George A. Sprecace M.D., J.D., F.A.C.P. and Allergy Associates of New London, P.C.
www.asthma-drsprecace.com


ALZHEIMER’S DISEASE

NOTES FROM THE RECENT LECTURE BY DAVID TROXEL, MPH

May 10, 2013, L&M Hospital, New London, Ct.

 

·         Currently, there are over 5 million persons – and their families – living with this disease. One in three families are touched by it.  This incidence is on track to quadruple in the next few decades. 

·         The costs involved in caring for these patients exceeds those for Cancer and Heart Disease.

·         Dr. Alzheimer in 1901 had a 51 year old patient, Auguste Detca, whose self-description was “ I have lost myself”.  At autopsy, Dr. Alzheimer found “plaques and tangles” in her brain.

·         The condition is age-related.  That did not much matter in 1900, when the life expectancy  was 47 years.  Now that is over 80 years.

·         The best diagnostic test is the PET scan, wherein glucose uptake measures brain activity.  The finding here: “a damaged brain”, particularly in the Hippocampus.

·         The hallmark symptom / sign is a progressive decrease in short-term memory.  Other signs include reduced reasoning and judgment, confusion, reduced speaking and writing ability, withdrawal, and changes in mood and personality.

·         “Dementia” is an umbrella term.  AD is a form of dememtia.

·         A complete medical and neurologic workup is vital, to rule out more treatable or different  conditions and to establish the diagnosis. This includes neuropsychologic  testing.

·         “If you remember forgetting, that’s OK.  If you forget that you forgot, that’s not OK.”

·         This disease is slow and progressive.  If there is a sudden development or increase of symptoms, look for something else. 

·         Treatment Modalities: Stay active, physically and mentally; (PS: studying a language or a musical instrument can be very helpful. GS).  Remain or become socially active. Follow the Mediterranean Diet. Several medications are available, although there has not been a break-through in 10 years, the medications have side-effects and also interactions with psychotropic agents…and they are generally only modestly effective and short-term.  Be aware of and treat concurrent pain appropriately.

·         How to deal with a patient with AD.  “Here we need bar-maids and beauticians:  up-beat and good listeners”.  Treat the patient as a real person.

·         Effective Tools: Conversation. Creative Activities. Purposeful Chores; Foster Learning and Growth; Use their  Life Story. Exercise; Music; Laughter. Pets and other animals. Use the  Outdoors; Give Choices. Ask for Opinions. Celebrate Cooking and Dining. Use Old Rituals, Old Habits. Fun and Novelty.

·         (If the patient has been religious, encourage that.  If the patient has not been spiritual, help him or her find a spiritual life.  GS)

·         Undertake legal and financial planning in timely fashion, (including Advanced Directive and Powers of Attorney for Health Affairs and for Financial Affairs – GS). Be prepared to use “Substituted Judgment” for the incompetent patient.

·         Don’t wait to tap available services outside of the family.

·         Be a “best friend”.

·         (In fact, this patient may be having a better day, day after day, than you are in caring for them: each day can be a new day, with new experiences and new “friends”…including yourself.  GS)

·         And think about your own life.  Be satisfied with yourself. Think about your anticipated care for yourself toward the end of this journey called Life. 

·         See “Best Friends Approach.com”.

A final personal note, in addition to those above (GS). 

Life is not an endurance contest.  Every stage should be lived to the fullest.  Remember Auntie Mame’s famous caution: “LIFE IS A BANQUET, AND MOST POOR SUCKERS ARE STARVING TO DEATH”.  And keep your “bucket” empty: if something is important to you and worth doing…DO IT NOW!      

George A. Sprecace, M.D., J.D.


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