Coping with the long, slow change of Alzheimer's
It may begin with an innocuous pattern of events. Your mother might keep forgetting her doctor's appointments. Or, your father has seemed agitated and upset for no apparent eason. When you ask him what's wrong, he snaps back: "Nothing leave me alone." While these evens could simply be part of the normal ebb and flow of getting older, they could also be early signs of Alzheimer's disease.
A mystery
What causes Alzheimer's is still a mystery — though an enormous amount of research is currently underway to solve the puzzle. David Greenspan, MD, director of geriatric psychiatry at Virtua Heatlh, explains: "The disease causes the slow destruction of brain tissue and with it, the disintegration of brain function. It is a progressive, degenerative disease, characterized by a pattern of physical and mental deterioration usually lasting seven to 10 years from the time it is medically diagnosed. Some researchers believe the disease might actually progress over a 20-year period."
Some of the signs
Characteristic early symptoms of Alzheimer's include memory loss that interferes with performance of everyday tasks and activities, disorientation and unexplained personality and behavioral changes — essentially, a slow unraveling of the ability to reason and solve problems.
Diagnosis
Jeffrey Friedman, DO, an internist at Virtua Health, elaborates: "Early on, Alzheimer's may often go undiagnosed. The clues can be very subtle. Most critical in making a correct diagnosis is giving the patient a mental exam to determine the degree of cognitive impairment. Just as important is constructing a detailed history of what has changed, and the pattern of changes in the patient's life."
While certain medical tests are performed — like blood work, a urine analysis and CT scan among others — they are done to exclude other diseases, rather than to determine a positive diagnosis of Alzheimer's. No single test can accurately indicate whether or not a person has the disease.
Treatment options
Although there is no cure for Alzheimer's, several FDA-approved drugs are available to delay disease symptoms. The newest is rivastigmine which received FDA approval in April of this year. Tacrine and donepezil can also offer some relief from symptoms, such as memory loss. Antipsychotic and antidepressant medications can also be useful in treating disruptive behavioral symptoms such as agitation, aggression and paranoia.
Counseling, support groups, family education and when necessary, respite or long-term care facilities can also help to make coping with the disease easier. Caring effectively for a person with this devastating disease takes a strong network of people and resources. The Geriatric Psychiatry Program at Virtua Memorial Hospital Burlington County specializes in the management of Alzheimer's disease. A range of inpatient and outpatient services is offered including programs to help patients and caregivers develop long-term strategies. Getting the right kind of help early can enhance a patient's quality of life and help families and caregivers plan for the future.
For any family facing Alzheimer's, Dr. Greenspan recommends the resource guide: The 36-Hour Day: A Family Guide to Caring for Persons with Alzheimer's Disease, Related Dementing Illnesses, and Memory Loss in Later Life by Nancy L. Mace.