ALZHEIMER’S DISEASE

About 15% of people over 65 have some form of dementia. Alzheimer’s Disease is by far the most common cause of pre-senile dementia.

The main causes of dementia are:

•  Alzheimer’s Disease (50%)

•  Multi-infarct dementia (20%)

•  Combination Alzheimer’s and Multi-infarct (15%)

•  Rarer causes (15%)

Alzheimer’s Disease is rare before the age of 45. The duration of the disease is between 3 to 20 years, with an average of 7.5 years from diagnosis to death. It causes progressive and irreversible damage to brain cells (with brain shrinkage visible on CT scans). Confirmation of the diagnosis requires examination of brain tissue (usually at autopsy). The cause is unknown and there is no treatment.

The onset is usually gradual and can mimic depression with:

•  Decline in initiative

•  Memory failure (especially recent memory)

•  Poor concentration

The patient is usually distressingly aware of these early failings. It is at this stage that a formal evaluation of mental state is helpful as a baseline to detect later changes.

The condition gradually progresses to affect:

•  Personality (suspicion, delusions)

•  Behavior (violence, wanderings)

•  Intellect (loss of memory)

•  Language (aphasia)

The level of consciousness remains normal (there is no drowsiness). Psychiatric problems are common (depression, psychotic features).

Finally, the person loses personality (“the loss of self”) and becomes:

•  Incapable of self-care

•  Disorientated

•  Incontinent

•  Mute

•  Bedbound (bedsores, contractures)

Death is usually from bronchopneumonia or other infection. Life-prolonging measures are not appropriate at this stage.

The burden on carers is long-term and can become all-consuming and exhausting. Most carers are elderly spouses (often with their own health problems) or adult daughters (with other responsibilities).

Carers need:

•  Good medical support and interest

•  Emotional support

•  Nursing assistance

•  Time off (respite care)

•  Financial support (laundry, equipment, loss of earnings, home help)

•  Social contact with other carers

•  Regular help (volunteers, neighbors)

•  Family communication (agreement about levels of care)

•  Advice in the terminal phase (symptom control, place of care)

•  Bereavement support (grief can be intense)

Hospice philosophy and practice can be adapted for Alzheimer’s Disease patients and their families. However, extra support given only during the terminal phase (when the patient is often bedbound, mute) is not enough. Carers need long term assistance (particularly emotional support). Hospices can extend their skills to include Alzheimer’s Disease (and other conditions) by learning from, working with and teaching other caring organizations, rather than by necessarily increasing their own patient load.

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.