Alzheimer’s Disease

I was saddened to hear the announcement that actor and former NRA president; Charlton Heston, has early signs of Alzheimer’s disease. I was also inspired to hear him speak out publicly and courageously about his illness and his determination to go on living his life. Mr. Heston joins former president, Ronald Reagan and 4 million other Americans who have been diagnosed with this disease.

Alzheimer’s disease (AD) is a condition that causes progressive and irreversible dementia, and eventually, death. Dementia is a significant loss of brain functioning and mental abilities, and is associated with increasing problems in memory, reasoning, orientation, impulse control and the stable intactness of one’s personality. Early signs of AD may include forgetting names, dates or directions to places, increased irritability and social withdrawal. Eventually AD will take away first newer and later, older memories. It will reduce the ability think and then even to communicate with loved ones. In the later stages, AD causes a breakdown in the most basic of self-care skills, requiring total reliance on others for even basic care and survival.

AD is, in most cases, an affliction of the elderly, rarely affecting those under 60 years of age. Over the age of 60, about 1 in 20 and over 80 years, 1 in 4 are diagnosed with AD. Women are slightly more likely to be diagnosed and, for reasons not fully understood, those with better educations are less likely to develop AD.

As there is no single reliable test for AD, it is not diagnosed without first excluding a number of other medical conditions, including Parkinson’s disease, tumors, head injuries, toxic states and illnesses causing loss of circulation to the brain. According to Alzheimer’s expert, Dr. Gary Small, Director of the UCLA Center on Aging, early detection of Alzheimer's disease is now possible using genetic measures and neuroimaging techniques, such as positron emission tomography.

In Dr. Small’s experience, “A lot of people ignore the symptoms early on…and it’s hard to differentiate complaints from early signs of Alzheimer’s from other conditions.” He also cautioned that fears of the symptoms and the stigma that they associate with the illness could keep people away from needed care.

Presently, we have no cure for AD, but several medications are now available that can offer moderate, short-term relief from some of the symptoms. A class of drugs called “cholinesterase inhibitors” has been found to be useful, delaying AD caused decreases in brain functioning. Dr. Small emphasizes, “These drugs have a big impact early on,” explaining that by stopping cognitive losses sooner, treatment can help keep these patients functioning longer.

Dr. Small and I discussed some recent research showing that there are some signs of changes in brain activity detectible in as early as the third decade. In light of these and other findings, identifying and treating Alzheimer’s and other brain deteriorating conditions earlier might enable us, as he says, “to keep people on the job longer.” Dr. Small has recently published a landmark book, The Memory Bible: An Innovative Strategy for Keeping Your Brain Young, where he provides a comprehensive set of strategies for maintaining brain and memory fitness throughout life, based on his clinic’s research findings.

In addition to medical treatments, psychosocial therapies and educational resources for families and caregivers can be of great value in reducing some of the distress associated with caring for this illness. Dealing with repetitive questions, unexpected losses of temper and sudden emotional outbursts, caregivers need occasional time off and supportive counsel to maintain their own stability during what can be an extended period of care.

Faced with certain losses of mind and eventual death, the public courage of president and Mrs. Reagan and Charlton Heston is an inspiration and a reminder to all of us to respond with compassion for them and for the many others who suffer, namelessly, from such conditions. I am sure that long after their own memories and lives have faded, we will remember them well for the way that the have faced their fates.

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