|MadSci Network: Neuroscience|
There is very little information on wandering in Alzheimer's disease patients. I have copied below the complete text from an informative article. As you can see, most of the research is on limiting dangers from wandering.
Wandering in Alzheimer's Disease patients is not driven by the motor system. If it were, handedness may indeed play a role in direction of wandering. Instead it seems to be driven by the patient's sense that 1) he or she does not recognize where they are and 2) therefore he or she must be in the wrong place. Alzheimer's Disease patients often remember how the town, street or room looked several years ago, and changes to the town, street or room that happened in the intervening years may cause the patients to feel like they are in the wrong place. Fortunately these feelings pass if they are addressed by a caregiver. For example, an Alzheimer's Disease patient sitting in his own living room may decide it is time to go home. If the patient is told he is already home, he will probably get upset (agitated). If the caregiver say, 'OK, let's walk home', and walks with the patient around the block, the patient will usually go happily right back inside. These examples are from my clinical experience, rather than from research, so while I can say that these things do happen, I can only guess why.
Alzheimer's disease appears to most affect areas in the brain with high concentrations of NMDA channels. These areas are also those involved in forming and storing long-term memory (see http://nootropics.com/nmda/, http://www.jneur osci.org/cgi/reprint/21/1/356.pdf). The cascade of ionic events that occur when these channels are activated leave these cells particularly vulnerable to oxidants, which appear to affect protein cleavage. Recently, an NMDA blocker has been developed which may have clinical benefit (see http://www.memantine.com/ but with a grain of salt).
The damaged protiens prevent the cells from communicating, resulting in loss of memory, limited ability to form new memories, impaired attention, and additional limitations as the disease progresses.
Healthcare Review. Alzheimer's Disease in Focus. Feb 12, 2002
Nearly 1 in five adults with Alzheimer's Disease found wandering leave from nursing homes and adult daycare centers, according to the most detailed report on Alzheimer wandering.
The report is significant because very little information is available on Alzheimer wandering. Wandering occurs when individuals with Alzheimer's Disease become separated and lost from their caregivers. Experts estimate that 60 percent of people with Alzheimer's will wander at some time. They also point out that if not located within 24 hours, 46 percent of wandering individuals may die.
"This kind of information will help professional and non-professional caregivers develop strategies to prevent wandering and help law enforcement find those who wander," said the Alzheimer's Association's associate director of safety services Brian Hance, who heads the Safe Return Program.
Meredeth A. Rowe, RN, PhD, associate professor in the College of Nursing and Institute on Aging at the University of Florida, Gainesville, wrote the report. She analyzed 1997-1998 data from the association's Safe Return Program, which helps return home individuals with Alzheimer's who wander away from their caregivers.
"While the study results are specific to the Safe Return Program only, this is the first time any data have become available on which to base policies related to cognitively-impaired wandering individuals," Rowe said.
"Even though caregivers or institutions had enacted significant prevention strategies, the incidents of unattended wandering were always unpredictable," Rowe wrote. "Ensuring that [cognitively impaired] individuals are registered with [Safe Return], regardless of their living situations, likely increases the chances of achieving safe returns. Professional-care facilities should consider requiring that all [cognitively impaired] individuals in their care be registered with the program."
Alzheimer individuals are likely to wander when they are in unfamiliar situations and their caregivers become distracted, Rowe wrote. She also noted that Alzheimer individuals living with adult-child care-givers -- as opposed to spousal caregivers -- are at greater risk of wandering because they are more likely to be left alone while the caregivers tend to other family and job responsibilities.
The report also found the following on adults with Alzheimer's who wander:
Context. In nearly 23 percent of cases, individuals wandered away from a daycare center, nursing home, other caregiving facility or while being transported by professional services. In addition, individuals wandered while with caregivers outside their homes (14.3 percent), when they became agitated inside their homes (13.1 percent), when their caregivers became distracted (13.1 percent), and when out alone (13.1 percent).
Living situation. Most lived with a spouse (36.5 percent). Other arrangements included living with a daughter (17.9 percent), alone (15.4 percent), and in a nursing home (13.4 percent).
Discovery locations. Individuals were found in residential yards (26 percent), on the street (22.3 percent), at businesses (11.8 percent), and in healthcare facilities (9.2 percent).
10 Tips to Reduce Alzheimer Wandering
1. Be prepared. There's no way to predict who will wander or when, or how it might happen. The best safety measure is to register a loved one in the Alzheimer's Association's Safe Return Program before a loved one gets lost.
2. Encourage movement and exercise. Make a shared exercise, such as walking, part of your daily routine together. This will reduce anxiety and restlessness. Also, allow the person with Alzheimer's access to a safe, enclosed area.
3. Be objective. Don't take the person's wandering behavior personally.
4. Be aware of hazards. Places that look safe might be dangerous for someone with Alzheimer's. Look in and around your home for potential hazards--fences and gates, bodies of water, dense foliage, bus stops, steep stairways, high balconies, and roadways with heavy traffic--and change what you can or block access.
5. Secure the living area. Do what you can to make your home safe and secure. Place locks out of the normal line of vision-either very high or very low on doors. Use doorknobs that prevent the person with Alzheimer's from opening the door. Other safety precautions include placing locks on gates, camouflaging doors, fencing in the patio or yard, installing electronic alarms or chimes on doors and using familiar objects, signs and nightlights to guide the person around a safe area.
6. Communicate with the person. Regularly remind and reassure the person with Alzheimer's that you know how to find him and that he's in the right place.
7. Identify the person. Have the person wear a Safe Return identification bracelet or necklace. Use sew-on or iron-on labels or permanent markers to mark clothing. Place identification on shoes, keys, and eyeglasses and in wallets and handbags.
8. Involve the neighbors. Inform your neighbors of your loved one's condition and keep a list of their names and phone numbers handy in case of emergency.
9. Involve the police. Some police departments will keep a photo and fingerprints of people with Alzheimer's on file. Have the following information ready for emergencies: the person's age, hair color, eye color, identifying marks, blood type, medical conditions, medication, dental work, jewelry, and allergies.
10. Be prepared for other modes of wandering. Although most wandering takes place on foot, some people with Alzheimer's have been known to drive hundreds of miles-sometimes in a vehicle that belongs to someone else. To prevent this problem, keep car keys out of sight or temporarily disable the car by removing its distributor cap. People with Alzheimer's also have traveled great distances by train, airplane, and public transportation.
To register a loved one in the Alzheimer's Association's Safe Return Program, visit www.alz.org, call (888) 572-8566 or contact your local chapter of the Alzheimer's Association and ask for a free registration brochure.
COPYRIGHT 2002 Healthcare Review
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