Resources

Aug 30, 2011

Among the fastest-growing and most debilitating diseases in the United States, Alzheimer’s affects an estimated 5.4 million Americans. One in eight seniors has Alzheimer’s, making it the most common form of dementia. The disease is the sixth-leading cause of death among all ages in the United States. For seniors 65 and older, it’s the fifth-leading cause of death. And with no known cause, cure or prevention, Alzheimer’s has the potential for being one of the greatest challenges faced by The Evangelical Lutheran Good Samaritan Society and other providers of long-term care.

 

Watch video: Attention to Alzheimer's: Understanding a troubling disease

 

 

 

Q&A with Dr. Matthew Malone

 

Dr. Matthew Malone is a geriatric psychiatrist and medical director of hospice services for Avera Behavioral Health Center in Sioux Falls, S.D. His care focus is dementia and its related behavioral symptoms. As a hospice and palliative care physician, Dr. Malone is dedicated to trying to find ways to palliate and alleviate some of the symptoms of Alzheimer’s disease and other dementias.

 

Q: Could you provide a historical perspective of the disease and its progression?

A: There’s been a long-standing stigma associated with Alzheimer’s disease that we try to overcome or disprove. In the past, people were thought to be crazy, or wrong or shamed for having the disease because it changed how they functioned. And so people were mistreated or neglected in many ways. There weren’t a lot of resources to support people as they’ve endured this. Over the decades, we’ve really tried to create a way to promote their lifestyle and functioning, and help them live dignified lives and be active for as long as they can. One of the most interesting things we’ve found is that although we do get some decline in our memory and cognitive abilities, Alzheimer’s disease is not a normal aging process. We don’t know the true mechanism that causes the disease, but we’re better able to understand what’s going on in the brain. It really is a separate disease entity.

 

Q: What side affects appear with Alzheimer’s disease?

A: There are so many ways the disease impacts us. Not only does it begin by robbing us of memory, but it changes the way we interact socially, it robs us of our peers and our networks, it removes us from our families, it isolates us from our communities, our social networks, our jobs, and it really destroys just about every way we interact in the world around us. So, there is a high rate of depression. People who have not yet been diagnosed often have the emergence of depressive symptoms prior to the diagnosis. And we don’t believe the depression is a cause of the disease, but really a symptom that starts to present first. Then, as the disease progresses, about 50 percent of people who have Alzheimer’s disease will have three behavioral symptoms, and 90 percent will have one behavioral symptom. As the brain changes, it does change how we function and how we behave and how we feel emotionally. And that’s only for the individual. This doesn’t even include all the emotional and social impacts of family and friends and the community around them.

 

Q: What are some behaviors that family members and caregivers can expect?

A: There are a lot of behavioral and psychological symptoms that accompany dementia. Irritability, sadness, withdrawal…and one of the common characteristics of the disease is apathy, this loss of expression of emotion, which is not actually depression. Behaviorally, we can see a lot of other changes. People can become suspicious or paranoid, and a lot of that’s driven by the loss of memory. As more changes occur, our ability to use our reasoning and judgment to make rational decisions gets worse. We often will see personality changes that have never been present before. People react to scenarios far different than they ever have, which is not only hard for the family members as well as the patient, but also for those who care for them.

 

Because it is a disease that progresses generally slower than a lot of other diseases, the initial symptoms are very subtle. What’s important to remember is that when memory deficits start to appear, they aren’t intentional. But in people’s attempts to respond to those memory losses, they will often get mad or try to be more forceful when making their point. There’s a high degree of frustration amongst the individual with the disease and others around them. And the hard part is to be able to step away and say that this isn’t done on purpose. It’s physically being removed from their abilities. And so early on, it’s gaining an understanding of what that person can and can’t do and actually realizing they can’t stop this. We have to increasingly become aware and start to make decisions that promote their safety, even at the risk of trumping their autonomy. And trying to create an environment where they can live and interact in is always important.

 

Q: Why is the number of Alzheimer’s cases rising?

A: We’ve seen people who previously used to die of other diseases now survive heart attacks or survive other chronic diseases and live long enough to really see the emergence of Alzheimer’s disease. There are a lot of questions as to what other factors are contributing to the disease. We aren’t seeing any obvious data that says that, statistically, we have more cases of Alzheimer’s disease now than we did in the past, so we don’t believe there’s something in our environment that’s causing it. But we know that as we get older, our risk factor really climbs. From age 65 to age 85, the rate practically doubles every five years.

 

Q: What do you suggest to help family members with stress and caring for a loved one with Alzheimer’s?

A: As a professional, I work a lot with the Alzheimer’s Association and similar organizations. Get help. Information is probably the best thing, because once we all know what we’re dealing with, then we can have a discussion about how to intervene. Find a professional to talk to. Get a good diagnosis to really understand what the pattern of change is, because we have to differentiate Alzheimer’s disease from other dementias.

 

Q: Why is early detection important?

A: We need to become aware of how to help that person and provide a care plan that’s appropriate for that person and their family, as well as have these discussions up front, so we know what to expect and we know what the person wants in the long term. Have a support network, because it’s very easy to become isolated and believe there’s no help at all. Caregivers and patients become a bit removed from society, particularly as their care needs increase. We really advocate for assistance and support networks, wherever they may be.

 

Q: What treatments are there, and what do they do?

A: We’ve got just a small handful of medications that really are designed to slow the symptoms of memory decline down. Usually, they plateau the decline for about a year. They promote activity, but don’t alter the course of the disease or the changes that are going on in the brain.

 

Q: What’s on the horizon for prevention, treatment or a cure?

A: The long-term goal is to find a way to prevent the disease, to intervene before it manifests. There are research trials going on to remove some of the changes that occur in Alzheimer’s disease — these plaques that get deposited in the brain — and using antibodies to remove those plaques. We have limited amounts of data on their full effect, but some studies offer some hope and encouragement that they may work in addition to the medications. But none to this point have really given us a lot of overwhelming evidence to say they’re halting the disease course, which is what we’d hoped for. We’re starting to see the first attempts to actually intervene or alter what’s going on in the brain, not just respond to the loss of cellular function in the brain, and that’s where the future of the research is going.

 

Q: Based on studies and your expertise, what can people do to improve brain health and maintain function?

A: Anything and everything in moderation. Exercise has been proven to help the vascular health of the brain and promote blood flow. Learning new tasks, rehearsing information, and cognitive exercises are always important in maintaining our associations to all of our different stored memories. The degree of redundancy helps minimize symptoms of emergence of disease or cognitive change. Maintain an active, healthy lifestyle. Controlling vascular risk factors — anything that contributes to heart disease — will benefit us in multiple ways, not just our heart health, but our brain health, too.

 

 

Read more about Alzheimer's disease in the Vol. 45, No. 2, issue of The Good Samaritan magazine:

 

Click to launch the full edition in a new window

 

Click here for more Good Samaritan Society articles and resources related to Alzheimer's disease and memory care.

 

Click here to visit the Alzheimer's Association Web site.

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