In order to better help your loved one who has Alzheimer’s, it is important to understand some of the facts surrounding the beginning stages and progression of Alzheimer’s disease. By understanding Alzheimer’s and its various stages and symptoms, one is better prepared to help their loved ones.
Understanding the progress of Alzheimer’s and how it is diagnosed is critical to the Search and Rescue Incident Command Teams that will search for Alzheimer’s patients who wander, as well as the search teams looking for missing Alzheimer’s elders. Knowing the signs and symptoms often leads a search and rescue team to the means, methods, tactics and utilization of search resources.
How is Alzheimer’s Diagnosed?
Alzheimer’s disease is distinguished from other forms of dementia by characteristic changes in the brain. These changes include a 50% reduction of acetylcholine, the primary brain chemical used in the retrieval of memory and the formation of plaques and tangles. These plaques and tangles are abnormal growths or accumulation of certain proteins that build within and surround brain cells. As a result of these changes, brain cells are damaged and eventually destroyed, which results in the symptoms of dementia, which include memory loss or confusion, a reduction in cognitive abilities, difficulty with language, perception, personality, judgment, coordination and changes in emotion and personality.
Alzheimer’s is considered to be a disease of exclusion, meaning that all other possible causes such as infection, disease, alcohol and drug abuse, vitamin deficiency, as well as mental illness must be ruled out before any probable diagnosis of Alzheimer’s is given. This is accomplished by undergoing a complete physical, neurological and psychological examination. However, due to the very nature of the Alzheimer’s disease, a true diagnosis of Alzheimer’s can only be confirmed by autopsy of brain tissue after death.
Memory and Alzheimer’s Disease
From the moment of birth, we humans are constantly learning and compiling more information into our brain’s memory. The parts of our brain which allow for memory storage and retrieval are primarily comprised of the cortex, the thin wrinkled outer layer of the brain, and billions of brain cells known as neurons. At birth although the cortex and neurons are present, the brain is not completely developed. The brain will continue to grow and expand as the child ages and develops.
A child’s skull, however, does not remain flexible forever. Once a child’s skull fusion and growth is complete, the brain cannot expand outward anymore. As a result, the brain must grow inward, developing those signature grooves and valleys, called gyri and sulci. These gyri and sulci increase the surface space of the brain and cortex allowing for more information to be stored within the brain and its neurons.
Memories are stored in a variety of areas and ways. An apple, for example, will not only store as the memory of an apple as we know it, but also as the memory of the taste of the apple, the color of the apple, the crunch of biting an apple, the smell of fresh apples, as well as the associated memories of baking apples and apple pie. The brain also saves the way apple is spelled, the way the ears hears the sound of the world apple, and if the person speaks another language (or more than two languages) the memory of that apple may also be stored there as well.
Each new taste of food, each new word, each new experience is stored in our memory cortex and neurons. As the brain grows and develops, memory storage cannot continue on a single plane. Instead the cortex and those memory-storing neurons develop layers. The earlier the memory, the deeper it is imbedded in the brain. Each time that memory is accessed, the retrieval process lays a trail, and the more times that trail is run, the easier that memory becomes to retrieve.
Alzheimer’s disease and its related dementias steal those memories. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (1987) characterizes Alzheimer’s disease as a chronically “progressive, global, cognitive loss.” The affected individual suffers a loss of capabilities in thinking and learningsufficient impairment to affect daily life, including social and/or occupational functioning.
As Alzheimer’s disease progresses, the loss of acetylcholine reduces the brain’s ability to retrieve memories; stated another way, it reduces the retrieval capability memory trail by half. You can use the analogy of removing two of the four tires on your automobile, even on a road we know like the back of our hands. Under those circumstances, how far will your car run on two tires before you have to stop?
Memory Blockages & Alzheimer’s Symptoms
Additionally the protein plaques and tangles that build in and around brain cells interrupt the neuron’s ability to process glucose into energy, send and receive necessary chemicals, and stop the life-sustaining communication between cells. As those damaged neurons die, they thin the cortex and take away memories.
Because these memory loss changes first occur in the outer layers of the cortex, the memories that dying neurons take away first are the most recent, leaving older memories and skills functioning in the brain. This is often why family members so often overlook Alzheimer’s disease in the early stages while Grandma cannot remember where she left her keys, coat or car, she can easily recall events and people from years ago.
It should be noted that brain and memory changes are often slow to progress and thus difficult to detect in the early stages. These symptoms may include short-term memory loss, anxiety or irritability, difficulty in conversation or inability to complete involved processes, such as balancing a checkbook or map orientation.
Eventually as the Alzheimer’s disease progresses, memory impairment becomes more severe and obvious. The Alzheimer’s person makes glaring mistakes in his or her work, repeats conversation or questions over and over, and loses more and more of the ability to remember persons, places or events. Short-term memory loss deteriorates into severe memory problems. Impaired judgment and radical personality changes may also become evident. The person’s physical self remains in the present, but their memory may regress ten, twenty or more years in the past.
Life History Document
Because short term memory loss occurs first in the Alzheimer’s person, it is therefore important and extremely helpful to get a complete detailed life history of that person. This information will provide insight for those who are helping the Alzheimer’s person, including search and rescue people searching for the missing person if and when they wander and get lost. The life history document is oftentimes helpful to searchers to develop a possible intent or destination for the missing Alzheimer’s person.