Help for Your Loved One

Does someone you care about have any of the following symptoms? Each question below is followed by a brief illustration of the types of problem behavior and responses that may occur when the condition is caused by Alzheimer’s disease.

These symptoms don’t necessarily spell a diagnosis of Alzheimer’s — only a physician can make an adequate evaluation. However, if you find that, on reflection, the person displays many of the symptoms listed below, it would be a good idea to have him examined by a physician. Early detection can make an important difference in treatment and hope.

Short-term memory lapses:

1. Does your loved one forget what happened a minute ago — or not
understand what’s taking place right at the moment?

a. Mrs. Meyer hung up the phone after talking with her daughter about their dinner plans. She went into the living room where her husband was sitting and immediately began complaining that she wished her daughter would call, since they were supposed to make plans for dinner. Her husband asked her who she had been talking to on the phone, and she couldn’t remember.

b. Ray began coming into the kitchen around dinner time and finding Marge had left a number of dishes half completed or discarded: vegetables were peeled and in a pot but the heat had been turned off, a roast left in the oven for hours was sorely overcooked, and noodles were dumped into a pan with no water. Marge had prided herself on her cooking abilities and had prepared masterful meals for her family for years. Yet, now her mind was no longer on what she was preparing. It was as though she didn’t care anymore.

2. Does he seem disoriented with respect to time?

Mr. Harris would arrive at his daughter’s house for dinner, take off his hat and coat and, a few minutes later, would begin insisting it was time to go home. His wife and daughter thought he was just being rude. If he didn’t get his way, however, he could become frustrated and angry.

3. Do familiar objects often strike the person as unfamiliar?

Laura had bought her husband Tim a plush rocking chair as a retirement present ten years ago. Now Tim would no longer sit in it, claiming it was “someone else’s chair.” He repeatedly asked where his chair had gone. Laura tried buying him another chair, which he himself picked out. A few months later, he launched into the same tirade, saying this, too, was not his chair.

Memory can be difficult for any number of reasons, not all of them connected to Alzheimer’s. While these memory lapses — particularly if they are frequent — may be indicative of Alzheimer’s, a careful assessment by a medical professional is advised. The clinical issues involved are very complicated.

Irrational behavior/mood swings

4. Is your loved one overly anxious about routine activities like shopping, dressing, or eating?

a. Joe’s eyes welled up with tears as he tried unsuccessfully to lace and tie his shoes. He couldn’t tell left from right, didn’t understand how the laces went into the shoes, and wasn’t sure what purpose it would serve him to tie them anyway. Frustrated, he kicked the shoes under the bed and locked himself in the bathroom.

b. Barbara told her mother they would stop at the post office and she would run in and get some stamps. When she got back into the car minutes later, her mother, sobbing and angry, complained that Barbara was deserting her. No amount of reassurance would calm her mother. She also could not convince her mother that she had been gone just a few moments.

5. Does she often disguise her confusion or forgetfulness with paranoia and blame others for the problem?

Mrs. Wright chronically mislaid her cooking utensils, scattering them in various rooms throughout the house. Every Tuesday while playing cards with her friends, she would complain to them that her husband was stealing her pots and pans and trying to drive her crazy. Her friends counseled her to confront him, thinking the problem had to do with her husband’s, not their friend’s, behavior.

One tragic result of the irrational, alienating behavior of the person with Alzheimer’s is that she may begin to lose friends. As the wife of an Alzheimer’s patient put it: “you might as well put a sign on the door that says ‘leprosy’ because that’s exactly what’s going to happen to you. You’re going to be deserted.” Of course, an early, proper diagnosis, shared with friends, can go a long way toward counteracting the “hands off” behavior of uncomprehending friends.

Communication breakdowns:

6. Does your loved one exhibit problems expressing himself? Will he frequently forget the names of simple things?

Barny often can’t remember his son’s name. If his wife Denise talks to him about “Jeff,” Barny knows who she is talking about. But if Barny is reminiscing about his family, there are days when he is too confused to remember Jeff’s name — or the names of his other children.

Patients have trouble naming familiar things. Even when they retain the name (e.g., sink, toothbrush), they often forget its function or purpose. Fear of confusion usually results, even when dealing with ordinary objects or activities (bathing, washing, eating).

7. Is he often unable to complete a sentence, or does he have a tendency to run fragments of thoughts one after another in random order?

Here’s an example of rambling, incoherent speech: “I know that if I ... it’s a matter of time and place ... you must see that he cannot be my son, my father — not without the suit coat ... it’s chilly where ... been outside?”

It’s not unusual for the Alzheimer’s patient to rattle off parts of phrases he recalls from previous speech. His ability to mimic speech patterns is not impaired, and it often seems as though his thinking just gets constantly sidetracked in mid-thought. What can be difficult for people with Alzheimer’s is to finish the thoughts and link them coherently with other thoughts.

8. Has he often ignored or grossly misinterpreted written instructions you leave for him? Is he, in general, inattentive, forgetful, and excessively willful?

a. Muriel left Fred a message on the kitchen counter: “I’ve gone to the doctor’s. Please take the chicken out of the freezer to thaw before I cook it.” Fred promptly put the chicken, wrapper and all, in the microwave, and turned it on. Then he called a cab and went to his doctor’s office. When Muriel arrived home, she found that the plastic wrapper had melted into the burnt chicken.

Complicated messages are usually too much for the Alzheimer’s patient to handle. He is liable to choose words or phrases that he can still recognize and provide his own meanings to them. Alzheimer’s patients cannot follow multiple commands. (“Go to the kitchen and get me a paper towel.”) You must use single, simple, and direct orders.

b. Jim and Marie were married for 44 years. When Jim started getting forgetful, he would often turn to Marie and say “Who are you? What are you doing in my house?” If she answered she was his wife and had every right to be in their house, he would get upset and threaten to call the police and have her evicted.

While none of these symptomatic behaviors is exclusively connected with Alzheimer’s disease, this example comes closest to being characteristic of the course of the disease — in particular, the masking of forgetfulness with difficult, obstreperous behavior.

Loss of coordination:

9. Does she have difficulty with simple movements such as walking or manual skills such as writing her name, dressing, or dialing a telephone?

Mrs. Barnes had always been an energetic walker. Now, however, she had difficulty just going from room to room in her house. She often tripped over her own feet. She would raise her legs far higher than she needed to, not fully aware of spatial relations about her. Or she would drag one leg as though she were unable to pick it up or bend the knee joint. It seemed as though she was gradually forgetting how to walk.

People with Alzheimer’s gradually “unlearn” the basic functions they acquired in their early life. If it’s a woman, perhaps she can no longer sew, knit, or measure and cook foods. For a man, perhaps it’s the inability to use a screwdriver, change a light bulb, or drive a car.

Warped or nonexistent sense of time:

10. Does he seem unable to measure the passing of time, sometimes asking repeatedly what time it is, or at other times not realizing that hours and hours have passed?

Arthur was beginning to pace up and down the hallways all night long. He would nap during the day, because he seemed unable to sleep at night. Some nights, he would wake his wife up every ten minutes and ask her the time. When she told him the time, saying “You asked me that ten minutes ago,” he would vehemently deny it. He claimed, to the contrary, that it had been several hours since he was up.

She sometimes found him working with his power saw in the wee hours of the morning, sawing planks of wood into small segments. From the debris on the floor, she guessed he had been at it for hours on end.

11. Will she get confused about how to read the time off a clock and know what time it means in terms of her daily routine?

Judy waited for her daughter to come home from work and cook dinner. Her daughter was always punctual, coming in the front door at 5:20 every evening. But when the daughter arrived home, she found her mother in angry tears, pointing at the clock and saying “Where have you been? I thought you were gone for good!” But the clock on the wall indicated 5:20.

* * * * *

If you can answer “yes” to a substantial number of these questions, chances are you should have your loved one undergo a thorough
medical examination.

This is by no means an exhaustive list of early Alzheimer’s symptoms, nor are these disorders exclusive to Alzheimer’s. But that is precisely why you should see a doctor or medical specialist as soon as possible, to determine what the problem may be — and, if it is Alzheimer’s, to take the necessary precautions so that your loved one won’t put him- or herself in grave danger.

As one doctor has put it, “If you notice that your memory is giving
you problems, you probably don’t have Alzheimer’s. If your spouse notices that your memory is giving you problems and you don’t, go
see somebody.”

Since Alzheimer’s patients most often maintain an outward appearance of well-being, their erratic, bizarre behavior is quite often not taken as a sign of illness, but rather just oddness or “nuttiness.” Because Alzheimer’s symptoms can easily be mistaken for nonmedical conditions, they are often considered to be completely unrelated to disease — and mistreated as such.

Some forgetfulness and confusion occur naturally in the aging process, but if these become chronic or severe, the problem may well be the
manifestations of a “hidden” illness such as Alzheimer’s. Many dementias have symptoms virtually identical to Alzheimer’s, but they differ in that they do have cures and effective treatments. It is therefore critical to obtain a thorough examination to arrive at the most definite diagnosis possible.

In addition to Alzheimer’s, there are many disorders involving loss of memory and other intellectual functions, some of which can be easily treated. These dementias are also illnesses, not the natural consequence of advancing years. However, some of these are reversible if treated properly and in a timely fashion.

Even when the diagnosis is Alzheimer’s, advances in science and the wealth of resources available for improving life for Alzheimer’s patients and their families have changed our outlook on this difficult disease: Today, there is hope where there was little before.

Awareness must begin at home, which is why diagnosis is so vitally important. You can never have too much information on the symptoms that are and are not part of the disease. For example, a medical condition unrelated to Alzheimer’s may be exaggerating the Alzheimer’s symptoms or placing the patient at risk of illness or injury; this medical condition needs to be treated separately as soon as it is identified as such. With a full, thorough diagnosis, the family can rest easier, knowing that all problems with the patient that can be fixed are being taken care of.

Early detection also means there is time for the family to be properly instructed in the best treatment methods. And when the family is fully informed, the behavioral problems of the Alzheimer’s patient can be minimized — or at least the negative effects on the caregivers can be softened. Now, while your loved one may never display certain forms of symptomatic behavior, if you can anticipate difficulties in dealing with him, they somehow become less difficult because you knew about them in advance. This is true even as the patient moves into the later phases of the disease. In these ways, guidance by medical professionals can be a life-saver for the caregivers.

Once your loved one has been diagnosed, it is critical that you also look to other sources of help. Keep an eye open for community resources at your disposal — meal and transportation services, free medical testing, volunteer visitors, and support groups. Gather as much data as you can in order to make informed decisions about living arrangements and health care. You will also want to have the latest results of research, so you know the progress of knowledge of the causes of Alzheimer’s and the treatments that show most promise.

Don’t hesitate to ask for outside support and guidance as your loved one progresses through the steps of this disease! Many of Alzheimer’s most troublesome symptoms can be managed — with a little help from your friends, your physicians, and your community.