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Jun 17, 2008 9:00 AM  CST  

Forgetting Disease 

It is the forgetting disease….forgetting names, places and eventually even loved ones. More and more we seem to be hearing about Alzheimer’s Disease, a disease of memory loss. There’s a good reason we’re hearing more about it. It is a disease of an older population and on the one hand, there is good news. We are living longer, longer than ever. The average life span in this country is approaching 80 years. But with that advancing age comes the opportunity for old age related diseases like arthritis, diabetes, or heart disease. One of those, one of the very important diseases that is often seen in the later years of our life is Alzheimer’s disease. Alzheimer’s has been known for well over one hundred years but recently because we are an aging population it is becoming much more important. We know that about 50% of all the people who are 85 years old or older have some degree of Alzheimer’s. Now that may be very mild and early or it could be quite late causing them to require nursing home care. Alzheimer’s robs memories, precious memories, lives full of memories and it has often been called the cruel thief. Just when an older couple is ready to retire and live out their lives together, perhaps traveling, gardening, being there for the family, if one of them develops Alzheimer’s, this thief of a disease steals their memories, steals their independence, and changes the life for not only them but for the whole family. 

Alzheimer’s is diagnosed by history. That means the doctor or nurse will ask important questions. There are four major areas in this medical history. One is memory loss, forgetting first of all short term memory— those things that just happened recently. Like where you put the car keys or what you had for breakfast. That memory loss just progresses and goes further and further back in time until sometimes even the husband or wife of fifty years is not recognized by the Alzheimer’s patient. Secondly, is difficulty learning.  We all know that our memory is important when we learn. We all can say our ABC’s because we remembered it as a little child. Remember how difficult it was learning all of the state capitals because we had to use rote memory to pass that state capital quiz in school? The third important historic point in the diagnosis is loss of language skills. People actually forget words but they still try to express themselves. Sometimes this has been called jumbled or scrambled sentences. The words just don’t fit in the sentence—the sentence doesn’t come out the right way and the meaning seems to be all twisted. As the disease progresses the fourth point in the medical history becomes very clear to everyone and that’s loss of normal body function. Functions like eating, feeding themselves, recognizing food, being able to dress themselves, even being able to go to the toilet by themselves—that body function is lost as the disease moves on.

Often times the Alzheimer’s patient can stay in the loving care of their family for quite a long time. As long as the family is able to supervise them and help them with everyday activities the patient seems to do well. Often times there is a sentinel event, that one special time, when everyone seems to realize this person has advancing Alzheimer’s and needs more help. That sentinel event, that signaling change, may be something like getting lost out driving to the barbershop or the grocery store and actually not being able to find their way home. Perhaps clothing themselves. Some times the sentinel event is because the patient wasn’t dressed properly or even at all going out on the front porch to check the mail. It could be that the sentinel event, or that important change in an Alzheimer’s patient’s life, is due to a disease like a fall and a broken hip, or a case of pneumonia or a urinary tract infection.  This sentinel event often gets the attention of the family, the doctors and the nurses. 

Because Alzheimer’s is a progressive disease that cannot be cured it is very important for us to recognize it early on in the very early stages when there’s just little short term memory loss. That way, medications like Aricept, Razadyne, Exelon, and Namenda may be added. Now, these medications don’t cure the disease. In fact, they don’t even make it better. But they do slow the process of the disease allowing the patient and their family to have more quality months and years together.

Early diagnosis is very important so that we can make a care plan—actually take care of this patient and their family. Start the medications if they are appropriate. You would have to check with your doctor about that. So, early diagnosis is what this is about. Often times the patient and the family recognize there is a change but we credit old age and not a disease process. We actually make humor out of it. Like someone with a “senior moment”. Or how about a “brain time out”? We all may have said this when we misplace the car keys or  can’t find a matching pair of socks. But in fact, these are little hints in older people that actually memory may be failing and could be very early signs. As the disease progresses the patient often allows family members to take over every day tasks like housekeeping, cooking, or paying the bills. Often times the family is happy to do it. They don’t even realize they are seeing changes in this person because they really just want to help. 

Whether the Alzheimer’s patient takes medications or not, we know that this is a slowly progressive disease. That means it gets worse all the time. Toward the final stages the changes come more rapidly. But in the early stages, there may not really be changes for a year or two or even more and that patient can often stay in the comfort of their own home. But finally when they are not able to feed themselves or clothe themselves or take care of themselves in the bathroom it becomes clear to their loved ones that they will need more help. Many Alzheimer’s patients eventually need an Alzheimer’s unit or nursing home care.

So if you have someone in your family who seems to be having more “senior moments” or they are unable to perform everyday tasks around the house you would want to visit with your doctor about these changes. I’m Dr. Leonard Hock wishing you the best of health.   
 
 

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Source: Covenant Hospice
http://www.covenanthospice.org

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