Learning To Live Optimally With Alzheimer’s

Nearly all of us have been touched by Alzheimer’s in one way or another. Maybe it’s a grandparent, a parent or a spouse who has it. Maybe it’s a neighbor. Maybe it’s you. Whomever it is, the reality of a brain in slow demise can be very scary. That’s why educating yourself about the disease can be helpful, particularly since there are ways to potentially slow it down.

For Alzheimer’s and Brain Awareness month, we are focusing on what a person who has recently been diagnosed can do to live a full life as long as possible. But first, what is Alzheimer’s?

Alzheimer’s is an incurable brain disease that causes memory loss and a decline in thinking skills. It’s a progressive, terminal neurogenerative disorder that destroys brain cells, actually shrinking the brain, and it slowly worsens over time, with some people’s health deteriorating faster than others. According to the Mayo Clinic, people with Alzheimer’s live approximately between three and 11 years post-diagnosis, with some living 20 years or more. And Alzheimer’s is the sixth leading cause of death in the U.S., according to the Alzheimer’s Association.

Alzheimer’s is often used interchangeably with dementia, but Alzheimer’s is actually just one type of dementia. Dementia is a blanket term used to describe a number of different neurological conditions affecting the brain that worsen over time; Alzheimer’s is the most common type of dementia.

There are three main phases of Alzheimer’s, according to the Alzheimer’s Association. It begins with mild symptoms, typically memory problems (some experts divide this into two mild phases, with a total of four – and sometimes more). In phase two, symptoms such as memory problems become more pronounced. A patient may also experience severely impaired reasoning and a loss of language. By phase three, the final stage of Alzheimer’s, patients can no longer recognize loved ones and are unable to care for themselves. In laymen’s terms, the brain is no longer communicating to the body how to do even the most basic things like swallowing, which makes eating and drinking a never-ending challenge and can lead to dehydration and malnutrition. Difficulty swallowing can also cause accidental inhalation of food, liquids, or other particles into the lungs instead of the esophagus, which can cause aspiration pneumonia, the most common cause of death among Alzheimer’s patients.

According to the Alzheimer’s Association, there are ten warning signs for Alzheimer’s. They are:

1. Memory loss that disrupts daily life. This isn’t simply forgetting appointments once in a while, which might be typical of someone who is ageing, we’re talking forgetting recently learned information This is particularly characteristic of Alzheimer’ in the early stages – and is the number one indicator of Alzheimer’s or another form of dementia.
2. Challenges in planning or solving information. Someone with Alzheimer’s or another form of dementia might start having problems making plans or working with numbers. They might find it difficult to follow a recipe or manage household bills.
3. Difficulty completing familiar tasks.
4. Confusion with time or place. People with Alzheimer’s might become confused about what day, month or season it is. Sometimes they get confused about where they are.
5. Trouble understanding visual images and spatial relationships. Some people with Alzheimer’s begin experiencing issues with their vision (not due to cataracts). This sometimes impacts their balance or ability to read. They may also have problems judging distances which can negatively impact their ability to drive.
6. New problems speaking or writing certain words. People with Alzheimer’s might have trouble following or joining a conversation. They might lose their train of thought, causing them to suddenly stop in the middle of a conversation. They might have trouble remembering the name of familiar objects such as “table” and “tree.”
7. Misplace things and lose the ability to retrace steps.
8. Experience decreased or poor judgement. People with Alzheimer’s may begin to show changes in decision making. For example, they might make poor/odd decisions regarding money and might begin to neglect personal hygiene, unaware that they need to regularly bathe.
9. Withdraw from work or social activities. A person with Alzheimer’s might find it challenging to follow conversations and because of this, withdraw from social settings.
10. Experience changes in mood and personality. This can take many forms: the person might become more irritable, depressed or easily anxious or fearful.

If you or a loved one is experiencing many of the above, it might be time to visit a doctor to get properly diagnosed. Doctors can use a variety of methods to see if a patient has Alzheimer’s or another form of dementia (or something else entirely). According to the National Institute of Health (NIH), these methods may include:

1. Asking the patient about their ability to carry out daily activities and any changes in behavior or personality. It is also very helpful to ask the patient’s loved ones the same questions because the patient themselves might not be able to give a clear answer.
2. Conduct tests of memory, problem solving, attention, counting, and language.
3. Order blood, urine, and other standard medical tests that can help identify other possible causes of the problem.
4. Order a blood test to measure levels of beta-amyloid, a protein that accumulates abnormally in the brains of people with Alzheimer’s. (Please note, this and other blood test results should not be the only tests used to diagnose dementia; they should be taken into consideration along with other tests. However, the availability of these diagnostic tests is still limited.)
5. Administer a psychiatric evaluation to determine if depression or another mental health condition is causing or contributing to a person’s symptoms.
6. Collect cerebrospinal fluid (CSF) via a spinal tap and measure the levels of proteins associated with Alzheimer’s and related dementias.
7. Perform brain scans, such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET) to support an Alzheimer’s diagnosis or rule out other possible causes for symptoms.

Are there any advantages to an early diagnosis?

Yes. Firstly, knowing you have a terminal disease can help you prioritize the rest of your life. For example, it might inspire you to take charge of your long-term care needs as well as legal and financial planning, such as your will. You can also discuss available treatments with your physician, including medications available (see below) and possible clinical trials. It also might help you prioritize: how do you want to spend the precious time you have and who do you really want to spend it with?

An early diagnosis could also help you focus on a healthier lifestyle as certain positive health changes may slow down symptoms – and also improve your quality of life. 

Below are some lifestyle changes that may improve your quality of life and may slow down the rate of symptoms worsening, according to the according to the Alzheimer’s Association:

1. Challenge your mind. Do crossword puzzles or learn a new skill. Think of it as a workout for your brain – it may help slow the cognitive decline caused by Alzheimer’s.
2. Challenge your body. Just as it’s important to work out your brain, it’s important to work out your body. Raising your heart rate and increasing blood flow to the body and brain may help improve cognitive functioning. So start exercising!
3. Quit smoking! Giving up the butts may lower the risk of cognitive decline to levels to those who don’t smoke.
4. Maintain healthy blood pressure. According to NYU Langone Health NewsHub, “high blood pressure damages blood vessels and causes blockages that reduce blood flow to the brain. It reduces the blood’s ability to clear harmful waste products and breaks down connectivity between areas of the brain.” Talk to your doctor about how you can lower your blood pressure.
5. Eat healthy. Some studies have shown that healthy eating habits may help reduce your risk of cognitive decline. A healthy diet includes lots of vegetables and leaner meats and unprocessed foods. This is also known as a “Mediterranean diet,” which is a diet high in anti-inflammatory foods, including healthy fats and antioxidants.
6. Manage your diabetes. While the exact connection between Alzheimer’s and type 2 diabetes is still in debate, according to the NIH, studies do suggest that “poorly controlled blood sugar may increase the risk of developing Alzheimer’s. This relationship is so strong that some have called Alzheimer’s ‘diabetes of the brain’ or ‘type 3 diabetes.’”
7. Maintain a healthy weight. According to many experts, including the Alzheimer’s Society, “people who maintain a healthy weight are more resilient to the changes in the brain that are caused by Alzheimer’s disease.”
8. Sleep Well: We all know how good we feel after a full night’s sleep, but did you know it’s the equivalent of ‘food’ for the brain? Your brain needs its rest and will only function optimally when it gets enough of it.
9. Manage your stress. Stress negatively impacts a person’s overall health, and this is true for someone with Alzheimer’s. Increased stress may exacerbate symptoms of Alzheimer’s, so do whatever it is that helps you prevent stress or at least minimize it. For some that’s meditating, for others, that’s going fishing – and many things in between.

Although there is no cure as of yet for Alzheimer’s, for many with the disease there are medicines available to treat some symptoms. Most medicines work best for people in the early to mid-stages of Alzheimer’s. Below are a few kinds of medications that doctors might prescribe:

1. Lecanemab and Donamab are two drugs that were approved by the FDA (2023 and 2024, respectively, with results differing) as immunotherapy drugs for the treatment of early Alzheimer’s. Both drugs target the beta-amyloid protein in the brain to aid in reducing amyloid plaques; a buildup of amyloid proteins in the brain is one of the causes of Alzheimer’s. Studies show that both drugs slowed the rate of cognitive decline among some participants. 
2. Cholinesterase inhibitors. This “family” of drugs includes galantamine, rivastigmine, and donepezil (all three are FDA approved) and may help reduce or control some cognitive and behavioral symptoms of someone with mild to moderate Alzheimer’s. According to the NIH, cholinesterase inhibitors “prevent the breakdown of acetylcholine, a brain chemical believed to be important for memory and thinking…a person living with Alzheimer’s may response better to one (cholinesterase inhibitor) drug versus another.” (It’s important to note that over time, these medications lose their effectiveness.)
3. NMDA (N-methyl-D-aspartate) antagonist: This includes the medication memantine, an FDA-approved drug that may decrease symptoms in someone with moderate to severe Alzheimer’s. For example, memantine might aid a person in the later stages of Alzheimer’s who struggles with bathroom functions.

When a patient starts any of these drugs, it is important that they continue to be monitored by their physician.

Being diagnosed with Alzheimer’s can be upsetting and overwhelming, but remember, you’re not alone. There are plenty of resources available to help you navigate this disease – just make sure you find the right ones (there’s a lot of not-so-accurate information on the internet). To help you on your journey, we’ve listed a few trustworthy websites about Alzheimer’s and dementia below:

Official website of the US government on Alzheimer’s:  Alzheimers.gov

Alzheimer’s Association: www.alz.org  (Also: call its 24/7 helpline anytime 800.272.3900)

National Institute on Ageing: www.nia.nih.gov

National Institute of Health: www.nih.gov

BrightFocus Foundation: www.brightfocus.org

ALZConnected: alzconnected.org

This information is for educational purposes. Please consult your physician for any medical issues. The Visiting Nurse Association of the Treasure Coast (VNA) is committed to bringing trusted and quality home health, private care and hospice to Indian River County patients. For more information about VNA services, call 772-567-5551 or visit www.vnatc.com.