Alzheimer's Disease

I had a very difficult task to perform last week. My older brother and I flew up to Wyoming to help my sister put my 75 year old father, who has been suffering for years from cerebrovascular disease, into a nursing home.

He has reached the point where he is almost continually confused and disoriented. The arthritis in his gnarled, workingman’s hands is so severe that he can no longer hold eating utensils, button his shirts, or zip his pants.

As we made the eight-hour trip up the road to the nursing home, he would perseverate, saying, “Four, four, four,” over and over, with no relevant context or meaning. At other times, he would interrupt our conversation with a question or comment totally unrelated to our ongoing conversation. At times, it was a genuine test of our ability to concentrate on two different subjects simultaneously.

Even with all my training, my learned ability to emotionally distance myself from my patients, in much the same way that a physician learns to observe and treat a disease separately from the person who has it, I had several tough moments. Probably the toughest came when we first arrived at the nursing home, because I could no longer pretend that we were all just going back to my hometown to visit. I could no longer deny the true purpose of our long trek north.

My experience is becoming an increasingly common one as the parents of the “baby-boomers” grow older and as the average life span increases. There are many diseases associated with increasing age. Arteriosclerosis is the build-up of deposits along blood vessel walls, restricting blood supply to the brain. In fact, cerebrovascular diseases, which include arteriosclerosis, is the third most common cause of death in the United States, according to one source I read recently.

Alzheimer’s Disease is another major cause of organic mental changes in the elderly. It is said to be the fourth leading cause of death, with over three million diagnosed cases in the United States.

Alzheimer’s Disease does not discriminate on the basis of sex, being found with equal frequency in both men and women. It may begin at any age after the early 30’s.

Alzheimer’s Disease begins with a gradual loss of memory and disturbances in speech and spatial orientation. A victim may become “turned around” and confused regarding directions home, etc. Mild forgetfulness such as misplacing one’s keys and forgetting appointments are common early signs of the memory loss.

Gradually, indications of the disease increase. The patient becomes disoriented for time and place. He/she may think the time is several years earlier and may even be confused as to what state he/she is in.

Finally, there is a total disintegration of all personality and intellectual functions. Towards the end, the patient becomes bedridden and incontinent (unable to control bladder functions). Death usually occurs five to six years after the onset of the disease, most commonly from pneumonia or infection of the urinary tract.

The emotional changes accompanying diseases of the elderly are tremendous. Good-natured individuals become paranoid and even violent towards family members. Throughout the progression of the disease, the patient will have strong denial of any problems, usually blaming any difficulties on relatives or events beyond his/her control.

I have just finished reading a book called Another Name for Madness by Marion Roach. This book describes the author’s account of her mother’s encounter with Alzheimer’s Disease and the reactions of the two adult daughters. It is written in novel format and a very easy, interesting read.

Another book well known to those involved with Alzheimer’s Disease is The 36-Hour Day. This book offers many good suggestions for caretakers of Alzheimer’s patients. The title refers to the exhaustion these caretakers experience.

The decision of how best to care for an aging relative involves a combination of emotional, judgmental, and logical factors. Since relatives tend to rely too heavily upon their emotions in making the decisions of how to care for their ill one, I emphasize heavy reliance upon a competent physician in choosing when and how the family should proceed in such cases.