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The Cruelty of
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. Johnsons condition as Alzheimers disease. Alzheimers disease has been called "the death of the mind," because it slowly destroys a persons brain while robbing them of their memories. This especially cruel disease is the most common cause of dementia, in which a persons 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 Alzheimers disease. He has seen many anxious patients who believe their forgetfulness is an early sign of Alzheimers. "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 Alzheimers disease is by examining brain tissue after a person is deceased. In a living person, Alzheimers 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.
"Alzheimers 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 Alzheimers 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 Alzheimers that might be causing the confusion or forgetfulness.
In its early stages, Alzheimers disease can be difficult to distinguish from ordinary forgetfulness. According to the Alzheimers Association, common symptoms of the disease are:
Although there currently is no cure for Alzheimers 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 Alzheimers 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 Alzheimers function better, if only temporarily. The key is to begin using this medicine while the disease is in its early stages.
Alzheimers progresses differently in different people, Dr. Sandals says. "It can happen at age 40 or at age 80," he says. "Some people dont survive with it for more than two years, and others can live for almost 20 years after diagnosis."
The causes of Alzheimers disease are unknown, but there are several theories. The disease does run in families, so there is a genetic link. Some researchers believe Alzheimers 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 Alzheimers doubles in each decade after age 65.
Alzheimers 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, Shes not my mother any more. The whole person is not there."
"Once Alzheimers has progressed, its 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."