Alzheimer Dementia explained
Understanding the common course of Alzheimer dementia
While there are many causes of dementia, Alzheimer disease or Alzheimer dementia is the most common type. This disease has major consequences not only for the patient, but also for their family members and loved ones around them. Unfortunately, we as yet do not have any ways to stop or cure this disease. While some therapies can possibly slow the progression of the disease, the data behind even that are far from convincing. Regardless, it is important to recognize the symptoms and possible changes so you and your loved ones can be adequately prepared for what’s to come.
Let me start by explaining the natural course of this heartbreaking disease. In the early stages of dementia, short term memory tends to be the first to go. It is a slow process and initial symptoms can be as subtle as forgetting what you had for lunch or asking the same question more than once. The higher the prior cognitive function, the harder it can be to detect early on. Patients may suddenly forget where they are going or get lost going to places they commonly go. During this phase, the long-term memory is still preserved so patients will still remember birthdays, anniversaries, major holidays and loved ones. As the dementia progresses, the short-term memory continues to worsen and then the long-term memory starts to go. Patients might start to wander out of the house or suddenly forget who you are or who they are. As the dementia progresses, patients can start to have confusion or sudden agitation. They can become suddenly aggressive or hallucinate. You might have heard of the term “sun-downing”, which tends to happen in the late afternoon to evening time as day starts to turn to night, and is associated with confusion and hallucinations. As the dementia progresses, patients will have “good days” (days where they remember everyone and seem like their normal self) and “bad days” (days where they don’t speak much or recognize their own spouse, parent or children). In the final stages of Alzheimer dementia, patients stop talking, eating and moving. Patients will tend to get recurrent infections. Either these or a lack of nutrition will ultimately lead to them passing away.
Dementia places incredible burden on the patient and their family. For one, the psychological toll on the family can be immense. For another, the financial and social tolls are also very difficult. Patients might need admissions to hospitals more frequently. In a lot of cases, they lose the ability to live independently, leading to need for nursing home or memory care placement. Family members may have a hard time going to work for fear of what the patient might do while they are at work. And the disease itself usually lasts for years, which means that this might be something that there are many years to plan for.
So, what can you do? The best thing you can do is to try to recognize the symptoms early and talk to your doctor. We can perform a simple test in the office that can give us an idea of how mild, moderate or severe the dementia is. While we as of yet don’t have a way to completely treat this, we do have some medications that can help manage the symptoms. We can also give you tips to help lower the risk of the confusion, such as frequent reorientation (remind them where they are, who you and they are and what day and time it is), checking for any reversible conditions that are making things worse (such as infections, constipation or being on too many sedating drugs), making sure they are using glasses and hearing aids if they need them, and so on. Ultimately, the best thing to do is plan with your family early. Understanding what stage of the disease you or your loved one are in can at least decrease some of the anxiety associated with the sudden changes.
