Remembering Alzheimer's

by John M. Grohol, Psy.D.

Alzheimer's disease is a brain disorder that results in the gradual deterioration of a person's memory. It also affects an individual's ability to learn new things, to imagine, and to reason.

This disorder, the cause of which is unknown, affects five to six percent of older Americans. A very small minority of people with Alzheimer's are under 50 years of age, but most are over 65. Fortunately, Alzheimer's disease is the exception, rather than the rule, in old age.

Although Alzheimer's is not curable or reversible, there are ways to reduce symptoms and suffering and to assist families, particularly those who are caring for family members at home during the early stages of disease. Indeed, family education and family support services are important aspects of medical management. When, or whether, to transfer an individual to a nursing home is a decision to be carefully considered by the family.

Symptoms and Course

The onset of Alzheimer's disease is usually quite gradual. Problems with memory, particularly recent or short-term memory, are common early in the course of the disease. For example, the individual may, on repeated occasions, forget to turn off the iron or may not recall which of the morning's medicines were taken. Mild personality changes, such as reduced spontaneity or a sense of apathy and a tendency to withdraw from social interactions, may occur early in the illness.

As the disease progresses, problems in abstract thinking or in intellectual functioning develop. The individual may begin to have trouble with figures when working on bills, with understanding what is being read, or with organizing the day's work. Further disturbances in behavior and appearance may also be seen at this point, including agitation, irritability, quarrelsomeness, and diminishing ability to dress appropriately.

Later in the course of the disorder, affected individuals may become confused or disoriented about what month or year it is and be unable to describe accurately where they live or to name correctly a place being visited. Eventually they may wander, be unable to engage in conversation, seem inattentive and erratic in mood, appear uncooperative, lose bladder and bowel control, and, in extreme cases, become totally incapable of caring for themselves. Death follows, perhaps from pneumonia or some other problem that occurs in severely deteriorated states of health.

The average course of the disease is about six to eight years, but it may range from under two to over 20 years. Those who develop the disorder later in life may die from other illnesses (such as heart disease) before Alzheimer's reaches its final and most serious stage. Throughout much of the course of the illness, individuals maintain the capacity for giving and receiving love, for sharing warm interpersonal relationships, and for participating in a variety of meaningful activities with family and friends. Working with a family member who has Alzheimer's is often frustrating and challenging, especially as the disease progresses to its later stages.

Assessment Is Critical

Not all memory changes or complaints in later life signal Alzheimer's disease or mental disorder. Many memory changes are only temporary, such as those that occur with bereavement or any stressful situation that makes it difficult to concentrate. In fact, older people are often accused or accuse themselves of memory changes that are not really taking place.

On the other hand, serious memory difficulties should not be dismissed as an unavoidable part of normal aging. Since rigorous studies on intelligence in later life show that healthy people who stay intellectually active maintain a sharp mind throughout the life cycle, noticeable decline in older adults that interferes with functioning should be explored for an underlying problem.

Because of the many other disorders that can be confused with Alzheimer's disease, a comprehensive clinical evaluation is essential to arrive at a correct diagnosis of symptoms that look like those of Alzheimer's. Such an assessment should include at least three major components:

  • a thorough general medical workup;
  • a neurological examination; and
  • a psychiatric evaluation that may include psychological or neuropsychological testing.

Support and Treatment

Individual, environmental, and family stresses can converge to exaggerate individual disability and family burden during the course of Alzheimer's disease. Identifying these stresses and making appropriate changes can provide the foundation for more effective treatment and fewer everyday problems.

Individual Issues

In the person with Alzheimer's, depression or delusions can further reduce functioning. These problems, which compound memory impairment, are treatable. by alleviating these other conditions, actual clinical improvement can result, even though the underlying disease process is still advancing. In other words, at a given point in time, the individual's symptoms can be reduced, suffering lowered, and capacity to cope improved, with family burden eased as a result.

Modifying the individual's immediate environment by , for example, providing different objects or cues to combat memory loses, can reduce frustration and disorganization. Finding the most protective but least restrictive setting for care is also important. This may, at some point, involve a move away from home to a nursing home or other care facility well equipped to deal with those who have Alzheimer's disease.

Other treatment interventions can involve support from the family, the help of a homemaker or other aide in the home, employment of behavioral therapies, and the use of medication.

Family Issues

Stress on the family can take a toll on the individual with Alzheimer's and caregivers alike. Caregivers are usually family members either spouses or children and are mainly wives and daughters. As time passes and the burden mounts, it not only places the mental health of family caregivers at risk, it also diminishes their ability to provide care to the individual with Alzheimer's. Clearly, assistance to the family as a whole is needed.

As the disease progresses, families experience increasing anxiety and pain at seeing unsettling changes in a loved one, and they commonly feel guilt over not being able to do enough. Caregivers are chronically stressed and are much more likely to suffer from depression than the average person. The likelihood, intensity, and duration of depression among caregivers may be lowered through additional family support, joining an Alzheimer's support group, or even supportive psychotherapy.

November is National Alzheimer's Disease Month

The source for interventions can range from family support groups such as those available through the Alzheimer's Association (AA), (sponsor of National Alzheimer's Disease Month), to professional consultations for the individual and family with a mental health specialist, to a variety of community programs such as day or respite care. Information on what assistance is available in a given community may be obtained by contacting the local Office on Aging, a Community Mental Health Center or local Medical Society, or a local chapter of the AA. In addition, every state has an Agency on Aging that provides information on services and programs.

Although Alzheimer's disease cannot, at present, be cured, reversed, or stopped in its progression, much can be done to help both the individual and the family live through the course of the illness with greater dignity and less discomfort. Toward this goal, education, appropriate clinical interventions, and community services should be vigorously sought.

This article is adapted from the U.S. National Institutes of Health Publication No. 94-3676, which was originally printed in 1990 and revised in 1992 and 1994.

Date published: 10/27/00
Last updated: 30 Apr 2016
Last reviewed: By John M. Grohol, Psy.D. on 30 Apr 2016
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