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!
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