Dealing with dementia
Alzheimer’s treatment programs offer hope, but first, families must
overcome fear of diagnosis.
KIMBERLY DISHONGH
SPECIAL TO THE DEMOCRAT-GAZETTE
It’s normal to have a harder time remembering things as you grow older, but not all
forgetfulness is a normal part of aging.
“If it’s just a name that your mother is having trouble with — she sees somebody in the
grocery store and they speak, and obviously she knows them but she can’t come up with
a name — that’s normal. It’s normal to be slower to recall the name; she might think of it
an hour after she gets home. ‘Oh, we used to play bridge with them,’” says Sharon
Hernandez, administrator of the Ginny and Bob Shell Alzheimer’s Center at Baptist
Health’s Parkway Village retirement center in Little Rock.
However, when your mother has used the same coconut cake recipe for 40 years and
suddenly can’t remember how to make it anymore, or when she puts her keys in the
refrigerator instead of on the hook by the door, or when she asks you four times in one
night how your son did on his math test and can’t remember what you told her — or that
she has already asked — it’s time to consider asking a doctor for help.
In 2006, Becky Hooker of Hot Springs noticed her mother, 76-yearold Annie Maude
Hinton of Prescott, doing things that were out of character. Hinton had taken framed
family photos from walls and stashed them in the shed behind her house and was
repeating herself in regular conversation. Hooker’s brother noticed that she had been
calling him four or five times in the evening, forgetting each time that she had called him
before.
Hinton’s primary care physician determined she was in the beginning stages of
Alzheimer’s and referred her to a neurologist. Medication seems to have slowed the
progression of the disease, says Hooker, but caring for her is still an arduous process for
the family.
“In the last year, Mother has progressed quite a bit,” Hooker says. “We’ve all noticed
that and she has, too. It’s very sad for her because my mother was always very active.
She had a catering business, she made wedding cakes. She has to depend on other people
to do things and it’s very difficult.”
A diagnosis of Alzheimer’s disease is, for many, the most frightening they could be
given.
“Some time ago it used to be that cancer was the most dreaded diagnosis and if you
heard that word, it was as if you were being sentenced to death,” says Dr. Jeanne Wei,
executive director of the Donald W. Reynolds Institute on Aging at the University of
Arkansas for Medical Sciences. “People didn’t want to talk about it, it was so depressing.
Many cancers are now quite readily treatable.
“That word — dementia — strikes fear and dread and depression, especially in older
people, the same way that cancer used to do.”
There is no cure for Alzheimer’s disease, but Wei says there is hope.
“The reason people are reluctant to go to the doctor is maybe the same reason that
people didn’t want to go for cancer evaluations. They figured there’s nothing you can do
anyway,” Wei says. “We don’t have a cure, but we certainly have many more treatments
that can help delay the rate of progression.”
Medications such as Razadyne, Aricept and Exelon have shown some success in
slowing the progression of Alzheimer’s disease by increasing the brain chemical
compound acetylcholine, which is a neurotransmitter in the central nervous system and
plays an important role in memory and learning. The drug Namenda is a glutamate
pathway modifier. Glutamate is an amino acid important for learning and memory. The
two types of medications can be used separately or in combination.
Most doctors agree that the earlier treatment begins, the better.
Starting treatment early means getting an early diagnosis, which is sometimes easier
said than done.
Priscilla Pittman, program director at Alzheimer’s Arkansas, hears often from people
seeking guidance on how to get loved ones to go to the doctor.
“I’ve seen some really bizarre things,” she says, “like trickery — they’ll say, ‘Let’s go
get some ice cream,’ and [they] end up at the doctor’s office. These people are doing
what they think they need to do.”
Pittman recalls instances where women talked up the facilities for geriatrics at UAMS
and St. Vincent Infirmary Medical Center, persuading their parents to pay a visit.
In one case, the daughter stepped aside and told her parents, “I’m going to be tested in
here and you’re going to be tested in there,” Pittman recalls.
Pittman urges people to see a doctor as soon as they notice a problem because it may
not be dementia — it could be something much more benign.
Thyroid problems, vitamin deficiencies, blood sugar disorders and other issues can
cause symptoms that mimic dementia and can be detected through blood tests, usually
standard for patients who exhibit cognitive decreases.
Depression can also look a great deal like dementia.
A chest X-ray may determine if enough oxygen is being moved by the lungs to the
brain, and a brain scan can help doctors determine what parts of the brain are functioning
and rule out mini-strokes.
“When I was an intern, I was at the [UAMS] Reynolds Institute on Aging, a woman
came in with her mother and said, ‘You don’t even need to test her, I know she’s got it,’”
Pittman recalls. “She didn’t. She had not had her eyes checked in 20 years; she couldn’t
see where she was walking ... and she needed hearing aids. She had to have things
repeated because she couldn’t hear ...
“There are just a whole host of things that it’s important for folks to know about. There
are things that we can reverse.”
Sometimes it’s not fear or anxiety that keeps people from seeing a physician. Certain
situations can mask the presence of memory problems, making early diagnosis difficult.
Amanda Franks of Magnolia noticed that her grandmother, VonCeylle Cragan, was
behaving differently shortly after her grandfather, Cecil Cragan, died in 2000.
Cragan began calling Franks in a panic.
“She couldn’t decipher what junk mail was — it would say she needed to do
something and she would get upset about it,” Franks says. “And it would be things like,
‘Well, I told you twice I was going out of town, Grandmother’ and she would get so mad
and say I didn’t tell her. I knew I had. Those type things started happening a lot.”
Cragan’s primary care physician diagnosed dementia after a simple test. He asked her
to remember two words and he would ask her to repeat them back to him in a few
minutes. He then asked her the name of the president, the year and her birth date before
asking what those two words were.
“She couldn’t do it,” Franks says. “I was kind of surprised, but she didn’t even get all
the questions right.”
Cecil Cragan had dementia and, in hindsight, Franks wonders if her grandmother’s
memory problems might have been going on long before they noticed.
“For a while I think we just thought it was because Granddaddy was gone,” she says of
her grandmother, who died April 1 at age 93. “I can see now that it probably went on a
few years before we realized she was losing her memory.”
Coping skills can delay a diagnosis.
“Highly intellectual people are able to hide the problem for a much longer time than a
person who hasn’t had a lot of education,” says Dr. David Lipschitz, executive director of
the Longevity Center at St. Vincent. “When the well-educated person can’t cope
anymore, [they are] further down the road.”
Suzanne McCarthy’s mother, Suzanne Stabnick, was probably aware that something
was amiss for years before anyone else noticed.
“My mom is probably one of the brightest people I’ve ever met,” McCarthy says, “and
she would say that your greatest asset can also be your greatest liability. [In retrospect] I
can see that she was losing some ability to perceive her environment and interact with her
environment the way she had in the past; she would overcompensate for it using her
intellectual skills. She could redirect conversations in a really fancy way. My mom was
the master of 50-cent words and she would pop out one of these mind-bogglers and
everybody would look at her and go, ‘Oh, she’s perfectly fine.’”
It wasn’t until her mother was hospitalized for an acute infection about five years ago
that McCarthy was certain there was a marked decline in her mental capacity.
Wei says that scenario is common.
“Say a senior [citizen] is starting to have some memory problems but if they are in
their own homes doing the routine things that they do every day, they might be having
signs of memory impairment and not show it until they are put into a new environment.
That could be one of the ways it gets diagnosed,” she says.
As McCarthy, director of government relations for the Arkansas Center for Health
Improvement at UAMS, waited for her mother’s appointment at the Reynolds Center, it
became even more apparent that her mother had a problem.
McCarthy’s mother became uncharacteristically angry and aggressive, accusing her of
stealing and calling the police to report a theft. McCarthy, the oldest of six children and
the only one living near her mother, was hurt by the accusations. She came to realize it
was the disease talking, not her mother.
Stabnick had had a brain scan after an earlier fall, and doctors at the Reynolds Center
detected some signs of Alzheimer’s.
“More importantly, the cognitive testing was very thoroughly done,” McCarthy says.
“[The doctor] wrote a very detailed report that was easily understandable and counseled
me well on her findings.”
McCarthy was assigned a social worker, who talked with her about her mother’s
diagnosis, helped assess whether the place where she was living would be safe and linked
her with some support groups and resources.
By the time Stabnick was diagnosed, she was already in the moderate stage of
Alzheimer’s, meaning she might have had difficulty remembering basic information, like
her address and phone number, and that she needed some assistance to stay in her own
home.
New guidelines for the diagnosis of Alzheimer’s released April 19 specify that there
are three stages of the disease — preclinical Alzheimer’s, before memory loss is apparent
but when measurable changes in biomarkers are present; mild cognitive impairment due
to Alzheimer’s, in which mild changes in memory and thinking ability are noticed by the
patient and to those around him; and dementia due to Alzheimer’s disease, which means
memory, thinking and behavior impair a person’s ability to function.
The guidelines, created by three expert work groups established by the Alzheimer’s
Association and the National Institute on Aging of the National Institutes of Health, are
designed to move toward earlier diagnosis, eventually even creating pre-symptomatic
treatment of the disease.
For people like Becky Hooker’s mother, that can’t come soon enough.
“I just hope they come up with something to help people with Alzheimer’s,” Hooker
says. “That is my prayer because it just is heartbreaking. You just watch those people that
you care so much about — there’s no control in a lot of their lives anymore.”
10 warning signs
Memory loss that disrupts daily life is not a typical part of aging, according to the
Alzheimer’s Association. On its website, alz.org, the association offers extended
descriptions of the following warning signs and suggests a doctor should be consulted if
any are evident.
1. Memory loss that disrupts daily life 2. Challenges in planning or solving problems 3.
Difficulty completing familiar tasks at home, at work or at leisure 4. Confusion with time
or place 5. Trouble understanding visual images and spatial relationships 6. New
problems with words in speaking or writing 7. Misplacing things and losing the ability to
retrace steps 8. Decreased or poor judgment 9. Withdrawal from work or social activities
10. Changes in mood and personality
Help available from websites and local clinics
If you suspect that you or a loved one may have Alzheimer’s disease, discuss it with a
doctor or neurologist.
In Little Rock, two medical centers have specialized clinics for aging patients.
Donald W. Reynolds Institute on Aging is a part of the University of Arkansas for
Medical Sciences. Call (501) 686-6219 to set up an appointment at the institute.
The Longevity Center at St. Vincent Health Center in Little Rock provides services to
aging patients. It also has a Memory Center, dedicated to the diagnosis and treatment of
memory loss. To schedule an appointment at The Longevity Center, call (501) 552-4777
or (866) 275-4777; stvincenthealth. com/longevity.
For more information:
Alzheimer’s Arkansas: Is a nonprofit providing support and assistance for Alzheimer’s
patients and their families. Phone: (501) 224-0021 or (800) 689-6090 or see alzark. org.
Alzheimer’s Disease Education and Referral Center: The National Institute on Aging
offers current, comprehensive Alzheimer’s disease information and resources from the
National Institute on Aging. See www.nia.nih. gov/Alzheimers, or call (800)-438-4380.
Alzheimer’s Association:
In addition to an information-packed website, alz.org, the nonprofit association has a 24hour telephone hot line providing referrals and other support for Alzheimer’s patients and
caregivers at (800) 272-3900.