Thefastpharma. Health news blog

The medical term for senility is dementia. Dementia refers to a set of symptoms, not a single illness – a generally progressive, irreversible decline in memory, reasoning, thinking. A number of diseases produce this inexorable intellectual deterioration. Though it has now become the popular catchword for everything, Alzheimer’s disease is only the most common of them.

When people have dementia (caused either by Alzheimer’s disease or by another illness) an early sign is trouble in remembering the ongoing events of daily life. A woman may forget she just made a phone call and call her daughter back. She may not remember driving to the store an hour earlier and may make a second trip.

Sometimes the first symptom is a change in personality. The person withdraws, becoming apathetic, abstracted. Or a life that had been tightly ordered seems to unravel. A fastidious housekeeper begins leaving the dinner dishes in the sink; her immaculate house is now in disarray. A dapper, punctual man regularly shows up at work hours late, disheveled, with a stained tie.

Changes like these are almost always either isolated incidents (How many of us have never blanked out on a phone call we made two seconds ago?) or signs that something is wrong with the emotional side of life. Personal problems may be preoccupying us, affecting our memory, our mood and our ability to handle life competently. It is very difficult to be sure a person is suffering from a dementing illness when the condition is in its earliest stages.

Strange or unusual behavior is often seen in retrospect as the first sign of the disease when, as the months pass, the victim’s mental processes deteriorate. For instance, when University of Michigan researchers interviewed family members of dementia victims, many said they had interpreted early symptoms in their loved ones, later diagnosed as Alzheimer’s disease, as emotional problems. When their mother became forgetful, children decided she was depressed or deliberately tuning them out. When a husband started behaving strangely, his wife might worry about their marriage. Some women even went for counseling or considered divorce.

Even if a family sensed what was really happening early on, they were often unable to articulate exactly what was peculiar or amiss and so had trouble convincing the doctor to take their worries seriously. Months might go by before the true condition was diagnosed.

If the problem is a dementing illness, things do get worse; eventually it becomes obvious that something is very wrong. As the illness reaches its middle stages, a person’s reasoning becomes strangely concrete. A man may be unable to follow simple instructions such as “turn right to Main Street” or “twist the cap to open the jar.” The advice to “just dive in” may be greeted by the puzzled comment, “I’m not near a swimming pool!”

Simple calculations become difficult. A woman may first have trouble making change, then forget that four quarters make a dollar, then not understand the word dollar. She may be unable to name objects correctly or remember their function – calling forks spoons, spearing steak with her knife, cutting food with her spoon. Judgment becomes increasingly unreliable, alarming family members. Children, worried at first that Mom might cross Main Street against a red light and be hit by a car, months later may find that their anxiety multiplies: “Will she run out on Main Street undressed?”

In the final stages there is profound disorientation, an inability to locate oneself in time or space. People are often unable to dress or feed themselves, control their bowels, remember their names, or recognize their families.

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GENERAL HEALTH

The person whose mind I have always envied most, my brilliant childhood friend who became a historian, has Alzheimer’s disease. Several years ago she began noticing changes in her teaching. She had trouble finding the right word for what she wanted to say. Sometimes she would pause in the middle of a sentence and begin a thought again. We all thought her complaints were psychological. She was too upset about her daughter’s divorce. We understood there was something seriously wrong only on our trip to Europe in the summer of 1984.

Janet had to ask the tour guide for the schedule several times a day. She could not keep the time the bus would leave in her head. She would ask questions about sights that had been discussed only a few minutes before. She seemed apathetic, not thrilled, when we visited the historical places I knew she loved. Restaurants were a problem. She had trouble finding her way back to our table after trips to the ladies’ room. Once we caught her about to walk out the door. Afterward I made excuses so I could take her there and back.

Over the next year or so she was able to handle life fairly well once back in the familiar surroundings of our town. She took a sabbatical from teaching but went to her office to “work” on papers several days a week. Everyone felt it would be good for her keep up the pretense, even though she could no longer really produce. Jack let her to do everything – shop, cook and take care of the house. He never stopped her from going out alone. But he was always upset. Would this be the time she took the car and wound up lost or dead? Would this dinner he the one where the stove was left on? By then she had been seen by specialists. Everyone knew what she probably had.

This year things have gotten much worse. My cool, rational friend now has outbursts of anger that come from left field. She sometimes is unable to sit still for more than a second at a time. When she is home she wants to go out. Once out, she wants to go back. She is like a person possessed – a firecracker of emotions without purpose or will.

Last week I invited Jack and her to dinner. When I would go into the kitchen, Janet would get up to go to the door. Jack would have to jump up, bring her back, and explain we were about to eat, only to have her pop up again. When I finally got dinner on the table, he had to cut her food and serve her. I was near tears by the time they left. What’s going on? Can’t anything be done to ease her suffering? What about me? What is my chance of getting this terrible disease?

Senility is everyone’s worst terror about old age. The flood of publicity about Alzheimer’s disease has multiplied this concern. We hear there is an epidemic; there is nothing medical science can do. But we know little else about this sword hanging over our later years: “Is my forgetting names more often a sign of beginning Alzheimer’s disease?” “Is becoming senile the inevitable price if we live to a ripe old age?” “What is senility?”

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GENERAL HEALTH