By Lerie Nel – Clinical Psychologist
Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear in their mid-60s. Alzheimer’s is the most common cause of dementia among older adults. How Do People Get Alzheimer’s? The disease usually occurs after age 65 and is linked to the apolipoprotein E (apoE) gene on chromosome 19. Chromosomes are threadlike structures that package DNA and genes inside of cells. Every person has an apoE gene, which comes in three forms. One of the forms (apoE4) increases a person’s risk of developing Alzheimer’s, while the other two forms appear to protect against the disease. A person may inherit the apoE4 form of the gene. While such a person is at an increased risk for Alzheimer’s, they will not necessarily develop it.
Younger individuals may develop Alzheimer’s from mutations in genes (defective copies of a gene) found on chromosomes 1, 14, and 21 which are rarer forms of the disease. Unfortunately, research is still far from knowing exactly what causes and progresses Alzheimer’s disease. However, scientists agree that the onset of Alzheimer’s disease likely starts 10 or more years prior to symptom appearance. During this pre-clinical period the patient usually does not present with memory or cognitive problems. While the patient appears healthy on the outside, the brain is increasingly bombarded by toxic changes. These changes primarily include tau tangles and abnormal deposits of proteins from amyloid plaques which cause once-healthy neurons (brain cells) to lose connections with other neurons, to stop functioning, and eventually neuronal death results. Alzheimer’s is a disease that affects the parts of the brain that are important for memory, thought, and language.
Signs and Symptoms include: Mild Cognitive Impairment such as memory problems atypical for a person’s age. At first it might be simple things such as mislaying things. As the disease worsens, people may forget how to do simple tasks such as brushing their hair or where friends and family live. Inability to think clearly such as word-finding difficulties, visual/spatial problems, impaired reasoning or judgement, depression and anxiety is also not uncommon in individuals with Alzheimer’s. Receiving treatment early will help to preserve daily functioning for as long as possible, although the underlying disease cannot be reversed or stopped. Managing behaviour is essential in patients with Alzheimer’s disease. Common behavioural symptoms of Alzheimer’s disease include sleeplessness, wandering, agitation, anxiety, and aggression. By treating behavioural problems, the life of both the Alzheimer’s patient and the caregiver is improved. Try to create a calm and soothing environment by reducing potential stressors. Exercise is equally important to the Alzheimer’s patient.
Other activities may include helping the patient to remember their past, interacting with other people is still important, and pets can provide a source of positive, nonverbal communication. It is very important to manage wandering in Alzheimer’s patients. Immediately redirect pacing or restless behaviour into productive activity or exercise, reassure the person if they appear disoriented, hiding items like purses or glasses that the person would not leave the house without may help, and make sure the person wears some form of identification at all times (E.g. nametag). How to find a missing Alzheimer’s patient? Check dangerous areas near the home, look within a 1.5 km radius of where the person was last seen, search in the direction of the wanderer’s dominant hand (wanderers usually stay close to roads), investigate familiar places, notify neighbours and police. How can you protect Alzheimer’s patients from harming themselves? Remove or prevent access to unsafe substances, such as cleaning products, alcohol, firearms, sharp knives, and medications. Prevent electrical accidents by blocking unused electrical outlets with childproofing devices. Lower the temperature on water heaters. Designate a special drawer of items that the person can safely “play” with when keen to rummage.
Managing aggression – don’t confront the person or try to discuss the angry behaviour, do not initiate physical contact during the angry outburst, let the person play out the aggression, look for patterns in the aggression and avoid activities or topics that anger the person, don’t take the aggressiveness personally, the person cannot help it. Don’t argue about what is real and what is fantasy. Respond to the emotional content of what the person is saying, rather than to the factual/fictional content. Other factors to consider include keeping and storing valuable or sentimental items in the same place all of the time where the person can find them, keep a regular sleep schedule, keep a night light on, place a commode next to the bed for night time urination, increase physical activity during the day, monitor napping, limit the patient’s caffeine, sugar, and manage eating problems – transition into providing only puréed or soft foods if person has difficulty swallowing. Caregiving for a loved one with Alzheimer’s can be extremely demanding and stressful.
Each day can bring more challenges and higher levels of anxiety, often without any signs of appreciation from the person you’re taking care of. Taking care of yourself and getting help and support is essential for both your well-being and your loved one’s quality of life. Respite care can provide a break to help you relieve stress and restore energy. Make use of any services available to you and don’t be afraid of asking for help from other family members. It can make all the difference to your success as a caregiver.