By Trisha A. Cloutier, CDA, RDH, BS, MA
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Yes, Mom, Ann is coming to the party. Not one minute passes before she asks again. “Is Ann coming to the party?”
Yes, Mom, Ann is coming to the party. Not one minute passes. “Is Ann coming to the party?”
Yes, Mom, Ann is coming to the party.
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This is not a typo. For those of you who know someone with Alzheimer’s disease, this conversation is all too familiar. A diagnosis of degenerative cognitive dementia or Alzheimer’s disease can be shocking and life altering, as the impact not only affects the individual but will ultimately test the strength of the whole family.
An estimated 5.4 million Americans of all ages had Alzheimer’s disease in 2016. This number includes an estimated 5.2 million people age 65 and older and approximately 200,000 individuals under 65 who have younger-onset Alzheimer’s.1,2 One in nine people 65 and older has the disease. The baby boomer population is expected to experience an increase of at least 14 percent in the number of people with Alzheimer’s between 2016 and 2025.3
Predictions suggest that the economic burden of this disease will be tremendous on our healthcare system. There is an impending social and economic crisis Americans will face unless a cure for Alzheimer’s is found.4
Plaques and Tangles
Alzheimer’s disease is a degenerative brain disease and the most common cause of dementia.5 Dementia is characterized by a decline in memory, language, problem-solving, and other cognitive skills that affect an individual’s ability to perform everyday activities. Small changes occur in the brain long before the first signs of memory loss become apparent. There are 100 billion neurons in the brain, which are responsible for communicating specific tasks. Some operations are involved in thinking, learning, and remembering; while others help to see, hear, and smell. As damage advances, neurons lose their ability to function and eventually die, causing irreversible changes to occur in the brain.
Plaques, deposits of a protein fragment called beta-amyloid (BAY-tuh AM-uh-loyd) that builds up in the spaces between neurons, and tangles, twisted fibers of another protein called tau (rhymes with “wow”) that build up inside the cells, are suspected to be the cause of damaging and killing neurons. Most people develop some plaques and tangles as they age; those with Alzheimer’s disease tend to develop far more. They also tend to develop them in a predictable pattern, beginning in areas important for memory before spreading to other parts of the brain.6
Scientists do not know exactly what role plaques and tangles play. Most experts believe they somehow play a critical role in blocking communication among neurons and disrupting processes that cells need to survive. The progressive destruction and death of neurons destroys memory and alters personality and the ability to carry out daily functions.6
Risk Factors
The greatest known risk factor is advancing age. Why this risk increases dramatically as we grow older is a mystery. Genetics and family history play a significant role in the development of Alzheimer’s disease. If you have a parent, brother, or sister with it, you are more likely to also develop the disease. The risk increases if more than one family member has the illness.
Most experts believe that the majority of Alzheimer’s disease occurs as a result of complex interactions among genes and other risk factors. Age, family history, and heredity cannot be changed.
However, research is beginning to discover other risk factors we may be able to influence through general lifestyle and wellness choices and effective management of other health conditions. Try to keep your weight within recommended guidelines, avoid tobacco and excess alcohol, stay socially connected, and exercise both your body and mind.6
Treatment
To date, there is no cure, and the medications available are used to alleviate symptoms. Worldwide, many scientists are researching ways to find new treatments to stop, slow, or even prevent Alzheimer’s, but presently no such medications exist.
We either know someone that is now suffering or we will eventually know someone who will be afflicted. It is only a matter of time, and there is one way we can help. By participating in the many clinical trials available while one is asymptomatic seems to be one way to move research forward. There are risks to being subjected to experimental medicines, so it is important for patients to have a conversation with primary care physicians to help determine the risks and benefits of such a commitment.
According to the Alzheimer’s Association, without clinical trials there can be no better treatments, no prevention, and no cure for Alzheimer’s disease. “Today, at least 50,000 volunteers, both with and without Alzheimer’s disease, are urgently needed to participate in more than 130 actively enrolling clinical trials about Alzheimer’s and related dementias. Recruiting and retaining trial participants is now the greatest obstacle, other than funding, to developing the next generation of Alzheimer’s treatments.”6
Nancy Reagan, former First Lady, watched her husband, President Ronald Reagan, succumb to the perils of Alzheimer’s.
“Alzheimer’s is a disease, like any other disease - cancer, heart disease, whatever,” she told an audience at the Hotel Pierre in New York in July 1995. But it is a “really very cruel disease, because for the caregiver, it’s a long goodbye,” she said, her eyes reddening and her voice breaking.7 She spent many hours with the love of her life as she continued to be a powerful advocate for new research into cures.
“Unfortunately, as Alzheimer’s disease progresses, the family often bears a heavy burden,” the former President wrote in his last letter to the country. “I only wish there was some way I could spare Nancy from this painful experience. When the time comes I am confident that with your help she will face it with faith and courage.”7
Your loved one will cognitively descend bit by bit until a shell of what you knew is left. You will try to instill as much dignity to them as possible. Patience and kindness will be the test of courage needed to face the unknown journey that lies ahead.
As dental hygienists, we have and will treat patients with Alzheimer’s disease. As the disease progresses, it will become more challenging. It’s important we remain flexible while keeping the patient from becoming agitated. As we plan treatment, we will work closely with the patient’s primary caregiver. Your assessment will not only include determining the ability of the patient to perform daily oral hygiene care, but you will also need to consider the ability of the caregiver. As the patient’s condition declines, you will need to continually revise their home care plan.
Dental hygienists should be educated on Alzheimer’s disease and help others to learn more. There are online resources, such as the Alzheimer’s Association (alz.org) and the National Institute on Aging (nia.nih.gov). Dental hygienists are accustomed to reading current research; however, others may require different opportunities to learn. One very popular book by Nicholas Sparks, The Notebook, provides an emotional look on how to handle this disease with grace, dignity, and realism. Other touching movies have portrayed characters with dementia or Alzheimer’s and are listed under the resources section.8RDH
Trisha A. Cloutier, CDA, RDH, BS, MA, is an associate professor at Bristol Community College in Fall River, Mass., where she is an ADHA Student Advisor. She graduated from the University of Rhode Island and practiced for 20 years. Trisha is an international speaker, the continuing education chair for the Rhode Island Dental Hygienists’ Association, and a curriculum evaluator with the ADA Commission on Dental Accreditation. She can be reached at [email protected].
References
1. Hebert LE, Weuve J, Scherr PA, Evans DA. Alzheimer disease in the United States (2010-2050) estimated using the 2010 Census. Neurology. 2013 May 7;80(19):1778-83.
2. Alzheimer’s Association. Early onset dementia: a national challenge, a future crisis.www.alz.org/national/documents/report_earlyonset_full.pdf". Published June 2006.
3. Weuve J, Hebert LE, Scherr PA, Evans DA. Prevalence of Alzheimer disease in US states. Epidemiology. 2015 Jan;26(1):e4-6.
4. Alzheimer’s: every minute counts. WGBH website. http://www.wgbh.org/programs/Alzheimers-Every-Minute-Counts-3577.
5. Wilson RS, Segawa E, Boyle, PA, Anagnos SE, Hizel LP, Bennett DA. The natural history of cognitive decline in Alzheimer’s disease. Psychol Aging. 2012 Dec;27(4):1008-17.
6. What is Alzheimer’s? Alzheimer’s Association website.http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp.
7. Clift E, Thomas E. How Nancy Reagan coped with Ronald Reagan’s Alzheimer’s disease. Newsweek. http://www.newsweek.com/nancy-reagan-coped-ronald-reagans-alzheimers-disease-president-434187. March 7, 2016.
8. Hill C. Eight movies about Alzheimer’s and dementia you shouldn’t miss. Verywell website. www.verywell.com/movies-about-dementia-and-alzheimers-disease-97664. February 5, 2017.
Resources
1. A powerful documentary presented by WGBH called Alzheimer’s: Every Minute Counts, that originally aired on January 25, 2017, provides information and much needed attention to one of the most critical public health crises facing America today. http://www.wgbh.org/programs/Alzheimers-Every-Minute-Counts-3577
2. Alzheimer’s Association: www.alz.org
3. National Institute on Aging: www.nia.nih.gov
4. https://www.verywell.com/movies-about-dementia-and-alzheimers-disease-97664
Early Signs and Symptoms
There are typical changes in memory that occur as we age. For example, making a bad decision once in a while, occasionally forgetting which word to use, or losing things from time to time are common. We may even forget which day it is and remember it later.6 According to the Alzheimer’s Association, there are 10 warning signs and symptoms:
1. Memory loss that disrupts daily life
One of the most common signs of Alzheimer’s is memory loss, especially forgetting recently learned information. Others include forgetting important dates or events, asking for the same information over and over, and increasingly needing to rely on memory aids (e.g. reminder notes or electronic devices) or family members for things they used to handle on their own.
2. Challenges in planning or solving problems
Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before.
3. Difficulty completing familiar tasks at home, at work, or at leisure
People with Alzheimer’s often find it hard to complete daily tasks. Sometimes, people may have trouble driving to a familiar location, managing a budget at work, or remembering the rules of a favorite game.
4. Confusion with time or place
People with Alzheimer’s can lose track of dates, seasons, and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there.
5. Trouble understanding visual images and spatial relationships
For some people, having vision problems is a sign of Alzheimer’s. They may have difficulty reading, judging distance, and determining color or contrast, which may cause problems with driving.
6. New problems with words in speaking or writing
People with Alzheimer’s may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g. calling a watch a “hand-clock”)
7. Misplacing things and losing the ability to retrace steps
A person with Alzheimer’s disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time.
8. Decreased or poor judgment
People with Alzheimer’s may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean.
9. Withdrawal from work or social activities
A person with Alzheimer’s may start to remove themselves from hobbies, social activities, work projects, or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced.
10. Changes in mood and personality
The mood and personalities of people with Alzheimer’s can change. They can become confused, suspicious, depressed, fearful, or anxious. They may be easily upset at home, at work, with friends, or in places where they are out of their comfort zone.
Source: ALZ.org
