Alzheimer’s Disease

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Many of us were fascinated by the movie “The curious case of Benjamin Button” and were left feeling somewhat sentimental afterwards. Interestingly, the path of Benjamin Button was one that does rather resemble that of a person suffering from Alzheimer’s Disease (AD). However, AD does not leave one feeling somewhat sentimental and touched. It is a draining, stressful illness – for those suffering from it, as well as their caretakers. There is often quite some confusion about what defines normal aging, dementia, and AD.

What is cognitively normal aging? Normal aging refers to the ability of people to perform activities relative to their life experience. Normal aging is not necessarily related to cognitive or intellectual decline. Just like other cells in the body age, so do nerve cells. So, our nerve cells in the brain shrink but we do not necessarily loose any nerve cells. If changes are noticeable, they might include minor memory problems, e.g. forgetfulness. They are however, unlike dementia, not debilitating, in that they do not interfere with behaviour and functioning. One of the changes that might be noticeable is that the speed of cognitive processing might decrease. Thus, possible, we do not think and reason as fast as we used to, when we age.

What is dementia? Dementia is a syndrome of multiple cognitive deficits. It can have various origins. Alzheimer’s Disease is one of the dementias.

What is Alzheimer’s Disease? Alzheimer’s Disease (AD) is the commonest type of dementia in older people. It is a neurodegenerative disorder, meaning that the nerve cells are damaged or die. AD specifically destroys nerve cells in the areas of the brain that are responsible for learning, memory, behaviour, emotion, and reasoning. This decline happens over a number of years. Impairment will be noticeable in memory function, for example:

– not being able to learn new information or to recall previously learned information

– one or more of these processes

– problems concentrating

– language difficulty, e.g. not being able to find words

– impaired ability to carry out motor activities (e.g. movements)

– failure to recognize or identify objects

– inability to plan, organize etc.

AD sufferers also sometimes have a behaviour disturbance. This means that you will see the person pacing, walking – visibly agitated.

How exactly does this happen? What seems like the most likely theory at the moment is that firstly, the process surrounding a protein called “amyloid precursor protein” is changed and it produces a by-product that is rather sticky and thus clumps together easily. It ends up forming plaques around areas of nerves and this leads either to the change in functioning of these neural pathways or their death. The second contributor to this illness is a protein called the “tau protein” which is used in maintaining the tube-like structure of neural pathways. These “tau proteins” are suddenly released from the nerve’s structure and the nerve pathways collapse into “neurofibrillary tangles”. Hence, when our neural pathways come crashing together in a heap or get encapsulated by a binding substance, we see the symptoms of Alzheimer’s disease.

Why is correct diagnosis important? The sad truth is that there is no cure for dementia. However, if we understand what someone is suffering from, it makes it easier for us to support that person. We will make informed choices. Uniformed assistance (even when it is well-meant) can sometimes have the opposite effect and stress the AD sufferer even more. Also, other illnesses have to be ruled out. It could be that the symptoms might be quite similar to those of Alzheimer yet have a different origin and thus warrant different treatment, for example delirium, stroke, or other infections. Furthermore, the AD sufferer might suffer from more illnesses than just this one and they may be the kind that are treatable, e.g. depression or anxiety.

Why is early diagnosis important? Caring for an AD sufferer is a 24/7 job and not many caretakers can afford to leave their job to take care of their loved one. Placement in old age homes is sought after and a waiting list is not always what we want to be on when we are so desperate. Thus we would like an early enough diagnosis to adequately plan for and assist our loved one. Secondly, we need to make sure that his truly is AD and not any one of many illnesses that have similar symptoms yet warrant very different treatment.

How do we recognise the onset of Alzheimer’s Disease? Early signs would be problems with memory and attention. Tasks like handling finances, driving and shopping become increasingly difficult. The creating of new memories becomes difficult, although old memories still remain intact.

What are our priorities in treating Alzheimer’s Disease? We would like to improve the quality of life for someone suffering from AD. We cannot cure it but we can try to empathically put ourselves in their shoes and truly understand their experience. The AD sufferer does not experience or understand the world around him or her in the way we do. They are unaware of their cognitive impairment just like a child cannot understand that it will mature into greater cognitive ability. When we understand this, we can start addressing their needs. In addition to the cognitive decline, other mental illness might become a burden to the AD sufferer, for example depression and anxiety, restlessness and insomnia. These are treatable and the AD sufferer’s burden can thus to some extent be alleviated.

 

Who does what? Psychologists and occupational therapists work with AD sufferers in improving their quality of life, e.g. regulating their behaviour, stimulating their senses. Psychologists also work with the caretakers of AD sufferer’s on a psycho-educational level as well as a therapeutic level. Psychiatrists are specialists who will be able to make the diagnosis. Furthermore, the psychiatrist will also support with medication. Symptoms of AD, like agitation, sleep disturbance, depression and anxiety can be controlled with medication. However, treating the elderly with medication is more complicated than treating the average adult. Thus, treatment should fall to someone knowledgeable or the specialist, namely the psychiatrist.

The caretaker’s world: One of the earliest decisions that have to be made is an assessment of the AD sufferer’s competence. The psychiatrist would be able to assist with this assessment. It is a difficult endeavour since the AD sufferer is mostly still aware that he or she is being denied things e.g. use oh his or her own automobile. Where before this was most often our very competent and autonomous parent, the nature of this disease all of a sudden threatens so many of the abilities needed to remain autonomous. It becomes a thin rope in determining our loved ones safety vs. respecting them for who they have always been – our own caretakers and role models.

Finally, and importantly, everyone needs support; and caring for an AD sufferer is a major burden and stressful experience. A burnt-out, depressed caregiver cannot adequately help. Allow yourself to be supported.

The Alzheimer Support Group meets every first Tuesday of the month at 18:00 at the Oude Rust Oord (Old Age Home). Please feel welcome to join us, if your loved one is an AD sufferer. It helps to share the AD antics and reflect on them together.

By Maika Eysselein

Intern Clinical Psychologist

References

Aderinwale, O. G., Ernst, H. W., & Mousa, S. A. (2010). Current Therapies and New Strategies for the Management of Alzheimer’s Disease. American Journal of Alzheimer’s Disease and Other Dementias, 25(5), 414-424.

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. Text Revision. Washington, DC: American Psychiatric Association.

Barbas, N. R., & Wilde, E. A. (2001). Competency Issues in Dementia: Medical Decision Making, Driving, and Independent Living. Journal of Geriatric Psychiatry and Neurology, 14, 199-212.

Brooks, J. O., & Hoblyn, J. C. (2007). Neurocognitive Costs and Benefits of Psychotropic Medications in Older Adults. Journal of Geriatric Psychiatry and Neurology, 20(4), 199–214.

Epstein-Lubow, G., Duncan Davis, J., Miller, I. W., & Tremont, G. (2008). Persisting Burden Predicts Depressive Symptoms in Dementia Caregivers. Journal of Geriatric Psychiatry and Neurology, 21(3), 198-203.

Rusted, J., Sheppard, L., & Waller, D. (2006). A Multi-centre Randomized Control Group Trial on the Use of Art Therapy for Older People with Dementia. Group Analysis, 39(4):517–536.

Sadock, B. J, & Sadock, V. A. (2003). Kaplan and Sadock’s Synopsis of Psychiatry. Ninth Edition. Philadelphia: Lippincott Williams & Wilkins.

Terry, R. D. (2006). Alzheimer’s Disease and the Aging Brain. Journal of Geriatric Psychiatry and Neurology, 19(3), 125-128.