Over the weekend, we attended the 85th birthday celebration of a well-loved matriarch whom we’ve been seeing in our clinic for the last 20 years.
She told her guests that she’s writing her journal every day because she might develop Alzheimer’s disease in a few years. We assured the family that her signs and symptoms are still acceptable for her age.
When one’s memory starts to fail—forgetting where keys, or eyeglasses were placed; or having to think a few seconds longer to remember the person one saw only a day before; or having difficulty recalling the names of acquaintances not seen for quite some time—these are still part growing older and not necessarily suggestive of Alzheimer’s disease.
At most, we can call them “senior moments,” when the memory falters. But there may be other more distinct signs and abnormal behavior of people afflicted with this disease that can affect one in eight seniors, 65 years and older, although younger people may also be affected.
Family and friends must be alert in detecting early warning indicators in the memory and speech of their loved ones.
In the early stages of Alzheimer’s, long-term memories usually remain intact, but it’s the short-term memories that can be problematic.
It may still be easy to remember one’s elementary teachers, but difficult to recall what one had discussed with them.
Confused
The person afflicted with Alzheimer’s would keep on asking questions you already answered or may have problems with speech, trying to grasp even commonly used words.
In later stages, behavioral changes show. The affected person may look confused even while performing simple tasks.
A senior member of the board of directors of a healthcare company, who was attending the company’s business meeting, was spotted by hotel employees at 2 a.m., listlessly walking in the lobby of the hotel where all the employees were staying. He was asking where the other employees were, and was upset that they “were late.”
He asked where the toilet was, and had problems finding his way back to the lobby.
A referral to a neurologist
As the disease progresses, mood swings, strange behavior, profound lapses in judgment, and carelessness with one’s hygiene become more prominent.
A patient, who always came for followups wearing impeccable clothes, arrived in what one usually wears when cleaning house. His hair was uncombed. He also had other hallmark symptoms of Alzheimer’s.
We usually refer our suspected Alzheimer’s patient to the neurologist or brain specialist in our group. Before requesting for more sophisticated tests, the neurologist does a thorough history check, getting the information from the patient’s relative, aside from that obtained from the patient.
The signs, symptoms and changes in behavior are noted. Then the neurologist proceeds with a mental status test and other screening tests that can assess the patient’s mental skills and short-term memory.
Brain scans like computerized tomography or magnetic resonance imaging may be requested to find out if the patient has other problems—a stroke, or tumor, which can explain the signs, symptoms and behavioral changes.
In Alzheimer’s, the nerve cells deteriorate or die; or they may undergo changes that can make them lose their normal functioning. With worsening of the disease, the brain tissue shrinks significantly, impairing memory, speech, comprehension and judgment.
Ordinary tasks such as paying the bills, using food utensils, taking a bath or dressing up may be a challenge already.
One study showed that difficulty in balancing the checkbook is one of the early signs of Alzheimer’s. In much later stages, failure to recognize familiar faces and family members, walking and balancing problems, incontinence and loss of language are evident.
Prohibited from driving
Patients with suspected or diagnosed Alzheimer’s should be prohibited from driving. One patient who snuck out driving the car out of the garage almost ran over his grandchild who was playing in front of the house.
The course of the disease varies from one patient to another. It can rapidly progress in some, who may last only a few years after diagnosis, while for others, the deterioration can be very gradual, taking up to 20 years or longer before the patient reaches the end stage of the disease.
The average lifespan after diagnosis of Alzheimer’s is three to nine years.
Alzheimer’s disease is still uncharted territory, and tried-and-tested effective treatments are not yet available. But there are some pills the doctor may prescribe which may help slow down the process and allow the patient to remain functional.
Physical activity and other supportive therapy should be encouraged. Exercise helps preserve muscle strength and maintain coordination of the muscles. It can help calm down the person with Alzheimer’s who’s exhibiting restlessness and anxiety. The family should also watch out for depression in their loved ones with Alzheimer’s, and take antisuicidal precautions if necessary.
A diet consisting of fruits, vegetables and food with high antioxidant content must be maintained.
Caring for a loved one with Alzheimer’s can be physically and mentally draining. The caregiver can easily develop burnout and the so-called Alzheimer’s caregiver syndrome, which may include anger, irritability and mood swings, headaches, dizziness or body pain, difficulty in sleeping, easy fatigability or exhaustion, and becoming sickly.
When the caregiver shows these symptoms, it’s time to get additional help. And when it reaches some stage of the disease when caregiving of the Alzheimer’s patient at home may no longer be advisable, there are a few facilities locally which can take care of Alzheimer’s patients. The monthly cost may be a problem for many families, however, and they may have no choice but take care of their loved ones themselves.
Caring for a loved one with Alzheimer’s can really be the utmost test of patience and love. We hope medical research can finally have that scientific breakthrough in easing the anguish, misery and pain of both Alzheimer’s patients and the ones caring for them.
