What To Expect When Someone Has Alzheimer's Disease

-- Mary Ellen's friends thought she was the perfect mother, wife, friend, and hostess. Her husband George, a prolific author, counted on her to edit his works and manage his schedule. He was the first to notice that she was no longer able to remember her good friends' names, her children's birthdays, or the details of her busy life. During social occasions, she could be seen sitting on the sidelines, answering politely but vaguely if spoken to, but never engaged in meaningful conversation. She was no longer able to go shopping or pay the household bills as she had done for the past 30 years. George was bewildered and could not understand what had happened to his close companion of so many years.

The onset of Alzheimer's disease is usually very slow and gradual, seldom occurring before age 65. Over time, however, it follows a progressively more serious course. Among the symptoms that typically develop, none is unique to Alzheimer's disease at its various stages. It is therefore essential for suspicious changes to be thoroughly evaluated before they become inappropriately or negligently labeled Alzheimer's disease.

Problems of memory, particularly recent or short-term memory, are common early in the course of the disease. For example, the individual may, on repeated occasions, forget to turn off the iron or may not recall which of the morning's medicines were taken. Mild personality changes, such as less spontaneity or a sense of apathy and a tendency to withdraw from social interactions, may occur early in the illness. As the disease progresses, problems in abstract thinking or in intellectual functioning develop. The individual may begin to have trouble with figures when working on bills, with understanding what is being read, or with organizing the day's work. Further disturbances in behavior and appearance may also be seen at this point, such as agitation, irritability, quarrelsomeness, and diminishing ability to dress appropriately.

Later in the course of the disorder, the affected individuals may become confused or disoriented about what month or year it is and be unable to describe accurately where they live or to name correctly a place being visited. Eventually they may wander, be unable to engage in conversation, seem inattentive and erratic in mood, appear uncooperative, lose bladder and bowel control, and, in extreme cases, become totally incapable of caring for themselves if the final stage is reached. Death then follows, perhaps from pneumonia or some other problem that occurs in severely deteriorated states of health. The average course of the disease from the time it is recognized to death is about 6 to 8 years, but it may range from under 2 to over 20 years. Those who develop the disorder later in life may die from other illnesses (such as heart disease) before Alzheimer's disease reaches its final and most serious stage.