10 Oct 2020
It’s the diagnosis that no one wants to receive: Alzheimer’s Disease. An incurable, progressive form of cognitive decline that affects more than five million Americans, advancing slowly and quietly, Alzheimer’s disease (AD) destroys brain cells relating to memory. It remains hard to detect until it starts to interfere with everyday functioning.
Widespread misconceptions about AD can lead some of us to ignore symptoms, brushing them off as a normal part of aging. For others, there lurks a paralyzing fear of the loss of independence and the inability to recall what (and who) is dearest and most familiar.
Yet if caught early, there can be ways to manage some symptoms of fading memory, confusion, and irritability.
First Things First: See Your Doctor
The first course of action is to get a medical opinion.
Your primary care doctor can administer simple memory tests and evaluate you or a loved one for any underlying conditions, such as diabetes or an undetected infection that may be causing symptoms. She can order neurological tests if warranted, and will review your medications to determine if, alone or in combination, they might be causing adverse cognitive effects. But if your doctor suspects AD, your next move should be to explore your options and resources.
“When the family of an Alzheimer’s patient first comes to our center, the question most often asked is, ‘what will Dad be like a year from now?’” says Jessica Zwerling, MD, associate director at The Montefiore Einstein Center for the Aging Brain. “Families are often confused, afraid, and overwhelmed by all they’ve heard about the disease.”
Zwerling works with a multidisciplinary team of neurologists, geriatricians, neuropsychologists, and social workers who conduct a battery of cognitive and functional assessments. The whole-person approach involves not just the patient but also the family and the primary caregiver. “We focus on brain health combined with overall physical and mental health,” she says. “Memory issues often arise out of a combination of risk factors, stress, sleep disturbances, or side effects of certain medicines.”
Zwerling directs families to health resources in the community. “Patients and caregivers may have difficulty recognizing the social determinants of health, especially food insecurity,” she says. Access to resources can be temporarily or permanently diminished, making it difficult to obtain healthy, nourishing food. Zwerling notes, “During the peak of the COVID-19 crisis, connecting families to resources like Meals on Wheels was crucial, as the caregivers themselves often were restricted by stay-at-home orders.”
Involving the family in the care and management of a person with newly diagnosed Alzheimer’s is a central tenet of licensed social worker Joan Nimmo’s practice. As a care consultant with the Alzheimer’s Association’s Hudson Valley Chapter, Nimmo often witnesses families struggling to accept the changes in their loved one. “Mom is not the way she used to be, and that can be upsetting to everyone,” she says. Nimmo points out that the essence of the person still remains, even though their brain is not functioning as it once did. It’s the disease, not a lack of love, that causes their behavior to become inscrutable, frustrating, and even frightening.
“It’s painful to see a loved one change,” Nimmo says. While some family members take it in stride, others become impatient. “Scolding or contradicting an older relative only raises their anxiety, making the problem worse. You have to pick your battles,” she says. “If Mom thinks it’s 1965, what difference does it make? But if she starts to go outside without a coat, she needs to be distracted and redirected. And always gently.”
Some studies have shown that caring for a person with Alzheimer’s disease may be associated with an increased risk for developing cognitive impairment, particularly among spouses and unpaid family members. “Caregivers display symptoms of dementia at six times the rate of the general population,” says Lisa Feiner, MBA, M.ED., cofounder of Sharp Again Naturally, a resource and education non-profit based in Larchmont. “The physical, emotional, and mental toll on caregivers is extraordinary.” Caregivers may be subject to constant worry or sleep disruption; they might not be eating right or socializing as much: the same risk factors often found in people with dementia.
WORDS OF WISDOM FOR CAREGIVERS
The toll [of caregiving] on a caregiver can be high. It is difficult to see someone you love with an illness, and often the caregiver does not care for themselves. We often use that instruction you hear on the airplane, “If we go through turbulence and the oxygen mask drops down, put it on your face first. You cannot help another person if you cannot breathe.” The caregiver has to take care of their needs; meet a friend for lunch, ask your son to have lunch with his dad, go on a walk, take a bubble bath. Do whatever feeds you. – Joan Nimmo, Care Consultant with Alzheimer’s Association Hudson Valley
Medication and Supplements
Behavioral manifestations common to AD patients can sometimes improve with the appropriate medication – but not always. The FDA has approved a small number of drugs that can delay or slow the progression of symptoms. Zwerling advises that all medications, even those specifically approved by the FDA for AD, should be reevaluated periodically. “In later stages, nutritional intake may be an issue,” she notes. “Medications such as donezepil may need to be pulled off if gastrointestinal side effects are inhibiting food intake.” As with all drugs, it’s important to discuss with your doctor whether the side effects are worth the tradeoff in quality of life.
An alternative to pharmaceutical intervention that many people consider is the use of herbal remedies and dietary supplements. Some over-the-counter preparations have been touted as memory enhancers that may prevent or delay the onset of symptoms. Among these are coenzyme Q10, gingko biloba, and omega-3 fatty acids in pill form. Bear in mind, these products are neither regulated by the FDA nor supported by peer-reviewed research, so their effectiveness, purity, and safety are unknown. If you’re curious about this approach, do your research and always run it by your healthcare practitioner.
Experts agree there is no magic bullet that guarantees improvement for people with Alzheimer’s – or anyone displaying signs of cognitive decline. “A multi-therapeutic approach, which views the body as a set of interacting systems making up the whole person, is the only way to show lasting effects,” says Feiner. “We need to factor in nutrition, exercise, vascular health, inflammation, and anything else that can potentially affect the body and the brain.”
Sharp Again Naturally suggests ten health factors that can impact memory that, when addressed, can potentially help cognitive function. While more discussion of these factors, such as reducing stress and improving nutrition, exercise, and sleep habits, can be found on page 40 in this issue, Feiner’s advice is straight forward: Review your diet with your physician, naturopath, or nutritionist. Go over all your prescriptions, supplements, and over-the-counter remedies with your pharmacist to see if any might be affecting your memory. Read up on the effects of environmental toxins and heavy metals. You may have been exposed to some of these hidden, everyday poisons in your workplace, your home, or in your medicines or dental fillings.
Make a plan to improve your overall health and stick to it. After all, says Feiner, “The only side effect is better health.”
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