Alzheimer's disease presents challenges for researchers, care-givers

A century after being identified, Alzheimer's disease remains much of a mystery to medical researchers. A new study has strengthened the genetic link, and it's known that people who are mentally, physically and socially active are less likely to have Alzheimer's disease, but no preventive connection has been established.

Another new study has found that a normal brain erases unneeded information continually, but in people with Alzheimer's the process is hyperactivated. A biochemical switch appears to get stuck in reverse, perhaps due to a decrease in plasticity.

In someone with Alzheimer's disease the memory areas of the brain develop more plaques and protein tangles than normal, which seems to prevent cells from functioning as they should. Scientists don't know why this occurs, but nerve cells are destroyed.

A person with mild Alzheimer's disease seems normal if forgetful. When that person progresses to the mild state she has a hard time remembering conversations and repeats herself. When she moves on to moderate Alzheimer's disease, other people notice. She might forget to eat and be unable to remember her address and phone number. She can't take care of her house.

At the severe stage she needs help dressing and bathing and sometimes is incontinent. She can't remember her own life.

The Missouri Veterans Home is one of the local nursing homes with a secure ward dedicated to Alzheimer's patients. Because 60 percent of Alzheimer's patients wander, the ward is kept locked. With 50 patients, it is at capacity and has a two-year waiting list.

At 11 a.m. one day last week, some patients sat in chairs or wheelchairs in the ward, some were in their rooms watching TV or movies.

Doris West talked with her husband Bill about the rain Tuesday, March 18, 2008, at the Missouri Veterans Home in Cape Girardeau. Bill, 65, is in the last stage of Alzheimer's disease, which is a progressive illness.

The ward is designed in part for its residents' special needs. The dining room has a fishing mural. Another mural is dedicated to farming. The ward has a large aviary with numerous small birds. All are meant to provoke memories.

A patient in a wheelchair wore a helmet. All wear a bracelet that sets off an alarm if they leave the unit. One of the unit's three halls is for patients in the severe stage. Few on that hall are mobile.

Touch is important to people with Alzheimer's. Jean Sherrill, the nurse who supervises the unit, said the staff does a lot of hugging. The staff reads them the newspaper. Most can't read anymore. "It's our honor to take care of these guys," Sherrill said.

Small stations around the ward offer physical activities. One has a typewriter, a rotary phone and an old calculator, reminders of the work many of the men did. Another is equipped with hardware, things like PVC pipe and a faucet. For group activities they watch old movies and play memory games. Black and white movies. "In a lot of these guys' minds, that is where they're at," Sherrill said.

Other parts of the ward's design are subtler. A loss of depth perception is one effect of Alzheimer's disease. A doormat might be perceived as a hole. You won't find any doormats. Some people with Alzheimer's can't see a white plate on a white tablecloth, Sherrill said. You won't find that combination. Some might try to pick a shadow up off the floor. The shower scares some patients. Tubs are available.

The patients bond with the staff but not really with each other, said Michelle Brown, a social worker and psychiatric nurse at the veterans home Alzheimer's unit. The staff tries to be sensitive to the mysterious reality these patients inhabit.

Sometimes men who are widowed ask where their wives are. The staff used to tell them their wives had died, but then the men would experience their grief all over again. Now, when asked, the staff tells the men their wives are out shopping.

Families are involved in life on the ward. Several wives visit every day.

Brown said each patient's medications and behaviors are reviewed each month. "We see if they can tolerate a reduction in their medicines."

Age and family history are the two primary determinants of Alzheimer's, but some people who get the disease have lived right and have no family history of Alzheimer's. Their families wonder why. "It's one of the toughest questions we have to answer," said Shannon Kitchen, an outreach coordinator for the Alzheimer's Association in Cape Girardeau.

An estimated 5 million people in the U.S. have been diagnosed with Alzheimer's disease. The cost of treating the disease in the U.S. is $148 billion annually.

There are at least 60 types of dementias. Alzheimer's is the most prevalent.

"A lot of things can mimic symptoms of Alzheimer's disease," Kitchen said.

Poor nutrition, sleeplessness, depression and an infection could provoke similar symptoms in an elderly person. A series of cognitive tests along with MRIs and CAT scans can help diagnose the disease, but only an autopsy can confirm the disease with 100 percent accuracy.

General practitioners and internists usually make the first diagnosis of Alzheimer's disease. Dr. Mark Hahn, a family practitioner in Cape Girardeau, said he may or may not refer the patient to a neurologist. "There are a few medications we can try to slow the progression," he said.

The FDA has approved five medications for treating Alzheimer's. They can help control and stabilize memory loss but don't slow the progression of the disease. It is not reversible.

"It's hard for [Alzheimer[']s patients] after they start progressing," Kitchen said. "They can't communicate their feelings any longer."

If the disease is progressing more rapidly than expected, Hahn said, he will refer patients to a neurologist or send them to the Alzheimer's Disease Research Center at Washington University. He and Kitchen both underwent training a few years ago at the center.

A new study that found the risk soars for children of two parents who have Alzheimer's did not surprise Hahn. "If one or both parents have Alzheimer's disease, you need to pay close attention for signs of the symptoms," said the physician, whose grandfather died of Alzheimer's disease. He said age 50 is a good time to start.

For people at younger ages he advocates stimulating activities. "Reading books, doing puzzles as opposed to vegging out in front of a TV," he said.

Healthy eating to prevent hardening of the arteries is another suggestion because vascular disease is often associated with Alzheimer's.

Family members who suspect a loved one may be slipping mentally should get in touch with their primary-care physician and accompany the person to the appointment. "Especially those with mild impairment say nothing is wrong. Yet you know something is wrong. Family members will give just as important information as the patient will," Hahn said.

Support groups are also important. "It's not like when you get a cold. This disease affects everybody around them, not just the immediate family," he said.

Kitchen and fellow outreach coordinator Lisa Hicks provide training for health agencies in 16 counties in Southeast Missouri. The organization's Web site, www.alzstl.org and helpline, 800-980-9080 are the two primary local sources of information about Alzheimer's disease. The Web site has a list of adult day-care services, community organizations, in-home agencies and nursing homes that can assist with Alzheimer's patients. Neither local hospital has a program designed specifically for Alzheimer's patients and their families.

Another resource is the Alzheimer's Disease Research Center at Washington University in St. Louis. That Web address is www.alzheimer.wustl.edu.

______________________________________________________________________

Living with Alzheimer's disease

Bill West's father has had Alzheimer's disease for 12 years. His mother has an undiagnosed dementia. A recent University of Washington study of families in which both parents had Alzheimer's found that 42 percent of their children developed the disease by age 70.

Bill was diagnosed with Alzheimer's at age 58. Now nearly 65, he appears to be in the final stage of the disease.

Bill enlisted in the U.S. Navy at 17 and became a radarman. He and his wife Doris lived in Fenton, Mo., until they retired to Lake Wapappello. Bill loved to fish. They wintered in the Rio Grande Valley in Texas.

Doris first noticed Bill was starting to forget where he'd put keys, tools and his billfold. A year later he was diagnosed with Alzheimer's disease.

People with Alzheimer's sometimes wander. Doris put alarms on the doors of their house and kept watch on Bill, but he still walked away from their home a few times, once traveling more than 4 miles. Twice Doris called the police to help look for him.

Their grown children helped her care for him, but she had to be constantly on guard. "The last two years I didn't leave him alone," she said.

Bill moved into the Missouri Veterans Home Alzheimer's Unit last May. Doris moved to Cape Girardeau in November to be near him.

Living on the ward required an adjustment, Doris said. Bill didn't want to go into the shower room that has a bathtub but didn't mind the shower room that has no tub. Dramatic mood swings are one symptom of Alzheimer's disease. Patients become upset but they can't explain why.

Unlike some Alzheimer's patients, Bill is still walking around and talking. But Doris says his chart indicates he's in the last stage of the disease. In that stage, the patient needs help dressing and bathing and the memory of his own life is a blur.

Doris has three children and Bill two, both from previous marriages. The closest lives an hour and a half away. When the subject of children came up, Bill asked her, "We didn't have any children, did we?"

"No, we didn't have any children," she said. "We had plenty between the two of us."

Jean Sherrill, a nurse in charge of the Alzheimer's Unit, said the staff worries about the wives — all but one of the 50 residents on the ward are men — as much as they do the patients. One wife drove to Cape Girardeau every day from Poplar Bluff, a distance of 83 miles each way. "It's like you need to be needed," Sherrill said. "Their lives are here."

Doris visits the ward every day and has lunch with Bill. "He's always looking for me, asking for me and waiting for me," she said.

When she leaves in the afternoon they say, "Good night, I love you, see you in the morning."

— SAM BLACKWELL

blackwell@semissourian.com

335-6611, extension 137

Have a comment?

Log on to semissourian.com/today