Coping With Alzheimer’s Disease

Lost connections

ILLUSTRATION BY BRITTANY INGLESE

In an interview that aired last spring on National Public Radio with Fresh Air’s Terry Gross, horror meister Stephen King revealed his deepest, darkest fear. As he’s grown older, he said, he finds that vampires and zombies no longer worry him much. Alzheimer’s disease does. “That’s the boogeyman in the closet now,” he said. “I’m afraid of losing my mind.”

It’s too bad that Alzheimer’s disease isn’t another nightmare-inducing idea that King dreamed up. Instead, it is a reality for an estimated 5.2 million Americans, according to the Alzheimer’s Association. One of us develops the disease every 68 seconds. And as the graying of the US population continues to increase, so will the prevalence of Alzheimer’s. By 2025, the number of people age 65 and older with Alzheimer’s disease is expected to reach 7.1 million.

Alzheimer’s is a progressive, terminal disease that destroys brain cells. It typically first reveals itself through short-term memory loss, but damage to other aspects of cognition becomes evident over time, such as when victims of Alzheimer’s lose their ability to drive and not get lost, to think through a recipe or to organize finances, says Patricia Locuratolo, MD, FAAN, a neurologist in private practice and at Portsmouth Regional Hospital. Alzheimer’s can harm our ability to think, speak and move.

In recent years, scientists have gained a better understanding of some of the processes that can influence the development of Alzheimer’s disease. It is known, for example, that the brains of Alzheimer’s patients have more “cellular garbage” called plaques and tangles — than the amount typically present in most aging brains, Locuratolo says.

But while tools such as neuropsychological testing and brain scans can help doctors confirm the likely presence or future development of Alzheimer’s disease, definitive diagnosis is possible only through an autopsy.

And a cure for Alzheimer’s disease remains elusive. Medication can lessen or delay symptoms by improving patients’ concentration and focus, and can make life easier for family members by making patients more manageable. But in general, medication only slows down the progress of the disease for a few months to a year or so, Locuratolo says.

Even though an ideal remedy for Alzheimer’s has yet to be discovered, it is important to recognize and establish that something is wrong early in the progression of Alzheimer’s, says Juergen H. Bludau, MD, an internist and fellowship-trained geriatrician who is executive medical director of geriatrics and director of Home Health for the Elliot Hospital, and author of the book “Aging, But Never Old.”

Alzheimer’s disease typically begins with subtle hints that something is wrong  —  so subtle that it’s easy to mistake the signs for forgetfulness or distraction. “Early in memory loss, people [who have Alzheimer’s] feel that something is wrong,” Bludau says. “They don’t know what it is. ‘I’m falling apart,’ they’ll say. ‘I’m worried.’ Sometimes family members brush it aside and say, ‘Why don’t you relax? Don’t worry.’”

Early detection and reaction to the disease enables families to provide support sooner in the disease process and to establish a will and a living will while their loved one can still be involved in planning and decision making. “There are many, many reasons” to recognize and begin dealing with the illness early, Bludau says.

Maintain your brain

Knowing that you have a familial link with Alzheimer’s disease can be unsettling, to say the least, but a genetic tie to the disease does not necessarily bind you to a future of dementia. “In some cases, [genes] play a very strong role,” Locuratolo says. But “by and large, it’s a sporadic disease,” and in reality, since Alzheimer’s is a common disorder, “everybody is at risk,” she says.

If you want to reduce your chance of developing Alzheimer’s disease, keep your brain healthy by making lifestyle choices that minimize your odds of developing vascular disease, particularly by engaging in exercise. “Exercise seems to be a brain medication,” Locuratolo says. “There’s something about the milieu of exercise that protects the brain and keeps it healthier.” Not a gym rat? That’s OK; an extreme level of commitment to intense workouts is not required, but the recommended beneficial amount is “exercising 20 minutes a day, three times a week to sweating,” Locuratolo says, “so it has to be pretty vigorous. I tell people to walk, but every third driveway, power walk.”

In addition, keep the cognitive juices flowing. Working your brain doesn’t have to come via “Sudoku or fancy programs you can buy online to exercise your mind, but it does have to be something that you actively engage in, when you can really feel yourself thinking and learning something,” Locuratolo says. Having social connections offers crucial benefits, as well. “We’re social beings,” Locuratolo says. “But I ask people to do what they like to do.” In other words, you don’t have to be joiner, she says, but everyone should find a form of exercise and mental stimulation that they enjoy and will be able to stick with.  

Helping a loved one who has memory loss

To support someone who is suffering from significant memory loss, do the following, says Juergen Bludau, MD, an internist and fellowship-trained geriatrician who is executive medical director of geriatrics and director of Home Health for the Elliot Hospital:

• Provide a predictable daily routine.
• Keep choices limited and simple.
• Establish what Bludau calls a “brain cane” by putting a large planner in the kitchen or other visible spot, and together every morning review the day’s schedule.
• Don’t put the person in a difficult situation. If you know that your mother is likely to struggle if she goes through the grocery store checkout without help, for example, don’t send her alone.
• Don’t say things like, “Don’t you remember?” Remember that the inability to remember is not a case of laziness or a lack of trying. People with memory loss “can’t help it,” Bludau says.
•  Remember that even people in the more advanced stages of memory loss and dementia still have feelings. Don’t treat them in a degrading manner.
• Recognize when you are no longer able to provide needed care.