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Lisa Catanese:
Writing Sample

The Cruelty of Alzheimer's Disease
By Lisa Catanese

For the past seven years, Mildred Johnson has watched in sorrow as her husband retreats into a world of forgetfulness and confusion. "When he retired five years ago, I think he knew then that something was wrong. He had been forgetting things like meetings and the names of people he met," she says of her husband, Maxwell Johnson, a former elementary school principal. "About three years ago I noticed he was becoming more forgetful, but I thought it was just because he was getting older."

It wasn’t until a trip to Europe last year that Mrs. Johnson realized something was very wrong. Her husband was agitated and confused, unable to remember where they had visited and what they had seen. "That trip was hard," she recalls sadly. "We had so looked forward to it, and things just sort of fell apart while we were there."

The Johnsons saw Ramon Nieto, MD, a Manchester internist and specialist in geriatric medicine, who diagnosed Mr. Johnson’s condition as Alzheimer’s disease. Alzheimer’s disease has been called "the death of the mind," because it slowly destroys a person’s brain while robbing them of their memories. This especially cruel disease is the most common cause of dementia, in which a person’s mental functions gradually decline, interfering with normal daily activities.

Dr. Nieto says the issue is to try to differentiate between a mild decline in mental agility and true Alzheimer’s disease. He has seen many anxious patients who believe their forgetfulness is an early sign of Alzheimer’s. "Sometimes a wife will be worried because she sent her husband to the store to buy milk and cheese, and he comes home with eggs and bread," he says. "Or he can remember everything about his friend except his name."

The only definite way to diagnose Alzheimer’s disease is by examining brain tissue after a person is deceased. In a living person, Alzheimer’s is diagnosed by ruling out other causes and through cognitive function tests that a physician can do in the office. An example of one such test is asking a person to draw a clock, spell words or answer simple questions such as the date or the name of the president.

"Alzheimer’s is a diagnosis of exclusion," says Tolland family physician Harold Sandals, MD, who is also a specialist in geriatric medicine and is the medical director of the Woodlake at Tolland nursing home. "Conditions that can mimic Alzheimer’s include mini-strokes, a vitamin deficiency, an underactive thyroid, a head injury, an adverse drug reaction, and other brain disorders." Blood tests, CT scans and MRI scans can help point to a condition other than Alzheimer’s that might be causing the confusion or forgetfulness.

In its early stages, Alzheimer’s disease can be difficult to distinguish from ordinary forgetfulness. According to the Alzheimer’s Association, common symptoms of the disease are:

  • Memory loss that affects your daily living. Alzheimer’s sufferers will repeatedly ask the same question.
  • Difficulty performing familiar tasks. Occasionally, everyone gets distracted and forgets. But people with Alzheimer’s may forget simple tasks such as how to tie their shoes, or even what shoes are for.
  • Misplacing things. Anyone can misplace their car keys or glasses. But a person with Alzheimer’s disease may not be able to find their belongings because they’ve put them in inappropriate places, such as their car keys in the freezer or their glasses in the washing machine.
  • Personality and behavioral changes. People with Alzheimer’s can have rapid mood swings for no apparent reason.
  • Loss of initiative. Alzheimer’s sufferers may no longer want to get involved in social or family activities that they once enjoyed.
  • Poor judgment. Someone with Alzheimer’s disease may forget to answer a ringing phone or turn off the faucet or stove. They may dress inappropriately, wearing several shirts at a time or forgetting to wear a coat outdoors.
  • Disorientation to time and place. People with Alzheimer’s may not know what year it is, where they live, or how to get to the grocery store. This disorientation is more than just momentary.
  • Problems with language. People with Alzheimer’s disease may have trouble finding the right words or may use inaccurate words. They may be unable to begin a conversation or may misinterpret what others say.
  • Problems with abstract thinking. A person with Alzheimer’s disease may forget how to write a check or how to play cards.

Although there currently is no cure for Alzheimer’s disease, early detection still is important. There is much that can be done to manage the disease and treat its symptoms to provide a better quality of life for those afflicted and their caregivers. For example, psychiatric medicines can help relieve paranoia, depression, agitation, sleeplessness, anxiety and similar symptoms. Physical exercise, social activity and good nutrition are important in maintaining overall good health. Modifying the living environment can help the affected person maintain comfort and dignity.

The FDA has approved medicines that treat the disabling symptoms of Alzheimer’s by raising the amounts of certain brain chemicals that are abnormally low due to the disease. Research has shown that some people with mild to moderate Alzheimer’s function better, if only temporarily. The key is to begin using this medicine while the disease is in its early stages.

Alzheimer’s progresses differently in different people, Dr. Sandals says. "It can happen at age 40 or at age 80," he says. "Some people don’t survive with it for more than two years, and others can live for almost 20 years after diagnosis."

The causes of Alzheimer’s disease are unknown, but there are several theories. The disease does run in families, so there is a genetic link. Some researchers believe Alzheimer’s is a cluster of diseases that, like diabetes and heart disease, may have more than one cause. The disease is not considered a part of normal aging. However, the possibility of developing Alzheimer’s doubles in each decade after age 65.

Alzheimer’s is especially hard on caregivers, the physicians say. "I tell relatives not to feel guilty taking a couple of days off," Dr. Nieto says. "They need a reprieve from constant caregiving. One person once told me, ‘She’s not my mother any more. The whole person is not there.’"

"Once Alzheimer’s has progressed, it’s so difficult for caregivers to keep a loved one at home," Dr. Sandals says. "Once they lose all complex thinking, they need help with bathing, dressing, eating, continence. The loss of humanity is the devastating thing. The disease steals everything — your memories, your cognitive abilities. You lose who you are."

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