Alzheimer’s Robber of reason

Alzheimer’s Disease
is a degenerative brain disease that slowly and steadily robs its victims of
their ability to reason and remember. There are a reported 26 million affected
by Alzheimer’s worldwide but the exact number of people with the disease in
Cayman is unknown, but efforts are underway to track the numbers, according to
Dr. Marc Lockhart, a psychiatrist at Chrissie Tomlinson Memorial Hospital.

Lockhart said there
was a renewed focus on collating statistics relating to the number of patients
with dementia-related diagnoses on the Islands. There are 15 Alzheimer’s
sufferers living at the Pines residential home and nine living at the
government’s Department of Children and Family Services four residential homes
across the Cayman Islands. Because some patients are cared for at home, the
total number of patients with Alzheimer’s and other forms of dementia is not
clear.

“We know that many
are kept at the Pines, but a large percentage of patients with Alzheimer’s in
our society are treated by the family members that are care givers. They’re
looked after by siblings or their children take care of them. Many are taken
care of by helpers,” Lockhart says.

He says that, unlike
in some other societies, putting relatives into residential care homes when
they develop dementia is usually a last resort for Cayman families. “They take
them to the Pines only when they have become increasingly difficult to manage
at home,” he said.

Sue Nicholson,
manager of The Pines, says that of the 36 elderly people living at the
residential home, 20 had dementia and, of those, 15 suffered from Alzheimer’s.

She agrees that most
families prefer to keep relatives with dementia at home and that it was rare to
see families just dropping off relatives with the illness and forgetting about
them.

“It’s really a last
resort when they bring them to The Pines. It’s when they just cannot manage to
care for them anymore at home. [The patients] get confused and wander off and
start to become a danger to themselves. Some of them get quite aggressive and
it’s difficult to manage them at home… They keep them at home as long as they
possibly can.

“Many families are at
their wits’ end, they don’t know where to turn. It’s extremely difficult,” she
says.

When the disease
progresses to a point where patients can no longer recognise their own children
or family, many relatives can no longer bear to visit them, Nicholson says.

“Some relatives get
very, very distressed when they come to see relatives with Alzheimer’s. Some
might criticise and say they’ve just dropped them off and left them, but I
totally understand. It is very distressing for someone to see their mother not
remember who they are. It’s very challenging emotionally for them to go through
that,” she explains.

Nicholson says the
Pines is seeing an increasing number of patients who have been diagnosed with
Alzheimer’s, but this may be due to better diagnoses rather than an actual
increase.

Alzheimer’s is the
most common form of dementia in those aged over 65. It is named after German
neurologist Alois Alzheimer who was the first to describe the disease in 1906.

The cause of the
disease, more than 100 years after it was identified, is still unknown, but
while there is no cure for it, there are medications and therapies that can
manage the disease and slow its progression.

Symptoms of the
disease, include loss of memory, a change in perception in which people begin
hearing and seeing things that are not there, confusion, mood swings and a
change in general behaviour, Lockhart explains.

It begins with signs
of forgetfulness and usually culminates in patients becoming bedridden and
uncomprehending.

“The first thing to
watch for is short-term memory loss. This is forgetting things that the person
should remember, not just forgetting where you put your keys or the name of
someone you met yesterday, but forgetting what you had for breakfast,
forgetting where the bathroom is, forgetting where you live – things of that
nature. That is generally the first sign.

“Then changes in
mood, this could happen over days – episodes of irritability, sadness or
tearfulness. That’s another sign. Also, a change in appetite and sleep, not
wanting to eat and having problems with sleep,” Lockhart says.

Lifestyle changes
that apply to other chronic disorders can also help to stave off Alzheimer’s and
other forms of dementia, the doctor says. “You monitor alcohol intake, watch
your weight, check for high cholesterol, “he says, adding that stimulation of
the brain, by playing games, reading and challenging the mind, plays a very
important part in delaying the onset of dementia and slowing its progression.

Cayman’s popular game
of dominoes is cited by some as one of those activities that keep the brain
active and engaged.

Lockhart recommends
that families should encourage retirees to get involved in activities that
stimulate the brain rather than letting them become bored and listless.

There are many
medications available to treat dementia and most of the drugs available in the
US for treating these disorders are in Cayman. However, as Lockhart pointed out,
it’s not simply a question of treating just the dementia. As the disease
progresses, patients can become depressed, or aggressive, and their physical
health declines, so all those symptoms must also be treated.

“It is important to
remember that there is a syndrome aspect associated with dementia. Medication
can slow down the progress of dementia… but we have to remember there can be
many components to dementia, including changes in mood and changes in behaviour
and changes in perception.”

Dawn Rankine, of the
Department of Children and Family Services, said the department offers
financial assistance to people who cannot afford health care or who need help
with a relative suffering from dementia at home. “Families can contact [the
department’s] social workers in the districts to find out what services are
available to people who have been diagnosed with Alzheimer’s,” says Rankine.
There are three government-funded homes for elderly residents in Grand Cayman
and one in Cayman Brac and generally, they try to place people in residential
homes in the district in which they live.

Cayman does not have
any support groups for families of people with dementia or for those at the
beginnings of the disorder. Information about the disease is available through
general practitioners and at the Island’s two hospitals. The Cayman Islands Hospital
holds a day programme which can be attended by higher functioning patients.

“A support group
would be fantastic,” said Nicholson. “It seems that for a lot of relatives, the
disease is almost worse for them than for the patients. The patient can be oblivious,
but for the relatives, it’s very distressing. But, it’s almost as if it’s too
personal and they can’t discuss it publicly.

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