Toby Laping Associates
Senior Care Connection

www.WNYCareManager.com

Eldercare News
 

Back To Eldercare News

You Need To Know . . .

Alzheimer’s Disease, An Epidemic

by Toby F. Laping, Ph.D., C.S.W.

Alzheimer’s Disease is the most common cause of dementia, a general term for an illness that causes a patient to lose his memory and become progressively confused so that the world around makes less and less sense to him. It’s been estimated that over half of seniors aged 85 and over show some signs of Alzheimer’s type dementia.

A slight deterioration in memory is very common as we age. It takes longer to learn directions or to remember where we put our keys. For a while, very early stage Alzheimer’s can be indistinguishable from such mild memory loss. But eventually, the forgetting reaches the stage where it is quite distinct from the common forgetting of names now and then. The onset of Alzheimer’s is insidious and often it’s only in retrospect that families realize there has been a problem.

Doctors now sometimes diagnose and treat Alzheimer’s when memory loss is not dramatically different from normal so a good work up is important at the very beginning of recognition of a problem. Medications are useful for some people at slowing the progress of early to moderate stage Alzheimer’s Disease. Research is in process regarding medications for more advanced Alzheimer’s patients.

A standard test called the Folstein Mini Mental State exam was introduced in 1975. It’s crude but very commonly used and is generally effective in detecting problems with time/place orientation, recall, etc. It’s also helpful at providing a baseline measure. A person with normal functioning will score in the rough range of 27 - 30 out of a possible 30. Scores decrease with increasing dementia. Some of the questions are obvious - date, day of the week, and address. Others are less so - count backwards from 100 by 7s, or spell “world” backwards.

Alzheimer’s is very difficult to diagnose with certainty although it is felt that we’ll have a definitive test within a few years. At this point, a definitive determination requires evidence on biopsy of plaques and tangles which collect in brains, and that type of biopsy is far too invasive to perform on a living person. Instead, a work up by a physician often produces a diagnosis by exclusion following a complete physical including blood work, evaluation of mood, and sometimes a CT or MRI. Diagnosis involves ruling out treatable and even reversible causes for dementia such as vitamin deficiency, depression, medication interactions, or alcoholism.

In a healthy brain, sensory input is converted into memory in three basic stages. It is held very briefly in an immediate storage system called a sensory buffer. Moments later, as the perception is given conscious attention, it passes into another very temporary system called short term or working memory. Information can survive there for up to some minutes before dissolving away. Some of the information in working memory is then converted into long term memory.

Long term memories can be episodic or semantic. Episodic memories are personal memories of first hand events. Semantic memories are what we know, as opposed to what we remember doing. These two types of memories are interrelated but separate systems. An early stage Alzheimer’s patient who can’t remember where she put the keys (episodic memory) has not forgotten what keys are for (semantic memories).

We talk about loss of short term memory, i.e. memories of what happened very recently, and know that at the same time, people may recall events of thirty years ago. That seems utterly confusing but it is consistent with what we know about how memories work. Unless the person has the ability to create working memory, he will not be able to form new long term memories.

A number of symptoms are particularly typical of early to moderate stage Alzheimer’s patients. One frequently seen symptom is expressive aphasia. People with that problem, the inability to find the right words to express thoughts, may well have coherent ideas but can’t find the words to express those ideas. Another often seen symptom is paranoia; patients can’t find items and assume someone has taken them. The real problem may well be that the patient forgets when she’s put things or she’s thrown them away.

Other typical symptoms of Alzheimer’s include sun downing, often described as restlessness, confusion, and anxiety as daylight fades. The patient may become demanding, more easily upset, and more disoriented. This is not a willful change of behavior; the cause may possibly be fatigue or change in light level.

Catastrophic reactions are also often reported symptoms. These occur when too many or too confusing a set of stimuli cause increased confusion. These reactions consist of sudden changes in mood, crying, combativeness, anger, or suspiciousness. Additionally, we often see hallucinations - both auditory and visual. These may be symptomatic of a spreading disease.

Some of these reactions can be moderated with good medical care, good social supports, a safe environment, and perhaps with medications. Ask the person’s physician whether medications are indicated, either to slow the progression of the disease or to moderate the symptoms so that the patient is more easily managed.