Alzheimer's Disease - A Guide For Carers
There are various definitions of Alzheimer 's disease including:
- "The slow onset of memory loss leading to a gradual
progression to a loss of judgement and changes in behaviour and
temperament." - "A living death" - "The global impairment of
higher functions, including memory, the capacity to solve
problems of day to day living, the performance of learned
percepto-motor skills (for example tasks like washing, dressing
and eating), and the control of emotional reactions in the
absence of gross clouding of consciousness."
Memory Loss
Memory loss occurs in all cases of Alzheimer's disease. The most
recent memories are the first to be affected, the things we've
done in the last few hours or days. Later, as the disease
progresses, the past memory also deteriorates. The fact that
memory loss is such an important feature of Alzheimer's, the
testing of a person's memory is an easy and cheap method of
diagnosing the condition. Questions asked should be extremely
basic, for example:
- What day is it today? - How old are you? - Where are we now?
- What year is it? - What month? - Count backwards from 20 to 1.
These questions will test a person's short term memory, and also
orientation; disorientation being another problem experienced by
Alzheimer's suffers. Disorientation
Disorientation, or not knowing who or where you are, is closely
connected to memory loss. Typically, an Alzheimer's sufferer
will forget birthdays, become unsure of what day it is, and even
forgets their own name. You can understand why Alzheimer's has
been called 'a living death'.
Because it is the short-term memory that goes first, suffers who
go out alone have often returned to a house they lived in years
ago, thinking they have come home.
Disorientation inside the home can become a problem too but not
until the disease is in its later stages. It is important that
nothing is moved or changed in the home to preserve continuity.
If their environment and routine remains unchanged, an
Alzheimer's sufferer will remain more content and confident;
change the environment however and their confusion and
disorientation becomes readily apparent. This is why treatment
at home rather than in hospital is preferred and transfer to
hospital should be a last resort.
Personality Change
One of the cruellest aspects of Alzheimer's disease is the
change in personality many people experience. Often, the general
behaviour and personality of Alzheimers suffers in the later
stages will be in complete contrast to their usual behaviour
they exhibited in earlier life.
Mood swings, from being ecstatically happy to extremely sad,
verbal and sometimes physical aggression, and extreme anxiety
and nervousness often affect the Alzheimers sufferer and, of
course, the carer who can help best by offering continuous
reassurance and patience.
Personal Hygiene
Personal hygiene often becomes a major issue with the sufferer
forgetting to wash and bathe. Body odour, and stained and soiled
clothing and hands can be a cause of great stress and result in
a cruel loss of dignity.
Communication
During the early stages understanding simple speech remains
unaffected, but finding the correct words can be a problem and
the Alzheimers sufferer will often leave sentences unfinished.
The taking of messages particularly over the telephone can be
difficult and this is often one of the first signs of dementia.
As the disease worsens communication will become more difficult
as comprehension skills decrease. Eventually their whole speech
can become gibberish until eventually the Alzheimer sufferer
will cease to talk altogether and will withdraw into his or her
small world.
Sleep
Although the amount of sleep required by an Alzheimers sufferer
is unlikely to change, their sleep cycle may do. So, instead of
wanting to sleep at night and be awake during the day, this
could become reversed. This isn't a problem of itself except for
the carer who will have his or her nights disrupted.
The carer is advised to keep the patient active and awake during
the day as much as possible, even though it is tempting to seize
an opportunity to do some chores and enjoy some peace and quiet
should the sufferer fall asleep. A warm drink at bedtime may
help, although any problems with incontinence should be
considered. Ensure there are no other reasons for the restless
nights, such as joint pain or night cramps. In the event the
latter are a problem, administer mild painkillers. In the worst
case scenario, many people use a night sitting service to ensure
the sufferer is closely supervised while the carer gets a few
nights of undisturbed sleep.
Malnutrition
Eating and drinking can be a problem with Alzheimer suffers.
More accurately the lack of food and drink and the resulting
malnutrition is the problem.
A sufferer may develop an irrational fear of the food you are
providing, or they may simply forget or refuse to eat. Two
likely causes of the latter are ill-fitting dentures, especially
if the sufferer has lost weight; and constipation. A well
balanced diet with plenty of roughage and a high fluid intake
will help prevent constipation.
General Advice For Carers
It is difficult to judge who has the worse time, the Alzheimers
sufferer or the carer. In the early stages of the disease it is
probably the sufferer, in the latter stages it is undoubtedly
the carer.
Help minimise disorientation by not moving anything in the home.
To do so will make their confusion worse.
Admit an Alzheimers suffer to hospital as a last resort. Once
you do so disorientation and confusion will increase markedly.
Do not let a sufferer out alone, they may have difficulty
finding the way back home.
Do all you can to help the sufferer maintain dignity. - A warm
drink or a tot of their favourite alcoholic drink may aid sleep
at night. - Try to keep the patient active and awake during the
day. - Keep a cold drink nearby to remind the sufferer to take
fluids. - Keep disruption to routine to a minimum to prolong the
Alzheimers sufferer's independence as long as possible.
Closely supervise medication. It is very easy for the Alzheimers
sufferer to forget they have taken their medication, and take it
repeatedly. Alzheimer's disease is progressive and incurable,
although there are drugs that can slow the progression. It is
one of the saddest diseases in that it is difficult to care for
or regularly visit someone who no longer knows your name or
recognises you.
About the author Tony Luck runs a web site for silver surfers. You can find
more advice on health for the over 50s at his site.