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Thursday, December 28, 2006

Keeping time with Alzheimer's

The following is an excellent article that I read in the San Francisco Chronicle.

"When guilt catches up with me, I am on the bike path above the creek, ducks swimming along beside me. Guilt rolls off our backs like you know what. Alone at last, I walk at my own pace. Fast. Fast is what Ben can no longer do -- and fast is slow compared with the woman coming toward me as I near the marsh. She is wearing shorts and earphones. She smiles and I smile back. What a good idea this is, walking out in the sun and cold. What could produce better clarity? I don't have to work it out the first day. I don't have to do it right the first time."

Source The SanFrancisco Chronicle

Keeping time with Alzheimer's

Persis Knobbe, Special to The Chronicle
Wednesday, December 27, 2006

Hanging on like the mom of a new kindergartner, I watch my husband from the social worker's glass cubicle. He is facing the piano player, the shrunken woman on one side of him, and on the other, falling asleep, the guy they call the Major. Ben -- of all people -- in that circle, a little dazed, being good, going along with the group, his new group. I can go home now and be alone for six hours. No TV, no one trailing after me. Shadowing, it's called. He doesn't always do it. Not yet.

He nods his head in time to the blues, then Gershwin suddenly returns someone's smile. It's beginning to look like a good bet. Senior Access, it's called, adult day care. This branch is in Novato, the best game in town as far as I know. I checked out every possibility that had a few men on the scene, not just a roomful of elderly ladies. Each time I took one look and said, "Never. Never Ben." So how did never become now?

Here is a moment, and for a change I recognize it. I will have a permanent memory of him joining the circle, lowering himself into the chair, eyes fixed on the piano, head bobbing immediately with the rhythm of the blues, then patting his knee as if he is soothing it. He knows he's in the right place before I do. He's one of them, not as far along on the Alzheimer's road as some, still dapper in his crisp shirt and clean Dockers. But he is one of them.

There is no going back to where he was, doing what passed for functioning at home, where he could still propel himself through the day with TV and frequent naps. He is ready; I'm the one not quite ready. From here in the cubicle, for the first time I see what "down the road" means: squeezing out every ounce of making it work at a level you can live with and then stepping down to the next level. Step, step, stepping along.

This is a good thing, I say to myself on the drive home, and I shouldn't turn it into dross because it's a gift. It's as close to what he needs, what we both need, as anything I could find, stimulation for him, a little freedom for me, twice-a-week freedom. Maybe we can work up to three days, who knows? And what will I do with the time and life this offers me? Catch up with two years of unfinished business? The house, the desk, the roses? Give way to a free-flowing all-out depression?

There is a Costco just off the freeway and the car veers off to the nearest exit on its own. "What am I doing?" I ask myself, as I push a huge cart with three items in it: two plants for the garden and a polo shirt for him. "What am I doing, killing a morning like this, wasting it on shopping?" Guilt approaching panic is making my heart beat faster. I will barely get home and have to go back for him.

Setting the plants near the front door with a thud that loosens the soil, I head for my desk. Checkbook and bank statement to my left, Italian class assignment to my right, I study the space between them until the phone rings. Sandra from the Caregiver's Group. "Would I have time for a few brief questions?" I already had time for a few brief questions. She asks about my family. Are they helping me? Am I being good to myself? Answer on a spectrum of "Always" to "Never." I answer with "Always" or "Never," nothing in between. Sandra says she'll call back another time.

When guilt catches up with me, I am on the bike path above the creek, ducks swimming along beside me. Guilt rolls off our backs like you know what. Alone at last, I walk at my own pace. Fast. Fast is what Ben can no longer do -- and fast is slow compared with the woman coming toward me as I near the marsh. She is wearing shorts and earphones. She smiles and I smile back. What a good idea this is, walking out in the sun and cold. What could produce better clarity? I don't have to work it out the first day. I don't have to do it right the first time.

By the time I go back for Ben, I'm capable of being quite pleasant. I don't ask him how it went. He still looks dazed, but he smiles when he sees me. We drive home, have dinner and rent a movie. A musical. We love musicals, the older, sweeter ones and the biting, jaded shows like tonight's. At least we used to. Neither of us is crazy about this one. I try to pry a critique out of him and he gets as far as "It was ..."

Then he opens his mouth wide, an expression of alarm in his eyes, his arms waving frantically. Abruptly he drops the pose. "It was ..." he says again and waits. "Boffo?" I ask. He doesn't answer. It is hard to engage him. "You mean every number was a showstopper? Over the top? Like Liza Minnelli?" He nods, slowly at first, then with mounting pleasure as I elaborate on the word "boffo" and I know one thing: He's not all gone. Not yet.

Persis Knobbe chronicles her journey with her late husband through his Alzheimer's disease. Read her essay "Farmers' markets can turn into lonely places'' (Home&Garden, July 29) on SFGate or e-mail her at

Tuesday, December 19, 2006

Alzheimer’s Disease--What is it? Who gets it? What causes it?

Alzheimer's disease is the most common cause of a condition called dementia. It is named for the German doctor who first described it, Alois Alzheimer. What is it? Who gets it? What causes it?

You can read about Alzheimer's Disease by clicking the link to the
The Caregiver Weblog in the headline.


Monday, December 18, 2006

Robert T DeMarco

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Bob DeMarco

Saturday, December 9, 2006

Blood Pressure Drug May Offset Alzheimer's Complication

The drug, valsartin (Diovan), is widely prescribed to treat high blood pressure in elderly patients and was identified as being effective in preventing the build-up of beta-amyloid in the brain.

This article discusses the possibility that drugs currently being used to counter hypertension may help prevent cognitive decline. To read the article in its entirity follw the link, Blood Pressure Drug May Offset Alzheimer's Complication.

Tuesday, November 28, 2006

The CareGiver: Dementia

I ran across this factsheet on Dementia from the Milton S Hershey Medical Center. The section entitled, What are the Symptoms, is particularly interesting.

Source Milton S Hershey Medical Center


What is it?

Dementia is the gradual deterioration of mental functioning, such as concentration, memory, and judgment, which affects a person’s ability to perform normal daily activities.

Who gets it?

Dementia occurs primarily in people who are over the age of 65, or in those with an injury or disease that affects brain function. While dementia is most commonly seen in the elderly, it is not a normal consequence of the aging process.

What causes it?

Dementia is caused by the death of brain cells. Brain cells can be destroyed by brain diseases, such as Alzheimer’s disease, or strokes (called vascular or multi-infarct dementia), which decrease blood flow to the brain. Lewy body dementia is another common cause attributed to changes in brain tissue. Other causes can include AIDS, high fever, dehydration, hydrocephalus, systemic lupus erythematosus, Lyme disease, long-term drug or alcohol abuse, vitamin deficiencies/poor nutrition, hypothyroidism or hypercalcemia, multiple sclerosis, brain tumor, or diseases such as Pick’s, Parkinson's, Creutzfeldt-Jakob, or Huntington's. Dementia can also result from a head injury that causes hemorrhaging in the brain or a reaction to a medication.

What are the symptoms?

In most cases, the symptoms of dementia occur gradually, over a period of years. Symptoms of dementia caused by injury or stroke occur more abruptly. Difficulties often begin with memory, progressing from simple forgetfulness to the inability to remember directions, recent events, and familiar faces and names. Other symptoms include difficulty with spoken communication, personality changes, problems with abstract thinking, poor personal hygiene, trouble sleeping, and poor judgment and decision making. Dementia is extremely frustrating for the patient, especially in the early stages when he or she is aware of the deficiencies it causes. People with dementia are likely to lash out at those around them, either out of frustration or because their difficulty with understanding makes them misinterpret the actions of others. They become extremely confused and anxious when in unfamiliar surroundings or with any change in routine. They may begin a task, such as cooking, then wander away aimlessly and completely forget what they had been doing. Dementia is often accompanied by depression and delirium, which is characterized by an inability to pay attention, fluctuating consciousness, hallucinations, paranoia, and delusions. People in advanced stages of dementia lose all control of bodily functions and are completely dependent upon others.

How is it diagnosed?

Dementia is diagnosed through a study of the patient’s medical history and a complete physical and neurological exam. The doctor will speak with those close to the patient to document a pattern of behavior. He or she will also evaluate the patient’s mental functioning with tests of mental status, such as those that require the patient to recall words, lists of objects, names of objects, and recent events. Diagnostic tests, such as blood tests, x-rays, or magnetic resonance imaging (MRI), positron emission tomography (PET), or computed tomography (CT) scans, can help determine the cause of the dementia.

What is the treatment?

In some instances, treating the cause of dementia may successfully reverse some or all of the symptoms. This is the case when the cause is related to a vitamin/nutritional deficiency, tumor, alcohol or drug abuse, reaction to a medication, or hormonal disorder. When dementia is related to an irreversible destruction of brain tissue, such as with Alzheimer’s disease, Lewy body dementia, or multiple strokes, treatment involves improving the patient’s quality of life as much as possible. This includes maintaining a stable, safe, supportive environment and providing constant supervision. While this may be done in the home, people in the advanced stages of dementia may require round-the-clock care in a long-term healthcare facility. It is important to provide the patient with structured activities and avoid disruptions to his or her daily routine. Many patients enjoy therapeutic activities, such as crafts or games, designed specifically for people with dementia. Some medications, such as donepezil and tacrine, have been effective in improving the mental functions of those in the beginning stages of dementia. Patients with hallucinations and delusions may also be treated with antipsychotic drugs, while antidepressant medications are used to treat depression.

Self-care tips

There is currently no known way to prevent dementia associated with Alzheimer's disease. You can decrease your risk of dementia associated with stroke by maintaining a healthy lifestyle, following a heart-healthy diet, and controlling high blood pressure and high cholesterol. Healthy lifestyles, including not smoking and not abusing drugs and alcohol, go a long way in keeping most people in good health. Caring for a person with dementia is stressful. It is important to learn all you can about the disease, seek the help of support groups, and find a responsible caregiver who can give you a break when needed. There are daycare programs specifically designed for patients with dementia that are good for the patient and the family.


This information has been designed as a comprehensive and quick reference guide written by our health care reviewers. The health information written by our authors is intended to be a supplement to the care provided by your physician. It is not intended nor implied to be a substitute for professional medical advice.

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