June is Alzheimer’s and Brain Awareness Month in the United States. I’ve discussed aspects of Alzheimer’s in the past, and I’d like to go into more depth about this devastating disease. My dad and several of his siblings suffered from Alzheimer’s dementia. As my patients have aged, I’ve had the difficult task of sharing the news with them and their families that dementia is getting worse.
There are an estimated 6.5 million people living with Alzheimer’s in the United States. The incidence increases with age from 5% at less than 65, to 33.2% of people over 85. In Texas, there were an estimated 400,000 patients with Alzheimer’s. That should increase to 490,000 by 2025.
Mild memory changes can result in a condition called mild cognitive impairment. If someone doesn’t do well on memory test or occasionally forgets things, but can still perform their usual activities like paying bills and shopping, they may have MCI. This condition can progress to Alzheimer’s disease, however.
The principal symptoms of Alzheimer’s disease are memory impairment, impaired executive/judgement functions, behavioral symptoms and impairment of other cognitive functions. The earliest memory impairment is for recent events. Patients have trouble remembering things that just happened or answers to questions they just asked. Other types of memory are affected as the disease progresses. Executive functions are things like managing finances, shopping, cooking and driving. Often patients aren’t aware they have a deficiency in an area until it becomes apparent to others. Patients can get lost in a familiar neighborhood, forget to pay bills or pay them twice, or leave the stove on or the refrigerator open. Early in the course of the disease, patients can be bothered by issues they experience. As it progresses, however, they lose insight into what they can or can’t do, and this can cause agitation or other behavioral issues. Behavioral symptoms can include irritability, apathy, and end with aggression or psychosis.
This is difficult for the patient and the family caring for them. In the patients I care for, the key is being open and honest about the diagnosis and begin planning as early as possible. The strain on caregivers is immense and, often, a child is left alone to manage things for the parent. I try to encourage them to care for themselves first, so they can then care for their parent. Some choose to have a provider come in for some hours of the day, others quit work and care for the parent full-time. It often takes an “all of the above” approach to care for a parent or family member with Alzheimer’s disease.
Your primary care physician should be available to have the difficult discussions and provide information to help through the process.
Michael Dominguez, MD, FAAFP is board certified in Family Medicine. His office is located at HealthTexas Medical Group, 590 N. General McMullen, 78228, phone: 210-249-0212.
