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Alzheimer's Disease

March 2001

WHAT IS ALZHEIMER’S DISEASE?

Alzheimer’s disease is a degenerative disease of the brain from which there is no recovery. Slowly and inexorably, the disease attacks nerve cells in all parts of the cortex of the brain, as well as some surrounding structures, thereby impairing a person’s abilities to govern emotions, recognize errors and patterns, coordinate movement, and remember. At the last, an afflicted person loses all memory and mental functioning.

WHO GETS ALZHEIMER'S DISEASE?

Alzheimer's disease is now the fourth leading cause of death in adults. Almost 4 million Americans, and 8 million more worldwide, have it. Unless effective methods for prevention and treatment are developed, Alzheimer's disease will reach epidemic proportions, afflicting an estimated 22 million people worldwide by 2025.

Age

Age is the biggest risk factor for Alzheimer's. The number of cases of Alzheimer's doubles every five years in people over 65 until by age 85 almost half of all people are afflicted.

Family History

People with a family history of the disease are at higher than average risk for Alzheimer's. [ See Genetic Factors under What Causes Alzheimer's Disease.]

Gender

A number of studies suggest that women are more likely to develop Alzheimer's, while one reported that men are more likely to suffer age-related brain damage. Studies are not consistent, however.

Population Demographics

Few well-conducted studies have been conducted on differences among population groups.

Genetic factors are at work in all groups but the same genes may have different effects depending on the ethnic population. Environmental factors also most likely play a role. For example, a study of Japanese men showed that their risk increased if they emigrated to America. And, the disease is rare in West Africa although African Americans share the same or higher risk with Caucasians Americans.

High Blood Pressure

Chronic high blood pressure is associated with mental deterioration in older people, including increased risks for short-term memory and attention, Alzheimer's disease, and dementia. The higher the blood pressure the greater the risk for mental impairment. (Controlling blood pressure may help ward off memory loss to begin with and treating blood pressure in older patients can reduce the risk of dementia in elderly patients with elevated systolic pressure.)

Down's Syndrome

Nearly all patients who inherit Down's syndrome develop changes in the brain that resemble Alzheimer's if they live into their 40s, although onset varies and can occur as late as age 70. Women under the age of 35, but not older mothers, who give birth to children with Down's syndrome are also at much higher risk for Alzheimer's.



WHAT CAUSES ALZHEIMER’S DISEASE?

Researchers are finding specific biologic factors involved with Alzheimer's disease. Various environmental and genetic players appear to contribute to or trigger the process by which these factors destroy nerve cells leading to this disease.

Biologic Factors in the Brain

Two significant abnormalities occur in brains of people affected by Alzheimer's:

Other factors also play a role.

The Effects of Neurofibrillary Tangles and Beta Amyloid in Alzheimer's. These biologic factors appear to be involved in the development Alzheimer's disease in the following ways:

Other Proteins. Researchers have now identified other important proteins in the areas of the brain affected by Alzheimer's disease.

Genetic Factors

Major research targets in Alzheimer's are the factors responsible for beta amyloid build-up and concentration in certain people and not in others. Genetic factors are believed to play a role in many cases.

The ApoE Gene and Late-Onset Alzheimer's. The major target in genetic research on late-onset Alzheimer's disease has been apolipoprotein E (ApoE), which plays a role in the movement and distribution of cholesterol for repairing nerve cells during development and after injury.

The gene for ApoE comes in three major types:

People inherit a copy of one type from each parent, but Alzheimer's disease is not inevitable even in people with two copies of the ApoE4 gene. Reports vary widely in estimating the extent of risk:

Some research suspects that some specific variation of the ApoE4 gene may be the actual culprit, since many people carry the ApoE4 and exhibit no signs of Alzheimer's.

Other Genetic Factors in Late-Onset Alzheimer's. Most people with late-onset Alzheimer’s disease do not carry the ApoE4 gene. Increasingly, researchers believe that many cases of late-onset Alzheimer's disease are a result of a collaboration of genetic factors that participate in the process of producing or degrading beta amyloid. Some under investigation are the following:

Genetic Factors for Early-Onset Alzheimer's. Scientists are coming closer to identifying defective genes responsible for early-onset Alzheimer's, an uncommon, but extremely aggressive form of the disease.

Oxidation and the Inflammatory Response

Researchers are also attempting to discover why beta amyloid is so toxic to nerve cells. Some researchers are focusing on two processes in the body that may be involved with Alzheimer's disease: oxidation and the inflammatory process . One scenario for their role in Alzheimer's is as follows:

Environmental and Other Factors

Also of interest to researchers are the environmental factors (eg, viruses, metals, or dietary factors) that may trigger oxidation, inflammation, and the disease process, particularly in people with genetic susceptibility to Alzheimer's.

Virus and Bacteria. Slow, infectious viruses cause a number of other degenerative neurologic diseases, such as kuru and Creutzfeldt-Jakob disease. Although no specific virus has been linked to Alzheimer's, some researchers theorize that people with a genetic susceptibility to Alzheimer's may be vulnerable to the actions of certain viruses, particularly under circumstances when the immune system may be weakened. Studies that help support this theory are as follows:

Metals. Some laboratory studies have associated the formation of amyloid plaques with excessive amounts of metal ions such as zinc, copper, aluminum, and iron. Such ions may also change the chemical architecture of beta amyloid, making it more harmful. A mildly acidic environment appears to be important in the process that binds these metals to beta amyloid. Experts observe that such conditions (acidic environment and higher levels of zinc and copper) commonly occur as part of the inflammatory response to local injury.

Electromagnetic Fields. Some studies on people exposed to intense electromagnetic fields have reported a higher incidence of Alzheimer's. Some researchers believe that magnetic fields may interfere with the concentration of calcium inside cells, and others believe that they may increase production of beta amyloid.

Head Injury. Some studies have found an association between serious head injuries in early adulthood and the development of Alzheimer's. It is not yet known if such injuries directly cause Alzheimer's or simply accelerate the disease in people who are already susceptible to it.

Childhood Malnutrition. According to one study, poor nutrition in childhood may render the brain more susceptible to mental impairments later in life, including Alzheimer's disease.

Vitamin B Deficiencies. Some studies suggest that deficiencies of the B vitamins B12 and folate may be a risk factor for Alzheimer's. Such vitamins are related to nerve protection.



HOW CAN ALZHEIMER’S DISEASE BE PREVENTED?

There have been no proven methods for preventing Alzheimer's disease since the cause of it is still unknown. Still, certain factors are showing some evidence of reducing risk.

Male and Female Hormones

Estrogen and Hormone Replacement Therapy. Estrogen, the primary female hormone, appears to have properties that protect against the memory loss and lower mental functioning associated with normal aging. Among its effects on the brain are the following:

Estrogen, the primary female hormone, appears to have properties that protect against the memory loss and lower mental functioning associated with normal aging. Among its effects on the brain are the following:

Studies Showing Positive Benefits on the Brain. Researchers, then, have been investigating whether hormone replacement therapy can actually help prevent Alzheimer's disease in women after menopause. The following are some results of studies weighing in for the brain-protective benefits of hormone replacement therapy (HRT):

Studies Showing No or Negative Benefits on the Brain. Women who take HRT, however, tend to be healthier and better educated to begin with. Some studies have reported no strong benefits:

While taking estrogen may prove to reduce the risk of Alzheimer's, its use for this purpose is still unproven, and women should not choose hormone replacement therapy solely to prevent Alzheimer's disease. [ For more information, see the Well-Connected Report, Menopause, Estrogen Loss, and Their Treatments.]

Testosterone. One small study suggested that testosterone might be helpful in reducing levels of beta amyloid. More research is warranted to determine if testosterone supplements may be protective in elderly men.

Common Medications

Nonsteroidal Anti-Inflammatory Drugs. Common nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin), and naproxyn, have properties that block specific factors in the inflammatory response believed to play a major role in nerve-cell degeneration. Long-term studies are reporting that regular use of even low-dose NSAIDs may be protective against Alzheimer's. (Note: acetaminophen (Tylenol) is not an anti-inflammatory drug and has no effect on this disease.)

Newer NSAIDs called COX-2 inhibitors (Vioxx, Celebrex) may have nerve-protecting properties without as severe side effects, but long-term studies are needed to determine this.



Special Warning on NSAIDs

Long-term use of NSAIDs can cause bleeding and ulcers in the gastrointestinal tract. Combinations of NSAIDs and stomach-protective agents, such as diclofenac and misoprostol (Arthrotec), may reduce this risk considerably. Still, no one should take NSAIDs for protection against Alzheimer's disease without the recommendation of a physician.



Statins. Of considerable interest are 1999 and 2000 studies reporting a significantly lower risk (60% to 73%) for Alzheimer's disease in people who were taking cholesterol lowering drugs known as statins. The most positive results to date are with lovastatin (Mevacor) and pravastatin (Pravachol). Oddly, in one study, patients taking simvastatin (Zocor), which is very similar to the others, did not appear to have a lower risk for Alzheimer's compared to the other two.

H2 Blockers. Some small studies have reported some protection from H2 blockers, common drugs used to treat heartburn. They include famotidine (Pepcid AC), cimetidine (Tagamet), ranitidine (Zantac), and nizatidine (Axid). (It should be noted that omeprazole, an agent called a proton pump inhibitor that is also used to treat heartburn, has been associated with a higher risk for Alzheimer's.) More research is needed on these agents.

Diet

Fats and Oils. Some population studies have reported an association between low-fat diets and a lower incidence in Alzheimer's. For example, in China and Nigeria, where fat intake is low, the risk of developing Alzheimer's is 1% at age of 65 compared to 5% in the US. Conversely, a study in the Netherlands reported an association between dementia and diets high in total fat, saturated fat, and cholesterol. A high-fat diet in people who carry the ApoE4 gene may confer a particularly high risk. In one 2000 study of Americans between the ages of 40 and 50, those who carried the ApoE4 gene and whose diet consisted of 40% fat calories had 29 times the risk for Alzheimer's compared to non-ApoE4 carriers on the same high-fat diet. Some dietary tips concerning fat intake are as follows:

Antioxidant-Rich Supplements and Foods. Much research on Alzheimer's disease has indicated that oxidation (release of damaging unstable particles) may play an important role in the disease process. Some reports have suggested, then, that dietary antioxidants, such as vitamins C and E, selenium and other food chemicals, may be protective against mental decline.

Calorie Restriction. Caloric intake itself may play a role in brain health. In one study on animals, restricting calories below normal (but above starvation levels) helped prevent age-related nerve degeneration. It should be pointed out, however, that in patients with existing Alzheimer's, weight loss is a strong indicator of mental decline. Educational Levels and Alzheimer'sA number of studies have reported a higher risk for Alzheimer’s disease in people with less education and a lower risk for dementia and Alzheimer's in those who remain mentally active. Concluding that education helps protect against Alzheimer's, however, is under debate:

Exercise

A 2001 study reported that older people who regularly exercised had lower rates of mental deterioration, Alzheimer's and dementia of any type.Investigative VaccinesOf great interest is the investigation of vaccines that use antibodies to attach to beta amyloid molecules. Antibodies are immune factors that target and attack specific molecular invaders in the body. Researchers hope that these antibodies will alert the immune system to attack and destroy the beta amyloid molecules, which are considered to be the building blocks of the nerve-destroying deposits in Alzheimer's brains. Animal studies are promising, and clinical trials on humans are now underway.What Are the Symptoms of Alzheimer’s Disease?Mild impairment in thinking is now believed to be a significant sign of early-stage Alzheimer's in older people. The early symptoms of Alzheimer’s disease may be overlooked because they resemble signs of natural aging. These symptoms include:

In healthy individuals, similar symptoms can result from a number of common aging problems:



[See Table , Differences between Normal Signs of Aging and Dementia, below.]



DIFFERENCES BETWEEN NORMAL SIGNS OF AGING AND DEMENTIA

Early Signs of Alzheimer’s

NORMAL

DEMENTIA

Memory And Concentration

Memory And Concentration

Periodic minor memory lapses or forgetfulness of part of an experience.

Occasional lapses in attention or lapses in attention or concentration.

Misplacement of important items.

Confusion about how to perform simple tasks.

Trouble with simple arithmetic problems.

Difficulty making routine decisions.

Confusion about month or season.

Mood And Behavior

Mood And Behavior

Temporary sadness or anxiety based on appropriate and specific cause.

Changing interests.

Increasingly cautious behavior.

Unpredictable mood changes.

Increasing loss of outside interests.

Depression, anger, or confusion in response to change.

Denial of symptoms.

Later Signs of Alzheimer’s Disease

NORMAL

DEMENTIA

Language And Speech.

Language And Speech.

Unimpaired language skills.

Difficulty completing sentences or finding the right words.

Inability to understand the meaning of words.

Reduced and/or irrelevant conversation.

Movement/ Coordination

Movement/ Coordination

Increasing caution in movement.

Slower reaction times.

Visibly impaired movement or coordination, including slowing of movements, halting gait, and reduced sense of balance.

Source: Alzheimer's Disease: Early Warning Signs and Diagnostic Resources. The Junior League of NYC, Inc, 1988

 

Many medical and psychological conditions can also cause Alzheimer's symptoms. About 20% of suspected Alzheimer’s cases, in fact, turn out to be some other disorder, half of which are potentially treatable or controllable. [ See How Is Alzheimer’s Disease Diagnosed?, below.]

HOW IS ALZHEIMER’S DISEASE DIAGNOSED?

Ruling Out Other Causes Memory Loss or Dementia

A definitive test to diagnose Alzheimer’s disease, even in patients showing signs of dementia, has not yet been devised, so the first step is to rule out other conditions that might be causing memory loss or dementia. There are now three known major causes for dementia in the elderly:

As yet, it is very difficult to differentiate among these dementias. Other diseases, many common in the elderly, can also cause symptoms that resemble Alzheimer's disease.

Lewy Bodies Variant. Lewy bodies are abnormalities found in the brains of patients with both Parkinson's disease and Alzheimer's. They can also be present in the absence of either disease; in such cases, the condition is called Lewy bodies variant (LBV). In all cases, the presence of Lewy bodies is highly associated with dementia. LBV was defined in 1997 and some experts believe it may be responsible for about 20% of people who have been diagnosed with Alzheimer's. One study reported that patients with LBV may be more likely than Alzheimer's patients to have hallucinations and delusions early on, to walk with a stoop, and to perform better on verbal recall but less well organizing objects.

Vascular Dementia. Vascular dementia is primarily caused by wither multi-infarct dementia (multiple small strokes) or Binswanger's disease (which affects tiny arteries in the midbrain). One analysis of a number of studies suggests that patients with vascular dementia have better long term verbal memory than Alzheimer's patients, but poorer executive function (less ability to integrate and organize). Experts currently believe that 60% of cases of dementia are due to Alzheimer's, 15% to vascular injuries, and the rest are a mixture of the two. In general, dementia caused by stroke is rarely reversible.

Mild Cognitive Impairment. Some elderly people have a condition called mild cognitive impairment, which involves more severe memory loss than normal but no other symptoms of Alzheimer's.

Other Conditions that Cause Similar Symptoms. A number of conditions, including many medications, can produce symptoms similar to Alzheimer's:

It is important that the physician recognize any treatable conditions that might be causing symptoms or worsening existing dementia caused by Alzheimer's or vascular abnormalities.

Psychological Testing. A number of psychologic tests are used or being developed to assess difficulties in attention, perception, and memory and problem-solving, social, and language skills.

Electroencephalography

Electroencephalography (EEG) traces brain-wave activity; in some Alzheimer’s patients this test reveals "slow waves.” Although other diseases may evidence similar abnormalities, EEG data helps distinguish a potential Alzheimer’s patient from a severely depressed person, whose brain waves are normal.

Imaging Tests

Computerized tomography (CT), magnetic resonance imaging (MRI), and positron-emission tomographic (PET) are sometimes used in confirming a diagnosis of Alzheimer's in patients with other indications. Positron-emission tomographic (PET) is a more advanced technique that can show brain activity and may eventually detect early Alzheimer's before symptoms occur. For example, in one study PET scans revealed higher brain activity in older APOE4 carriers who were undergoing memory tasks than noncarying peers. These results suggest that the genetically susceptible people find such tasks more demanding. (Blood tests alone for ApoE4 gene are not useful for diagnosing Alzheimer's.) Such scans can also be used to detect the presence or rule out multi-infarct dementia, stroke, blood clots, tumors, or hydrocephalus.

Blood Tests

High blood levels of a substance called p97 may prove to help detect the presence of Alzheimer's, but more research is needed. Other blood tests may rule out metabolic abnormalities.

Odor Test

Of interest was a study in which individuals with mild mental impairments were given a "scratch and sniff" test and asked to distinguish between about 40 different odors. About 40% of those who had a significantly difficult time distinguishing between smells went on to develop Alzheimer's over a 20 month period. (Most of them believed they had a good sense of smell). None of the people who could distinguish odors developed the disease.

Determining Severity after a Diagnosis Has Been Made

Once a diagnosis has been made, some experts observe that certain factors at the time of diagnosis indicate a higher risk for a more rapid decline:

WHAT ARE THE LATEST DRUG TREATMENTS FOR ALZHEIMER’S DISEASE?

Most drugs currently being used or that are under investigation to treat Alzheimer's are aimed at slowing progression. To date, none are cures. In fact, the improvements from some of these drugs may be so modest that even the patients and their families are not aware of them. Even in these cases, however, the drugs may delay the need for admission to nursing homes. Since nearly all the studies are conducted on Alzheimer’s patients in mild to moderate stages of the disease, it is important to seek out clinical drug trials as soon as Alzheimer’s disease is diagnosed. Caregivers need to be available to help patients comply with any experimental therapies.

Drugs that Protect the Cholinergic System

The standard drugs used for Alzheimer's are designed to protect the cholinergic system, which is essential for memory and learning and is progressively destroyed in Alzheimer’s. The benefits of these drugs are far from dramatic, however. About half of patients with mild to moderate disease show slight improvement, and when they go off the drugs the deterioration continues. All drugs have gastrointestinal side effects, including nausea. Many experts have reservations about developing more drugs that affect the cholinergic system since, at best, they only slow progression, but will never cure the disease.

Comparative studies are needed to determine which of these agents are most beneficial with least side effects.

Anti-Inflammatory Drugs as Treatment

Anti-inflammatory drugs are being studied for treatment as well as prevention of Alzheimer's.

Ginkgo Biloba

Ginkgo biloba is a common herb that has antioxidant properties and appears to increase blood flow to the brain. Some studies have suggested that ginkgo biloba may slightly improve the memory of Alzheimer's patients. Small studies have indicated that the effects in the brain were comparable to those of tacrine and donepezil and that ginkgo has only minimal side effects. The herb is available over the counter, but there are no standards in the US to regulate its quality or effectiveness. (The website www.naturaldatabase.com compares brands by quality.) The agent poses a small risk for bleeding, which may increase in combination with other medications, such as warfarin or high-doses of vitamin E.

Nicotine and Related Agents

Nicotine enhances the actions of the cholinergic system (which is depleted in Alzheimer's disease) and is known to improve concentration and memory in the short term. Some studies have suggested that nicotine may protect nerve cells and help prevent the formation of beta amyloid.

Nicotine Agents. Researchers are investigating nicotine replacements and a number of nicotine-like drugs or agents that act on the receptors for nicotine in the brain. Research to date, however, has found no strong evidence of improvement with the nicotine patches or other nicotine replacement methods.

Smoking. There is no evidence that smoking is protective against Alzheimer's. In fact, some research suggests it may slightly increase the risk for dementia. One study indicated that smoking might help protect against Alzheimer's disease in carriers, but not noncarriers, of the ApoE4 gene. In any case, smoking is never recommended for either prevention or treatment. (Nicotine itself, unlike smoking, does not appear to cause cancer.)

Other Investigative Agents

A number of other agents are being investigated and show promise in early or late trials. Intense areas of research are focusing on agents that prevent beta amyloid build-up, its toxic effects on nerve cells, or other mechanisms of the disease process. Among them are the following:

Investigative Procedures

Certain procedures are being tested for Alzheimer's.

Treating Symptoms Associated with Alzheimer's

Depression. Major depression with dementia that occurs in elderly people may be an early sign of Alzheimer's; in such cases, it precedes Alzheimer's by two years or less. Some experts believe that disease progression may even be delayed by treating such people with both an antidepressant and a drug, such as donepezil, currently used for Alzheimer's. The antidepressants known as selective serotonin reuptake inhibitors (SSRIs) may be particularly effective in relieving depression, irritability, and restlessness associated with Alzheimer's.

Apathy. Depression is often confused with apathy, which according to one study is more common than depression in Alzheimer's patients and responds to stimulants, such as methylphenidate (Ritalin), rather than antidepressants. An apathetic patient lacks emotions, motivation, interest, and enthusiasm while a depressed patient is generally very sad, tearful, and hopeless.

Symptoms of Psychosis (Wandering, Irritability, Aggression, and Hallucinations). Verbally or physically aggressive behavior, wandering, and hallucinations have been traditionally treated with standard antipsychotic drugs, such as haloperidol (Haldol), but they have severe side effects. Newer, so-called atypical antipsychotics, including risperidone (Risperdal) and olanzapine (Zyprexa), appear to significantly decrease symptoms of psychosis and aggression while posing a very low risk for severe side effects. Carbamazepine, an anti-seizure drug, may also be effective for agitation and dementia.

Disturbed Sleep. Alzheimer's patients commonly experience disturbances in their sleep/wake cycles. Studies suggest that exposure to brighter-than-normal artificial light during the day can reset these cycles and prevent nighttime wandering and sleeplessness. This treatment is not effective for visually impaired patients. Trials on melatonin, a natural hormone that helps trigger sleep at night, are in progress.

WHAT ARE THE PHASES OF ALZHEIMER'S DISEASE AND THEIR MANAGEMENT?

The remaining life span of an Alzheimer’s victim is generally reduced, although a patient may live anywhere from three to twenty years after diagnosis. The final phase of the disease may last from a few months to several years, during which time the patient becomes increasingly immobile and dysfunctional. Caregivers should understand the phases of this illness in order to help determine their own capacities for dealing with this painfully sad disease.

Home Treatment in Early Stages

Telling the Patient. Often physicians will not tell patients that they have Alzheimer's. Studies indicate that progression may be slowed down with intellectual effort and most investigative drug trials are performed in early stages. If an Alzheimer’s patient expresses a need to know the truth, it should be disclosed. Both the caregiver and the patient can then begin to address issues of this disabling disease that can be controlled, such as access to support groups and drug research.

Mood and Emotional Behavior. Alzheimer’s patients display abrupt mood swings and many become aggressive and angry. Some of this erratic behavior is caused by chemical changes in the brain. But certainly, it can also be attributed to the terrible and real experience of losing the knowledge and understanding of one’s surroundings, causing fear and frustration that they can no longer express verbally.

The following recommendations for caregivers may help reduce agitation:

Although much attention is given to the negative emotions of Alzheimer’s patients, some become extremely gentle, retaining an ability to laugh at themselves or appreciate simple visual jokes even after their verbal abilities have disappeared. Some appear not unhappy, but to be in a drug-like or “mystical” state focusing on the present experience as their past and future slip away. Encouraging and even enjoying such states may bring some comfort to a caregiver.

There is no single Alzheimer’s personality, just as there is no single human personality. All patients must be treated as the individuals they continue to be, even after the social selves have vanished.

Appearance and Cleanliness. For the caregiver, grooming the Alzheimer’s patient may be an alienating experience. For one thing, many patients resist bathing or taking a shower. Some spouses find that showering with their afflicted mate can solve the problem for a while. Often the Alzheimer’s patient loses the sense of color and design and will put on odd or mismatched clothing. This may be very frustrating to a loved one, particularly since (certainly in the beginning) embarrassment is a common and painful emotion experienced by the caregiver. It is important to maintain a sense of humor and perspective and to learn which battles are worth fighting and which ones are best abandoned.

Driving. As soon as Alzheimer’s is diagnosed, the patient should be prevented from driving. A Swedish study found that over half of elderly people involved in fatal accidents had some degree of neurologic damage.

Wandering. A potentially dangerous trait is the Alzheimer’s patient’s tendency to wander. At the point the patient develops this tendency, many caregivers feel it is time to seek out nursing homes or other protective institutions for their loved ones. For those who remain at home, the following precautions are recommended:

Sexuality. In many cases, the Alzheimer’s patient becomes uninhibited sexually; at the same time, the patient’s physical deterioration and receding capacity to recognize the spouse as a known and loved individual can make sexual activity despairing and repellent for the caregiving spouse. Other patients may lose interest in sex. If sexual issues are a problem, they should be discussed openly with the physician, and ways should be found to maintain non-sexual physical affection that can bring comfort to both the patient and the spouse.


Twelve Steps for Caregivers



1. Although I cannot control the disease process, I need to remember I can control many aspects of how it affects my relative.

2. I need to take care of myself so that I can continue doing the things that are most important.

3. I need to simplify my lifestyle so that my time and energy are available for things that are really important at this time.

4. I need to cultivate the gift of allowing others to help me, because caring for my relative is too big a job to be done by one person.

5. I need to take one day at a time rather than worry about what may or may not happen in the future.

6. I need to structure my day because a consistent schedule makes life easier for me and my relative.

7. I need to have a sense of humor because laughter helps to put things in a more positive perspective.

8. I need to remember that my relative is not being difficult on purpose; rather that his/her behavior and emotions are distorted by the illness.

9. I need to focus on and enjoy what my relative can still do rather than constantly lament over what is gone.

10. I need to increasingly depend upon other relationships for love and support.

11. I need to frequently remind myself that I am doing the best that I can at this very moment.

12. I need to draw upon the Higher Power, which I believe is available to me



Source: The American Journal of Alzheimer's Care and Related Disorders & Research, Nov/Dec 1989

 



Home Treatment During Later Stages

The Alzheimer’s patient needs 24-hour a day attention. Even if the caregiver has the resources to keep the Alzheimer’s patient at home during later stages of the disease, outside help is still essential.

Incontinence. An Alzheimer’s patient’s incontinence is generally devastating to the caregiver and a primary reason why many caregivers decide to seek nursing home placement when the patient reaches this stage. When the patient first shows signs of incontinence, the doctor should ascertain that it is not caused by an infection. Urinary incontinence may be controlled for some time by trying to monitor times of liquid intake, feeding, and urinating. Once a schedule has been established, the caregiver may be able to anticipate incontinent episodes and get the patient to the toilet before they occur.