Vicki Gillmore, Nursing Home Administrator, Elizabethtown, PA
"The value of this training and its implementation for those at the end of life, in pain or with dementia has been incredible."
Understanding Alzheimer's Part 1
Vol. 11, Issue 01
You don't have to look too far to find a person with Alzheimer's disease (AD) or someone caring for a family member with this devastating condition. While teaching massage therapists about working with people with Alzheimer's disease, common questions - and misperceptions - emerge.
Sound information gives us a foundation from which to act and increases our comfort level to serve this special population. In this two-part series, I'll answer some of these questions and explore the shared human experience of living with Alzheimer's disease.
What's the difference between dementia and Alzheimer's disease?
People sometimes use the term "Alzheimer's" to describe any kind of cognitive impairment. Some believe that Alzheimer's is a normal part of growing old. Neither is quite accurate. According to the Alzheimer's Association:
"Dementia is a general term meaning loss of memory and other intellectual abilities serious enough to interfere with daily life. There are many diseases that result in dementia, including cerebral vascular accident (stroke), metabolic disorders and brain tumors, although Alzheimer's disease is the most common. Alzheimer's disease is a progressive brain disorder that damages and eventually destroys brain cells, leading to loss of memory, thinking and other brain functions. AD is not a part of normal aging, but results from a complex pattern of abnormal changes."
What Causes AD?
In spite of years and dollars spent on research it still is not known what causes AD. While the exact cause remains unknown, what happens in the brain resulting in symptoms is clear to scientists. Brain damage gradually occurs due to complex cellular abnormalities called plaques and tangles. As the disease progresses, the brain tissue actually shrinks significantly.
Is AD hereditary?
There appears to be a genetic link in what's called "early-onset AD", which tends to run in families. Relatively rare (less than 10 percent of all AD cases), early-onset AD strikes people before age 65.
How is AD diagnosed?
Since there is no single medical test that definitively diagnoses AD, physicians rely on a battery of examinations. Interviewing the patient and family provides information about cognitive and behavioral changes and other symptoms. Initial medical tests will be conducted to rule out other possible causes for the dementia. For example, blood tests can detect hypothyroidism or vitamin B12 deficiency both of which can cause dementia in frail elders. Brain imaging tests reveal problems like blood clots or tumors. Common brain imaging tests include computerized tomography (CT scan) and magnetic resonance imaging (MRI). Positron emission tomography (PET) measures brain activity and can detect plaque cell density. A neuropsychological exam may be prescribed. This is a complex set of tests that measures problem solving, memory and language skills. The physician finally takes all this information into account to diagnosis AD.
How does the disease progress?
It's important to note that no two people are alike when it comes to how the disease progresses. However, experts give us general guidelines. The Alzheimer's Association identifies seven stages of AD but it is simpler to categorize in terms of mild, moderate, and severe. AD develops slowly and gradually worsens as more brain cells shrink and die. Ultimately, the disease is fatal. A thorough account of the stages is too extensive for this article, but what follows is a general description offered by the American Health Assistance Foundation, which conducts AD research.
Stage 1 (mild): Early in the illness, those with Alzheimer's tend to be less energetic and spontaneous. They exhibit minor memory loss and mood swings, and are slow to learn and react. They may become withdrawn, avoid people and new places and prefer the familiar. Individuals become confused, have difficulty organizing and planning, get lost easily and exercise poor judgment. They may have difficulty performing routine tasks, and have trouble communicating and understanding written material. If the person is employed, memory loss may begin to affect job performance. They can become angry and frustrated.
Stage 2 (moderate): In this stage, the person with Alzheimer's is clearly becoming disabled. Individuals can still perform simple tasks independently, but may need assistance with more complicated activities. They forget recent events and their personal history, and become more disoriented and disconnected from reality. Memories of the distant past may be confused with the present, and affect the person's ability to comprehend the current situation, date and time. They may have trouble recognizing familiar people. Speech problems arise and understanding, reading and writing are more difficult, and the individual may invent words. They may no longer be safe alone and can wander. As Alzheimer's patients become aware of this loss of control, they may become depressed, irritable and restless or apathetic and withdrawn. They may experience sleep disturbances and have more trouble eating, grooming and dressing.
Stage 3 (severe): During this final stage, people may lose the ability to feed themselves, speak, recognize people and control bodily functions. Their memory worsens and may become almost non-existent. Constant care is typically necessary. In a weakened physical state, the patient may become vulnerable to other illnesses and respiratory problems, particularly when bedridden.
Are there drugs that slow the progression of AD?
In recent years, certain drugs have emerged as helpful in managing certain symptoms associated with AD. Drugs that help regulate neurotransmitters (e.g. Aricept) may help maintain cognitive and behavioral function for months or a few years but there is no drug that stops the progression of the disease.
How long can a person live with AD?
There are individual differences but generally survival is four to six years after being diagnosed and some people live much longer.
How prevalent is AD?
According to the Alzheimer's Association, there are currently 5.3 million people with AD in the United States and that number is expected to grow to 16 million by 2050.
Are most people with ad in nursing homes?
No. Actually about 70 percent of people with AD are cared for at home. That equals to a lot of our friends, colleagues and neighbors dealing with the consuming task of caregiving.
What support is available for families of people with AD?
Thankfully there is a great deal of support. Many communities offer caregiver support groups and local resources. A good place to start is your local area office on aging or your regional Alzheimer's Association office.
Massage therapists, with specialized training, have a great deal to offer to improve the quality of life of people with AD. In Part 2 of this series, I'll explore the specific benefits of sensitive massage and focused touch for the person living with AD as well as the human experience of AD.
- Alzheimer's Association, 225 N. Michigan Ave., Fl. 17 Chicago, IL 60601. www.alz.org
- American Health Assistance Foundation, 22512 Gateway Center Drive Clarksburg, MD 20871. www.ahaf.org
- Alzheimer's Disease Education and Referral Center, National Institute on Aging, PO Box 8250 Silver Spring, MD 20907. www.nia.nih.gov
- Peterson R. The Mayo Clinic Guide to Alzheimer's Disease, 2007. Mayo Clinic, 200 First Street S.W.Rochester, MN 55905. www.mayoclinic.com
- Callone P. Alzheimer's Disease: The Dignity Within: A Handbook for Caregivers, Family, and Friends. Accessible Publishing Systems, 2008.