We believe that education and knowledge is the first line of defense against mental health stigma. As we continue our series on some common mental health diagnoses, it’s our sincere hope that this information helps spark conversation and supplies knowledge for those who may know someone who has these diagnoses. Today’s conversation centers around Alzheimer’s Disease.
Here’s more from our conversation with Dr. Elizabeth Fitelson, Assistant Professor of Psychiatry at Columbia University and director of their Women’s Mental Health Program, as she helps us explain and open the dialogue around mental health diagnoses:
Philosophy: For those who might not be familiar, what is Alzheimer’s Disease?
Dr. Fitelson: Alzheimer’s is a form of dementia that is generally considered a progressive, degenerative disorder that attacks the brain’s neurons, resulting in loss of memory, thinking, and language skills along with behavioral changes.
Philosophy: What are the symptoms that lead to diagnosis?
Dr. Fitelson: It develops in stages, and usually starts with something called Mild Cognitive Impairment. The issue is that Mild Cognitive Impairment has many different causes in older adults, from small strokes, medication side-effects, or issues like head trauma. But it all starts with the same characteristic forgetfulness symptoms, like forgetting words and misplacing objects like your keys more often than normal. Forgetting things you’ve read, asking the same questions over and over, not remembering names or plans you’ve made; that’s all considered the mild, early stages.
If it progresses, there can be an increase in memory loss with periods of real confusion. Patients can forget the names of their family and friends, and in some occasions don’t recognize them at all. (Alzheimer’s patients experience) decreased ability to perform self-sufficiency tasks like paying bills on time, cooking, running a bath and/or bathing properly, or even getting dressed. At this stage, people who have otherwise been very competent might even get lost in a city they’ve known their whole lives, suddenly finding themselves disoriented and not able to navigate otherwise familiar surroundings, which can be very disorienting.
In the late stages of Alzheimer’s, most patients might recognize faces but not really remember names, or they might mistake a person for someone else, thinking that their daughter is their mother or their granddaughter is their daughter — that kind of thing. They may think start to believe their present is the past, reliving certain situations where they have to go to work or perform some other task they don’t currently. Sometimes, even basic abilities such as walking, eating, reading and writing can falter and fade. The disease presents a progressive loss of ability to function from mild symptoms at the beginning to a severe loss of basic self-care toward the end.
Philosophy: What’s the treatment for Alzheimer’s Disease?
Dr. Fitelson: There are some medications which seem to be able to slow the progression of the disease, but right now there is no cure. There’s a lot of research going on, and a lot of people feel very hopeful about that. But there are certain medications that might help slow the process seem to have some success, especially if started right at early onset diagnosis. There are other behavioral enhancements that can helpful to help those diagnosed orient themselves, like having a large calendar and clock immediately available with large type; making sure the person gets outside or has access to a window where they can see that it’s day or night; and continually reminding people where they are, who you are, and what the time is. Helping to ground people in the here and now can be very orienting. People in the mild stages of Alzheimer’s can essentially function for a while in their familiar environment, but then if something happens, like they get hospitalized and all of a sudden they’re a completely unfamiliar environment with different medications, there can be a real, seemingly sudden decomposition where the person gets very disoriented. In those cases, like n the hospital example, that event can lead to a delirium-like state where people can be very confused, which is when the behavioral techniques become crucial, continually grounding them and making sure they get sunlight during the day hours and are able to sleep at night.
Philosophy: If you believe you have it, or you know you have it, what are some best practices for self-care?
Dr. Fitelson: I think the first thing is to not be afraid to talk to your doctor about it. I think a lot of people are so fearful of having Alzheimer’s that they avoid getting evaluated for fear of confirmation. But, as I said before, there are many different reasons why people might be suffering from some memory loss; maybe there’s some other problem going on with your kidneys or your heart that should be checked out to rule out the diagnosis. But if it is Alzheimer’s, the diagnosis can be a very difficult with which to deal. It can be helpful to start to implement some of those behavioral things early on to keep people functioning and emotionally well in the earlier stages for as long as possible. Reaching out to a few trusted people, talking to them about the diagnosis, and getting support in terms of the emotional burden I think are all very helpful. Also, make a plan for what you want to happen should you become incapacitated in any way, whether hospitalized or getting sick at various points, and have honest conversations with the people you care about, about the ways you want to be cared for. All of this can be incredibly helpful.
Philosophy: If someone you love is affected, how do you best support them?
Dr. Fitelson: I think the first thing is to get support for yourself, because it’s very hard emotionally, physically, and practically. It also involves accepting that this is really happening, and expressing the need for support: you need emotional support from a support group; you may need practical help; you will need some release of emotion; and you must realize you can’t be on 24/7. You should know at some points in Alzheimer’s disease, sometimes patients get day-night reversed, so they might be up wandering around in the middle of the night and potentially doing things with no awareness that might be dangerous. Getting practical support, getting a release, making sure you take a break from the caregiving responsibilities, and reaching out so you don’t taking it all on yourself are all really key, both for your health and also for the relationship with your loved one you support. But you can’t take care of anyone else if you can’t take care of yourself, too. It’s why I believe self-care is one of the key components of being able to care for someone with Alzheimer’s.