What is Alzheimer's Disease?

By Cheryl Theriault

Alzheimer's Disease is defined as a progressive, degenerative disease that attacks the brain and impacts memory, thinking, and behavior. It is the most common form of dementia. Dementias affect people's memory, thinking ability, their ability to care for their daily activities of living. Alzheimer's disease ultimately results in death and is the fourth leading cause of death in adults. The leading three causes of death in adults are heart disease, cancer, and stroke. Alzheimer's usually occurs in persons 65 years of age or older but can begin when people are in their 40s or 50s.

Symptoms of Alzheimer's disease include forgetfulness, decreased capacity to manage daily activities of living such as bathing, dressing, shopping, meal preparation, medication management, bill paying, etc. There can be personality changes including reclusive ness, paranoia, and aggressiveness. Frequently persons with Alzheimer's disease are disoriented, have trouble with language skills, and lose the ability to use good judgment, follow steps, and problem solve.

The progression of the disease varies from person to person but the average time from onset to death is eight years. This is just an average range and the span between onset to death has been as little as three years and as long as twenty years. Some warning signs include:

• Recent memory loss that affects job skills or ability to drive
  
• Difficulty performing familiar tasks
  
• Language skill problems
  
• Disorientation regarding time and place
  
• Poor judgment
  
• Problems with abstract reasoning
  
• Misplacing things
  
• Changes in mood and/or behavior
  
• Changes in personality
  
• Loss of initiative

It is extremely important to note that sudden onset of any or all of the above symptoms might reflect some reversible medical trauma the individual is suffering. This can be as simple as a urinary tract infection, side effects or a new medication, the body's reaction to the trauma of a fall. Therefore the first course of action is to get immediate medical attention to see if there is a treatable, reversible medical event going on.

Diagnosing Alzheimer's disease continues to be elusive. A detailed medical evaluation must take place and should include:

• lab work
• medical history
• neurological testing
• mental status assessments
• a thorough physical examination.

A diagnosis is usually arrived at by first ruling out all other possible causes however confirmation of the diagnosis requires examination of brain tissue which is done by autopsy.

There are no treatments to "cure" Alzheimer's disease. There are medications that can slow the progression. There are interventions that can be developed to deal with physical, mental, and behavioral changes. There is advance planning that can take place in the form of getting final affairs in order while the Alzheimer's victim can still execute legal documents such as Power of Attorney, Health Care Power or Attorney, Living Will.

Educating the caregivers and family is an important step in coping with the changes that are occurring. Dealing with difficult behaviors, maintaining a calm, comfortable routine, how to include social activities and maintain adequate hygiene and nutrition are all important skills that must be learned.

Many people find adult day programs to be an excellent source of specialized socialization. Raleigh has even developed a Saturday and evening program (for people who become restless and wander and pace as the night hours approach).

If you hear people talk about the "stages" of Alzheimer's disease the following provides a brief summary:

Early Stage (2-4 years leading up to and including diagnosis)

Symptoms:

• Recent memory loss
  
• Progressive forgetfulness; difficulty with routine chores
  
• Confusion regarding directions, decisions, and money management
  
• Loss of spontaneity and initiative
  
• Repetitive actions and statements
  
• Mood, personality, and judgment changes
  
• Disorientation of time and place

Examples:

• Forgets if bills are paid
  
• Loses things and/or forgets they are lost
  
• Arrives at the wrong place and/or the wrong time
  
• Constantly checks calendar
  
• Forgets frequently called phone number

Second Stage: (2 - 10 years - the longest stage)

Symptoms:

• Increased memory loss, confusion, and shorter attention span
  
• Difficulty recognizing close friends and/or family
  
• Wandering
  
• Restlessness, especially in late afternoon or evening
  
• Occasional muscle twitching or jerking
  
• Difficulty organizing thoughts or logical thinking
  
• May see or hear things that are not there
  
• Needs full-time supervision

Examples:

• Sleeps often - awakens frequently at night and may get up and wander (Sundowner's syndrome)
  
• Perceptual motor problems - difficulty getting into a chair, setting the table
  
• Can't read signs, write name, and or subtract
  
• Suspicious - may accuse people of hiding things or of infidelity - paranoia
  
• Loss of impulse control - may undress at inappropriate times or places. May use offensive language.
  
• Huge appetite for junk food - forgets when last meal was eaten; may lose interest in eating

Third Stage: (1-3 years)

Symptoms:

• Unable to recognize family members or self
  
• Loss of weight even with appropriate diet
  
• Unable to care for personal needs
  
• Spoken language disappears
  
• Tries to put everything in their mouth; compulsion for touching
  
• Bowel and bladder incontinence
  
• May experience difficulty swallowing, skin breakdown, infections, or seizures

Examples:

• Looks in mirror and talks to own image
  
• Needs total care with bathing, dressing, eating, and toileting
  
• May groan, scream, or make grunting noises
  
• Sleeps more, becomes comatose ending in death

Research continues into the causes of Alzheimer's disease.

Additional Resources

Duke University Hospital in Durham, N.C. is a very active research center and has the latest information.

• Duke's Family Support program (919) 660-7510.
• Geriatric Evaluation and Treatment Clinic (919) 620-4070.
• Neurological Disorders Clinic - (919) 668-7600.

UNC Health Care in Chapel Hill also offers a Geriatric Evaluation and Treatment Clinic. They can be reached by calling (919) 966-5945.

The Alzheimer's Association has a wealth of printed materials, support groups, resource rooms, counseling, and teaching. To find an office near you contact:

• the National Office at 1-800-272-3900
• or The Eastern North Carolina Chapter at (919) 832-3732.

The Alzheimer's Association developed the Safe Return Program for persons with Alzheimer's disease. People register with their National Safe Return Program and receive identifying jewelry or clothing labels for the loved one to wear in the event they wander and get lost.

Additional information can be obtained from the National Office or Eastern North Carolina Chapter referenced above.