Sister Rosemary Goulet, an expert in elder health care, answers questions at a seminar for caregivers about Alzheimer’s disease and dementia Aug. 20. The program was sponsored by the Office for Family Life. — Kathleen Ogle photo
Understanding Alzheimer's
By Kathleen Ogle
Managing Editor
PISCATAWAY — Can’t remember where you left your keys? Missed that appointment for that medical test you’ve been dreading? What about your cousin’s husband’s first name?
While forgetfulness is a normal part of aging, it is not necessarily an early sign of Alzheimer’s disease, according to an expert in elder health care.
Sister Rosemary Goulet, a member of the Servants, Sisters of the Immaculate Heart of Mary, led a seminar about dementia and Alzheimer’s disease Aug. 20 at the St. John Neumann Pastoral Center, outlining the signs and symptoms and providing practical information about its progression.
Sponsored by the Office of Family Life, the seminar drew attendees concerned about a family member or friend who may be experiencing signs of dementia as well as those whose loved ones have been diagnosed with Alzheimer’s disease.
“Forgetfulness may be only a symptom of a busy, stressful lifestyle,” said Sister Rosemary, a licensed nursing home administrator with 20 years experience in the field of elder health care with master’s degrees in health administration and counseling from St. Joseph University, Philadelphia.
Warning signs of a possible problem include: forgetting recently learned information vs. occasionally forgetting names or appointments; replacing simple words with a description of the word vs. occasionally not finding the right word; and misplacing things in unusual places vs. simply misplacing something.
“Signs of a problem include a serious change in memory, usually short term, that continues to be a constant problem,” Sister Rosemary said, adding that if the problem is consistent it is necessary to see a physician and obtain a specific diagnosis.
Lapses in memory are often accompanied by changes in personality or behavior, which are often the result of the person trying to cover up the problem.
“What ends up happening is they start to worry and get anxious and concerned about those things that they are not remembering leading to personality as well as behavioral changes,” she said.
For example, a person who is outgoing may not want to leave the house or try new things because he or she knows it is difficult to handle new situations.
Sister Rosemary advises people who have concerns about their own memory loss or that of a parent to make an appointment with their doctor and be ready to provide examples of specific events and situations that present problems.
Dementia: Not a diagnosis
Dementia, which is an umbrella term used to describe a group of symptoms that are caused by changes in brain function, is not a specific diagnosis, Sister Rosemary said.
A physician who suspects dementia will typically order blood, urine and neurological tests, as well as a psychiatric evaluation, to find the underlying cause. In addition, the doctor will review the patient’s medical history, medications including over-the-counter drugs, diet and general health.
Because some forms of dementia are reversible and others are not, it is important to find out what is causing it.
Reversible dementia is associated with diet deficiencies, dehydration, illness, high fever, medication, thyroid problems, head injury or depression — all conditions that can impact memory. Dementia may be irreversible if it is associated with vascular problems such as a stroke, Alzheimer’s disease, Parkinson’s disease and Lewy body disease.
“If it’s reversible, we take care of the problem, and the person is back to functioning the way they were,” Sister Rosemary said. “If it’s irreversible we’re talking about a disease process and you can’t reclaim what was loss, and most likely you’re talking about a progressive disease.”
The most common form of dementia is Alzheimer’s disease, which involves physical changes in the brain resulting in the gradual impairment of memory, thinking and behavior, and it is irreversible, she said.
When a person has Alzheimer’s disease, the brain is “attacked” with plaque that tangles or chokes off the neurons that carry messages from one part of the brain to the other. Brain cells die and the brain actually shrinks.
“It usually starts out with short-term memory loss and it gets worse and worse,” she said.
Alzheimer’s affects brain functions that govern memory, judgment, perception, concentration, the ability to speak, read, write or understand verbal communication, and the ability to perform sequential tasks.
Sister Rosemary described the stages of Alzheimer’s:
Mild Alzheimer’s signs can include memory loss, confusion, difficulty handling money, poor judgment, mood changes and increased anxiety.
In moderate Alzheimer’s, the person has trouble recognizing people and may wander.
In severe Alzheimer’s, the person is dependent upon others for total care. Symptoms can include weight loss, seizures, skin infections, groaning, moaning and grunting.
The final stage of Alzheimer’s is also the most difficult for the caregiver.
“Every stage that occurs with this disease is a new stage in the caregiver’s life as well,” she said. “Your expectations will constantly need to be adjusted; you are going to have to change the expectation of that person and of what they can do and can’t do, and it’s also going to change your expectation of what you can and can’t do.”
Once a diagnosis of Alzheimer’s is made the need for adjustment is constant, she said.
Impact of memory loss
Memory helps people establish parameters and relationships, and its loss is devastating to the person with Alzheimer’s disease, Sister Rosemary said.
“Memory helps you know who you are. Without access to memory, you are unable to find your place in the world. Without access to memory, there is a strangeness that begins to enter a
person’s life,” she said.
Without memory of recent events, a person can live only in the past, she explained.
Memory is necessary for learning, so Alzheimer’s also interferes with a person’s ability to learn.
“A person with Alzheimer’s cannot create memory from present activity,” she explained. “If you can’t learn something, then you can’t create short-term memory. If you don’t have short-term memory you have nothing that eventually converts to long-term memory. Then you have nothing.”
For persons living with Alzheimer’s, time is not sequential. A person with Alzheimer’s may talk about the past as if it’s the present; the past becomes the present. Memory may be there one moment and gone the next, especially in the early stages. A person only knows what they know at a given moment.
Persons with Alzheimer’s may remember how to drive, but eventually they begin to lose the ability to judge distances for stopping or to recognize a stop sign and to remember what it means.
“More people who are diagnosed with Alzheimer’s end up in car accidents making a left hand turn, not a right hand turn, because they can’t judge the cars that are coming on or when it’s appropriate to make that turn,” Sister Rosemary said.
Although there is no treatment that can stop or cure Alzheimer’s disease there are several drugs that can slow its progression. There are also medications that can ease or control behavioral symptoms such as sleeplessness, agitation, wandering, anxiety and depression.
“The sooner a diagnosis is made, the sooner a person can be prescribed medication,” Sister Rosemary said.
Mixed dementias
Alzheimer’s is the most common type of dementia; however, dementia is also associated with vascular disease, Lewy body disease and Parkinson’s disease.
According to Sister Rosemary, an individual person’s dementia can be associated with more than one disease. For example, a patient may have dementia from Alzheimer’s and vascular disease, or Alzheimer’s and Lewy body disease, or Parkinson’s with Alzheimer’s, or vascular disease with Alzheimer’s and Lewy body disease.
Medical research has shown that approximately 20 percent of people with dementia have Lewy body disease, in which round clumps of protein appear in the brain.
“The cause of Lewy body disease and the risk factors that bring it on are unknown,” Sister Rosemary said, adding that it also does not seem to be inherited.
Unlike Alzheimer’s disease, in Lewy body disease there is a fluctuation in cognitive functioning.
“Attention span and alertness comes and goes,” Sister Rosemary said. “It is usually noticed when a person is working or in the process of a task or a conversation, and they just seem to drift. Then 10 minutes later they are paying attention and they know what’s going on.”
The loss of alertness may occur for hours at a time, it may be more noticeable in the morning or afternoon, or it may occur for days at a time.
Editor’s note: Part two, “Communicatiing with Alzheimer’s,” of this two-part article appeared in the Sept. 4 issue. To read part one, click here.
