Alia Bucciarelli - Alzheimer’s Disease

Several people contributed directly or indirectly to this book. I sincerely thank Jenny Figueroa and Lavonne Beckford for sharing their caregiving experiences with me with candor and grace; it is their mother, Violet, upon whom the opening vignettes are based. I also thank Madeline Siedler, who provided me research and writing support, for which I am grateful. Finally, I thank my husband and children for their love.

Chapter Opener Figure Credits

- Cerebral lobes by derivative work of this - Gutenberg Encyclopedia.

Licensed under CC BY-SA 3.0 via Wikimedia Commons

) - Own work. Licensed under Public

Domain via Wikimedia Commons

- License CC0 Public Domain

- by Daniel Sone (Photographer)

- by Ray Nata - Own work. Licensed under GFDL via Wikimedia Commons

- by Sigismund von Dobschtz - Own work. Licensed under CC BY-SA 3.0 via

Wikimedia Commons

- by I Craig from Glasgow, Scotland - Birthday Cake

- by Department of Foreign Affairs and Trade -Operation Open Heart.

Licensed under CC BY 2.0 via Wikimedia Commons

- by Alex Proimos from Sydney, Australia - The Fountain of Youth.

Licensed under CC BY 2.0 via Wikimedia Commons

CHAPTER

In the evenings, after the desert heat had dissipated but before the sun had set, you could find Violet gardening in her front yard. Wife, mother of four, and grandmother of 6, Violet could coax the plum tree in the center of her yard into bloom despite the Arizona desert climate. She always had a story or joke to share with the neighbors and was the first person they would ask about the local goings-on. When she wasnt gardening, she was babysitting her grandkids, helping them with their homework, and cooking them food from her native Jamaica.

It wasnt long after she turned 73 that Violet began to become forgetful. Disorganization and trouble making decisions followed. At first, her daughters and husband thought that she was just getting quirky as she aged. But when her memory problems worsened, her daughters took her to see a doctor. They knew something was wrong, but they didnt suspect Alzheimers disease. Looking back, Violets daughters wish they had known what Alzheimers disease was and how it affected the brain so that they could have recognized their mothers symptoms, sought help earlier, and begun planning for her care right away.

Alzheimers disease is a progressive disease that affects the brain. The first symptoms of Alzheimers disease develop slowly. They are usually memory loss and confusion. But over time, symptoms worsen and begin to include changes in personality and behavior. Ultimately, people with the disease lose the ability to function on their own and need total care. There is neither a cure nor a treatment to prevent or delay the inevitable progression of the disease.

Alzheimers disease and its symptoms are not a part of normal aging. Some people may mistakenly think so, however, because Alzheimers disease symptoms start after age 65 in most people.

As we age, changes take place in all parts of our bodies, including the brain. This is normal. Some people find that it takes them longer to learn new things, that they dont retain information as well as they used to, or that they lose or misplace items like their keys or glasses. Although these signs of mild forgetfulness may be annoying, they are not serious memory problems. In people with Alzheimers disease, however, what seems like simple forgetfulness at first eventually becomes trouble thinking clearly and doing everyday tasks like shopping, driving, and cooking. Over time, people with Alzheimers disease need someone to take care of even their most basic needs, including feeding, bathing, and dressing.

The disease is named after Dr. Alois Alzheimer, a German doctor (see ). In 1906 he described the case of a woman who had died of an unusual mental illness that included memory loss, language problems, and unpredictable behavior. In the autopsy of her brain, he noted that she had abnormal brain tissue. In 1910 a colleague of Dr. Alzheimers, Emil Kraepelin, called this condition Alzheimers disease in his book, Psychiatrie, which classified and described psychiatric disorders.

FIGURE 1.1

Dr. Alois Alzheimer, who first described Alzheimers disease

A healthy brain has billions of nerve cells (neurons) . These cells have long branches that extend out from them. The places where the branches connect to other nerve cells are called synapses . These connections enable information to travel throughout the brain and form the basis for memories, thoughts, sensations, emotions, movements, and skills.

Broadly, Alzheimers disease causes nerve cells and synapses in the brain to stop working and eventually die.

Experts think that Alzheimers disease begins to damage the brain 20 or more years before symptoms become noticeable. This period of time is sometimes called the preclinical stage of Alzheimers disease. Preclinical means before symptoms can be observed and diagnosed.

The three main hallmarks in the brain of Alzheimers disease are:

• Beta-amyloid plaques clumps made up of bits of protein, brain cells, and nerve cells in the space between brain cells
• Neurofibrillary tangles build-up of a protein called tau inside nerve cells
• Loss of synapses between brain cells

Amyloid plaques and neurofibrillary tangles tend to spread in the brain in a predictable pattern. For example, they first start to form in areas of the brain involved in learning and memory and in thinking and planning. Then they spread to areas involved in speaking and understanding speech.