I guess, after the months that I have been writing about older people, memory and emotion, I should spend some time describing what, in my eyes, is Alzheimer’s disease – bearing in mind that this is my interpretation, rather than say the view you might get from another doctor, whether geriatrician, psychiatrist or neurologist.
There is the physical component of Alzheimer’s – the disease described back in 1912 by Alois, which has now become eponymous. This is related to what have been described as tangles and plaques made-up of proteins, found in the brains, after death of people who have this disease.
As brain biopsy is not something we routinely, if ever, undertake to establish the cause of a person’s symptoms (plus, there are more useful non-invasive ways to work things out, such as talking to the person and their family), many people receive a diagnosis of Alzheimer’s based upon their symptoms – changes to memory, personality, orientation, language ability and the pace at which they evolve. (Typically, slowly over many months and years.)
In other words, we the doctors, who diagnose, usually base our treatments on best-guess work; I think by and large, this is OK – for the majority of the time we get it right (sometimes, we pick the wrong type of dementia, for example, Vascular rather than Alzheimer’s), but on the whole, when things are obvious i.e. older person forgetting the way home from the newsagent, we are accurate.
You might think that in this day and age, such speculative attempts at diagnosis are inadequate – surely there must be a blood test or an x-ray that will tell us what is wrong and what to do; unfortunately, or fortunately for us humans, the brain, the most complex combination of fats and proteins in the universe, does not allow for such easy interpretation – and I, for the moment, am quite content accepting that as the way things are.
So, again, what is Alzheimer’s?
The textbooks define it is a chronic degenerative neurological disease associated with the deposition of neurofibrillary tangles and protein plaques in the brains of affected individuals, resulting in a progressive decline in function, dependent upon which area is affected, all complicated by the personality, the likes and dislikes, interests and tastes, passions and loves of the person.
That, I guess, is quite long-winded, and I probably, have left something out. I haven’t described the ways in which the levels of neurotransmitters are altered or how the rest of a person’s body responds to this change, the way behaviour affects function, whether because of changes to sleep pattern, nutrition, level of exercise or social interactions.
This again, is not something that you should take away as being all you need to know; what you need to know, is dependent on your position, relationship to the disease – patient, carer, doctor, nurse, social worker or child. (There are lots of books & websites – I would start with the Alzheimer’s Society, UK)
There is therefore, not a singular ‘Alzheimer’s disease’ – because of its complexity, because of the way it is inextricably interwoven with the personalities of those affected, no two people with Alzheimer’s disease are alike.
We can expect some common features – most experience some degree of memory loss; most people encounter a change in their personality or mood, but how that is translated into everyday activities will differ for each person and is likely to differ depending on the time of day, environment or company.
As to whether this has helped anyone understand a little better ‘Alzheimer’s disease – what is it?’ I don’t know – please get back to me with your thoughts.