Managing Alzheimer's disease and related disorders: a major challenge of this century.
Understanding the disease
Alzheimer's disease is very complex, with a wide range of manifestations and symptoms. Each patient is different and their disorders need to be addressed in a differentiated way. Therapies that work for one patient may not work for another. The challenge will be to adapt to the patient and to approach him/her holistically by focusing on his/her life history.
Communication in Alzheimer's patients and those with related diseases
Communication is impaired to varying degrees depending on the severity of the disease
- Anomia: trouble finding words, or forgetting words. Affects all types of words, initially the least used. Need to implement compensatory strategies: paraphrasing (the word “rose” for “flower”), periphrasing (“you drink with this” to replace the word “cup”). Use of generic words: things, stuff, what-d’you-call-it etc. Numerous periods of silence. Gets worse: communication becomes less and less rich
- Intrusions: appearance of words unrelated to the conversation
- Perseveration: repetition of intrusions
- Syntax issues: words, complements, subjects and verbs are not in the right order
- Echolalia: repetition of words that have just been heard or said
- Palilalia: uncontrolled repetition of syllables or words
- Aphasia: loss of language: emission of sounds
The different types of memory
- Verbal episodic memory (memory of recent events) is the first to be affected
- Then the others, semantic (storage of general knowledge), working (calculation, for example), visual-spatial (estimation of distances) etc.
- So-called “archaic” memories are affected last
- memory of affects, emotions
- memory of smells and tastes
Memory loss is often accompanied by an increased “emotional sensitivity” with an important need for contact, attention, softness…
3 things to know
Temporal and spatial disorientation: patients cannot find their way in time or space. They may mistake their son for their father. A situation that causes patients much anxiety.
It is up to relatives and others in general to adapt to the personality and disorders of the patient, and not the other way around. Patients no longer have the ability to adapt; they have lost it.
Their capabilities make it necessary to set extremely simple goals.
Understanding how to deal with the disease
The patient is a 72-year-old retired man who worked as a bank teller. He has cognitive issues which were diagnosed at the age of 69.
He is admitted to an ORPEA centre in 2010 at the age of 71 because it became impossible to manage him at home. His disease progresses rapidly with an increase in anxiety attacks and severe agitation with a hetero-aggressive component. In addition, his wife, his main caregiver, is in poor health and cannot take care of him.
As soon as he is admitted to the facility, he presents erratic wandering, spatial and temporal disorientation, impairment in episodic memory, difficulty communicating and is easily irritated with verbal aggression towards those around him.
His disorientation causes him to urinate whenever he enters a lift. Even when he is offered the opportunity to go to the toilet before leaving, the incident continues to occur consistently in the lift. This leads to aggression on the part of the patient.
After analysing the predisposing factors, the mirror in the lift is covered with fabric as a test, leading to a positive result. The patient associated entering the lift with entering the toilet because of the presence of the mirror.
Thanks to this adaptation, the team is able to fully manage the patient’s disorder, to calm him down and to reduce his aggression.
Knowledge of the resident’s personal history, habits and attitudes, as well as a multidisciplinary approach, helped in analysing the disorder and implementing an adapted solution.
Testimonial: When Thierry arrives, his mother calls him “Dad”. Why?
Thierry is returning from the United States for the first time in five years. He is 40 years old. His sister gave up working to look after their mother, who has Alzheimer’s disease, at home.
When Thierry arrives, his mother calls him “Dad”. Why?
Because she recognised him as someone close to her but she cannot remember his first name (aphasia) and because he looks like her father (agnosia), she sensed that he is someone she loves (emotional sensitivity). The mother may now be around 15 years old in her head (amnesia). So her son probably looks like her father did at 40. For the son, it is a shock.
His mother will notice the shock, which will arouse strong feelings in her (Alzheimer’s patients show great emotional sensitivity): She has, without wanting to, caused harm to her son. She realises this but does not understand why, which will result in her depression worsening: feelings of worthlessness, worsening of attention, sleep and therefore memory disorders and related behavioural problems. So she enters a vicious circle.
To get out of it, the son needs support, as do the daughter and their mother, to regain a certain emotional balance between them. This support is based on initiating therapies that enable positive emotional impressions.