When a Loved One Has Alzheimer’s Disease
It’s normal for people to become a bit forgetful as they age. So how can you tell a harmless “senior moment” from Alzheimer’s disease? One in eight people 65 and older have this devastating form of dementia. In its first stages, Alzheimer’s may not be obvious to friends and family. But there are some early warning signs to watch for.
In early Alzheimer’s, long-term memories usually remain intact while short-term memories become sketchy. Your loved one may forget conversations you had. She may repeat questions that were already answered. The disease also disrupts speech, so she might struggle to remember common words.
In addition to memory loss, Alzheimer’s can cause confusion and behavior changes. Your loved one may get lost in familiar places. Mood swings and lapses in judgment are also common, as is poor hygiene. People who were once stylish may start wearing stained clothes and forget to wash their hair.
It’s hard to face the thought that a loved one could have this disease, but it’s better to see a doctor sooner rather than later. First, the diagnosis might be something else. The symptoms could be caused by a highly treatable problem, like a thyroid imbalance. And if it is Alzheimer’s, treatments work best when they’re used early in the course of the disease.
There’s no simple test for Alzheimer’s, so the doctor will rely on you to describe the changes in your loved one. A mental status test, sometimes called a “mini-cog,” or other screening tests can measure his mental skills and short-term memory. Neurological exams and brain scans may be used to rule out other problems, like a stroke or tumor, and they can provide other information about his brain.
Alzheimer’s causes nerve cell death and tissue loss throughout the brain. As the disease gets worse, brain tissue shrinks and areas that contain cerebrospinal fluid become larger. The damage harms memory, speech, and comprehension.
Alzheimer’s takes a different path in every person. Sometimes the symptoms get worse quickly and lead to severe memory loss and confusion within a few years. For other people the changes are gradual. It could take 20 years for the disease to run its course. Most people live 3 to 9 years after diagnosis.
Alzheimer’s affects concentration, so your loved one may not be able to do ordinary tasks like cooking or paying the bills. A study suggests trouble balancing the checkbook is often one of the first signs of the disease. As symptoms worsen, he may not recognize familiar people or places. He may get lost easily or use utensils improperly, like combing his hair with a fork. Incontinence, balance problems, and loss of language are common in advanced stages.
Poor coordination, memory loss, and confusion are a dangerous combination behind the wheel. If you feel your loved one should stop driving, tell her why. If she won’t listen, ask her doctor to step in. If she still insists on driving, contact the Department of Motor Vehicles for an assessment. Then make other plans for her transportation needs.
Physical activity can help your loved one keep some muscle strength and coordination. It might also boost his mood and help him feel less anxious. Check with his doctor to learn which types of exercise are appropriate. Repetitive activities, like walking, gardening, or even folding laundry may be the best at giving him a sense of calm.
There’s no cure for Alzheimer’s and no way to slow the nerve damage it causes in the brain. But there are medications that appear to help maintain mental skills and slow the disease’s effects. If your loved one gets treatment early on, she may be able to stay independent and do her daily tasks for a longer period of time.
If you’re caring for someone with this disease, you’ll probably wear many hats — cook, chauffeur, and accountant to name a few. While you may have to handle meal planning and finances, encourage your loved one to do some things for herself. It may help to label cabinets with their contents and put up sticky notes with reminders of daily tasks. Be sure to buy a weekly pill box for her medications.
In the early stages, people with Alzheimer’s often understand what’s happening to them. They may be ashamed or get anxious. Watch for signs of depression, which the doctor can manage with medication. Later on, your loved one may become paranoid or aggressive and could even turn on you. Remember that the disease is responsible for this change. Tell the doctor about this kind of behavior promptly.
Experts don’t know why, but some people with Alzheimer’s get upset when the sun goes down. This tends to last through the evening and sometimes all night long. To ease tension, keep the house well lit and close the drapes before sunset. Try to distract your loved one with a favorite activity or TV show. Switch him to decaf after breakfast.
Many people with Alzheimer’s have trouble remembering names, even of people closest to them. A temporary fix is to put up pictures of people they’re likely to see often or know well with names printed underneath. Eventually, your loved one may no longer recognize faces and may react as if family members are strangers. This can be distressing, especially for the main caregiver.
Caring for someone with Alzheimer’s can be physically and mentally draining. Signs of caregiver stress include:
To avoid caregiver burnout, make sure you take at least a few minutes to do something you enjoy every day. Stay in touch with friends and keep up with hobbies when you can. Find a friend or relative to be your support person. You can also join an online or local caregiver support group through the Alzheimer’s Association.
While your loved one is still able to make important decisions, talk to an attorney about drafting advance directives. These are legal documents that spell out what he wants in terms of medical treatments and end-of-life care. He should name someone to make health care decisions and manage finances on his behalf. This will help avoid confusion later on if he’s no longer able to state his wishes.
Many people want to stay in their own homes as long as possible. That’s not easy if they have trouble getting dressed or using the bathroom on their own. A home health aide can help with personal hygiene and other daily tasks. You can also check with your local Area Agency on Aging for information on services that deliver meals or provide transportation to the elderly.
There may come a day when your loved one can no longer be cared for at home. If she doesn’t need 24-hour nursing care, an assisted-living facility may be good choice. They provide housing, meals, and activities, but are much less expensive than nursing homes. Look for one with an Alzheimer’s special care unit that can give 24-hour supervision and personal care to meet the needs of people with dementia.
People with advanced Alzheimer’s may lose their ability to walk, talk, or respond to others. Eventually, the disease can hinder vital functions, like the ability to swallow. This may be the time to switch to hospice care, which provides pain relief and comfort for people with terminal illnesses.
Children may feel confused, afraid, or even resentful when a family member has Alzheimer’s. Let the child know these feelings are normal and answer her questions about the illness honestly. Help her celebrate happy memories of your loved one. You could create a scrapbook with pictures from happier times.
Is there anything you can do to lower your chances of getting this disease? Research in this area is ongoing, but diet and exercise appear to be important. Studies show people who eat a Mediterranean diet rich in vegetables, fish, and nuts and get plenty of physical activity are the least likely to get Alzheimer’s.
Lava, MD on April 14, 2018
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American Health Assistance Foundation.
Beth Kallmyer, MSW, director of client services, National Office of the Alzheimer’s Association, Chicago.
Erin Heintz, public relations associate director, Alzheimer’s Association, Chicago.
Fisher Center for Alzheimer’s Research Foundation.
Melrose, R.J. Journal of Geriatric Psychiatry and Neurology, September 2011.
National Institute on Aging.
Querfurth, H.W. New England Journal of Medicine, January 2010.
Reviewed by Neil
Lava, MD on April 14, 2018
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