Often referred to as ‘the long goodbye,’ Alzheimer’s disease now affects 5 million Americans. It is a progressive, degenerative disorder that attacks the nerve cells of the brain, leading to loss of memory and other intellectual abilities. Even though dementia was recognized by the Greeks and Romans, German psychiatrist Alois Alzheimer was the first to diagnose a case, in 1901. Alzheimer followed his 50-year-old patient, Auguste D., until she died in 1906, when he reported his findings publicly. Although the disease mostly affects people over age 65, it is not considered to be a normal part of aging.
is it alzheimer’s?
alzheimer’s vs. dementia
Alzheimer’s disease is the most common of all the progressive dementias and, according to the Alzheimer’s Association, accounts for 60 to 80 percent of all dementia cases. While forgetfulness can be a normal part of aging, Dr. Michael Gerardo of Mercy Clinic Internal Medicine and Geriatrics says a disease is present only if the memory loss significantly disrupts daily life. Early symptoms include an inability to retain newly learned information and to remember dates and times. As the disease progresses, he says, a person will have increased difficulty carrying out tasks like managing finances and will experience deepening confusion about events, times and places. Eventually, as more of the brain becomes affected, bodily function shuts down. The brain, in effect, forgets how to speak, how to swallow and how to move.
Gerardo says in the other progressive, irreversible conditions like dementia with Lewy bodies (DLB), there are more likely to be marked behavior changes earlier on. Patients with DLB may experience sleep disturbances as well as delusions and visual hallucinations, while frontotemporal patients may experience changes in personality and have difficulty with language. Vascular dementia, the doctor says, is the kind that results from a ‘vascular insult’ (or stroke) to the brain, which leads to an abrupt change in cognitive or physical status—an inability to retrieve words, for example, or muscle weakness. Gerardo adds that a kind of dementia can be present with lead poisoning or hyperthyroidism, but that form goes away with treatment.
the biology
“Alzheimer’s is distinctive for what it physically does to the brain,” says Toni Dewhirst, resident care coordinator at Dolan Memory Care Homes. Hallmark abnormalities, she says, are certain ‘plaques’ and ‘tangles’ of protein that build up between and inside nerve cells. The damage initially appears to take place in the hippocampus, the part of the brain essential in forming memories, but as neurons die, more and more of the brain is affected. Though some build-up of plaques and tangles is normal as we age, the Alzheimer’s brain tends to be more extreme. By the time the disease is in its final stages, the brain has usually shrunk significantly.
Gerardo says that while there’s no cure for Alzheimer’s disease, there are medications that can slow its progression. Aricept is most commonly prescribed for mild to moderate cases, but it doesn’t work for everyone, he says. Namenda also can help delay late-stage behavior changes by binding to receptors in the brain. “We know that in a small subset, cognition may improve for a while, allowing a person to stay in their own home for longer,” Gerardo says. “But sadly, the outcome is always the same.”
men vs. women
why we get it?
Two out of three people with Alzheimer’s are women, and while the verdict is still out as to why, a simple reason might be age, says Dr. John Morris, director of the Knight Alzheimer’s Disease Research Center at Washington University School of Medicine. “Women live longer than men, and the greatest risk factor for Alzheimer’s is age,” he says, adding that 93 percent of those with a clinical diagnosis are over 70. “The older we are, the more likely we are to have it,” he says. Morris adds, however, that there may be a genetic component at play as well, with an interesting twist: “If your parents had the disease, you have increased risk, and that risk seems to be higher still if your mother had it,” he explains.
Dr. George Grossberg, Samuel W. Fordyce professor in the department of psychiatry and behavioral neuroscience at Saint Louis University School of Medicine, is skeptical of viewing women’s longevity as an explanation of the disease’s prevalence in the female population. “If you control for age and take 1,000 men age 85 and 1,000 women age 85, you’ll always see more cases in the female group,” he says. This leads him to conclude that estrogen might play a part. “We know the hormone is good for the brain and central nervous system, and we know it drops off after menopause,” he says. “This leads us to wonder if older women are losing its protective effects since animal studies have shown that estrogen also can improve connectedness between cells.”
estrogen’s role
One problem could be that, because of health concerns, doctors do not recommend estrogen supplements. “The risks of cancers, blood clots, heart attack and stroke associated with the hormone outweigh its protective value where Alzheimer’s is concerned,” Grossberg says. He adds that plant-derived phytoestrogens (found in soy, for example) may be the safer option for post- menopausal women, but says they shouldn’t be taken long term either, because they also have been shown to increase risk for gynecological malignancies.
Grossberg also offers another theory: Research seems to say that exercising our neurons may help keep dementia at bay. And if octogenarian women today had fewer educational opportunities in their youth than their male counterparts, might that bode well for future aging female populations now that opportunities are more equal?
Morris offers yet more hope: prevention trials begun three or four years ago are looking at whether certain medications might work prophylactically in folks who have the pathology, but no clinical deterioration as yet. “It’s too early to know for sure,” he says. “But the trials are going well in the sense that the medications are being well received by the people who are taking them.”
new philosophies
what is memory lane?
As rates of Alzheimer’s climb, so does the need for good ‘memory care.’ Retirement communities everywhere are creating programs to meet the needs of people for whom ‘living in the moment’ has a particular importance. Lesley Pedroli, director of sales and marketing at Stonecrest at Clayton View, stresses the value of “meeting a person where they are,” and reducing their anxiety as much as possible. This might mean eliminating ‘remember when … ‘ questions from conversation and relating to a person in different ways—for instance, through music, gardening or art. This, Pedroli says, is the philosophy of leading dementia expert Teepa Snow, who teaches the value of connection when primary verbal communication has been altered by dementia. “When there is memory impairment, the art of conversation has to change. One of our main goals is to help families learn new ways to communicate with a loved one whose interactive abilities are not what they once were,” Pedroli says.
it takes a village
“We are a culture that promotes family involvement,” she says, adding that Stonecrest works with families to learn as much as possible about a resident’s life story so that staff also can relate on a deeper level. Stonecrest has implemented a Music & Memory program to help residents reconnect with the world through music-triggered memories, and provides each memory-impaired resident with an iPod of personalized tunes. “No matter what the memory loss is, people still remember songs,” Pedroli says. “Music really can make a difference.”
So can other sensory elements. The Sheridan at Creve Coeur, opening in spring 2017, believes that aromatherapy is effective in treating a host of dementia-related issues. ‘Essence’ is a participant-specific program that uses essential oil massage to address things like anxiety, sleeplessness and the afternoon restlessness that often accompanies Alzheimer’s. “Our focus is on well-being,” says Hollie Kemp, corporate director of resident experience. “And on providing meaningful experiences for people with rich histories.” ‘Bookmarks’ is a Sheridan program that promotes reading by offering a book club and literature appreciation classes. Reading, Kemp explains, is an in-the-moment experience, which gives people purpose. In addition, she says our ability to read impacts our independence. “The longer we can keep our residents reading, the longer they feel their autonomy.” Similarly, the ‘Spark’ program is designed specifically to promote brain health and stimulation, offering classes in sleep, nutrition, stress management and physical education.
“Memory loss is a difficult journey,” Kemp says. “But it’s so important to focus on possibility—not just on what has been lost, but on what remains.”
10 early signs and symptoms from the Alzheimer’s Association
* Memory loss that disrupts daily life
* Challenges in planning or solving problems
* Difficulty completing familiar tasks at home or work
* Confusion with time or place
* Trouble understanding visual images and spatial relationship
* Problems with spoken or written words
* Misplacing things and losing the ability to retrace steps
* Decreased or poor judgment
* Withdrawal from work and social activities
* Changes in mood and personality