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Dementia: How and Whom Does It Affect?

Running Head: DEMENTIA: HOW AND WHOM DOES IT AFFECT? 1 Dementia: How and Whom Does it Affect? Liberty University COUNS 502 B-23LUO Instructor: Dr. Richard Pace Shelly M. Becker March 5, 2013 DEMENTIA: HOW AND WHOM DOES IT AFFECT? 2 Abstract Although dementia is often viewed as an “old person’s disorder, its effects ripple down in many directions such as family, caregivers, finances, and the healthcare system, leaving behind many unanswered questions and confusion for all.

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The purpose of this paper will be to answer some of these questions, so that a better understanding of dementia will be possible.

By doing so through research already performed, articles written on the subject, and information found in books written by experts in the fields of gerontology, developmental disorders (neurological), and dementia specifically, the average reader will be able to define dementia, understand basic concepts and theories of causation, explain the progression of this disorder, and fully appreciate the potential and real effects this disorder has on the individual, caregivers, costs (both for the individual and society), and lastly, learn coping strategies to help all affected make the best out of a debilitating disorder of the brain.

Keywords: dementia, gerontology, neurological, developmental disorders, caregivers DEMENTIA: HOW AND WHOM DOES IT AFFECT? 3 Dementia: How and Whom Does it Affect? Introduction Although dementia is often viewed as an “old person’s” disorder, it affects ripple down in many directions such as to family, caregivers, finances, and the healthcare system, leaving behind many unanswered questions and confusion for all.

Based on research and information reported by experts in many fields, this paper will explore the different aspects surrounding dementia, specifically Alzheimer’s Disease, with the goal of helping the average person to better understand this debilitating disorder, become more familiar with how it affects everyone, and lastly, make available to the reader techniques and strategies that could benefit the afflicted, their caregivers, and medical professionals dealing with patients suffering from dementia. It is safe to say that everyone does, or will, know someone in their lifetime that has dementia.

One reason for this is the rapid growing numbers of elderly as a segment of global population. According to Chop and Robnett (1999): Baby boomers first turned 50 in 1996, and since then, every 7 seconds an American will turn 50 until the year 2014. In addition, growth of the older than 65 cohorts will continue to increase as baby boomers began turning 65 in 2010. It is estimated that y 2030, 22 percent, or 70. 2 million, Americans will be older than the age of 65. Even more astonishing, those over 85 years of age are the fastest growing segment of our DEMENTIA: HOW AND WHOM DOES IT AFFECT? population. They are expected to triple in size between 1986 and 2030, and be nearly seven times larger in 2050 than in 1980! (pp. 2-3) The rapid growth of this age group is not only being seen in America, it is occurring globally. In addition to the baby boomers now becoming “of age”, [quotation marks added] other factors contributing to the larger numbers of elderly, are the advances in the fields of medicine and in technology. It was not too long ago that the average life expectancy was around “45 years of age in 1900”, according to Chop and Robnett (1999), “increasing to 76 years in 990”(p. 48). Because dementia is more commonly diagnosed in the elderly, we will be experiencing an increase in numbers of diagnoses. This doesn’t necessarily mean that a greater percentage of the elderly are being affected by dementia, but more likely that this is a reflection of the greater number of elderly surviving to the age that onset is more likely to occur. This in turn will increase the probability that each of us at some point in our lives will be affected by this disorder, whether it is through a family member, friend, co-worker, or ourselves.

In light of the above, it is more important now than ever, to bring about a greater awareness and understanding to all so that we may better be prepared to meet the needs, at all levels, of this rapidly growing group of our elders. Types and Symptoms of Dementia One of the areas that is of concern, and that research is being aimed at, is the need to find an accurate diagnostic tool(s) that can definitively diagnose dementia in its early DEMENTIA: HOW AND WHOM DOES IT AFFECT? 5 stages. As we age, there is a natural decline in many areas of our functioning and/or appearance.

We often see changes in physical capabilities such as balance, strength, and we see changes in our sight, hearing, and general appearance, (hair color, we become shorter, or develop wrinkles). And yes, there are often changes of decline in cognition as we age, changes in comprehension, memory, or clarity of thought. In the past, we thought, as a society, that this was normal aging, all of it. Grandma was senile and that was the way life progressed. As stated earlier, our life expectancy was much shorter and we often did not see the final stages of dementia, therefore we didn’t view the decline in these areas as abnormal.

The early stages of dementia often mimic the natural decline in some people of their senses. With medical advances, and longer life spans, we began to see that some people didn’t experience this deterioration in the same way. Some people live to be 100 and are still alert and in control of all their functions!! So to answer the question, are individuals with dementia normal? Should we all be afraid that the longer we live, the less capable we will be in living life? The answer is no. “Progressive severe loss of memory-routinely forgetting conversations or that one ate at a particular restaurant-and impaired thinking abilities are not a normal part of aging.

Rather, such problems may be signs of a dementia-loss of brain functions due to an organic cause. Dementia is a generic term that includes a host of symptoms related to brain failure. There are several causes of dementia, but Alzheimer’s disease (AD) is the most common cause. ” (Kuhn, 1999. p. 11) Dementia is not a disease. It is a condition caused by a number of diseases. Currently, it DEMENTIA: HOW AND WHOM DOES IT AFFECT? 6 is estimated that more than 4 million, to as many as 7 million, people in the United States have dementia and more than 14 million people will be demented by the year 2050. (Levine, 2006. p. 6) The following is a list of the different types of dementia found in the DSM-IV-TR, Fourth Edition (2000): Alzheimer’s; Vascular Type; Type Due to HIV Disease; Dementia Due to Head Trauma; Dementia Due to Huntington’s Disease; Dementia Due to Parkinson’s Disease; Dementia Due to Pick’s Disease; Dementia Due to Creutzfeldt-Jakob Disease; Dementia Due to Other General Medical Conditions; Substance-Induced Persisting Dementia; Dementia Due to Multiple Etiologies; and Dementia Not Otherwise Specified (p. 147).

The common feature of these different types is memory impairment. Depending on the etiology, the other features of each vary. For example, with AD, the progression is very slow, lasting 8-10 years or longer, resulting in death. On the other hand, in Vascular Dementia, the onset is abrupt with rapid changes in functioning occurring versus slow the progression of symptoms. Also, early treatment of hypertension and vascular disease may prevent further progression, whereas in AD there is no way at this time, to prevent its progression.

For the purpose of this paper there are too many different types of dementia, and their symptoms vary, making it impractical to discuss them all. Therefore, because Alzheimer’s is the most common of the types, the following discussion will be limited to its main features. (Hoffman, 2009. ) Alzheimer’s was first described in 1906 by a German neurologist named Dr. Alois DEMENTIA: HOW AND WHOM DOES IT AFFECT? 7 Alzheimer. During that time period, as was pointed out earlier, the symptoms of Alzheimer’s disease were viewed collectively as senility. What Dr.

Alzheimer found when he performed an autopsy on a woman of 51 years of age was what we call today beta-amyloid plaques between neurons and bundles of protein threads within the neurons. These were the same as what were found in the brains of the elderly who were considered senile and just getting old. It wasn’t until the 1960’s that these were understood to be intrinsic to a brain disease, Alzheimer’s Disease (AD), and that the symptoms of AD were not a normal part of aging, but rather were due to the diseased brain failing and dying off in part due to these plaques and tangles. pp. 2-5) This was not the only organic feature found as a part of AD. The discovery of certain mutant genes present in those suffering from AD, led to evidence of a genetic cause that places one at higher risk. In cases like this, the onset of AD occurs between the ages of 30-50 yrs. This is referred to as early-onset AD, as it occurs between the ages of 30-50 years old. Late on-set AD, typically occurs after the age of 65. Other factors that increase the risk of AD are (Hoffman, 2009, p. 50) high blood pressure, diet, diabetes type 2, women are slightly higher at risk, as well as (Feldman, 2000, p. ) African Americans and Hispanics being at higher risk than Caucasians. (Andersen, Kessing, Korner, Lauritzen, ; Lopez, 2007). Also, disorders such as depression or delusional disorder increase the chances of developing AD (p. 628). Again, the risk factors are there, but little is known as to why how, or if they will affect the outcome of developing AD, or not.

So much research has been going on over the last 20 or so years, which has DEMENTIA: HOW AND WHOM DOES IT AFFECT? 8 increased the understanding of AD tremendously. But being able to have a way to detect AD in its earliest stages at this time, is still not possible. The goal of this intense research is that we may be able to use the information learned thus far, like the presence of tangles and plaques, the body’s inability to be able to circumvent their build up in the brain, to find a way to stop the progression of AD before the symptoms are too many, and/or re unable to be stopped. So much more needs to be learned before we reach that point. Nevertheless, advances in the field of medicine and in technology are so amazing and rapid. The use of magnetic resonance imaging (MRI’s}, and other high tech instruments that are now available to view images of the brain and how it functions, will hopefully lead to answers soon for the victims of AD and other types of dementia, and for their families. The areas that are affected for the individual with AD are many. The most devastating is the affect on memory.

There is a normal amount of memory loss in most of us as we age. The difference for somebody with AD is that it begins to interfere with their ability to perform daily activities and continues to progress as time moves forward. It can be compared to the disease model of addiction. Something becomes an addiction when it interferes with your life on a daily basis, and it exhibits progression. AD is difficult to diagnose in its early stage. The individual and family members usually notice that something is different, but it doesn’t get addressed at this point.

This could be for many reasons such as fear, denial, and /or just being plain uninformed about AD. The first 2 or 3 years seem to be a gradual decline, in the short term memory especially DEMENTIA: HOW AND WHOM DOES IT AFFECT? 9 at first. (Kuhn, 1999. ) The brain is so amazing that as humans, we learn to compensate for deficiencies when we have them. (p. 43) For example, someone who has head trauma from an accident and loses some speech can often, with therapy, retrain the brain in another area to relearn how to speak. This applies to AD also.

Because of the progression though, this can only be done for so long. After around 2-3 years, the decline in memory, and the effects that this has on other areas of functioning, begins to spiral down at a faster rate. As the brain cells die and the neurons and synapses no longer are working, the person will begin to forget names, places, events, how to use the telephone, where they are, and eventually who they and their loved ones are anymore. In the beginning, the individual is often aware of what is happening, and this will cause a reaction, of course.

Their past coping skills, their support system, and their spiritual beliefs concerning life and death, will all influence how they will handle what is happening to them. Often some grieving will occur both in the individual, as well as those close to him. There is the knowledge of impending death, but in addition, now the family members watch as the person literally dies away in front of them. And for the afflicted, they grieve as they see themselves losing their sense of self and not knowing how they now will fit into the world ( Feldman, 2000).

During the stage of development known as adolescence, one’s cognitive and emotional advances lead to being able to form relationships with others, think abstractly, which aids in the development of spirituality when trying to find one’s identity, and to perform executive functions such as making plans, organizing, projecting oneself into the future mentally, and following steps in an DEMENTIA: HOW AND WHOM DOES IT AFFECT? 10 order to achieve something (pp. 385-389). All of this leads to a loss of being able to relate to others which can lead to isolation and depression and anxiety at times. Levine, MD. , 2006). Other areas of the person that diminish in capability are language, visual-spatial perceptions, such as depth perception which can interfere with walking for example, as well as getting lost. Behavior is also affected and can be seen when impulses and socially acceptable boundaries are no longer relevant, or controllable because of a lack of comprehension, or they are just forgotten, leading to inappropriate actions or speech. In the late stage, the person is no longer even recognizable as the loved one once known.

They become incontinent, unable to feed their self, talk, walk, or interact in any way (pp. 45-47). Effects on Family, Caregivers, and Society Little has been done to study the effects of dementia on children in the families where a parent has been diagnosed with early-onset AD. One study performed in the Uk by researchers Spector, Stott, and Svanberg, in 2009, looked at 12 children under the age of 18. They found that overall, the burden of caring for a parent with AD has a negative impact on their relationships with peers, on their schoolwork and achievement goals, and often led to emotional difficulties.

The children often felt that it was their responsibility and downplayed the whole situation. They often felt a loss of their parent and that they were now taking on the role as the parent. Grieving was common. A positive outcome was the possibility of the experience leading to higher self-esteem due to the fact that it DEMENTIA: HOW AND WHOM DOES IT AFFECT? 11 showed the resilience within them to adapt. One finding was that the children had little, to no support system, or anyone to talk to. Their peers had no clue and support groups were / are not set up and available.

This would be one way to assist these children. Another would be to educate the school system and train counselors to assist children, who are acting as adults in situations like this (p. 740). According to Harris and Keady (2008), in their study of selfhood in patients with early-onset, the loss of self is often more complex and unique to each family than in those with late-onset. This possibly is due to the fact that between 30-50 years old, one’s self-identity has many active components they must face losing such as their work identity, sexual identity, and family identity (p. 437).

Some of these may overlap with patients of late-onset AD, but most often they don’t. This area of research is very scarce and in need of more studies so as to be able to help this group of families find strategies to better cope as they work their way through this situation “The most common form of caregiving relationship in dementia is between spouses or partners” (Clare, van Dijkhuizen, Pearce, & Quinn, 2008, p. 770). Often an adult child takes on the role of caregiver. In all instances, the stress of caring for a loved one with AD is usually very stressful and leads to feelings of depression, anxiety, confusion, and even anger.

As an adult child caregiver, the parent-child roles get reversed and this can create uneasiness for both parties. In the early stage of AD, the sources of frustration and stress come more from having to learn how to cope with the changes that are required to be a caregiver, such as free time to relax, socialize, etc. Also, the fact that little DEMENTIA: HOW AND WHOM DOES IT AFFECT? 12 information is provided about the condition(s) to families and caregivers makes it more difficult to know what to do and when.

Not knowing what to expect next can be a stressor in itself. Not only is there a negative impact on the mental condition of caregivers, but there is also a negative impact on their health. Looking at the overall picture, the story looks grim. Life is full of challenges and not only can they strengthen us to learn new ways to adapt and cope, but they are God-given opportunities to connect at a level so deep with another being, and then use that connection to hopefully relieve some of their suffering and pain.

Everyone deserves to be treated with dignity and respect throughout life and at this final life span stage, those who have AD and are losing everything to the disease, deserve to be treated in such a way that they too may be able to die with dignity. Society in Western Culture often has a negative overall view of old age. If you are non-productive, and unable to care for yourself, many take the view that you are worthless and a drain on society. This is turn influences the decisions made by politicians and government about how this huge group of elderly will be cared for.

Seeing the elderly as negative is called ageism, and it is alive and well like many other ‘isms’ of today. The problem now is that the reality of issues concerning healthcare, financial assistance and housing options for the elderly, especially those who are ill with AD and/or other types of dementia, are no longer concerns of the future. These need to be addressed now in order to truly benefit this fast growing cohort and the future for us when we also reach this stage of life. DEMENTIA: HOW AND WHOM DOES IT AFFECT? 13 Conclusion

We now know that dementia is a condition that is caused by underlying diseases such as vascular disease. It is not a normal part of aging and it has genetic component, as well as a malfunction in the brain that causes the buildup of tangles and plaques which kill the neurons, cells, and synapses in the brain. This all leads to the symptoms which slowly rob a person of all their faculties, resulting in death. The effects on the patient are many and can create depression, anxiety, and frustration over what is happening to them. It also has effects of the family members and the caregivers.

The majority of these effects seem to be negative (depression, anger, isolation, and illness). But they can also be positive, such as satisfaction and increased affection toward the patient, or higher self esteem due to doing the right thing and being responsible and loving. In our society, we all have to come to grips with our attitudes toward the aging. The enormous numbers of those over 55 can’t be ignored any longer. Increased awareness of AD and its symptoms will hopefully create motivation for creating and developing programs to assist in teaching strategies and coping skills for caregivers.

Another avenue for change is creating groups to advocate for national healthcare that will then assist in making healthcare available to those with AD and to the elderly as a whole. And last, continuing research to search for a way to diagnose AD in its early stage with the hope that we can then provide ways to treat the symptoms and possibly slow down the progression of AD. The more knowledge we have, the more empowered we are to make changes. The focus should be on all pulling together to make a difference in the lives of those suffering with DEMENTIA: HOW AND WHOM DOES IT AFFECT? 14

AD in their “Golden Years” instead of enjoying this last stage of life and being able to feel content as we self reflect and pass on our wisdom and/or truths we have learned about life as we complete our passage through this last stage of existence. Running header: ANNOTATED BIBLIOGRAPHY 1 DEMENTIA AND ITS EFFECTS Shelly Becker Liberty University Introduction to Human Development COUN 502 B-23 LUO Dr. Richard Pace March 6, 2013 ANNOTATED BIBLIOGRAPHY 2

Berman, C. W. , & Becker, M. F. (2010). Transference in Patients and caregivers. American Journal of Psychotherapy, 64(1), 107-114 Retrieved February 4, 2013 from http:/search. ebscohost. com. ezproxy. liberty. edu: 2048/login. aspx-? direct=+ rue &db=a9h&AN=48973816&site=ehost-live&scope=site The topic of transference is relevant to all therapeutic relationships. The caregiver and recipient of care are seen as being in such a relationship, which then implies that trans- ference is at high risk of occurring.

The article explores counter-transference as well, and how if not dealt with, this can have a negative effect on the overall relationship, and its therapeutic outcome. Braun, M. , Scholz, U. , Bailey, B. , Perren S. , Hornung, R. , & Martin, M. (2009). Dementia care-giving in spousal relationships: A dyadic perspective. Aging & Mental Health, 13(3), 426-436. doi: 10. 1080/13607860902879441 This article investigates the various effects of care-giving for spouses diagnosed with dementia on both the caregiver and the recipient.

Previously, the data compiled mostly came from the caregiver only. This study differs in that it takes into account the feedback from both parties to get a better picture of the overall effects on the dyadic relationship. By doing so, hopefully this will lead to new insights and more effective interventions for a better outcome as the article points out. Castelli, I. , Pini, A. , Alberoni, M. , Liverta-Sempio, O. , Baglio, F. , Massaro, D. , & Nemni, R. (2011).

Mapping levels of theory of mind in Alzheimer’s disease: ANNOTATED BIBLIOGRAPHY 3 a preliminary study. Aging & Mental Health, 15(2), 157-168. doi: 10. 1080/ 13607863. 2010. 513038 This article specifically deals with how Theory of Mind (ToM) is understood in relation to dementia and various forms of dementia such as Alzheimer’s. When neuro-imaging is explained as the basis for learning in cognitive early stages of development, it is easier to understand how it might fit in with dementia and Alzheimer’s.

In very simplistic terms, neuro-mirror-imaging underlies ToM and if this is no longer functional in the aging brain, it could explain to an extent, the symptoms exhibited in these brain disorders which in turn could lead to more effective interventions. Clare, Li, Dijkhuizen, M. , Pearce, A. , & Quinn, C. (2008). The experience of providing care in the early stages of dementia: an interpretative phenomenological analysis. Aging & Mental Health, 12(6), 769-775. Retrieved February 8, 2013 from: Academic Search Complete, EBSCOhost

Many families, and patients with dementia, are given little to no information on Dementia, especially the early stages of it. It seems that very little is known about the early stages. This article is looked at from the point of view of the care-givers and how they interpret the situation and subsequently the care they give to the patient, who is often their spouse or parent. The relationship to the “patient” prior to the onset of dementia influences the perceptions and actions of both the caregiver and recipient.

All of this is reflected in the article. ANNOTATED BIBLIOGRAPHY 4 Diagnosis. (2011). Annals of Internal Medicine, 154(11), 5-8. Retrieved on February 8, 2013 from: http://search. Ebscohost. com. ezproxy. liberty. edu: 2048/login. aspx? Direct=true & db=a9h & AN=62807891 & site = ehost-live 7 scope = site This article is very informative with respect to the importance of early detection of dementia as well as an accurate diagnosis of dementia.

The effects of longer life spans in the field of medicine are discussed. We now have to deal with a much longer, and complex unfolding of the aging process than say 50 years ago. What can we do to improve diagnostic capabilities of trained medical professionals so as to be able to provide timely and accurate information and treatment interventions so as to increase the outcomes of successful? Harris, P. , & Keady, J. (2009). Selfhood in younger onset dementia: Transitions and testimonies. Aging & Mental Health, 133), 437-444. oi:10. 1080/13607860802534609 Very interesting article! Most often dementia is thought of as only an “old person’s” disorder. This article indentifies 5 areas of self and discusses how they are affected by the onset of dementia and other brain degenerative disorders, specifically with regard to the younger people if effects (ex. ages 40-67). Personal testimonies were gathered from those afflicted and then carefully interpreted and grouped and validated to reach the conclusions drawn. The results on the self are very informative!

ANNOTATED BIBLIOGRAPHY 5 Korner, A. , Lopez, A. G. , Lauritzen, L. , Andersen, P. K. , & Kessing, L. V. (2008). Delusional disorder in old age and the risk of developing dementia-a nationwide register-based study. Aging & Mental Health, 12(5), 625-629. doi: 10. 1080/13607860802343118 The distinction between delusional and demented is discussed. Questions such as if being delusional is a reliable predictor of future dementia were posed, as well as looking for the connecting factor(s), if any, between the two disorders.

Symptomology was discussed and the importance of medical professionals being well-versed in this, so as to be able to correctly diagnose, offer appropriate treatment, and increase the chances for predicting future disorders in a fairly reliable fashion. Spek, A. A. , Scholte, E. M. & Van Berckelaer-Onnes, I. A. (2010). Theory of Mind in adults with High Functioning Autism (HFT) & Asperger Syndrome. Journal of Autism & Developmental Disorders, 40(3), 280-289. doi: 10. 1077/s10803-009-0860-y ToM is explained in detail s to how it applies to the two disorders mentioned in the title.

The reason I chose to include this article was because it gave a very good historical view of Theory of Mind as well as explained how it is seen as being the ‘possible missing link” between normal cognitive functioning and the functioning of brain disorders like HFA and Aspergers, as well as dementia and Alzheimers. ANNOTATED BIBLIOGRAPHY 6 This article gave me a broader understanding of ToM and its applications. This article also included applications to theories of religion, philosophy, and life in general.

I found it very useful and enlightening and intend on researching it much more in depth in the future! Svanberg, E. , Scott, J. , & Spector, A. (2010). ‘Just Helping’: Children living with a parent with young onset dementia. Aging & Mental Health, 14(6), 740-751. doi: 10. 1080/1360786100371374 With the onset of dementia in younger patient, under 67 or so, the children of this group have been forgotten in the research. I believe this is due in part to the numbers of this group are small in comparison to the overall age of onset.

This has left the families and children, as well as the patient with little information and or helpful interventions aimed at them specifically. These children, as pointed out in the article, suffer effects in their schooling, social lives, and their overall description and responsibilities expected of them in their previous roles as children. Often now they must act as if the ‘parent’ and the ‘parent’ as if the child. The study was helpful in understanding this group better and its implications for the adolescent or younger child.

Tremont, G. (2011). Family Care-giving in Dementia. Medicine & Health Rhode ANNOTATED BIBLIOGRAPHY 7 Island, 94(2), 36-38. Retrieve February 2, 2012 from: http:// search. ebscohost. com. ezproxy. liberty. edu: 2048/login. aspx? direct=true & db=a9h & AN=58104122& site=ehost-live&scope=site This article centered around care-giving when the caregiver was a family member of the patient. Most often this was the spouse, then the adult child.

The factors that ere isolated were gender, type of relationship (married, parent/child), age, and the general feature of the relationship prior to the onset of dementia. For example, was the marriage controlled by one or the other more, or was it considered to lean toward equality? Did the spouse take on characteristics of the parent prior to onset of dementia? Were there built up resentments? Was this true for either the caregiver and/or the recipient? If it is an adult child, how did the relationship while growing up play into the current care-giving situation?

These types of questions are important to all concerned for many reasons. A lot of this article is pertinent to my paper. Running Head: REFERENCES 1 Dementia: How and Whom Does it Affect? Liberty University HSER 502 B-23–LUO Dr. Richard Pace March 5, 2013 REFERENCES 2 REFERENCE LIST American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. 2000). Washington, DC: American Psychiatric Association. Berman, C. W. , & Becker, M. F. (2010). Transference in Patients and caregivers. American Journal of Psychotherapy, 64(1), 107-114 Retrieved February 4, 2013 from http:/search. ebscohost. com. ezproxy. liberty. edu: 2048/login. aspx-? direct=+ rue &db=a9h&AN=48973816&site=ehost-live&scope=site Braun, M. , Scholz, U. , Bailey, B. , Perren S. , Hornung, R. , & Martin, M. (2009). Dementia care-giving in spousal relationships: A dyadic perspective.

Aging & Mental Health, 13(3), 426-436. doi: 10. 1080/13607860902879441 Castelli, I. , Pini, A. , Alberoni, M. , Liverta-Sempio, O. , Baglio, F. , Massaro, D. & Nemni, R. (2011). Mapping levels of theory of mind in Alzheimer’s disease: a preliminary study. Aging & Mental Health, 15(2), 157-168. doi: 10. 1080/ 13607863. 2010. 513038 Chop,W. C. , & Robnett, R. H. (1999). Gerontology for the Health Care Professional. Philadelphia: F. A. Davis Company. Clare, Li, Dijkhuizen, M. , Pearce, A. , & Quinn, C. (2008).

The experience of providing care in the early stages of dementia: an interpretative phenomenological analysis. Aging & Mental Health, 12(6), 769-775. Retrieved February 8, 2013 from: Academic Search Complete, EBSCOhost REFERENCES 3 Diagnosis. (2011). Annals of Internal Medicine, 154(11), 5-8. Retrieved on February 8, 2013 from: http://search. Ebscohost. com. ezproxy. liberty. edu: 2048/login. aspx? Direct=true & db=a9h & AN=62807891 & site = ehost-live 7 scope = site Feldman, R.

S. (2001). Development across the Life Span. Upper Saddle River, New Jersey: Pearson Foundation, Inc.. Froemke, S. , Golant, S. , & Hoffman, J. (2009). The Alzheimer’s Project Momentum in Science. New York, N. Y. : Public Affairs. Harris, P. , & Keady, J. (2009). Selfhood in younger onset dementia: Transitions and testimonies. Aging & Mental Health, 133), 437-444. doi:10. 1080/13607860802534609 Kuhn, David, MSW. (1999). Alzheimer’s Early Stages. Salt Lake City, Utah: Publishers Press. Korner, A. , Lopez, A. G. , Lauritzen, L. , Andersen, P. K. & Kessing, L. V. (2008). Delusional disorder in old age and the risk of developing dementia-a nationwide register-based study. Aging & Mental Health, 12(5), 625-629. doi: 10. 1080/13607860802343118 Levine, R. A. M. D. (2006). Understanding and Preventing Alzheimer’s and Related Disorders. Lanham, Maryland: Rowan & Littlefield Publishers, Inc. Spek, A. A. , Scholte, E. M. & Van Berckelaer-Onnes, I. A. (2010). Theory of Mind in adults with High Functioning Autism (HFT) & Asperger Syndrome. Journal of Autism & Developmental Disorders, 40(3), 280-289.

REFERENCES 4 doi: 10. 1077/s10803-009-0860-y Svanberg, E. , Scott, J. , & Spector, A. (2010). ‘Just Helping’: Children living with a parent with young onset dementia. Aging & Mental Health, 14(6), 740-751. doi: 10. 1080/1360786100371374 Tremont, G. (2011). Family Care-giving in Dementia. Medicine & Health Rhode Island, 94(2), 36-38. Retrieve February 2, 2012 from: http:// search. ebscohost. com. ezproxy. liberty. edu: 2048/login. aspx? direct=true & db=a9h & AN=58104122& site=ehost-live&scope=site

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