Alzheimers Diease

Background:
About two years ago, my wife, Marie, was diagnosed with Alzheimer's Dimentia. She was 84 years old. Her neurologist showed the family the image from her MRI brain scan. He pointed to the frontal cortex, and said that she had lost 50% of her brain cells in that area.

Marie's mental ability, at that time, was variable - but fairly stable. She had trouble with her short- term memory. But now, this is slowly declining. While she still knows me, and our daughters by name, she has entered the slippery slope of memory decline, so common with Alzheimer Disease.
And so, ever since her diagnosis, I have been very interested in the subject of Alzheimers Disease.

The Alzheimer’s Project

I didn’t see the Special on HBO on Alzheimer’s Disease (AD). My daughter, Mary, let me review the AD Project Kit. Besides the HBO, it is co-sponsored by the National Institute on Aging, of the National Institutes of Health, in association with the Alzheimer’s Association, the Fidelity Charitable Gift Fund, and the Geoffrey Beene Gives Back Alzheimer Initiative. The kit contained four DVD’s on the subject. While watching them, I made rough notes. I will use them to try and paraphrase the subject matter.
Alosis Alexander was the discoverer of A.D. back in 1906. He was a Pathologist, and he discovered lesions in the brain, after death.
Maria Shriver Schwarzenegger was the moderator on Tape 2. She covered kids reaction to the disease, plus she talked about her Dad’s A.D. Here are some of Maria’s quotes:-
You don’t know the future - you live in the present.
When it comes to A.D., just go with the flow the best that you can.
It’s O.K. to be afraid of A.D.
It’s hard to accept a mind with no memories - our lives are made up of memories.
You have to let it sink in and accept it - when they don’t know who you are.
Remember, when they get angry, it is not them. It is nothing you did,
it is not she or him.
A family is a collection of emotions and experiences. You want to remember them the way that they used to be.
A.D. is difficult - both emotionally and financially.
On Tape 3, they discuss Plaques and Tangles.
A.D. is the second most feared disease - after cancer. As many as five million people in the U.S. have Alzheimer Disease. It causes not only human suffering, but A.D. has a huge financial impact. A.D. destroys brain cells. An MRI scan confirms A.D. The challenge is, how does the brain go wrong? Alzheimer predicted that we will see plaques and tangles in the brains of people who die with A.D.



The synapses, in the brain, transmits information. When they die, they no longer work, and you can no longer remember.
There are two types of the A.D. disease - Early and Late Onset. The “Early” is defined by ages 40-50, in 3 % of the population. “Late” is defined as late 70’s and early 80’s. The risk rises with age. It is a disease of the entire human body - not just the brain. It is not normal aging. He found that Beta amyloid plaques (composed of A-Beta cells and produced by the brain) and tau tangles (proteins), adjacent to the amyloid plaque in the brain, interfere with the synapses (information switches) ability to transmit information between the cells. Beta neurons produce amyloid Beta in the brain, which forms tau tangles, and must be cleared. Eventually, synopses are lost and the neurons are destroyed. Producing too much Beta amyloid, or not clearing it away, is toxic to neurons and synapses. When they are gone, it establishes the clinical diagnoses of A.D. If they can slow the chemical reaction, they can design drugs (which are also chemicals) to do this. They take spinal taps to analyze the A-Beta in the spinal fluid. The scientists are trying to determine why it is killing neurons and destroying synapses. Lowering the production of Beta amyloid slows A.D.
The average human male-brain weighs about 1100 grams (2.4 lbs.),
Our insulin system is very important for healthy aging. It is produced in the pancreas, in response to the need to transmit glucose into the cells. Insulin resistance underlying pathology is that it prevents glucose from entering the cells. Insulin resistance begins in mid-life, and detected by levels of insulin. It is treatable through diet and exercise.
Researchers are looking for “markers” APO-E (A-Beta) is one of them, pointing to susceptibility to the disease. Inflammation kills brain cells.
High blood pressure changes the heart, because it has to work harder to pump blood to the brain, and it leaves some residual blood still in the heart. People diagnosed with AD are very likely to have clogged arteries. The arteries in the brain become inflamed, and they can’t do their normal job of eliminating the excess A Beta from the brain.
It then accumulates in the brain as plaque.
People with high cholesterol and high blood pressure are candidates for A.D. There is a connection between vascular disease (V.D.) and dementia. Vascular disease can enter the brain and cause mental problems, when you are older due to an abnormal brain. In autopsies of older people, A.D. and V.D. are most common in dead brains. Brain injuries accumulate, resulting in late onset A.D. Statins lower cholesterol, and the brain damage goes away. Statins have been found to decrease the onset of A.D.
By the time that people are aware of their mental problem, they already need a caregiver. - even though they will tell you that they can take care of themselves. “Chuck”, one of the\ people, with A.D., that they interviewed, said, “If you can’t cry about it all the time, you might as well laugh about it half of the time.” Very profound!
Caregivers need respite. If they don’t have anything else to do , stress will get them. The Caregiver will know when she/he is maxed out with stress. The sequence of care goes - friend - family - professional care - grave. People in family support groups have said, “live life in the moment”; it takes indomitable spirit. It is like saying a long goodbye. It is exhausting and you get scared. There is some “denial” by both patient and the caregiver. Spirits fade as the illness progresses. A.D. patients tend to not like noise or crowds, they just want to stay home. With wandering, and toileting, a Caretaker in the home can cost $100 a night or $3,000 a month. One on one, is the toughest kind of schedule - it creates a fast burnout. You cannot be a caregiver unless you love the person you are caring for. A caregiver’s responsibility never leaves your shoulders.
Medications have side effects. The change in the patient is more noticeable when you don’t see them every day. Some people will make vows to loved ones that they will never put them in a nursing home. But, some vows you have to break - you have no choice. In the film, a woman was feeding her husband and said, “You gotta eat everything, it will make hair grow on your chest.” then, she said, “Do you remember when you used to tell our boys that?” Some other quotes -
We never say goodbye.
It is hard to see him the way he is now.
Family takes care of family.
It is hard to see someone who was so full of life.
When it’s time for me to leave, I will - until then, I’m holding on.
You don’t want to lose a person that you can’t live without.
Aren’t we lucky. (by an A.D. patient. I had a long-time friend with
A.D., and he used to tell me that.!)
It’s the bodies way of shutting down. Nutrition is not that important anymore.
The doctor said to the wife,” What do you want to prolong?” (Wife) It’s not fair to him. It’s not what he wants.
(Patient) - Memory problems are not fun.
In autopsies of people with A.D., they have found that the hippocampus has shrunk.
The genetic researchers have determined that genes influence the progress of A.D. or the probability of getting it. A gene makes the protein which makes the plaque. Late onset A.D. is not inherited. It is caused by the contributions of many genes, each of which make a small contribution. You cannot modify your genetics, but you can modify your lifestyle.
Postscript.
Marie’s neurologist, Dr. Pai of Kaiser, diagnosed her Alzheimer dementia a couple of years ago - based on her MRI. Watching these four DVD’s was very emotional for me.


RCL - 6/26/09.