Wendell used to be vibrant and healthy, sharp as a tack with anyone he met. He could answer any question you threw at him, and he loved to laugh. His chuckling would resonate throughout the room.
When he was much younger, Wendell could easily count backwards from 100, by sevens. Once, to the amazement of his friend, Wendell started at 1,000, and by sevens he counted in reverse, to zero.
Wendell was a psychologist with a private practice until he was in his early 70s. But those days seem so long ago now. At 76, Wendell can’t remember what you just told him seven seconds ago.
Ask him to recall the struggles with writing his dissertation in graduate school 50 years ago, however, and he will paint a vivid picture of all the challenges and frustrations that went into the process. He can also tell you in great detail what the document was about, even though he hasn’t looked at it in nearly half a century.
He can remember the address of his childhood home as well as the first house he and his wife owned. There have been three other homes since, all of which Wendell could describe in great detail as recently as six months ago.
He wishes that he could stay in his present place, but his daughter said that he could no longer live alone. So kicking and screaming, Wendell “permitted” her to place him in an assisted living community. She visits him several times a week. Each time, she leavers sadder than when she came.
It’s hard for her to see her father “losing his mind.” But that’s what dementia does to a person. It robs them of the present moment.
Dementia Is Not Alzheimer’s
“Dementia is a symptom; much like a cough or a fever is a symptom of the flu,” said Jennifer Hay, in Alzheimer’s & dementia: Questions you have . . . answers you need (1996). “If you have a cough, it doesn’t necessarily mean you have lung cancer, and if you have dementia, it doesn’t necessarily mean you have Alzheimer’s disease. The cough could be a symptom of respiratory influence, for example, and dementia could be a symptom of a stroke.”
Wendell never had a stroke. In fact, his doctor proclaimed him “health as a horse” during his last check-up. Heart disease does not run in Wendell’s family. So why can’t he recall the simplest things?
People with dementia have particular problems with their short-term memory, consistently forgetting what they’ve just said or done, even though they can often clearly remember events that happened many years ago (Hay, 1996). Their sense of time and place in the here and now is typically lost. They may develop problems with finding words, and it becomes increasingly difficult for them to learn new information and to do new things.
As time goes by, they need help to perform even the most basic tasks of everyday living, including washing, dressing, and eating. Eventually, people with dementia may become uncommunicative and incontinent (Hay, 1996).
Possible Round-the-Clock Care
Wendell isn’t at this stage yet, but his daughter suspects it is coming. Most people with dementia eventually require 24-hour care, often for many years—five, 10, or even 20 years. As the disease progresses, these individuals may experience confusion or disorientation; perform repetitive behaviors; have difficulty tracking or processing information; or find themselves anxious, fearful, or paranoid. The dementia-challenged person may also shuffle and be slightly off balance, or have problems with depth perception, according to the National Institute on Aging (2011).
“Dementia frequently brings about impaired judgment and a loss of inhibitions, causing individuals to exhibit behaviors that may appear odd and may be out of character for them,” said Laura Wayman, author of A Loving Approach to Dementia Care. “Worse still, as their short-term memory fades, they can become caught up in painful, unresolved memories and feel trapped by the negative feelings the memories trigger. This ‘rut’ may be behind the strange behaviors” (2011).
In addition, persons with dementia might have difficulty making decisions. Their ability to be organized and to do multiple tasks simultaneously might become limited. And, they might choose not to participate in usual activities if there are too many outside stimuli, according to Laura Wayman, author of A loving approach to dementia care (2011).
“Dementia turns the person’s life upside down,” Wayman said. “It steals their personality, likes, dislikes, and their special individuality, little by little. After a while, they become nothing more than a shell of their former selves” (2011).
The Odds Are Stacked Against Him
Wendell’s’ daughter dreads the day she will no longer recognize her dad because dementia has stolen his astute, animated personality. She also hopes against all hope that his form of dementia is not Alzheimer’s disease, because Alzheimer’s can be deadly. But the odds are not good because Alzheimer’s is the most common type of dementia, accounting for 60 percent to 80 percent of all dementia cases (Alzheimer’s Association, 2011). It is the fourth leading cause of death in the United States, accounting for 150,000 deaths per year. By the year 2040, 14 million Americans will be directly affected by this disease (McCurry & Larson, 2002).
The greatest known risk factor for Alzheimer’s is increasing age, and the majority of people with the disease are 65 or older. In fact, the likelihood of developing Alzheimer’s doubles about every five years after age 65, according to the Alzheimer’s Association. After age 85, the risk reaches nearly 50 percent (2011).
One of the greatest mysteries of Alzheimer’s disease is why the risk rises so dramatically as we grow older, states the Alzheimer’s Association. Researchers have yet to come up with an answer.
The one thing that researchers do know, though, is that Alzheimer’s is not just a disease of old age. As many as 5 percent of people with the disease have early-onset Alzheimer’s, also known as younger-onset. It often appears when someone is in their 40s or 50s, according to the National Institute on Aging (2011).
Risk Factors: What to Look For
Regardless of when Alzheimer’s emerges in the individual, those who have a parent, brother, sister, or adult child with Alzheimer’s are more likely to develop the disease. The risk spikes if more than one family member has the illness. When diseases tend to run in families, either heredity or environmental factors, or both, may be the culprit (Cayton, Graham, & Warner, 2001).
While important risk factors like age, family history, and heredity can’t be changed, emerging evidence suggests there may be other factors that can increase the chance of acquiring Alzheimer’s, according to Fisher Center for Alzheimer’s Research Foundation (2010). They include general lifestyle, wellness choices, and effective management of other health conditions such as the following:
- Head trauma: A strong link exists between serious head injury and future risk of Alzheimer’s, especially when trauma occurs repeatedly or involves loss of consciousness. To guard against this kind of trauma, the Fisher Center for Alzheimer’s Research Foundation said it is important to do things like use a seat belt when driving; wear a helmet when participating in sports; or “fall-proof” your home (2010).
- Heart-head connection: Growing evidence links brain health to heart health. The brain is nourished by one of the body’s richest networks of blood vessels. Every heartbeat pumps about 20 percent to 25 percent of blood to the head, where brain cells use at least 20 percent of the food and oxygen that the blood carries (Fisher Center for Alzheimer’s Research Foundation, 2010).
The Alzheimer’s Foundation of America confirms the heat-head connection, stating that the risk of developing Alzheimer’s, or vascular dementia—a form of Alzheimer’s—appears to be increased by many conditions that damage the heart or blood vessels. These include high blood pressure, heart disease, stroke, diabetes, and high cholesterol. For this reason, it may be imperative for a person to work with his or her doctor to monitor heart health and treat any problems that arise (2010).
“Studies of donated brain tissue provide additional evidence for the heat-head connection,” reports the Alzheimer’s Foundation of America. “These studies suggest that plaque and tangles in the brain are more likely to cause Alzheimer’s symptoms if strokes or other damage to the brain’s blood vessels are also present” (2010).
- General healthy aging: Other lines of evidence suggest that strategies for overall healthy aging may help keep the brain as well as the body fit. The strategies might even offer some protection against developing Alzheimer’s or related disorders, according to the Fisher Center for Alzheimer’s Research Foundation. Areas to focus on include keeping weight within recommended guidelines; avoiding tobacco and excess alcohol; staying socially connected; and exercising both body and mind (2010).
Health and wellness choices might not even be enough to slow or prevent the onset of Alzheimer’s disease amongst Latinos and African-Americans in the United States, said the Alzheimer’s Association. These two groups have higher rates of vascular disease. Because of this, they might also have a greater propensity for developing Alzheimer’s. Among the population in general, a growing body of evidence for vascular disease—including diabetes, high blood pressure, and high cholesterol—may be a risk factor for Alzheimer’s and stroke-related dementia (2011).
Was Wendell Predisposed to Alzheimer’s?
Wendell suffered a fairly significant head injury when he was younger. He was involved in a car crash on an icy road some years back that at the time seemed life threatening. So it’s possible the accident might have predisposed him to Alzheimer’s. But the verdict is still out on this diagnosis.
If Wendell does develop Alzheimer’s, it’s likely to cause his death within 4-6 years, as the disease methodically twists and ties up nerve cells in certain areas of the brain that control cognitive ability and basic motor skills such as swallowing, walking, or controlling bladder and bowel movements, said Emily Yoffe, author of How Does Alzheimer’s Kill? (2001).
For example, difficulty swallowing can cause food to be inhaled, which can result in pneumonia. Inability to work can lead to bedsores. In continence can result in bladder infections. These infections become particularly difficult to deal with because Alzheimer’s patients are unable to understand and participate in their own treatment. They may forget how to perform simple tasks and, ultimately, how to move their muscles. Finally, they may end up in a vegetative state (Yoffe, 2001).
“Doctors say it’s possible that an Alzheimer’s patient can progress to the point that damage occurs to the centers of the brain that controls breathing—leading to the person’s death,” Yoffe said. “But patients rarely get that far without an infection setting in. Once a patient is extremely incapacitated, there is little medical motivation to aggressively treat such infections, and the patient usually dies” (2001).
Corey Leidenfrost, author of How Does Alzheimer’s Eventually Kill You? states that physical problems are compromised due to the consequences associated with the course of the disease. As a result, the person’s ability to deal with infections or other illnesses is severely weakened, and there is little the family can do to prevent death from coming (2011).
“While a clot in the lung, or a heart attack, may take the person’s life, it is often more likely that something as simple as a cold may be the culprit in the advanced stages of the Alzheimer’s, taking the individual’s life,” said Leidenfrost said (2011).
No Cure for Alzheimer’s Yet, Unfortunately
Exacerbating the problem is that there is no known cure for Alzheimer’s disease, according to the Alzheimer’s Foundation of America. Researchers are continually testing the effectiveness of various drug therapies to control symptoms; reduce or reverse mental and behavioral indicators; and prevent or halt the disease. But at present, the best researchers can hope for is that medications provide some relief of symptoms and decline in mental function (2010).
This places the burden on caregivers, who are charged with such responsibilities as making financial decisions; managing changes in behavior; and helping a loved one get dressed in the morning, said Wyman. Further complicating the issue is that no two people experience Alzheimer’s disease in the same way. As a result, there is no one approach to caregiving (2011).
“Something that all caregivers share in common, though, is that their duties are hard work,” Wyman said. “But by learning caregiving skills, you can make sure that your loved one feels supported and is living a full life. You can also ensure that you are taking steps to preserve your own well-being” (2011).
This is the hope that Wendell’s daughter has for her father as his disease progresses. She wants him to be well cared for. He will receive the care he needs if she finds the people and resources to help him.
Difficulties, Not Ease, Awaits Wendell
But as the dementia takes its course, Wendell will become more and more resistant to getting up and out of the house on time, especially for his appointments. Over time, the disease will drain him of energy and enthusiasm. He will withdraw from social activities. He will experience changes in mood and personality. Moreover, difficulties with words in speaking and writing will occur. And when he converses with others, he will ask for the same information over and over.
Nothing will make sense to Wendell. His daughter will feel the same way. She will be at her wit’s end knowing how to care for her father.
So she will have to turn to organizations such as the Alzheimer’s Association (alz.org), Alzheimer’s Foundation of America (alzfdn.org), Alzheimer’s Disease Education and Referral Center (alzheimers.org), and the National Institute on Aging (nia.nih.gov). She will also have to recall something a friend once told her about Alzheimer’s: Take it one day at a time.
Embracing this advice, Wendell’s daughter must find the strength to persevere. This should be welcomed relief to Wendell, who desperately needs her daughter for as long as he lives.
Alzheimer’s Association. (2011). What is Alzheimer’s? Retrieved from http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp
Alzheimer’s Foundation of America (2010). Brain health. Retrieved from http://www.alzfdn.org/BrainHealth/issuestoaddress.html
Cayton, H., Graham, N., & Warner, J. (2001). Alzheimer’s and other dementias: The at-your-fingertips guide. London, GBR: Class Publishing. Retrieved from http://site.ebrary.com/lib/benu/Doc?id=10089208&ppg=1
Fisher Center for Alzheimer’s Research Foundation. (2010). Treatment and care. Retrieved from http://www.alzinfo.org/treatment-care
Hay, J. (1996). Alzheimer’s & dementia: Questions you have . . . answers you need. Allentown, PA: People’s Medical Society.
Leidenfrost, C. (2011). How does Alzheimer’s eventually kill you? Retrieved from http://www.livestrong.com/article/140863-how-does-alzheimers-eventually-kill-you/#ixzz1To7v3jo0
Wayman, L. (2011). A loving approach to dementia care. Baltimore: The Johns Hopkins University Press.
Yoffe, E. (2001). How does Alzheimer’s kill? Retrieved from http://www.slate.com/id/1007601/