Diagnosing someone with Alzheimer’s can be a long and extensive process.
For Dr. Michael Lindberg, chief medical officer at Monadnock Community Hospital and board certified in internal medicine and geriatrics, it’s about eliminating possibilities that might resemble symptoms associated with the progressive and incurable disease. There’s depression and hyperthyroidism, sleep impairment, hearing loss and medication complications that can all mask as early warning signs of Alzheimer’s. But the difference is that all of those can be treated to reverse the symptoms.
With aging comes a certain degree of memory loss, so mere lapses in one’s ability to remember doesn’t automatically mean the beginning of Alzheimer’s. Memory loss is the first noticeable sign of the disease and can be a red flag for caregivers and family members seeking a reason for a sudden or gradual change.
Once certain conditions are eliminated, Lindberg will do a simple round of testing. He typically starts with three words that the patient will repeat back and need to hold on to for later in the exam. There’s construction skills, like being able to properly draw a clock and copy a simple drawing, followed by the need to remember those three words.
“You want to start doing some evaluations to see the degree of severity,” Lindberg said.
If deemed necessary, Lindberg will do more sophisticated testing, using the Mini-Mental State Examination, the Saint Louis University. Mental Status or the Montreal Cognitive Assessment.
The scores depend on education level, but they usually give an indication if Alzheimer’s is the cause. There are also diagnostic tests like MRIs and CT scans that can help paint the picture of what is going on.
The reason Lindberg likes to look for and test for other ailments is that “you hate getting to a diagnosis you can’t do anything about,” he said. But it always has to be among the list of possibilities because “if you don’t think about a diagnosis, you’ll miss it.”
“The primary part of the diagnosis is to get people prepared,” Lindberg said. An early diagnosis can allow for the necessary time to get legal and financial affairs in order.
During a presentation at the recent Active Aging event in Peterborough, Lindberg, the keynote speaker, said that there are 24,000 current Alzheimer’s diagnoses in New Hampshire and 67,000 people providing care for loved ones. In 2016, Lindberg said, there were 432 deaths caused by Alzheimer’s. The typical life expectancy for someone diagnosed with Alzheimer’s is eight to ten years.
“This is ultimately an irreversible disease that will end in death,” Lindberg said.
For D’Vorah Kelley of Keene, she knew her life would never be the same after her husband’s dementia diagnosis. It’s not considered Alzheimer’s because Kelley said he doesn’t fit into any one category.
There had been changes in Bob. Nothing major, but subtle differences in his memory that caused Kelley to push for a reason for her husband’s decline. About a year ago, they received the diagnosis and things have progressively gotten worse.
Kelley said it’s like caring for a toddler. “A two-year-old that can do some things for themselves,” she said.
It’s not easy for Kelley. There are many tough days caring for her husband of almost 45 years. especially when she starts to think about the future they expected to have together.
“We had a totally different plan for retirement,” Kelley said.
Kelley is part of three support groups which allows her to talk openly about her challenges, something that is hard to do with someone who can’t relate to what it’s like to care for a love one with Alzheimer’s. During the weekdays, she utilizes the Castle Center Adult Day Care in Keene, where Bob goes for seven hours a day.
“That gives me from 9 to 4, five days a week, where I don’t have to be a caregiver,” Kelley said.
As an independent person who likes to travel and be involved in many different things, her husband’s diagnosis has forced her to drop a number of elements of her life.
“I’ve basically given up most things that happen in the evening,” Kelley said.
While she wouldn’t wish this life on her worst enemy, Kelley said her husband’s disease has given her perspective.
“This has taught me to slow down and be more patient and that’s one of the gifts,” she said.
There are still those moments where she sees the old Bob.
“Right now his long term memory is still good,” Kelley said. “But his short term memory is probably 30 seconds.”
And the reality of it all is hard to handle.
“Piece by piece something falls away,” Kelley said. “And it’s heartbreaking.”
Kelley said it is vital to have a good support system in place to be able to get that reprieve when needed.
At Scott-Farrar at Peterborough, there are currently 22 residents living in the Memory Care Unit that features 18 studios. The unit is home to patients with a wide range of cognitive issues, including Alzheimer’s.
Some are highly functioning but just need assistance, while others need closer attention.
Most residents come to the facility from a home setting where they’re being cared for by family, while others need to transition from either independent or assisted living.
“A majority of the time, the family knows they need to be in memory care,” said Michelle Humphrey, resident care director at Scott-Farrar.
Humphrey said the idea for those working on the Memory Care Unit is to live in the moment with the residents. The care providers learn a lot from on the job training.
“It’s about knowing your residents,” Humphrey said.
It’s about providing a personal based care filled with opportunities for residents to get out in the community and experience life, no matter how much of it is remembered. And routine is key.
“It’s not the words they remember, but the feeling they had,” Humphrey said.
The unit is a secure portion of the building, which opened in January 2017, added on after the major renovation project completed three years ago.
It works to keep the residents safe and prevent anyone from wandering off, but provides a sense of freedom at the same time. There’s an enclosed garden with a circular pathway for the chance to get outside and enjoy that important aspect of life.
Lindberg not only works with and diagnoses patients with Alzheimer’s, but his father also had it. Having lived through it on the caregiver side, Lindberg knows how important it is to understand how the disease progresses and the steps needed to get everything in order.
He also understands what a support system for caregivers means.
“You cannot take care of your loved one, if you don’t take care of yourself,” Lindberg said.
As the disease progresses, there are more issues that arise, like language barriers and decreased decision-making skills .
“You see more gaps in remote memory,” Lindberg said.
Lindberg knows it can be hard for people to think their loved one has Alzheimer’s, but his best advice is to bring any concerns to a physician.
November is Alzheimer’s Awareness Month and it provides an opportunity to bring attention to and spread awareness of the disease that is the sixth leading cause of death.
For more information, visit the Alzheimer’s Association website, www.alz.org.