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1/31/2010

Alzheimer's Disease: Early Signs and Symptoms You Need to Know

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I’d like to apologize to all my lovely readers for the absence of recent posts. Right after my last post in November, my beautiful mother-in-law’s health declined rapidly, and she passed away right before Thanksgiving due to Alzheimer's Disease.

All families endure difficult life happenings at one time or another. I don’t think anyone with loved ones escapes this. As well imagined, my efforts were directed at supporting my family through our loss and taking care of all the necessary things required, when we lose someone.

However, I did miss sharing blog posts with you, and I’m ready to return to writing them. With that said, I do hope you will forgive me for taking time off and I hope you will continue to be a Holistic Diva reader.

This life loss inspired my current topic of discussion; Alzheimer’s: The Early Signs and Symptoms You Need To Know. My amazing mother-in-law unfortunately lost many of her later years to the insidious grip of Alzheimer’s Disease. As incredibly tragic as this was, her husband, my father-in-law, also suffered and died from this unforgiving disease.

Due to this unusual occurrence, we gained substantial insight and a “working” knowledge of many of the signs and symptoms of Alzheimer’s. Also, it affects each person differently, and it did for them as well.

We Can Age Well and Enjoy Our Golden Years Together

There are of course, organizations offering support to people and families dealing with Alzheimer’s disease, and we commend and recommend using them. However, I was often left with more questions than answers when visiting these websites.

It is my wish to share with you the subtle changes, symptoms and signs of Alzheimer’s, so you will be able to recognize any potential “red flags” you may see with a loved one. I share with you personal examples from many of the symptoms we observed.

Alzheimer's disease is the most common form of dementia among older people, although dementia is common, with an expected prevalence of 13 in 1000 in people aged 65-69 and 122 in 1000 in those over 80, only about half of those affected are diagnosed.

This disorder involves parts of the brain controlling thought, memory and language and can seriously affect a person's ability to carry out daily activities. Without a diagnosis, patients and care givers cannot access the services they need, so earlier diagnosis is key. However, early diagnosis is not always easy and no definitive test exists.

Its been found, people who are not aware they are forgetful are more likely to have a form of dementia. Currently, new memory tests are being developed, but the commonly used Mini Memory Test, is an effective tool for testing a person’s memory who is suspected of having memory deficit problems. After which time, family members can be observant of further clues, like the ones I list here.



(This beautiful picture was done by the talented artist Leah Piken Kolidas of the Blue Tree Art Gallery. In her description of the picture she writes, “The brain's pathways often remind me of a tree's branches, in this case it relates to my family tree, as my grandmother has Alzheimer's Disease.”)

Signs and Symptoms to Watch For

Weight Loss – Weight loss of 20 or more pounds over a relatively short period of time (a few months), with no known medical condition causing the loss. May occur up to ten years prior to other symptoms being observed. Both my in-laws lost 20+ pounds when subtle signs were beginning to manifest. Their physician disregarded it as a common occurrence in older people. This is incorrect. 

Excessive Sleeping – When the brain has to work overtime to compensate for the memory decline, it often makes the person tired and sleepy, and they require more sleep. They may not be interested in socializing. I think it requires such concentration to follow and carry on a conversation, that it’s exhausting for many in the beginning. The support agencies call this apathy, but I really believe it’s exhaustion. My father-in-law slept for long hours during the day. But my mother-in-law did not have this symptom ever. She was a spitfire right up to the end.

Repeating Oneself – Asking the same question again and again, repeating pieces of conversation over and over, repeating the same story almost word for word, many times. It’s like they never heard the answer to the question, and don’t realize they just told you the same story over again. This was one of the first signs my mother-in-law displayed. She would ask the same questions to things she could no longer remember. She’d ask, “How long have you lived here? How far away am I from you?”

Difficulty Following Directions – Difficulty following directions, especially with things they commonly did or are familiar with. Examples: washing a dish by hand, loading the dishwasher, putting dishes away, running the washing machine. Upon explaining how it's done, they don't understand, or are unable to complete the task. A simple task like setting the table can become a struggle to complete without assistance, or may take much longer to complete. Concentration becomes impacted.

Forgetting or Unable to Operate Common Household Appliances – Things like washing machines and gas grills can become a challenge with someone suffering from dementia, and it can be subtle where you’re not even aware they are having a problem. The person will try to compensate for their confusion by finding another way to get something done. My father-in-law had great trouble with his stereo. He was unable to remember how to even turn it on. Mom compensated for him by using an old fashioned radio to play music. My mother-in-law had increasing difficulty with the washing machine and would wash the clothes by hand.

Difficulty Following and Remembering Conversations – You might tell a story about a person for instance, and a while later if part of the conversation is mentioned, they won’t recall it or they’ve mixed up the details of the story. They may forget ever having the conversation. The short-term memory is the first to be affected. This will begin to happen as a pattern, because of course, everyone forgets things or conversations. It’s the pattern of the behavior to look for.

Lack of Hygiene – Failing to brush one’s teeth, shower or bathe, wash their clothes, or even put  on clean clothes. Or, their efforts with these daily living activities are poor. They may wash their body but forget to wash their hair until reminded. If asked, they will insist they have bathed or their clothes are clean. This is a rather common sign.

Inappropriately Dressing – I think it’s mentioned in all pamphlets about how someone with dementia might put on two shirts or mix up types of clothes, like pajamas and street clothes. With both of my in-laws, we did not see this happen. However, my father-in-law would try to put on a spring raincoat when it was the dead of winter. He did not realize the difference or what was required for dressing for the weather.
  
Forgetting Birthdays, Anniversaries, Family Member’s Names – Very common. Yes, they both forgot these early on. They didn’t even remember their own birthdays or anniversary without reminders. My mother-in-law would often have a birthday card out on the desk close to a grandchild’s birthday for instance, but would never remember to send it, or why she had it out. It’s like there was a moment of clarity, then it was gone.

They may also forget the names of people they see everyday. They will recognize them, but not remember their name. My mother-in-law would say, “Hi ya honey” to friends or family when she couldn’t remember a name. Sometimes, later on in the visit, she would remember and would use it. However, as time went on, she even forgot her own name. 

Personality Changes – This is an interesting one. Since we are all unique, then the changes in personality will be as well. The person may become fearful of things they were never afraid of, like a dog barking or getting their teeth cleaned, more prone to outbursts of anger or tears, less generous if they once were a giving person, may think people are out to take advantage of them, their time or money, may become less trusting.  

My mother-in-law was always very generous with her time and gifts. She started to believe people invited them out to dinner, as one example, just so they would have to pay for it. It seems perfectly logical to them, and they’ll tell you how they know this, which in no way will make any sense. 

Loss of Speech, Language Problems – Some people with Alzheimer’s lose their ability to carry on a conversation and can not speak in sentences. They can not “find” the right word to convey their thoughts. It’s so devastating. They may often forget the name of common objects or mix up words and call things by the wrong name. May begin to misspell common words and perhaps even their name. The inability to write may follow. They may retain the ability to write “hi” or “no,” or very simple words.  

My father-in-law lost all ability to speak except for, “hey” when greeting you. Very sad, as he was a brilliant man. He would whistle to communicate in his own way.

He was clever at compensating. One time when I was over to help write out checks and make sure the bills were getting paid, he wanted to remind me the quarterly taxes were due. So, he came over to the table and put a quarter down and pointed to it. I told him I understood, not to worry, they would be paid. How brilliant was that! Again, everyone forgets the name of something, but it’s the pattern of forgetfulness that is of concern.

Hoarding – Collecting and hoarding trivial things and refusing to throw them away. When living at the  retirement community, my mom-in-law would have an over abundance of sugar packets in her purse, or saltine crackers, or napkins, tissues, decks of cards, pens, bananas etc. 

It can  be anything, but whatever it is, they will amass as much as they can. We would find bananas in the bedside drawers, the cupboards, the closet, her purse, and in the fridge. 

I must admit, it’s almost humorous. Sometimes the only way to survive this illness as a care giver or family member, is to look for the humor and laugh about it.

Confusion of Time or Place – Unable to distinguish one month from another, not recognizing familiar neighborhoods or areas they usually travel, not understanding the seasons of the year, getting lost taking a walk on their street, not knowing where they live, not knowing how they arrived somewhere.  

When we brought my in-laws over to visit, they would be confused as to where they were and forget we picked them up and drove them over. The calendar became useless as they didn’t understand the passing of days. If there was a doctor’s appointment and we said, “Now remember, Wednesday you have a doctor’s appointment and we’ll be over to pick you up at 11:00 AM,” they were unable to comprehend that. We would call the night before and again in the morning to remind them.

Inability To Manage Money, Finances Neglecting to pay bills, inability to  do banking or make financial decisions, unable to do simple arithmetic needed to add or subtract money, etc. My father-in-law handled all the bills and money decisions.We had no idea, and either did my mother-in-law that the bills were not getting paid. I happen to see a notice threatening to turn their heat off if the bill wasn’t paid by such and such date! From that time forward, I made sure my mother-in-law was paying all the current bills and doing the banking.

Forgetfulness – Forgetting recent events or information, forgetting where they left things, forgetting what they were doing, etc. My father-in-law would always ask his wife where his glasses and slippers were. This was while he could still converse. He never remembered where he left them. Again, it’s the patterns you begin to observe with increased forgetfulness and questions about where things are, or who is President, or what month it is, or what day it is, etc.

Driving Errors – This one is crucial to be observant of if the person has a car and is still driving and you suspect they are having memory problems. I personally don’t believe someone suffering from dementia should still drive. My father-in-law was driving himself and his poker buddies to their poker game at a friend’s house. He was perhaps 72 years old at the time. The friends told of how he started to drive onto the expressway via an exit ramp! After learning of this, we insisted he could no longer drive, and that mom would be the driver from now on. (She did not show signs of Alzheimer’s yet at this point). He was saddened by this because he loved to drive. He would take the car keys and try to go drive. She had to hide them from him for awhile.

Paranoia and Suspicion – Although not always an early sign, I did have a friend who’s mother thought her own husband was a stranger in the house. She was terribly confused about who he was. This was the main symptom catching the family’s attention, however, I’m sure there were others before this one manifested, but they were unaware her behavior or memory problems should be a concern. 

The person may become paranoid someone is going to break in during the night, or suspicious  people are trying to steal money or possessions from them. My mother-in-law thought someone was coming into her apartment at night, while she was living at the retirement community, and stealing her pants and leaving different ones. In actuality, the pants no longer fit and were too small (from the weight loss mentioned above). So, she thought someone left those but took her pants with them. I must say, it’s quite funny. Again, sometimes you need to be able to laugh.  

She also thought someone was going to get in during the night, so she would jimmy a chair under her door into the apartment. And even though she was on the second floor, she wouldn’t open her drapes because a stranger might see in. The paranoia and suspicion would come and go. It was not what I would say was an early sign for her however. It was more into the middle stages, but some people may show this symptom in the earlier stages.

In summary, concerns are warranted if you notice a person cannot remember the date, write a sentence or does not know where he or she is, over a period of time. A primary care physician can administer or make a referral for a cognitive evaluation if the patient exhibits – or family members notice – signs of memory loss. If you suspect a loved one may be suffering from memory problems, I urge you to keep notes, make a doctor’s appointment and go with them for further evaluation. 

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Mediterranean diet may be brain-protective - A presentation scheduled for the American Academy of Neurology's 62nd Annual Meeting in Toronto April 10 to April 17, 2010 will reveal the finding of Nicolaos Scarmeas, MD, MSc at Columbia University Medical Center in New York that consuming a Mediterranean diet may help preserve memory and learning ability by protecting against cerebrovascular disease.

The diet typically consumed in the Mediterranean region provides high amounts of fruits, vegetables, legumes, cereal, fish, and monounsaturated fats, low levels of saturated fats, red meat and poultry, and a moderate amount of alcohol. In previous research conducted by Scarmeas and his colleagues, an association was found between adherence to a Mediterranean diet and a lower risk of developing Alzheimer's disease in addition to improved survival among Alzheimer's disease patients.

The authors conclude a "Higher adherence to a Mediterranean diet is associated with reduced cerebrovascular disease suggesting the impact of a Mediterranean diet on cognition may be partially mediated by brain infarction." ~~ from the February 12, 2010 Life Extension Update


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NEW information has been collected, indicating up to 50% of diagnosed Alzheimer's is incorrect. Many doctors are not spending enough time with a concerned patient, to completely access the whole picture. Make sure your attending physician is checking all these possible culprits, which could be causing symptoms of dementia, but may actually be something more treatable: Did the Doctor Make an Error in Diagnosis? 

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NEW research has found consuming coconut oil in one's diet may be beneficial in treating Alzheimer's. Check out the latest research findings here: Coconut Oil: Can it Stop Alzheimer's?


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