Momentary lapses of memory can be annoying, but they generally are not cause for concern. When memory loss has a serious impact on a person’s everyday life, it may be a sign of Alzheimer’s disease.
“With normal aging, our thinking processes slow down a bit,” says California Pacific Medical Center neurologist Catherine Madison, M.D. “We may have trouble coming up with a specific word or struggle with multi-tasking. Increased longevity over the last century has led to a greater number of individuals with neurodegenerative diseases, including Alzheimer’s.”
Alzheimer’s is a type of dementia, a progressive brain disorder that gradually destroys a person’s memory and ability to carry out daily activities. “Early signs of Alzheimer’s can be subtle and insidious, which is why they are often missed,” Madison says. “Symptoms may include problems with learning and short-term memory that disrupt normal routines, getting lost or disoriented even in familiar surroundings, using poor judgment, changes in personality, or loss of interest in social activities.”
Madison notes that symptoms of Alzheimer’s are caused by disruption of nerve- cell function in the brain. “The brain has over 100 billion cells called neurons that communicate with each other,” she explains. “With aging, we begin to accumulate collections of proteins – or plaques – between neurons that may cause cell death. The fibers running through nerve cells can also become disorganized –called tangles- further disturbing the normal flow of information. Large numbers of plaques and tangles in specific areas of the brain results in Alzheimer’s. There are other causes of dementia, but Alzheimer’s is the most common, affecting more than five million Americans.”
The primary risk factor for developing Alzheimer’s is aging. A family history of Alzheimer’s disease increases that risk. Other factors include head injury, hypertension, smoking, high cholesterol and diabetes. Physical and mental activity also play a role.
“That old phrase, use it or lose it,” applies to the brain as well as the body,” Madison says. “That’s why neurologists, and other doctors now lecture patients on the importance of exercise and a healthy diet. I also recommend getting a good night’s sleep and managing stress.”
Anyone experiencing changes in memory or signs of Alzheimer’s should seek an evaluation. “It is good to at least get a baseline analysis and discuss how to modify any risk factors,” Madison says. “The ‘work-up’ depends on the person’s specific situation and medical history, as well as examination results. Unfortunately, our ability to clearly see plaques and tangles in the brain is still limited, but ongoing research is getting us closer to making this more available. Imaging tests of the brain with MRI or CT scans are frequently performed along with blood tests.”
Cognitive testing provides additional information on memory and other cognitive abilities. Susan Woolley-Levine, Ph.D., a California Pacific neuropsychologist works closely with Madison to provide these evaluations. “Testing provides important information about whether there is a memory problem and why.” explains Woolley. Testing also assesses mood and stressors which can impact memory and thinking, and shows objective data about how a person’s cognition compares to age and education-matched peers.
For persons with memory concerns and undetected deficits, the results can provide reassurance and education. For others, when results show memory impairment, this is a starting point for a difficult discussion “Sometimes family members become frustrated with their loved one, because they think that person is simply not listening. But when the testing reveals brain-related problems, it helps provide the family with more direct information about a person’s inability to remember,” says Woolley.
Treatment options depend on the diagnosis. “It can be a relatively simple fix in a case of confusion and poor memory caused by improper medications or a sleep disorder,” Madison explains. “With a diagnosis of Alzheimer’s, we may use cholinesterase inhibitors that slow the breakdown of acetylcholine, an essential neurotransmitter. This can improve memory and help individuals stay mentally engaged. Another medication is available that can also aid with changes in behavior and memory. Other medications may help with attention, mood and sleep.”
Another aspect of treatment is providing supportive care to help individuals and their families deal with Alzheimer’s. Many people live at home, with care provided by family and friends.
“Alzheimer’s can create a heavy burden for caregivers,” says Robert Sarison, program manager for the Irene Swindells Alzheimer’s Residential Care ProgramOpens new window at California Pacific. “It helps ease the burden if caregivers recognize that even though their loved one is suffering from Alzheimer’s, there is still a person inside who needs to be loved and supported.”
Sarison advises families to “Stay positive, you can still have a meaningful relationship. Establish a comfortable routine. If the patient becomes argumentative or moody, don’t take it personally – it’s not you, it’s the disease.”
Sarison notes that caregivers also need to care for themselves. California Pacific offers a Caregivers’ Café support group that meets twice a month. Another resource he recommends is the Family Caregiver Alliance, which offers referrals to community resources such as day programs, support groups and homecare services.
California Pacific offers a day program in addition to a residential program for Alzheimer’s patients. Both are named for a former patient, Irene Swindells, whose sisters – Mrs. Harley C. Stevens and Mrs. Morris Doyle – donated funds in her memory. The day program helps give caregivers a respite while providing therapeutic services for the patient. The residential program provides long-term care for patients with moderate-to-severe dementia, including Alzheimer’s.
“We focus on enhancing patients’ quality of life with music, art and play therapy to stimulate cognition,” Sarison says. “People with dementia like an established routine, but they also enjoy participating in activities they can still do. Short-term memory is generally impaired first while long-term memory can still be intact, so we play old, familiar music.