Caring For Your Loved One With Alzheimer's Disease

By: Lisa J. Reeves, M.D.
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.