Alzheimer's Disease: Behind the Fog

Alzheimer's disease touches the lives of everyone in our society. Many try to deny the fact that Alzheimer's is a possibility. Denial only adds to the difficulty of dealing with the illness, both for the patients and their family and friends. People seem more eager to own up to having a disease that primarily affects the body, than to one that affects the mind.

I have a friend who has Alzheimer's. He agreed to speak with me, and I will refer to him as "Al."

Al and his wife knew something was wrong four years before his official diagnosis in 2003. He was in his mid-fifties, and was healthy physically, but noticed that he could not think normally at work. Al said that it was like walking around in a cloud. Since numbers confused him, coworkers and supervisors helped him fill out his time card. The effects slowly progressed over two years. Al was unable to think, walked around in a daze, and felt angry because of his mental confusion. "I knew it was affecting my mind, though I didn't know what it was," he said.

When Al first went to the doctor, he could not tell his doctor the colors in a streetlight or draw a clock. Before they knew what was wrong, Al and his family feared a tumor or perhaps a nervous breakdown. Al admitted that not knowing the cause of his condition was confusing, and he would often have crying spells.

When I asked Al if things were foggy or if he just forgets, he said that he just doesn't know some facts that were previously easy to recall.

"My mind just goes blank," he said. "I am aware something is wrong, it just doesn't register. I can only do one thing at a time now, where I used to do several things at once. I used to read the newspaper and listen to the radio; I can't multi-task any more. My short-term memory is also getting worse, I can tell."

Al said he would get aggravated and frustrated when his memory failed him. He also said that when he speaks and gets interrupted he loses his train of thought, or sometimes he will be talking and the words will just go away. He said it is like a window blind has been pulled, and everything goes blank. Al also realizes that he is less tolerant. When I asked him if he felt like a different person than before, Al said, "Yes. I don't know how, I just know I am."

"It is like the brain is in neutral, is the only way I know how to explain it." Al admitted that he has no emotions concerning love or other sentiments. The part of his brain that controls emotions is gone; there is a kind of flatness to the thoughts and feelings he expressed.

Al also has panic-like attacks caused by his frustration at being unable to do something. He leaves coffee cups all over the house because it is easier to get a new cup than it is to remember where he left the others. He has stopped driving because of visual perception problems and blind spots caused by malfunctioning parts of his brain. And he has devised a way to remember his own right and left hand, but could not tell which of my hands were right and left.

So far, the damage to Al's brain has occurred in the front temporal lobe, and is associated with the loss of executive function. The disease progresses differently for each person, and at varying speeds. Al realizes that Alzheimer's will be debilitating for him someday, that it will ruin his life, and that he will eventually end up in a vegetative state. At first, the disease may affect just one part of the brain, but eventually it can spread and affect other brain functions as well.

Before Al was put on medication he reached a stage where he couldn't write. He didn't know his ABCs and couldn't even sign his own name. With the help of medication, Al can now sign his name and write small notes, although he still has trouble spelling simple words. The drug he takes is Aricept. He started out taking 5 mg and went right to 10 mg, as the lower dosage was insufficient. He also takes the drug Celexa, an antidepressant.

After his diagnosis and medications, the fog lifted and some relief came with just knowing what they were facing. "Though the fog is gone, I still can't remember," Al was quick to add.

I asked him if he blamed God or anyone for his condition. He said, "No. It's like a person who is in a car wreck or anything else, it just happens."

Looking to the future, I asked Al what his greatest fear was, and he answered, "I really don't have any. I think God will take care of me. He takes care of me day-to-day and I just go on." Al stated, "I don't fear the future. If I have to go to a nursing home sometime in the future, I will just have to go, that's all."

I asked Al if he had made any arrangements for the future when his memory gets worse. "After my diagnosis we went to lawyers and made wills, living wills, trusts and filled out power of attorney papers."

I commented on how important that is, since some people continue to deny a problem until it is too late to deal with the legal issues.

Alzheimer's is not something to be ashamed of. But because it takes away one's ability to think, patients need to make their wishes known to their family early on, so that their wishes can be carried out when they can no longer think or express themselves. It is also crucial to get an early diagnosis and receive the medications to hold Alzheimer's at bay for as long as possible.

Often it takes some pretty blunt words to get a friend or relative to seek help, but sometimes the caregiver has to take charge when the person with the problem refuses. See your doctor today if your memory is failing or if you've had a change in your personality. Do this not only for yourself, but for your family as well.

For more information, see: • Alzheimer's Association (USA) • Alzheimer's Disease Education and Referral (ADEAR) Center (from the US National Institutes of Health) • Société Alzheimer's Society (Canada)

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