At the beautiful age of 71, Helen loves to wear purple, has a cat named Phoebe, enjoys fiddling in her flower garden and has a pile of magazines and paperbacks on her coffee table. Her two daughters, Jane and Sue, live near her with their children and make up all the family she ever sees, and although her husband died a few years back, she still lives at home and is drives around in a car she’s had for close to ten years.
Questions and more questions
Helen visits church on Sundays, the grocery store on Mondays, her friend's house for cards on Thursdays, and her daughters and grandchildren on the weekends. Helen seems to be self-sufficient and content, except that she is beginning to show signs of AD.
“Where did I leave my pocketbook?”
“What night do we play cards? I just can't remember.”
“I can't think of the right word...it's on the tip of my tongue!”
“I don't remember when my husband passed away.”
Her daughters have noticed the small changes, and they talk about these every time Helen’s friend visits them. They’re all in a quandary though as to whether it’s merely short-term forgetfulness, or more than that. Together, they talked Helen into seeing a doctor.
Their family physician
Their family physician, Dr. J, started off with a little small talk to put her at ease. Helen promptly shared that she had a routine that included church, cards and weekends playing with her grandchildren. He then proceeded to run an assessment: “Helen,” he ventured, “I'm going to give you a name and address. I want you to remember it because I'm going to ask you for it in a few minutes. John Brown. 42 East Street, Chicago, Illinois.” He followed that with a series of questions, including:
“What is today's date?”
“Can you tell me about something that happened in the news recently?”
“Would you mind drawing me a clock, including all of the numbers?”
“Now can you please mark the hands to show 9:10?”
“Remember that name and address I asked you? Can you please repeat them to me?”
Then Dr. Jones then turned to her daughters for the next part of the assessment:
“Tell me, does your mom have trouble recalling memories, recent or distant?”
“Does she have a hard time finding the right word during conversations?”
“How is your mom doing managing her finances and maintaining her home?”
“Is she able to perform all of her activities of daily living (dressing, bathing, eating, etc.), or has she needed more assistance?”
“Can she still drive? How do you feel as a passenger while she is driving?”
“How long have you noticed these symptoms?”
Following this, he performed a physical exam on Helen during which he explained that this was to rule out that symptoms that might have been caused by an underlying disease such as depression, thyroid disease or vitamin B-12 deficiency.
Dr. J explained how these questions regarding memory, problem-solving, abstract thinking and conversations are helpful in the diagnosis of a type of dementia. At the end of the appointment, he diagnosed Helen with Stage 3 Mild Alzheimer's Disease.
AD is a disease of the brain, Dr. J elaborated, causing brain cells to die, leading to progressive and irreversible damage. In the end, he encouraged Helen to continue reading, playing cards, doing word searches, jigsaw puzzles and the like. He then looked at Helen’s daughters and added that a continuous regimen of mental stimulation can mitigate the pace with which the brain’s functioning was regressing. He also suggested that she:
Reduce the amount of stress in her life through physical exercise
Eat a balanced heart-healthy diet of fruits, vegetables, grains, fish, and nuts
Maintain a daily calendar of activities.
Keep her keys near the front door.
Label her cabinets and drawers.
Write down helpful phone numbers and keep those near the phone
The initial treatment
Treatments differ drastically for different patients. However, for the time being, Dr. J recommended that Helen continue to visit him regularly. Eventually, as her symptoms progressed, another specialist would likely be needed to better care for her. At the present, they had treatment options to consider:
Medications: Donepezil, Rivastigmine and Gualantamine. These are that target neurotransmitters, which relay chemical information among brain cells. Once neurotransmitters are regulated, memory, thinking, and communication skills are better maintained. They had some side effects however, notably diarrhea, insomnia, headaches and fatigue. These however are not for everyone and need to be monitored regularly.
Remain well hydrated by drinking lots of water.
Occupational therapy could help in the future when activities of daily living become difficult.
Cognitive-Behavioral Therapy could be beneficial to help Helen talk through her emotions, fears and concerns.
Helen though was still Helen, despite her unnerving diagnosis. She was able to begin taking medications to reduce the onset of symptoms. And she benefited from a closer relationship with her daughters and grandchildren. She also got into the habit of starting each day with a glass of water, brain games, and a stroll to the end of her street.
Do you have a loved one experiencing signs of Alzheimer's Disease? Begin taking notice of the signs you observe and schedule an appointment with his or her physician. Check out these additional resources for more information:
The National Institute on Aging Guide to Caring for a Person with Alzheimer's Disease
Alzheimer's Association: If you have Alzheimer's Disease, what you should know, what you should do