“Is the medical community getting any closer to finding a cure for Alzheimer’s?”

Like the disease itself, the answer is complicated.  For any disease the first step in finding a cure is pinpointing the cause.  In this respect, Alzheimer’s researchers believe they are making progress.

Experts have long believed that Alzheimer’s is caused by the brain producing too much of a natural protein called beta amyloid.  But recent findings suggest the problem may not be over-production but rather the inability of the brain to properly dispose of this protein.  One study likens it to a “clogged drain.”  Researchers are now refocusing efforts on ways to speed up the disposal process.

On another front, scientists are also testing ways to better identify who is at risk for Alzheimer’s.  Current screening methods including spinal taps and brain scans are not only costly but impractical for large populations.  An experimental technique which many believe still holds promise is a blood test to detect beta amyloid.

Obviously no cure will come until the precise cause can be determined.  To date, efforts to develop medications to slow production or rid the brain of excess amyloid have been unsuccessful.

Doug Stark, President, ComfortCare Homes (This article featured in the Wichita Eagle, July 22, 2011)

“Why does Mom get so angry and spiteful these days? She was always such a loving and understanding person.”

Despite researchers’ best efforts, there’s still no cure for Alzheimer’s disease.  Because of the progressive deterioration of brain cells, a person with the disease will generally go through seven stages of decline.  Among symptoms in the early stages are irritability, anxiety and depression.

It’s human nature for us to feel a certain degree of antagonism or hostility when we find ourselves in threatening or unfamiliar circumstances.  For someone with Alzheimer’s disease, these feelings are ongoing and only increase over time.  Their inability to recall recent conversations or events, their failure to form connections with their surroundings or even with loved ones – these conditions can foster feelings of frustration, anger and paranoia.  In addition, your mother’s anger may be the result of drug interactions or side-effects from medications.  Be sure to keep her doctor informed of any significant change in her behavior.

Doug Stark, President, ComfortCare Homes (This article featured in the Wichita Eagle, July 20, 2011)

“Dad seems so blue. Is this another symptom of the disease? What’s the best way to handle it?”

According to the Alzheimer’s Association, up to 40% of people with Alzheimer’s are clinically depressed.  However, diagnosing their depression may be difficult.  One reason is their disease often precludes them from articulating their feelings.  Another is that many symptoms of depression such as apathy and social withdrawal are themselves symptoms of dementia.  In addition, side-effects from certain medications or unrecognized medical conditions can be mistaken for depression. For all these reasons the first step in accurate diagnosis is a professional medical evaluation.  The Alzheimer’s Association suggestions consulting a geriatric psychiatrist or clinical psychologist with an emphasis on the elderly.  Treating depression in someone with Alzheimer’s usually involves a combination of medication and social therapies.  One of several medically-approved antidepressants may be prescribed.  Also family members and caregivers are encouraged to develop a supportive routine to help the individual reconnect to the activities and people they enjoy.

Doug Stark, President, ComfortCare Homes (This article featured in the Wichita Eagle, July 21, 2011)

Living with Alzheimer's (Part II)

Today the number of Americans with Alzheimer’s disease is greater than at any time in the past.  What’s more, that number is expected to increase in the years ahead.  In 2009 approximately 5.3 million Americans had the disease.  This is a first in a series of articles I will be writing for Health Matters Magazine, explaining  what is known about Alzheimer's and related diseases --  the causes, diagnoses, and effects -- and alternative methods of treatment and care for persons with the disease.  

As we age, many of our physical capabilities diminish.  Memory is thought to be one of these.  It is not uncommon for older people to experience occasional periods of forgetfulness, sometimes referred to as age related memory loss (ARML).  In a healthy person these episodes happen infrequently, are relatively short in duration, and usually can be recalled by the person after the fact -- often with some embarrassment.   But it is important to distinguish between these occasional and natural experiences and what is today recognized as a serious disease.

For a good part of the last century, most people suffering from profound memory loss were simply labeled "senile."  But as medical science has learned more about these diseases in recent years, doctors have done a better job of diagnosing them.  Today we know that acute memory-loss and other mental impairments severe enough to interfere with daily life are more than just "senility" or a normal symptom of aging.  The general term we use to describe these conditions is dementia. 

Someone diagnosed with clinical dementia will experience periods of memory loss with increasing frequency and intensity, and often will not remember the episode.  Doctors have identified many forms of dementia.  Vascular dementia occurs when the blood supply to the brain is interrupted, often by a series of small strokes, commonly referred to as TIAs.  Although these “mini-strokes” frequently go unnoticed and their effect is only temporary, the damage caused over time can interfere with basic cognitive faculties and disrupt everyday functioning.  Other types of dementia include Lewy bodies (DLB), Parkinson's disease dementia (PDD), and frontotemporal dementia (Pick’s).  But by far the most common type of dementia and the one I wish to focus on here is Alzheimer's disease.  

Named for German physician Alois Alzheimer who first described it in 1906, Alzheimer's is a progressive brain disease that destroys brain cells and basic patterns in memory, thinking and behavior.  Although the medical community has learned a great deal about Alzheimer's -- most notably within the last 15 years -- researchers still have not discovered a cure.  However, treatments for symptoms, combined with specialized services and support, can make life better for those living with the disease. 

The most recent studies indicate that Alzheimer’s disease is the fifth leading cause of death in the 65-and-older age group.  The duration of the disease can range from 3 to 20 years after diagnosis. 

One reason Alzheimer's seems so much more prevalent today than in years past is that it is a disease which primarily affects the elderly.  Since this is currently the fastest growing segment of our nation's population, the raw numbers of people at risk is greater today than at any   other time in history.  In 1994, the 65-and-older segment represented about 12% of our population.  By 2030, it will represent about 20%.  In addition, as people age their susceptibility to the disease increases.  The National Alzheimer’s Association estimates that about 10% of people 65 and older have the disease, but among those 85 and older, more than 47% will have Alzheimer’s or some other form of dementia. 

Because occasional lapses in memory happen to everyone, it is important to get a complete diagnostic workup for someone whose condition you suspect may be serious.  But just because he or she may have a harder time remembering some things does not mean they have Alzheimer’s.  A lapse in memory is not always disease related. 

While doctor’s as yet have no cure for Alzheimer’s, they have about a 90% success rate in accurately diagnosing the disease.  In some cases where dementia-like symptoms are caused by treatable conditions such as depression, drug interaction, thyroid problems, excess use of alcohol or certain vitamin deficiencies, the symptoms can be reversed.  By reviewing a person’s medical history, conducting medical and neurological examinations, and performing various psychiatric and psychological tests, the doctor should be able to determine whether someone’s symptoms are the result of a treatable disorder -- and therefore might be halted or reversed -- or if their condition is in fact Alzheimer’s disease.  

People stricken with Alzheimer’s may initially react with a sense of dread.  As the disease progresses and things once easy for them become increasingly difficult, they can become frustrated and depressed.  We know that understanding and emotional support are just as important as physical support.  For family members or those providing care, it's important to know what to expect and how best to respond. 

People diagnosed with Alzheimer’s or another form of memory loss have very special needs.  We know these needs change and become more intense as their symptoms progress and their abilities diminish.  In addition to loss of memory, Alzheimer’s disease causes loss of communication skills and loss of judgment.  Family members often notice changes in the person’s behavior and personality.  This can be devastating to relationships.  Recent studies estimate that nearly 10 million Americans provide unpaid care for people with Alzheimer’s or other types of dementia.  Nearly 90 percent of caregivers are relatives.  More than 40 percent of caregivers rate the emotional stress of care-giving as high or very high, and approximately one-third show symptoms of clinical depression.  Thus the victims of Alzheimer’s extend beyond just those with the disease to include their networks of family and friends as well.

As functioning becomes increasingly impaired, the person with Alzheimer’s becomes more dependent on caregivers for help with tasks such as dressing, washing and even eating.  And with this dependency comes an increased demand for safety.  For these reasons, care is best provided in a secure, home-like environment with familiar surroundings and a high ratio of caregivers to residents, where there is greatest opportunity for one-on-one attention and interaction.

Doug Stark, President, ComfortCare Homes (This article featured in Health Matters Magazine, June/July 2011 issue)

"It's obvious Dad can no longer care for Mom by himself. How can we get him to accept the fact he needs help?"

Caring for a family member with Alzheimer's can be overwhelming, especially for someone whose own abilities may be in decline.  Yet telling your Dad he needs help can cause resentment.  Put yourself in his shoes and the reason may become clearer.

Chances are your parents lived their adult lives making their own decisions.  Now, because of circumstances beyond their control, their independence is slipping away.  That's hard to accept.  So despite your good intentions, your Dad hears suggestions to get help as criticism, confirmation that he's no longer able to meet his "responsibilities."

The best advice is to try to see the world through his eyes.  Offer suggestions instead of "orders."  Avoid language he might perceive as criticism.  If he has friends in similar circumstances, ask how they're doing.  Emphasize the positive, that getting help probably made their lives better.  Plant ideas that allow our Dad to reach the right conclusion on his own.  But take it slow.  Suggest that checking into help now might make it easier "down the road," in case the time would come he couldn't care for Mom.

Doug Stark, President, ComfortCare Homes (This article featured in the Wichita Eagle, June 28, 2011)

"We can't bear the thought of putting Dad in an 'institution.' Isn't there any alternative?"

There was a time when families had few options in caring for a loved one with Alzheimer's. They could either try to provide the care themselves - quickly realizing how impractical or even harmful that could be as the disease progressed - or they could place their loved one in a nursing home.  Today, as a growing number of sociologists and medical professionals acknowledge the failings of "institutions" in providing his type of care, more are advocating "patient-centered" alternatives such  as the concept pioneered by our family in 1993.

A ComfortCare Home is just that - a single-family residence where specialized, individually-focused care is provided in a familiar, comfortable, home environment.  Typically no more than six residents share the home with a CareTeam.  With a higher certified staff-to-residents ratio, we can provide a combination of personalized care and professional expertise not available in either an institution or the family's own home.

Doug Stark, President, ComfortCare Homes (This article featured in the Wichita Eagle, May 26, 2011)

"What kind of enviroment is best for caring for someone with Alzheimer's?"

In quality medical care, as a general rule, bigger is better.  Where memory loss is concerned the opposite is more often true.  In addition to loss of memory, Alzheimer's disease causes loss of judgement and communication skills.  As the disease progresses, physical coordination diminishes and the person with Alzheimer's faces increased risk of injury, becoming disorientated or wandering off.  A proper caregiving environment takes all of these factors into account, not only in planning, but also in staffing and daily operations.

As functioning becomes increasingly impaired, the person with Alzheimer's becomes more dependent on caregivers for help with tasks such as dressing, washing and even eating.  And with this dependency comes an increased demand for safety.  For these reasons, care is best provided in a secure, home-like environment with familiar surroundings and a high ratio of caregivers to residents, where there is greatest opportunity for one-on-one attention and interaction.

Doug Stark, President, ComfortCare Homes (This article featured in the Wichita Eagle, May 25, 2011)