A little over two years ago my Grandfather
("Pa" as we like to call him)
was diagnosed with Alzheimer's Disease.
This page is dedicated to him.
March 21 1921 - September 16 -2006
Yesterday
I'm Twenty-two for a moment..
I walk with a strut that the ladies admire,
I am very handsome, so I am told,
Living without a care in the world,
I remember it like it was yesterday.
I'm Thirty-three for a moment..
With a family on my mind,
A soft hearted man with a lovely wife,
It's a wonderful life, I'm so very proud,
I remember it like it was yesterday.
I'm Forty-four for a moment..
With a little graying in my hair,
A growing family with many in tow,
It's a gracious life that I lead,
I remember it like it was yesterday.
I'm Fifty-five for moment..
Retirement on the way,
A gaggle of grandchildren,
A wife so loving and caring
I remember it like it was yesterday.
I'm Sixty-six for a moment..
Why can't I think?
Where are my thoughts?
I am losing mind!!
Who am I?
Who are you?
What do you want me to do?
Is it today or yesterday?
I'm Seventy-seven for a moment..
A tortured man that sits in a chair
With old familiar life planted firmly behind
An even more uncertain road ahead
Is it today or yesterday?
I'm twenty-two for a moment..
I walk with a strut that the ladies admire,
I am very handsome, so I am told,
Living without a care in the world,
I remember it like it was yesterday.
This poem is dedicated to Pa
And his loving family.
© Char 2005
Dementia is a brain disorder that seriously affects a person's ability to carry out daily activities. The most common form of dementia among older people is Alzheimer's disease (AD), which involves the parts of the brain that control thought, memory, and language. Although scientists are learning more every day, right now they still do not know what causes AD, and there is no cure.
Scientists think that as many as 4.5 million Americans suffer from AD. The disease usually begins after age 60, and risk goes up with age. While younger people also may get AD, it is much less common. About 5 percent of men and women ages 65 to 74 have AD, and nearly half of those age 85 and older may have the disease. It is important to note, however, that AD is not a normal part of aging.
AD is named after Dr. Alois Alzheimer, a German doctor. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. He found abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary tangles). Today, these plaques and tangles in the brain are considered signs of AD.
Scientists do not yet fully understand what causes AD. There probably is not one single cause, but several factors that affect each person differently. Age is the most important known risk factor for AD. The number of people with the disease doubles every 5 years beyond age 65.Family history is another risk factor. Scientists believe that genetics may play a role in many AD cases.
What Are the Symptoms of AD?
AD begins slowly. At first, the only symptom may be mild forgetfulness. In this stage, people may have trouble remembering recent events, activities, or the names of familiar people or things. They may not be able to solve simple math problems. Such difficulties may be a bother, but usually they are not serious enough to cause alarm.
However, as the disease goes on, symptoms are more easily noticed and become serious enough to cause people with AD or their family members to seek medical help. For example, people in the middle stages of AD may forget how to do simple tasks, like brushing their teeth or combing their hair. They can no longer think clearly. They begin to have problems speaking, under-standing, reading, or writing. Later on, people with AD may become anxious or aggressive, or wander away from home. Eventually, patients need total care.
How is AD Diagnosed?
An early, accurate diagnosis of AD helps patients and their families plan for the future. It gives them time to discuss care while the patient can still take part in making decisions. Early diagnosis will also offer the best chance to treat the symptoms of the disease.Today, the only definite way to diagnose AD is to find out whether there are plaques and tangles in brain tissue. To look at brain tissue, how-ever, doctors must wait until they do an autopsy, which is an examination of the body done after a person dies. Therefore, doctors can only make a diagnosis of "possible" or "probable" AD while the person is still alive.
At specialized centers, doctors can diagnose AD correctly up to 90 percent of the time. Doctors use several tools to diagnose "probable" AD, including:
questions about the person's general health, past medical problems, and the history of any difficulties the person has carrying out daily activities, tests of memory, problem solving, attention, counting, and language, medical tests-such as tests of blood, urine, or spinal fluid, and brain scans.
Some of these test results help the doctor find other possible causes of the person's symptoms. For example, thyroid problems, drug reactions, depression, brain tumors, and blood vessel disease in the brain can cause AD-like symptoms. Some of these other conditions can be treated successfully.
The 7 stages of AD
Experts have documented common patterns of symptom progression that occur in many individuals with Alzheimer’s disease and developed several methods of “staging” based on these patterns. Progression of symptoms corresponds in a general way to the underlying nerve cell degeneration that takes place in Alzheimer’s disease. Nerve cell damage typically begins with cells involved in learning and memory and gradually spreads to cells that control every aspect of thinking, judgment, and behavior. The damage eventually affects cells that control and coordinate movement.
Staging systems provide useful frames of reference for understanding how the disease may unfold and for making future plans. But it is important to note that all stages are artificial benchmarks in a continuous process that can vary greatly from one person to another. Not everyone will experience every symptom and symptoms may occur at different times in different individuals. People with Alzheimer’s live an average of 8 years after diagnosis, but may survive anywhere from 3 to 20 years.
The framework for this section is a system that outlines key symptoms characterizing seven stages ranging from unimpaired function to very severe cognitive decline. This framework is based on a system developed by Barry Reisberg, M.D., Clinical Director of the New York University School of Medicine’s Silberstein Aging and Dementia Research Center.
Within this framework, we have noted which stages correspond to the widely used concepts of mild, moderate, moderately severe, and severe Alzheimer’s disease. We have also noted which stages fall within the more general divisions of early-stage, mid-stage, and late-stage categories.
Stage 1: No impairment (normal function) Unimpaired individuals experience no memory problems and none are evident to a health care professional during a medical interview.
Stage 2: Very mild cognitive decline (may be normal age-related changes or earliest signs of Alzheimer's disease) Individuals may feel as if they have memory lapses, especially in forgetting familiar words or names or the location of keys, eyeglasses or other everyday objects. But these problems are not evident during a medical examination or apparent to friends, family or co-workers.
Stage 3: Mild cognitive decline Early-stage Alzheimer's can be diagnosed in some, but not all, individuals with these symptoms
Friends, family or co-workers begin to notice deficiencies. Problems with memory or concentration may be measurable in clinical testing or discernible during a detailed medical interview. Common difficulties include:
Word- or name-finding problems noticeable to family or close associates
Decreased ability to remember names when introduced to new people
Performance issues in social or work settings noticeable to family, friends or co-workers
Reading a passage and retaining little material
Losing or misplacing a valuable object
Decline in ability to plan or organize
Stage 4: Moderate cognitive decline (Mild or early-stage Alzheimer's disease)
At this stage, a careful medical interview detects clear-cut deficiencies in the following areas:
Decreased knowledge of recent occasions or current events
Impaired ability to perform challenging mental arithmetic-for example, to count backward from 100 by 7s
Decreased capacity to perform complex tasks, such as marketing, planning dinner for guests or paying bills and managing finances
Reduced memory of personal history
The affected individual may seem subdued and withdrawn, especially in socially or mentally challenging situations
Stage 5: Moderately severe cognitive decline (Moderate or mid-stage Alzheimer's disease)
Major gaps in memory and deficits in cognitive function emerge. Some assistance with day-to-day activities becomes essential. At this stage, individuals may:
Be unable during a medical interview to recall such important details as their current address, their telephone number or the name of the college or high school from which they graduated
Become confused about where they are or about the date, day of the week, or season
Have trouble with less challenging mental arithmetic; for example, counting backward from 40 by 4s or from 20 by 2s
Need help choosing proper clothing for the season or the occasion
Usually retain substantial knowledge about themselves and know their own name and the names of their spouse or children
Usually require no assistance with eating or using the toilet
Stage 6: Severe cognitive decline (Moderately severe or mid-stage Alzheimer's disease)
Memory difficulties continue to worsen, significant personality changes may emerge and affected individuals need extensive help with customary daily activities. At this stage, individuals may:
Lose most awareness of recent experiences and events as well as of their surroundings
Recollect their personal history imperfectly, although they generally recall their own name
Occasionally forget the name of their spouse or primary caregiver but generally can distinguish familiar from unfamiliar faces
Need help getting dressed properly; without supervision, may make such errors as putting pajamas over daytime clothes or shoes on wrong feet
Experience disruption of their normal sleep/waking cycle
Need help with handling details of toileting (flushing toilet, wiping and disposing of tissue properly)
Have increasing episodes of urinary or fecal incontinence
Experience significant personality changes and behavioral symptoms, including suspiciousness and delusions (for example, believing that their caregiver is an impostor); hallucinations (seeing or hearing things that are not really there); or compulsive, repetitive behaviors such as hand-wringing or tissue shredding
Tend to wander and become lost
stage 7: Very severe cognitive decline (Severe or late-stage Alzheimer's disease)
This is the final stage of the disease when individuals lose the ability to respond to their environment, the ability to speak and, ultimately, the ability to control movement.
Frequently individuals lose their capacity for recognizable speech, although words or phrases may occasionally be uttered
Individuals need help with eating and toileting and there is general incontinence of urine
Individuals lose the ability to walk without assistance, then the ability to sit without support, the ability to smile, and the ability to hold their head up. Reflexes become abnormal and muscles grow rigid. Swallowing is impaired.
How is AD Treated?
AD is a slow disease, starting with mild memory problems and ending with severe brain damage. The course the disease takes and how fast changes occur vary from person to person. On average, AD patients live from 8 to 10 years after they are diagnosed, though the disease can last for as many as 20 years.
No treatment can stop AD. However, for some people in the early and middle stages of the disease, the drugs tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon), or galantamine (Razadyne, formerly known as Reminyl) may help prevent some symptoms from becoming worse for a limited time. Another drug, memantine (Namenda), has been approved for treatment of moderate to severe AD. Also, some medicines may help control behavioral symptoms of AD such as sleeplessness, agitation, wandering, anxiety, and depression. Treating these symptoms often makes patients more comfortable and makes their care easier for caregivers.
Developing new treatments for AD is an active area of research. Scientists are testing a number of drugs to see if they prevent AD, slow the disease, or help reduce symptoms.There is evidence that inflammation in the brain may contribute to AD damage. Some scientists believe that drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs) might help slow the progression of AD, although recent studies of two of these drugs, rofecoxib (Vioxx) and naproxen (Aleve), have shown that they did not delay the progression of AD in people who already have the disease. Now, scientists are studying the NSAIDs celecoxib (Celebrex) and naproxen to find out if they can slow the onset of the disease.
Research has shown that vitamin E slows the progress of some consequences of AD by about 7 months. Scientists now are studying vitamin E to learn whether it can prevent or delay AD in patients with MCI.
Recent research suggests that ginkgo biloba may be of some help in treating AD symptoms. There is no evidence that ginkgo will cure or prevent AD. Scientists now are trying to find out whether ginkgo biloba can delay or prevent dementia in older people.
Recent findings from the Women's Health Initiative (WHI) highlight the importance of clinical trials, which are studies to find out whether a treatment is both safe and effective. Earlier studies had suggested that the hormone replacement therapy that millions of women take after menopause may be protective against AD. However, the WHI clinical trial found an increased risk of AD in women taking hormones as compared with those taking an inactive pill. The trial used a commonly pre-scribed pill combining estrogens and progesterone. Further studies on estrogen alone and other hormone preparations, such as the estrogen patch, continue.
Is There Help for Caregivers?
Most often, spouses or other family members provide the day-to-day care for people with AD. As the disease gets worse, people often need more and more care. This can be hard for caregivers and can affect their physical and mental health, family life, job, and finances.
The Alzheimer's Association has chapters nationwide that provide educational programs and support groups for caregivers and family members of people with AD. For more information, contact the Alzheimer's Association listed at the end of this fact sheet.
For More Information
To learn about support groups, services, research centers, getting involved in studies, and publications about AD, contact the following:
Alzheimer's Association
225 N. Michigan Avenue, Suite 1700
Chicago, IL 60611-7633
1-800-272-3900
Website:Alzheimer's Association
This non-profit association supports families and caregivers of patients with AD. Chapters nationwide provide referrals to local resources and services, and sponsor support groups and educational programs.
This non-profit association supports families and caregivers of patients with AD. Chapters nationwide provide referrals to local resources and services, and sponsor support groups and educational programs.
Alzheimer's Disease Education and Referral (ADEAR) Center
P.O. Box 8250
Silver Spring, MD 20907-8250
1-800-438-4380
Website: Alzheimer's Disease Education & Referral Center
This service of the NIA is funded by the Federal Government. It offers information and publications on diagnosis, treatment, patient care, caregiver needs, long-term care, education and training, and research related to AD. Publications can be previewed and ordered on the Web site. Staff answer telephone, e-mail, and written requests and make referrals to local and national resources.
Eldercare Locator
800-677-1116
Website: Eldercare
This service of the Administration on Aging is funded by the Federal Government. It offers information about and referrals to respite care and other home and community services offered by State and Area Agencies on Aging.
Alzheimer's Foundation of America
Forgetting: A Portrait of Alzheimer's (PBS Special Page)
