"Who are you and what are you doing in my house? What did you do to my angel? Get out of here! Leave me alone!"
"Nana, it's me, Angel, your granddaughter."
"No you're not, she screamed! Where is she? Oh my God, my angel", she said, with her hands over her face, weeping inconsolably. "Please don't cry, I'll go get her", said Angel, briefly holding nana's hands while looking at her for some sign of recognition, but there was none. So she went out into the hall, closing the door behind her. And then she started to cry. She waited outside the door for what seemed an eternity, but was really only a half hour, during which time she managed to compose herself before walking back in, cheerily.
"Angel, I missed you, where have you been?", said nana, taking her face in her hands and kissing her cheeks. "I went to the store", said Angel, realizing then that she had no package to show for it, but nana didn't notice. "I'll make us some tea, nana".
They sat companionably at the small kitchen table, having biscotti and tea, the radio playing faintly in the background. This went on day after day after day until eventually, nana didn't recognize her at all. It was exhausting and heart-breaking for Angel, but the glimpses she got of nana the way she used to be kept her hanging on.
Extremely difficult to deal with are the loss of familiarity, non responsiveness, agitation, sleeplessness, and disorientation to people, places and time that occurs with AD. Someone suffering from AD may associate strangers with people they once knew who are now deceased. A caregiver's sense of reason tells her not to take the behaviors personally. Still, it's painful to see your close family member follow someone they don't know when they look right through you, not recognizing you.
"There are currently no validated biomarkers for Alzheimer's disease, but researchers are investigating several promising candidates, including brain imaging, proteins in cerebrospinal fluid, proteins in blood and genetic risk profiling." http://www.alz.org/research/science/earlier_alzheimers_diagnosis.asp
As is true for any illness, better outcomes are achievable when the disease is diagnosed and treated at the onset. There are screening tools used in a geriatric mental health assessment that can determine the presence of AD. Following an examination by the primary care physician, the local Alzheimer's Association is a
great resource for information and guidance.
Some of the symptoms that can occur with Alzheimer's are: repetitiveness, wandering, forgetfulness, aggression, depression and aphasia. There will be a decline in a person's ability to perform activities of daily living (ADLs) and the person will need some form of help, whether it's reminders, cueing or hands on care.
Two common medications prescribed for AD are Aricept and Namenda. Diet and exercise also play a role in treatment. As much as possible, it's best to keep change to a minimum and the environment clutter free. Labeling commonly used household items can be helpful to some. As the disease progresses, it may become necessary to take greater precautions, such as locking doors, installing alarms or using other monitors, and removing stove handles.
Something to be aware of when an elderly person is hospitalized or in rehab, especially for an extended period of time, is that strange surroundings, UTIs or other infections, as well as medication changes, can sometimes mimic AD; or, in some cases, exacerbate it.
It's important that the caregiver gets a respite and there are several ways to do it. Home care, day care with memory programs and Sundowners programs are some available options. For some, a combination of home care during the day and Sundowners (overnight) program, works out well.
When caring for a relative at home becomes overwhelming, the choices can be assisted living or skilled nursing facilities that have Alzheimer's units. Some ALPS have "work stations" with familiar settings for the residents.
Many Alzheimer's patients respond favorably to the arts, most notably music therapy. I witnessed this most recently when I got to participate alongside residents and colleagues in a program given by Marlon Sobol from the Institute for Music and Neurologic Function at Beth Abraham. The harmony of our drumming, clapping, stomping and singing was something to behold! It was truly engaging and fun.
Information about music therapy can be found at: www.musictherapy.org and www.cbmt.org.
"Rhythmic activities, ideas, and resources" for caregivers of people with dementia can be found at:
http://www.health.state.ny.us/diseases/conditions/dementia/edge/interventions/bethabraham/docs/beth_abraham_handbook_rhythmic_activities.pdf
About Maureen
Maureen Hildebrand has 10 years experience as a Case Manager delivering services to the adult care population in both public and private sectors. She has a Master's in Public Administration with a specialization in government. Maureen is currently working as an Elder Care Consultant based in Putnam Valley, NY and her contact information is seniorservicesspecialist@gmail.com.
