As we become caregivers to our parents, many of us come face-to-face with Alzheimers disease for the first time. The impact of Alzheimers can be devastating on families, with patients, spouses, children and caregivers having to make tough choices from difficult decisions.
K.P. Unnikrishnan, a management consultant who lost his vibrant 70-year old mother to Alzheimers, eventually had to place her in a care-home and endure more than ten years of visits with a parent whose memory of him had faded completely.
Another family shared their story of a mother-in-law who was physically healthy but who kept trying to take a bus out of town.
As some of us approach middle age and are afflicted by a forgetfulness we laughingly blame on senior moments, there is an unspoken fear – what if this happens to me?
Dr. Renu Lalwani, Assistant Clinical Professor of Medicine at Columbia University, offers a perspective on understanding Alzheimers and how one can cope.
Alzheimers is a debilitating degenerative disease of the mind and the body; along with other dementia, Alzheimers is the fifth leading cause of death for the elderly and estimated to affect 1 in 8 persons in the age group of 69 and above.
In the US, about 4.5 million Americans suffer from Alzheimers and other dementias and these numbers are on the rise.
What symptoms should you look for?
Alzheimer sufferers face a gradual decline in verbal skills, forgetfulness, memory loss, anxiety and depression, leading to frustration, irritability and helplessness. As symptoms escalate patients may tend to repeat words or phrases, have hallucinations, show changes in personality, get lost in familiar territory or wander off.
How it presents
Alzheimers presents in two forms. In early onset Alzheimers, symptoms appear before the age of 60. The second more common type is late onset Alzheimers that presents after the age of 60. Rarely does it strike individuals as early as 30, but after the onset of Alzheimers, the average life span is usually about 8 years, though some patients have lived for over 20 years.
What causes Alzheimers?
The cause of Alzheimers is not well understood. Currently tests can help determine what type of dementia some patients have (for those who have an awareness of their problem) and if any treatable action is necessary. Some patients undergo tests to rule out other diseases causing dementia – such as a brain tumor, infection, stroke or a vitamin deficiency.
Can it be prevented?
Despite recent advances however, there are no definite treatments available that have been shown to stop or reverse the progression of Alzheimers.
In the US, FDA-approved medications do help to manage symptoms and delay progression, but currently there is no prevention for Alzheimers.
Behavioral interventions
In recent years, researchers have begun to explore behavioral interventions in preventing and slowing the progress of dementia. Evidence from observational studies show that when people participate in cognitive leisure activities in middle and late life, it may have a protective effect on the development and progression of Alzheimers disease and other dementias.
Research says, ‘stay active’
One prospective study from the New England Journal of Medicine tracked 500 subjects aged 75+ (without any baseline dementia) over a 5-year period; the study evaluated the risk of dementia against a baseline level of participation in leisure activities.
Results showed that those who regularly read, wrote, played board games, solved crossword puzzles, did arts and crafts, listened to music or played a musical instrument had a reduced risk of developing dementia. The study also showed that social dancing was the only physical activity associated with reduced risk.
Research has found that listening to music or playing an instrument can maintain and improve memory. Another excellent way to keep a patient active is to dance to music; it maintains gross and fine motor skills and helps improve balance. Participation in arts and crafts projects that stimulate creativity – molding clay, painting, stringing beads, knitting, crocheting, flower arrangement as well as hobbies like puzzles, reading and writing, – enhance a sense of pride and fulfillment and offer a venue for free expression.
A word of caution
Remember that these activities are not intended to keep a patient busy; rather, treat them as an aid to provide meaning in a patient’s daily life – tools that enable them to learn, play, contribute and interact socially while feeling safe with others.
It’s important too, that the leisure activity chosen is appropriate to the patient’s cognitive skills, language level, attention span and physical mobility limitations. If the activity is too difficult, it can frustrate the patient and if the activity is too simple he or she could feel humiliated and depressed.
The benefits of staying active
These activities have benefits; memory training, using memory devices like word lists or mnemonics, has been shown to have a positive impact in the area of the brain cells that processes memory.
Functional magnetic resonance imaging has shown reverse brain changes in mild cognitive impairment (a precursor state to dementia). The comparison of before and after images of memory training show increased activation and new recruitment of brain cells in this area of the brain.
Any activity that combines mental, physical and social stimulation offers the greatest benefit to patients in whom the illness has manifested. The success of such activities, however, depends on whether the task is meaningful, gives immediate pleasure and helps patients recapture their dignity and respect.
In the interim it seems prudent for those who are elderly and approaching middle age to continue to challenge ourselves in social and physical leisure pursuits and give ourselves a fighting change with the vagaries of aging and Alzheimers.
The information presented in this article is offered for educational and informational purposes only and should not be construed as personal medical advice. You should consult with your personal physician/care giver regarding your own medical care.
Meera Kymal is a contributing editor to India Currents