FinalFrontier: Report on Alzheimer's Disease

Preface for this report:

The following are excerpts from a report written in 2004 for my biology class. The full report contains a great deal of research,  terminology, and details unnecessary for this forum. If you want to know more about Alzheimer's Disease, please visit www.alz.org or the resources provided. Nothing in this report should be considered a medical recommendation; this is a recollection of events and emotions involving my mother.

Something’s Wrong with Mom.

Alzheimer’s Disease began stealing little pieces of my Mom over 11 years ago. This horrible thief worked so slowly and discreetly that we suspected nothing. Dad and I were simply aggravated by Mom’s repeated questions and inability to keep up with conversation. Dad began to see odd behavior that he chalked up to sleepwalking – empty dishes put in the refrigerator, food put in the pantry. I noticed her inability to keep a large set of facts straight in a developing health situation regarding her bladder. She became defensive, paranoid, and very secretive. Her personality was changing, and we felt attacked and confused. In reality, she was desperately trying to hold onto her independence, but knew it was slowly eroding. She began to get “lost” and would drive around for hours trying to find something familiar. When she would come to her senses in a familiar parking lot, she would begin crying hysterically. She relinquished her keys to Dad after several of these incidents, and completely stopped driving about six years ago.

Since then, Mom has lost all ability to perform routine tasks around the home, manage her own finances, and even walk confidently without losing balance. She also has begun to “lose” people. Her sister died last spring, and she could only remember one of her sister’s three children. The others had disappeared from memory. She still remembers all her children and grandchildren; she still knows how to hold and comfort a baby; she still loves to read to the children; she still wants to know what’s going on in the lives of her family members, she just can’t remember from one sentence to the next. As Alzheimer’s patients go, she is still very functional – toileting, showering, dressing, and eating on her own. Mom is in moderate-to-late-stage Alzheimer’s disease.

The deepest, most personal parts of my Mom have been stolen by this thief - her sharp intellect, her sense of humor, her perceptiveness, and her indomitable will. All those parts of her are gone, and what remains is like a cardboard cut-out of Mom. I sit her on the couch for visits, I sit her at the table for meals, and I lead her to and from the car for activities. Even though she doesn’t know much of what’s going on around her, she still loves me, and now this is my time to love her, care for her, and say my goodbyes.

Mom has Alzheimer’s Disease.

Mom was diagnosed with Alzheimer’s Disease four years ago after months of medical and intelligence tests. To learn more about this disease, I found the National Institute on Aging’s website – www.alzheimers.org - where they have published pages and pages of very current information for patients, caregivers, and researchers to explore. The National Institute on Aging (NIA) in their report entitled “Alzheimer’s Disease: Unraveling the Mystery” states that Alzheimer’s is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, and, eventually, even the ability to carry out the simplest tasks (page 4). Alzheimer’s is a fatal disease, and the time from diagnosis to death ranges from three years to 10 or more, usually based on age at diagnosis (page 24).

Alzheimer’s Disease is the most common cause of dementia among people age 65 and over. Dementia is the loss of memory, reason, judgment, and language to such an extent that it interferes with a person’s daily life and activities (page 6). While the exact cause of Alzheimer’s Disease is not known, research has shown the brains of affected patients have an abundance of two abnormal structures – beta amyloid plaques and neurofibrillary tangles - always present in the regions of the brain responsible for memory. It is their abundance, not just their presence, that indicate Alzheimer’s. It is not known, however, if these substances are the cause of the disease, or if they are a result (page 20).

Stages and Symptoms

Preclinical Alzheimer's

Alzheimer's begins in the entorhinal cortex, which is near and directly connected to the hippocampus. It proceeds to the hippocampus, the essential formation point of both short-term and long-term memories. Those affected regions begin to atrophy, or shrink. The beginnings of the disease start 10 to 20 years before any noticeable signs appear. The first symptom, memory loss, is seen as mild cognitive impairment (MCI), and is thought to be an initial phase of transitioning between normal brain aging and Alzheimer's Disease (page 25). I have no idea how long Mom was in this stage.

Mild Alzheimer's Disease

For reference, Mom was in this stage from 1993 - 2001, including (when I gave her the Mother's Day present mentioned in another post). When the disease starts to affect the cerebral cortex, memory loss continues and changes in other cognitive abilities begin. This is the point at which Alzheimer's can be diagnosed. In this stage, a person seems to be completely healthy, but their mental functioning is “off kilter.” Alzheimer's Disease is busy damaging the brain only in the areas that control memory, language, and reasoning at this stage. Symptoms include:

*memory loss

*confusion about familiar places – getting lost

*taking longer to accomplish routine daily tasks

*trouble handling money, paying bills,

*poor judgment leading to bad decisions

*loss of spontaneity and sense of initiative

*mood and personality changes, increased anxiety (page 26)

Moderate Alzheimer's Disease

At this stage, Alzheimer's Disease damage has spread to more areas of the cerebral cortex controlling language, reasoning, sensory processing, and conscious thought. Affected regions continue to atrophy, and the symptoms become more obvious and varied. New problems such as wandering, agitation, and delusions appear. Patients at this stage require constant intensive supervision to keep them from harming themselves or wandering. This is the stage Mom was in from 2002 - 2006 (see this post). Symptoms include:

*increasing memory loss and confusion

*shortened attention span

*problems recognizing loved ones

*difficulty with language: reading writing, working with numbers

*difficulty with organizing thoughts and thinking logically

*inability to cope with new or unexpected situations, crowds, or noise

*restlessness, agitation, anxiety, tearfulness, wandering, drumming constantly with fingers

*complete disorientation, especially at night

*hallucinations, delusions, suspiciousness/paranoia, irritability

*loss of impulse control shown in sloppy table manners, saying or doing inappropriate things

*perceptual-motor problems - getting out of a chair, folding clothes, or setting the table (page 27)

Severe Alzheimer's Disease

In late stage Alzheimer's, plaques and tangles are widespread throughout the brain, and entire regions of the brain have atrophied further. Patients cannot recognize loved ones, can’t communicate, and they are completely dependent on others for care. Mom was in this stage from 2006 until her death in 2010. Symptoms include:

*weight loss

*seizures, skin infections, difficulty swallowing

*groaning, moaning, grunting

*increased sleeping

*lack of bladder and bowel control

At the end of their disease, patients are in bed much of the time. Although Alzheimer's will eventually cause death, most patients die from other illnesses brought on by the symptoms; frequently it is pneumonia resulting from improper swallowing (page 28).

Do Alzheimer's drugs work?

Medications have been developed to slow the progression of Alzheimer's. They offer little in the way of symptom relief and nothing in the way of a cure, but the intriguing benefit these drugs offer is time. They offer time for an Alzheimer's patient to continue to live at home with a caregiver rather than in a nursing home (currently priced at over $30,000 annually). Any drug, or combination of drugs, that can give an Alzheimer's patient an extra year or two at home is quite a miracle!

Prescriptions for Alzheimer's patients may also include folic acid and vitamins B6 and B12 to reduce homocysteine levels, which become elevated in patients, and may cause some cell death. Anti-depressants are often combined with other drugs to manage behavioral symptoms including pacing, aggression, agitation, anger, and depression. Other drugs are employed to combat sleeplessness, hallucinations and delusions (page 35).

What about me: will I get Alzheimer's?

I am plagued by the constant nagging fear that I, too, will some day have to deal with this disease, and that my children will be forced to watch my intelligence and personality erode slowly and uncontrollably. Researchers have suggested there are some actions that can be taken that may reduce several possible Alzheimer's risk factors. These actions include lowering cholesterol and homocysteine levels, lowering high blood pressure levels, being physically active, and engaging in intellectually stimulating activities. Whether or not these actions can prevent Alzheimer's, they definitely can lead to a healthier lifestyle (page 4, Volume 11, Numbers 3 and 4). Hopefully, the research will move quickly and find the cause and cure for Alzheimer’s Disease. Until then, we will wait, and hope.

Works Cited

National Institutes of Health.  “Alzheimer’s Disease: Unraveling the Mystery.” ADEAR – Alzheimer’s Disease Education and Referral Center, a division of the National Institute on Aging. 2002.

 www.alzheimers.org/unraveling/unraveling.pdf

National Institutes of Health.  “Connections Newsletter, Volume 11, Numbers 3 and 4.” ADEAR – Alzheimer’s Disease Education and Referral Center, a division of the National Institute on Aging. 2003.

 www.alzheimers.org/pubs/conv11n3and4.htm (link no longer functioning - use information above.