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The Alzheimer's Advisor: A Caregiver's Guide to Dealing with the Tough Legal and Practical Issues

The Alzheimer's Advisor: A Caregiver's Guide to Dealing with the Tough Legal and Practical Issues

by Vaughn E. JAMES

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For anyone who has ever cared for a person with Alzheimer's, coping with the emotional, financial, and day-to-day issues can be grueling. While many people are aware of the physical effects of this disease, very few know how to handle the practical issues that can make dealing with a loved one or patient with Alzheimer's that much more difficult. In The Alzheimer's


For anyone who has ever cared for a person with Alzheimer's, coping with the emotional, financial, and day-to-day issues can be grueling. While many people are aware of the physical effects of this disease, very few know how to handle the practical issues that can make dealing with a loved one or patient with Alzheimer's that much more difficult. In The Alzheimer's Advisor, Vaughn E. James offers an empathetic and straightforward guide to the legal and ethical dilemmas associated with this disorder. Using real-life situations, the author offers invaluable advice on such topics as: estate planning • the emotional issues of caring for a patient with Alzheimer's • how to cope with the cost of care • living wills, power of attorney, and guardian--ship • treatment and diagnosis • finding the right lawyer and paying for the cost of legal help • legal issues for the mobile Alzheimer's patient From recognizing the early signs of the disease to understanding the legal implications, this is the one book that will enable caregivers, health-care practitioners, and family members to protect themselves and their loved ones.

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17 Years

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Chapter 1

Those Memory Lapses!

Grandpa’s Story

Grandpa has been acting strangely of late. Last Monday, I told him I was heading to the movies. When I got back home, he asked, “So, how is Aunty Sheila?”

“Aunty Sheila?” I asked, startled. Aunty Sheila, Grandpa’s sister, had been dead for some five months.

“Yes,” Grandpa replied. “Didn’t you tell me you were going to see her?”

“No, Grandpa. Aunty Sheila died in January. I went to the movies.”

“Aunty Sheila is dead?” Grandpa asked, surprised. “What happened to her?”

“Grandpa, she died of pneumonia. Have you forgotten?”

“Pneumonia? I never knew that.”

How could Grandpa, one of Aunty Sheila’s pallbearers, have forgotten that his beloved sister had died? I put the episode down to hearing problems (Grandpa must have heard me say “Aunty Sheila” when I had said “the movies”) and a temporary memory lapse (these lapses happen to us all, right?).

On Tuesday morning, I gave Grandpa a $100 bill to pass on to Granny. He placed the bill on the coffee table. I left the house and headed to the library. I had forgotten to take one of the books I had to return to the library, so I turned around and headed back home. Granny met me at the door. “You forgot to leave the money,” she said.

“No,” I replied, “I gave it to Grandpa.”

When we asked Grandpa about the money, he denied that I had ever given him any. Yet there on the coffee table sat the $100 bill. When we asked Grandpa how the money got there, he simply replied, “I have no idea.”

On Wednesday, all hell broke loose. Grandpa woke up early and announced that he had to do some work in the yard. He said that he “was tired” of seeing the yard open to stray dogs and cats, so he wanted to spend the day building a 4-foot-high concrete fence around the perimeter of the property. I agreed to stay home to help him. We worked through the morning, and by the time we were finished, we had built a 4-foot-high concrete wall around the perimeter of our property, with an 8-foot-wide space for the cars to drive into and out of the property.

About an hour after we were finished, Grandpa took a shower, got dressed, and announced that he was heading to the supermarket. He took his keys, got into his car and—yes, you guessed it—instead of heading through the 8-foot-wide opening, backed straight into the wall we had just built! Maybe, I thought, Grandpa is losing his eyesight. Imagine my surprise when Grandpa got out of the car and began asking who had built the wall and who could be so dumb as to put a wall around the perimeter of the property, followed by saying that whoever had done this “stupid thing” should pay to fix his car.

By Wednesday night, I was beginning to believe that Grandpa was experiencing more than hearing loss, poor eyesight, and temporary memory lapses. I had heard the words “dementia,” “senile dementia,” and “Alzheimer’s disease” before, but I knew nothing about them. In fact, I wasn’t sure whether the three terms referred to the same condition, if one was just a type of the other, or whether someone could suffer from all three conditions simultaneously. Still, I did begin to wonder from which, if any, Grandpa was suffering. I set myself to doing the research.


Some of you may recall moments when you apparently forgot to do or say something or when some event or person “slipped your mind.” Some of these lapses are minor, like searching for your glasses while they are perched on your nose; searching for the car keys, only to discover they have been in one of your pocket all along; trying to remember the words of a hymn you sang so well at church two weeks ago; or trying to remember the name of the actor or actress in a favorite movie. We typically dismiss such instances as part of the aging process. Even young people sometimes joke with each other about “old age creeping in” or “Alzheimer’s taking its toll.”

Yet sometimes these memory lapses are no laughing matter. Indeed, especially in the elderly, they could be—and often are—the result of some form of dementia.

What Is Dementia?

Dementia is not itself a disease but is the name given to a group of symptoms including memory loss, reduced ability to reason, impaired judgment, and progressive loss of ability to understand either spoken or written language. Put in simple terms, dementia is somewhat like a fever. A fever is not a disease; it is merely a symptom of some disease. This, though, is where the similarities end.

A person suffering from dementia generally behaves in ways that others find irrational. He or she usually suffers from severe mood or personality changes, is physically aggressive, becomes easily agitated, and experiences altered perceptions such as hallucinations (accepting mental phenomena as being real), misperceptions (the inability to organize perceptual information), and delusions (holding on to unfounded, unrealistic beliefs without supporting evidence). In the later stages of the condition, the patient may become disoriented in time (i.e., not knowing the day of the week, the date of the month, or the month), place (not knowing where he or she is), and person (not knowing who he or she is—or who anybody else is, for that matter). The mere nature of these symptoms reveal why they are termed “dementia.” After all, the term dementia comes from a Latin word that means “apart or away from the mind,” or in common parlance, “irrational.”

To define a medical condition as dementia, medical professionals generally look for the presence of at least two types of impairment: (1) significant memory problems, and (2) impairment of at least one other cognitive function, such as speech, the ability to think abstractly and exercise judgment, and the ability to articulate or manage previously learned information. As you can imagine, a dementia diagnosis can have serious implications for the patient, family members, and other caregivers, if any. After all, the condition results in a restriction in the patient’s daily activities and, in most cases, leads to the long-term need for care.

While relatively young people (i.e., those between forty and fifty years of age) are sometimes afflicted with dementia, the incidence and prevalence of the disease are age-related. According to Professor Marshall Kapp of Southern Illinois University, almost 5 percent of persons age 65 and older are severely demented, with another 10 percent of that group in the moderate dementia category. Among persons age 85 and older, Professor Kapp states, more than 15 percent are severely demented.1

While people often speak of dementia as a single disease, in reality at least seventy-five distinct diseases belong to the “dementia group.” Of these, Alzheimer’s disease is the most prevalent, accounting for more than two-thirds of all dementia cases.2 Other forms of dementia include senile dementia, vascular dementia, Pick’s disease, and AIDS-induced dementia. Let’s take a look at senile dementia and Alzheimer’s disease in more detail.

Senile Dementia

As the name indicates, senile dementia is a type of dementia. It is caused by the degeneration of brain cells. Someone suffering from senile dementia experiences a gradual deterioration in brain function, resulting in the progressive loss of memory and mental abilities and noticeable personality changes.

Like its “parent,” dementia, senile dementia encompasses several other forms of dementia. Foremost among these are Alzheimer’s disease and Binswanger’s disease. Senile dementia is the result of an underlying disease or condition that damages the patient’s brain tissue and, as a result, causes brain function to diminish. While some forms of senile dementia, such as Alzheimer’s disease, are irreversible, other forms—such as senile dementia caused by depression, poor nutrition, thyroid dysfunction, drug poisoning, and alcoholism, to name a few—can often be healed by treating the underlying problem.

Alzheimer’s Disease

As previously stated, Alzheimer’s disease accounts for approximately two-thirds of dementia cases. Unlike some of the other forms of dementia, Alzheimer’s disease is a brain disease that physically attacks the brain itself. Accordingly, the memory loss experienced by the Alzheimer’s patient is merely a symptom or function of the brain disease, not the disease itself.

Because Alzheimer’s physically attacks the brain, it is, in all senses of the word, irreversible. Over the course of its progression, it robs the patient of memory and cognitive skills and causes him or her to have severe changes in personality and behavior. While the disease itself does not cause death, it causes conditions (such as pneumonia, pressure ulcers, and the inability to swallow) that eventually lead to the patient’s death. Although some people have lived up to twenty years with the disease, the average post-diagnosis life span for an Alzheimer’s patient is eight to ten years.

The disease takes its name from a German physician, Dr. Alois Alzheimer. On November 26, 1901, Dr. Alzheimer began treated a 51-year-old woman who has become known as Auguste D. Auguste D. died on April 8, 1906, after having suffered for years from memory loss, progressive deterioration of her cognitive functions, and severe alterations in her personality. After Auguste D. died, Dr. Alzheimer performed an autopsy on her, including an autopsy of her brain. He noticed many unusual lesions and entanglements in her brain, which resembled those he had seen in older people who had been diagnosed with senile dementia. But Auguste D. was different. She had died at such a relatively young age that Dr. Alzheimer figured she was too young to have developed senile dementia. He therefore termed the condition pre-senile dementia. In the century since Dr. Alzheimer made his discovery, scientists have developed a much better understanding of the brain lesions and entanglements and their effects on the human brain. They have dubbed the condition caused by them “Alzheimer’s disease.”

Meet the Author

Vaughn E. James (Lubbock, TX) is Professor of Law at Texas Tech University School of Law. As a professor and attorney, he has taught about the legal aspects of the disease and has had several clients who have been in the early stages of Alzheimer's. He al

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