The things people with dementia do – their behaviors – can be the most distressing part of their illness. Dementia damages the brain, so the person cannot make sense out of what he sees or hears —The Thirty-six Hour Day, by Nancy L. Mace and Dr. Peter V. Rabins.
Did you know that there is a way in which the memories of a 75 year old and a 25 year old are exactly the same? I certainly didn’t.
I found that intriguing bit of knowledge at a lecture last week given by Dr. Peter Rabins, co-author of the book for caregivers I often recommend to you titled The Thirty-Six Hour Day. For some time, I have been in awe of Dr. Rabins work at the Johns Hopkins University School of Medicine where he is a psychiatrist. I was excited to see and listen to him in person, and he did not disappoint. However, before I go much further, you probably want to know about the memory thing.
Here it is: If you give a 75 year-old three words to remember, and then talk for ten minutes, and then ask him to repeat the three words, chances are he will not be able to repeat them. A normal 25 year-old will nearly always get them right. However, the 75 year old will do as well as the younger person on what is called “recognition and recall.” If the Doctor’s questions are more like a multiple choice test, where the Dr. asks “Did I give you the word, “Ball” – yes or no?, the older person will do as well as the younger person on the test. On such a test, said Rabins, the older person obviously knows the information. It is, therefore, our ability to quickly access the information in our brain that declines as we age.
In addition to his work as a professor of Psychiatry, Dr. Rabins is the Richman Family Professor of Alzheimer’s and Related Dementias. He has focused his career on the study of psychiatric disorders in older persons. His current research focuses on the effectiveness of current therapies for Alzheimer’s disease, the development of measures of quality of life in persons with Alzheimer’s disease, and the care of patients with late stage dementia.
Among other things he said, is that a person with Alzheimer’s Disease cannot do “recognition and recall” as described above. Other than that, the Dr. said, it is a false idea and assumption that a healthy person always deteriorates with age.
Dr. Rabins explained that dementia, which has been around as a condition for hundreds of years has three defining characteristics: It always starts in adulthood, it impairs at least two aspects of thinking and the person with dementia has a normal level of consciousness and is totally alert. A person can actually have dementia and have a normal memory.
Not so with Alzheimer’s Disease. The diagnostic features of that disease include: it always starts in adulthood, it is a slowly progressive dementia, other possible causes of the dementia have been ruled out (such as Parkinsons, etc. In fact 75 diseases can cause dementia) and there is a decline in memory plus either asphasia, apraxia or agnosia.
For a quick review, Asphasia is defined as the loss of a previously held ability to speak or understand spoken or written language, due to disease or injury of the brain. If this happens suddenly, it is likely a stroke. If it develops over time, it is likely a result of Alzheimer’s Disease.
Apraxia is a disorder of the nervous system, characterized by an inability to perform purposeful movements. Dr Rabins described this as the inability to do something that you learned to do when you were young, such as learning to brush your teeth or take off your jacket, both of which become very automatic. These functions actually require a number of progressive steps and, in Alzheimer’s Disease they are unlearned in exactly the reverse order of the way they were learned.
The third condition, Agnosia, is the partial or total inability to recognize objects by use of the senses. Alzheimer’s always has memory loss, plus it always has just one of the above-described conditions.
When I was a child, an elderly person acting strangely was often referred to as having hardening of the arteries. Dr. Rabins said that the phrase was used to describe people whose symptoms probably actually indicated Alzheimer’s Disease, because actual hardening of the arteries is the exact same in healthy people as in dementia patients.
As for helping caregivers, Dr. Rabins said that the goal of a sort of “rehab” for Alzheimer’s patients is to figure out what they can no longer do and do it for them – such as cutting up their meat. It is important, he cautioned, to help them in this way by cutting up their meat in the kitchen, so it won’t embarrass them at the table in front of others. The second part is figuring out what they can do, and letting them do it.
In 2005, Dr. Rabins wrote a book that I did not know about until the lecture. It is called Getting Old Without Getting Anxious. It’s on the way from Amazon. I’ll let you know how it turns out.
Thank you for reading. Stay well. See you next week.