical pattern. Although therapies, including drugs, are not yet very satisfactory, what can be done to slow the progression is best initiated early. Furthermore, if the onset of dementia is recognized, then appropriate safety precautions, such as restriction of driving motor vehicles, and other guidance measures can be initiated.

Richard Mayeaux, MD published an excellent review article entitled “Early Alzheimer’s Disease” in the New England Journal of Medicine (2010;362:2194-201). Here are a few facts and observations from the article. Alzheimer’s disease (AD) is the most frequent cause of dementia in Western societies, affecting approximately 5 million persons in the U.S.  The proportion of persons age 80 years or older with AD is approaching 30%, or nearly 1 in 3 persons.

The symptoms are usually insidious in onset, beginning with mild short-term memory impairment and forgetfulness. As the disease worsens, a person begins to lose cognitive abilities, including abstract reasoning, special orientation, managing complicated and then simple tasks, language, and decision making. Sometimes mood and behavior change for the worse, or a person may lose the ability to show emotion. When a person becomes severely affected, they may have delusions or act in a psychotic (out of touch with reality) manner, but this is not always the case.

Memory loss associated with early AD may be difficult to differentiate from the “normal” memory loss seen in elders, in which there is failure to recall names of people and places, and recent events. Long-term memory for distant events may be retained during this period. Other features of early AD include mild cognitive impairment, failure to remember and use words, and difficulty with sequential tasks. Perhaps the most indicative problem, which correlates with subsequent development of more severe AD, is inability to carry out the normal activities of daily living (such as dressing, eating, and other routines).

There are neuropsychological tests, such as a Clinical Dementia Rating, that can be performed to determine the extent to which AD is a possibility and progressing. A magnetic resonance image (MRI) of the brain will assist to identify whether or not there has been brain atrophy. Usually, a reasonably extensive and cost-effective neurological and medical evaluation will be undertaken to rule out other causes of dementia.

If AD is diagnosed, then all efforts should be made to help the victim adapt to his or her prognosis. With respect to outdoor activities, this will mean a state of more frequent-leading to constant companionship. Close supervision in situations of potential danger, such as trails from which there could be a fall, near bodies or water (whether swimming, in a boat, or on shore), handling dangerous implements, near a fire, in a situation where becoming lost is a possibility, and so forth. The companion should remember that instructions will be forgotten and rules not appreciated, so one must to the best extent possible create buffer zones of safety. However, that doesn’t mean that the AD patient cannot take pleasure in the environment, because he or she lives in the moment. The beautiful sunset just observed may soon be forgotten, but while it happens, it can bring joy and a brief moment of tranquility to both patient and caregiver.

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Tags: Staying Safe

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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