Alzheimer's, The Forgotten Disease   Frank Barnhill M.D.
 

Alzheimer’s is currently felt to affect about 4.5 million persons in the United States and probably will affect over 12 million by the year 2050. This means it will obviously place increasing stress on American families to provide their seniors with adequate care and sooner than you think will affect every American family in one way or another.

The cost just to provide medical care for all those afflicted will be in the billions and insurance companies and taxpayers will bear the load. Therefore, it’s to everyone’s benefit to delay onset of Alzheimer’s or at least slow the disease progression and lessen the family and financial stressors. With that thought in mind, let’s take a look at this devastating brain disorder.

Although no one has yet to clearly identify why some persons develop Alzheimer’s disease and others don’t, we do know that a brain chemical called glutamate is involved. Apparently if glutamate levels are increased, certain proteins, Amyloid and Tau, are also produced in higher levels. These proteins are responsible for formation of plaques and fibrous tangles that interfere with normal nerve conduction and memory storage.

Once a certain level of nerve involvement is reached, neurons or nerve cells are destroyed causing memory and cognitive impairment and eventually death. Since this can occur over long periods of time, it’s possible to clearly identify three cognitive stages of the disease, as mild (stage 1), moderate (stage 2) and severe (stage 3).

Mild cognitive impairment usually involves problems with memory and concentration. Often patients complain they lose their car keys or pocketbooks easily or forget where they put them. They may forget where they’re going and drive to the wrong address or be unable to find their way back home. They often forget appointments or fail to let the dog out or back in or simply forget to feed them. Sometimes they will tell you it’s hard to read or they can’t learn new things such as how to use DVDs or computers. In this stage they often deny anything is “wrong” with them and blame it on simple forgetfulness. It’s really easy for them to become depressed, sad and withdrawn because they “know something is wrong”, but “can’t quite put their finger on it”.

In moderate Alzheimer’s, family will notice a much more intense level of symptoms from stage 1, as well as varying levels of depression, confusion and difficulty remembering recent events such as last night’s supper or a trip to the mall. As this stage progresses, the affected person will have problems recalling past events accurately, such as what happened at their wedding or high school graduation. And more nerve damage occurs, this person may need help in cooking, cleaning house, mowing the grass, bathing or dressing. They often become irritable or agitated when confronted with their memory loss. These persons can seem reclusive and eccentric.

Stage 3 or severe cognitive impairment of Alzheimer’s leads to sleeping problems, getting days mixed up nights, problems with urine and bowel control, hallucinations and shouting or acting out behavior. As nerve cells continue to literally die, motor movement problems with speech, swallowing difficulties arise and muscle stiffness and weakness occur that leave these unfortunate persons dependent on family or nursing facilities for everything from feeding, dressing and bathing, to maintenance of bladder and bowel movement control.

While there is no known cure for Alzheimer’s disease, there are many drug therapies available to slow progression of the disease and in some cases improve nerve function sufficiently to help memory and behavioral problems. These drugs include tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon), galantamine (Reminyl), and memantine (Namenda).

Interestingly, while the others seem to only stabilize nerve cell loss or improve cognition over a period of 3 to 4 years, memantine appears to prevent further nerve cell death and significantly slow memory loss even in severe cases. Of course two problems exist with the use of these drugs: they are expensive and require frequent blood tests to monitor side effects.

Now that we understand the disease a little better, let’s concentrate on things you can do without medications to help your Alzheimer stricken loved ones.

1. Anti-inflammatory drugs such as ibuprofen are thought to slow progression of the disease by reducing swelling from inflamed nerves. Talk to your doctor about starting your seniors on preventative therapy.
2. Don’t let your senior sit watching television for hours at a time. Reading the newspaper, working word search and daily cross word puzzles seems to delay onset of Alzheimer’s. One study showed that people who worked with a lot of numbers on a daily basis had a lower rate of occurrence.
3. You can lessen confusion and agitation in your affected seniors by not shouting, raising your voice, arguing with, or accusing affected persons of being senile, forgetful or brain damaged. You can’t imagine how often this occurs and it just serves to cause denial and frustration and deepens depression in Alzheimer’s patients.
4. Provide written clues in stage 1 and add visual clues in stage 2 to prompt the Alzheimer’s patient to do needed things about the house. This would include notes and pictures on the bathroom mirror to remind them of tooth brushing and other hygiene necessities.
5. Placing graphic instructions in the kitchen will help them to remember to take medicines, turn off the stove after cooking and close the refrigerator. Some families simply disconnect the stove and provide a microwave. Don’t forget to lower the water heater temperature below 105 degrees so they can’t accidentally scald themselves.
6. Consider electronic key finders and labeling places for your loved one to place keys, wallets, and other essentials. Make use of light timers and ample bathroom lighting to lessen confusion if they get out of bed at night.
7. Use familiar items to help improve their memory. For example, if you wish them to call you every day at 7 PM, place your picture beside the phone with a large note saying “call me (your name) at 7 o’clock tonight at (your phone number)”.
8. Do not remove familiar items from their home unless they pose a danger. Doing so will disorient them and cause confusion. If they are moved to a nursing facility, take as many of these same items with them as possible. Doing so will decrease agitation and confusion and help orient them to their new home.
9. In stage 2 persons, you need to consider restricting access to dangerous parts of the house such as basements, attics, and chemical storage areas. Stop signs on doors tend to work well, but if your loved one may be seriously injured, then you should consider locks on such doors. Remember, do not restrict their ability to get out of the house in case of fire and clearly mark exits and provide emergency lighting.
10. When your senior is forgetful and prone to getting lost, restrict driving privileges by removing the car form the premises. Taking their driver’s license away won’t work; they’ll just forget they don’t have it and drive anyway!
11. Persons in stages 1 and 2 and sometimes 3 respond well to hand holding and hugging. These gestures can help decrease agitation and anger when used sincerely. Most Alzheimer’s patients can tell when you are patronizing them and will react badly.
12. Avoid correcting their verbal mistakes or moments of seeming confusion or forgetfulness. Instead, ask leading questions that allow them to correct themselves. You’ll save them and yourself a lot of hurt feelings this way!
13. Stage 3 Alzheimer’s patients may require nursing care, as they will probably be unable to assist in their feeding, dressing, bathing or hygiene activities of daily living. Stiffness may limit the ability to walk or transfer out of bed, necessitating use of lift chairs and wheelchairs. Swallowing difficulties may cause much frustration and weight loss. At this point most families need professional help. If your senior is in this stage, you are seeing a prime example of why you should prevent, slow the progression and treat Alzheimer’s as early as possible.

1. Alzheimer’s is almost always a progressive disease with no current cure
2. The earlier it is treated the better the outcome and the longer life
3. It is probably never too late to start medical therapy, as memantine has been show to help in moderately severe cases
4. The earlier you change the affected person’s environment and start behavioral training, the longer they may remain independent
5. Patience and your love will help your loved one more than most therapies
6. Respect is considered a must for Alzheimer’s family members and patients! Remember, you may have a 10 to 15 % chance of being in the same condition by age 65

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