Introduction
What
is Alzheimer’s Disease and How is it Diagnosed?
What
Should I Expect If My Loved One has Alzheimer’s Disease?
Is Alzheimer’s
Disease Fatal?
What
Should I Do if My Loved One has Alzheimer’s Disease?
Depression and
Alzheimer’s Disease
Care Facilities
Where
Can I Learn More About Alzheimer’s Disease?
Introduction
“Doctor, my memory isn’t what it used to be. Do you
think I could have Alzheimer’s?”
As a general internist with a large number of patients
over the age of 60, I hear this question often. The answer is not always
an easy one. The “good” news is that as we age, we all become a
little forgetful; only a small percentage of people develop a significant
memory problem. The trick is to differentiate “normal” forgetfulness from
disease.
If you or a loved one is having difficulties with memory,
your medical doctor can help you determine the type and cause of the problem.
Although there are many different causes for memory loss in older persons,
Alzheimer’s Disease (AD) is the most common, affecting nearly 1 in 10 people
over the age of 70. This article offers you a working definition of the
disease and some thoughts on what you can expect if you have a loved one
with Alzheimer’s.
What
is Alzheimer’s Disease and How is it Diagnosed?
Dementia
Alzheimer’s Disease is loosely defined as ‘unexplained
progressive memory loss’, usually affecting people over the age of 50.
Although problems with memory are characteristic of the disorder, Alzheimer’s
causes more than simple memory loss. It is a problem that falls under the
medical category known as 'dementia'.
Dementia is defined as a long-term change in a person’s
thought process. Someone with dementia can no longer learn new information
or remember recently learned information. He or she may have difficulties
with speaking, planning, judgment, problem solving, or simply organizing
his or her thoughts. The diagnosis of dementia is usually made when these
deficits become constant and severe enough to impair the person’s ability
to function normally or safely in occupational, social, and personal (the
most familiar) settings.
These changes can develop very slowly, so dementia can
be difficult to diagnose. Forgetting where you put your keys or forgetting
the name of an acquaintance in the heat of a social introduction is not
dementia. Some ‘slips of memory’ typical of actual dementia are: not knowing
what year it is an hour after being told the date, chronically forgetting
telephone numbers and addresses that have been the same for years, wandering
out of the house and getting lost on formerly familiar streets, and making
up details about recent events. This type of behavior should be evaluated
by a doctor. General internists, family practitioners, geriatricians and
neurologists are all trained in identifying and treating the various forms
of dementia, including Alzheimer’s Disease.
Diagnosis
Most people who have Alzheimer’s Disease are not aware
of it themselves and have been accompanied by a family member to a doctor
for medical care. To reach a diagnosis, a doctor will take a detailed medical,
psychiatric and functional history of the patient, and then do a careful
physical exam, including a memory evaluation to confirm evidence of dementia
versus some other medical problem that can mimic the symptoms of Alzheimer’s
Disease (depression is the most common). If true dementia is suspected,
the next step is to check specific blood tests, and possibly do a CT
scan of the brain in order to determine the type of dementia. It is
important to determine a patient’s type of dementia because a few types
are reversible, and many can be prevented from progressing further. Alzheimer’s
Disease is diagnosed when no other cause for dementia can be identified.
What
Should I Expect If My Loved One has Alzheimer’s Disease?
Unfortunately, Alzheimer’s is a degenerative disease.
The time-course of decline from mildly affected to severely affected is
variable, usually between 3 and 7 years.
Early stages
In its early stages, Alzheimer’s Disease affects people
in very subtle ways. Those with mild dementia instinctively compensate
for the disease and effectively mask the symptoms. Those with mild memory
difficulties will often change the subject or make up answers to questions
to hide the fact that they are struggling with their memory. Frustrated
by their difficulties, some with early Alzheimer’s become easily annoyed
or agitated.
Middle stages
Eventually more profound cognitive problems surface.
Typically, people with early moderate-dementia lose the ability to manage
complex tasks, such as paying bills, shopping, or driving safely. They
may lose their jobs or suffer the decline of a personal business because
the mental tasks required become too complex. As the disease progresses,
people with Alzheimer’s may develop problems with maintaining personal
hygiene and may exhibit poor or unsafe judgment. They may leave the burners
going on the stove, or get lost outside of the house. In addition, they
may undergo significant personality changes, becoming more irritable or
aggressive or, conversely, more withdrawn or passive.
Late stages
This path can be likened to the reverse progression of
how a baby learns to eat, talk, dress and wash. When adults with Alzheimer’s
Disease progress to advanced dementia, they cannot perform these basic
activities of living and need constant care. In the severest form of dementia,
they may forget to swallow the food that has been placed in their mouths
by caretakers. They may no longer recognize even the closest of family,
such as a long-time mate or child.
Is
Alzheimer’s Disease Fatal?
Alzheimer’s Disease does not directly cause death.
It does, however, make people more susceptible to injuries or infections
that could hasten the end of life. The most common causes of death in people
with advanced AD are pneumonia, malnutrition, dehydration and overwhelming
infection of the body. Pneumonia occurs frequently because people with
advanced AD lose coordination of the swallow reflex and inhale food and
saliva into their lungs. Malnutrition or dehydration can occur when AD
patients are not given the proper food and drink by their caretakers. Infections
such as “bed sores” (decubitus ulcers) and urinary tract infections
can result from patients’ immobility or poor personal hygiene. These infections
can spread through the body if they are not caught early.
What
Should I Do if My Loved One has Alzheimer’s Disease?
Living with Alzheimer’s Disease can be difficult for both
the affected individual and his or her loved ones. Luckily, it progresses
slowly, and there are lots of ways you can help a loved one.
Medical science offers hope
While medical science has not yet discovered a way to
cure AD, recent advances in drug therapy offer tremendous hope. Donepezil
hydrochloride (trade name, Aricept), a relatively new medicine,
seems to improve cognitive function by setting the disease state back to
an earlier stage. Unfortunately, it is not effective in everyone with the
disease and it does not halt future progression. Other medicines are under
investigation.
Making plans with your loved one
Maximizing the health and function of your loved one
and preparing for the future should be the real focus of early Alzheimer’s
Disease care. Enjoy your loved one’s company as much as possible. While
it is still possible to have conversations that include abstract ideas,
discuss plans for future care with your loved one in the event that someone
else must make medical and personal decisions for him or her. From a medical
standpoint, this means learning whether he or she wishes to have certain
life-extending measures performed in the event of an acute life-threatening
event or in the context of a chronic long-term illness. It is vitally important
to discuss your loved one’s wishes about receiving nutrition and hydration
through tubes in the mouth or directly into the stomach if he or she is
unable to eat properly. Some states recognize living wills, which
are written documents outlining a person’s wishes regarding end-of-life
care. The patient can choose a relative or close friend to be a health
care proxy, with the legal right and responsibility for making medical
decisions if needed.
Keeping things familiar
There are some straightforward strategies for optimizing
the day-to-day functioning of your loved one for as long as possible. It
is very helpful to keep their living environment familiar and unchanged
while they are still sentient. Keeping things familiar will minimize all
sorts of confusions. Grown children should avoid relocating a parent with
dementia to their home or a care facility unless care cannot be adequately
offered at the parent’s home. If your loved one requires constant attention
and supervision it may be necessary to have a home health aide come into
the home.
Staying in shape
Maintaining general medical health, eyesight, and hearing
maximizes functional ability and reduces the potential for injury. Your
loved one’s doctor can help you find an exercise program or enlist a physical
therapist to keep his or her body strong and limber. Daily physical and
social activity, provided in the home or through a community or hospital
day program, will also keep your loved one’s spirits up and help limit
nighttime insomnia.
Depression
and Alzheimer’s Disease
Depression is common in people with Alzheimer’s Disease
and can worsen the dementia significantly. Symptoms and signs of depression
in the elderly with Alzheimer’s include:
- Loss of appetite
- Weight loss even while being able to eat
- Marked changes in sleep behavior
- Irritability
- Crying
- Preoccupation with aches and pains of the body.
Luckily, depression is treatable once diagnosed. In many
cases, difficulties with memory and mental functioning improve as the depression
improves. Other emotional or behavioral problems commonly associated with
advancing dementia, such as agitation, aggressive behavior, delusions,
and hallucinations, are treatable as well. You can help by speaking to
your loved one’s doctor if he or she is experiencing any of the signs or
symptoms of depression.
Care
Facilities
Other problems such as incontinence and wandering can
be difficult to treat or manage. As the disease progresses, your loved
one with Alzheimer’s may require constant care and attention 24 hours a
day. This can be a significant burden on a family. If you do not have the
luxury of extended home care with an aide, consider placing your loved
one in a nursing facility that can provide round-the-clock care. These
facilities are equipped to feed, bathe, exercise, and provide basic medical
care for their residents. Most important, they keep your loved one safe
– safe from wandering into the streets (most facilities use electronic
localizing devices that sound an alarm if the person wanders past a certain
spot), and safe from potential accidents in the home.
Another benefit of nursing care is that it gives family
and friends the freedom to focus on their emotional and social relationships
with their loved one, as most of the labor-intensive chores are given over
to a hired care-provider.
Where
Can I Learn More About Alzheimer’s Disease?
It is important to remember that you are not alone if
you are experiencing the challenges and heartache of having a family member
with Alzheimer’s Disease. Your doctor can provide you with the names and
locations of local resources, including support groups for families caring
for a loved one with Alzheimer’s. You can call the National Alzheimer’s
Disease and Related Disorders Association, toll free at 1-800-621-0379,
for additional information. A great deal of information is also available
online. A good starting point is the Alzheimer’s Disease Education and
Referral Center website, published by the National Institute on Aging and
the National Institutes of Health, at www.alzheimers.org.
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