Alzheimer’s /Cures? No. Local assistance? Yes.

ORIGINALLY WRITTEN CYNTHIA MARTENS
Your mom is constantly writing down extensive notes every time you talk to her on the phone.


Your dad can’t remember how to get to the same grocery store he’s been going to for the last 50 years.


Your spouse incessantly paces the floor and aimlessly wanders about the house or neighborhood.


What’s wrong? Is it just a symptom of getting older? Can’t these odd behaviors just be ignored?


These could be symptoms of Alzheimer’s disease, and they are not a normal part of growing old, according to the Administration on Aging of the U.S. Department of Health and Human Services.


Well aware of Alzheimer’s symptoms, Noreen Weems, director of the Marion County Department for the Elderly, tries to help people who are confused and don’t know where to turn when a loved one has Alzheimer’s.


“We try to encourage family members to go to their physicians and contact the New Life Development Center,” Weems said.


To help bring attention to the disease on the local and national level, November has been set aside as National Alzheimer’s Disease Awareness Month.


Since 1983, November has been designated as a time to raise awareness of Alzheimer’s disease, focus on personal stories of people with the disease, and emphasize the importance of finding treatments, prevention and a cure.


Alzheimer’s disease is a disease that destroys brain cells. This cell destruction causes a decline in mental functions and affects memory, thinking, language and behavior.


While the disease can occur in people in their 40s and 50s, it most commonly affects those 65 and older.


Statistically, about one in every 10 people over 65 is diagnosed with Alzheimer’s, according to information offered by Randolph Whitely, family practice physician from Hillsboro.


Although many healthy individuals have more difficulty remembering certain kinds of information as they get older, the symptoms of Alzheimer’s disease involve more than simple lapses in memory, according to the Administration on Aging.


People with Alzheimer’s experience difficulties communicating, learning, thinking and reasoning, and these difficulties have an impact on a person’s work, social and family life.


“It helps for family members to know that the natural progression of Alzheimer’s is to become more and more forgetful, and eventually they don’t even remember their family members,” Whitely said.


“They usually start to fail to eat, get ‘the dwindles’ (losing weight) and most often eventually succumb to pneumonia due to a weak immune system (because they are malnourished.)”


Symptoms of the disease, which vary from person to person and change as the disease progresses, are usually categorized in the following three stages:


–The first symptom is forgetfulness. “Mom starts to fix a meal and forgets to turn the stove off with a pot sitting on the burner.”


Everyone begins to have some memory problems as they get older. For a person in the early stages of Alzheimer’s, these problems are more noticeable than in others of the same age. Forgetting people’s names or the location of familiar items is typical. But at this stage, forgetfulness still has little impact on lifestyle or employment.


–After a while, the memory loss becomes more severe. “Grandpa went shopping the other day and

didn’t remember where or how to record the amount of his purchase in his checkbook.”


Coworkers and friends notice the person’s memory loss and their difficulty understanding written material. The person may misplace or lose valuable objects.


As the disease progresses, the person can forget even major recent events and personal history, and can’t handle financial matters. At this stage, recent memory is more severely affected than long-term memory.


–In later stages, the person becomes disoriented and confused, and can no longer remember major personal facts. “I asked Dad about my uncle, and he couldn’t remember he even had a brother and then he got really angry with me.”


Familiar objects and people become unfamiliar. Personality and emotional changes also may occur. The individual may hallucinate, become delusional and anxious, or lose any sense of motivation. The person is often restless and active at night.


Someone with Alzheimer’s may not recognize the need for care and may resist help during the later stages. As brain function decreases, the ability to talk, move or do any self-care is eventually lost.


Alzheimer’s does not go away. The brain function of a person who has the disease continues to get worse until the person dies, which can occur three years to 20 years after diagnosis, according to information from Whitely.


One problem family members face is knowing what to do and where to turn if they suspect their family member has Alzheimer’s.


According to the Administration on Aging, it’s important that a professional evaluation is done to determine the cause of any signs of dementia.


The probable diagnosis of Alzheimer’s disease can be made after the physician takes a careful medical history and gives a physical examination, according to Whitely.


“Alzheimer’s is really a diagnosis by default,” Whitely said. “We first rule out metabolic causes, such as anemia, electrolyte abnormalities and Lupus. And if all is negative, but they do have short-term memory problems, (the probable cause is) Alzheimer’s.”


After a thorough medical exam and all other medical conditions are ruled out, the physician can administer a standardized set of scored questions to the patient in the exam room.


Whitely administers a Mini Mental State Examination and said this exam can be repeated over time to assess progression of the disease in each patient.


Questions and tasks, with a few examples listed in the following, are on the exam:


— Orientation. What is the year? What town or city are we in? What country are we in?


–Immediate recall. The physician says three words clearly and slowly, and asks the patient to repeat them.


–Attention and calculation. The patient is asked to begin with 100 and count backward by seven.


–Recall. The physician asks the patient to recall the three words previously asked in the immediate recall section.


–Language. Different language skills are tested, such as directing the patient to: “Take the paper in your right hand, fold it in half and put it on the floor.”


“No single test can diagnose Alzheimer’s disease, but clinical diagnosis is thought to be about 80 to 90 percent accurate,” according to information from the Alzheimer’s Association Sunflower Chapter in Wichita.


However, a definite diagnosis of Alzheimer’s disease can only be made after death by examining the brain tissue, Whitely pointed out.


He also said that there is no cure for Alzheimer’s. The goal of treatment is to preserve mental and physical function as much and as long as possible.


Medication is sometimes helpful. Some doctors believe medications such as tacrin (Cognex) and donepezil (Aricept) can be used in the early stages of Alzheimer’s to slow the progression of memory loss, according to information provided by Whitely.


Other community resources are also available for Alzheimer’s patients and their families.


Social workers, home-health care agencies and out-of-home services, such as adult day-care centers and mental health services, co-operate with the physician to help families deal with a loved one with Alzheimer’s.


The New Life Development Center at Hillsboro Community Medical Center is one local agency designed to help families coping with Alzheimer’s and other forms of dementia.


“We’re a short-stay, inpatient unit,” said Geraldine Hett, program director at New Life Center. “We evaluate the situation, diagnose and treat medically with medications.”


Patients typically stay 10 to 14 days on Hett’s unit, but they may stay longer if necessary for their treatment.


“A lot of people don’t know that this kind of help is right here in Marion County,” she said.


A geriatric psychiatric unit established in 1992, New Life accepts patients 65 years and older who have Alzheimer’s and other forms of dementia.


“A physician has to write the order for them to come here,” Hett said.


Staff at New Life consists of Hett, a social worker, an activity director, a nurse and a nurse’s aide.


The purpose of the facility is to evaluate the medical and mental state of each patient, help them adjust to care-giving and medications, provide counseling for family members, and recommend the appropriate placement when they leave the program.


“We probably see 100 patients come through here in a year, and we get them from all over the state,” Hett said. “Our facility is 100 percent reimbursed by Medicare after the Medicare deductible. The deductible is covered by either a secondary insurance or Medicaid.


“So a patient pays nothing to come here,” she said.


New Life has patient referrals from all different areas of the community.


Some patients will admit themselves because of their depression, family members will admit others, or nursing homes will admit patients with advanced stages of Alzheimer’s.


During the 10 to 14 days on Hett’s locked unit at HCMC, patients stay overnight with 24-hour supervision.


A typical day at New Life includes an activity schedule with games, exercise and socializing from 7 a.m. to 7 p.m.


At family consultations, Hett and her staff stress the importance of having a durable power of attorney.


When a patient can no longer make rational decisions for themselves, the staff tells the family it is imperative for them to have the DPOA to make those decisions for them, Hett said.


“We frequently help (family members) get emergency power of attorney for people who are in an acute stage,” she said.


An emergency DPOA can be acquired through the courts in 24 hours.


After a stay at New Life, Hett and her staff will recommend options available for long-term care of the patient.


If the patient is in the early stages of Alzheimer’s, they may be able to go back into their home or live with family members, while those in more advanced stages may go into care facilities.


Major advances have been made recently in identifying the brain chemistry and cellular processes that appear to be involved in the disease.


These recent discoveries raise hope that specific prevention or treatment measures can be developed in the future.


For the present, information from Whitely and Hett suggests people who have a family history of Alzheimer’s should see their physician on a regular basis.


And family members who suspect their loved ones have Alzheimer’s disease, should seek help through their local community medical resources.




Next week: Long-term options.

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