[J109]Journal Of Alzheimers Disease

* Alzheimer's disease begins slowly.

Like a stroke, Alzheimer's kills brain cells. Unlike a stroke, however, Alzheimer's does not strike suddenly. And, its effects are more far-ranging. Experts like to say that Alzheimer's has an insidious onset. This means simply that the disease starts slowly and unfolds very gradually. So gradually, in fact, that the person who has Alzheimer's may not realize that anything is wrong until a great deal of brain tissue has been destroyed.

* Early symptoms reflect what is happening inside the brain.

Alzheimer's disease attacks tissue deep within the brain and spreads out to include all those regions associated with complex thinking and learning; those regions of the brain that make us uniquely human. As the path of destruction widens, individuals who have Alzheimer's will eventually notice that their thinking skills are deteriorating. More often than not, they will notice that their memory is failing. But, it is not just a series of senior moments. Individuals stricken by Alzheimer's will have more than a little difficulty finding the right words to express their thoughts and feeling. They may forget the names of familiar places and long-term acquaintances. They are likely to forget long standing appointments. To compensate for these everyday losses, they may withdraw from friends and avoid social gatherings. Their homes may become littered with notes and other reminders as they struggle to overcome their memory losses.

* Alzheimer's disease affects personality and behavior.

Interestingly, even as problems accumulate, many individuals will actively deny their difficulties. Denial is a common way of coping in the earliest stages of Alzheimer's. It is a defense mechanism that helps to preserve a sense of self-worth, which becomes increasingly fragile as thinking skills fail. Unfortunately, denial does not ?work? forever or for everyone. When denial no longer works, some individuals sink into depression. Others may react with angry outbursts, even rage, in the face of everyday frustrations. It is especially common for individuals afflicted with Alzheimer's to develop a kind of apathy. They lose interest in those things that used to bring them joy.

* Early signs of Alzheimer's may go unrecognized by family members.

Families often engage in their own form of denial when it comes to Alzheimer's in a loved one. Significant memory problems in their loved one may be dismissed as simply a part of getting old. As a result, family members often overlook the earliest signs of mental deterioration. They become concerned and seek outside help only after they begin to notice the more obvious changes in behavior or personality. By then, Alzheimer's has probably progressed to the point where their loved one can no longer live independently.

* Families must be prepared for what is going to happen.

Whenever the diagnosis of Alzheimer's is finally made, it is important for family members to understand that this is not a disease that can be cured or reversed. The fact is, individuals who have Alzheimer's will spiral downward toward total care and, ultimately, death. It may take years, but individuals who have Alzheimer's will eventually lose everything that defines their personhood. Among other things, their ability to communicate will continue to decline. They will lose the ability to dress and groom themselves. They will need assistance using the toilet. They may begin to wander and to experience hallucinations. In the final stages of the disease, individuals afflicted with Alzheimer's will be unable to recognize a spouse or a child. Motor skills will decline so much that they will be unable to walk or to feed themselves. They will lose all control of bowel and bladder. Eventually, all body systems will shut down.

* Families must be willing to reach out for help.

Families need to think carefully about the amount of assistance they are willing and able to provide. Affection for the afflicted individual, as well as a sense of obligation, can initially blind family members to the harsh realities of caring for their loved one. Families must understand that the kind of care required will become more and more demanding. Worse, they will have to watch as the deterioration takes place. Among family caregivers, stress reactions can be quite severe and depression is very common. To cope, family caregivers must seek help from their larger community. The local Alzheimer's Association should be their first stop. It is the best single resource available. The local Alzheimer's Association can direct families to a variety of services and assistance. For example, many communities have respite programs to give families a short break from care giving. Adult daycare also may be available to provide care during the day while family caregivers continue with their regular jobs. Often times, special support groups are available to help caregivers deal with the depression and other negative emotions that can develop over time. In any case, families of persons afflicted with Alzheimer's disease do not have to go it alone. Help is available.