The most common form of senile dementia is Alzheimer’s disease (AD), which accounts for as much as 60 to 70 percent of this problem among seniors. Approximately 4.5 million people in the United States live with AD, and since symptoms are typically noticed after age sixty, that number is expected to rise as more baby boomers move into their sixties and beyond. It is estimated, based on current projections, that by the year 2050 more than 13 million Americans will have this disease.
Alzheimer’s disease is a progressive neurodegenerative illness for which there is currently no cure. People live, on average, between eight and ten years after the diagnosis of AD is first made, although some may live with this disease for more than twenty years.
Because of its prevalence and the level of disability that it creates, AD has a tremendous impact on society. The total cost of caring for people afflicted with this disease is estimated to be as much as $100 billion per year in the United States. But more significantly than the national economic impact of Alzheimer’s are its devastating effects on its sufferers and their families. People with AD experiences sadness, frustration, and anger at their progressive loss of memory and inability to communicate and think clearly. They may also be fearful because of their uncertain future and the potential pain the disease will cause family and loved ones. It is important to note, however, that individual experiences with AD (and with other chronic dementias) vary considerably. Not everyone progresses relentlessly to a full-blown, incapacitating condition. Taking the process one step at a time, while planning for potential development, is wise and reasonable. Worrying incessantly about the future is not.
The impact on loved ones in no less significant. It is one thing to watch a grandparent, parent, spouse, or other loved one weaken and die because of heart disease, cancer, or any other disorder that leaves the basic identity intact. But with AD (and the other dementias as well), physical death is but the final loss after a seemingly endless series of losses, a literal death by inches over years or even decades. The person you know gradually seems to fade into someone else whose thoughts, behavior, and personality are usually anything but pleasant. Since more than half of people with AD receive in-home care (as opposed to residing in a nursing home), spouse, children, and friends of the Alzheimer’s victim experience not only the heartbreak of watching this relentless decline, but they may also become exhausted—physically, emotionally, and perhaps financially as well—as they deal with the realities of full-time care for this person.
Needless to say, caregivers need all of the help they can get and should feel comfortable asking for help as well. Conversely, the community, and especially the church, needs to step up and support those who bear the primary responsibility for the care of ailing seniors, with or without dementia. If you know someone who is in this situation, call and make a specific offer to help (for example, “what would be a good morning or afternoon for me to stay with your mom for a few hours?”). If you are facing this situation yourself, don’t try to do it alone. Admit when you need help and don’t be afraid to ask for it or accept it.
Symptoms and stages of Alzheimer’s disease
Alzheimer’s disease manifests itself in three stages. The progression of the disease is different in each person, and some stages may appear shorter or more prolonged in certain individuals.
A person in the early stage of AD will likely be able to carry out a range of normal activities but may need guidance with various tasks that require multiple steps, such as balancing a checkbook. She may have difficulty remembering people’s names, as well as recent events and conversations. Finding the right word when speaking becomes a challenge, and she might misplace items with increasing regularity. Mood swings, depression, and anxiety may develop.
In the intermediate stage, a person with Alzheimer’s is still able to carry out many daily activities but begins to have greater difficulty caring for herself. She may need assistance bathing, dressing, and using the toilet. She will need help cooking (for her own and everyone else’s safety) and may need to be reminded to eat. Sleep patterns can become reversed, so that she sleeps during the day and stays awake at night, often with a tendency to wander around rather than simply rest in bed. These nocturnal adventures can be doubly unsettling because confusion may increase after the sun goes down. The emotional weather may grow more turbulent, with anxiety, anger, and agitation dominating the landscape. When combined with impaired memory and confusion, these feelings can also generate suspicion or outright paranoia. As the condition worsens, she may no longer recognize family members.
In the late, severe stage of AD, she becomes dependent on others for assistance with the most basic functions of life: walking, standing, dressing, eating, and using the toilet. If she hasn’t done so already, she may begin to lose bowel and bladder control. Her verbalization will usually dwindle to a few words, and she may appear not to remember or recognize anyone. Eventually, she may lose her interest in food and finally the ability to swallow. Unfortunately, as the person reaches the very end stage of this disease, interventions such as feeding tubes will only prolong the dying process. Unless she dies from an acute illness (usually an infection such as pneumonia) or the consequences of some other disease, AD will eventually take her to a state of increasingly unresponsiveness, coma, and death.
As bleak as this picture might look, it is crucial to remember that the person with Alzheimer’s disease—or any other form of dementia, even in the most advanced stages—is still a human being who must not be devalued or disrespected. He or she needs love and gentle care, as do the caregivers, through the full course of the illness. We must resist any campaign that would push our culture toward allowing deliberate measures to terminate the life of those with dementia because they’d be “better off dead.”
Managing and treating Alzheimer’s disease
The brain of a person with AD, if examined under a microscope, would reveal tangled nerve fibers (called neurofibrillary tangles) and abnormal, sticky clumps of protein (known as amyloid plaques). While these hallmarks of the disease are well defined, the precise physiological steps that lead to AD are poorly understood, and thus there is currently no cure for the disease. However, there are some medical treatments that can slow its progression or at least decrease the severity of some of the symptoms. The currently approved classes of treatment include:
Cholinesterase inhibitors. Drugs in this class include donepezil (Aricept), rivastigmine (Exelon), tacrine (Cognex), and galantamine (Razadyne). Reduced levels of the neurotransmitter acetycholine are believed to be responsible for some of the symptoms of AD, such as declines in memory, attention, and reasoning. These drugs inhibit the activity of activity of acetylcholinesterase, the enzyme that breaks down acetycholine. While cholinesterase inhibitors can help Alzheimer’s patients maintain their current level of ability, these medications do not address the underlying cause of decline. As a result, the evidence indicates that they will not prevent the dementia from progressing, but they may temporarily slow that progression. This treatment can thus stabilize the individual for several months and potentially make a major difference in the lives of the patient and his family members for that time. Unfortunately, these drugs are very expensive. Also, patients taking cholinesterase inhibitors often experience an ongoing loss of appetite or overt nausea.
NMDA receptor antagonists. This class includes the drug memantine (Nemenda). The amino acid glutamate is a neurotransmitter (chemical messenger) in the brain that plays an important role in learning and memory through its effect on a nerve cell structure known as the N-methyl-D-aspartate (or NMDA) receptor, which alters the chemical environment within the cell.
Researchers believe that some of the symptoms of Alzheimer’s disease may be due to improper regulation of glutamate level, which, if too high, can lead to disruption and death of nerve cells. Memantine is believed to work by limiting access of glutamate to NMDA receptors, thus helping to protect these cells. While memantine has been approved by the FDA for use in treating moderate to severe Alzheimer’s disease, like the cholinesterase inhibitors, it has not been shown to alter any pf the underlying processed that cause dementia. It has the same advantages as cholinesterase inhibitors. When combined with one of them, the stabilizing effect may even be more significant, and the appetite and nausea problems may be diminished. However, it is also expensive, especially when taken with one of the cholinesterase inhibitors.
Risk factors for Alzheimer’s disease
The best way to deal with any disease is to avoid it, but with diseases like AD, whose causes are poorly understood, it can be difficult to make strong recommendations for prevention. Of the known risk factors for this disease, two are unalterable.
Age. The average age of onset for AD is in the mid to late sixties, and the risk for developing the disease increases as one ages. The incidence of AD—that is, the number of people who develop it in a given year—is about one percent at age sixty, but the number doubles every five years.
Genetics. Alzheimer’s disease can be classified as either familial or sporadic. The familial, or hereditary, form of the disease occurs in only a small percentage of cases but can result in the horrific scenario of a person developing the disease well in advance of the average age of onset. The sporadic form of Alzheimer’s does not show any evident inheritance pattern, but it does appear to be affected by a gene for apolipoprotein E (apoE). Apoliproteins are proteins that combine with lipids to form lipoproteins, large molecules such as low-density lipoprotein (LDL) and high-density lipoprotein (HDL), which help transport cholesterol through the bloodstream.
There are multiple forms of the gene that codes for the apoE protein, and one form, the APOE e4 gene, appears much more frequently in individuals with sporadic AD. The exact link between APOE e4 and the disease is uncertain at this time, although it is known that the apoE protein is involved in the repair of neuronal membranes.
The encouraging news about Alzheimer’s disease is that biology is not destiny. Even is a person has risk factors of age and genetics going against him, it is not certain that he will develop AD. Other factors that are within our control may make us less likely to experience Alzheimer’s, or may at least delay onset of the disease. These include:
Here is yet another reason to quit (or never start) smoking. The research is not definitive, but some studies indicate that smokers are more likely than nonsmokers to develop vascular dementia and AD. Do your brain a favor and don’t light up.
Some report claims that vitamin E may reduce the risk of developing Alzheimer’s disease. One study published in 2004 suggests that a daily combination of 500 mg of vitamin C and 400 IU of vitamin E may reduce the risk of developing AD. Curiously, other research indicates that vitamin E intake from food—but not vitamin supplements—offers a protective benefit against AD. In addition, studies suggest that people with elevated levels of homocysteine are at a greater risk for AD. Elevated homocysteine levels may be tied to low levels of folic acid and vitamin B12 and supplementing these nutrients may lower blood homocysteine.
Studies suggest that physical activity can enhance cognitive performance, stimulate formation of new connections between neurons (synapses), and promote resistance to neurodegenerative disease and injury within the brain. To keep your brain healthy, stay active.
A number of studies suggest that several of the factors that increase the risk of heart disease and stroke (such as elevated blood pressure and unfavorable cholesterol levels) may also increase the risk of developing AD.
It has been hypothesized that regular mental stimulation and activity (such as reading, solving puzzles, and doing math problem) help the brain form more synapses. And while damaged neurons in the brain do not appear to regenerate, there is evidence that learning and mental stimulation may cause neurons to be generated in certain parts of the brain. This may reduce the likelihood of developing dementia or cognitive decline, since the creation of new neurons and synapses could compensate for the loss of others due to injury or disease.
There are many things you can do to keep your mind alert. (These include activities that connect you with other people).
- Shut off the TV and start reading. Become a regular at the library or your favorite bookstore. For more stimulation, gather some friends together to create an informal book club where you can discuss interesting and worthwhile reading material.
- Become a lifelong learner. Take a class at your local community college on a subject that interests you, or perhaps go back and complete that degree you never quite finished.
- Keep a journal. Do more than just lit the day’s event; pour out your feelings in a diary. One day, your children will treasure being able to gain a deeper understanding of what made you tick.
- Write your memoirs. Your experience, insights, and descriptions of what past events and family traditions will be a treasure for future generations.
- Write letter. Keep your family and friends updated not only on what you are doing, but also what you’re thinking about. Write to your elected representative (city, state, or federal) about matters that concern you. (Believe it or not, your opinion does make a difference.)
- Become a computer literate. Many older adults see the world of computers and the internet as foreign or even hostile territory. Wrong! These are powerful tolls, and you’re never too old to learn how to use them for all sorts of worthwhile purposes.
- Do the daily crossword puzzle.
- Tutor a student
- Learn to play a musical instrument
- Learn a foreign langue
Get the idea? The list is nearly endless!