Dementia

Years ago, as far back as the early 1900's, many elderly people were diagnosed as being 'senile,' and were often put into state hospitals. Senile was known as a peculiar disease, and meant 'old,' by medical professionals back then. In 1906, a German doctor, Alois Alzheimer, was credited for identifying Alzheimer's Disease, and wrote a paper on the clinical cause of Dementia.

Cognitive measurement scales were used to determine the levels of memory loss caused by Dementia in the late 1960's. In 1980, the Alzheimer's Association rapidly began to advance research, and raise awareness about Dementia. Studies have concluded that one of the causes of memory loss, caused by Dementia, has to do with chromosome 21, the same chromosome that causes Down Syndrome. In 1984, the Nationwide Infrastructure for Alzheimer's research, NIA, was established, and in 1987, the first Alzheimer's drug trial was conducted. Over the past 30 years, medical specialists and psychiatrists have been trying to find the causes, and find medications, to help those with Dementia. It is a sad fact that too many elderly people with Dementia do not get diagnosed or receives the medical and mental attention they so desperately need.

On July 14, Paula White, of the Housing Authority, City of Pueblo, was notified that Joe Montoya, a resident at the Mineral Palace Tower apartments, a HUD facility, had not been seen for a couple of days. White notified police and paramedics.

Mineral Palace Tower Apartments, located next to Mineral Palace Park.

Police were called to 1414 North Santa Fe Avenue on July 14.

Paramedics were also called to 1414 Santa Fe Avenue.

Police and Paramedics were called to the Mineral Palace Tower apartments, also known as the 'Tower,' on July 14, at approximately 2 p.m. When Corporal Lee Karr, Pueblo Police Department, and another officer, who did not wish to be named arrived, Montoya was in the activity room located downstairs of the apartment complex. Montoya was observed acting erratically. When the officers approached Montoya, he became resistant and was verbally lashing out at the officers. Montoya repeatedly said, "Go away! I'm O.K.!"

Corporal Lee Karr

When paramedics tried to communicate with Montoya, he became even more resistant. Paramedics asked him if he had eaten anything that day, and Montoya responded, "Why do you want to know? I'm O.K.! Leave me alone!" as he clenched his fist.

Joe Montoya with Paramedics

Several residents of the Tower, located on Santa Fe Avenue, next to Mineral Palace Park, said that Montoya has been diagnosed as having Dementia. One resident, Claudette Garcia, has known Montoya for several years, and was present during the incident on July 14. Garcia commented that she has brought him food a couple of times a week for quite some time. She said that Montoya looks like he has been losing weight recently. "Joe is always seen for at least a couple of hours every day in the activity room. When he didn't show up for a couple of days, a few of us became concerned and called Paula White," said Ms. Garcia. "He has been doing some strange stuff lately. I have seen him taking his clothes into the men's restroom next to the activity room, and I guess he's doing his laundry in there."

Claudette Garcia, resident at Mineral Palace Tower apartments.

Another resident of the Tower, Susan Pruiette, has been a resident there for several years and said, "Joe was already living here when I moved in. I have noticed a decline in his motor skills, and he has a worsening speech impediment that makes it tough to understand him sometimes. I have been taking him food once in awhile, and try to encourage him to come eat in the dining room where meals are provided on weekdays for two dollars." Ms. Pruiette went on to say, "It's really sad that Joe has two daughters who live right here in Pueblo, and they never hardly come to see him to make sure he's O.K. Joe should really be in a facility where he can be properly cared for. I have noticed his health rapidly deteriorating over the past couple of months," added Ms. Pruiett.

Susan Pruiette, resident at Mineral Palace Tower.

Several other residents of the Tower have commented that Montoya has been seen vomiting in the men's room next to the dining area after a meal. He has also been observed eating food out of the trash. Montoya has also been known for wearing the same clothes for a few days in a row, and having incontinent accidents on occasion.

Janet S. Le May has lived nest door to Joe Montoya since June of 2008. "I have observed that he has never bought groceries, so there's no way he could prepare a meal for himself. Joe used to go to SRDA, Senior Resource Development Agency, located here in Pueblo, for meals on weekdays. On Sundays, church groups, who provide meals at Mineral Palace Park, located next to our apartments, would bring Joe a meal," stated Ms. Le May. She went on to say, "Other people who live here give Joe food to eat, but some days he only eats one meal."

Janet S. Le May, resident at Mineral Palace Tower apartments.

Ms. Le May stated that Montoya has been known to be late paying rent, and his cable has been turned off due to non-payment. She also added, "Joe has not followed up on regular medical care, and in the past argued his release from the hospital and nursing home. He has numerous issues to address, and dementia being among them." Ms. Le May has observed Montoya tearing up his mail, eating out of the trash, quarreling with others when he doesn't get his way, refuse medical treatment, and wearing soiled clothing.

By refusing medical attention when paramedics tried to take him to the hospital for observation of his medical and mental conditions, Montoya did not receive the help he appeared to desperately need on July 14.

Montoya is observed refusing to go with paramedics.

Montoya demonstrated irrational and angry behavior towards police officers and paramedics, but when asked to be able to take his picture after they left, his entire demeanor took a flip turn, and he was happy to pose for a picture.

Joe Montoya, taken after police and paramedics left.

Montoya's actions are a perfect example of some of the symptoms of Dementia. There are four prevalent forms of Dementia, Alzheimer's disease being number one. Common symptoms of Alzheimer's are memory loss, confusion, difficulty communicating, anxiousness, and paranoia. Another form of Dementia is Vascular Dementia which also has symptoms of memory loss, along with impaired judgment, decrease ability to plan, and loss of motivation. Lewy Body Dementia results in sleep problems, memory loss, hallucinations, and frequent swings in alertness. Frontotemporal Dementia has symptoms that include decreased inhibition, (frequently leading to inappropriate behavior), apathy and loss of motivation, decreased empathy, repetitive compulsive behaviors, anxiety, and depression.

Joe Montoya is fortunate to have several residents at Mineral Palace Tower apartments that care enough to make sure he eats regularly, and checks on him on almost a daily basis. It is unfortunate that many elderly people in our society do not get the care for Dementia symptoms, and have difficulty functioning in a normal capacity in their own home, and end up with serious medical conditions.

In Pueblo, there are quite a few facilities that are designed to care for both physical and mental needs of the elderly in our community. Brookdale El Camino, Senior Living Solutions, is one such facility that is known for it's outstanding care of seniors' needs, including those with Dementia. It takes many people working together to insure that elderly residents are cared for properly, eat regularly, receive medical attention, get assistance with showers and dressing, and receive medications as prescribed.

Brookdale El Camino, Senior Living Solutions, Southside, Pueblo

Tiffany Moore, Registered Nurse for Brookdale, evaluates and assesses new residents, reviews their medications and physical needs, handles ordering of prescriptions, and schedules all doctors' appointments.

Tiffany Moore, RN for Brookdale

Ava Jay, receptionist at Brookdale for almost six years, is one of the first people you see when entering Brookdale. "I handle all inquiries from families and doctor's referrals, and home health care agencies. I take new residents and their families on a tour, I discuss financial costs, and have a meal with tentative new residents," said Ms Jay.

Ava Jay, receptionist at Brookdale

Angel Alarid is the business office coordinator, head of Human Services, handles payroll, and has worked for Brookdale for six years.

Angel Alarid, business office coordinator, head of H.R.

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Christa Bissonnette, pictured in the garden area, has worked for Brookdale for two and a half years as a Resident Assistant, which is a very important position when it comes to caring for the residents' needs, including those with Dementia. "I have a lot of patience, and I put myself in their shoes. I realize that they don't always realize what is going on at all times," said Ms Bissonnette. "And even when residents have anger bursts, which are common for people with Dementia, I still make sure to give them love and kindness."

Crista Bissonnette, Resident Assistant at Brookdale in the garden area.

Ms Bissonnette also added, "Family members realize that their loved ones need full care, and they can look into facilities like Brookdale to take care of their needs. We are part of the Alzheimer's Walk that takes place in Pueblo in August each year, and we cater a meal and tour to the public a couple of times a year."

Activities at Brookdale are a daily part of the routine of residents. Activities Director, Kimberly Robinson, is in charge of helping residents 'flex their brain,' and 'boost their brain,' during activities time. "There is 'heads up,' which is an activity where residents hold a card on their forehead for others to give them clues to figure out the word," said Ms Robinson.

Kimberly Robinson, Activities Director

Bingo Game

Common area at Brookdale

Ms. Robinson continued to say, "We have bingo, music entertainers, and we even have margarita Saturdays to help residents feel normal." Ms Robinson went on to add, "We have monthly outings for the residents to interact with the community. This month's outing was taking a train ride through the Royal Gorge."

Residents are not restricted to Brookdale, they often go on family outings.

Residents also have the opportunity to go out on fun trips with staff members

and family, to places like the Royal Gorge Train Ride, and a meal.

Andrea Trujillo is a Qualified Medication Administer Person, QMAP, and a Resident Associate for Brookdal for the past seven years. "I assist residents with different necessities, and make sure each resident has their scheduled medications," said Ms Trujillo.

Andrea Trujillo is pictured here in the dining area at Brookdale.

Nancy Salas, also a QMAP for the past seven years at Brookdale, stated, "I assist all residents with medications, bathroom needs, and also serve all meals. I escort residents to activities, and to transportation for appointments."

Nancy Salas, QMAP at Brookdale.

Ashley Marshall is the Sales Manager for Brookdale for the past eight years. She handles all move-ins and tours. Ms Marshall commented, "We have fun and celebrate life everyday!"

Ashley Marshall, Sales Manager at Brookdale.

Michelle Brasseu, also a QMAP, and Resident Assistant, is seen standing next to a beautiful fish tank located in a common area at Brookdale. Ms Brasseu stated, "I take care of the residents here in their "home" by providing loving, compassionate care, while always trying to preserve their dignity."

Michelle Brasseu, QMAP at Brookdale.

For the residents' convenience, Mary Ann Cole provides hair cuts, hair coloring, perms, and roll-and-sets, at Brookdale.

Mary Ann Cole, salon services

Families don't have to worry about their loved ones with physical and/or mental handicaps who reside in facilities such as Brookdale. Having a 'home-like' atmosphere, and staff that treats residents like family, even those with Dementia, can enjoy life on a daily basis. There are activities daily, and a library and pool room for residents to enjoy at Brookdale with their families during visits.

Pool room, located on the second floor at Brookdale.

Residents, their family and friends can enjoy playing pool together.

Library located on the second floor at Brookdale.

There are several in-home care providers around Pueblo for people who only have minor symptoms of Dementia, and are still cognitive enough to perform simple daily tasks and are capable, with assistance, to remain in their own home. InnovAge, in Pueblo, provides adult day programs, home care, memory care, senior housing and caregiver support. Meals or provided at the day programs located at InnovAge, Greater Colorado, PACE, (Program of All-inclusive Care for the Elderly), at 401 West Northern Avenue. Shuttles pick up people at their home on weekdays to take them to InnovAge. In-home care includes housecleaning, assistance doing laundry, basic daily necessities, and medication monitoring and administering. In-home care is designed to help the elderly maintain their independence.

In recent years, there have been many experimental medications for people who are diagnosed with Dementia. Dr. Michael Saathoff, Psychiatrist here in Pueblo, came here 20 years ago with his wife, Dr. Kristen Saathoff, retired pediatrician, and their twin daughters.

"I have a private practice treating adult and geriatric patients for psychiatric problems here in Pueblo, including those with Dementia," stated Dr. Saathoff.

Dr. Michael Saathoff, Psychiatrist in Pueblo.

Dr. Saathoff did his undergraduate studies at Stanford University in California. He attended University of Texas, San Antonio, Medical School to acquire his M.D., and four years doing his psychiatry residency at San Antonio. Dr. Saathoff was also assistant Professor of Psychiatry at San Antonio Medical School up until he moved to Pueblo in 1997. "I was also the Medical Director for Saint Mary Corwin Hospital, the geriatric psychiatry unit, up until 2002, at which time the unit was closed down," said Dr. Saathoff. During the 20 years of practice here in Pueblo, Dr. Saathoff has been one of a select few Psychiatrists that practice in Pueblo.

Dr. Saathoff went on to say, "Making the diagnosis is the first and most critical step. There are no specific tests or primary workup for Dementia. Making a diagnosis involves ruling out other causes of cognitive impairments, such as a brain tumor, hydrocephalus, (water on the brain), or general medical problems such as, anemia, hypothyroidism, or vitamin deficiencies."

When patients first come to Dr. Saathoff, they have already received a full physical examination, lab tests, a head CT scan, and/or an MRI. Dr. Saathoff also added, "Geriatric testing is somewhat promising in terms of diagnosis, but at this point has limited clinical utility."

CT Scan machine at Saint Mary Corwin Hospital, Pueblo

MRI machine at Saint Mary Corwin Hospital, Pueblo.

No cameras allowed inside MRI room because of magnetic field.

When defining Dementia, Dr. Saathoff said, "Dementia is like a general term, like an infection is a general term that says there's something going on, but no specific diagnosis." Dr. Saathoff went on to say, " There are two classes of medications commonly used to treat Alzheimer's Disease. The first class of medication would be Cholinesterace inhibitors such as Avicept, Razadyme, and Exelon. The second class of medications for Dementia would be NMDA, (a type of receptor in the brain), modulators, such as Namenda." Dr. Saathoff continued to discuss more about medications for those with Dementia and Alzheimer's. "There is some evidence that certain medications can also help with problem behaviors such as irritability or agitation. However, it is still often necessary to use other psychotropic medications to treat symptoms such as anxiety, agitation, depression, or psychosis."

"General practitioners don't always feel that they have the ability to diagnose and treat Dementia, and may have a lack of confidence in the efficacy of Alzheimer's medications," said Dr. Saathoff. He also added, "People with Dementia, or any of its' forms, usually don't realize they have Dementia. It's most often their immediate family members or their primary care doctors refer them to a psychiatrist when they begin showing symptoms of Dementia. One of the first indications of Dementia are signs of memory loss, which commonly causes irritability, confusion, and agitation." Dr. Saathoff concluded by saying, "There are also those who have a dual diagnosis, and it is necessary for them to be in a mental institution in order to receive round-the-clock care."

When following up on how Joe Montoya was doing and couple of days later, on Sunday, July 17, he appeared to be in good spirits while having a meal in the dining area of Mineral Palace Tower apartments. On Sundays, in Mineral Palace Park, next to the Tower, there are several church groups that provide free meals to those in need. The various church groups know Montoya well, and ensure he gets a good meal just about every Sunday.

Joe Montoya in the dining area at Mineral Palace Tower apartments on Sunday, July 17.

Whenever Montoya is asked how he is doing on a good day, he always responds by saying, "Grrrrreat!"

Joe Montoya saying "Grrrrrreat", when asked how he is doing.

Since the early 1900's, Dementia has been studied, but there is still no cure. Medical specialists, psychiatrists, and neurologists, diagnose causes of Dementia, but even with medications can't stop the scientific malfunctions and deterioration of the human brain.

Today, it is a sad fact that many people who have some type of Dementia never receive the care they so desperately need. The fortunate ones affected do receive help when family members, social services, and medical professionals see the signs of Dementia, and get involved. Depending on the level and type of Dementia, some are fortunate enough to be able to remain in their homes with assistance, and some require an assisted living environment to care for their needs. Someday, hopefully, there will be a cure to prevent, or address the symptoms of Dementia.