Let’s not forget Alzheimer’s and the strategies for care

Millions of Filipinos are experiencing mental changes as they age and are struggling with the question, “Am I getting Alzheimer’s?” After all, Alzheimer’s disease is the most common cause of dementia, which is defined as a loss of intellectual and social abilities severe enough to interfere with daily functioning. Dementia affects about 10 percent of people over age 70 and Alzheimer’s accounts for 60 to 80 percent of all cases of dementia.

The disease is named after Dr. Alois Alzheimer, the German neurologist who first described it in 1906. It is a progressive, degenerative brain disease, whose causes, up to now, still aren’t well understood. It may start with a slight memory loss and confusion, but it eventually leads to irreversible mental impairment, personality changes, and abnormal behavior. As the mind gradually deteriorates, the body loses its ability to function.

People who develop Alzheimer’s experience the disease in very different ways. This includes the rate at which the disease progresses and the type and severity of the symptoms. Nevertheless, certain patterns are common in almost everyone with Alzheimer’s and most of these patients experience common signs and symptoms, such as:

• Increasing and persistent forgetfulness. At its onset, Alzheimer’s disease is marked by periods of forgetfulness, especially of recent events or simple directions. People with Alzheimer’s may repeat things and forget conversations or appointments. They routinely misplace things, often putting them in illogical locations. They frequently forget the names of family members and everyday objects.

• Difficulty with abstract thinking. People with Alzheimer’s may initially have trouble balancing their checkbook, a problem that progresses to trouble recognizing and dealing with numbers.

• Difficulty finding the right word. It may be a challenge for those with Alzheimer’s to find the right words to express thoughts or even follow conversations. Eventually, reading and writing are also affected.

• Disorientation. People with Alzheimer’s often lose their sense of time and dates, and may find themselves lost in familiar surroundings.

• Loss of judgment. Solving everyday problems becomes increasingly difficult and eventually impossible. Alzheimer’s is characterized by greater difficulty with things that require planning, decision-making, and judgment.

• Difficulty performing familiar tasks. Once-routine tasks that require sequential steps, such as cooking, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer’s may forget how to do even the most basic things.

• Personality changes. People with Alzheimer’s may exhibit mood swings. Early on, this may be a response to the frustration they feel as they notice uncontrollable changes in their memory. As the disease progresses, people with Alzheimer’s may become anxious or aggressive and behave inappropriately.

Diagnosis

It is estimated that more than 50 percent of people who have dementia never receive a diagnosis. They may think that they’re just “getting old,” or they may be afraid of the possibility it might be something more serious and hesitate to see the doctor. There’s no one test that can diagnose Alzheimer’s disease. For now, doctors use a process of elimination to rule out other conditions and rely on screening tools to identify key characteristics of Alzheimer’s. Using these different methods, doctors are actually able to make an accurate diagnosis of Alzheimer’s about 90 percent of the time.

An early diagnosis is important for a variety of reasons. It can give you the opportunity to be involved in making important legal, financial, social, and medical decisions that affect you and your family members. Additionally, it can give you time to prepare mentally and emotionally for the changes ahead and allow your family to plan living arrangements and care. Although being diagnosed with Alzheimer’s is a frightening experience, it also gives you the chance to seek out appropriate treatment options that can help alleviate your signs and symptoms.

Treatment

Currently, there’s no known cure that can halt or prevent Alzheimer’s. Treatment strategies focus on managing the symptoms of the disease through a combination of drug therapies and behavioral strategies.

• Medications. Cholinesterase inhibitors are a group of drugs that improve the levels of neurotransmitters in the brain and help stabilize cognitive functions. They include donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl). Cholinesterase inhibitors are generally used only in the mild to moderate stages of Alzheimer’s, as they seem to lose much of their effectiveness after this point. However, in 2006, donepezil was approved for use at the severe stages of the disease after its effectiveness in improving cognitive functions was established. Mayo Clinic researchers have also found that donepezil may slow the rate of brain shrinkage in people with mild cognitive impairment and a genetic predisposition for Alzheimer’s.

About half of the people taking cholinesterase inhibitors show some improvement in their signs and symptoms. Gastrointestinal problems — such as diarrhea and stomach pain — are common side effects of these medications, but they usually lessen with time. Another drug, memantine (Abixa), is a newer class of medication intended for use at the moderate and severe stages of Alzheimer’s. Memantine seems to slow the loss of daily living skills, such as dressing, eating, and going to the bathroom. It is sometimes used in combination with a cholinesterase inhibitor. Memantine’s most common side effect is dizziness.

• Behavioral strategies. Extreme changes in mood and behavior become common as Alzheimer’s progresses and can include aggression, agitation, delusions, paranoia, and sleep disturbances. These behaviors may be the only way individuals can express themselves as their communication skills decline. Managing these challenging behaviors requires patience and understanding on the part of caregivers.

Drugs such as antidepressants, antipsychotics, and mood stabilizers may help treat the behavioral symptoms of Alzheimer’s. However, these drugs can intensify cognitive losses, and their side effects can be severe in older adults. In general, they’re used when the patient, family, and doctor feel the benefits of their use outweigh risks.

Caring Strategies

While medications can help, caregiving is at the heart of Alzheimer’s treatment. The key to caregiving is focusing on the things your loved one can still do and enjoy at each stage. As behavior changes occur, be patient and reassuring. Keep in mind that the person is expressing real emotions. Help engage your loved one by listening, making eye contact, and using familiar words and clear statements. Try these strategies:

• Stick to a daily routine. A familiar schedule can make things easier for both of you.

• Break task down into small, orderly steps. Don’t rush through things — it will just add to your loved one’s confusion and slow things down.

• Limit choices and participate together. Involve loved one in tasks as much as possible. Getting dressed may seem overwhelming when faced with a closet full of clothes. Instead, offer two outfits and let the individual decide.

• Be respectful and reassuring. Preserve your loved one’s dignity while assisting with personal tasks, and respond to his/her emotions with understanding and empathy, not reason.

• Avoid large, noisy settings. These can be overwhelming and disorienting.

• Control visitor encounter. Consider limiting the number of visitors at one time.

Caring for a person with Alzheimer’s is physically and emotionally demanding. Feelings of anger, guilt, frustration, discouragement, worry, grief, and social isolation are common. If you’re a caregiver for someone with Alzheimer’s disease, you can help yourself by asking friends and family members for help and by joining a support group. Learn as much as you can about the disease, and talk with the doctor and other health care professionals involved in the care of your loved one.

Hope On The Horizon

Just because there’s no cure for Alzheimer’s right now doesn’t mean that you shouldn’t seek treatment for the disease. There are still many things you can do to ease symptoms and improve the quality of life for everyone involved. Most researchers expect to see major progress in the treatment and prevention of Alzheimer’s in the next few decades, providing hope for millions of people and their loved ones.–Tyrone M. Reyes, M.D., Philippine Star