Alzheimer's Progress Is Cruel and One-Way by Dr. David Lipschitz on Creators.com

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Alzheimer's Progress Is Cruel and One-Way

Alzheimer's is a gradually progressive disease that eventually leads to relentless declines in memory, with loss of virtually every aspect of intellectual function. Early on, the disease is nothing more than a minor disability.

Short-term memory is impaired, but with strong family support, compulsive medical care and perhaps the use of medications to slow the rate of progression of the disease, an individual can have many productive years and be perfectly able to manage in the community and enjoy life with family and friends. At this stage of the illness, anything is possible.

But as the disease relentlessly progresses, memory insidiously declines and with time, many different elements of intellectual function become impaired. The patient may remain physically healthy but intellectually, he or she becomes more and more dependent and closely anchored to his or her major caregiver, either a spouse or an offspring. At this stage of the disease, the patient may follow the caregiver from room to room and become agitated if the caregiver leaves his or her sight for even an instant. Ever so slowly, the person we cherished and loved, who we recognized physically, becomes more and more of a stranger. It is a truly cruel disease.

During the course of the disease, many problems occur. Most alarming is the involvement of the front of the brain, which plays a key role in language and judgment. It is the part of the brain that keeps us centered, sensible and prevents us from doing things we should not. It keeps us inhibited.

Frontal-lobe involvement in Alzheimer's disease creates disinhibition. A deacon of the church may start to curse or behave inappropriately sexually, physically or verbally — saying or doing things that before would be truly unthinkable. Sadly, there is not much that can be done to reverse or improve this embarrassing and difficult behavior, except to be understanding and realize that the symptoms are not the patient's fault and that our role as loved ones must be to protect and avoid disasters.

Just as serious are hallucinations and delusions. Fortunately, hallucinations are usually not frightening.

The patient may see children playing or have discussions with friends who are not there. These should never be treated unless they make the patient agitated or distressed.

If this does occur, medications can be prescribed that can prove helpful. These drugs increase the risk of death and stroke in older people and must be used only if absolutely needed and as a last resort. An example is a medication called Risperdal. (It has been so widely misused that an Arkansas trial judge recently imposed a fine of $1.2 million on the pharmaceutical company that aggressively marketed the drug for nonindicated reasons.)

Occasionally, patients with advanced Alzheimer's may develop disruptive behavior and can become violent. The patient may fail to recognize someone he sees daily. If this person is not appropriately trained and attempts to persuade the patient to get dressed, bathe or go to the dining room, he may lash out because he sees a total stranger attempting to manhandle him. Often the patient is blamed and medication is prescribed that does more harm than good. Well-trained staff who truly understands the subtleties of patient care can minimize problems.

Many caregivers experience great pain when their loved one no longer recognizes them or asks who they are and demands to see his spouse. Too much noise and too many family members can make things worse, leading to more agitation and difficult behaviors. At this stage of the disease, the patient can no longer be left alone and on occasion, may wander away.

Dealing with Alzheimer's truly takes a village. The nurse, social worker, psychotherapist and physician all play key roles in improving the quality of life of the patient and the family. Just as important are community support groups such as the Alzheimer's Association and Alzheimer's Arkansas. Crises occur frequently, and a team is needed to obtain the appropriate help.

By far, the hardest role is to persuade the family that it is time to let go and that they have done everything possible. But as the patient becomes more dependent and disabled, a nursing home or memory disorder center is the best choice to assure a better quality of life.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at:

www.drdavidhealth.com